Uganda Work Plan FY 2018 Project Year 7

October 2017–September 2018

ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by the US Agency for International Development under cooperative agreement No. AID-OAA-A-11- 00048. The period of performance for ENVISION is September 30, 2011 through September 30, 2019.

The author’s views expressed in this publication do not necessarily reflect the views of the US Agency for International Development or the US Government.

ENVISION Project Overview

The US Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm, whipworm, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at global and country levels and support ministries of health (MOHs) to achieve their NTD control and elimination goals. At the global level, ENVISION—in close coordination and collaboration with WHO, USAID, and other stakeholders—contributes to several technical areas in support of global NTD control and elimination goals, including the following: • Drug and diagnostics procurement, where global donation programs are unavailable • Capacity strengthening • Management and implementation of ENVISION’s Technical Assistance Facility (TAF) • Disease mapping • NTD policy and technical guideline development • NTD monitoring and evaluation (M&E) At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including the following: • Strategic annual and multi-year planning • Advocacy • Social mobilization and health education • Capacity strengthening • Baseline disease mapping • Preventive chemotherapy (PC) or mass drug administration (MDA) • Drug and commodity supply management and procurement • Program supervision • M&E, including disease-specific assessments (DSAs) and surveillance In , ENVISION project activities are implemented by RTI International and The Carter Center.

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TABLE OF CONTENTS ENVISION Project Overview ...... ii TABLE OF TABLES ...... iv TABLE OF FIGURES ...... v ACRONYMS LIST ...... vi COUNTRY OVERVIEW ...... 8 1) General Country Background ...... 8 a) Administrative Structure ...... 8 b) Other NTD Partners ...... 9 2) National NTD Program Overview ...... 14 a) Lymphatic Filariasis ...... 15 b) Trachoma ...... 16 c) Onchocerciasis ...... 17 d) Schistosomiasis ...... 18 e) Soil-Transmitted Helminthiasis ...... 19 3) Snapshot of NTD Status in Uganda ...... 20 PLANNED ACTIVITIES ...... 21 1) NTD Program Capacity Strengthening ...... 21 a) Situation ...... Error! Bookmark not defined. b) Strategic Capacity Strengthening Approach ...... Error! Bookmark not defined. c) Capacity Strengthening Objectives and Interventions ...... Error! Bookmark not defined. d) Supporting Field-based ENVISION Staff in Capacity Strengthening ...... Error! Bookmark not defined. e) Monitoring Capacity Strengthening ...... 21 2) Project Assistance ...... 23 a) Strategic Planning ...... 23 b) NTD Secretariat ...... 24 a) Building Advocacy for a Sustainable National NTD Program ...... 24 b) Mapping ...... 26 c) MDA Coverage ...... 26 d) Social Mobilization to Enable NTD Program Activities ...... 28 e) Training ...... 33 f) Drug and Commodity Supply Management and Procurement ...... 37 g) Supervision for MDA ...... 37

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h) M&E ...... 38 i) Supervision for M&E and DSAs ...... 41 j) Dossier Development ...... 42 k) Short-Term Technical Assistance ...... Error! Bookmark not defined. 3) Planned FOGs to Local Organizations and/or Governments ...... Error! Bookmark not defined. 4) Cross-Portfolio Requests for Support ...... Error! Bookmark not defined. 5) Maps ...... 44 APPENDIX 1: Country Staffing/Partner Organizational Chart ...... Error! Bookmark not defined. APPENDIX 2: Work Plan Timeline...... 48 APPENDIX 3: Work Plan Deliverables...... Error! Bookmark not defined. APPENIDX 4. Table of USAID-supported Regions and Districts in FY18 ...... 50 APPENDIX 5: FY17 Q1-2 Uganda SAR ...... Error! Bookmark not defined. APPENDIX 6: Program Workbook (MS Excel) ...... Error! Bookmark not defined. APPENDIX 7: Disease Workbook (MS Excel) ...... Error! Bookmark not defined. APPENDIX 8: Country Budget (MS Excel) ...... Error! Bookmark not defined. APPENDIX 9: UOEEAC’s OV Flag ...... 54

TABLE OF TABLES

Table 1: Non-ENVISION NTD partners working in country, donor support, and summarized activities ...... 13 Table 2: Snapshot of the expected status of the NTD program in Uganda as of September 30, 2017 ...... 20 Table 3: Project assistance for capacity strengthening ...... Error! Bookmark not defined. Table 4: USAID-supported coverage results for FY16 ...... Error! Bookmark not defined. Table 5: USAID-supported districts and estimated target populations for MDA in FY18 ...... 27 Table 6: Social mobilization/communication activities and materials checklist for NTD work planning ...... 30 Table 7: Training targets ...... 34 Table 8A: Reporting of DSA supported with USAID funds that did not meet critical cutoff thresholds as of September 30, 2017 ...... Error! Bookmark not defined. Table 8B: Reporting of OV-specific DSA supported with USAID funds that did not meet critical cutoff thresholds as of September 30, 2017 ...... Error! Bookmark not defined. Table 9a: Planned DSAs for FY18 by disease ...... 41 Table 9b: Planned OV-specific assessments for FY18 ...... 41 Table 10: Technical assistance request from ENVISION ...... Error! Bookmark not defined.

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Table 11: Planned FOG recipients ...... Error! Bookmark not defined.

TABLE OF FIGURES

Figure 1: Uganda regional and district maps ...... 8 Figure 2: ENVISION-supported MDA for LF, FY12–FY16 ...... Error! Bookmark not defined. Figure 4: ENVISION-supported MDA for trachoma, FY12–FY16 ...... Error! Bookmark not defined. Figure 3: ENVISION-supported MDA for Oncho, FY12–FY16 ...... Error! Bookmark not defined. Figure 5: ENVISION-supported MDA for Schistosomiasis, FY12–FY16 Error! Bookmark not defined. Figure 6: ENVISION-supported MDA for STH, FY12–FY16 ...... Error! Bookmark not defined. Figure 7. Uganda LF, OV, STH, SCH, and Trachoma Endemicity Maps ...... 44 Figure 8. Uganda LF, OV, SCH, STH, and Trachoma Geographic Coverage Maps ...... 44 Figure 9. Uganda Progress Toward LF Elimination Map ...... 46 Figure 10. Uganda Progress Toward Trachoma Elimination Map ...... 47

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ACRONYMS LIST

AE Adverse Events AFRO WHO Regional Office for Africa ALB Albendazole BCC Behavior Change Communication CAO Chief Administrative Officer CBM Christian Blindness Mission CCP John Hopkins School of Public Health’s Center for Communication Programs CDD Community Drug Distributor CFA Circulating Filarial Antigen CHEW Community Health Extension Worker CLTS Community-led Total Sanitation CY Calendar Year DDT Dichlorodiphenyltrichloroethane DFID (United Kingdom) Department for International Development DGHS Director General of Health Services DHO District Health Office(r) DRC Democratic Republic of the Congo DSA Disease-Specific Assessments ELISA Enzyme-Linked Immunosorbent Assay EU Evaluation Unit FOGs Fixed Obligated Grants FTS Filariasis Test Strip FY Fiscal Year GTMP Global Trachoma Mapping Project HAT Human African Trypanosomiasis HMIS Health Management and Information System HPED Health Promotion Education Division (MOH) HSD Health Sub district IDM Innovative and Intensified Disease Management IEC Information, Education, and Communication IRS Indoor Residual Spraying ITI International Trachoma Initiative IU Implementation Unit IVM Ivermectin JRSM Joint Request for Selected (PC) Medicines (WHO) KAP Knowledge, Attitudes, and Practices (study) LC LF Lymphatic Filariasis LLIN Long Lasting Insecticide Treated Net M&E Monitoring and Evaluation MDA Mass Drug Administration MEB Mebendazole Mf Microfilariae MMDP Morbidity Management and Disability Prevention

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MOH Ministry of Health MP Member of Parliament NMS National Medical Stores NOCP National Onchocerciasis Control Program NTD Neglected Tropical Disease NTDCP Neglected Tropical Disease Control Program OV Onchocerciasis PC Preventive Chemotherapy PCR Polymerase Chain Reaction PDC Parish Development Committee PELF Program to Eliminate Lymphatic Filariasis PTS Post-Treatment Surveillance PM Program manager PZQ Praziquantel RDC Resident District Commissioner RPRG Regional Program Review Group SAC School-Aged Children SAE Serious Adverse Event SAFE Surgery, Antibiotics, Facial cleanliness, Environmental improvements SAR Semi Annual Report SAS Senior Assistant Secretary SCH Schistosomiasis SCI Schistosomiasis Control Initiative (Imperial College London, UK) STH Soil-Transmitted Helminths STTA Short-Term Technical Assistance TA Technical Assistance TAF Technical Assistance Facility TAS Transmission Assessment Survey TEO Tetracycline Eye Ointment TF Trachomatous Inflammation - Follicular TIS Trachoma Impact Survey TOT Training of Trainers Trust Queen Elizabeth Diamond Jubilee Trust TSS Trachoma Surveillance Survey TT Trachomatous Trichiasis UNICEF United Nations Children’s Fund UOEEAC Uganda Onchocerciasis Elimination Expert Advisory Committee USAID United States Agency for International Development VCD Vector Control Division (MOH) VHT Village Health Team WASH Water, Sanitation, and Hygiene WHO World Health Organization WVU World Vision Uganda ZTH Zithromax®

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COUNTRY OVERVIEW

1) General Country Background a) Administrative Structure

Uganda is divided into four administrative regions: Central, Western, Eastern, and Northern. These four regions are in turn divided into districts, subcounties, parishes, and villages. In September 2015, an act of parliament created 23 new districts to be phased in over three years, increasing the number to 116 in 2016, 122 in 2017, and 128 in 2018.

Districts are sometimes loosely grouped into one of 11 sub-regions based on names given during the colonial period: , , Bukedi, Teso, Karamoja, Lango, Acholi, West Nile, Bunyoro, Ankole, and Kigezi (see Ugandan regional and district maps, Figure 1). For example, Karamoja sub-region is comprised of eight districts. Sub-regions are not active administrative or political units, although they approximately demarcate ethnic groups and are used to refer to key targeted areas and populations for disease control activities, such as targeting specific information, education, and communication (IEC) materials.

Figure 1: Uganda regional and district maps

Regions of Uganda

District administration Uganda has a decentralized administrative system with some powers devolved to the district and lower- level local governments. The Ugandan Ministry of Health (MOH), including the neglected tropical disease (NTD) program, conducts its activities along the same political and civil service administrative structures found in districts, as outlined below. Each district has an elected political head, known as the Local Council (LC) 5 chairperson, who presides over a council of elected subcounty representatives. The LC5 chairperson selects ministers or secretaries from the council who are responsible for specific portfolios: for example, the Secretary for Health is the

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district equivalent of the national-level Minister of Health. Other district-level leaders include the Chief Administrative Officer (CAO)—a civil servant who is the district accounting officer and who has overall oversight of the district civil service in the district. The Resident District Commissioner (RDC) represents the Office of the President in the district and is responsible for the supervision of implementation of all government programs as well as coordinating security matters. The district local government headquarters are normally located in the biggest town or municipal council (urban center). Town and municipal councils have their own structures similar to those of the district local administrations. In FY18, ENVISION will support mass drug administration (MDA) and related activities in 26 districts.

County and subcounty administration Districts used to be divided into counties; these have now been replaced by political constituencies and are administratively non-functional save for the creation of health sub districts (HSDs), which operate at the level of the former counties. Currently, the functional administrative unit in the local government system is the subcounty. The subcounty is headed by a Senior Assistant Secretary (SAS), formerly titled supcountry chief, a civil servant reporting directly to the CAO. Also at the subcounty level are LC3 chairpersons and councilors who are elected representatives. The LC3 chairperson is the political head of the subcounty and chairs the subcounty council, while the SAS is the representative of the CAO at that level and is responsible for the supervision of civil servants and ensuring government programs are implemented. The LC3 chairperson and the SAS work together in program planning and implementation at the subcounty level. In FY18, ENVISION will support MDA and related activities in 245 subcounties.

Parish and village administration Subcounties are divided into parishes, each headed by a parish chief—a civil servant—and an LC2 chairperson—an elected political leader. Each parish has a parish development committee (PDC), responsible for identifying priority development issues and challenges. The lowest administrative unit in Uganda is the village, known as LC1. Some large or densely populated LC1s are subdivided into cells, especially in urban areas. The LC1 is headed by a chairperson and assisted by an executive. At each council level from district (LC5) to village, (LC1), women representatives are part of the configuration. In FY18, ENVISION will support MDA and related activities in 1,171 parishes and 10,980 villages. b) Other NTD Partners

The MOH’s NTD Control Program (NTDCP) is led by an Assistant Commissioner, Health Services who is assisted by disease specific program managers, senior program staff, scientists, technologists/ technicians, and other support staff. For better coordination of the program, a secretariat, comprising of all NTD partners was established and is chaired by the Assistant Commissioner assisted by program managers (PMs). The NTDCP manages and coordinates activities against five preventive chemotherapy (PC) NTDs (trachoma, lymphatic filariasis [LF], onchocerciasis [OV], schistosomiasis [SCH], and soil- transmitted helminthiases [STH]), as well as the Innovative and Intensified Disease Management (IDM) Case Management NTDs.1 The MOH sets the country’s NTD policies, includes NTDs in its annual statement and budget to parliament, and provides an enabling environment for NTD-related program implementation and research.

1 Including human African trypanosomiasis (HAT), leishmaniasis, jiggers, Buruli ulcer, cysticercosis, tungiasis, rabies, leprocy, plague, and Guinea worm (which has been eliminated from Uganda). National programs for HAT, leishmaniasis, and cysticercosis are based at the MOH Vector Control Division; the program for plague is based at Uganda Virus Research Institute in ; and Buruli ulcer disease and jigger control are based at the MOH headquarters.

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The MOH Top Management Committee, chaired by the Director General of Health Services (DGHS), serves as the steering committee for the entire MOH. The NTD Technical Committee (described further in the Strategic Planning section) is also part of the MOH Top Management Committee. The MOH Top Management Committee, through the DGHS and the Minister of Health, the State Minister for Health– General Duties, and the State Minister for Health–Primary Health Care, conducts program-specific high- level advocacy on behalf of the NTDCP; for example, during visits with representatives of parliament and meetings with visiting partner delegations (e.g., US Agency for International Development [USAID], RTI leadership, Pfizer, UK Department for International Development [DFID]) etc. The disease-specific programs are managed by trained and experienced MOH staff, comprising program managers, scientists, technicians, and support staff. The MOH pays salaries, provides office and laboratory space and contributes to the procurement of laboratory equipment. At other levels of the health system, the MOH and district local governments recruit and provide salaries for NTD administrative and technical staff. Clearing, handling, and transportation of NTD drugs and supplies from the port of entry to districts and lower-level health units is handled by the National Medical Stores (NMS) through an agreement with MOH and the National Treasury. On occasion, ENVISION hires vehicles to transport drugs to districts when the NMS delivery schedule is not in alignment with the MDA schedule. The major donors supporting the NTDCP are USAID, the World Health Organization (WHO), DFID, and the Queen Elizabeth Diamond Jubilee Trust (TheTrust). Implementing partners include RTI International, The Carter Center, Sightsavers (UK), Schistosomiasis Control Initiative (SCI, Imperial College London, UK), and Christian Blindness Mission (CBM) International (Germany). The NTDCP has additional partners working on water, sanitation, and hygiene (WASH) activities, many of which overlap with the trachoma program in particular (see details in Table 1). The Carter Center supports OV elimination activities in 21 districts (including 3 districts co-supported by Sightsavers) with funding from USAID through ENVISION and from private sources. These activities include MDA; targeted vector control where there is ongoing transmission; post-treatment surveillance (PTS) where transmission has been interrupted; and knowledge, attitudes, and practices (KAP) studies in districts where three years of PTS have been completed. The Carter Center also supports OV-related cross-border activities between Uganda and the Democratic Republic of Congo (DRC) and South Sudan, including activities in each of those two other countries. It is important to note that ENVISION activities proposed by The Carter Center for FY18 are also partially funded by its other donors and are not exclusively funded by USAID. The Carter Center also supports the national molecular laboratory, where essential tests are performed to verify interruption of river blindness transmission, through a collaboration with the University of South Florida (Professor Tom Unnasch), and the Uganda Onchocerciasis Elimination Expert Advisory Committee (UOEEAC). The UOEEAC provides technical oversight of the national OV elimination program and guidance to the MOH. The Trust provides financial support for the implementation of the Surgery (S), Facial cleanliness (F), and Environmental improvements (E) components of the Surgery, Antibiotics, Facial Cleanliness, and Environmental improvement (SAFE) strategy. The Trust’s focus is particularly on surgery, with some complementary support for the F and E components. In Uganda, The Carter Center administers Trust funds and manages planning and coordination; Sightsavers and CBM serve as Trust implementing partners. Significant Trust-supported activities include conducting Trachomatous trichiasis (TT)-only surveys especially in districts that recorded a disparity in the TT backlog reported in earlier surveys; and large-

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scale TT surgery camps in 17 eastern districts, including all districts of Busoga and Karamoja sub-regions. Some districts have now reached the ultimate intervention goals for trachomatous inflammation– follicular (TF) and TT—required for elimination of trachoma. In 2017, the Trust extended these activities to the rest of the trachoma-endemic districts in Northern, Western, and West Nile regions, reaching 31 districts. The Trust also supports small-scale facial cleanliness and environmental improvement initiatives through its WASH partners: Water Mission Uganda, WaterAid Uganda, Busoga Trust, Concern, World Vision, and Welthungerhilfe. The John Hopkins School of Public Health’s Center for Communication Programs (CCP) signed an agreement with The Carter Center and The Trust to provide them with strategic communication technical support. CCP is finalizing a set of updated integrated IEC/behavior change communication (BCC) materials, following a review of the existing IEC materials and communication strategy shared with them by RTI. CBM was one of The Trust’s two implementing partners for TT surgeries in five districts in eastern Uganda: Napak and in Karamoja sub-region, and Bugiri, Namayingo, and Namutumba in Busoga sub-region. However, CBM ended its TT surgical activities in Uganda and closed its field offices in April 2017 after Uganda achieved its ultimate intervention goal for TT in these districts. Sightsavers has long been a partner for trachoma and eye disease control. In 2006, it supported the first trachoma baseline surveys in eastern Uganda and has for many years supported eye care services through specialized clinics throughout the country. Sightsavers is The Trust’s other implementing partner for TT surgeries, supporting these in 17 districts, and in June 2017 expanding the program to 14 more districts in northern and the eastern parts of the country. During fiscal year 2018 (FY18), Sightsavers will be implementing Trust supported activities in 17 districts: Lira, Kitgum, Yumbe, , Maracha, , Nebbi, Zombo, , Moyo, Lamwo, , Omoro, Amuru, , Oyam, and Pader. Sightsavers also supports OV control/elimination in eastern Uganda, including MDA in , Buliisa, , and Kibaale, and PTS activities in Hoima and Kibaale. Of these, ENVISION supports only Buliisa, for SCH and/or trachoma MDA. Sightsavers will continue supporting vector control in Pader, Kitgum, and Lamwo districts. In FY18, Sightsavers will support the NTDCP’s LF Program by conducting a KAP study in 3 districts (Lira, Kitgum, and Yumbe); rapid assessments of the burden of chronic manifestations of LF; and support Morbidity Management and Disability Prevention (MMDP) activities in districts co-endemic for OV, through hydrocelectomies and lympheodema management in 16 districts in Acholi, West Nile, and parts of Lango sub-region.. SCI/DFID: DFID has supported SCH and STH control in Uganda since 2003 through SCI (Imperial College London, UK), focusing on MDA, disease re-assessments, and operational research. Prior to FY16, SCI supported MDA and assessments in districts with low SCH endemicity (prevalence of 1%–10%). In FY16, RTI transferred STH support activities for a number of districts to SCI, with the agreement of the MOH. In FY17, ENVISION transferred NTDCP support activities for an additional 26 districts that are endemic for SCH/STH only to SCI. This arrangement enables SCI to support districts that are endemic for SCH and STH only, and ENVISION to support districts that require integrated treatment. For its operational research component, SCI collaborates with institutions supported by the European Union, Wellcome Trust, Medical Research Council (UK), The Royal Society (UK), and Kenya Medical Research Institute.

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WASH partners • Water-Aid Uganda supports small-scale sanitation programs in selected subcounties and parishes in Busoga and Karamoja sub-regions. • Water Mission is conducting a three-year program (2016–2018) in all 10 districts (88 subcounties, 587 parishes of Busoga sub-region) in the east. The focus is improved community sanitation by training district and subcounty leaders, teachers, religious leaders, and parish and community F and E ambassadors of change. Participants are trained on the causes, transmission, control, and prevention of trachoma. Water Mission also supports water harvesting for domestic use and establishing community water points (taps) in subcounties in the districts of and Namayingo. • Busoga Trust supports water supply and sanitation programs in Busoga sub-region. It is managed by the Church of Uganda. • John Hopkins University-CCP researches communication barriers and designs appropriate IEC and BCC materials to eliminate trachoma and control SCH. In FY17, CCP partnered with MOH, ENVISION, and other partners to review and update IEC materials, which will be rolled out in FY18. CCP does not have a budget to print IEC materials; therefore, ENVISION will provide that support. • United Nations Children’s Fund (UNICEF) is one of Uganda’s key WASH partners, funding related programs in schools and working closely with the MOH’s Health Promotion and Education Division (HPED) and Environmental Health. • Concern strengthens coordination and delivery of trachoma- and WASH-related messages to promote hygiene and trachoma awareness. It also updates and prints health education materials for the Mother Care Groups. • World Vision Uganda (WVU) encourages schools to have WASH clubs, spurs villages to adopt community-led total sanitation (CLTS), and promotes WASH coordination meetings in 3 districts. WVU also trains hygiene promoters, Mother Care Group Lead Mothers, teachers, and others to promote hygiene and increase awareness of trachoma. WVU provides health education materials and holds community meetings/dialogues and video shows, among other media activities. • Water-Aid Uganda installs water points in schools, trains hygiene promoters and others on trachoma/WASH, builds latrines and handwashing facilities, and spurs villages to adopt CLTS. It also updates materials to promote key behaviors to encourage the prevention and treatment of trachoma. • WHO Country Office : Globally, WHO sets the guidelines for the control and elimination of NTDs and coordinates NTD drug donations, including albendazole (ALB) for LF and STH, mebendazole (MEB) for STH, praziquantel (PZQ) for SCH, and ivermectin (IVM) for LF and OV. In Uganda, the WHO Country Office participates in the NTD Technical Committee and in NTD Secretariat meetings. From 2005–2015, WHO funded a study, conducted by the MOH Vector Control Division (VCD), to assess the impact of STH deworming in 10 districts in five regions (Karamoja, Eastern, Central, Western, and West Nile). The districts were selected based on favorable STH transmission conditions (SCH was not targeted, but since the diagnostic method is the same, it was also reported). The WHO Country Office also helps the NTDCP to procure diagnostics of the proper type and quality standards. WHO Uganda also provides technical assistance during preparation of joint applications for donated NTD drugs, and through the Regional Program Review Group (RPRG), where it advises

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the NTDCP on implementation units to undertake transmission assessment surveys (TAS) or to stop MDA for LF. • Malaria Consortium Uganda is piloting podoconiosis case detection and management in Kibaale, , and districts, with activities that include training health workers, supportive supervision, and community awareness-raising through mass media and production of IEC and training materials, expected to continue into 2018. The Consortium has shown interest in supporting MMDP activities for LF; however, no formal commitment has been made. • Footworks conducted health worker training for podoconiosis case management in October 2015 in Kamwenge, Kabarole, Kibaale, Ibanda (western Uganda), Kween, and Manafwa districts (eastern Uganda). It is hoped that Footworks will extend similar support to other highly- affected districts such as Nakapiripirit and Napak in eastern Uganda, which are co-endemic for podoconiosis and LF.

Table 1: Non-ENVISION NTD partners working in country, donor support, and summarized activities List other donors Partner Location Activities supporting these partners/activities The Carter Center 21 OV-endemic districts • Capacity building, planning, The Trust support to MOH and districts for OV MDA; vector control/elimination; entomological surveillance; OV impact assessments; post-PTS and KAP studies • Lead agency for technical assistance (TA) and funds management for TT surgeries and WASH activities for The Trust • TT surgeries in trachoma- endemic districts of northern and western Uganda, beginning in April 2017 CBM Northern and Eastern CBM was an implementing partner The Trust Uganda for TT surgery and trachoma- related field surveys up to April 2017 when it closed its field offices in Uganda Sightsavers a) Busoga sub-region in a) Technical and financial The Trust; Standard Chartered Eastern Uganda (7 assistance to NTDCP and district Bank (Uganda); Standard districts), local governments for strategic Chartered Bank; DFID Karamoja sub-region in planning, capacity building, Eastern Region (5 equipment for TT surgeries and eye districts) care; logistics, motorcycles, mobile sound systems for IEC campaigns in Karamoja sub-region where radio services are not well developed

b) Bunyoro-Western (4 b) OV control and elimination districts) activities in 3 districts (MDA and Simulium vector control)

c) Northern Region in 4 c) Simulium vector control, districts involving dosing of rivers with

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List other donors Partner Location Activities supporting these partners/activities Abate (an organophosphate)

d) Northern Uganda in 4 d) MMDP activities – rapid districts assessment of magnitude; lymphedema management and hydrocelectomies in 4 districts SCI Central Region (districts TA, capacity-building, operational DFID along the shores of Lake research, MDA and reassessments Victoria and Victoria Nile of prevalence, intensity and and island districts morbidity in SCH endemicity within the Lake) and districts Western Uganda Trachoma WASH Busoga and Karamoja Financial and technical support for The Trust partners (Water regions trachoma-related WASH activities Mission, WaterAid, and BCC Busoga Trust, AVSI/Italian Cooperation, World Vision, and John Hopkins University WHO Country Office In all NTD-endemic At country level, provides technical WHO Uganda, African Regional districts with active PC- support, coordination of capacity Office, and Geneva NTD programs building/trainings, and assessment headquarters of interventions on STH infections Lions Club Uganda Central level Advocacy at national and district Lions Club International levels Acts as a conduit for funds to support trachoma implementation activities Environmental Health All regions Guidelines on sanitation; WHO, Danida, DFID, German Division, MOH handwashing programs in schools; International Cooperation, latrine coverage surveys in Italian Cooperation, others districts; M&E Ministry of Education’s All regions Deworming, sanitation, and WASH UNICEF School Health activities in schools Department Training of teachers in charge of pupils’ health and sanitation Policy formulation, coordination, advocacy, training, and M&E

2) National NTD Program Overview

USAID support for Uganda’s NTDCP began in 2007, and is one of the Agency’s longest-standing NTD country program commitments. Support initially focused on the completion of mapping, the integration of four vertical PC-NTD programs (trachoma, LF, OV, SCH), and the scale-up of MDA to all eligible districts. Support is now focused on maintaining good MDA coverage, reaching the 2020 elimination goals, and developing strong, sustainable disease control programs. In all NTD-endemic districts, including those supported by USAID, the NTD Secretariat works with districts to coordinate the range of activities necessary for MDA including but not limited to logistics

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management, MDA implementation, social mobilization, and supervision. The NTDCP also conducts extensive national- and district-level capacity building, including training. a) Lymphatic Filariasis

In Uganda, LF is transmitted by the common malaria mosquitoes Anopheles gambiae and An. funestus; the Culex mosquito is also prevalent in urban areas. Baseline epidemiological studies and rapid mapping of LF started in 1998, using a combination of chronic clinical manifestations, circulating filarial antigen (CFA), and night blood smears to detect microfilariae (Mf). LF was found to be highly endemic in parts of northern and eastern Uganda, with prevalence higher than 30% in some areas. The most common clinical manifestation was hydrocele, followed by elephantiasis. Rapid mapping using CFA in school-age children (SAC) and adults was conducted nationwide from 2000 to 2002, demonstrating wide LF distribution, with highly endemic areas in northern and eastern Uganda, north of the central lakes (Kyoga and Kwania). A small focus was found in and Districts in the west along the DRC border, where the disease is associated with An. bwambae (of the An. gambiae species complex) which breeds in the hot sulfur springs. The Program to Eliminate Lymphatic Filariasis (PELF) is part of the VCD of the MOH. The national NTD plan aims to eliminate LF by 2020 through a multi-pronged approach that includes: • Annual MDA with IVM and ALB in all endemic districts • MMDP to reduce the burden of LF chronic manifestations in affected populations • Promotion of other interventions that have an impact on LF, such as long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS) PELF first conducted MDA for LF in 2002 in Lira and districts (which have now split into 7 districts), treating more than a million people. Treatment was extended to 5, then 12 districts, with support from WHO and the Liverpool LF Support Centre. This support was for a single round of treatment, as partners were uncomfortable with the country’s political situation. The civil war and insurgency that escalated in northern and eastern Uganda in 2003 interrupted treatment in that year and again in 2006. With the support of USAID, nationwide LF mapping was conducted in early 2010, and MDA scaled up to 100% geographical coverage by the end of the same year. Since the commencement of USAID support, LF-endemic districts have conducted five or six rounds of MDA, although some rounds may not have not achieved sufficient 65% epidemiological coverage in all districts. TAS conducted through FY15 indicated that LF transmission has been interrupted in 35 districts. This equates to approximately 8.4 million people freed from the risk of infection. An additional 8 districts passed TAS in FY16. The MOH has submitted a request to the WHO Regional Office for Africa (AFRO) RPRG to approve these districts to stop MDA. It should be noted that RPRG approval is not formally required to stop treatment following a successful TAS; henceforth, NTDCP will not wait for RPRG approval following successful TAS. In FY17, 5 further districts conducted TAS leaving 9 districts with a population of 2.5 million people still requiring MDA. This includes Omoro, which is newly created through re-districting. In FY18, 3 districts will conduct TAS-1 and 17 districts will conduct TAS-2, leaving only 7 districts requiring MDA (includes which is expected to split from Arua in 2018). The country is on track to achieve interruption of LF transmission by 2020. The seven districts still requiring treatment include some of the most difficult populations to reach, and there is a need for an improvement in MDA drug coverage in these areas. The most heavily affected

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districts are in the Northern Region where, historically, the chronic manifestations of LF (hydrocele and elephantiasis) have also been most common. This includes , which requires an enhanced MDA strategy to reach populations in urban settings. Morbidity management is the second pillar of the LF elimination strategy, with related activities supported by Sightsavers in the northern districts of Amuru, Lamwo, Pader, and Kitgum. This support focuses on the rapid assessment of the morbidity burden, with subsequent lymphedema management and hydrocelectomies conducted in some health facilities. In FY17, a KAP study to inform IEC materials on morbidity management was conducted in four districts co-endemic for LF and OV. The materials will be used for community education to increase health-seeking behaviors among people with LF morbidity. Vector control interventions such as the use of IRS and LLINs are led by the MOH’s Malaria Control Program and are likely to indirectly contribute to LF elimination. The MOH conducts IRS in malaria hyper-endemic districts in the north and east where LF is co-endemic. The MOH has distributed LLINs in all of the country’s districts. If these initiatives are sustained, they will have the ancillary benefit of helping to reduce residual transmission of LF. b) Trachoma

Baseline epidemiological mapping of trachoma using WHO-approved methods and supported by Sightsavers started in 2006. The surveys covered 2 districts in Karamoja sub-region and 4 districts in Busoga sub-region. Trachoma was found to be highly endemic in all districts surveyed, with TF rates in children ranging from 30% to 65%. Mapping of the rest of the country commenced when the NTDCP was established in 2007, starting with priority regions in northern and eastern Uganda. By 2011, 51 districts originally suspected of being endemic for trachoma had been mapped, reporting TF prevalence >5% (ranging up to 67%) in 44 districts, and TF <5% in 7 districts. In 2014, ENVISION provided technical and financial support for a desk review of 8 districts neighboring known trachoma-endemic districts that analyzed eye clinic and health management and information system (HMIS) records for reported eye infections and morbidity including TF, TT, and evidence of corneal scarring. The review showed just 1 district () with evidence of significant active trachoma; the district subsequently registered TF of 5%–9.9% when mapped. The WHO SAFE strategy for trachoma elimination guides NTDCP trachoma activities. The first MDA with Zithromax® (ZTH) and tetracycline eye ointment (TEO) commenced in eastern Uganda in 2007, with scale-up to 100% geographic coverage by 2013, thanks to support from USAID through ENVISION. The NTDCP conducted MDA in 36 endemic districts (38 following redistricting) based on baseline TF prevalence and impact survey results: at least one round with sufficient coverage in districts with prevalence of 5%–9.9%, three rounds in districts with prevalence of 10%–29.9%, and at least five rounds in districts with TF of ≥30%. In FY18, the NTDCP will conduct MDA in 3 districts (increased from 2 following redistricting) in Karamoja sub-region, with ENVISION support. As of June 2017, the NTDCP is still conducting the trachoma impact surveys (TIS) and surveillance surveys in 19 districts scheduled for FY17. The preliminary results indicate that Amudat and Kabong require one more round of MDA, which will occur in October 2017 and be reported in the FY17 workbooks. In FY18, TIS will be conducted in Amudat and Kabong while trachoma surveillance surveys (TSS) will be carried out in 13 districts (18 evaluation units [EU]). The MOH has implemented TT surgeries in the highly endemic Busoga sub-region in Eastern Uganda with support from Sightsavers and CBM through The Trust.

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c) Onchocerciasis

OV, caused by the filarial worm Onchocerca volvulus , was originally endemic in 37 of the country’s then 112 districts. An estimated 2 million people are infected, and nearly 3 million people are at risk of infection. These numbers are under review by the NTD Secretariat following successful cessation of MDA in many foci, and may consequently be reduced. As of June 2017, 20 districts have been able to stop MDA, with treatment continuing in only 21 districts. OV mapping and vector surveys began in the 1940s, and large-scale OV control started in the 1950s focused on the Victoria Nile and consisting of intermittent treatment of the River Nile with low doses of dichlorodiphenyltrichloroethane (DDT), a chlorinated hydrocarbon insecticide. This larviciding resulted in elimination of the S. damnosum sl vector in that focus in 1974. From 1992 to 2007, the MOH started implementation of annual MDA with IVM. USAID support for OV control and elimination began in 2007, when the MOH’s National Onchocerciasis Control Program (NOCP) launched a two-pronged control and elimination strategy, as recommended by WHO and African Program for Onchocerciasis Control. The strategy entails: (1) MDA once or twice per year in all endemic foci, using IVM alone or in combination with ALB in areas co-endemic for LF; and (2) vector control/elimination campaigns in all isolated foci and in some semi-isolated foci where control/elimination was deemed feasible by the NOCP. Areas targeted for OV control conduct treatment annually, whereas areas targeted for OV elimination conducted treatments twice per year. Since 2007, MDA has been halted in 18 districts (10 foci) and is continuing in 21 districts in the 9 remaining foci. ENVISION funds MDA twice per year in 21 districts (led by the NOCP with support from The Carter Center and RTI)2 and once per year in 2 districts (Yumbe and Koboko) co-endemic for LF and confirmed as not having OV transmission the NOCP ENVISION also supports: (1) the training cascade; (2) mobilization and sensitization (health education); (3) MDA registration or register updates; (4) epidemiologic assessments; (5) coverage validation; (6) IEC materials; and (7) cross-border surveillance. MDA treatment and data validation take place twice a year, and entomological assessments are conducted monthly. Other activities are implemented annually. The NOCP implements vector monitoring and/or vector control alongside MDA in six of the nine remaining foci with support from The Carter Center and other partners (non-USAID funds). Sightsavers supports vector control in the Northern Region focus, where disease endemicity and transmission historically have been high. The NOCP conducts river-dosing activities in some foci, using Abate insecticide as a larvicide (supported by The Carter Center, with non-USAID funds). Analyses of fly and blood samples from residents in endemic areas is undertaken at the VCD advanced molecular biology laboratory. Post-treatment surveillance surveys to determine recrudescence potential and infection with OV parasites are conducted through parasitological indicators (skin snips microscopy for Mf and OV-16 enzyme-linked immunosorbent assay [ELISA] serology for parasites in blood) and entomological indicators (polymerase chain reaction [PCR] analysis of black flies for infective larvae). PTS surveys have been conducted in all foci where MDA has stopped, with no positive cases or signs of recrudescence to date. Crab trapping forms part of the surveillance of vector elimination. The fresh water crabs ( Potamonautes spp ) live in phoretic association with the larvae and pupae of flies of the S. neavei complex. Crabs are examined for the larvae, pupae, and pupal cases, which attach to the body

2 ENVISION supports a second round of OV treatment integrated with LF or STH in all 21 districts; in 3 of those (Masindi, Buliisa, and Hoima), Sightsavers also makes a partial contribution

ENVISION FY18 PY7 Uganda Work Plan 17

and limbs of the crabs. These are identified to species level using morphology, and then preserved. The numbers caught are recorded to determine any changes in abundance and species composition. In some foci, crabs have disappeared following dosing of rivers and deforestation. Human-landing catches are also used to collect biting adult Simulium neavei sl and other fly species. In FY18, ENVISION will continue to support monthly fly and crab captures where treatment is ongoing. The MOH plans to continue these activities during the PTS period in selected foci; The Carter Center will support river dosing with donated Abate with non-USAID funds. The UOEEAC was formed in 2008 to advise the MOH on whether and when MDA can be stopped. The UOEEAC is composed of Ugandan and international OV experts, and chaired by Prof. Tom Unnasch from the University of South Florida. The UOEEAC’s annual meeting is financially supported by The Carter Center and ENVISION. UOEEAC responsibilities are to: • Review program activity reports annually from each elimination-targeted focus • Advise the MOH on focus-specific monitoring and evaluation (M&E) activities and recommend halting treatment when appropriate, in accordance with international and national guidelines • Make any other recommendations to the MOH on activities needed to reach the national 2020 OV elimination goal. (Please see Appendix 9 for the August 2017 version of the UOEEAC’s OV “flag.”) d) Schistosomiasis

SCH, caused by Schistosoma mansoni for intestinal SCH and S. haematobium for urogenital SCH, is endemic in 87 districts. S. mansoni is widespread, occurring in all 87 districts, while S. haematobium is now confined to a few northern districts. In Uganda, SCH is associated with large water bodies; permanent and semi-permanent rivers, streams, and reservoirs constructed for watering animals; and irrigation schemes. In high-risk (≥50% prevalence) areas, the NTDCP follows WHO guidance in treating school aged children (SAC) and high-risk adults annually. In moderate risk areas (≥10%–<50% prevalence) SAC are treated annually, and once every two years in low-risk (≥1%–<10% prevalence) areas, as compared to the WHO recommended minimum of once every two years and twice during primary school ages, respectively. The NTDCP often conducts MDA for SCH at the sub district level, resulting in more than one treatment strategy in any given district. The NTDCP conducts SCH prevalence evaluation surveys once districts complete their fifth or sixth round of SCH MDA and aims to adjust the district treatment strategy depending on the findings. The surveys are based on the lot quality assurance sampling method and use the Kato-Katz diagnostic technique. One such assessment is planned for FY17 and results will inform FY18 treatment strategy. Approximately 5.4 million people are infected with SCH, and 10.9 million are at risk. Of the 93 endemic districts, 37 are considered high risk, 13 moderate risk, and 43 low risk. Reinfection rates remain high in some districts in the Albertine Rift valley (Nebbi, Buliisa, Hoima, Ntoroko) and in the east (Namayingo and ), with concern that infection is not falling even after several rounds of annual treatment. Human behavior, cultural practices, poor sanitation, cross border movements in search of fish and snails, susceptible snail hosts, and perennial transmission help maintain high SCH endemicity. Recent studies by VCD and Medical Research Council demonstrated that in a cohort of treated school children, almost 80% were re-infected and shedding S. mansoni eggs three weeks later. Also, up to 50% of children under five years who are not treated through MDA for lack of pediatric formulation were infected. Intensified efforts and operational research have been called for by the NTD Technical Committee, national and regional meetings, and the recent joint NTDCP-SCI SCH workshop.

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ENVISION support for SCH MDA varies by year due to the cyclical treatment schedule recommended by WHO. ENVISION supported treatment in 32 districts in FY16, and 14 districts in FY17. In FY18, ENVISION will support treatment in only 16 districts after transferring support for a further 26 to SCI, as discussed with the MOH. These 26 districts were previously endemic for LF and/or trachoma and/or OV, but have successfully passed stop-MDA surveys for these diseases. ENVISION SCH support in FY18 is, therefore, only for districts that are co-endemic for SCH and other NTDs. ENVISION provides financial and technical support for social mobilization activities to improve PZQ uptake, such as community dialogue on SCH prevention practices. Major landing sites are used as locations for discussion with community members that involve Beach Management Units 3 and local leaders. In FY18, ENVISION will continue to support these activities by providing disease-specific assessment (DSA) for district political leaders to mobilize people for MDA and supervise MDA activities, especially in densely populated landing sites. e) Soil-Transmitted Helminthiasis

STH is endemic in all 128 districts. Baseline surveys showed that hookworm is relatively homogenously distributed in the country, exceeding 60% mean prevalence in SAC. Infections with A. lumbricoides and T. trichiura are concentrated in the southwest, where prevalence can be as high as 100%. Infections with T. trichiura have historically been lighter, but there is some evidence of infections spreading to central Uganda due to migration, as evidenced from recent SCH/STH re-assessment surveys. The MOH conducts twice-yearly deworming of children aged 1–15 years across the entire country, in April and October, during Child Health Days (which includes treatment in schools). This is coordinated by the Child Health Division and jointly funded by the MOH’s primary health care funds and UNICEF. In districts co-endemic for LF and STH, the MDA is integrated, so children take a combination of IVM+ALB (or ALB alone for under-fives) during the first round of treatment and ALB alone in the second round. The NTDCP LF program, funded by ENVISION, has contributed to control of STH. ENVISION-supported MDA aligns with Child Health Days, thus coordinating the two programs. In districts co-endemic for LF, the ALB required for STH is provided by PELF MDA. In cases where LF funds and/or drugs are delayed, districts generally postpone their Child Health Days while awaiting LF MDA resources.

3 Management units of landing sites/marinas, elected by residents to implement regulation of fishing, health, and security

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3) Snapshot of NTD Status in Uganda

Table 2: Snapshot of the expected status of the NTD program in Uganda as of September 30, 2017 4 Columns C+D+E=B for each Columns F+G+H=C for each disease disease* MDA MAPPING GAP MDA GAP DETERMINATION ACHIEVEMEN DSA NEEDS DETERMINATION T A B C D E F G H I No. of No. of districts Expected no. districts expected to be No. of of districts Total No. of No. of receiving in need of MDA No. of districts where criteria no. of districts districts MDA at any level: districts classifie for stopping Disease districts classified in need as of MDA not yet requiring DSA d as district-level in as of initial 09/30/17 started, or has as of non- MDA have Uganda endemic mapping USAID prematurely 09/30/17 endemic been met as of Fun- Others stopped as of 09/30/17 ded 09/30/17 TAS1: 3 Lymphatic 61 67 0 9 0 0 52 TAS2: 17 Filariasis TAS3: 0 Onchocerciasis 41 85 0 215 0 0 20 0

Schistosomiasis 128 93 35 0 16 77 0 0 0 Soil-transmitted 128 0 0 9 119 0 0 0 helminths TIS:27 Trachoma 47 81 0 56 0 0 42 TSS:13 8

4 This represents the 2018 geography of 128 districts therefore Columns C+D+E do not equal B nor do Columns F+G+H equal C 5 Two districts, Yumbe and Koboko, are no longer treating for LF and OV. Also, Sightsavers partially supports one round of OV MDA in three districts 6 We list 5 districts because Nakapiripirit will form Nabilatuk during FY18. 7 In FY17 two districts (Amudat and Kabong) conducted TIS that resulted in TF prevalence between 5-9.9%. Both districts are conducting MDA in October 2017 and will conduct another TIS in FY18.. 8 There are 13 districts that will require a TSS in FY18, however, 5 of them have large populations requiring them to be split into two. Therefore, there are 18 evaluation units requiring surveillance surveys.

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PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

In FY18, ENVISION will support capacity strengthening activities for the MOH NTD Secretariat as described below. On a more routine basis, ENVISION’s capacity strengthening efforts are also embedded within program activities . Objective 1. Strengthen capacity for annual work planning and activity planning Intervention 1: Train/orient the MOH NTDCP data manager on information systems and data management systems: ENVISION will support the NTDCP’s data manager to take a three-week training on information systems and database management at the Uganda Management Institute, in March 2018. This activity was planned for FY17; unfortunately, the data manager was not able to participate due to a scheduling conflict with the coverage validation survey. Intervention 2: Senior NTD staff training in program planning, management, financial management, and evaluation: In FY18, ENVISION will support 10 senior MOH NTD staff to attend a two-week evening course of program planning, management, financial management, and evaluation. The course will be conducted at the Uganda Management Institute in . The MOH NTD Coordinator will provide post-training monitoring for her team and check the extent to which acquired knowledge is being utilized. The course will increase the participants’ knowledge and skills in problem analysis, M&E, participatory approaches towards project planning and management, and procurement. It is expected that providing this training will reduce the MOH’s reliance on RTI to plan NTD activities and improve on the timely implementation of activities, all of which are important for program continuity. Objective 2. Strengthen capacity to manage PC-NTD data and to use data for decision-making Intervention 1: Training for senior NTDCP staff on the integrated NTD Database: NTDCP managers and senior program staff were introduced to the NTD database during its development, but it is necessary to keep training them in its use. This will help ensure they can access and extract data from the database for programmatic decision making and to feed into the development of the LF and trachoma dossiers. Costs include meals and refreshments. Intervention 2: Trachoma Dossier Development: The Uganda MOH has formed a small technical working group consisting of MOH and partner representative to develop the trachoma dossier. Instead of using a consultant to drive this activity, RTI will support the MOH to lead this effort.

a) Monitoring Capacity Strengthening

The following indicators will be used to monitor and report on the activities described above: Objective 1. Strengthen capacity for annual work planning and activity planning • Timely planning and implementation of activities tracked through ENVISION’s quarterly budget expenditure and forecast. Monthly reports and disease/program workbooks will also show timely implementation of activities. • Improved quality of reports and plans tracked through internal feedback from partners

ENVISION FY18 PY7 Uganda Work Plan 21

Objective 2. Strengthen capacity to manage PC-NTD data and to use data for decision making • NTD data accessed by all relevant personnel • NTD database completed, verified, and regularly updated • Programmatic decisions based on data analyzed • Trachoma dossier developed using data in NTD database

ENVISION FY18 PY7 Uganda Work Plan 22

2) Project Assistance

a) Strategic Planning

Activity 1: NTD Technical Committee meetings : The NTD Technical Committee, established in 2014, provides guidance on NTD activity planning. ENVISION will support two 2-day quarterly meetings in FY18. ENVISION will support committee members to provide technical oversight and monitoring of activities in the field, particularly in ENVISION-supported districts. The Committee will also help guide the transition from donor support to full government ownership. ENVISION will work with the committee to guide the development of transition plans for districts that have stopped MDA for LF and trachoma. Additionally, the Committee will continue using data from the Integrated NTD Database in its discussions, and supports data use in programmatic decision making. Activity 2: National planning and data review meeting : This meeting will address issues of data quality and accuracy, and use this information to inform program planning and implementation. The first day will focus on data review—specifically, the ongoing issue of data incompleteness—and how to use district and sub district level data to inform program design. The district biostatisticians and planners will review data processes. Days 2 and 3 will review the implementation of the FY17 recommendations, and identify priority activities for FY19. Day 4 will focus on cross-border issues with the aim of developing a harmonized operational plan for NTD control across national borders. The meeting will be attended by DHOs and district NTD focal persons; NTD pprogram managers; NMS representatives; and key partners and representatives of the National Technical Advisory Committee. MOH representatives from DRC, South Sudan, and Kenya will be invited. Activity 3: Regional planning and review workshop : ENVISION will support one meeting for districts still receiving project support. This will be convened by the NTD Secretariat and involve the DHO, CAO, the NTD focal pperson, and implementing partners. The meeting will review MDA coverage data and survey results, discuss specific challenges and related solutions, and develop district-level plans and budgets for FY18 including program sustainability approaches. An area of focus will be identifying and documenting best practices to improve coverage. These work plans will inform the contents of ENVISION’s FY19 fixed obligation grants (FOGs) to these districts. ENVISION staff will work closely with the NTD Secretariat to jointly lead the meeting. Activity 4: District microplanning and post-MDA feedback meetings: ENVISION will support a three-day microplanning meeting in each of the 26 ENVISION-supported districts using the template developed in FY17. Completed templates will be shared with the NTDCP and used by ENVISION for FOG preparation. In order to promote ownership, the micro plan will be signed and submitted to the MOH and ENVISION by the district CAO with a commitment note to file. Prior to these meetings, the NTD program managers and RTI will conduct refresher training for central-level supervisors who will support district micro plan development. Costs for this activity include per diem, meals, transport for the district and central teams, venue rental, stationery, and coordination expenses. Additionally, each district will receive a copy of the updated National NTD Master Plan, which will be printed by ENVISION. Activity 5: SCH/STH transition planning (RTI) : Uganda has made great progress in achieving the elimination aims of trachoma, LF, and OV. Support for SCH and STH MDA implementation (the “control diseases”) presently comes from three main sources: 1) USAID through funding of integrated MDA; 2) SCI, which supports SCH/STH MDA in some parts of the country, and which in FY17 took on support for SCH MDA from RTI in 26 districts no longer requiring integrated treatment; and 3) MOH’s Child Health Division, with support from UNICEF, which conducts twice-yearly treatment against STH for children

ENVISION FY18 PY7 Uganda Work Plan 23

aged 1–15 years. In FY18, ENVISION will pilot the RTI SCH/STH transition plan developed in FY17. This will help to plan for how SCH and STH control will continue in the future, including procurement of PZQ for adults. This will be discussed with stakeholders (MOH, Ministry of Education, SCI) at the Uganda SCH meeting to be held in late August 2017. Activity 6: Uganda Onchocerciasis Elimination Expert Advisory Committee meeting : In FY18, ENVISION will support a five-day UOEEAC meeting (August 2018), with an estimated 50 participants. On Day 1 selected vector control officers will prepare and review presentations prior to the UOEEAC. Days 2, 3, and 4 will comprise a focused review of the progress of the NOCP, including the results of the April 2017 coverage validation survey, and epidemiological and entomological surveys carried out during FY17. Committee rrecommendations will include a clear plan for whether to stop or continue IVM treatment in specific foci. In line with WHO’s 2016 OV elimination guidance, the Ccommittee will recommend post-treatment surveillance in areas that stop MDA. As a best practice, the reasons for stopping treatment will be explained to communities, along with guidance to avoid recrudescence. Participants will be provided with copies of the report from the previous meeting and will assess the extent to which recommendations have been implemented. On Day 5, vector control officers will review recommendations and plan surveillance activities. Activity 7: National Stakeholder Meeting —River Blindness Program review meetings : ENVISION will support The Carter Center’s facilitation of two biannual OV review meetings to share field experiences, assess progress, discuss challenges, and plan the way forward. Participants will include 42 NTD focal persons and assistants from the 21 districts receiving treatment for OV, central-level MOH officials including the OV Program Manager, National NTD Coordinator, and partners. These meetings will be conducted in January and June 2018.

b) NTD Secretariat

Activity 1: Operational and program supervision support for NTDCP (RTI) : In FY18, ENVISION will continue to provide financial support to maintain office equipment and vehicles (including replacing vehicle tires and fuel and minor repairs) for the office of the National NTD Coordinator and the PELF, Bilharzia and Worm Control Program, NOCP, data manager, health educator, and trachoma program managers. Per diem for program officers conducting supervisory visits will also be covered. Activity 2: NTD Secretariat coordination meetings (RTI) : The NTD Secretariat has 17 officers from: MOH NTD (PC and IDM) program; human African trypanosomiasis (HAT), leishmaniasis, rabies, and jiggers programs; HPED; and representatives from RTI, SCI, Sightsavers, The Carter Center, the Technical Advisory Committee, and WHO. The national NTD Coordinator, who is also the Assistant Commissioner of Health Services, Vector Borne Diseases Control, chairs the Secretariat. The NTD Secretariat meets quarterly and is responsible for the overall planning, implementation, and M&E of NTD programs, which includes but is not limited to building capacity at central and district levels, reviewing resource allocationso NTDs, and supporting and participating in the development of guidelines, manuals, and IEC materials. In FY18, ENVISION will provide refreshments for two meetings. a) Building Advocacy for a Sustainable National NTD Program

In FY17, ENVISION provided technical and financial support to finalize the NTD communication strategy. Key staff attended a workshop to review existing documents and information from past surveys to develop this strategy. In FY18, ENVISION will support a combination of activities at national, district, and community levels to implement this strategy to help improve MDA coverage. The strategy identifies critical advocacy issues to increase country ownership and resource allocation; key among them are

ENVISION FY18 PY7 Uganda Work Plan 24

increasing integration of NTD activities and budgets into district plans, strengthening enforcement of existing by-laws promoting household and community sanitation, increasing communities’ access to clean water, and increasing participation of community leaders in MDA activities. In FY18, ENVISION support for advocacy will be as follows. Activity 1: Breakfast meeting with members of parliament (MPs) from the 26 ENVISION-supported districts: The political leaders (MPs) of ENVISION-supported districts will be targeted to inform them of the status of NTDs in their districts, the challenges experienced in achieving acceptable treatment coverage, and the need for NTDs to be included in national and district plans and budgets. MPs are responsible for making decisions on national budget allocations and can influence decisions to integrate NTDs into national and district plans, with sufficient funding from either government or partners. ENVISION, working with the NTD Secretariat, will organize one breakfast meeting in Kampala with MPs from these 26 districts. Presentations on the NTD status in these districts will be made by the MOH. A district has an average of three MPs, so 115 MPs will be invited to participate alongside representatives from WHO, The Carter Center, Sightsavers, SCI, MOH, Ministry of Local Government, and Ministry of Education. Some members of the national Technical Advisory Committee will participate in this meeting. Key outcomes will include: (1) better understanding of the burden of NTDs among decision-makers; (2) an understanding of government and partner achievements to date; and (3) explicit MP commitments, by signing a declaration, to give voice in parliament to NTD priorities and to advocate for inclusion of the NTD agenda in national and district plans and budgets. Activity 2: Northern Uganda regional advocacy meeting: This meeting targets district political, civic, and technical leaders including resident district commissioners, CAOs, DHOs, chief finance officers, assistant DHOs, NTD focal persons, LC5 chairpersons, LC5 vice chairperson, secretaries for health, district education officers, district inspectors of schools, district auditors, religious leaders, heads of health sub- districts, district health educators and district planners/biostatisticians. In FY18, ENVISION will support one regional meeting for the nine ENVISION-supported districts from northern Uganda. Topics to be covered include timely release of FOG funds from district accounts to reduce MDA delays, and the inclusion of NTDs in district budgets to foster sustainability. Other areas of discussion will include improvement of data management, particularly data collection, analysis, and use for program improvement. Activity 3: District-level advocacy meetings : In FY17, these meetings provided an opportunity to review district program performance and plan supportive supervision by district leaders. They also helped identify local resources to support MDA, for example radio airtime for mobilization provided by the RDC. In FY18, ENVISION will focus our support on the nine districts in northern Uganda where MDA coverage has been a recurrent problem. ENVISION support will allow central-level NTDCP to conduct half-day advocacy meetings in each district. It is expected that political, technical, and administrative district staff, including the DHO, will provide opportunities for continued engagement to identify post-ENVISION support for program activities.. Activity 4: News publications on NTDs : During FY17, ENVISION helped the NTD Secretariat establish functional working relationships with the print and electronic media. This resulted in increased coverage of NTDs in the daily newspapers with stories published weekly in the newspaper and on NBS television. Journalists and reporters were provided with transport and per diem to travel to the field to cover stories from the viewpoint of program beneficiaries and to interview district and community leaders on program performance. In FY18, this partnership will be strengthened to ensure adequate coverage of program activities, including reporting on areas that have stopped MDA to demonstrate

ENVISION FY18 PY7 Uganda Work Plan 25

that elimination is possible. To put in more effort for MDA, ENVISION will pay for field trips for journalists and reporters to cover and document success stories as well as report on areas that still need support from national and local leaders. ENVISION will document success stories and distribute them to districts, media houses, partners and the USAID Mission office.

b) Mapping

As the Uganda NTD program approaches LF and trachoma elimination, now is the appropriate time to ensure that all geographic areas have been adequately assessed for these NTDs. Following recent discussions with WHO and partners, the NTDCP identified additional mapping needs before reaching elimination. In FY18, ENVISION will support the following two mapping activities to ensure this is completed. Activity 1: Trachoma baseline assessments and surveys : There are 18 districts that share common borders with trachoma-endemic districts. These districts have never been surveyed for trachoma, as they were considered unlikely to harbor infection, and a previous desk review of some of the districts focusing on hospital records indicated that they were not endemic. In FY18, ENVISION will support trachoma rapid assessments (TRA) in suspected endemic districts to determine where full mapping surveys should be conducted. TRA will be performed in all suspected 18 districts. For budgeting purposes, we estimate that 10 of these districts will require full surveys Activity 2: LF and trachoma mapping in refugee settlements ): Over the last three years, Uganda has received an influx of refugees displaced by the civil and military conflicts in South Sudan and DRC, particularly into the border districts of Adjumani, Koboko, Moyo, Yumbe, , Arua, and Lamwo. These districts have received almost 1 million refugees to date who have settled in an estimated 15 camps spread across these districts. The refugees arrive in transit camps for screening and are later re-settled in camps, of which the numbers vary from district to district. The refugee settlements are supported by the Office of the Prime Minister and the United Nations High Commission for Refugees, with the support of local and international refugee agencies such as World Vision International, and the respective district local governments. Many refugees originate from areas known to be endemic for PC- NTDs (trachoma, LF, OV, SCH, STH) and sleeping sickness. There is a real concern that the influx of refugees will increase the risk of NTD recrudescence in these districts and counteract the gains to date. In FY18, ENVISION will support an NTD assessment for LF and trachoma in these 15 camps.

c) MDA Coverage

In FY17, ENVISION supported MDA in 55 districts: 20 received MDA in October 2017, 13 received MDA in April 2017, and 22 in July/August 2017. In FY18 ENVISION will support MDA in 26 districts 9: • 7 districts for LF and STH (in April 2018 and October 2018) • 3 districts for trachoma (in October 2018) • 21 districts for OV (21 will be treated in October 2017 and 21 in April 2018)10 • 16 districts for SCH (in April 2018)

9 We recognize there are discrepancies between the narrative and workbooks. This is due to redistricting. 10 While these are tallied as 21 here, the workbook tallies 25 due to re-districting. We are awaiting confirmation of OV endemicity of new districts.

ENVISION FY18 PY7 Uganda Work Plan 26

ENVISION funds for LF, STH, trachoma, and SCH MDA in the 26 districts will support all pre-and post- MDA activities, including advocacy, training of trainers (TOT), microplanning, social mobilization, registration and facilitation of community drug distributors (CDDs) during data collection. For these diseases, ENVISION also funds all treatment rounds. For OV, ENVISION funds all pre- and post-MDA activities for the first round of treatment in 21districts. The UOECC approved two rounds of treatment in 21 districts; therefore, ENVISION supports The Carter Center to distribute a second round in 18 districts, while Sightsavers funds and implements the second round in 3 districts. It should be noted that the 2 districts (Yumbe and Koboko) passed TAS1 in FY17 and will no longer be receiving treatment. ENVISION will support enhanced supervision in the districts receiving trachoma MDA ( Moroto, Nakapiripirit, and Nabilatuk ) and the three districts receiving LF MDA that have had persistently low MDA coverage (Gulu, Omoro and Kitgum)

Table 5: USAID-supported districts and estimated target populations for MDA in FY18 Age groups Total number Number of targeted Number of rounds of eligible Distribution districts to be NTD (per disease of distribution people to be platform(s) treated workbook annually targeted in FY18 instructions) in FY18 Community- and Entire population 5 Lymphatic Filariasis 1 school-based 7 1,533,919 years and older MDA Community- Entire population 5 2 21 2,350,630 Onchocerciasis based MDA years and older

Community- and Entire population 5 Schistosomiasis 1 school-based 16 2,411,467 years and older MDA Entire population 5 1 Community MDA 7 194,047 Soil-Transmitted years and older Helminths School-based SAC only 2 7 1,633,232 MDA Community- and Trachoma Entire population 1 school-based 3 299,920 MDA

Activity 1: Registration/update of treatment registers : Current treatment registers run through 2017. In FY18, districts will be supplied with new multi-year registers, and correspondingly, fresh registration will be conducted in all districts, except for those in the Karamoja Region, which received revised and simplified registers in 2016. This activity will be managed by central teams who, prior to implementation, will be dispatched to support the district teams to conduct community registration. The number of administration units—communities, schools, parishes, subcounties, HSDs, and health facilities—will be confirmed at that point. This is to ensure that all endemic communities/schools are registered to help plan for adequate stocks of drugs and related logistics. The district biostatistician and planners will be directly involved in this process to ensure the data retrieved are aligned with data available at district level. Activity 2: MDA LF-OV : ENVISION will support the procurement of 7,263 registers, provide airtime and district level data validation in Nebbi, Zombo, Arua, Adjumani, Gulu, Amuru, Kitgum, Lamwo, Lira, Moyo, Nwoya, Omoro, Pader, , and Rubanda. Oyam is not scheduled for validation in FY18. This takes place in November/December and April/May, after MDA. Sightsavers will conduct data validation in Bulisa, Hoima and Masindi.

ENVISION FY18 PY7 Uganda Work Plan 27

Activity 3: Trachoma MDA in Amudat and Kaboong 2017 trailing costs: ENVISION will support MDA in these two districts that had TF>5% following TIS.

d) Social Mobilization to Enable NTD Program Activities

In FY17, the NTD Secretariat and partners to finalized an NTD social mobilization strategy, providing a framework for the design and implementation of social mobilization activities. In FY18, ENVISION will support a combination of activities at national, district, and community levels to implement this strategy and improve MDA coverage. These include Activity 1: Community dialogue to improve MDA coverage : in the seven districts receiving LF and STH MDA, CDDs and parish supervisors will engage community members in discussions of NTDs, with a focus on NTD medicines. Drug side-effects will be discussed as well as other concerns raised by the community. The communication gaps articulated above will form the framework for engagement. The village LC chairpersons will mobilize household members to attend these meetings. Each village will hold such meetings during FY18. At the end of the meeting, IEC materials will be distributed to reinforce relevant messages. Question and answer sessions will assess the extent to which community members’ fears and perceptions have been allayed and the level of satisfaction with the exercise. CDDs will require flip charts to help in the community education process. In low performing areas, health workers and subcounty supervisors will reinforce the CDD teams and parish supervisors. In schools, existing clubs and groups will be used where available to discuss NTDs and provide the required information through club leaders and trained school teachers. Activity 2: Multimedia campaign for PC-NTDs : ENVISION will support the NTDCP to plan and implement a multimedia campaign using print media, radio, and TV channels during the two months prior to MDA. The multimedia campaign will aim to normalize MDA and assure all that the MDA approach is important for the prevention, control, and elimination of NTDs. The campaign will emphasize the safety of the medicines and explain how, when, and by whom medicines should be taken. The NTD Secretariat will form a task force to coordinate the multimedia campaign. Members will include representatives from the Health Education and Promotion Division of the MOH, NTD partners, the media fraternity, and ENVISION. Specifics of the campaign will include: • Radio: The radio component will comprise talk shows attended by key personalities like DHOs, NTD focal persons, NTD Secretariat members, community members who have benefited from treatment, CDDs, and local leaders. They will be call-in shows to allow community members to ask questions. Radio jingles and announcements will be aired around the time of MDA on local and regional radio stations. Communities will be informed of the time when the shows will be aired through radio announcements and by CDDs. In addition, subcounty supervisors, parish supervisors, and CDDs will use megaphones to inform communities about MDA and the planned radio talk shows and urge them to tune in. This approach was used in FY17 and helped to attract community members to treatment centers. This approach will also be used to mobilize community members for education and dialogue meetings at village level. • Television: Weekly panel discussions will be organized for four consecutive weeks prior to MDA. These will be aired on three TV stations: UBC, NTV, and NBS, to allow the widest reach. During FY17 this strategy was used on one TV station (NBS) with feedback from viewers that it was well received and long overdue. The panel discussion will cover NTDs and the prevention and control efforts the government has put in place. The MDA schedule and locations will be communicated during these

ENVISION FY18 PY7 Uganda Work Plan 28

discussions. Drug safety and possible side-effects will be explained. These will be call-in programs to allow viewers and listeners to ask questions. Members of the NTD Secretariat, and other senior MOH staff of the including the Director General of Health Services, will participate. ENVISION will support air time for the TV stations (where applicable) and provide allowances for the participants, especially those who are not MOH staff. • Documentation of success stories after MDA: The district supervisors will identify one beneficiary of trachoma and STH treatment per subcounty and document that beneficiary’s perception of MDA in the form of a story. Activity 3: Sensitization of sub county leadership : In FY18, ENVISION will provide technical assistance through the NTD Secretariat to help districts sensitize health sub districts and sub county leaders on NTDs and planned MDA. Within the local government system, the subcounty is the level at which government programs are implemented and supervised. This level receives direct district financial allocations. Subcounty chiefs/SASs have not been actively engaged in the NTDCP to date, and this has led to a lack of subcounty accountability regarding implementation activities. Subcounty chiefs and heads of health sub districts will be oriented on NTDs and their roles in the promotion of activities, especially MDAs. Treatment targets for subcounties will be agreed upon and the chiefs will be charged with ensuring achievement of those targets in their subcounties. Costs include per diem, vehicle hire, and fuel for vehicles. Activity 4: Disseminate documentaries for SCH in Albertine Region and trachoma in Karamoja Region ): In FY17, ENVISION supported the development of two documentaries; one on SCH in Albertine Region and one on trachoma in Karamoja Region. In FY18, ENVISION will support the dissemination of these documentaries in the form of producing 100 CDs that will be distributed to communities, including drama groups; having the documentaries aired on TV talk shows; and discussing the documentaries on radio. Activity 5: OV-related health education and sensitization by community supervisors: ENVISION will support community supervisor delivery of health education at community meetings and gatherings. IEC materials will be used to communicate key messages. The aim is to ensure community members understand the importance of registering themselves and family members, to understand the dangers of not taking IVM, and the exclusion criteria for treatment, among others. This will enhance IVM uptake, community participation, and ownership. The community supervisors will encourage their communities to select more women to work as CDDs and supervisors at the parish and community levels. Activity 6: Production of IEC Materials: Development of 98,000 posters and fact sheets in five local languages. These posters were revised during the FY17 social mobilization workshop and are now ready for printing and distribution

ENVISION FY18 PY7 Uganda Work Plan 29

Table 6: Social mobilization/communication activities and materials checklist for NTD work planning Has this material/ Where/ message or Key messages (in Target when will approach been Category English and local IEC Activity Frequency population they be evaluated? If languages 11 ) distributed not please detail how that will be addressed Pre-MDA -It is necessary to Eligible Training In the Once before Yes, it has been register population groups / communities every MDA evaluated and yourselves/family meetings approved by the for treatment. MOH -The risk of not taking IVM -Exclusion criteria for treatment -The utility of selecting women CDDs (The Carter Center) MDA MDA will take place Community -Radio Local station, -4 times daily -# of times Participation in communities and members living -TV 4 weeks in for 20 days, messages aired on schools [RTI] in endemic -Newspapers advance of, -Weekly radio during areas, -Community and 2 weeks school reference period- SAC, meetings during MDA assemblies Radio broadcast teachers -School campaign. for 4 weeks reports assemblies -One -Posters Weekly meeting per -% of targeted newspaper village population who pull-outs. before MDA seek NTD drugs during MDA Village meetings -% of audience who recall message- coverage survey, local/national omnibus survey Length of MDA, -Community -Radio -Local station -4 times daily -# of times what diseases are members living -Community messages for 20 days messages aired on targeted, drugs and in endemic meetings twice weekly -One radio during staggering of areas -TV for 4 weeks meeting per reference period— treatments [RTI] -SAC discussions in advance of village radio broadcast -Teachers -Flyers MDA before MDA reports -Sub county chiefs -TV program -# of meetings Religious for 4 weeks held and leaders Cultural preceding community leaders MDA and members attended

11 Acholi, Lango, Lugbara, Alur, Madi, Karimojong, Ateso, Kumam, Lusoga, Lunyole, Kiswahili, Lunyoro/Rutoro/Runyankole, and Luganda

ENVISION FY18 PY7 Uganda Work Plan 30

Has this material/ Where/ message or Key messages (in Target when will approach been Category English and local IEC Activity Frequency population they be evaluated? If languages 11 ) distributed not please detail how that will be addressed Local council once every chairpersons week during -% of audience MDA who recall campaign message— coverage survey, local/national omnibus survey

Endemic diseases, -Community -Radio -Local -Weekly -# of times causes, signs and members in -Community station, a radio messages aired on symptoms, endemic areas meetings few days programs radio during prevention and -SAC -Newspaper before MDA -One reference period— control, what is -Political pull outs -Village meeting per radio broadcast being done including leaders -TV panel meetings village reports MDA schedule [RTI] -Teachers discussions -TV stations -School -Flyers -School discussion -% of population -Fact sheets settings groups that believe NTDs -Posters are not caused by witchcraft based on KAP survey

-% of audience who recall message— coverage survey, local/national omnibus survey -# of times -Local messages aired on station, 2 radio during -4 times daily weeks in reference period- for 20 days advance of —radio broadcast -Community once and 2 weeks reports members in -Weekly during MDA endemic and newspaper The drugs provided -Radio campaign -% of targeted targeted articles [RTI] are free and safe -Brochures [RTI] population that districts [RTI + The Carter -Newspaper seek NTD drugs -SAC -Messages Center] articles -Local station during MDA -Political play 10 times 1 week in leaders a day in advance of -% of audience -Teachers evening [The OV/LF MDA who recall Carter campaign message—- Center] [The Carter coverage survey, Center] local/national omnibus survey It is common for -Community -Training -District level -Flip charts, -# of flip charts, drugs to have mild members manuals CDD/ VHT VHT handbooks, side-effects. targeted for -Brochures teacher handbooks & and training guides

ENVISION FY18 PY7 Uganda Work Plan 31

Has this material/ Where/ message or Key messages (in Target when will approach been Category English and local IEC Activity Frequency population they be evaluated? If languages 11 ) distributed not please detail how that will be addressed These are mild, MDA -Radio refresher training disseminated transitory, and self- -Teachers -Newspaper training manuals will during reference limiting. -SAC articles -Radio be period [RTI + The Carter -TV panel -TV distributed - training Center] -CDDs discussions -Village once attendance list -Testimonies meetings annually (focal person by satisfied [RTI] [RTI] report) [RTI] clients -Radio and [RTI] -Subcounty TV panel -# of flip charts level discussions disseminated -Flip chart community weekly during reference [The Carter supervisors’ -Brochures period- training Center] and CDD distributed in attendance list refresher schools and (administration training [The at report) [The Carter Carter community Center] Center] meetings

-Flip charts will be distributed once annually [The Carter Center] Drugs handed out at -SAC -Brochures -Teacher -Brochures -# of brochures, school are safe and -Teachers -School club refresher to be handbooks, and keep you healthy -Parents and discussions training distributed training guides [RTI] guardians -School -Schools once to SAC disseminated assemblies -Radio -Radio during reference -Radio panel announceme period- training discussions nts during attendance list -Village the 4 weeks (focal person meetings before MDA report) -VHT -Weekly handbook, school club -% of targeted training discussions population who manual -VHT believe drugs are handbooks & safe training manuals will be distributed once annually Drugs handed out at In the % of audience who All eligible health units to community recall seeing the community Posters Once a year community and 2 weeks poster and members supervisors for their before MDA message—in

ENVISION FY18 PY7 Uganda Work Plan 32

Has this material/ Where/ message or Key messages (in Target when will approach been Category English and local IEC Activity Frequency population they be evaluated? If languages 11 ) distributed not please detail how that will be addressed respective coverage survey, communities [The or at point of MDA Carter Center) PTS Period -Interruption of Community Jingles, In the Once Yes, it has been transmission was members and posters, and community evaluated and declared, outlining leaders at brochures and various approved by the roles of stakeholders various levels district MOH at different levels offices -Be on the lookout for suspected infections and report them to the nearest Local leader, health workers, or health unit (The Carter Center)

e) Training

Activity 1: Training of central trainers/supervisors : ENVISION will support a three-day refresher/retraining of 60 central trainers at VCD/MOH, with facilitation by the NTD program, ENVISION, and other partner organizations. This will focus on the background to each disease and improvements in supportive supervision, especially the use of the supervision checklist. Central supervisors are responsible for providing technical guidance to districts. Their main responsibilities are to train district- based trainers (district TOTs); conduct district advocacy, and supportive supervision; and participate in impact assessments where appropriate. Before they are dispatched to districts, trainers and supervisors will be equipped with up-to-date knowledge of NTDs and the tools used in the program, including NTD factsheets and manuals. Activity 2: Training of district NTD focal persons at VCD : ENVISION will support the three-day training of 26 district focal points at the national level. Trainers will include members of the NTD Secretariat, NTD technical advisory committee, and the ENVISION data manager, who provides support with data tools. The training will focus on various topics including the role of the district in the program, the use of data for planning and evaluation, supply chain management, the use of data collection tools, reporting, and the management of adverse events and serious adverse events (AEs/SAEs). During training, programmatic challenges and mitigation approaches will be discussed with the focal points. Training is required annually because the district level focal points is an assignment rather than a full-time job, and hence there is some turnover each year. Activity 3: Training of trainers in the districts : ENVISION will continue to support TOT in FY18. This cadre will provide training to lower administrative levels and provide continued supportive supervision. In FY18, ENVISION will support a total of 364 district-level trainers (10 district health teams + 4 HSDs per

ENVISION FY18 PY7 Uganda Work Plan 33

district) to be trained for two days at each of the 26 district headquarters. The ENVISION Uganda team will provide technical assistance to the NTD Secretariat to plan and conduct these trainings. Activity 4: Training of trachoma graders and recorders: Prior to starting the planned surveys, the certified graders and recorders will undergo a one-day refresher training. Activity 5: Training of subcounty and parish supervisors, CDDs, and teachers: In the districts receiving MDA, ENVISION will support the training of 2,342 parish supervisors (two from every parish) ,32,940 CDDs and two teachers from each school in the sub county. Activity 6: OV-specific training of supervisors and Health workers : ENVISION will support training of 24,816 supervisors and health workers in 18 districts. Each training will take one day and include district and subcounty staff participation. Trained supervisors then supervise CDDs. Activity 7: OV-specific training of CDDs: ENVISION will support community-level training of 16,360 new CDDs, and refresher training for 13,590 CDDs at the community level, in 18 districts.

Table 7: Training targets Number to be trained (for The Carter Center, this Name Number includes training supported Location of other Training groups Training topics training by all funding sources) training(s) funding days Total partner New Refresher trainees •NTDs in Uganda •Manifestations •Causes and transmission •Distribution–maps •Control – drugs, vectors, other •Data tools •Dose poles use District •Adverse events and management 80 284 364 2 District HQ None TOTs [RTI] •Advocacy for control •Timelines–work plan •Allocation of drugs •Social mobilization •Coverage targets •MDA, post-MDA •Tools and how to fill •NTDs in Uganda •Manifestations •Causes and transmission •Distribution–maps •Control – drugs, vectors, other •Data tools •Dose poles use Health workers •Adverse events and management 104 513 617 1 HSD None [RTI] •Advocacy for control •Timelines–work plan •Allocation of drugs •Social mobilization •Coverage targets •MDA, post-MDA •Tools and how to fill

ENVISION FY18 PY7 Uganda Work Plan 34

Number to be trained (for The Carter Center, this Name Number includes training supported Location of other Training groups Training topics training by all funding sources) training(s) funding days Total partner New Refresher trainees Health workers •Clinical diagnostics 1,234 0 1,234 3 National None [RTI] •NTD disease surveillance •NTDs in district and subcounty Subcounty HSD or •IEC materials 25 465 490 1 None Supervisors [RTI] County HQ •Rest as above •NTDs in subcounty •Transmission – elementary cycle •Medicines for control •Side-effects •Tools for registration Parish Subcounty •Tally sheets 117 2,225 2,342 1 None Supervisors [RTI] HQ •IEC materials •Use of dose poles •CDD supervision •How to make a summary report from the register •NTDs in area, distribution •Drugs for control •Registration CDDs [RTI] •Use of dose poles 4,941 27,999 32,940 2 Parish None •Eating before treatment •Common adverse effects •Use of tally sheets •NTDs in area, distribution •Drugs for control •Registration Teachers [RTI] •Use of dose poles 1,930 4,504 6,434 1 Schools None •Eating before treatment •Common adverse effects •Use of tally sheets •NTDs in Uganda •Distribution, endemic areas •Transmission •Control •Drugs used, quantities •Side-effects, management •Cascade training NTD Focal •Planning MDA Kampala, 3 25 28 3 None Persons [RTI] •Implementation units Hotel •Tools •Registration •Sensitization •Supportive supervision •Stock outs •Reporting •Financial responsibilities

ENVISION FY18 PY7 Uganda Work Plan 35

Number to be trained (for The Carter Center, this Name Number includes training supported Location of other Training groups Training topics training by all funding sources) training(s) funding days Total partner New Refresher trainees NTD Focal •Grant management Persons, Chief •Questionnaires Administrative •Anti-terrorism forms Kampala 14 70 84 1 None Officers, and •FOGs milestones Hotel District Health •Auditing Officers [RTI] •Progress Reports Central As for NTD focal persons Kampala Trainers / 2 58 60 2 None •Supportive supervision tools VCD Supervisors [RTI] Program planning, management and evaluation (including financial management): • Project cycle • Problem analysis • Needs assessments • Logical framework Uganda ENVISION staff • Project design Manageme and MOH NTD • Project analysis 13 0 13 14 nt Institute None PMs and Senior • Participatory approaches Kampala Staff • Reports campus • M&E • Cost structures and budgeting • Project implementation • Use of grant charts • Managing procurement process • Business investment plan • Global Trachoma Mapping Project Endemic Graders and methodology of TF, TT, opacity, district- 10 0 10 5 None Recorders blindness grading and Nakapiripiri • Data recording, transmission t • Financial management • Project management and budget monitoring • Strategic planning & management • Public policy analysis & evaluation • Financial management • Records management & microplanning Kampala • Accurate financial statements ENVISION Staff 12 0 12 7 max and outside None • Manage the audit process Uganda • Develop budgets in support of program needs • USAID rules & regulations • Grants & cooperative agreements • USAID Project Management • USAID TOT • USAID proposal development • Database use M&E Assistants • Microplanning template 10 0 10 5 Kampala None • Data analysis

ENVISION FY18 PY7 Uganda Work Plan 36

Number to be trained (for The Carter Center, this Name Number includes training supported Location of other Training groups Training topics training by all funding sources) training(s) funding days Total partner New Refresher trainees Core District Data Development and use of integrated NTD 84 0 84 3 Regional None Team database

• OV as a disease • Transmission • Signs and symptoms • OV endemic areas • Life cycle of OV Supervisors and • Effect of OV health workers for • Treatment exclusion criteria 303 24,513 24,816 1 Subcounty OV MDA (The • IVM administration (e.g., Carter Center) dosing) • Roles • Data collection tools and record keeping • Community mobilization • Recording and reporting

CDDs for OV MDA Sightsaver (The Carter Same as above 13,590 16,360 29,950 1 Community s Center)

f) Drug and Commodity Supply Management and Procurement

Activity 1: Drug delivery : ENVISION will continue to work closely with MOH and NMS to ensure timely delivery of drugs to each district. Activity 2: Reverse supply chain: Reverse logistics is fully supported by ENVISION after each MDA, and this will continue in FY18.

g) Supervision for MDA

The NTD Secretariat, with support from RTI, will continue to conduct supportive supervision in districts during implementation. Supervision will be increased in Gulu, Arua, and , which have recurrent low coverage and require close monitoring. Special attention will be given to key activities like training, register updates, and MDA itself. During this process, the central-level supervisors will make field visits and interact with health workers, subcounty focal persons, parish and community supervisors, teachers, CDDs, and community members to ascertain the level of knowledge and utilization. The central supervisors will also conduct random spot checks at all levels (district, subcounty, parish, school, and community) during and after training. Results from these supervisory visits will be collated through a standardized supervisory questionnaire/checklist and submitted to the NTDCP and ENVISION for review. RTI’s M&E team will analyze the results and share with the NTD Secretariat and RTI’s senior management for action. It is at the discretion of the central supervisor/trainer to liaise with the district NTD focal person and the NTD Secretariat to arrange a quick, on-the-spot (re)training of cadres deemed deficient in knowledge. Attention will be paid to areas that have repeatedly reported low coverage.

ENVISION FY18 PY7 Uganda Work Plan 37

In FY18 RTI will support the following activities: Activity 1: Supportive supervision during training of subcounty supervisors and health workers in 26 districts : This will be conducted by central staff from RTI and MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime. Activity 2: Supervision during training of parish supervisors : This will be conducted by central staff from RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime. Activity 3: Supervision of registration : This will be conducted by central staff from RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime. Activity 4: Supervision during training of CDDs and teachers: This will be conducted by central staff from RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime. Activity 5: Supervision during MDA and data collection : This will be conducted by central staff from RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime. Activity 6: Supportive supervision for finance : This will be conducted by central staff from RTI and the MOH. Costs include vehicle rental, fuel, and per diem. Activity 7: Enhanced Supervision of MDA in Gulu, Omoro and Kitgum: This will be conducted by central staff from RTI and the MOH and will involve having a supervisor in each subcounty. Costs include vehicle rental, fuel, and per diem. Activity 8: Supervision of MDA for LF-OV (The Carter Center): Supervision of the distribution of the drugs will be carried out to ensure that the drugs are distributed to the targeted communities through the national health care services per MOH policy and per WHO guidelines (when they do not conflict with MOH policy). After distribution, supervisory teams from the central office ensure that the eligible populations in all targeted communities are treated with Ivermectin. They also check the quality of the treatment through examination to check for the proper use of dose poles and the correct quantity of drugs. The supervisory team in Kampala also checks to ensure that the drugs are accounted for. The central office also conducts data validation to ensure the accuracy of treatment numbers that are reported. During the training of CDDs, emphasis is put on the usage of data collection tools, such as, registers, data collection forms and the recording of information in the data treatment book. Additionally, exclusion criteria are emphasized with the aim of ensuring that the correct populations are treated and recorded. Supervision during this exercise is paramount, especially in problematic districts and communities.

Focus group discussions/community meetings are held to establish knowledge regarding river blindness disease, community drug distributors, treatment period, and the eligible population. These activities are discussed in more detail in the social mobilization section.

h) M&E

ENVISION will continue to support M&E efforts in FY18 in the following ways: Activity 1: Coverage validation surveys for LF, OV, trachoma and SCH/STH MDA (RTI–M&E) : In FY17, coverage surveys were conducted in five districts: Namayingo (LF and SCH/STH), (OV/STH), Nebbi (LF, trachoma, SCH/STH), (trachoma) and Kitgum (LF, OV, SCH/STH). The surveys used the WHO

ENVISION FY18 PY7 Uganda Work Plan 38

protocol, and technical assistance was provided by WHO and RTI. Results are being analyzed, and it is expected that lessons learned will be applied to the FY18 activities. In FY18, coverage surveys, with a KAP component, will be conducted in another five districts: Gulu, Lamwo, and Arua (OV, LF, and SCH/STH); and Moroto and Nakapiripirit (or the new ) in Karamoja for trachoma MDA. Some of these districts have consistently reported poor coverage, especially Gulu and Arua, prompting the surveys. Further, some of the districts have failed to achieve the five rounds of effective MDA coverage. The survey design used in FY17 will be adopted or modified based on findings of the survey recently completed. Probability proportional to size methods will be used to select parishes, and 30 randomly selected villages will be sampled per district. Details of the sampling and survey procedures and tools are contained in the WHO protocol for validation of reported coverages after MDA. Activity 2: LF TAS1 stopping MDA in three districts (RTI– M&E): In FY18, TAS1 will be conducted in three districts: Mayuge, Bugiri, and Namayingo. These have each had at least five effective rounds of MDA and successfully passed pre-TAS. The methodology will be based on WHO guidelines and the use of the survey sample builder. Activity 3: LF TAS2: Post-MDA surveillance in 17 districts (RTI- M&E) : In FY18, TAS2 will be conducted in 17 districts. These are , Namutumba, Luuka, , , Buyende, Bukedea, Kumi, , Kaberamaido, Serere and in Eastern Region; Apac, Kole, Adjumani, Oyam, and Moyo in Northern Region. Activity 4: TSS in 13 districts (RTI): In FY18, ENVISION will support TSSs in 13 districts that stopped MDA in 2016. The districts are Butaleka, Mayuge*, Namayingo, Paalisa*, , Apac*, Kitgum, Kole, Lamwo, Oyam*, Yumbe*, Kiryandongo and Masindi. Districts marked with an asterisk have large populations that need to be split into two EUs. Activity 5: TIS in two districts (RTI): In FY18, ENVISION will support TIS in two districts-Amudat and Kaboong. Activity 6: OV epidemiological assessment (The Carter Center): To re-affirm OV interruption, epidemiological activities (OV16 ELISA and skin snips) will be conducted in foci that have completed three years of PTS. The transition of some districts to post-MDA will be contingent on passing LF TAS and therefore stopping IVM treatment. This includes Maracha and Nebbi (the latter will depend on RPRG decisions, to be communicated in mid-2018). The assessments will include serological and entomological surveys to determine whether OV has been eliminated. Blood samples will be collected from 7,000 children under 10 years old in the sampled communities/parishes where adult skin snips were conducted. For cross-border foci: Uganda’s focus of Bwindi, which is in the districts of Kanungu and Kisoro, and the cross-border areas of DRC in the district of Ruchuru-Goma will conduct skin snips in January 2018. Uganda’s Lubiriha focus, which includes the district of Kasese, and the cross-border area of DRC in the district of Beni-Butembo will conduct OV16 ELISA and skin snips, assuming the security situation in DRC remains workable around June 2018. Uganda’s West Nile focus, which includes the districts of Koboko and Yumbe, and the cross-border area of DRC in Ituri District (northern part) and in South Sudan in the Yei District, will conduct OV16 ELISA and skin snips depending on South Sudan’s security situation. Uganda’s Madi–Mid North focus, including the districts of Lamwo, Moyo, Adjumani, and Amuru (among others), will conduct cross-border OV16 ELISA and skin snipping with the county of Magwi in South Sudan, depending on South Sudan’s security situation.

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Additionally, entomological surveys for analysis of infective potential (vector control) of district/foci will be conducted in Nebbi (in both the Wadelai and Nyagak-Bondo foci), Kasese (in both the Nyamugasani and Lubiriha foci), Rubanda, Kanungu, Kisoro (Bwindi), Pader, Kitgum, Lamwo, Gulu, Amuru, Nwoya, Oyam, Lira, Moyo, and Adjumani (Madi–Mid North) and part of Moyo (in Obongi focus), Yumbe, Koboko (West Nile), Arua, Zombo (Nyagak-Bondo), Maracha (Maracha-Terego), Masindi, Bulisa, and Hoima (Budongo). These activities will be partially supported with ENVISION funds and partially supported by other Carter Center funding sources. Cross-border entomological monitoring will be carried out in Uganda’s Kanungu and Kisoro districts (Bwindi foci) and in DRC’s Ruchuru-Goma District. Similarly, Arua, Nebbi, and Zombo districts in Uganda’s Nyagak-Bondo foci will be included in quarterly cross-border entomological monitoring in the southern part of DRC’s Ituri District. Uganda’s districts of Yumbe and Koboko (West Nile foci) will be included in quarterly entomological monitoring that will also include the northern part of Ituri District in DRC, and Yei District in South Sudan.

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Table 9a: Planned DSAs for FY18 by disease No. of No. of No. of districts Evaluation Units Type of Diagnostic method (Indicator: Disease endemic planned for planned for DSA assessment Mf, FTS, etc.) districts DSA (if known) LFTS for antigenemia; mf in night 3 TAS1 blood Lymphatic Filariasis 61 LFTS for antigenemia; mf in night 17 TAS2 blood 2 TIS Trachoma 47 Clinical grading (GTMP surveys) 13 TSS Skin snips, OV16 ELISA blood spots, Mf, positive children, crab Onchocerciasis 21 21 and entomological infestation, and fly infections surveillance Schistosomiasis 87 0 N/A Soil-Transmitted 128 0 N/A Helminths

Table 9b: Planned OV-specific assessments for FY18

Diagnostic method (Indicator: Mf, Focus Districts Type of assessment FTS, etc.) Budongo Hoima, Masindi, & Buliisa Entomological surveillance Crab infestation and fly infections West Nile Koboko & Yumbe Entomological surveillance Crab infestation and fly infections Nyagak-Bondo Arua, Zombo, & Nebbi Entomological surveillance Crab infestation and fly infections Maracha-Terego Terego Entomological surveillance Crab infestation and fly infections Bwindi Rubanda, Kisoro & Kanungu Entomological surveillance Crab infestation and fly infections Obongi Moyo Entomological surveillance Crab infestation and fly infections Nyamugasani Kasese Entomological surveillance Fly infections Skin snips, OV16 blood Moyo, Adjumani, Amuru, Mf, positive children, crab infestation, Madi–Mid North spots, and entomological Nwoya, Oyam, Gulu and fly infections surveillance Lubiriha Kasese Entomological surveillance Fly infections

i) Supervision for M&E and DSAs

In FY18, ENVISION will support: Activity 1: Supervision of coverage validation surveys (RTI): RTI and MOH will conduct supervision in each of the five districts conducting coverage surveys. Costs will include vehicle hire and per diem. Activity 2: Supervision of LF TAS1 (RTI): The LF program manager regularly shares plans, survey drafts, and results with ENVISION for comment. This will continue in FY18. ENVISION staff, including the Resident Program Advisor and Senior Technical Advisor, participate in field surveys and the training of district staff on the use of filariasis test strips (FTS) for LF surveillance. Activity 3: Supervision of LF TAS2 (RTI): The LF program manager regularly shares plans, survey drafts, and results with ENVISION for comment. This will continue in FY18. ENVISION staff, including the COP and CTA, participate in field surveys and the training of district staff on the use of FTS for LF surveillance.

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Activity 4: Supervision of TSS (RTI): ENVISION staff and consultants are part of the planning process. ENVISION has secured the services of a trachoma quality control consultant who is the only ophthalmologist in the country certified to train and supervise graders and recorders. The consultant ensures that WHO and Tropical Data gold standards are adhered to. Activity 5: Supervision of TIS (RTI): ENVISION staff and consultants are part of the planning process. ENVISION has secured the services of a trachoma quality control consultant who is the only ophthalmologist in the country certified to train and supervise graders and recorders. The consultant ensures that WHO and GTMP/Tropical Data standards are adhered to. Activity 6: OV epidemiological assessment (The Carter Center): For OV16, sampling is carried out directly by the Kampala headquarters. Carter Center personnel go with the teams for OV16 surveys. Management ensures that proper protocols are observed, that quality data are obtained, and to ensure the fidelity of geographical targets per the sampling frame. For entomological monitoring, teams are organized by the Carter Center Kampala office, with occasional supportive supervisory visits to ensure that proper protocols are observed as the activities are carried out. This also ensures that quality data are received. If challenges arise (such as under-capture as a result of fly catchers leaving early), the management team provides novel solutions to these issues.

j) Dossier Development

Activity 1: LF dossier: The MOH has requested support for the development of the LF dossier. ENVISION will support a dossier consultant in FY18 for 30 days. As part of the final LF elimination process, the MOH will convene a workshop of 12 participants to review historical data and begin to draft the dossier. ENVISION will pay for the venue, refreshments and transport. ENVISION will also support the printing of key LF MMDP assessment tools to be given to each district, this will enable the consultant to summarize the country’s MMDP situation, MMDP services available in health units and communities which are all key to completing the dossier.

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3) Maps

Figure 7. Uganda LF, OV, STH, SCH, and Trachoma Endemicity Maps

Figure 8. Uganda LF, OV, SCH, STH, and Trachoma Geographic Coverage Maps

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ENVISION FY18 PY7 Uganda Work Plan 45

Figure 9. Uganda Progress towards LF Elimination Map

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Figure 10. Uganda Progress towards Trachoma Elimination Map

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APPENDIX 2: Work Plan Timeline

FY18 Activities Management Support NTD Program Capacity Strengthening Train/Orient the MOH NTD Data Manager on information systems and data management systems (RTI) Training in program planning, management, and evaluation—including financial management at Uganda Management Institute (RTI) Continued training for NTDCP senior staff on the integrated NTD database (RTI) Project Assistance Strategic Planning 2 NTD Technical Committee Meeting (RTI) National Planning & Data Review Meeting (RTI) Regional Planning & Review Workshop (RTI) Microplanning in 26 districts (RTI) National Stakeholder Meeting (River Blindness Program Review Meetings (The Carter Center) UOEEAC (The Carter Center) NTD Secretariat Operational & program supervision support costs for NTDCP (RTI) NTD secretariat MOH quarterly meetings (RTI) Building Advocacy for Sustainable National NTD Program Breakfast meeting with MPs from the 26 ENVISION-supported districts (RTI) Northern Uganda Regional Advocacy Meeting (RTI) District-level advocacy meetings (RTI) News publications on NTDs (RTI) MDA Coverage Registration/update of treatment registers (The Carter Center): LF and STH MDA in 7 districts (RTI) SCH MDA in 16 districts (RTI) Trachoma MDA in 2 districts (RTI) OV MDA in 23 districts (RTI and TCC) Social Mobilization to Enable NTD Program Activities Community dialogue to improve MDA coverage level (RTI): Multimedia campaign for PC-NTDs (RTI): Sensitization of subcounty leadership (RTI) Disseminate documentaries for SCH in Albertine and trachoma in Karamoja regions (RTI) OV-related health education and sensitization by community supervisors (The Carter Center) Training Training of central trainers/supervisors in 26 districts (RTI): Training of trachoma graders and recorders at VCD (RTI): Training of district NTD focal persons at VCD(RTI): Training of trainers (TOTs) in 26 districts (RTI: Training of subcounty supervisors and health workers at HSDs and lower health units on MDA planning, implementation, and reporting (RTI) Training of parish supervisors on MDA planning, implementation, and reporting (RTI) Training of CDDs/VHTs and teachers (RTI) OV-specific training of supervisors and health workers (The Carter Center) OV-specific re/training of CDDs (The Carter Center) Supervision for MDA Supportive supervision during training of subcounty supervisors & health workers in 26 districts Supervision during training of parish supervisors Supervision of registration Supervision during training of CDDs and teachers Supervision during MDA and data collection

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FY18 Activities Monitoring and Evaluations Coverage validation surveys for LF, OV, Trachoma and SCH/STH MDAs (RT) LF TAS 1 in 3 districts (RTI) LF TAS 2 in 17 districts (RTI) Trachoma Impact Survey in 2 districts (RTI) Trachoma Surveillance Survey 13 districts (RTI) OV16 and/or skin snips Vector monitoring (monthly fly catching) Vector monitoring (quarterly, based on security situation) Supervision of M&E Supervision of Coverage Validation Surveys (RTI) Supervision of LF TAS1 (RTI) Supervision of LF TAS2 (RTI) Supervision of TSS (RTI) Supervision of TIS (RTI) Dossier Development LF dossier consultant STTA Trachoma Quality Control Consultant (RTI) SAE Consultant (RTI) Cross-Border Strategic Plan Consultant (RTI) NTD Documentary Consultant (RTI) M&E Assistants (RTI) LF Dossier Consultant (RTI) *If necessary

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APPENIDX 4. Table of USAID-supported Regions and Districts in FY18

Baseline DSA Mapping Health sentinel MDA Sn Region (list (list type: TAS 2, TSS, etc.) Districts sites (list disease(s) disease(s) LF OV SCH STH TRA LF OV SCH STH TRA Entomological 1 Kasese x x surveillance Entomological 2 Buliisa x x surveillance Entomological 3 Rubanda x surveillance Entomological 4 Western Kisoro x surveillance 5 Kanungu 6 Kiryandongo LF & TRA TSS

Entomological 7 Hoima x surveillance Entomological 8 Masindi x TSS surveillance 10 Amudat TIS 11 TSS 12 Moroto x 13 Nakapiripirit x

14 Nabilatuk x

15 Kaabong TIS 16 Kotido 17 Mayuge TAS1 TSS 18 Bugiri TAS1 19 Eastern Namayingo TAS1 TSS 20 Iganga TAS2

21 Namutumba TAS2

22 Luuka TAS2 23 Kamuli TAS2

24 Kaliro TAS2

25 Buyende TAS2

26 Bukedea TAS2 27 Kumi TAS2 28 Ngora TAS2

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Baseline DSA Mapping Health sentinel MDA Sn Region (list (list type: TAS 2, TSS, etc.) Districts sites (list disease(s) disease(s) LF OV SCH STH TRA LF OV SCH STH TRA 29 Kaberamaido TAS2 30 Pallisa TSS 31 Serere TAS2 32 Soroti TAS2 33 Busia 34 35 Kween 36

37 Jinja

38 Apac TAS2 TSS 39 Kole TAS2 40 Adjumani LF & TRA x x TAS2 Skin snips, OV16 ELISA blood spots, 41 Moyo LF & TRA TAS2 and entomological surveillance Entomological 42 Koboko LF & TRA x RA surveillance Entomological 43 Yumbe LF & TRA x RA Assessments Assessments TSS surveillance 44 Northern* Maracha 45 Terego Skin snips, OV16 ELISA blood spots, 46 Amuru x x and entomological surveillance Entomological 47 Arua LF & TRA x x x x RA surveillance 48 Omoro x x x x Skin snips, 49 Gulu x x x x OV16 ELISA blood spots,

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Baseline DSA Mapping Health sentinel MDA Sn Region (list (list type: TAS 2, TSS, etc.) Districts sites (list disease(s) disease(s) LF OV SCH STH TRA LF OV SCH STH TRA and entomological surveillance 50 Kitgum x x x x Assessments Assessments TSS 51 Kole TSS 52 Lamwo LF & TRA x x x RA TSS 53 Maracha x x Entomological 54 Nebbi x x surveillance 55 Pakwach x x Assessments Assessments Skin snips, OV16 ELISA blood spots, 56 Nwoya x x and entomological surveillance 57 Pader x Assessments Assessments 58 Zombo

59 Adjumani Assessments Assessments Skin snips, OV16 ELISA blood spots, 60 Moyo x x Assessments Assessments and entomological surveillance Skin snips, OV16 ELISA blood spots, 61 Oyam x x TAS2 TSS and entomological surveillance 62 Amolatar TSS 63 64 Luwero 65 66 Central

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Baseline DSA Mapping Health sentinel MDA Sn Region (list (list type: TAS 2, TSS, etc.) Districts sites (list disease(s) disease(s) LF OV SCH STH TRA LF OV SCH STH TRA 67 68 64 Buvuma 65

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APPENDIX 9: UOEEAC’s OV Flag

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