JAF-FAC - WHO | World Health Organization

African Programme for Onchocerciasis Control (APOC)Prograrnme africain de lutte corltre l'onchocercose

JAF-FAC

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JOINT ACTION FORUMOffice of the Chairman

JOINT ACTION FORUMFourth session

Accra. 9-11 December 1998

FORUM D'ACTION COMMUNEBureau du Pr6sident

JAF4/INF/DOC.5ENGLISH ONLYOctober 1998

REPORT OF THE FIFTH WORKSHOP ON THE PHILOSOPHY OF APOC,THE CONCE,PT AND HARMONIZATION OF COMMUNITY-DIRECTED

TREATMENT WITH IVERMECTIN (CDTI)NAIROBT, (KENYA),20-25 APRIL 1998

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AFRICAI.{ PROGRAMMEFOR

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(APOC)

Workshop on the PhilosoPhY of theAfrican Programme for Onchocerciasis Control (APOC)

Concept and Harmonization ofCommunity-Directed Treatment with Ivermectin (CDTI)

20-25,April 1998Nairobi, Kenya

TABLE OF CONTENTS

LTST OF ACRONYMS

ACKNOWLEDGEMENTS

1. EXECUTIVE SUMMARY

OPENING CEREMONY. .

TECHNICAL SESSION

WORKSHOP SESSIONS

4.1. Philosophy of APOC

4.2. REMO/GIS...

4.3. Administration/Budget /Financial Management

4.4. Communitv Participation and Sustainabilitv of CDTI

4.5. Training and Health Education

4.6. Ordering, Procurement and Delivery of Ivermectin

4.7, Recording/Reporting & Feedback at all levels

4.8. Integration of CDTI into Health Services

4.9. National Plan and Project Proposal

4.10. Other Matters.

4.11. Conclusions and Recommendations

5) APPENDICES

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APOC

LIST OF ACRONIYMS

African Programme for Onchocerciasis Control

Community - Directed Distributor

Community - Directed Treatment with Ivermectin

Continuing Professional Development

District Health Department

Expanded Programme on fmmunization

Food and Agriculture Organization

Geographical Information System

Health For All

Health Net International

Jomo Kenyatta International Airport

Mectizan Donation Programme

Mozambique Company for Exporting and Importing Drugs

Ministry of Health

Mombassa

Medical Supplies Coordinating Unit

National Drug Service

Non-Governmental Development Organization

National Onchocerciasis Task Force

Onchocerciasis Control Programme

Operation Life Line Sudan / Southern Sector

Rapid Epidemiological Assessment

Rapid Epidemiological Mapping for Onchocerciasis

CDD

CDTIt

CPD

DHD

EPI

FAO

GIS

HFA

HNI

JKIA

IVIDP

MEDIMOC

MOH

MSA

MSCU

NDS

NGDO

NOTF

OCP

OLS/SS

REA

REMO

TB

UN

RHB

RMS

SRRA

TCC

TDR

UNDP

TiNICEF

WHA

wHo

ZHI)

Regional IIeaIth Board

Regional Medical Stores

Sudan Relief and Rehabilitation Association

Tuberculosis

Technical Consultative Committee

Tropical Diseases Research

United Nations

United Nations Development Programme

United Nations Children's Fund

World Health Assembly

\1 orld Health Organization

Zonal Health Department

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ACKNOWLEDGEMENTS

We the participants from Ethiopa, Kenya, Liberia" Mozambique and Southern Sudan wishto express our sincere thanks and appreciation to the Government and people of theRepublic of Kenya for the hospitality accorded us during our stay in Nairobi.

We also highly appreciate the full participation and contributions made by representativesof the World Banh Mectizan Donation Programme, NGDOs and others. Wewholeheartedly commend the APOC management for the patience, guidance andexpertise exhibited during this workshop.

Last but not least, our sincere thanks goes to the Facilitators and Rapporteurs, whostayed behind and wrote a comprehensive report of the workshop. We will alwaysremember the week of sleepless nights they spent in Nairobi. No degree of gratirude but,the successful control or elimination of Onchocerciasis will be the appropriate reward.

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woRKSHoPoNTHEPHILOSOPHYoFTIIEAFRICANPR0GRAMMEFoRONCHOCERCIASISCONTROL(APOC)'

CONCEPT AND HARMONIZATION OF COMMUNITY-DIRECTEDTRBATMENT WITH IVERMECTIN (CDTI)

APRIL 20-25,1998Nairobi, KenYa

1. EXECUTIVE SUMMARY

Ethiopia, Kenya, Liberia, Mozambique, and Southern Sudan and are among the 19 countries

to be covered by the African Programme for onchocerciasis control (APOC)' This workshop

was organized to provide a forum through which onchocerciasis control programme issues

which face each country could be discussed. The issues addressed were :

l.l The concept of partnership within the NOTF and APoc for each participating

country in the implementation of CDTI

1.2 The execution and validation of REMo/REA to identify endemic communities

requiring treatment

1.3 Programme budgeting and establishment of an efficient flow of funds from all partners

for effective use in the treatment of endemic communities and ensuring proper

accounting st-stems for funds reieased at all levels'

1.4 Designing training and health education material and activities to properly train health

workers and mobilize the communities to participate actively and take ownership of

the control of Onchocerciasis

1.5 Approaching the community on the establishment and ownership of CDTI including

ways of ens[ring sustainabiiity of the programme after external funding ceases'

1.6 Procurement, delivery and distribution of ivermectin in an integrated and efficient

rumner to all eligible persons in endemic communities. Also ways of ensuring proper

management,ruf.tyandstorageofivermectinatalllevels'

1.7 How to record, report and monitor treated communities to ensure proper

imPlementation of CDTI'

l.SHowtointegrateCDTIintoexistinghealthsystemsaswellasin-countryandcomm*ity irog.*s that have piou"n successful, without jeopardizing the

technical aspects of the various progralnmes'

1.9 What requirements and steps need to be taken to develop National Action Plans and

qualitY APOC Project ProPosals'

1 . 10 Possible means of in-country and inter-country communication on APOC related

activities which will keep all participating countries abreast of innovative and

stimulating info rmat io n'

The working sessions were in the form of formal presentations by lead speakers, followed by

working groups (country specffic or mixed) and generaldiscussions at plenary. At the end ofdiscussions conclusions and recommendations were made.

2. OPENING CEREMONY

Dr. D.K. S*g, Kenya National Onchocerciasis Coordinator, welcomed participants and

thanked APOC for choosing Kenya as host for the workshop. He asked participants to feel at

home and enjoy the warm hospitality of Kenya.

Professor M. Homeida, APOC/TCC, spoke of the need for country teams to appreciate the

availability of free ivermectin for as long as is required. He stressed an awakening of all

members to strong partnerships in onchocerciasis control with emphasis on the importance ofsustainability and integrating CDTI into existing community structures.

In his opening remarks, the WHO Representative in Kenya, Dr. Paul Chuke represented by the

WHO Advisor on Disease Prevention and Control, Dr. D.M. Mutie stressed the need for

community involvement, participation and ownership of health prograrnmes. He emphasised

the need for "Continuing Professional Development" (CPD) of health workers to keep abreast

of current development in their field.

The Keny'a Minister of Healttr- Hon. Jackson Kalweo. represented by Dr. Ivlaina Kahindo

(Depury Director, Medical Serv-ices) w'ho officially opened the workshop and pointed out his

desire for the participants to avail themselves of the knowledge they could acquire from the

workshop (Appendix A).

3. TECHNTCAL SESSION

3.1 Workshop Agenda

A provisional workshop agenda which was presented to the facilitators and

participants was discussed, amended and adopted for the workshop. (Appendix B)

3.2 Participants and Facilitators

Participants for the workshop were drawn from Ministries of Healtll research

institutions, universities, LIN Agencies and NGDOs working on onchocerciasis in

Ethiopia, Keny4 Liberia, Mozambique, and Southern Sudan. Facilitators for the

workshop were from APOC/WHO and NGDOs (Appendix C).

3.3 Workshop Design

The workshop was in the form of initial presentations on the various topics in plenary

fotlowed by discussions. Country-specific working groups met to discuss issues raised

pertaining to their own situations. There were mixed groups to facilitate cross-

fertilization of ideas and sharing of experiences. This format was adopted in order to

create an atmosphere of open exchange of ideas and experiences with active

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involvement of the participants who were mostly field officers. Issues were raised

regarding their field experiences and solutions proferred.

Dr. Uche AmaTigo, APOC, presented the objectives and eupected outcome as follows:

3.4 Workshop Objectives

3.4.1. To agree on the modalities for establishing CDTI projects and promoting community

ownership o f ivermectin distribution fo r sustainability.

3.4.2. To discuss the development of National Plans and CDTI Project Proposals for

submission to APOC.

3.4.3. To reach a common understanding on how to establish sustainable CDTI projects

integrated into the existing health care systems of each country represented.

3.4.4. To streamline procedures for financial and administrative nunagement of CDTIprojects in the spirit of APOC partnership.

3.4.5. To determine ways to avoid duplication of resources and minimize costs at all levels ofproject implementation by the National Onchocerciasis Task Forces (NOTFs).

3.4.6. To dialogue and harmonise the process of training communiry selected distributors.

3 .4.7 . To re-orient existing and new ivermectin delivery projects to the new strategy of full

community participation in and ownership of projects, as a stakeholder.

3.5 Expected Outcomes

3.5.1. Participants would have a clear understanding of the philosophy of APOC and the

steps for implementing CDTI.

3.5.2. Country teams would make recommendations on ways to integrate CDTI into existing

health systems for sustainability, procure and deliver ivermectin to the communities,

and determine how funds will flow from central to district levels.

3.5.3. Partnership spirit among key actors would be strengthened.

3.5.4. National Plans and feasible CDTI Project Proposals would be developed by country

representatives fo llo wing the wo rkshop.

3.5.5. Participants would understand the roles and responsibilities of the community, health

services, NGDOs, external donors and other partners of APOC .

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4. woRKSHOP SESSIONS

The tbllowing topics were addressed during the workshop sesslons

4.1 Philosophy of APOC/Concept of CDTIOverview of Onchocerciasis (special session)

REMO/GISAd.ministratio n/ Bud getff inanc ial Management o f APOC Projects

Community Participation and Sustainability of CDTI

Training and Health Education

Ordering/Pro curement and Delivery o f Ivermectin

Recording/Reporting and Feedback at all levels

Integration of CDTI in the Health Services

National Ptans and Project Proposals

Other MattersCo nclusions/Reco mmendation o f the Workshop

4.2.4.3.4.4.4.5.4.6.4.7.4.8.4.9.4.1 0.

4.1 l.

The higtrlights and discussions of these topics are presented in the following secttons:

4.1 Philosophy of APOC/Concept of CDTI

Dr. D. Etya'ale, NGDO International Coalition Coordinator, WHO/Geneva and Dr. Uche

Amazigo. Scientist. APOC presented papers on the philosophy of APOC in which the

following issues were higtrlighted:

4.1.1 . ApOC is a multiple partnership involving participating goverrlments and theil

affected communities, NGDos, World Bank, wHo, LINDP and FAo;

4.1.2. In all ApOC assisted countries, the partnership is operationalised through the

National Onchocercerciasis Task Force (NOTF) in which governments and their

partnersQ..iGDosandotheragencies)areallrepresented;

4.1.3. In keeping with the APOC philosophy of partnership, emphasis should be placed

on NOTF rather than on individualplayers. Consequently, the NOTF should be

the focal point of all APOC assisted onchocerciasis control activities;

4.1.4. AII partners should ensure that any success achieved will be through and with the

NOTF.

4.1.5. CDTI is a new approach for the delivery of ivermectin to eligible persons and

empowers ufe"tea communities/villages to design and implement the distribution

o f ivermectin (Mectizan@)'

4.1.6. The CDTI approach confers project ownership to the communities and to the

health service as equal stakeholders'

4.1.7. To maintain a successful partnership, efforts should be made to improve

coordination and dialogue'

4.1 .g. The NOTF should ensure a minimum coverage of 650/o in treated communities to

achieve elimination of onchocerciasis as a public health problem.

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A special session on the overview of onchocerciasis requested by the participants waspresented by Professor C. D. McKenzie of Michigan Srare University,Lsa. in trispresentation the following were highlighted:o Parasite and its biologyo Clinical presentation of the disease. Important characteristics of the disease that relate to treatmento The need to provide correct information on the disease and the treatment

c It was recommended that this component should be incorporated into future A1OCworkshops in counny.

4.2. Rapid Epidemiologicar Mapping of onchocerciasis (REMO) andGeographical Information System (GIS)

Dr' H' Edeghere of APOC gave a presentation on the status of REMO/GIS in the planning,design and implementation of REMo. The following issues were discussed:

4'2'l' REMO is e:tremely important to APOC & NOTF for determining endemicitylevels and planning control activities in participating countries. triaadition.REMO is a prerequisite for consideration by APOC/TCC of national plans andproject proposals. APOC management anticipates that each country should haveits REMO completed by the fonowin.s tentative dates:

4.2.1.1. Ethiopia4.2.1.2. Kenya4.2.1.3. Liberia4.2.1.4. Mozambique4.2.1.5. Southern Sudan

December, 1998November, 1998June,1998?July, 1998Will conduct REA through December 199g

4'2'2' Data from each of the REMO exercises must be cross-validated independently,using internal or external validators.

4'2'3' There is a great need for training of trainers for REMO/GIS and therefore allparticipating countries need to discuss with APOC nrurnagement the mostappropriate dates for this to be undertaken in their countries.

4'2'4' APOC numagement will ensure that all activities related to the above are wellsupported. In particular, adequate support will be provided for the transfer ofcapacity and resources to assist the countries in generating essential data andmaps and ensure that they are readily available to all partners.

4-2.5. REMO activities were officialry handed over by wHo/TDR to Apoc inSeptember 1997.lt is therefore recommended that all requests related to REMoare forwarded to ApOC management.

4'2'6' In dfficult situations (civil unrest and wars) it is recommended that un-validatedREMO results could be used for start of treatment. Where REMO is found to bestrategically unacceptable, comprehensive REA results could be used as analternative.

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4.2.1 In areas of insecurity where people have not stayed for more than 3 years,

women may be included in the sampling for REA in the absence of the required

number of males if they meet the requirements.

4.2.8 All countries should ensure that high risk groups in inaccessible areas are notdropped because of the inconvenience to the REMO team rather, more effortsshould be made to access such areas.

4.2.9. Countries should try to get multiple atlases to update maps for REMO.

4.2.l0.Information on endemic villages to be sampled for REMO, should be donejointly by all three members of the team (Geographer, Epidemiologist, and

Entomologist).

4.2.11. REMO/REA is a continuous exercise which should be refined and updated fromtime to time.

A special REMO session was conducted by Dr. H. Edeghere at the request of the participants

to clarify the following rssaes.'

. Step-by-step REMO/REA methodologtc Training needs

. GISo Internal and external validation of REMO/REA resultsc Technical expertise from external sources by APOC

4.3. Administration /Budget/Financial Management of APOC Project

The two presentations on guidelines for preparation of the budget for APOC funded

CDTI projects by Professor M. Homeida, and APOC Financial and Administrative

rumagement presented by Mr. Y.M. Aholou, APOC Administrator, highlighted the

following:

4.3.1. Prerequisites for good projects that will be in line with the budget guidelines

include the following:

4.3.1 . I . well defined activities and requirements for carrying these out

effectively4.3.1.2. population to be treated4.3.1.3. distances to be covered4.3.1.4. strategy to be used for administering treatment

4.3.2. Justification of the budget must be detailed for each line item

4.3.3. Costs not covered bY APOC:4.3.3.1. Basic salaries, office space, transport of drugs from port of entry to

health centre.

4.3.4. Costs that may be covered by APOC:4.3.4.1. Materials for training, meetings/workshops, consultancies, capital

equipment.

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4.3.5. ApOC FinancialGuidelines along with the WHO Imprest Accounting System

must be closely followed.

4.3.6. Atl activities in APOC assisted projects should be in consideration of full

community ownershiP in 5 Years.4.3.6.1. It is essential to ensure that the community accepts the programme's

financial support and management approaches'

4.3.6.2. Adapt the financial accounting procedures to unique situations (e.g.

receiPts not available).

4.3.1. The flow of finances for each of the participating countries goes through the

NOTF central account and to the project sites through the most appropriate and

efficient means for each country. NGDO and National Onchocerciasis

Coordinator representing MOH serve as signatories to the account.

4.3.8. The Southern Sudan finance flow is quite different due to the NOTF being in

Khartoum and the need to utilize NGDO systems to get funds to the project

sites.

4.3.9 . APOC only funds proposals from NOTF. It is therefore important that NOTFs

are formed immediately.

4.3.10. After project approval contracts are signed annually and fi:nds released on an

imprest basis.

4.3.1 l. APOC management would ensure minimum delays in the release of project

funds. Any reimbursement would be based on timely submission of accounts by

NOTF.

4.3.12. All partners in the CDTI projects must be involved in the disbursement,

utilization and accounting of funds from APOC.

4.3.l3.There is need for advocacy at high levels by the APOC Management (e.g'

Ethiopia) to countries with financial systerns which might not facilitate the

APOC trust fund requirements. However, flexibility on this matter should be

both on the part of APOC and the host government.

4.3.14. Since most countries in Africa do not budget as much as $2.00 per person for

health, it is important to ensure that the cost of treatment in APOC projects is

reduced to a minimum that can be sustained by the government and the

communities.

Country working groups were assigned the task of designing administrotive andfinanciol Jlowcharts which is attached in Appendix 4.

4.4. Community Participation and Sustainabilty of CDTI

Drs. Etizabeth Elhassan, J.B. Roungou and Josephine Namboze of APOC, presented papers on

CDTI implementation with reference to approaching the community and issues of community

involvement and ownership of CDTI projects. The APOC CDTI training video, which

highlights vital steps in the implementation of CDTI was shown to participants to further

enhance their understanding of the concepts of CDTI. Drs. Elhassan and Amazigo also

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presented a paper on issues related to sustainability of CDTI. After these presentations and

iubsequent discussions, participants were divided into mixed working groups to examine issues

of community involvement, ownership and sustainability of CDTI with special reference to re-

orientation of on-going ivermectin distribution projects. It was noted that CDTI could initiate

and induce communities toward improvement of their health. Conclusions and recommendations

were made on the various issues discussed as follows:

4.4.1. The socio-cultural norrns and practices of the people should be taken into

consideration prior to approaching the community to introduce the concept ofCDTI. The team approaching the community should be as simple as possible,

without giving the impression of overt wealth (e.g. moving with a large convoy

of vehicles).

4.4.2. Women should be involved in the prograrnme at all levels

4.4.3.

4.4.4.

4.4.5.

4.4.6

To implement the CDTI approach, there is need to re-orient existing and new

projecis to the CDTI strategy of full community participation and ownership of

the programme.

There is need for clearly defined roles for partners in CDTI and ensuring

commitment and full participation at all levels.

NOTF should clearly define roles and responsibiJities of the communities

especiall-r- as pertains to decision making. prograrnme rvlnasement- suneillance

and mobilisation roles.

Communities should be given a free hand to ptan and implement the CDTI

activities.

4.4.7. Health workers should be sensitized to accept CDTI as a partnership between

them and the communities. They should facilitate the successfuIimplementation

of the prograrnme.

4.4.8. The social and political structures should not be disturbed or antagonised but can

be used when approaching the communities for CDTI'

4.4.g. Communities and other partners must accept the responsibilities related to CDTI

and assure compliance over a long period; adequate and consistent advocacy and

health education should be provided at all levels'

4.4.10. Adequate numbers of CDDs should be nominated by each community'

Communities should be allowed to increase the number of CDDs to be trained or

change as necessary.

4.4.1L There should be no payments of incentives to CDDs by extemalsources, rather'

communities should be allowed to decide on the issue of motivation or incentives

for their distributors.

4.4.12.The ownership of the CDTI should be at all levels of implementation -- not just

at the communitY level.

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4.4.13. Health education messages should be clear, standardized and emphasize

community involvement and ownership of the progralrlme'

4.4.l4.There is need to identify and target key personalities in the political and social

structures for advocac), to raise the levelof awareness and accord priority to the

programme.

4.4.15.It is important that programmes are built towards sustenance by both

communities and governments after cessation of external support.

4.4.16.partners in the projects should think of ways of promoting community self image

and self-confidence and implement this early in order to facilitate community

acceptance and ownership of the prograrnme'

4.5. Training and llealth Education

Mr. J. Watson, APOC, presented a paper on various aspects of training and health education

requirements for implementation of CDTI projects, drawing from field experiences. During the

g.orp work, participants identified the target groups to be trained and health educated at all

ieu"ts including the approach, topics and materials to be used. Generally, it was agreed that

those to be trained oi health educated should be persons who will support, facilitate, and

mobilize resources for the successful implementation of the CDTI prograrnme. It was noted that

the ke.v- componenrs for successful implemenrarion of CDTI w'ere training. health education and

mobiliali6n of the communitv. It was recommended that:

4.5.1. Health Education, being the foundation of successful implementation of CDTI,

should be approached systematically and carefully,

4.5.2. Trainers should be more of facilitators in discussions/activities using a

participatory approach to learning rather than lecturing to the trainees.

4.5.3. The number of CDDs to be trained per community should be related to the

number of persons to be treated. It was suggested that projects train at least 2

CDDs Per 250 Persons to be treated.

4.5.4. Health education and mobilisation of communities is a key component of the

CDTI approach.

4.5.5. Target groups for training & health education at the national level should include

students, health workers, key policy makers, (including those of other

ministries), the media, NOTF members, NGDO personnel and teachers'

4.5.6. Target groups for training and health education at the county, region and district

leveis should include health workers, media, staffof related ministries (e.g.

Educatioru Agriculture), NGDO personnel and teachers'

4.5.7. Target groups for training and health education at the community level should

inctuae nealih workers, local development organization, community members,

CDDs, teachers, traditional and religious leaders and healers.

4.5.8. Health education and training topics should include information about the

disease, the use of ivermectin for treatment, community mobilization, record

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keeping, and the need for the community to embrace the programme as their

own.

4.5.9. There is a need to establish a subcommittee within NOTF to develop prototype

training and health education materials which can be modified/adapted for use in

various project areas in the country.

4.5.10. Most materials need to be developed at the national, state, local government and

community levels, however, materials such as field manuals, flipcharts, and

calendars could be designed and printed at the national level.

4.5.1 l. Posters and village level health education materials (e.g. jingles in local

languages) should be developed in the villages with community member

participation.

4.5.12. APOC to provide technical support to NOTFs in various aspects of programme

implementation and capacity building as the need arises.

4.5.13. APOC should help provide prototype health education and training materials and

make them available to member countries.

Country working groups were assigned the task of determining the target groups at all

levels for training and health education (See Appendlx 4)

4.6. Ordering, Procurement and Delivery of lvermectin

Nfu. J. Watson, APOC, presented guidelines using the Nigerian experience on procurement and

delivery of ivermectin at all levels. Dr. Mary Allemaq MDP, provided background information

on the Mectizan Donation Programme with emphasis on requirements for drug procuement

and retirement by NOTFs. Dr. H. Edeghere, APOC gave an overview of areas of integration ofivermectin procurement and delivery into the national system. Drs. H. Edeghere and Josephine

Namboze, presented a paper on the management, safety and storage of ivermectin at all levels.

Since ivermectin procurement and delivery is one of the important aspects of the CDTIprograrnme, adequate time was allowed for extensive discussion of the topics. At the end ofdeliberations, the following recommendations and conclusions were made:

Procurement

4.6.1. Ivermectin procurement and delivery should be integrated into existing national

drug procurement and delivery system(s).

4.6.2. NOTF should ensure that ivermectin is ordered on time (at least 8 months prior

to the treatment period) and be responsible for customs clearance, tax

exemptions, transport to the project sites and fulIaccountability for the

ivermectin.

4.6.3. The community is responsible for picking up the ivermectin from agreed

collection points.

4.6.4. Community leveldecision making on procurement of ivermectin should involve

the community leaders, members, health workers, village volunteers, and

goverrlment, and other sector representatives.

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Storage

4.6.5. Adequate arrangements should be made for the storage of ivermectin from portof entry to the delivery in the community to avoid pilferage or damage.

4.6.6. The two months shelf-life of an opened 3 mg tablet bottle (500 tabs), after theremoval of the foil seal requires that distribution activities be undertaken withinthis period to avoid expiration and therefore wastage of ivermectin tablets.

4.6.7. Efforts should be made to avoid situations which lead to exptation of theivermectin as this could jeopardize the prograrnme.

4.6.8

Delivery

NOTF and the communities should agree on the suitable central collection pointswhere the communities can collect ivermectin.

4.6.9. Communities should be informed well in advance about the availability ofivermectin at the central location for collection.

4.6.10. There is need for appropriate timing in the communitl' for ivermectin delivenand distribution. takine into consideration the socio-cultural and economicactivities of the people.

Safefy

4.6.11. Adequate training should be given to the distributors to ensue:4.6.11.1. Adequate health education information is passed to community

members4.6.11.2. Adherence to eligibility criteria4.6.11.3. Correct dosage (especially with the new 3 mg tablet formulation)4.6.11.4. Adequate recording and reporting4.6.11.5. Adequate management and referral of cases of adverse reactions

4.6.12. Special efforts must be made to educate the communities prior to treatment onpossible adverse reactions. There must be careful monitoring of cases of severereactions to reassure treated persons.

4.6.13. Where there are severe reactions health education should be intensified to avoidincreased number of refusals/absentees during the next round of treatment.Mechanism should be put in place to train health workers to effectively dealwithsevere reactions especially at the community level.

4.6.14. Expired ivermectin should be disposed of by burning the tablets in a controlledenvironment.

Professor C.D. McKenzie also presented a paper on numagement of minor and severeadverse reactions to ivermectin treatment. This was by request of the participants. Following thepresentation and discussion recommendations are as addressed n 4.6.11, 4.6.12 and 4.6.13.

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4.7. Recording/Reporting and Feedback at all levels

Papers were presented by Dr. Elizabeth Elhassan providing information on data collection,reporting, analysis, and feedback on onchocerciasis control activities at all levels. Drs. J.B.Roungou, and Terese Aparicio presented papers on monitoring of CDTI while Dr. JosephineNamboze, gave an overview of key issues considered in evaluating CDTI projects using theAPOC forms.

During the country group work, the various components of data collection, analysis, andreporting at all levels of programme implementation were discussed. Also, issues related toproject monitoring were addressed. It was noted that the importance of data collection, timelyand routine reporting of data and monitoring activities cannot be over emphasized for thesuccess of the CDTI prograrnme. It is therefore recorunended that:

4.7.1. commitments from all participating partners in Ethiopia, Kenya, Liberia,Mozambique and Southern Sudan is necessary for the collection of informationrequired at all levels. There is need to adhere to recording/reporting formatsdevised/revised by NOTF as necessary.

4.7.2. Information required from the CDDs should be kept to a minimum and be simpleand straight-forward and should include the following:

4.7 .2.1. Total population of the community (census)4.7.2.2. Total eligible population/number of ineligible population4.7.2.3. Number of people treated4.7 .2.4. Number of refusals/absentees4.7.2.5. Number of severe reactions (treated/referred)4.7 .2.6. Household ffirmation

4.7 .2.6.1. PHC number of household (where applicable)4.7.2.6.2. Information on Household members (name, age. sex)4.7.2.6.3. Number of tablets given to each person4.7.2.6.4. Year of treatment

4.7.3. Methods of data collection:4.7.3.1. CDDs should use simple exercise or register books which the

communities can afford for recording and reporting.4.7.3.2. The community should be given the responsibility of designing their

own ways of recording and reporting of CDTI activities.4.7.3.3. The NOTF should decide with CDDs in the mobile communities,

where the records should be kept if the community is moving toanother location.

4.7 .3.4. For the purpose of uniformity of reporting and recording, it isrecommended that the NOTF should design a simple and uniformmethod of data collection for all levels of CDTI (county, regions,zones, districts).

t2

4.7.4. Repeated training activities for the community and their CDDs is required foradequate and timely reporting. These training sessions should also extend to thehealth facilities and county/district level.

4 -7 .5 - A checklist of indicators for recording and reporting should be developed at alllevels.

4.1-6. Provision of adequate logistical support by partners (e.g. vehicles, motorcycles,communications) to prograrnmes is required in order to initiate frequent andadequate data collection and monitoring of CDTI activities.

4-1.7. Where feasible, reporting, recording and feedback activities for CDTI could beintegrated into other health or development activities as appropriate.

4.7.8. NOTF should ensure adequate and timely reporting of CDTI activities to MDpand APOC as appropriate.

4.7.9. There is need for annual feedback on prograrnme implementation to all partners.

Monitoring

4.7.10. Project monitoring is used to improve operational plans for CDTI and to identifistreng.rhs and weaknesses in its implementation.

4.7.11. Standard monitoring indicators, which include input, output and effects havebeen identified for use in all projects.

4.7.12. There is need to carry out routine monitoring by the NOTF to assure effectiveimplementation of the CDTI projects. Independent monitoring should also beundertaken by APOC to ensure that programme objectives are accomplished.

Evaluation

4.1.13. APOC evaluation forms for CDTI projects should be filled annually for eachprolect

4.7.14. Evaluation forms consist rnainly of five parts which are all supposed to be filledincluding:4.7.14.1. Project profile and management4.7.14.2. Ivermectin procurement, delivery system and distribution4.1.14.3. Capacity of the NOTF/Oncho Coordinators/support staffand PHC

system4.7.14.4. Performance indicators4.7.14.5. Other comments

4.8. Integration of CDTI into Health Services

Drs. J.B. Roungou and Elizabeth Elhassan, from APOC, gave a presentation highlightingreasons for, implications and constraints, possible steps/processes and mechanisms ofintegrating CDTI into the Primary Health Care systenr, and some of the CDTI activities thatcould be integrated into the primary health system. Considering the importance of integrationof CDTI into the health system to ensure sustainability, extensive discussions were allowed.These discussions centred on the various levels of integration, when and where to integrate inrelation to the existence of functional PHC system in the country. Country working groups wereassigned the task of developing strategies for integration of CDTI into health services andidentify constraints of integration and strategies for overcoming them.

4.8.1. Steps towards integration may include:

4.8.1.1.4.8.1.2.4.8.1.3.4.8.t.4.4.8.1.5.

4.8. 1.6.

Ident ification o f health structures/institutions;Identification of level of integration;Sensitizatio n/re-orientation o f health staff;Advocacy to health planners and managers;Integrate training of cDDs into existing training activities for otherhealth prograrnmes;Set up (or re-activate) community health committees for overseeingCDTI and other health activities.

4.8.2

4.8.3

4.8.4

Health w'orkers should not onlv be trained on the health aspects of the diseasebut also on advocacy and management, which helps them to understand theirroles and expectations of the prograrnme.

Integration will only be successful if all partners are convinced of the approachand that this will not in any way affect the technical aspects of the variousprograrnmes.

Some aspects of reporting may not easily be integrated as varioui-prograrnmeshave differing requirements and expectations.

4.8.5. CDTI could be used as an entry point upon which PHC could be buiit andstrengthened

4.8.6. For compatibility, CDTI integration should be carried out gradually identifyingthe priority areas to be integrated.

4.8.7. For long term sustainability, it is necessary to integrate CDTI into existing healthsystems, and development based activities. Areas and programmes with goodpotential for integration are training, drug distribution, EpI, TB/Leprosy, etc.

4.8.8. Integration should not jeopardise either CDTI or the prograrnme(s) with which itis being integrated.

4.8'9. Inventory of the community mechanisms/structures should be done to identifythose that can be used in the implementation of CDTI whether or not PHCstructures exist.

t4

4.8.10. There is need to establish as soon as possible enabling policies at the highestlevelin support of integration of CDTI into the health sysrem.

4.8.1 l. Where cost-sharing is introduced, this should be done in such a way that eligiblepersons are not excluded.

4.9. National Plan and Project Proposal

Professor M. Homeida provided guidelines on preparation of national plans and APOC projectproposals while Dr. D. Etya'ale higtrlighted the strengths and weaknesses of CDTI proposalssubmitted to APOC. Country working groups were assigned to develop country-specificformats for their national plans and APOC project proposals.

National plans and APOC project proposals for each of the countries are tentatively scheduledfor completion as follows:

4.9.1. Each participating country in the APOC initiative must establish an NOTF withMOH, NGDOs, IJN agencies, and other relevant partners.

4-9.2. The Ministries of Health of the participating countries through the NOTFs are todevelop National Action Plans.

4.9.3. National Action Plans are reviewed by the TCC for approval prior to receivingany APOC proposals for a given country.

4.9.4. Proposals must be carefully prepared with the lead taken by the MOH with thepartner groups assisting according to ApOC guidetines.

4.9.5.

4.9.6.

4.9.7.

4.9.8.

4.9.9.

Proposals should be well written with appropriate maps, charts, histograms, andtables to clearly reflect the plans for the project. In addition, questions in theAPOC proposal guidelines must be thoroughly answered.

Draft proposals should be developed well in advance of the due date forsubmission for thorough review and revision by partners.

It is recommended by APOC numagement that the proposals be submitted onemonth in advance of the due date to ensure it arrivei in ouagadougou to becirculated to TCC members for review prior to their scheduled meeting.

Southern Sudan acknowledged the proposal for the southern sector and reservesthe right to make adjustments and changes during imprementation.

Southern Sudan recommended that the NorF should be expanded to includeimplementors from the field.

National Plan APOQ ProposalEthiopia July, 1998 (first draft) September,l998Kenya January, 1999 January,1999Liberia July, 1998 (fust draft) ? SeptembeL 1998Mozambique November, 1998 November. 1998Southern Sudan Completed Completed

t5

4.9.10 Ethiopia, Kenya, Liberia, and Mozambique have prepared backgroundinformation for the development of National Plans and APOC project proposals.

4.9.11. APOC Project Proposals for Ethiopia, Kenya, Liberia and Mozambique will be

developed as indicated in the preceding table.

See Appendix 4 for ffirmation required for National Plans

4.10. Other Matters

Other issues discussed with appropriate recommendations were as follows

410.1. Idea of APOC Newsletter as well as in-country newsletters to communicateoverall progress and information concerning the prograrnme

4.11. Conclusions/Recommendations of the Workshop

Professor C. D. McKenzie led an open discussion on the sunmary report of the workshop.Issues covering specific items were discussed and changes were made upon consensus opinion.

The final summary document containing conclusions and recommendations were given to

participants.

l6

18

22

28

35

44

53

62

7l

80

86

D

J)

Appendices

Appendix

A) Opening CeremonY SPeeches..

B) Workshop Agenda

C) List of ParticiPants.........

D) Ethiopia Country RePort....

E) Kenya Country Report.............

F) Liberia Country Report.............'

G) MozambiqueCountryReport..........

H) Southern Sudan CountrY RePort.

Monitoring Form

Evaluation Form

t7

APOC/NOTF WORKSHOP ON COMMUNITY DTRECTEDTREATMENT WITH TVERMECTIN

Welcoming remarks by the National Coordinator

The Hon. Minister for Health, Prof. M. Hemeida, Dr. Paul Chuke, DrDaniel Etya'ale', Dr. Uche Amazigo, distinguished guests, fellowparticipants, ladies and gentlemen.

Welcome to Nairobi for the African Programme for OnchocerciaasisControl and National Onchocerciasis Task Force workshop.

We are going to deliberate on important issues on the operations and

sustenability of community based programmes, mainly of drugdistribution and also vector control in liited foci.

As you know the disease is onchocerciasis (oncho). commonly known as

river blindness is caused by a nematode Onchocerca volvulus whichparasitizes the skin and is transmiffed by blackflies of the genusSimulium. Details of the importance of the disease, its endemicity andmorbidity in various countries will be given during this workshop, insufficient detail to enable us to see the way forward in terms of control.

Once again Karibu Kenya!!

l8

t'

WHO STATENTENT BY DR. PAUL CHUKE, WHO REPRESENTATIVE,KET{YA

(READ BY DR D M MUTTE, DISEASE CONTROL OFFICER. WR'S OFFICE,KEI.IYA)

Mr. Chairman of this session,

Hon. Minister for Health,Director of Medical Services,

Dr. Danniel Etya'ale, NGDO CoordinatorDr. Uche Amazigo, APOCWHO Representatives of HQ and AFRODistinguished DelegatesLadies and Gentlemerq

On behalf of the WHO Country office Kenya and on behalf of Prof. Paul Chuke the WHORepresentative, I have the honour and pleasure of welcoming you all to Nairobi and to this

inter-country APOC Workshop. Cognizant of the role played by infections and parasitic

diseases in Africa as major contributors of "Burden of Disease" VIHO, the World Bank

and their collaborators have had a strong hand in programmes such as the APOC. [n this

connection, Dr. Nakajima the Director General of WHO, has a messa-ee of hope in the

1996 World Health Report. In part he says, and I quote. ull/e stand on the threshold ofa neu, era, in which hundreds of millions of people will at least be safe from some ofthe worlds most tenible diseases. Sooner rather than later, poliomyelitis, leprosy,

guinea worm diseose, iver blindness chagas disease and neonatal tetanus will joinsmall pox as diseases of the past" end of quote.

Your meeting should be yet another important milestone on the road towards the

elimination of onchocerciasis, as a public health problem in APOC countries-of sub-

Saharan Africa.

Cost effectiveness, affordability, access and use of health care services are fashionable

terms within WHO's 9th Programme of Work, which runs from 1996 - 2001. The goals

and targets in this particular Programme of Work are an expression of commitment of the

international health community, in achieving improvements in health status including the

reduction of disabilities such as blindness caused by oncho. Disease.

Your meeting comes at another important point in time. Two weeks ago, on the 7th April1998, WHO celebrated it's 5fth anniversary. In his message to mark this day, the WHO

Regional Director for Africa Dr. Samba said and I quote: "Half a century ago, in a spiitof equity and solidaity, the member states of United Nations Organizttions gottogether and made a solemn pledge to set up a technical body equipped with the

necessary resources and erpertise to address various health isszes, diseases and other

causes of suffering and death" end ofquote.

l9

As you press on with your relentless fight against river blindness, the WHO's commitmentremains unaltered. Already on the agenda of the WHA next month is an item of RenewingFIFA Strategy for the 2l st century. Disease control, elimination and, were feasible,eradication are important components of this renewing of FIFA in the new century.Onchocerciasis elimination is on the firing line.

The 1997 WHO World Health Report w:uns us that with many governments andinternational aid agenciesforced to tighten spending in recent years, funding for essentialservices is in short supply. The challenge now is to find ways of improving health deliverysystems at costs people can afford while ensuring the sustainability of programmes andservices. In this connection I commend APOC on their innovative strategy to be discussedduring this meeting,i.e. Community Directed Treatment with Ivermectin (QDTI).

The WHO and UMCEF have, over a considerable period of time, talked aboutCommunity involvemenl Later on Community panicipation was preferred - ( I guessthat one can be involved in a certain event without necessary participating!). Andcurrpntly the best term seems tobe Community ownerchip of health It is my hope thatyou will explore ways and means to place CDTI on the community ownership's account .

Since 1994, the IITIO Regional Office for A-frica has been promoting the concept of a"ilIipimum Health Package" alternatively called the Essential Clinical and Public HealthPacfage for acceleration of [IFA. It is my hope that within the APOC countries,Onqhocerciasis control will form an ingredient of the "Nfinimam Package". One of thetools for this approach is " Essential Medical Care" and treatment with ivermectin shouldbe considered as an integral part of essential medical care within the "minimum Package".

Last but not the least, may I remind you that such gatherings as this week's meetings is animportant forum for "Continuing Education,'l for health workers. [n some of the latestissues of the LANCET, one of the renowned medical journals published in the U K ( fthink it was the 4th, April, 1998 issue) I read that "continuing education" is now beingreferred to asuContinuing Professional Development" or CPD. The author of thearticle says that there is an educative value in professional workers attending a meetingeven for those who finally find out that there is no reason to change their practice. [nother words, even if at the end you find that you know almost everything discussed, thatrealization is a form of learning. There are also many aspects of learning that are noteasily measurable.

I hope you will learn a great deal during your deliberations.

Thank you and good luck!

20

APOCNOTF WORKSHOP ONCOMMUNITY DIRECTED TREATMENT WITH IVERMECTIN

(cDrr)NAIROBI, KENYA, APRrL 20_25, lggg

SPEECH BY TFM DIRECTOR OF MEDICAL SERVICES, DR. JAMES N MWANZIA

Prof M. Homeida, Dr. Daniel E. Etya'ale', Dr. Uche Amazigo, Dr. paul Chuke, Members ofSponsoring Agencies, distinguished guests, participants from ApOC countries, ladies andgentlemen.

It is with great pleasure for us to host this workshop on community directed treatment ofoncho with ivermectin. oncho remains a serious put[" health p.obl.* in much of tropicalAfrica affecting 17.6 million people, of who l5 million (or more than 85%) now live outsidethe oCP areas of west Africa. Prior to 1987 no safe drug for a community based treatment ofoncho was available, until ivermectin was registered for ho-* use. The most seriousconsequences of the disease is blindness and a very severe skin disease accompanied by anintense itching.

APOC has a goalof implementing a community based sustainable control of oncho in up to l6countries of Africa where the disease is still a public health problern The programme (ApOC)will control the disease by designing and implementin-s a communitv based ir.Jrmectindistribution systenl supplemented by vector eradication in a few isolated foci.

This approach ensures ownership of the prograrnme by the community with minimum buteffective medical supervision. It forms an important step in eliminating the disease as a publichealth and socio-economic problem in Africa outside the eleven OCp countries of WestAfrica.

The drug ivermectin (Mectizan) has been provided free of charge for as long as it is needed.APOC will take advantage of this window of opportunity to bring oncho *i.. control. Isincerely thank Merck & co. for this generous donation of Mectizan.

Community self treatment with ivermectin will provide an important entry point for othercommunity based health interventions, and thus help to develop a practicaibasis forstrengthening primary health care (pHC) in some of the poorest communities.

Kenya eliminated onchocerciasis by instituting antivector measures in certain well defined fociin the western part of the country in the 1950s and 1960s. However, residual foci persisted onMt. Elgon on the common boundary with Uganda and in the surrounding hills where thedisease was recently detected. The disease has also been detected in refugees and otherimmigrants living in Kenya, particularly from Sudan. This and the p..r..rJ. of the vector inKenya makes re-establishment of the disease as a public health protl"rn a real possibility.

An epidemiological assessment is necessary to establish the level of the disease in the country.

Thank you.

21

Appendix B

TVORKSHOP ON THE PHILOSOPHY OF THE AFRICAN PROGRAMME FORONCHOCERCIASIS CONTROL (APOC), CONCEPT AND HARIVIONIZATION OF

COMMUNITY -DIRECTED TREATMENT WITE TYERIVIECTTN (CDTI).NAIROBI, KENYA (20 - 25 APRrL 1998).

ANNOTATED AGENDA (Revision l)

Sunday 19/04/98

Informal meeting with participants/ election of Rapporteurs/

introduction of Facilitators19H30 - 20H30

Monday 20/04/98

SESSION 1: Opening / General Announcements

ll

Chairman:Rapporteurs:Facilitators:Election of officersChairmanVice-Charman

08H00 - 08H10

1.2 Adoption of Workshop Agenda 08H10 - 08H20

I.3 Objectives, Expected outcome of Worksho,p (Amazigo) 08H20 - 08H35

1.4 Pre-test ( Roungou and Namboze) 08H35 - 08H50

1.5 APOC/ CDTI Training video fiLn 08H50- 09H30

1.6 09H30 -10H30

COFFEE BREAK r0H30 - 10H45

SESSION 2: Philosophy of APOC/ Concept of CDTIChairman:Rapporteurs:Facilitator:

2.1 Philosophy of APOC @tya ale) 10H45 - I lH00Ccrncept of Community Directed Treatment with ivermectin (Amazigo) I IH00 - I lHl0

2.2 Partrrership in APOC @tya ale/ Goepp) I lHl0 - 11H30

Opening CeremonyVideo from Sudan (7-8 mins)Welcome address by Natiural Coord:nator/ KenyaAd&ess by Dr. P. Chuke (WHO Represortative in Kenya)Prof M. Homeida /Technical Consultative Commiuee, APOC

Ope"iog address by Hon. Minister of Heahh, Kerya

')')

2.3

3.5

3.6

LUNCH BREAK 12H30-14H30

SESSION 3. Administration, Budget, Financial Management of APOC projectsChairman:Rapporteurs:Facilitator: Edeghere

3.1 Guidelines for elaboration of budget @rof. Homeida) 14H30 - 14H50

3.2 Administration & Management of APOC Fund (Aholu) 14H50 - 15H30

3.3 Discussion l5FI30 - 16H00

COFFEE break: 16H00 - 16H15

3.4 Working goups (5 countryteams) on Administration, Financial Management

- Frnancial Flow (chart) from Central -District Levels l6Hl5 - l8Hl5- Administration/ Financial Reporting Systems

Tuesday 2l/04198

Rapid Epidemiological Mapping of Onchocerciasis (REMO)Obj eaive/ methodologyitmportant steps (Edeghere)

Status of REMO /GIS for APOC countries @deghere)C o n clu s i o n/ Re co mmen dation s

Plarary . Presentation of Financial Flow charts and Administration/Financial Reporting Systems by country teams

C o n clu s io n u n d Reco mmen datio n s

I IH30-l2Hl0

l2Hl0-12H30

7H30 - 08H30

08H30 - 09H00

09H00 - 09H1509H15 - 09H3009H30 - 09H5009H50 - l0Hl5

l0Hl5 - 10H30

r0H30 - 12H00

12H00 - 12H30

SESSION 4: Community Participation & Sustainabilty of CDTIChairman:Rapporteurs:Facilitator:

4.1 Approaching the Community @lhassan)4.2 Filrn (lSmrns)4.3 Other roles & responsibilities of communities (Roungou/ Namboze)

4.4 Discussion (Questions)

COFFEE BREAK

4.5 lYorking groups an: Approaching communrty & responsibililies

in ivermectin distribution

Plenary on Approaching community & responsibilitiesReports from groups:

4.6

LTINCH BREAK

23

t2H30 - 14H30

Reports from groups on Approaching community & responsibilrties

Co n cl u sio n an d Reco mmen dat io n s

Community involvement and ownership of CDTVSustainability of CDTI (Amazigo/Elhassan)(With special reference to reorientation of on-going proiects/Lessons from participating NGDOs)

COFFEE BREAK

Working groups on Communrty rnvolvement and ownership of CDTU

Sustainability of CDTI

Participants' assessment ofthe organization of the Workshop

- What needs to be improved? / What is going on well? (Etya ale)

Wednesd ay 22104198

Plenary: Presentation of workrng groups on:

Community involvement and ownership of CDTVSustarnabrlrry of CDTIC o n cl u sio ns and Reco mmen datio n s

SESSION 5: TRAINING AND HEALTH EDUCATION

4.7

4.8

4.9

5.1

14H30 - 15H0015H00 - 15H30

r5H30 - 16H00

I6H00 - 16H30

16H30 - 17H00

17H00 - 18H30

18H30 - 19H00

08H00 - 08H30

08H30 - 09H00

08H00 - 08H3008H30 - 08H45

o8Hls - 09H0009H00 - 90H30

09H30 - l0Hl5

l0Hl5 - 10H30

10H30 -I lH30

l lH30 - 12H00

5.2

5.3

Chairman:Rapporteurs:Facilitator:Training & IEC materials in the context of CDTI

(JeffWatsur)Country Experiences: Training & IEC matenalsTraining video (section on training CDDs) & APOCCDTI Training manual (Amazigo)Harmonizatisp sf Jl3ining /Heahh EducationmAhods and materials (JeffWatson)

-process

-materials-budgeting for lEC/Traurmg materials in CDTI projectsWorking Groups (mixed): Training/fleahh Education/ tEC for CDTI

COFFEE BREAK Group photograph

Plenary on Harmonization of Training /Heahh Education/IECPresentations by working groups

54

5.5

5.6

5.7 ConclusionsondRecommcndations

24

LUNCH BREAK

SESSION 6: Ordering, Procurement and delivery of ivermectinChairman:Rapporteurs:Facilrtators:

6. I Introduction: Procurement and delivery of ivermectin (Watson)

-Procedure for Ordenng Mectizan@ (MDP)

-lntegration of ivermectin procurement & delivery in the national

system @deghere)6.2 Management, Safety and Storage of ivermectrn

at all levels @deghereAlamboze)Discussions

COFFEE BREAK

6.3 Working grouPs (by country) on Ordering, ProcuremerU

Drug Delivery circuit and integration of ivermectin

into the national delivery sYstem

6.4 Plenary on Orderrng, ProcuremenU Drug delivery circurt

and integration of ivermectln in the national heahh system

6 5 Conclusions and Reconunendalions6.6 Management of mmor and severe adverse reactions

12H45 - 14H30

14H30 - 14H45

t4H45 - 15H05

15H05 - 15H20

15H20 - 15H45

15H45 - 16H00

16H00 - l6Hl0

16H10 - 17H10

17H10 - 17H40

17H40 - l8Hl0l8Hl0 - 18H40

09H45 - I lHl5lrHl5 - l2Hl5

l2Hl5 - 12H45

Thursday 23104198

SESSION 7: RECORDING, REPORTING AND FEEDBACK AT ALL LEVELSChairman:RapporteursFacilitator:

7 .l Collection of information/ Recordurg/Reportrng/Feedback @lhassan) 08H00 - 08H30

7.2 Monitoring of CDTI Projects @oungou) 08H30 -08H45

7.3 Participatory monitorurg of Projects (Aparicio) 08H45 - 09H00

7 .4 Forms for Evaluation of CDTI Projects (Namboze) 09H00 - 09H30

COFFEE BREAK 09H30 - 09H45

7.5

7.6

Working groups on Recordrng/ Reporting/Monitoring/Evaluation ( at all levels)

Plenary on Recording/ Reporting/ Monitomg/Evaluation ( at all levels)

Recommendations on Recording, Reportingand Feedback

7.7

LUNCH BREAK

25

12H45 - 14H30

SESSION 8: Integration of CDTI in the Health Care Service

8.1

Chairman:Rapporteurs:Facilitator:

lntroduction: Integration rnto Health Care Service (Roungor.r/ Elhassan) 14H30 - 14H50

8. I . I Importance of ntegration of CDTI8.1.2 Process of integration of CDTI

8.2 Working groups on integration into Heafth Service

COFFEE BREAK

14H50 - 16H00

16H00 - l6Hl5

16H15 -I7HI5

l7Hl5 -18H00

08H00 - 08H2008H20 - 08H40

08H40 - 09H0009H00 - 10H00

838.4

Plenary on Integration of CDTI in the Heahh Care servrce

Presentations by working groups

8.5 Conclusionandrecommendations

Friday'24104198

SESSION 9: National Plan and Project ProposalChairman:Rapporteurs:Facilitator:

9.1 Guidelines on National Plan and Project Proposal (Homeida)

9.2 Strengths & Wealaresses of Proposals submiued by NOTFs -and lessons leamed (Etya ale)

9.3 Discussions/Questions9.4 Working groups ( country teams) on national Plan & Prqect Pro,posals

9.69.7

COFFEE BREAK:

9.5 Country Working Groups session on National Plan and ProJect proposalcontrnue.Presentation of Country Reports

Conclusions and Recommendations

LUNCH BREAK

SESSION l0: Other mattersChairman:Rapporteurs:Facilitator:Any other matters ( on all issues)

10H00 - r0H15

l0Hl5 - 10H45

10H45 - 11H45

l rH45 - l2Hl5

l2Hl5 - 14H30

26

14H30 - I5H00

SESSION 1l: Conclusions/Recommendations of the WorkshopChairman:Rapporteurs:Facilitators:

l0.l Adoption of Plan of the Workshop Report

by country delegates and participants10.2 Adoption of the Conclusions and Recommendations of the Workshop

COFFEE BREAK:

10.3 Post Test (Roungou/ Namboze)

SESSION 12

Closure of the l{orkshop

t5H00 - 15H30

15H30 - 17H00

17H00 - l0Hl5

17H15 - 17H45

r7H45 - l8IU5

27

Appendix C

WORKSHOP ON THE PHILOSOPHY OF THE AFRICAN PROGRAfuTME FORONCHOCERCUSIS CONTROL (APOC), CONCEPT AND HARMONIZATION OF

C O MMU N ITY- D I RE CT E D T REATME NT II/ITH IYE RME CT IN, NA I RO B I, K E NYA,20 - 25 APRIL 199E

Provisional List of Participants

Participants

Ethiopia

l. Dr. Desta Alamerew, Epidemiologist, Malaria & Other Vector Borne Diseases Control Unit,Ministry of Health P.O. Box 1234, Addis-Ababa, Ethiopia -Tel: (251) 1 51 6617 - Fax: (251) I 5193 66

2. Dt. Tekle-Mariam Shiferaw , Head, Health Researches and Public Health Lab., p.O. Box 149,Awassa, Ethiopia - Tel: (25 t) 6 20 t6 45 - Fax: (25 t) 6 ZO t6 76

3. Dr Wondwosen Yimam Getahun, Head of Rigenal. Maleria and Other Vector Borne DiseasesControl Department, Benshangul-Gumuz Health Bureau Assosa, P.O. Box 71, Ethiopia -Tel: (25t)7 6t 10 87

4. Mr. Sheleme Chibsa Tujuba , Head, Malaria and Other Vector Borne Diseases ControlDepartment for the Region of Oromia, Oromia Health Bureau, Addis Ababa, Ethiopia - Tel: (251)r sl40 76 (A.A)

5. Mr. Yeshiwondim Asnakew Kebede, Team Leader, Malaria and Other Vector Borne Diseasescontrol, P.o. Box 495, Bahir Dar, Ethiopia, Tel: (z5l) 8 20 09 22 -Fax: (251) g zo t5 17

Ken!a

6. Dr. Maina Kahindo, Head, Division of Communicable of Veector Diseases Control (DCVDC),Ministry of HealttL AFYA House, P.O. Box z}T}l,Nairobi, Kenya -Tel. Qs$2720 533 or (254)2727 809 or (254)2716 515 - For. (2s4)2720 533 or (254)2713824

7. Dr. David S*9, APOC National Coordinator, Division of Vector Borne Diseases, Ministry ofHealt[ P.o Box 20750, Nairobi, Keny4 TeI. (254) z 724 3oz or (254) z 725 833 -Fax. (254)2 72s 624 -Emul: SCHISTO@|KEN.HEALTHNET.ORG

8. Mr. David Koectq Officer in Charge DVBD Rift Valley Province, P.O. Box 5, Kapsabet, Kenya,Tel Q5\ 326 2020

28

9. Mr. Wesiela Francis Chemasweti, Prov. Clinical Lab. Technologist, P.O Box 15, Kakamega,

Kenya, Tel. (254) 331 30052

10. Mr. Langat Alfred Kipngeno, Senior Public Health Officer, Ministry of Health, P.O. Box 30016,

Nairobi, Kenya, Tel. (254) 2717 077

I 1. Mrs. Obel Millie Chepkemoi, Faculty ofHealth Science, Moi University, P.O. Box 4606 Eldoret,

Kenya, Tel. Q5$ 321 32569

12. Mr. John Oluoch, Officer in charge, Division of Vector borne Diseases (DVBD), P.O. Box 92,

Kisil, Kenya, Tel: (254) 381 20801

13. Dr. Akhwale Willis Simon, District Medical Officer of Health, Trans NZOIA - P.O. Box 98

Kitale, Kenya, Tel: (254) 0325 70451 - Fax: (254) 0325 31900

14. Dr. Aba Nwachukwu, Zoology Department, University of Nairobi, P.O. Box 30197, Nairobi,

Kenya, Tel: (245) 2 72 40 13

15. Dr. Phoebe Josiah, Research Consultant, Health Environment & Population Consultancy, P.O.

Box 42679, Nairobi, Kenya, Tel: (254) 2 823 100 or (254) 2 350 002 - Fax (254) 2 542 090

Liberia

16. Dr. Samuel T. Dopoe, National Coordinator, Onchocerciasis Programme c/o Ministry of Health

& Social Welfare c/o Wortd Health Organization (WHO) Liberia" P.O. Box 316, Monrovia, Liberia,

Tel. (23r) 226 208 - Fax: (231) 226 Zo8

17 . Dr.Dolopei Eugene Ddi, Deputy Director, Liberian Institute for Biomedical Researctq P.O. Box

3 1, Charlesville, Margibi County, Liberia, Tel: (23 l\ 22 62 08 - Fax: (231) 22 62 0$

18. Mr. David K. Franklin, Data Analyst, Christian Health Association of Liberia (CHAL), P.O. Box

9056, Monrovia Liberia Tel (231) 22 68 23 -Fax (231) 226 187

19. Dr. Fatorma K. Bolay, Disease Prevention and Control Officer (DPCO), World Health

Organization (WHO), P.O. Box 316, Monrovia, Liberia,Tel'. (231)226 208 - Fax: (231)226208

Mozambique

20. Dra. Maria Ivone Ferrdo Teimizira, Ministry of Health, P.O. Box 264Maputo, Mozambique,

Tel: (258) I 430814(2s8) I 427131 - Fax(2s8) | 426s471(2s8) 1 33320

27. Dra. Lorna Maria Fialho Gujral, National Institute of Health, Ministry of Healtb P.O. Box 264

Maputo, Mozambique, Tel: (258) 1 431103 or (258) 1 430970 - Fax: (258) 1 431103 or (258) I

43097 0 - Email. [email protected]

29

South Sudan

?2. Mr . Gordon Solomon Alebe, PHCP Senior Supervisor/OV Supervisor, Senior Medical Assistant,PHCP - Maridi County, South Sudan

23. Prof Mackenzie Charles, Adviser, Gl00, Dean's Office, VMC, Michigan State University EastLansing, \ytr,48824, USA Tel: (517) 432 2388 - Fax. (517) 432 1037 -Email: mackenzie@ cvm. msu. edu.

24. Mr. Lawrence Bona. Brock, OV Supervisor, A/?HC/Supervisor, Sanetarian, Mundri County,South Sudan

25. Mr. PeremunaWuraAmaya, SeniorPHC Supervisor, CHD/PHCP, Mundri/I(otobi, SouthSudan

26. Mr. Mangu Wandege Michael, OV County Supervisor, OV County Office, Tambura, SouthSudan

27. Dr. Deng Samuel Mayak, Medical Doctor, Volunteer Medical Officer, CCM, Alpha CivilHospital, Billing, Rumbek County, South Sudan

28 Mr. Gabriel Chol Dhuor, Nurse, Bilin-e Hospital. Rumbek Countv. South Sudan

29. Mr. Bith Maguruk Macol, Laboratory Assistant, Alpha Civil Hospital, Billing Hospital, RumbekCounty, South Sudan

30. Mr. Gordon Makuek Marol, Community Health Worker, Kolcum, PHCU, Billing Hospital,Rumbek County, South Sudan

3 l. Mr. Simon Kuot Kuot, Health Coordinator, Medical Assistant, Responsible for Nyamlell PHCC,Aweil West County, South Sudan

32. Dr. AmaMorrisTimothy,M.ScStudent,LondonSchoolofHygiene&TropicalMedicine,JohnAstor House, 3 Foley Street, Londorg WIP 8AN, United Kingdonq Tel'. +44 0171 380 9l 19 - Fax.+ 44 0171 436 5389 - Email: [email protected]

33. IvIr. Camillo Yee Mangieamanga, SRRA Secretary, Tambura County, South Sudan

34. Mr. Philip Caiaphas, PHC Coordinator/OV Supervisor, East Mundri, New Sudan, c/o MundriReliefandDevelopment Association(MRDA), P.O. Box60837Nairobi, Kenyq Tel. Q592720995- Fax: (254)2720977

35. Mr. Emannuel Ezam4 ov Supervisor, PHCP-CHD, Yambio County, South Sudan

30

Facilitatorc

36' Dr' Josephine Namboze, Disease Prevention and Control Medical Officer, p.O. Box 149Kampala, uganda. Tel. (256) 41 344038/34405g - Email: [email protected]

37' Mr' Jeffrey Watson, Oncho Programme Coordinator, Christoffel Blindenmission (CBM) 34Gomwalk Close, Jos, plateau State, NigeriaTel: (234) 73 45 65 78, Fax: (234) 73 45 42 30, E-mail <Jeffivatson@maf org>

38 Dr' Henry Edeghere, wHo, zonalNPl Surveillance coordinator, wHo, I Golf Course Road,Kaduna, Nigeria, Tel: (234) 62 237925 or (234) 62 2t3432 or (234) 62 ztt 764 - Celtphone: 09080 50 87 - Fax: (234\ 62 237 924 or (234) 62 238 360 - Email: [email protected]

39' Dr' Elisabeth osim Elhassan, Country Representative, Sight Savers International (SSD, I GolfCourse Road, P.o. Box 503, Kadunq Ngerii, Tet. (234) 62 23g360 - Home: (234) 62 2lo 723 -Fax. (234) 62 238360

40 Profl Mamoun M. A. Homeida, National Coordinator & Chairman of NoTF/Sudan, p.o Box12810, Khartoum, Sudan, Tel: (249) lt 72 47 62 -Fax. (z4g) lt Tz 47 gg

4l Ms Joyce Msuya' Health Speciaiist, the World Bank, Africa Region-onchocerciasiscoordination Unit, 18r8 H street, N.w., washington D.c., 2033, usATel (202) 4sB 77 tz - Fax: (2oz) 5zz 3157 -r,mail: JMSITYA@WORLDBANK oRG

42. Ms. Teresa Aparicio-Gabarq Social Anthropologist, LCSES, the world Banh lglg H StreetN.w., washington, D C., 20433,Ter. (zoz) 45& 90r; - Fax (2oD) 676 9373

WHO/APOC Stafr, Geneva

43. Dr. Daniel Etya'ale, wHo/Apoc, Geneva 27, cH 1211, switzerland,Tel @122) 791 26 4Z,Fax. (4122) 7gt477T

WHO/APOC Staff, Burkina Faso

44. Dr. Uche Amazigo, wHo/Apoc, p.o. Box 549, ouagadougou, Burkina FasoTet. (226) 30 23 t2/30 23 t3/30 23 ot,Fax: (226) 30 2r +1tpzi134 26 4843. Dr. Jean-Baptiste Roungou, OTD/AFRO, p.o. Box 549, ouagadougou, Burkina Faso,Tel. (226) 30 23 12/30 23 t3t3o 23 ot,Fax: (226) 30 zt 47/(226) 34 za qg

45' Mr' Yaovi Mokpoko Aholou, WHO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso,Tel: (226) 30 23 rzl30 23 t3/30 23 ot,Fax: (226) 30 zr 47/(226) li zo qa

46. Ms. Patricia Mensah, wHo/Apoc, Box 549, ouagadougou, Burkina Faso,Tet. (226) 30 23 12t30 23 r3t3o 23 ot,Fax. (226) tO it 47/A2q 34 26 48

3l

WHO KENYA

47. Dr. Zagana Nevio, Medical Officer, CTD Division, Onchocerciasis Unit, World Health

Organization WHOA{airobi, Kenya, Tel: (254) 7 7212 534 - Fax: (254) 2 7214 777 - Email:

[email protected]

48. Dr. Mutie Dominic Makaa, WR a.i., World Health Organization (WHO), P. O. Box Nairobi,

Kenya, Tel: (254) 2 72 30 69 - Fax: (254) 2 72 00 50

NGDOs

49. Ms. Irene Goepp, Programme Manager, OlS/Southern Sudan OV Control Programme,

HealtlNetlnternational, SuguttaRoadP.O.Box40643,Nairobi,Kenya,TeL.(25$2573704-Fax:(254) 2 574 452,E-mul: [email protected]

50. Mr. Fasil B. Chane, HealthNet International, Sugutta Road P.O. Box 40643, Nairobi, Kenya,

Tel. (254) 2 573 704 - Fax: (254) 2 574 452, E-mail: [email protected]

51. Dr. Mary M. Alleman, Associate Director, Mectizan Donation Program, 750 Commerce Drive

Suit 400, Decatur, GA 30030, Atlanta, USA Tel. (404) 371 1460 - Fax: (404) 371 1138 - Email:

malleman@asldorce org

52.Mr.Ben Male, Programme Support Manager, Sight Savers lnternational - East Central Southern

Africa Region, P.O. Box 34690, Nairobi, Kenya, Tel. (254) 2 50 38 35 - Fax: (254) 2 50 55 48 -

Email: benmale@ africaonline. co. ke

53. h/k. Cox Ross, Resident Advisor, Global 2000, The Carter Center, P.O. Box 51911, Nairobi ,

Kenya, Tel'.Q54)2245697 -Fax:(254) 2245690-Email:GLOB2000@AFRICAONUNE CO.KE

54. Dr. Ayodele Benjamin Aderinola, Endemic Diseases Coordinator, Aktion Afrika Hilfe (AAH -

Sudan Programme), P.O. Box 76598, Nairobi, Kenya - Tel. (254) 2 571 978 or (254) 2 571 979 'Fax. (254) 2 574 969 - Email: akafri@form net comm

55 Gathigira Julie Wachera" lnternational Rescue Committee (IRC), P.O. Box 62727, Nairobi,

Kenya, Tel. (254)Z 574 488, Fax: (254)2 574 495

56. Ms. Roslind Awando, Health Officer/OV Coordinator, South Sudarq World Vision lnternational

(WVD), P. O. Box 56527, Nairobi, Kenya; Tel. (254) 2 Ml 777 - Fax'. (254) 2 441 819

57. Dr Bellario Ahoy Ngong Geng, Chiefl Health Coordinator, Sudan Relief and Rehabilitation

Association (SRRA)New Cush New Sudan, P.O. Box 39892, Nairobi, KenyaTel: (254) 2 44 0l 56 or (254) 2 44 80 75 - Fax: (254) 2 44 80 78

58. Dr. Eyamba Albert, Project Advisor, Carter Center, P. O. Box 4794, Yaounde, Cameroorq

Tel/Fax: (237) 20 50 12

32

Other Participants

59. Prof. Braide Ekanem Ikpi, Temporary Advisor to WHO on Impact Assessment, l6 Ibom Layout,P.O. Box 3679, Calabar, Nigeria -TeL. (234) 87 222 87? or (234) 87 220 452 - Fax: (234) | 87 222 872 or (234) 87 220 452

60. Mr. Davies Rowland, Observer, c/o P.O. Box 10018, Nairobi, Kenya

PWANC 2J.OJ.I99E

))

34

EthiopiaAppendix D

Unselected Areas for REMO

Oncho Free Areas

CDTI to refine

REMO

35

ffi

CDTI Areas

Afar

ETHIOPTA

General information

Ethiopia is located in the Horn of Africa. [t shares borders with five countries, Eritrea inthe norttr, Sudan in the west, Kenya and Somalia in the south and Djibouti in the east.

According to a recent census, the population of Ethiopia is about 57 million and 85 % ofthis is rural. More than 60To of the population lives in the highland plateau where thepopulation density is very high. In the low lands, the land is sparsely populated.

Topography, climate and accessibility

Ethiopia is a mountainous country with a highland plateau that is divided into several parts

by tlre five major river basins (Tekeze, Abbay, Barro, Omo and Genalle). The country is

divided in to two parts by the great Rift Valley which crosses from south-west to north-east.

The,long rainy season in the country extends from June to September and the short one,

occurs between January and February, covering some parts of the country. The dryseason starts in October and ends in June.

Due to the rugged terrain and the numerous rivers in the country, access to many ruralareas is very limited. Up to the zonal level, there are usually all weather roads connectingthe zones to the regional capitals. Beyond the district capitals, most of the roads can onlybe accessed during the dry season.

Administration

Administratively, the country is divided into ten autonomous regional states which are

then sub-divided into 55 zones and more than 500 districts. The health managementsystenL follows the same set up. At the central level, there is the Federal Ministry ofHealttU at the regional level- the regional health office, at the zonal level - the zonal healthdepartment and at district level - the district health office.

The health care delivery systern, starts from bottom upwards with the primary health care

units @HC unit), the district hospital, Regional referral hospital and specialized centralhospital. The current health service coverage is about 45%o, that is, the population thathas access to health facilities.

Onchocerciasis endemicity

The existence of Onchocerciasis in Ethiopia was established in 1940 by ttalianinvestigators, in Keffa region. Subsequent studies have identified the disease to beprevalent in the western and southern parts of Ethiopia. The REMO survey, that wascarried out in 1997, showed that the population living in meso- to hyper - endemic areas is

about 2.5 million. These areas are isolated foci in south - western and north - westernparts of the country. The number of endemic communities is expected to expand after therefinement of REMO, by end of 1998.

36

Objectives

General objective:

To reduce the prevalence of Onchocerciasis to the extent that it will no longer be a majorpublic health problem.

Specific objectives:

l. To complete and refine REMO in the remaining parts of the country

2. To attain 80% CDTI coverage in meso and hyper endemic communities by theyear 2003.

3. To initiate vector control activities in selected endemic foci.

Strategies

1. Advocate support for onchocerciasis control at all levels.

2. Conduct training on implementation of CDTI at all levels.

3. Establish onchocerciasis task forces at different levels.

4. Appoint onchocerciasis coordinators at different levels.

5. Integrate CDTI activities into existing systems.

Administration of the programme

1. The NOTF has not been established yet.

2. The proposed composition of NOTF is as follows:

Head of Epidemiology and AIDS department - Chair person

National onchocerciasis coordinator - Secretary

NGDO representative - Vice chairman

Other NGDOs - Members

Regional onchocerciasis coordinators - Members

WHO representative - Member

LINICEF representative - Member

NGDOs

To date, Africare, Global 2000, Sight Savers International and Bahai community haveexpressed their interests in Onchocerciasis control in the country, informally.

37

Eth'opiaF inance Flow Chart

APOC/WHOWorld Bank Trust Fund

/I

Federal MOIJ.INOTF

Sisnatories:?

Regional HealthBureau

/I

Zonal HealthDepartment

/I

District HealthOffice

/I

Community? to be settled between

APOC & MOH

<- Fund Transfer* Reporting Flow

38

Eth'opiaMectizanFlow Chart

6 months

# Mectizan Flow* Reporting Flow

2 weeks

2 weeks

2 weeks

1 week

1 week

MSD(France)

MSI)(usA)

II

\

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Federal MinistrYof Health

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BoardI

I

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/I

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I

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Distributors)

1 week

EthiopiaReporting Flow Chart

---+ Report Submission

Community

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/I

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I

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/I

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42

EDUCATION/MOBILIZATTON TARGET GROUPSEthio la

Target Group Level(Nat., State, LocalGovt.,Community)

Message/Information

Who willcommunicate the

informstion

Means ofCommunication

NOTF National EndemicityCommencement of the

Program

NOTF WorkshopsLeaflets

NOTF WorkshopsLeaflets

Policy Makers National Key Health EducationMessages

CRDA -Christian Relief& Dev. Assoc.

National Advocacy NOTF WorkshopsLeaflets

Religious LeadersUniversity

National Advocacy NOTF WorkshopsLeaflets

NGDO, Reg.Policy makers,Reg.Healthbureau

Regional Advocacy and BasicInformation

ROTF WorkshopsLeaflets

NlOtvMoEMOAAIGDO

Zonal Basic InformationAdvocacy

ZOTF WorkshopsLeaflets

Council/MOHMOA/MOEMOE/ReligiousLeader

District Advocacy and BasicInformation

DOTF WorkshopsLeaflets

Comm. LeadersTeachersRel. LeaderLocal Assoc.Health Workers

Community Basic InformationAdvocacy

DOTF WorkshopsLeaflets

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Appendix E

Kenya

. Eldoret

. Nairobi

Non-endemic

Suspected endemic areas

44

KEI{YA

General Information

Kenya is situated on the eastern seaboard of Africa, lying astride the Equator between 4o 30'N and

S, respectively and between 35" E and 41" E. To the south east is the Indian Ocean, Tanzania in the

south, Uganda in the west, Ethiopia in the north and Somalia to the north east.

Topography, Climate and Accessibility

The territory covers 58?,647 sq km ofwhich 13,096 sq km is water and 488,100 sq km (82%) is arid

and semi arid lowlands. The latter occupies the northern and eastern parts of the country.Approximat ely 90Yo ofthe total population (30 million) live in the highlands, the Lake Victoria basin

of Nyanza, Western provinces and on the Coast. This comprises 104,000 sq km (18%) of the totalarea of the country.The landscape is dominated by the south west higtrlands bisected by the Great Rift Valley, which runs

from north to south. Most of the rainfall occurs between March to September, with the short rains

in December. The dry season is mainly between October and March.

A central railway runs from the Port of Mombasa on the Indian Ocean, through Nairobi, Nakuru

and Eldoret to Uganda. At Lake Victori4 there is water transport to other East African Ports.

Road transport runs alon,e the main railway to Uganda.

There are several river systems with their sources in the highlands The largest of these is the Tana

which together with the Athi, drain into the Indian Ocean. Rivers Sondu, Nzoia and Yala run

westwards and drain into Lake Victoria, while Rivers Turkwel and Kerio run northwards and drain

into Lake Turkana..

Administration

Kenya is divided into eight provinces: Rift Valley, Nyanza, Coast, Eastern, North Eastern, Central,

Western and Nairobi, the capital city. The provinces are divided into sixty eight (68) districts.

The Ministry of Health is headed by a Minister, Permanent Secretary and Director of Medical

Services. It is divided into several Divisions, including Preventive and Promotive, Primary Health

Care, Curative Services and Environmental Health.

The control ofvector borne diseases, including Onchocerciasis falls under Preventive and Promotive

Health Division which together with PHC deals with prevention and control of infectious diseases.

Community Structure

The Districts are divided into Locations, which are governed by Chiefs. The Chiefs are assisted by

Assistant Chiefs, who govern several villages in each Location. Each village is represenled by an

Elder, who together wiitr the Assistant Chieiare elected by the community, while the Chiefs are Civil

Servants.In villages are women groups and cooperative societies, which extend to the district and national

levels.

45

Onchocerciasis Endemicity

Onchocerciasis was first detected in Kenya n l92l among the Kipsigis and Kisii communities livingin the vicinity of the well watered Chemosit and Kipsonoi, tributaries of the River Sondu.In an epidemiological study conducted in Kakamega in 1939, a prevalence rate of 50%owasrecordedamong 6l patientg detected. The disease occurred in the Kakamega and Kaimosi forests and in theTiriki and Nandi \ills, and further into the western plains as far as Marach and Buhayo.

Onchocerciasis occurs in the highlands, west of the Rift Valley, Nyanza and Western provinces inmore or less clearly demarcated foci. This is within an area of high rainfall and drained by the RiverSondu and Yala and their tributaries. In the south the areas affected are Bomet, Kisii, Kericho andRachuonyo while in the central areas Nandi, Kakamega and Vihiga are affected.The northern foci occur on Mount Elgon and the Cherangany Hills. The latter hills occur on thecommon boundary between Trans Nzoia, West Pokot, Uasin Gshu and Marakwet-districts.

Objectives:

To determine the prevalence of Onchocerciasis in the original foci and suspected areas.

To control Onchocerciasis using CDTI strategy and focal vector control.

Strategies

REMO/REA will be carried out in all foci and in areas within the range of the vectorSimulium naevei.

2. CDTI strategy to be adopted for control of Onchocerciasis

3. Focal vector control on the slopes of Mount Elgon in collaboration with Uganda.

NOTF

The NOTF will be established in January,l999, after the completion of REMO/REA.

2

46

I

I

KenyaFinance Flow Chart

APOC/WHOWorld Bank Trust Fund

/I

NOTF Nat. CoordinatorSignatories:

NGDO Rep.

/I

DistrictHealth Unit

District CoordinatorNGDO Rep.

Rgp,. ,

Sisnatories:

II

PHC Facility

/I

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#_ Fund rransfer

47

* Reporting Flow

KenyaMectizanFlow Chart

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49

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EDUC ATIONTM O BILIZATION T ARGET GROUPSKe

Means ofCommunication

Who willcommunicate the

information

Message/Information

Level(Nat., State, Local

Gow.,Commun!ryL

Target Group

LetterNationalCoordinator

Oncho Plan of ActionNationalMediaPolicy makers

Face to face

visitNationalCoordinator

Oncho Plan of ActionProvinceProvincial HealthManagementTeam

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Planner

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Appendix F

Liberia

Monrovia

Not yet assessed for oncho

Counties

CapemountBongBomiMontserradoNimbaMargibiGrand Bassa

SinoeGrand KruMqryland

2J4)

89I1

I

Sr,rspected endernic areas

53

LIBERIA

General information

Liberia is located on the west coast of Africa. It is bordered on the west by Sierra Leone,north by Guinea, east by Ivory Cost and south by Atlantic Ocean. Liberia

-hu, un area of

43,000 sq. miles with a population of 2.8 million. 43.1o of this population is below 20years of age. The population growth rate is about 2.6%. Liberia is recovering from aseven year war

Topography, climate and accessibiliqv

The country has flat rain forests and mountainous terrain. The major rivers are St. John,St. Paul, Lofa, cavalla, Farmington, cestos, Nuon, Marfa Low4 Mano and Maho. Thecountry has two seasons, the rainy season (May - September) and the dry season (Octoberto April)

Most roads are inaccessible during the rainy season. Communication between Monrovia isby telephone, fax and telex. However, from Monrovia to the counties, communication isonly by radio.

Adlinistration

There are thirteen counties made up of several districts. In the districts, are clans made upof towns. At the central level, is the Ministry of Internal Affairs and the Ministry ofHealth and Social Welfare. The laner is headed by a Minister. There are three deputy-ministers and four assistant ministers with various responsibilities. The Ministrv.supervises, monitors and evaluates health care delivery system in the country. At thecounty level, is the county health team headed by the county health officer. The countyhealth team is the implementing arm of the MinistryAt the local government level, the head of the county is the superintendent. There are alsodistrict commissioners, paramount chiefs, clan and town chiefs.

Onchocerciasis endemicity

Onchocerciasis poses a serious public health problem in Liberia. The prevalence data hasbeen available since 1950 in Mar_eibi, Grand Bass4 Grand Bong and Lofa, Bomi,Capemount, Grand Gedeh and Monrserrado counties. Data have also been prol.ided bvscientist from the Liberian Institute of Biomedical Research. Eight of the thirteen counriesare known to be endemic for onchocerciasis while otherc u." y"i to be assessed

At many health posts, clinics, health centres and hospitals throughout the country,onchocerciasis dermatitis is frequently observed as well as palpa-ble nodules.

Objectives

General objective:

To identify and treat endemic communities with ivermectin and eliminate Onchocerciasisas a public health problem

54

Specific objectives:

I To determine the prevalence of Onchocerciasis in the country

2. To establish a sustainable CDTI programme

Strategies:

l. Awareness workshops at National, County and community levels

2. REMO training and assessment of endemic communities

3 Treatment of endemic communities using CDTI

NOTF

The NOTF is not yet formed but the Ministry has appointed a National Onchocerciasis

Coordinator.

55

LiberiaFinance Flow Chart

APOC/WHOWorld Bank Trust Fund

National

County

<- Fund Transfer

II

NOTF Nat. CoordinatorNGDO Rep.

I tories:

wHo Rep.I

I

CountyOncho Unit

County Health OfficerNGDO Rep.

'Control Off.

Sienatories:

/I

Health Facility

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56

* Reporting Flow

LiberiaMecti zan f low Chart

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Service)

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(CurrentlYnot functioning)

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60

EDUCATIONTM O BILIZATION TARGET GROUPS

LiberiaTarget GrouP Level

(Nat., State, LocalGovt.,CommunitY)

Message/Information

Who willcommunicate the

information

Means ofCommunication

NationalAuthoritiesMOFVAgric.Internal Affairs

National APOC Philosophy of CDTIInformation about the threat

of onchocerciasis

NOTF VideoVisitGroup meeting

County Health I

Team and CGR(Country Gov.Representative)

County Information about oncho

Philosophy of APOCNOTF Visit

IECGroupdiscussions

Community Community Philosophy of APOCPrinciples of CDTI

County HealthWorkers

IEC materials

6l

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Mozambique Appendix G

Indian Ocean

Non-endemic

Suspected endemic areas

Malawi

Tanzanta

o la

e

Zambia

Zimbabwe

GazaInhamb

South Africa 62

'-\ i,:'

I ''i l'' ,:-',, t.

l- r i'-a, l

{

MOZAMBIQUE

General information

Mozambique shares borders with Tanzania in the north, Malawi and Zanfria to the north-west, Zimbabwe to the west, Swaziland to the south-west, South Africa to the south andsouth - east and the Indian Ocean to the east and the north-east. The major rivers in thecountry are Zambezi and Rovuma,

The population is about l7 million made of Bantu and other races. There are variousreligious groupings made up of Catholics, Anglicans, Moslems and,Ziorletc. Subsistencefarming accounts for 7SYo of the major economic activity There is a high level of mobilityacross Malawi. A peace agreement was signed about five years ago, following a ten yearscivil war.

Topography, climate, accessibility

The vegetation is almost all savanna except for the Milange forest areas. The rainy seasonis frpm November to March and the dry season April to October. There are still a lot ofland'mines which makes access difficult. The roads are currently being rehabilitated.

-Colmunication between districts and provincial levels is by radio while the telephone and

fax gan be used in the provinces.

Administration

Mozambique has l0 provinces, each being is divided into distrios. Each district is sub-divided into localities and the localities sub-divided into villages. At the central level,therp is the Ministry of Health made up of National Directorates of Health. Under theseare fhe Provincial Directorates of Healttr, responsible for hospitals and health centres.

I

The'District Directorates of health are responsible for rural hospitals and health centreswhile the localities are responsible for health posts.

AII community health activities are carried out by indMduals selected by the community.These are trained for six months by MOH as community health workers. Their mainactiYities after training are health education for communities, mobilization and treatment ofsonle diseases that are locally endemic. By national law, these people are the only onesallowed to manage and administer drugs. It is therefore likely that these are the samepeople that will be used in this programme

Onchocerciasis endemicity

Knowledge of onchocerciasis in the country was reported about 30 years ago but was notdocpmented. The possible endemic provinces are Tete, Manica, Zambezia,Nampula,Nia$sa and Cabo Delgado. A survey in Milange district inZanbena showed thai thedistrict is endemic for onchocerciasis.

There may be cross-border considerations in areas bordering Malawi and Tanzania. Thepresence of other filaria infections have been reported in the country.

63

Objective:

To control Onchocerciasis in the endemic communities in the country

Strategies:

I Conduct REMO and review other relevant information that is available

2. Streamline structures pertaining to ivermectin procurement, delivery and

distribution

3. Integrate CDTI into the existing system of MOH

For long term sustainablity, the programme will use village appointed health workers. Therefugee populations have already been integrated into villages thus will require no

additional attention.

NOTF

This is yet to be formed. The NGDO's to work on the prograrnme have not yet been

identified.

64

MozambiqueFinance Flow Chart

APOC/WHOWorld Bank Trust Fund

<- Fund Transfer

/I

NOTF Nat. CoordinatorNGDO Rep.

rgnatories:

wR/wHo/

I

ProvincialHealth Dir.

Prov. Health OfficerNGDO Representative

/

I

DistrictalHealth Dir.

District Health OfficerNGDO Representative

Signatories:

/I

Community

65

-----> Reporting Flow

Sisnatories:

MozambiqueMectizan Flow Chart

2 days

1 day

6 months

3 days

2 weeks

1 weeks

2 days

<- Mectizan Flow-----> Reporting Flow

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66

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Means ofCommunicstion

Who willcommunicate the

information

Message/Information

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Target Group

VisitVideo/TVNews Paper

Radio

NationalCoordinator

Meetings and

Documentation

VisitVideo/TVNews Paper

Radio

NationatCoordinator

Meetings and

Documentation

National Leaders National

ProvinceProvincialLeaders

VisitsSeminars

Posters

National CoordProv. Worker

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DocumentationDistrict Leaders

VisitsPosters

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Meetings and

DocumentationAdmin. Workers District

VisitsPosters

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Advocacy and BasicInformation

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VisitsPosters

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messages

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Groups at-risk ofoncho infection

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messages

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Appendix IJ

SouthernSudan

Aweill TwicGogrral

Raga

l--l llt f|-!r-f:r U

l1

E. Equa

Lakes

SOUTHERN SUDAN

General information

South Sudan is bordered in the west by the central African Republic' in the south by

Democratic Republic of Congo ura ugunJa' in the east by Kenya and Ethiopia and in the

nont, the bo.rrrJary is contentious a::f, :l!-defined

Topography, climate, accessibility

The water flow is mainly towards the white Nile in the north-eastern direction in the

south-western area. The latter is divided into:

i) Southern water shed zone (Nile/ congo divide) o-f forest and savanna with good

annual rainfall and fertile soil. There i-s a gtadual slope of streams and rivers

iD lron stone plateau zone ( intermediate) of savanna with unreliable annual rainfall

andshallow,oironironstone.Streamsandriversarefastflowing.

iii) Alluvial plains towards Bahr El Arab (10 N) and White Nile (33 0 E)' Grasslands

with patchy;;;, unreliable ranrurt-una flat alluvial plains with wide shallow slow

flowine rivers'

There are two main seasons. The dry season (Iiovember-- March) during which fishing

and hunting activities occur and the *.ir.uron (April - October) mainly for farming

activities.

only one all season road exists ( western Equatoria- Lakes); most roads being seasonal

due to destruction of bridges, lack of maintenance or military barricades resulting from the

war. Access by OLiAS Indsenio. Snne tturis possible by air only from Kenya' Four

wheel drive vehicr.rl*o,otuikes and bicycles are used internally' But by far the

commonest means of transport is by foot'

Administration

Southern Sudan is divided into six regions each consisting of a number of counties'

Except for upper Nile, these regions u,..*t,ouy ( Western_Equatoria and Lakes) or largely

controlled by the Sudan Peoples I-iberation Mo"*tnt (sPLIvD Each county.consists of

a number of Payams each of which in turn is made up of several villages' civil

administrative structures have been set;;f1.* the village.level ( Village Councils) to the

national level (National Executiu. CounJifi. In additiof tf SPLM has a humanitarian

wing, the Sudan n ri"i-a Rehabilitation,{ssociation (SRRA)- Together with ols/ss

and other NGOs, this body is responsible for relief and rehabilitation actirities

Health services are delivered by oLS/SS and other NGOs in coordination with SRR*A

health sector headed by the Chief SRRA coo.ainator. Delivery is through the PHC

system which still requires complete structural development in some areas' About fwenty-

72

three NGOs are involved in the delivery of health services in the SRRA accessible areas

However, due to the war situation'this number of NGO's fluctuates

Community structure

Many ethnic groups, subsistence economy is related to zones of permanent residence;

i) Sedentary farmers found in the southern water shed zone

ii) Mixed sedentary farmers/fishernerL hunters and semi-nomadic pastoralists found

in the iron stone Plateau zones.

iii) Semi-nomadic pastoralists found in the alluvial plain zone.

The leadership structure is principally the same for these groups and consi:l o-f u

paramount chief with several exetutive chiefs below him. The executive chief rules over a

number of sub-chiefs below him, each of whom has several Gol leaders (headmen) under

ni.] n.iig,ous leaders, women associations and traditional healers are among the

influential social grouPings.

Onchocerciasis endemicitY

Onchocerciasis was first reported by Bryant in 1933. He also associated it with endemic

blindness in Bahr EI Ghazi and calied ii "Jur blindness" because of it's prevalence then

amons the Jur and Balanda tribes near tributaries of the Jur river (Bryant1935) By 1959'

more foci had been identified and reported in Bahr El Ghazal, Western Equatori4 Upper

Nile and Jonglei. Further investigations in the 1960's, 1970's and 1980's confirmed

former findings and revealed additional foci in Lakes and Eastern Equatoria regions' It is

therefore clear that the disease is prevalent in all the regions of South Sudan with a total

population of about 2.5 million persons at risk. However, the magnitude of the problem

remains undefined as epidemiotogical surveys done so far have covered seleot

communities onlY.

Objective

To control onchocerciasis by mass annual ivermectin treatment in endemic communities

tkough APOC PaternershiP.

Strategies

Determination of onchocerciasis endemicity levels

Establishment of sustainable CDTI project

NOTF

To ensure sustainability and full coverage of all SRRA accessible areas' a New Sudan

Onchocerciasis task force ( NSOTF), a partnership of SRRA and NGDO's is to replace

the SSOCp Field implementors *iilbe included in the NSOTF' Health Net International

(HIII), the principat Ncoo shall be the NSOTF coordinator and shall represent it in all

NOTF cooidination meetings. The NSOTF shall be located in Nairobi, Kenya'

73

Southern SudanFinance Flow Chart

APOC/WHOWorld Bank Trust Fund

/I

NOTF Nat. CoordinatorNGDO RepWR/WHO

ignatories:

/I

NairobiIlealthNet Int.

Sisnatories:HealthNetNGDO Rep.

/

I

NGDO/SRRAHNI Store

/I

CountiesNGDO/SRRA Store

/I

PHC Facility

CDDs(Community Directed

Distributors)

+_ Fund rransfer

-> Reporting Flow

14

Southern SudanMectizanflow Chart

3 months

I -2 weeks

I -3 weeks

I week

1 week

<- Mectizan Flow

MSD(usA)

MSD(France)

II

\

\

NairobiSchenker AgentNOTF

Health NetI

I

LokiHNI Store

/I

CountiesNGDO Store

/

I

PHC FacilitylPayam Store

CDDs(Community Directed

Distributors)------> Reporting Flow

t5

Southern SudanReportirrg Flow Chart

Community

/I

PHC Facility

/I

CountyNGDO/SRRA Unit

/I

NSOTF/NairobiHealthNet Int.

I

I

NOTF

--> Report Submission

# Feedback

APOC/WHOWorld Bank Trust Fund

76

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EDUCATION/MOBILTZATION TARGET GROUPS

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SRRA Secretary

NGDOsOLS

National APOC PhilosophY of CDTI APOC/HMMcKenzie

Modern Tech.

Mesns ofCommunication

Who willcommunicate the

information

Message/Information

Level(Nat., State, Local

Govt.,Community)

Target GrouP

Modern Tech.Chief HealthCoordinatorHealthManagement

APOC PhilosophY

DiseaseRegionalCounty Health

DeptInter-churchNGDOs

AppropriateTech.

RegionalTrainersOV Coordinator

Principles of CDTICountyPayamAdmin.ChiefsEducationlYouth

AppropriateTech

County TraineesBasics of the disease

TreatmentSide Effects

CommunityVHCs (ViilagehealthCommittees)Students

79

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Appendix I

Alrican Prograrttttte titr Ortcitoccrciasis Corttrol (APOC)Proqranrnre africain dc lLltte contre ['onchocercose

JOINT ACTION FORUIvI

Office of the Chairrnan

JAF'-FAC FORUM D'ACTION COMlvl UNE

Bureau du Pr6sident

JOINT ACTION FORUIVI

l'.,ird sess^orr

Liveroool. 4-5 December 1997

JAF3/INF/DOC.8r^'^y\rl,

rll\ii. )LL

OCTOBER I997

APOC PROJECTS MONITOzuNG FORM

80

JAF3/INF/DOC 8

Pagc I

Bockgroutd. This document is a forrnat tbr Monrtoring CDTI projects. The background intbrntation or.r

Evaluatton and Monitoring tenns is explanatory, necessary to understand the process used in dcvelopin_umonitortng indicators. You may rvish to skip this section and refer drrectly to the Monitoring Forms if you arefanriliar ',vith the differences as rvell as gray areas betrveen the two terms.

Prograntnte evaluation otletttpts lo cletennine the cortgntetlce between petfornnttce (i.e., what occurretl)attd llte rtb,iet'lit,es (i.e. y'ltQt tt,o.s rrrnnnqp,l lo occtrr.l nrrrl ln irnlnto Iho gnlrn/cl nf n "^o-ifir, .ttt-^,',.' /.,11

pt'ogt'Qtttttt(ltic change.s.. outputs, elJeus, ancl intpacts). Programme evaluation focuses pnncipally, although notexclusively, on internal validity of the programme: did this programmc rvork in this setting, and did it producethe observed change?

One assumption in programme evaluation is that the model or theoretical basis of the intervention has beenconfirmed by previous evaluation research (in this case the TDR multi-country study).

There are three interrelated levels of the general characteristics of evaluation which are described rn table I

belorv:

Table I : General characteristics of levels of Evaluation

Ler.el

l. Process evaluarion: Programme Qualitl, AssuranceRevie*'

Selected general characteristics

Applies non experimental designs

Assesses operating procedures

Examines structure and process

Conducts observational analysis

Performs qual itative observations

Monitors efforts-activity

Reviews-audits data and records

Applies quasi-experimental and expcrimentaldesigns

Assesses behavioural impact

2. Programme evaluation: Effectit,eness Assessment

Uses non-random or random assignment

Emphasizes internal validity

Uses simple analysis and comparisons

Applics tested interventions

3. [:r'aluation resc:trclr Appl ies expcrimental designs

Uses randomization and controls

Tests hypothesis on bchaviour chanqc

Uses multivariate analyses

lmprovcs knorvlcdgc base

Is groundcd in thcory

asizcs intcrnal and cxtcrnal vllidr ty

.IAIT3/INF/DOC 8

Page 2

MONITORTNG

Definition: "Periotlic collectiott artcl atrolys'is of selected indicators to erruble ntonager:i to determine wltethet

key activities are being corriecl out as planned and are lnvhtg the expected effects on tlte target populaliott".Monitoring is herern considered as process evaluation.

Objectives of utorritoring CDTI projects.

(i) to provide t'eedback to the NOTF and the APOC management on CDTI implementation,(ii) to improve operational plans for CDTI,(iii) to assist the NOTF and APOC Management to identify strengths and weaknesses in CDTI

implementation and to apply if necessary corrective measures.

Scope of CDTI project fu[onitorirry

(i) Target area: CDTI specific project areas'

(ii) Faciliries:- Drug delrvery circuit (port to distrrct)- Involvement of the health services- Comn-runiry mobrlization- Collectron of rhe drug by the communir'- (cost covered by'the communlr\')- Trainrng of CBDs- Dtstributton of ivermecttn- Supervrsion- Reporting and leedback to communiry

(iii) Pers orr nc l:- NOTF personnel from central level to the communily- Health workers at various levels- Administrative officers at dislrict ievel (financial support to CDTI)- Community leaders- Communiry dtstributors

(w) Duration of ntonitorittg

Three options on the duration of monitoring are suggested below

for as long as project is funded from APOC Trust Fund (5 years).

as long as CDTI implemcntation is necessary (longer than 5 years).

fbr 3 years and discontinr-re monitoring if the project performance is considered as satisfactoryand rn addition the n-rediurn-term evaluation shows a similar lrend.

(i)( ii)(iii)

Indicalors

For tht'i)Lrrp()sc ol.ntonitoring CDTI pro1ects, the team identrfied and defined three categorres oIindicators namell,: eltect. output and input rndicators. Qr-restions rvere developed covering the three indicatorsas prese nted in thc Atrncxes below.

Definitiorts of rlte rlrrea indicators foltl[ottiroring

l. Effect indicators

Effects are defined as the knowledge, attitude, and behaviour/practice that result from the outputs82

JAF3/INF/DOC 8

Pagc 3

t .I . behaviorrt'/coveruge ( comniunity particrpatiort. coverage)

1.2. knowledge (Knorvledge of why taking ivermectin fbr many years is inrportant)

t 3 .skills ( appropnate skrlls developed by the actors in CDTI)

., n"+'..'+ i-rlinafrrrc

Outputs are immcdiate prodr.rcts and services produced by the programmc

2.1 . utilization o.f'sen,ice (acceptors/users, pro.;ect continuation, drop-outs. cost)2.2. clualitt, of CDTI service (management of cases, education, contacts. access to CDTIl

3. [nput indicators

lnputs are resources needed to carry out CD'fl activities

3.1 . persontrel. (manporver developed at vital levels for CDTI implementation)3 2. Logistics ( iunds. ivermectrn supply. transportation etc)

3.3.reporting (ararlabrlinoimatenalslorreportrns-notebooks.tbrms.summan'booksetc)

83

iAF3/tNF r)OC.8Pagc .1

iVI ONITO ITI \ ( ] IiORr\I (C] I{ ECK I, IST IIO II I{O Ti'I' I N E N I ONI'IO RI N G)

EFFECT INI)l(-r\TORS

Nuu.rt.t.r ot' target communities that decrded on the critena for CBDs selection, or on the pcrttlcl or

nretlrt'.I o t' cirug ciistribution/ Annual'lreatment Oblective (A'tO)

OUTPUT INI)I('ATOIIS

Nunri..'r ot'at-rrsk r r[[ages treated/ ATONunri.i'r trt'eligrble persons treated / ATOCost p.'r [)crson treated

Nunrt.t.r ot'target conrmunities rn rvhich CBD rs a part of or is supervrsed by the pnnlary healtl'r carc

systeru \TO

Numtrr ot' target communities s'hich received

ivernrcit irr treatment iATOhealth education about importance of extended

TNPUT INDT(..\TORS

NumL'cr' (rt target communities u'tth trained CBDs /ATONumL's: trf communitres that erperienced late supply or shortage of ivermectin/ATO

Numrc: oi target conlmunlties rvhtch collected ivermectin fiom the health centreIATO

\urr,l.': ot' irealei commuilllles sirh surnman tonns -l'TO

Numci: oi health cenlres u'tth records -\TO

84

JAF3iINF/DOC 8

Page 5

vroNrroRING FORI{ (CHECKLIST FOR INDEPENDENT MONITORS)

Independent monitors ',vill be required to use elaborate social science methods to address these indicators

in addition to others they may select and submit a comprehensive report to APOC.

EFFECT INDTCATORS

Nu'tt_..'- rc t::-3,.- :omnrunitres rvl.i.|., decid"d the period s1 msthnd oI trextment

Number of target communities that decided on the criteria for CBDs selection

OUTPUT INDTCATORS

Number of refusals two months after drstributionNumber of eligible persons that dropped-out of the fteatment due to cost (Cameroon), side-etfects,

feeling of well-being (all countries). (From year 2)

Number of at-risk villages lreatedCost per person treated

Number of communities where CBDs were changed by the communiry after the first treatment

Number of target communities in which the CBD is a part of or is supen'ised by the primary health care

systemNumber oi targel communities rvhich received health education about tmportance oI ertended

lverrnectin treStment

Number of children 5 vears and above u'ho recetved lvermecttn

TNPUT INDICATORS

Number of target communities with lrained CBDsNumber of communities/ projects that experienced late supply or shortage of ivermectinNumber of pro.lects rvhich experienced late supply of funds

Number of target communities which collected ivermectin from the heaith centre

Number of CBDs rvith measuring device for heightNumber of treated communities with summary formsNumber of health centres without records

85

JOIN'f ACTION FORUMOf tlce ol the Chairman

iOINT ACTION FORUIvIThird session

Af'rican I)rograntntc titr Onchocerciasis Control (APOC)[)r'ograrr.rnrc alricain rlc lutte cor]tre I'onchocercose

JAF-FAC

APOC PROJECTS EVALUATION FOfuVI

F'ORUNI D'ACTION COMIVIU NE

Bureau du Pr6sident

JAF3/INF/DOC.7ORIGINAL:ENGLISHOCTOBER 1997

86

WORLD HEALTH ORGANZATIONAFRICAN REGION

ORGANISATION MONDIALE DE LA SANTE

REGION DE L'AFRIQUE

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC)

PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE

B.P. 549 OUAGADOUGOU, Burkina Faso T6169r': ONCHO OUAGADOUGOU

Tel-.. (226)30 23 01 -1[23 12- 30 23 13 Telex: ONCHO 5241 BF Fax (226\3021 47

APOC PROJECTS EVALUATION FORM

EVALUATIoNoFcoMMUNITYDIRECTEDTREATMENTWITHIVERMECTIN(cDTl) PROJECTS

please complete this form by providing detailed answers to all of the question: b"l9Y: You are required to give the

exact figures and where n""Li.rry a Jescriptive explanation. The programme's actjvities will eventually be

evalua6d against sustainability and coverage indicators'

THE EVALUATION FORM HAS FIVE SECTIONS: please complete allsections'

For each approved project a separate evaruation form should be completed. Please return the completed copy(ies)

to APOC Headquarters in Ouagadougou'

Country State Region

Project Phase Project Code Period being evaluated

Form completed and endorsed bY

DateSignatureNational Onchocerciasis coordinator [Mrs] tMsl [Md [Dr]

e-mailFaxPhone

DateSignatureNOTF Chairperson/chairman [Mrs] [Ms] tMr] tDrl

e-mail:Fax:Phone

87

PART I PROJECT PROFILE AND MANAGEMENT

1. Project Profile

2. Management RePorting SYstem

. please, list the principal activities of the project carried out during the period being

evaluated:

Are activities being carried out according to the plans of NOTF and on schedule?

lf not please, state the major constraint(s) experienced

o

a

anization in the project dr€? (name & number)administrative org

Number of target communitiesNumber of communities

Population of target communitiesPopulation of communities

Major constraints

88

Solutions

o Were record forms from the prolect area accurate and completed on time?

Expected report forms(S'l ) Received record forms(52) Form reporting rate e6) (S3)53 = (S2:S1)x 100

Report forms co,mPletelY filled

Report forms PartiallY filled

Report forms received on time

Report forms not received on time

3. Administrative and Financial Management of the CDTI project

Please attached the twelve month financial report

. Which is the month of the last statement received from the bank?

o Which is the month of the last bank reconciliation in the accounts of the project?

. Have any of the accounts been audited?

. lf yes, give the date

. Are the NOTF accounts being operated to the satisfaction of the NOTF?

. Have there been any complaints or financial irregularities?

. Give the exact amount and date the Trust Fund money was last credited into NOTF

account. Amount credited (US $). Date:

. Did the date of receipt of Trust Fund money meet your expectation?

. Did the NOTF experience any administrative problem(s) with the bank?

. lf yes, state succinctly the problem(s)

What should be done to avoid the problem (if any) in future bank transactions?

89

Are the financial reports from the zones/ProvincesiRegionsiDistricts(s)/LGAs received

on time at the NOTF Headquarters?

lf not, state succinctly the reason(s )

o

a

4. Support from National Authorities

(state which level of government provided an assistance)

What action has the government (Federal/National. Regional. State District, LGA) taken in

support of the project since its inception on

. Personnel needs for CDTI operations

Transportation needs (in the current phase only)o

a Accommodation needs (e.g. buildings provided by government, be specific)

a lndicate any other type of support from the government

90

t

5. Effectiveness of communication

please indicate (X) beside your response the type of communication frequently used in the current

year and which you found most efficient

APOC HQ andoffice ofNOTF HQ

NOTF HQ &office of chairmanNGDO coalition

NOTF HA &Zonal or Regionaloffices

Zonal /Regionaloffices DistricULGAoffice ofthe coordiriator

DistricULGAoffice of thecoordinator &

community leader

Type ofCommunication

Effective Noteffective

Effective Noteffective

Effective Noteffective

Eff ective Noteffectrve

Effective Notef fectrve

Radio

Telephone

Fax

lnternet (E-Mail)

Courier

Ordinary mail

Messenger

Any suggestions to improve communication for better management of the project?Please indicate

9l

WORLD HEALTH ORGANZATIONAFRICAN REGION

ORGANISATION MONDIALE DE LA SANTEREGION DE L'AFRIQUE

1

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC)PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE

B P. 549 OUAGADOUGOU, Burkina Faso Telegr.: ONCHO OUAGADOUGOU

Tel. (226) 30 23 01 - 9 23 12 - 30 23 1 3 Telcx: ONCHO 5241 BF Fax. (226) N 21 47

APOC PROJECTS EVALUATION FORM - Project Code

EVALUATTON OF COMMUNTTY DTRECTED TREATMENT WITH IVERMECTTN (CDTI) PROJECTS

PART II IVERMECTIN PROCUREMENT, DELIVERY SYSTEM AND DISTRIBUTION

Procurement and movement from the Mectizan Donation to the national store house

What date was the order to Mectizan Donation Program made by the NOTF?

On Which date did the drug arrive at the port?

On which date was the clearance from port completed and drug taken to central store house?

Who cleared the drug from the port? (Check below)

Does the Govemment accord an exemption from taxes and customs duties?

Did the MOH or partner /WHO pay any fees/charges for drug procurement from port of entry?

a lf yes, how much US $ to whom were the fees/charges paid?

Any other problem(s) in connection with the movement of the drug from Mectizan DonationProgram to the store house? Please indicate

o

O

O

o

o

a

Office of the NGDO partner WHO

NOTF Secretariat Ministry of Health (MOH)

Others Please specify

92

a

2 Delivery and Distribution of ivermectin from national store house to the community

2.1 Movement of IVERMECTIN from national store house to the community

What is the average (state minimum and maximum) time it takes for the drug to arrive

a Any special problem(s) in connection with the movement of the drug from the national store

house to the community? Please indicate

Problems Steps taken to deal with the problems

Distribution of IVERMECTIN

What is the average (state the minimum and maximum) time taken by most communities for

drug distribution

Time [Hours, days]

Average Minimum Maximum

a Any special problem(s) in connection with distribution at communi$ level? Please indicate

Problems Steps taken to deal with the problems

2.2

a

from national store house to Averagetime

Minimum time Maximum time

Regional/Province/Zonal store

DistricULGA store

Central Drug collection point (health racilitv

nearest to the communitY)

Time [Hours, Days]

From arrival of drug at the district untilit gets to the communitY

93

I

lf several other sfeps more than stated below are involved, please specify

94

WORLD HEALTH ORGANIZATIONAFRICAN REGION

ORGANISATION MONDIALE DE LA SANTEREGION DE L'AFRIQUE

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC)PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE

B.P. 549 OUAGADOUGOU, Burkina Faso Telegr.: ONCHO OUAGADOUGOU

Tel..: (226) 30 23 01 -{23 12 - 30 23 13 Telex: ONCHO 5241 BF Far (226)3o21 47

APOC PROJECTS EVALUATION FORM- Project Code:

EVALUATION OF COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (CDTI) PROJECTS

PART III CAPACITY OF THE NOTF/ONCHO COORDINATORS/SUPPORTS STAFFAND THE PHC SYSTEM

Please provide below information on the size of the NOTF (full and part-time staff) by giving the numberand category of staff involved in CDTI at:

Fulltime Part-time

Level Category of staff Number Category of staff Number

Central

RegionalZonal

DistricVLocal G overn m ent

Community

95

o How many different categories of personnel lptease srate number in each category) are involvedin the training of.

Government Staff NGDO Staff

Activity Category Numberby category

Category Number bycategory

Communitydirecteddistributors(cDD)

DistricVLGAcoordinators

Healthpersonnelinvolved in CDTI

Healtheducation andinformation tocommunity

I

a

a Please provide below information

- days CDDs were trained in all project communities (averase, minimum, maximum)

tr Average number of training days o Minimum... ...... o Maximum

- Total number of CDDs trained: o Female o Male

- Number of trained CDDs still on job o Female r Male

Number and proportion of the health staff at the districULGA levels involved in theproject with:

Number of health staff Proportion

Training the community directed distributors

Supervision of ivermectin distribution

Management of severe adverse reactions

How many of the CDDs are health workers?a

96

I

./ORLD H EALTH ORGANIZATION.

AFRICAN REGION

ORGANISATION MONDIALE DE LA SANTEREGION DE L'AFRIQUE

AFRICAN PROGRAMI\4E FOR ONCHOCERCIASIS CONTROL (APOC)

PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSEB.P. 549 OUAGADOUGOU, Burkina Faso Til6gr.. ONCHO OUAGADOUGOU

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APOC PROJECTS EVALUATION FORM - Project Code

EVALUATION OF COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (CDTI) PROJf CTS

PART IV PERFORMANCE INDICATORS

1. lndicators of SustainabilitY

1.1. Commitment of the Partners

o lndicate in US dollars using current United Nations exchange rate to local currency,

amount and percentage share of all costs being provided by:

o lndicate in kind contribution of Communities

1.2. Communityinvolvement

State the number of target endemic communities under evaluation involved in

. procurement and collection of IVERMECTIN from centralpoint:..

o reporting cases of severe adverse reactions:.

o referral of cases of severe adverse reactions:.

97

Budgeted Released

A,mount($ US) otlo Amount ($ US) otto

The Ministry of Health (MOH)

The local NGO(s)

The NGDO partner(s)

APOC Trust Fund

Districl/LGA

Total

1.3 lntegration into health service

State activities under drug procurement and delivery which are being carried out by healthpersonnel in the project area:

State the number of target endemic communities in wfrich the CDD is

Number of targetendemic communities

parUstaff of the health delivery system

supeMsed by the primary health care personnel

State the number of target endemic communities in wl^rich supervision is done by PrimaryHealth Care personnel

Number of targetendemic communities

SupeMsion is done by PHC personnel

1.4. A Round Treatment Estimated Cost

lndicate in US dollars using the current United Nations exchange rate to local currency, costof:

a

a

Estimated cost ($ US)

Drug delivery from port of entry to central collection point

Training CDDs

Supervising CDDs

Monitoring CDTI

Total (T1)

98

a

z Ref usal/absentees

2.1. Refusals

Please state

Number

Number of communities in the districUlGA where cases of refusal have been recorded

number of people who refused treatment in this phase lrzy

Average number of refusals per community

State the three frequent reasons for refusals

How did the NOTF deal wrth the problem of refusals lrorp€riodbeinsevatuated)?

2.2. Absenteeism

What is Number

the number of communities in the districts (LGA) where absenteeism is the main reasonfor not receiving treatment?

Total number of people who were absent from their treatment areas during this phase 6rs1

average number of absentees per communi\p

Please state, howdid the NOTF deal wth the problem of absenteeism (rorperiodbeinsevaruated) ?

99

Number of targeted

CDTI communities treated with IVERMECTIN

CDTI communities not treated with IVERMECTIN

Population in the CDTI communities (A)

Eligible persons not treated (for one of the following reasons)

- pregnancy (cl)

- breastfeeding 1cz1

- sickness 1cs1

Total Population not treated (B) = (cl + c2 + 63 + fl + T3)

Total Population treated (T41 = 4 - t

3. lndicators of coverage of CDTI

Please indicate below the number of targeted

a

4.

a

a

o

Reporting/Management of cases of severe adverse reaction

Have you had reporting of severe adverse reactions during the period under

evaluation? .....

lf yes, is the NOTF satisfied with the reporting of cases of severe adverse reactions?

Please indicate who reported cases of severe adverse reactions (multiplechoice) ?

o Communities a Community Distributors a Health staff

ls the NOTF satisfied with the management of cases of adverse reactions in the project

arca?.

D lf yes, what are the major causes of satisfaction?

o lf not, what are the major problems and how is the NOTF addressing them?

a

r00

5

a

Local Operational Research

Are you conducting any operational research in the current reporting period?

a lf yes, please give the title of the project and the districulcA vr,trere the operationalresearch study is being conducted.

ll

DistricULGA

a Please state one or two reasons for the choice of the topic of research

6. Local effort to evaluate integration and coverage of the CDTI Project

O Are there plans (local efforts) to evaluate the integration of CDTI into health caresystem?

a Are the communities leaders participating in the projet integration or in theimprovement of coverage ? lf yes, list activities/decisions;....

a Are there planned activities to promote the involvement of women, school children andnon-literates in cDTl activities? lf yes indicate those activities:

a

a Please describe succinctly the any activities which could contribute to promote or tormprove coverage

r0l

PART V

Please write freely but succinctly on any aspects of the execution of this project that miglrt not

have been adequately covered in the preceding structured questionnaire.

a

t02