APOC PHILOSOPHY AND COMMUNITY.DIRECTED

NATTONAL ONGHOCERCTASTS TASK FORCE (NOTF) OF LIBER|A AFRTCAN PRGRAMME FOR ONCHOCERCTASTS CONTROL (APOC)

APOC PHILOSOPHY AND COMMUNITY.DIRECTED

TREATMENT W|TH TVERMECTTN (cDTl)

22

-

26 May 2006 Monrovia, Liberia

28 May 2006

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LIST OF FACILITATORS

Ms. Peace Habomugisha Country Representative The Carter Center Uganda

P. O. Box 12027, Kampala Uganda Tel.: (256-41) -251025

e-m ai l : vrbprg@utlanlltne. co.uq Mrs.

Ogbu

Pearce Acting National Coordinator

National Onchocerciasis Task Force Ministry of Health, Abuja

Tel (234) 80 3 5 6 1 3104 t 09

5237049

e-mail: peie2004@vahoo.com

Dr. Uche Enyinnaya Project Administrator The Carter Center Nigeria

lmo/Abia Project

Plot R60 High Court road Owerri, lmo State

Tel(234) 080347 18708

i

⁰⁸³²³¹ 090 e-mail: enviuche2003@vahoo. com

Dr. Atabe Andrew Project Officer

Sight Savers lnternational B.P. 4484, Yaounde, Cameroon Tel (237) 767 2729 I 221 1233

e-mail:

atabe

andv@vahoo.co.uk / aatabe@ssi-cameroon.org

Dr. Bolay Fotrama WCO/DPC

WHO/Liberia Tel (231) 6513040

e-mail: bolavf@lr. afro.who. int Dr. H. TudaeTorboh National Coordionator

National Onchocerciasis Task Force Secretariat Monrovia, Liberia

P.O. Box 10

-

⁹⁰⁰⁹

Tel (231) 6s 51 e41

Mrs. Verda L. Tarpeh Country Representative

Sight Savers lnternational, Liberia NDS Building, JFK Compound P.O. Box 20-4760

Sinkor, 1000 Monrovia 20, Liberia Tel (231)

6

526

U2

a mail. aailihariaAnacamail aam rrarrla fri\hnfmail nam g-l _I tqll. 99lllv9l lq\wl lqggl I lqll.v9l I rr Yvl vs l\wl lvrl I ls.r.vvr I I

Dr. [t/lounkaila Noma Chief of Epidemiology and Vector Elimination

African Programme for Onchocerciasis Control (APOC) Bp. 549 Ouaga 01, Ouagadougou, Burkina Faso Tet (226) 50 34 29 53 t 50 34 29 60

e-mail: nomam@oncho.oms. ^bf, noma562000 tOvahoo.com

TABLE OF CONTENTS

LlsT oF FACTLTTATORS ...

TABLE OF CONTENTS ...

EXECUTIVE SUMMARY.

I.

INTRODUCTION

rv.

METHODOLOGY...

VIII.

IVERMECTIN PROCUREMENT

lx.

INTEGRATION OF COMMUNTTY-DIRECTED TREATMENT W|TH TVERMECTTN (CDT|) tN THE NATIONAL HEALTH SYSTEM

X.

ADMINISTRATION, BUDGETAND FINANCE...

XI.

^FIELD VISIT IN CDTI COMMUNITIES IN NORTH WEST AND SOUTH WEST IIBERIA...

XII.

TRAINING AND HEALTH EADUCATION ...

XIII.

^DATA COLLECTION, TRANSMISSION AND REPORTING

xlv.

susTArNAB|L|TY oF coMMUN|TY-DTRECTED TREATMENT WITH TVERMECTTN (CDTI)...

XV.

MONITORING AND EVALUATION OF APOC PROJECTS

xvr.

coNcLUStoNS...,...

ANNEX

l:

LIST OF PARTICIPANTS

ANNEX

ll:

AGENDA OF THE WORSKOP.

,2 .3

.4

.5 .b

10

ANNEX III:

ANNEX IV:

ANNEX V:

ANNEX VI:

RAPID EPIDEMILOGICAL MAPPING OF ONCHOCERCIASIS IN LIBERIA CHECK LIST FOR COMMUNITY VISIT...

MESSAGE CONCEPTS FOR RURAL MEN AND WOMEN

PRE/POST TEST ON APOC PHILOSOPHY AND CDTI STRATEGY

EXECUTIVE SUMMARY

A

workshop on APOC Philosophy and CDTI strategy was conducted in Monrovia, Liberia, trom ²²

to 26

May 2006 and was facilitated by APOC team, WHO country otfice

and

NOTF Liberia. lts objectives are:

. to

provide appropriate information

to

county CDTI implementers and national decision-makers on ^C om m un ity-d i rected treatment with ivermecti ⁿ

o to

harmonize and agree upon controlling Onchocerciasis as

a

^public health problem

in

Liberia through community own ivermectin distribution programme

o to

build capacity

and

strengthen

the

partnership among

the

stakeholders

in

Liberia

to

boost ivermectin treatment through a sustainable ivermectin distribution system.

The

team conducted

in

house lessons and also visited

two

randomly selected communities one

from

North West and one from South East CDTI project with all

the

participants. What come out clearly from this workshop ^is:

o

CDTI is not conducted properly

.

Community involvement in decision-making is minimum

.

No data to show activities underway on the ground

.

NOTF not to be playing its role well. There is lack of cooperation between NOTF members ^and this is likely to hinder CDTI activities

What is encouraging, however is community members are interested in the Programme and willing to continue taking ivermectin.

APOC Team therefore recommended that

.

The l.Jational Coor.dinator and Sight Savers !nternational country P.epresentati've are encourage to build partnership based on mutual respect and transparency

o

NOTF to collect data on CDTI activities and use ^it for planning and decision-making

.

NOTF to provide evidence based data to APOC tVlanagement and WHO country otfice

o

The National Onchocerciasis Task Force to increase the number of CDDs to reach the ratio of 1 CDD per 100 population

o

The NOTF to involve county Onchocerciasis supervisors in planning and implementation of CDTI activities including ordering ivermectin.

I.

INTRODUCTION

The first Community-directed treatment with ivermectin (CDTI) project

of

Liberia (North East) was approved in August 1999

and

launched

in

February 2OOO.

ln

March ZOO2,

the

CDTI projects of

south

East

and

South

west were

approved

for

funding

by APoc Trust. The social

instability experienced by

the

country hindered

the

implementation of CDTI projects and as at 2005, South West CDTI project had not

yet

started ivermectin distribution.

At the

country level,

the

National Onchocerciasis Task Force (NOTF) is composed by Representatives of the Ministry of Health and Social

Welfare,

Non-governmental development organizations (NGDOs), namely

Sight

Savers lnternational

(ssl) and christian

Health Association

of

Liberia (CHAL).

tn

2002,

the NoTF

of Liberia was _about

to

commence ivermectin distribution in the three CDTI project areas when the

war

broke out. Since then, Community-directed treatment with ivermectin was carried

out

by the local NGDO, Christian Health Association

of

Liberia.

The

independent participatory monitoring in

North

West

project carried between 17 August

and 6

September

2005

reveated

that the

main constraints were the setting up of the communities: the internal displaced population (lDp) _camps which were artificial and temporal settlements thus decision-making, community participation _and ownership were minimal. These key elements (decision-making, participation, ownership)

of

the sustainability of CDTI projects were under the responsibility of a local NGDO (CHAL), World Food Programme

WFP)

and mobile clinic teams.

Hence,

the

Management of

APoC

in collaboration with the Ministry

of

Health and Social Welfare and WHO country office decided

to

hold

a

meeting on APOC Philosophy and CDTI strategy to mobilize

all the

stakeholders

in

order

to

establish

a

community-directed ivermectin distribution system in Liberia.

The workshop was held at the conference room of

wHo

country office of Liberia from 22to 26 May

2006. lt

was attended

by

participants

from

national and county level

as

revealed

by the list

of participants (Annex l).

II.

OBJECTIVES

The objectives of the workshop were the following.

1.

to provide appropriate information to county CDTI implementers and national decision- makers on community-directed treatment with ivermectin

2. to

harmonize and agree upon controlling Onchocerciasis as

a

public health problem in

Liberia through community owned ivermectin distribution programme

6

to build capacity and to strengthen the partnership among the stakeholders in Liberia to boost ivermectin treatment through

a

sustainable ivermectin distribution system

in

line with APOC philosophy and CDTI strategy.

The expected outcome of the workshop is to establish a sustainable community-directed treatment with ivermectin in North West, South East and South West'

lll.

^Opening

The

National Onchocerciasis Coordinator, Dr. Torboh, welcomed

the

participants to the workshop'

He

stated

that his

country

is

coming

out of

conflict and need

full

support from

APoC

and other partners to control onchocerciasis as a public health problem.

on

the behalf of

APoC

Programme Director, Dr. Uche Amazigo, APOC Representative Dr. Mounkaila Noma thanked

the

Ministry of Health and Social Welfare

for

authorizing

the

workshop

to be

held

in

Monrovia during

this

early stage of

the

reconstruction of

the

country.

The

participation of

the

Ministry official to

the

opening

and

sessions

of the

workshop

were

^pointed

out as

government commitment

to

onchocerciasis

control

activities

in

Liberia

to

^protect

the

success

of the

onchocerciasis

control

^{Programme in}

west

^Africa

(ocp)

and

to

relieve Liberia onchocerciasis endemic communities from a debilitating

disease. The

Representative of

wHo

^country Representative,

Dr.

Bolay Fotrama, welcome the participants

in the auspice of wHo of Liberia and

expressed

the interest of wHo

^country

Representative to the outcomes of the workshop in order to have well defined check list to monitor Onchocerciasis Control in Liberia. He invited the participants to feel free in the venue ^{provided by} the WR to facilitate fruitful conclusions of away forward regarding CDTI implementation in Liberia'

The

Representative of

the

Honourable Minister of Health and Social Welfare, Dr.S. Benson Barh, emphasize

the

commitment

of

Liberia Government

to

support community-directed treatment with

ivermectin and to

^provide

support to

Onchocerciasis

Control activities. He

informed

that

the opening ceremony as

well

as

the

workshop sessions

will

be attended by county Onchocerciasis

supervisors and National Directors. He declared opened the workshop and wished

fruitful conclusions to the participants. The revised agenda of the workshop is in annex

ll'

IV.

METHODOLOGY

The workshop was held in the conference room of Liberia

wHo

country office from 22

to 26

^May 2006. Daily a chair and a co chair were selected

to

lead the workshop

to

reach the agenda items.

3

The workshop was carried out through (a) presentations of the facilitators, (b) working sessions, (c) plenary presentations of working groups, (d) discussions and formulation of recommendations.

V.

RAPID EPIDEMIOLOGTCAL MAPPING OF ONCHOCERCIASIS IN LTBERIA

The officer in charge of Disease Prevention and Control (DPC) of WHO country office, Dr Fatorma K. Bolay presented the status of the mapping of Onchocerciasis in Liberia (REMO map of Liberia in

annex

lll).

From

the

available data (collected

in

1999),

the

population infected was estimated at 263,832 people and the population at high risk of contracting Onchocerciasis

at

1,113,213 people in 2005. This population at high risk isforecasted

to be

1,193,351 persons in 2010. The meeting was warned

by

pafticipants

that

large scale ivermectin mass treatment was carried

out in

areas defined as hypo-endemic in River Gee, Grand Gedeh and Sinoe counties. The meeting recognized

the

importance of complying with

the

CDTI strategy and request

to

conduct rapid epidemiological assessment of Onchocerciasis in Gee, Grand Gedeh and Sinoe counties to determine the level of Onchocerciasis endemicity in these counties following

the

resettlement of the communities since the cessation of the war.

Recommendation

7: To _complete the REMO map of Liberia by conducting refinement exercise in Bopolu and Belleh districts (Gbarpolu county) and

Zozor

distict (Lofa Couniyy and by vatidating the On-chocerciasis prevalence data

in

River

6ee,

Grand Gedeh and Sinoe counties ^-by end

ofiuty

2006.

Actions

to be taken:

' ^{The N9TF to}

^proposed

^a

^period

^{for the}

completion (refinement and validation) of

the

REMO map of Liberia by 30 June 2006 the latest

'

^APOC Management

to

provide technical and financial support to enable the implementation of the exercise in July 2006.

V!.

APOC PHILOSOPHY, CDT! STRATEGY AND IMPLEMENTATION PROCESS

Dr. Uche Enyinnaya introduced the topic to the meeting. From his presentation, the meeting noted that in Community-directed treatment with ivermectin (CDTI) process it is crucial that the Ministry of Health and Social Welfare and the NGDO partners be committed to empowering the communities (not dominating them) to enable them play

a

major role in determining their own health outcomes.

Ms. Peace Habomugisha introduced the topics on approaching communities and

the

o

responsibilities of

the

communities in

the

implementation

of cDTl.

Experience and lessons learnt

on community

mobilization

and

sensitization

in Uganda and ^{Nigeria were shared with}

^the

participants

by Ms. Peace

Habomugisha

and Mrs. Pearce ogbu.

Management

of ^stocks

^of

ivermectin by communities was then introduced to by Mr. Atabe Andrew'

From the different presentation, the participants recognized:

The importance of community involvement in sustainable health actions and underscored that CDTI approach is the operationalway

to

implement Alma Ata Declaration

of

1978, the Ottawa Charter of Health promotion of 1986 and the renewed Bamako lnitiative of 2000;

Two of the

four

strategic directions identifled for facilitating

the

achievement

of

Health

for

All policy

for

21"1 century in the African Region strongly support

the

development

of

community- based interventions for sustainable health development and CDTI is providing evidence-based proofs that communities can improve their health status and contribute

to

poverty alleviation if they are given opportunity to design, own and manage a health intervention;

The needs of reliable census data

for

planning mobilization/sensitisation of all onchocerciasis endemic communities and for meeting their in ivermectin tablets were stressed out.

Communities,

first line health facilities and county health statf can ^deal with the ^issue

^of

incentives for CDDs as long as APOC Philosophy and CDTI strategy is well understood'

Actions

to

be

taken:

The

National Onchocerciasis Task Force (NOTF Secretariat and NGDO ^partner) should carry

out a workshop on

^poc

Phiiosophy ancj

cDTi strategy at

co.unty

ievei. The

^proposeci workshop

will target

onchocerciasis county supervisors,

ihe district

^personnel

in

charge of health (lCH),

"or*rnity L"O"t.

and CDDs. The workshop will be conducted before ivermectin treatment ^cYcle.

Apoc

Management to ^provide financial and technical support for implementing the workshop.

WHo

country office,

to

assist

the

National Onchocerciasis Task Force (NOTF) by ^requesting

the

^Ministry

ot

t-teatth

and social welfare to

issue

a

^policy

on

incentives

for all

^community-

based programmes.

a

o

a

Recommendation ^2: the meeting recommended that APOC Philosophy and CDTI strategy should be introduced to onchocerciasis Lounty health staff, first line health facilities, and communities ^and community distributors

(coor)

in order to enhance the implementation of a sustainable ivermectin distribution system.

a

a

a

v[. REsPoNSlBlLlw oF orHER PARTNERS (MoH, NGDos, NGos, Donors, wHo country office

and Merck & Co. tnc.)

Dr'

Mounkalla Noma provided

a

brief presentation on

the

composition and responsibilities of the National Onchocerciasis Task Force (NOTF). The presentation enable the participants to stress out the need of setting up a functional NOTF for Liberia which will be composed by Representatives of

the

Ministry

of

Health and Social welfare (MOH), NGDOs (lnternationat and locat) supporting the MOH in Onchocerciasis control, Representatives of WHO country office. lt was proposed that the NOTF should meet on

a

regular basis and

the

minutes of NOTF meeting should be circulated to NOTF members, WHO country office and APOC Management.

The

meeting recommended that the NOTF should review technical and financial reports of CDTI projects before their submission to APOC Technical Consultative Committee (TCC) and

APOC

Management.

The

mandate

of

the NOTF is

to

coordinate Onchocerciasis control

in

Liberia through community-direct treatment with ivermectin and to mobilize government contributions to support CDTI activities.

Mrs'

Tarpeh

made a

presentation

on

approach

and

responsibilities

other

^partners

to

facilitate discussions on partnership and role of partners in CDTI implementation in Liberia. The session on responsibilities of other partners led to recommendation 3.

Recommendation 3:

3.a.

^T.

he

Ministry

of Health and Social welfare to issue an official

document defining the composition of the NOTF and its responsibilities

3.b. The

National Onchocerciasis Coordinator

to

^provide

_{to the}

Ministry

of

Health

and

Social Welfare,

WHO country offlce, the NOTF

members

and APOC

Management,

the list of

the members

of the

National Onchocerciasis

Control

Programme including-

tne

^position

and

time allocated by each members to onchocerciasis control activities.

Action

to be taken:

'

The National Onchocerciasis Coordinator to prepare and submit the official document on NOTF composition and responsibilities

to the

Honourable Minister

of

Health and Social Welfare for consideration and ratification. Action to be completed by 10 June 2006.

' ^The

National coordinator

to

made available

to

WHO country office and APOC l\/anagement, the organizational chart of the National Onchocerciasis Progiamme, the list of the meribers oi

National Onchocerciasis

Control

Programme and

the

mandate of each members

by

10 June 2006.

VIII.

IVERMEGTINPROCUREMENT

Mrs.

Ogbu pearce, Acting National Onchocerciasis Coordinator

of

Nigeria presented

a

^{paper on} procurement

and delivery of

ivermectin

up to the entry port of entry in the country and

^its

integration into the national drug

procurement

and delivery system' She gave a

^detailed

explanation of the ordering form

of

lvermectin (Mectizano

).

^{She stressed that any slight mistake}

may

lead Mectizan Donation programme _(MDP) form back for corrections and

this

may delay the process of getting the drug in time. To avoid delay in ivermectin procurement, she urged the NOTF

for

early completion of ivermectin ordering form which should be carefully

filled.

For easy delivery

of

Mectizan@ (ivermectin) she recommended

the

integration

of

ivermectin into

the

national health

drug

delivery system

to enable

availability

of

ivermectin

at all first

^health

facilities

nearest to onchocerciasis meso

and

hyper endemic communities. Participants

were

reminded

the

cost of ivermectin

tablets and every tablet must be

accounted

for. Hence a ^proper

accountability of ivermectin tablets received, used, damaged, stolen should be set up at all level (from community to NOTF Headquarters).

Dr.

Torboh,

the

National Onchocerciasis Coordinator

of

Liberia ^presented

the

experience

of

his

country in the

procurement

and

delivery

of ivermectin. wHo

^county

otfice, clears

^ivermectin

tablets

when

they

reached

the

^country

^and

handed over

to the

^NOTF Secretariat

which

stored

ivermectin tablets

in the

national drug store and from

there

ivermectin tablets are channeled to

peripheral health structure through the national drug delivery system (county, district,

^and community also known as town ).

Based on the two presentations on drug procurement participants stressed out important points

a County Coordinators did not know how

to

request for the needed number of ivermectin tablets

for

onchocerciasis endemic communities. Because of

this

lack

of

knowledge, they asked for

any

^amount

of

tablets

and (a)

sometimes, some

of them get too little

leaving

some

^people untreated or (b) too much tablets are received and later expire in communities.

No community census has been done. County Coordinators have been using old census data

(uNcEF

in 2001). They seem to think that conducting community census is too much work and therefore should be left the way it ^is.

o

a

County

coordinators

are not

empowered

enough to know what their

responsibilities are regarding community-directed treatment with ivermectin.

Recommendation 4:

4.a. the

National Onchocerciasis

Task force

should

facilitate

census

taking by

community- directed distributors (CDDs) in all meso and hyper endemic communities.

4.b.

County coordinators should

be

^involved

in

planning, ordering and delivery

of

ivermectin tablets based on complete census data.

Action

to

be

taken:

The

National Onchocerciasis

Task

Force

to

facilitate census taking

in

CDTI communities by CDDs prior to ivermectin treatment campaign

The

NOTF

to

conduct training of trainers

for

County Onchocerciasis supervisor

to

enable to training and supervise first line health workers in charge of training and supervision community- directed distributors (CDDs).

Community-directed distributors

to conduct census in their

respective community

prior

to ivermectin m ass distribution

TNTEGRATTON

OF

COMMUNTTY-DIRECTED TREATMENT

WITH

IVERMEGTTN (CDT|) IN THE NATIONAL HEALTH SYSTEM

Ms Peace Habomugisha presented

a

paper on integration of CDTI in the national health system.

lntegration

of

CDTI

in the

national health system

was

defined

as: the

implementation

of

CDTI activities together with other health and development activities using the same resources (human, financial and material etc) to achieve a common

goal.

Levels of integration may vary from country to country and Liberia's health structures were used to help participants to discuss the topic:

a

a

a

tx.

3

^NOTF

C

Counties

3

Districts

3

Towns (communities)

National drug service County Health team Office in charge

Com m unity-distri butors

Participants were invited to look at what should be integrated at these levels as follows

Participants were led to find out indications of integration that must show

3

Evidence of written activity plan that includes CDTI;

3

Active involvement of health workers and administrative staff in CDTI activities ;

3

Evidence of reporting system for CDTI that includes other programs;

3

integrated

training, health education,

mobilization

&

sensitization

of CDTI with

other programs;

3

lvermectin transmission and distribution is done though the health system.

Participants recognized the importance of integration because ^it:

3

^{helps to} rationalize merger financial resources.

3

^{increases the} knowledge, and commitment of community members to deal with a series of health problems at the same time (their own health).

3

enhances experiences and confidence among the community members.

3

helps communities to gain more confidence in demanding for better services from relevant institutions and individuals.

3

unlocks vast human and other resources

vitalfor

program development.

3

promotes primary health care, and improves equity and accessibility of essential health care for the disadvantaged who are in most cases the majority.

3

saves time for those involved especially the health workers who are over loaded with their daily routine work.

Following discussions on

the

presentation

on

integration

of

CDTI

in the

National health system, participants were divided into three groups _{based on} first and second day's presentations in order

to

find out whether they were getting the concepts. Each group was given a topic to discuss and later present it to the whole group in plenary. The topics given were (a) Approaching communities, mobilizing and sensitizing them, (b) procurement and delivery of ivermectin into the health system and integration of CDTI into national health system.

The results of the working session showed that, all three groups had understood what was said in

the

last two days. Facilitators were _confldent that they were gaining

a

lot through

the

workshop.

They hope that participants will transfer acquired knowledge to the lower levels when back to their respective counties.

X.

ADMINISTRATTON, BUDGET AND FINANCE

The

financial flowchart

of

Liberia

was

^presented

by Dr. Bolay of the behalf of the

National Onchocerciasis Coordinator,

and then Dr.

Noma made

a

presentation

on the

Steps leading to disbursement of APOC funds. Participants were informed about the requisite of submitting monthly financial returns: a total of 12 monthly reports is expected from each CDTI project receiving APOC

Trust

Fund. Participants noted

that 3

months

delay in

submission

of

financial returns

will

lead automatically to suspension of funds from APOC Trust Fund. Participants agreed that ApOC is an evidence-based program and annual technical and financial report should be provided on time to APOC Technical Consultative Committee (TCC) and APOC Management to enable preparation of Letter of Agreement. The following evidence was noted by the meeting: no technical and financial report = no Letter of Agreement = no release of funds from

Apoc rrust

Fund.

The

discussions

on

disbursement

of

funds to

CDTI projects raised concerns about

the signatories

of checks for

withdrawing funds

from

WHO/APOC/NOTF

bank

accountant. lt

was

noted that, since

the

breaking of the war in 2002, signatories of checks are the National Coordinator

and the local

NGDOs, Christian Association of Liberia (CHAL).

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Recommendation ^5:

It was

recommended

that checks for

withdrawing

funds from the ^{NOTF bank}

^accountant

(WHO/APOC/NOTF) should have two

signatories

^A-n official of

the

Ministry

of

Health and Social Welfare nominated iry

the

Honorable Minister, namely

the

chairperson of

the

NOTF

will

sign the

checks on the oenjf ^{of the Ministry} of Health. The second signature should be from

the chairperson of the NGDo coalition, namely Sight Savers.lnternational in Liberia. ln absence of the Chaiiperson

of the NoTF, the

Honorable Minister

of

Health

and

Social Welfare

can

allow the National Coordinator sign checks in his capacity as a substitute to the NOTF chairperson.

Actions

to be

taken:

o The

National onchocerciasis Coordinator should provide

to WHo

^country

^office

^{and APOC}

Management the names and positions of the signaiories of checks who

will

be responsible for withdrawing funds from WHO/APOC/NOTF bank account'

o The NOTF should

communicate

to WHO country office and APOC

Management, the composition

of the NGDO

coalition

and name and ^position of the

chairperson

of

NGDO coalition

XI.

FIELD VISIT IN CDTI COMMUNITIES IN NORTH WEST AND SOUTH WEST LIBERIA

ln daythree

^of

theworkshop

(24 May 2006),

the

participants and the facilitators paid

a

surprise

visit

to

two

communities.

The

aim of

the

visit was

to find

out whether CDTI activities were being

conducted at this level and whether community members were involved in the

^program.

participants and facilitators

wanted also to see whether

community registers existed

and

how recordings were being ^kePt.

Two

communities were randomly selected. These

are

namely Voice of America from ^Careyburg district

in

tvlonstserrado county

of

Northwest project and Quakpalah from Kakata district, Margibi County in Southwest project. The county supervisors led the participants and facilitators to the first

line

health facility where

they got the

^officer

in

charge

who

^{led them}

to the

communities.

ln

the communities, the group introduced itself to the community leader and told him the purpose of their

visit.

He welcomed

the

^{group and allowed them}

to

interview him and other community members

the

group wanted

to

talk

to. using

checklist (Annex

lV)

^prepared

a

day before, participants then carried out interviews.

The results from the community distributors shows that registers were available in the communities but entries were not properly done, e.g.

two

households were registered on one page leaving no room

for

expansion

for

the following years. However

the

registers were

well

kept by community members. Well calibrated sticks were also available. Most CDDs were not selected by their own community members.

The

majority

were

selected

by

community leaders

and frontline

health- workers while some few others volunteered to distribute the drug. Most of the CDDs were trained

for one day. To

our judgment

the

distributors (CDDs)

did not grasp

important issues

like

the knowledge

of

Onchocerciasis and its control. Their training

in

most cases focused on treatment.

The

training _centers were about

3 km

away from

their

homes.

The

CDDs walked

a

distance of about

6

kilometers

to

collect ivermectin

and

community members

did not

assist

them in

drug collection. Treatment took about one month to complete for most CDDs and for others treatment is

still on

going during

the time of field visit

therefore

it was not

possible

to

know when

they

will complete. Some CDDs were given

5

liberty (Liberia

$ 5)

per each household while others were giving free services. What was encouraging however was that all

the

CDDs interviewed said that they

will

continue distributing ivermectin even when

they are not

receiving incentives from their community members.

Results from community members indicated that majority of them did not receive health education

but

CDDs would

find them in their

homes and

give them ivermectin.

Few

who

said

that

they received health education mentioned that they were told by CDDs when administering ivermectin

to them. They

mentioned

that they were told that

Onchocerciasis

affects eyes and can

be controlled by taking ivermectin.

The results also revealed that

the

people did not participate in CDDs selection and some did not know who selected

the

CDDs. Some

few

individuals said that they were nominated by front line health facilities. Some people

did not

know

when

Onchocerciasis control program began while others said

in

2002 and 2006 respectively. Some people had never taken ivermectin while others

took it

once

or

twice. Those who

took

and

got side

effects

did not

know what

to do;

they just remained at home until they disappeared on their own. However people knew the number of CDDs

they

have

in their

communities. Some community members said that

they

helped

in

mobilizing others for CDTI activities. Community members expressed the need to continue taking ivermectin in the following years.

Results concerning community leaders revealed that they were

knowledgeable

about

river blindness and CDTI strategy. They knew that Onchocerciasis exists in their own communities and they have CDDs who are distributing ivermectin to control the disease. They had health education and participated in the CDDs selection. They mentioned that the distance from their homes to the health education centers was about 3

km.

Such a long distance probably confirms why community members in the communities visited did not receive health education. They mentioned their role in the prograrn as that of mobilizing members to go for CDTI. They promised to continue doing it ^and also taking ivermectin every Year.

Regarding adverse events following ivermectin treatment, participants noted the lack of drugs and minimum equipment

in first line

health facilities

for

management

of mild and severe

adverse events.

Recommendation ^6:

6.a. The

^NOTF

to make sure that health

education

is

conducted

in each

community before ivermectin mass ^distri bution

6.b. CDDs should be extensively trained of CDTI strategy

6.c. New CDTI ^should be selected by their respective

communities

and trained on

APOC Philosophy and

cDTl

strategy with the aim of preventing

cDD

fatigue

6.d. The issue of incentives for should be harmonized in all the counties

6.e. Front line health facilities should be provided essential drugs and material to manage adverse events following ivermectin intake.

Actions

to

be

taken

O

^{NOTF to} get data on the number of CDDs available in each community and by CDTI county

c

^NOTF

^to

^elaborate a strategic plan and budget proposal for training and retraining of CDDs to reach the ratio of 1 CDD per 100 population

C

NOTF (Ministry of Health and Social Welfare, NGDOs), WHO country otfice

to

harmonize ^and adopt policy on incentives to CDDs in all community-based programmes.

3

^ApOC tr/lanagement, Sight Savers lnternational, WHO country office and the Ministry of Health to fund the trainingiretraining of CDDs and first line health workers.

C NOTF to train front line health workers and

community-distributors

in

management and reporting of adverse events following ivermectin distribution.

3

NOTF

to

provide essential drugs and equipment to first line health facilities and CDDs to treat adverse events.

XtI.

TRAINING AND HEALTH EADUCATION

Day

four

(26 May 2006) was begun with an introduction on training and health education and on lnformation Education and Communication (lEC) facilitated by Ms Peace Habomugisha.

lmportance of training and health education to support a sustainable CDTI system was pointed out.

The presenter revealed that it helps in acquiring relevant skills that will be used to run and manage CDTI projects effectively and efficiently based on knowledge of the disease and its control. Health Education makes stakeholders at different levels to know their roles and responsibilities; it helps to minimize mistakes

in

implementation

of

CDTI activities;

and it

makes beneficiaries

to

know that

they are part and

percale

of the

program (community ownership

and

empowering community).

Therefore, all stakeholders

at

relevant levels should be trained

and

health educated.

The

higher level should

take

responsibility

of

training and health educating

the

lower levels following health structures of a country.

ln

case

of

Liberia, participants were reminded

that

health education and training of

the

different levels could be as follows:

+

NOTF (MoH & NGDOs)

+

County health team (CHT) members (county project managers)

+

Districts - Officers in charge (OlC)

+

Towns (Community members)

-

In Liberia communities are known as towns

Training and health education should be focused on: (a) Onchocerciasis and its control looking at transmission, signs/symptoms, complications, prevention and control;

(b)

lvermectin and dosage determination (using height); (c) management of adverse reactions; (d) exclusion criteria; and (e) record keeping.

TNFORMATTON EDUCATTON & COMMUNTCATTON (rEC)

The

session

was

^continued

by a topic on IEC

materials. Participants

noted (a) that lECs

are

instruments used to convey particular messages to an intended audience for a

^particular

prograrnme and purpose; (b) that IEC can be in form of pictures, messages, film shows and drama which can be also used for both training and health education.

Production of

IEG

materials

Before producing IEC materials, it is good to know behavior changes of the intended audience and

then

design

the

materials accordingly. Behavior change

can be

influenced

by family

members, peers, communities, gender, customs, institutions (APOC, NOTF, World Bank, other development programme),

policy makers

^(MOH,

WHO, UN, UNiCEF...). One needs to know how

^people behave,

their likes and dislike before

^producing

any IEC ^material. IEC

materials

must

have ,SMART' objectives, that is, they must be specific, measurable (achievable), appropriate, realistic and time bound.

To

produce appropriate IEC materials, specialists (artists, drama films) should be involved

to

help in the production. The ^person who needs these materials must know what message she/he wants

to

^put across

to the

intended audience.

The

message should be conveyed

to

specialists who be given time

to

produce IEC materials which

will

be approved by

the NOTF.

The NOTF should ^be flexible by giving room to the specialists to select appropriate messages that can attract the target audience.

The

^produced

^IEC materials should be pre tested by a sample of the

^{intended audiences}

(communities) prior their

wide use. lf

sampled communities get

the

messages conveyed

by

IEC materials,

then they can be

reproduced

in

sufficient

quantity. lf the different

messages rise concerns

(lEC

materials should speak by themselves), then,

the

materials should

be

discussed

with

communities and

the

comments and suggestions should be taken into account

in

reviewing

IEC materials.

Why

should

^pre-test

of

IEC be done?

(a) pre-test helps to know

whether

the

message

is

understood

or not and if not then

make corrections until

the

IEC becomes self explanatory to the intended audiences before production ^is made. ln so doing, it saves time, energy and money.

Ms Peace

Habomugisha

concluded by saying that

knowledge

of smart

objectives

helps

in producing sensible

IEC

materials.

Wrong

messages convey improper information

and can

be destructive to Onchocerciasis program.

Group

Work

Afterthe

presentation, the participants were divided into three groups and each group was given its own message (Annex V). They were left to make their own decisions on how to produce what they wanted. All the three groups drew some pictures and also did drama. After they had all finish, they presented

their IEC

materials. Members

of other groups became

intended audiences

of

the presenting

group. They gave

comments

and

observations

of each. At the end of it all,

they concluded that according to the messages given, drama would have been the appropriate tool.

Recommendation 7:

County supervisors should make use of the locally available IEC materials (more especially drama) in conducting health education.

Action

to be taken:

.

NOTF to train and provide IEC materials to County Onchocerciasis supervisors and Officer in Charge (OlC)

o

Sight

Savers

lnternational and

APOC

Management

to

assist technically

and

financially the MOH to develop IEC instruments based on local materials.

XIII.

DATA COLLECTION, TRANSMISSION AND REPORTING Day five mainly focused on four sessions namely:

(a)

Data collection, transitlon and reporting,

(b)

S ustai nability of com m unity-di rected treatment with iverm ectin,

(c)

Monitoring and evaluation of APOC projects and

(d)

Evaluation of theworkshop.

Utilization of

data

in planning

and management

of

CDTI

projects

Ms peace Habomugisha handled the session on Utilization of data in planning and management of CDTI projects. She said that availability of data is very important in planning and management. lt ^is essential

for

policy making and

for

funds rising or for justification

of

resources allocated

to

CDTI projects or any others health intervention'

Concerning CDTI projects, reliable, complete, and

time

bounded

data are

requested

for

^proper

planning, list of data being requested ^is the following:

.

Census data of CDTI communities (total population, population under 5 years, population by gender)

.

Total number of communities in each project areas by endemicity level (hyper, meso and hypo endemic communities)

o

Total number of CDTI communities (hyper and meso endemic communities)

o

Total number of communities treated during the year being reported

o Total

population

in each CDTI

project areas

by

endemicity

level

(population

in

hyper' meso and hyPo endemic communitY)

o Total

population

of CDTI

communities (population

living in meso or hyper

endemic communities)

r

Total population treated in CDTI communities during the period being reported

o

Therapeutic and geographic coverage for each CDTI project for the period being reported

.

lvermectin

(Mectizant I ^data

^(number

^{of tablets}

ordered, number

of tablets

received,

number of tablets

distributed,

number tablets lost, number of tablets which

^expired, number of tablets returned to health facilities)

.

Number of severe adverse events following ivermectin treatment (total number of adverse events, number of severe adverse events, number of mild events)

.

Number of trained CDDs

in

each CDTI ^project areas (total number

of

CDDs, number of CDDs by gender)

o

Number of new trained

cDDs

by gender per project for the year being reported

.

Number of health workers trained in CDTI activities

o

Health workers involved in CDTI

.

Number of Community supervisors (by gender)

.

Number of communities which received health education per project

Number of communities mobilized per project

Contributions

of the

^partners

in CDTI

activities

per

project (Government contributions, NGDOs contributions)

lmportance of record keeping on census, treatment and ivermectin tablets was recognized to justify

the

resources allocated

to

CDTI activities based

on

reports providing evidence based

data.

ln CDTI,

data is

important

and

should

be

recorded

in all

aspects

of

CDTI activities including key resources persons, CDDs

per

gender, demographic data (total population, ineligible population, and eligible population), geographic and therapeutic coverage.

ln short, utilization of data in planning and management of CDTI is very important because it helps in identifying program strength and weaknesses early enough and also assists program managers to make focused plans for the future.

Recommendation 8:

NOTF should have relevant data from all the levels of implementation in order to make meaningful plans and management plans for CDTI activities.

Actions

to

be

taken:

C

NOTF should provide on time treatment, population, training, supervision, monitoring, health education and mobilization data to APOC Management and WHO country office

3 NOTF

Secretariat

should set up a

computerized

for data entry, storage,

compilation and reporting

3 APOC

Management

and WHO country office to assist the NOTF in setting up a

^data

management system at the NOTF Secretariat level.

C

APOC Management to transfer capacity in data management to the NOTF of Liberia by end of July 2006.

xrv SUSTAINABILITY OF

COMMUNITY.DIRECTED

TREATMENT WITH

IVERMECTIN

(cDfl)

Dr. Atabe Andrew

on

presenting

the

above topic started by defining CDTI

as

being sustainable when

its

activities continue

to

function effectively

for the

foreseeable future,

with

high treatment

a a

coverage, integrated

into

available health

care

services,

with

strong community ownership and using resources mobilized by the community and the government.

He

^proceeded

by

explaining

the

difference between sustainability

and self

sufficiency,

with

self sufficiency meaning the ability of

a

project to continue functioning etfectively, using only resources generated within the country itself.

Next he gave the following points as reasons why CDTI needs to be sustained

3

Onchocerciasis is debilitating and has profound medical and socioeconomic impacts

3 ^lt

requires treatment with ivermectin (Mectizan@ ) for at least 15 years.

3

CDTI has proven to be a very effective means of Onchocerciasis control

3

Sustainability evaluations

in

some APOC countries revealed

that

some projects

are

making progress towards sustainability with few

or

no support from external funds (APOC Trust Fund and NGDO contributions)

Comments made

by

participants during

the

discussion session that followed highlighted

the

fact that project implementers should all be aware of the fact that these projects would be evaluated for sustainability

by

^year

three of their implementation.

During

this

exercise

the

projects

would

be investigated

for how well they were making

^progress

towards sustainability. To do this,

the following indicators would

be

used: planning, leadership, supervision and monitoring, Mectizan@

supply, training and health education, supervision, monitoring (HSAM), integration in

the

national

health system, financing, transport and material

resources,

human resources and

treatment coverage.

Strengthening

Commu

nity Ownership

Ms Peace Habomugisha facilitated the session on 'strengthening community ownership'. She said

that it is

important

to

strengthen community ownership because

it

makes community members obtiged

to:

^(a) accountable

for the

program, (b)

in

^large numbers

to

take advantage of what the program offers (Mectizan), (c) accept

the

program, (d) be part and parcel of

the

program, and (e) harbour no thoughts of frustrating the program; (f) to own

the

program. This will eventually lead to program success and sustainability.

How

community ownership

of CDTI can be strengthened?

Ms Peace Habomugisha revealed community ownership is a major factor for program sustainability

in

CDTI. This can

be

strengthened

by

making sure community members

are

heavily involved in

decision

rnaking process

from the time the

^program

is

introduced

to their area.

Community members must freely make decisions on the following:

(a)

Mode and time of treatment

(b)

Selecting and changing their resource persons (CDDs & community supervisors)

(c)

Collecting ivermectin and storing it during mass treatment

(d)

Selecting venues for treatment and health education

(e)

Mobilizing other members for CDTI activities

(f)

Having adequate knowledge about

the

disease

and its

control

and how

CDTI strategy works

(g)

Constant meetings with community members

to

remind them of their roles and discussing with them some difficulties met during program implementation

(h)

Remind them that all eligible persons will be required

to

continue taking ivermectin once a year for many years

Assure community

members

that:

(i)

tablets will be kept at the nearest health center for some time in order to cater for those who will miss during distribution

(a)

after selecting community resource persons (CDDs) they will be trained within their communities

(b) their decisions on how to run the program will be respected by other partners.

(c)

lvermectin will continue being given to them free of charge.

(d) both men and women are key

^players

in the

success

of CDTI and

shoutd therefore participate equally

in

their program

(e)

lf they do community self monitoring, they

will

be in

a

better position

to

identify program problems and will collectively look for possible solutions.

Recommendation ^g:

NOTF should guide community members

to

heavily participate in decision making on how to rune the program.

a

O

o

Action to be

taken:

NOTF should make sure that community members are health educated on their

roles pertaining CDTI activities.

ApOC Management and WHO country office should monitor on regular basis (once a year) the implementation of CDTI activities ⁱⁿ the approved projects areas

APOC

Management

to provide technical

assistance

to Liberia NOTF to re-launch

CDTI activities in allAPOC funded projects.

XV.

MONITORING AND EVALUATION OF APOC FUNDED PROJECTS

Monitoring of CDTI project was introduced to participants. Monitoring was as an assessment of the ongoing project activities in order to find out whether the project is doing well or not. lf the project is not doing well, then cases will be identified and possible solutions sought.

Who should monitor CDTI Projects?

participants were informed that all stakeholders and partners may monitor the project if they find it necessary. These include donors, implementing bodies (APOC, NGDO, ^tt/lOH

at

relevant levels and the affected communities).

For CDTI program to be monitored properly, monitoring checklist and indicators must be used at ^all levels

of

implementation. They include, planning, leadership, monitoring & supervision, ivermectin distribution,

training and

HSAM, finance, transport, integration, human resource

and

treatment coverage

These

indicators

must be used at all

implementing levels

in

CDTI

within a ^given

^{country. For}

Liberia, for example, these levels are the national, county, district and the community (town).

IMonitoring

tools such as such as

questionnaires

to capture both

qualitative

and

quantitative information may be used. Focus group discussions are also very important as they help in getting information that cannot be easily obtained when using questionnaires.

Monitoring

at the

community

level should

include interviewing community

leaders,

household

heads (men and

women), community supervisors,

CDDs

NGDOs

and local NGO

involved in Onchocerciasis control activities. Data obtained from monitoring exercise should be analyzed and

a report written showing both the strength and weakness should be made

available

to

all stakeholders.

Dr. Uche Enyinnaya presented the experience of projects evaluated in Nigeria with the expectation

that

participants

from

Liberia

will learn

lessons

form

Nigeria evaluated projects

to

improve the implementation of Liberia CDTI projects. Below were some of these issues raised.

a PLANNING:

Council.

a TRAINING

a MONITOR!NG / SUPERVISION

monitoring/evaluation of the PHC system.

MECTIZAN@

\ TL^ --^:^^l^ J^-^-.!^J ^- f,t/-hn^ 5^- ir^^ri-^^/6\ ^^il^^l;^^

r llls PluJErvr.D LrEpElluEu Ui i l\L7UVU iUi ivitiuiizaIiLry r-UiieciiUai.

a REGORD KEEPING AND REPORTING 5

state, region and zone).

o F!NANCE

a TREATMENT COVERAGE

XVI.

EVALUATION OF THE WORKSHOP

The

results of the pre and post tests to evaluate knowledge acquired by participants revealed that participants had learnt on APOC Philosophy and CDTI strategy'

XVII.

CONCLUSIONS

The main recommendations of the workshop on APOC Philosophy and CDTI strategy stated by the participants are the following:

Recommendations

addressed

to the Ministry of

Health and

SocialWelfare

Tha l/tinic{nr af lJaat{h anr{ Qnnia! \Alclfaro tn cr.aate a lr.!=finna! Onahncereiasis Task INIOTF\

iiie iviiiiisii)i Ui i-iuAiiii Ciii\i \rvili.7i rvsiiqiE au wivqiv - i--.iuiiqi viiv..vYv,vrsvrv '- " I

and to define the responsibilities and composition of the NOTF.

The Ministry of Health and Social Welfare project coordinators

for

North West, South East ^and South West CDTI projects to assist the National Onchocerciasis Coordinator

The

tMinistry

of Health and Social Welfare to

harmonize

the ^policy on incentives in

all community-based programs according to APOC Philosophy and CDTI strategy

The Ministry

of

Health and SocialWelfare to allocate budget line for Onchocerciasis Control ⁱⁿ Liberia in line of the sustainability of CDTI project.

a

a

a

Recommendations addressed

to the

Nationa!

Onchocerciasis

Task Force (NOTF)

' ^{The National} Onchocerciasis Coordinator and Sight Savers lnternational

Country Representative

to

collaborate

in the spirit of

APOC partnership

to

implement

a

sustainable ivermectin distribution system in Liberia

' ^{The NOTF to}

facilitate

the

completion

of the REMO map of

Liberia;

a

^proposat

for

the refinement of the REMO map of Liberia to be submitted by the NOTF by end of July the latest

'

^{The NOTF}

^to

conduct a workshop of APOC philosophy and CDTI strategy at county level for involving

all the

stakeholders (County Onchocerciasis supervisors, Community-distributors, community leaders)

'

^The

^NorF

to set up a data collection, entry and processing system

'

^{The NOTF to} provide 2006 treatment and training data to APOC Management

o The NOTF to train

community-directed distributors

in conducting census in each

CDTI communities

'

^{The NOTF to} elaborate a strategic plan for (a) training/retraining of CDDs and front line health workers, (b) conduction health education and sensitization in each of the APOC funded CDTI projects in Liberia

Recommendations addressed to ApOC Management

'

^APOC Management to provide technical and financial support for conducting the completion of the REMO map of Liberia

r APoc

Management to build capacity in data management in Liberia

. APoc

Management to facilitate census taking in Liberia

cDTl

^projects

' ^APOC

Management

to

provide technical support

for

training

of the

implementers

of

Liberia

.

projects health education, IEC and production of materials for IEC

ANNEX

l:

LIST OF PARTICIPANTS

SN

1

2 3 4 5 6 7

I I

10 11 12 13 14 15

Participants S. Benson ^Barh Moses Pewu DanielKoon Yah ^{S. Dolo} Nimely T. SamPson Virginia O. Hinneh Christiana Dagadu James Goaneh Annette ^Doe Larry ^{D. Gee} Jessie ^Duncan Flomo Gwesa Dee Zoe Lake Bill D. Korboi Alfred B. Beyan

Position NOTF Chair

NOTF accountant

National Coordinator SSI Country ^Rep DPCM/HO Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor Oncho Supervisor

Address MOH

MOH

Bureau of ^Social Welfare/MOH NOTF HQ

NOTF HQ

Family Health Division/MOH National Health Promotion Division Christian Health Association NOTF HQ

NOTF HQ MOH MOH MOH MOH NOTF HQ NOTF HQ SSI

WHO/Liberia Montserado CountY River Cess ^CountY Gbarpolu CountY Oncho BomiCounty

Nimba County Sinoe County MargibiCounty Grand Bassa CountY Maryland CountY Cape Mount CountY Bong County NOTF HQ f,tnTE Lln rrvll tlu

NOTF HQ

Christian Health Association A.M. DogliottiCollege of Medicine

Phone 6s22160 655021 5

77292645 6550843 6469536 4760410 6405120 6573221 6512897 6517797 6522644 77715577 6526503

6551 941 6526842 659451

I

6457381 4717942 6472819 6824639 6594092 77004703

4753995 6451450 6455884 56561 90

653831 3 6525935

16

Dr. H. TudaeTorboh

17

Mrs. Verda ^TarPeh

18

Dr. Fatorma BolaY

19

^Mr. David S. George

20

Andrew A. Saah

21

^{Alfred T. Musa}

22

^{J. Sumo PaYwala}

23

Rancy W. Leesala

24

^{William Bedford}

25

^{Moses Logan}

26

ThomasS. Siazia

27

^{Paul K. Targbe}

28

^{Oretha Scell}

29

^{Stephen CooPar}

30

Frances J. SarPee

^a ta-4L^.., n^..,^L

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32

^{Matthew KarPeh}

33

Jenkins Jorgbor

34

^{Victoria lreland}

ANNEX

II:

^AGENDA OF THE WORSKOP

WORKSHOP ^ON APOC PHILOSOPHY AND CDTI STRATEGY

Monrovia,22 to 26 May 2006-05-22

Rev.1

-

^{22May 2006}

Monday 22 May 2006

08H30

- 09H15

9H15

- 09H30

10H00 -10H30 Opening ceremony

-

Opening address by the National Coordinator

-

Opening address by the Representative of APOC Director

-

Opening address by the WHO Representative

-

Official opening by the Representative of the Honourable Minister of Health

Coffee break - Refreshment

10H30 -11H00

11H00 -13H00 Working sessions

Election of Chair persons (10 minutes)

- ^Dr

^Torboh

Adoption of the Agenda (5 minutes) - Dr. Torboh

Objectives of the workshop and expected outcomes (5 miniutes)

-

^{Dr. Noma}

Pre-test (20 minutes)

-

^Mr.Atabe & Dr. Enyinnaya

Session l: Partnership

13H00 -14H30

14H30 -16H00

Session ll:

REMO

Lunch Break

Current

status of Rapid

Epidemiological Mapping

of

Onchocerciasis (REMO) in Liberia (10 minutes)

-

^{Dr. Bolay}

Session lll: APOC Philosophy,

CDTI

strategy and implementation process Session lll.1: APOC Philosophy and

CDTI

strategy

- APOC

Philosophy

and

Community-directed treatment

with

ivermectin (CDTI) concept (15 minutes) - Dr.Enyinnaya

-

Discussion ( 10 minutes)

Session lll.2:

CDTI

strategy: Community participation

Approaching communities (15 minutes )

-

Ms Habomugisha Responsibility of communities (10 minutes

)-

^Ms Habomugisha

Community mobilization

and

sensitisation

(15 minutes) Mrs Ogbu and

Ms Habomugisha

Registration of the participants Arrival of invited guests and officials

16H00 -16H15

Coffee Break