I

I

RESERVED FOR PROIECT LOGO/IIEADINGFinal Northwest Project

ORIGINAL : English

ANNUAL NOTF SECRETARIAT TECHNICAL REPORTTO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

To APOC Management by 31 Januarv for March TCC meeting

To APOC Management by 31 Julv for September TCC meeting

AFRICANPROGRAMME FORONCHOCERCTASTS CONTROL (APOC)

)

COUNTRY/: LIBERIA NOTFApproval vearz 1999Renortins Period (Month/Year): January 1r2006 December 31,2006

Proiectvearofthisrenort: (circle)l 2 3 4 (Q 6 7 8 9 l0lll2t3 t4

mitted:Date su

n 3 FFU ?tf{17

ANNUAL NOTF SECRETARIAT TECHNICAL REPORTTO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

ENDORSEMENT

Please confirm you have read this report by signing in theappropriate space.

OFFICERS to sign the report:

Country: Liberia

National Coordinator Name: Dr. H. Tudae Torboh

Signature: Dr. H. Tudae Torboh

Date: December 2006

NOTF ChairName: Dr. Moses Pewu

Signature: Dr. Moses Pewu

Date: December 2006

This report has been prepared by Name: Dr. H. Tudae Torboh

Designation: APOC

Signature: Dr. H. Tudae Torboh

Date: December 2006

I WHO/APOC, 3 October2004

Definitions

(v)

(i) Total population: the total population living in meso/hyper-endemic communitieswithin the project area (based on REMO and census taking).

(ii) Eligible population: calculated as 84Yo of the total population in meso/hyper-endemic communities in the project area.

(iii) Annual Treatment Objective: (ATO): the estimated number of persons living inmeso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in agiven year.

(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people tobe treated annually in mesoftryper endemic areas within the project area,ultimately to be reached when the project has reached full geographic coverage(normally the project should be expected to reach the UTG at the end of the 3'd

year ofthe project).

Therapeutic coveraqe: number of people treated in a given year over the totalpopulation (this should be expressed as a percentage).

(vi) Geogaphical coverage: number of communities treated in a given year over thetotal number of meso/hyper-endemic communities as identified by REMO in theproject area (this should be expressed as a percentage).

(vii) Integration: The bringing together of two or more health programs, removingbarriers between/among them, in order to maximise cost-effectiveness and permitfree and equal association. For example delivering additional health interventions(i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.)through CDTI (using the same systems, training, supervision and personnel) inorder to maximise cost-effectiveness and empower communities to solve more oftheir health problems. This does not include activities or interventions carried outby community distributors outside of CDTI.

(viii) Sustainability: CDTI activities in an area are sustainable when they continue tofunction effectively for the foreseeable future, with high treatment coverage,integrated into the available healthcare service, with strong community ownership,using resources mobilised by the community and the government.

iii WHO/APOC, 10 April2003

FOLLOW UP ON TCC RECOMMENDATIONS

Using the table below, fill in the recommendations of the last TCC on the project and describehow they have been addressed.

TCC session

(Please add more rows if necessary)

Number ofRecommendationin the Report

TCCRECOMMENDATION

ACTIONS TAKEN BYTHE NOTF

SECRETARIAT

FOR TCAAPOCMGT USE ONLY

Joint mission visitrepresentative of TCC,

APOC Management

Mission visited LiberiaMay 22-26,2006

')

To avoid repeated datamistakes

Total population and UTGadopted 2006

)Obtain a simplified

reporting form

Received simplified form inDecember 2006

1V WHO/APOC, l0 April2003

I

Executive Summary

Prepare an Execufive summary of the report in not more than one page,

L Summary of treatment and population data comparing projects, trends in treatmentover time i.e.- Total number of communities, communities' treated, total population,UTG, ATO and persons treated.

2. Summary of training data of projects (nationally) for:- Project Officer (training of trainers and/or other specific training), totd number

of CDDs and health workers trained, total population per active CDD trained.

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

4. Strengths and weaknesses of the national onchocerciasis control program; challengesand how they were overcome; and opportunities that will strengthen the program.

5. Key activities undertaken by the NOTF during this reporting period.

6. Progress on vector elimination activities (where applicable)

v WHO/APOC, l0 April2003

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

From available estimated data of 1,252,588 people infected in the entire project area withOnchocerciasis, a total number 826,004 persons were treated in2l56 communities.

During the reporting period under review, two training sessions for the County Health Teams (CHTs)were held. The training sessions took place in Gbarnga, Bong County. A Total of 75 CHTs fromthe fifteen counties attended the training sessions. The project also conducted two training sessions forOfficers-in-Charge (OICs) of Bong, Lofa, Nimba, Montserrado and Gbarpolu counties. A total ofll5 OICs were trained in this training workshops. A total of 12,537 CDDs were trained by theOICs.

Beneficiaries within the target communities were mobilized and all did receive health education regardingthe disease Onchocerciasis. The communities received health education on River blindness by means ofusing health education kit containing posters, CDD brochures, measuring device and mectizan tablets. Theselected CDDs by the communities were all trained by thel l5 Officers-in-Charge (OICs) within their areas.

The Ministry of Health and Social Welfare of Liberia, Sight Saver Intemational (SSI) and the ChristianHealth Association of Liberia (CHAL) provided moral, logistics, financial and technical support for theimplementation of the project. The financial and logistical support from APOC cannot beoveremphasized. Financial contribution by the NGO, SSI has been very minimal. E.G. in 2006.

The annual training of trainers (TOTs) has been stepped upwards with the establishment of more healthfacilities in the five counties. Many health NGOs partners have set-up health posts and centers within thefifteen counties with new health workers that need training. When these new health workers are trained andincorporated into the project activities, it will go a long way in the process of monitoring and supervision.This endeavor will aid the project for better therapeutic coverage in the year 2007. The willingness of thecommunities to take ownership of the program as manifested by their compliance to annual treatment,collection of their tablets from the agreed points of collection and their minimum support for their selectedCDDs can be mentioned as strengths within the project.

The major constraint encountered by the project is the inability of all beneficiaries to contribute for thesupport of the CDDs. Many community dwellers especially those residing in Lofa County are just trying toput their lives back together after the 14 years of civil upheaval. These rural dwellers themselves need tobe motivated, hence their ability to motivate the CDDs chosen by them is an issue that has been handed toan appreciable level.

Challenges:

Inaccessibility ofaffected areas due to bad roadsInadequate OICS to carry out CDTI activitiesDemand by CDDs for financial compensation from NOTF

The logistical challenge has largely been handle by the provision of motorbike by APOC to facilitate travelof OICs to train the CDDs in their various localities.

Regular visits to communities to explain and assure them that CDTI was own by them and they shouldtherefore be encourage to support their appointed CDDs.

SECTION 1: Background information

l.)J.

6

1.1. Generalinformation

WHO/APOC, 26 September 2003

1.f.1. Description of the country program -CDTI and vector elimination (briefly)

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

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

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

In Liberia, there are three (3) major projects, Northwest: Lofa, Bong, Montserrado, Gbarpoluand Nimba. Southwest: Grand Cape Mount, Bomi, Margibi, and Grand Bassa, Southeast:River Gee, Grand Gedeh, Maryland, Grand Kru and Sinoe. From the available data (1999) thepopulation infected is estimated at263,832 people and the population at high risk ofcontracting onchocerciasis at l,l 13,213 people.

In the project areas, there are enough health facility run by MOH or NGO, the entire center isdecentralized. The heath system and health care delivery is run by capable CHTs, OICs andother health personnel (see map provided).

1.1.2. Partnership

Indicate the partners involved in project implementation at all levels (MOH,NGDOs -national, international)Describe overall working relationship urmong partners, clearly indicating specificareas of project activities where all partners are involved (planning, supervision,advocacy, resources mobilization, endemicity mapping / assessment, developmentof IEC materials, studies or surveys etc).State plans if any to solve any issues arising as regards CDTI implementrtion.

Our partners are MOH, WHO, NGDO (SSI) working relation between WHO and MOH arecordial. The relationship between NOTF is strain. The Country Representation of SSInormally wants to take over of the work of the National Coordinator thereby pretending to doallthe work.

The Representative carry out her own advocacy, planning, monitoring and supervision incertain CDTI project areas such as Southwest, but never present any result to NOTF. There islittle or no financial support from SSI.

7 WHO/APOC, l0 April2003

Name of CDTIProiect

Total communitiesin meso/hyper-endemic zone

Total population inmeso/hyper-endemic

zone

Ultimate TreatmentGoal (UTG) by 2010

Northwest 787 569,245

Southwest 847 415,560

Southeast 522 267,783

TOTAL 2,156 1,252,599

L.2, Population and Health system

Table l: Projects and population at risk in the entire country whether they are treated or notduring the reporting period. (Please add more rows if necessary)

Source: From Oncho Project reports: National census: Other source,specify 2 Year ofsource:

UTG: Calculated as the maximum number of people to be treated annually in meso/hyperendemic areas within the project area, ultimately to be reached when the projeci has reached fullgePgraphic coverage (normally the project should be expected to reach the UTG at the end of the3'd year of the project).

SECTION 2: Summary of CDTI lmplementation

2.1. Distributionperiod

Chart the actual distribution period for each CDTI Project in the country in the table below

Overview of distribution undertaken rows as

Briefly note any problems/issues (one paragraph)

8

{

Distribution PeriodProjectName Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec

SW Training Training sup Sup. Sup. Distr Distr Distr Coll.Rep

Coll.Rep.

RepWrit

RepWritr Training Training S,rp sup. sup. Distr Distr Distr Coll.

RepColl.Rep

RepWrit

RepWrit

Training Training Sup. Sup Sup. Distr Distr Distr Coll.Rep

Coll.Rep

RepWrit

RepWrit

WHO/APOC, l0 April2003

2.2. Advocacy and Sensitization

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

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

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

Advocacy is carry out by the National Coordinator to the decision makers such as theSuperintendent, chiefs and elders in the various county and communities. This hasresulted into willingness of the community to accept CDTI implementation and CDDsoffer voluntary services as mentioned before. The constraints were the demand ofcompensation by CDDs, but by constant appealand educating them on the ownershipof CDTI project, they gradually understood and accepted the project.

The intervention of these political leaders result to voluntary rendering CDTI services

To plan to improve advocacy through the work of other health workers.

2,3. Information, Education and communication strategy and materials development

Briefly describe the IEC strategy being used in the country for CDTI.

Note if any new IEC materials were developed or revised, the type of the material, themessage and target audience, and where they were distributed.- How were the IEC materials developed ?- Are the materials reviewed to address upcoming issues (like decreasing refusals,

sustainability, maintaining compliance to long-term treatment, SAEs)?- Report if any KAP surveys have been done and how their results were used?

Beneficiaries within the target communities were mobilized and all did receive health educationregarding the disease Onchocerciasis. The communities received health education on Riverblindness by means of using health education kit containing posters, COO brochures, measuring,device and mectizan tablets. The selected COs by the communities were all trained by the ll5Officers-in-Charge (OICs) within their areas.

Summarize information on:- The use of appropriate and innovative media and/or other strategies to disseminate

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

2,4. Communities' involvementin decision-making

Comment on community participation making comparisons among projects- Participation of female and youth members of the community at health education

meetings;

9 WHO/APOC, l0 April2003

In general, how do you rate the participation of minority groups and female members incommunity meetings, decision-making, (attendance, participation in the discussion etc.)other issues.

2.5. Capacity building

Training of national, district level staff in CDTI and general management skills(computer applications, project planning, etc.)

Briefly describe any training done by the NOTF for specific CDTI or Vector Control Projects(Objectives, participants, outcomes, any follow-up needed).

The annual training of trainers (TOTs) has been reviewed upwards with the establishment of morehealth facilities in the five counties. Many health NGOs partners have set-up health posts andcenters within the five counties with health workers that need training. When these new healthworkers are trained and incorporated into the project activities, it will go a long way in the processof monitoring and supervision. This endeavor will aid the project for better therapeutic coveragein the year 2007. The willingness of the communities to take ownership of the program asmanifested by their compliance to annual treatment, collection of their tablets from the agreedpoints of collection and their minimum support for their selected CDDs can be mentioned asstrengths within the project.

Table 3: Type of training undertaken at national level by the GTNONOTF(Tick the boxes where specific training was carried out during the reporting period)

Type of training Projectstaff

MOH staff OpinionLeaders

Others(speci&)

Programmanagement ^/

./

How to conductHealth education ^/ ^/

OtCs

Management ofSAEs ^/

./ OICs

CSM

SHM

Data collection ./ OICs, COS &CDDs

Data analysis ./ ./

Report writing ./ NC, CHO & OICs

Others (speciff)

l0 WHO/APOC, l0 April2003

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

2,7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF'dealing with them?

2.7.3. Briefly describe all known and verified serious adverse events (SAEs) andprovide in table 7 the required information when available.

2.7.4, In case the country has had no case of serious adverse event (SAE) during thisreporting period, please tick in the box.

No case to report

Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period'lease add more rows

* SAEs should be verified by project coordinator

Sequelea is detined as those cases that have not recoveredfully from the SAE and are leftwith lasting neurological or other debililating effects.

{

Name of project Number ofverified* SAEcases reported

Action taken Number ofcases withsequelea

Number ofdeaths

t4 WHO/APOC, l0April2003

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2.8. Superuision

2.8,1 Note the supervision that was undertaken by the NOTF (Project supervised, date,by whom, objective of supervision mission, outcome, follow-up needed)

sion undertaken the NOTF lease add more rows

2.8.1. What were the main issues identified during supervision?

Lacks of means of transportation, CDDs walk long distances, therefore motorbikes andbicycles are needed.

2.8.2, Was a standard supervision checklist used?

Better means of transport needed

2.8.3. What were the outcomes at each level of CDTI implementation supervised?

2.8.4. Was feed-back given to the supervised, and how was the feedback used inimproving the overall performance of the project?

Complains were answered by National Coordinator based on information from the workshopteam.

Project Name Supervisor Date Objective ofsupervision

Outcome/follow-upneeded

Northwest Nat. Cord. &ProjectManager

May 5-62006

Zorzor &Voinjama

Using checklist toexamine andcorrect all ledgersofrecords onproject areas

Records correctedwhen necessary andmonitoring carry out

Southeast Nat. Cord. &ProjectManagerMr. GaowehCHAL

May 6-72006

Zwedru

Using checklist toexamine andcorrect all ledgersofrecords onproiect areas

Records correctedwhen necessary andmonitoring carry out

Southwest Nat. Cord. &ProjectManagerRev. Jorgboh

May 7-82006

KakataMargibi

Using checklist toexamine andcorrect all ledgersofrecords onproiect areas

Records correctedwhen necessary and

monitoring carry out

t6 WHO/APOC, l0April2003

2.9. Community self-monitoring and Stakeholders Meeting

Table l0: Community self-monitoring and Stakeholders Meeting (Please add more rows if

Describe how the results of theaffected project implementationcycle.

community self- monitoring andor how they would be utilized

stakeholders meetings haveduring the next treaftnent

2.10 Compliance to long-term treatment with Ivermectin

Mention specific activities in the Table ll that the NOTF has done to ensure that CDTIprojects comply with long-term mass treatment with ivermectin? (For projects 4 and aboveyears old)

Table I l: Activities of that promote compliance to long-term treatment with ivermectin

Objective Specific Activities Project targetedl. Promote Integration of CDTIwith other health care services

Southwest CDTI I't year

2. Maintain high therapeutic(> 65%) and geo graphic( I 00%)

3. Promote strong communityqu4ryrship

4. Promote high governmentcommitnent5. Support strong partnership

6. Put in place a strong IECstrategy that encouragescontinued treatment

Southwest CDTI I't year

Other

SECTION 3: Other activities of the NOTF

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

It has been any vector elimination in any of the project area.

3.2 What was done to coordinate CDTI Project activities?

l. CDTI activities are coordinated to PHC System

Project Name Total # of LGAs ordistricts in the entire

project area

No. and % of LGAs ordistricts that canied outself monitoring (CSlt)

No. and % of LGAs ordistricts that conducted

stakeholders meeting(sHIvr)

TOTAL

t7 WHO/APOC, l0 April 2003

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2. Encouraged OICs to include Oncho among their daily/weekly health education talks at theclinics

3. Ensured that all communities/clinics display a CDTI poster and understand it

Note meetings convened for the NOTF. (objective of meeting, issuesaddressed, date, participants, outcome, constraints faced follow-upneeded)

Note meetings attended to provide technical input to other projects, othercountries, or other sectors.

Held meetings with the Mano River Union countries, Sierra Leone and Guinea to encouragesimultaneous border treatment for enhanced control

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

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

3.7 Insert the Plan of Action for next year

3.3

3.4

18 WHO/APOC, 10 April2003

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If there are problems with release of counterpart funds, how were they addressed?- Comments

State the number of projects that had no funding from APOC Trust Fund? N/AState the number of projects that had no funding from any outside source? N/A

State the number of projects that are late in submission of the financial reports toAPOC? N/A

4.2. Other forms of community support

- Describe (indicate forms of in-kind contributions of communities if any) N/A

4.3. Resourcemobilizationefforts

Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and theoutcome of those efforts.

Adwocacy with the Committee on Health at the National Legislature (Parliament). As a resultUS$20,000 was allocated in the national budget for CDTI implementation.

4.4. Expenditure per activity by the NOTF secretariat

- Indicate the expenditure on activities below in US dollars using the current United Nations exchangerate to local currency

Table l3: Indicate how much the NOTF secretariat project spent for each activity listed below during the

Comments: The frrll amount approved by the management of APOC and GOL for theimplementation of the project was not disbursed to the project.

Activity of NOTF secretariatExpenditure ($ US) and

Source(s) of fundingAPOC MOH NGDO OTHER

300.00

300.00

Drug delivery from NOTF HQ/entrypqiqt to projects, districts, etcMonitoring and supervision of CDTIProjectsTraining of Project officers, TOT,NOTF staff, etc.Advocacy visits to health and politicalauthorities at national level

15,755.00

1,500.00

100.00

302.00IEC KAP studies, materialsdevelopment,

Annual review workshops

Bi annual NOTF meetings

Fuel and maintenance of Vehicles, 1,110.00

Maintenance of office equipment 250.00

Stationery

Others (JAF MRU Meeting) 17,958.00 1,096.00 9,148.00

TOTAL 36,573.00 2,098.00 9,148.00 -0-

Total number of persons treated 316,210

21 WHO/APOC, l0 April2003

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Source

Type ofEquipment

APOC MOH Otherdonors

NGDO Private

Condition of the equipment * Please state

1. Vehicle 2 functional2. Motor cycle 5 functional3. Computers I functional4. Printers I functional5. Fax Machines

6. Othersa) Air conditioner 1 functionalb)c)

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4.5. Equipment

Status of ofNOTF Secretariat add more rows ne

*Condition of the equipment (Functional, Currently non-functional but repairable, Written off).

How does the project intend to maintain and replace existing equipment and other materials?

- Describe the adequacy of available knowledgeable manpower at all levels.

- rMhere frequent transfers of trained staff occur, state what project is doing or intends to do to remedythe situation (The most importont issue is what measures were taken to ensure adequate CDTIimplementation where not enough lvtowledgeable manpower was available or staff often transferredduring the course of the campaign).

Budget allocation has been made for the maintenance and repairs of the equipment. Negotiation is goingon with GOL for the replacement of existing equipment and other materials.

22 WHO/APOC, l0 April2003

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5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3)

What arangements have been made to sustain CDTI after APOC funding ceases in terms of :

5.2.7. Planning at all relevant levels.

5.2.2. Funds

5.2.3. Transport and equipment (replacement and maintenance)

5.2.4. Human resources

5.2.5. Which projects have submitted sustainability plan?

5.2.6. To what extent have the plans been implemented?

5.3. Integration

Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration.

5.3.1. Ivermectin delivery mechanisms

5.3.2. Training

5.3.3. Joint supervision and monitoring with other programs

5.3.4. Release of funds

5.3.5. Is CDTI included in the PHC budget?

5.3.6. Describe other health programmes that are using the CDTI structure and how this wasachieved. What have been the achievements?

5.3.7. Describe other issues considered in the integration of CDTI

5.3.8. Describe the integration of other programs into CDTI in your country and the results ofthis integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are theresults, is screening for cataract of primary eye care interventions integrated in all or someprojects, if no integration has taken place, are there plans to pilot test a stratery, etc?)

Yes there are plans to pilot integrating eye care in2007

5.4 Operational research

5.4.1. Summarize in half of a page the operational research undertaken in the country areawithin the reporting period.

None

5.4.2. How were the results applied in the project?

a

,

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25 WHO/APOC, l0April2003

I

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

SECTION 6: Strengths, weaknesses, challenges and opportunities

List the strengths, weaknesses, opportunities and threats of CDTI implementation process.

List the strengths, weaknesses, opportunities and threats of the vector elimination project (whereapplicable).

fndicate how challenges were addressed.

Indicate how opportunities can be utilized to improve CDTI.

\

26 WHO/APOC, l0 April 2003

I