Year Three October 2012 to September 2013

Workplan: Year Three October 2012 to September 2013

End Neglected Tropical Diseases in Asia

Revised and Approved: June 28, 2013

i Table of Contents

List of Acronyms ...... iii I. Introduction ...... 1 II. Goals and Objectives ...... 2 III. Accomplishments To Date ...... 4 IV. Activities Planned for Year Three ...... 5 Component 1: Grants Issuance and Management and Component 2: Coordination of FHI 360 Support Activities, Technical Assistance and Capacity Building ...... 5 Component 3: Data Management and Dissemination of Best Practices ...... 8 Component 4: Collaboration and Coordination ...... 9 V. Management and Staffing ...... 10 VI. Performance Monitoring Plan ...... 11 Annex I: Budget Summary ...... 16 Annex II: International Travel Schedule ...... 18 Annex III: Gantt Chart ...... 20 Annex IV: Collaborative Workplans ...... 24 END in Asia in Bangladesh ...... 25 END in Asia in Cambodia ...... 35 END in Asia in Lao PDR ...... 46 END in Asia in the Philippines...... 55 END in Asia in Vietnam ...... 66 END in Asia in Papua New Guinea...... 77 Annex V: Organizational Chart ...... 84

ii List of Acronyms

APRO Asia Pacific Regional Office CAP Corrective Action Plan FHI 360 Family Health International MDA Mass Drug Administration M&E Monitoring and Evaluation NDOH National Department of Health (PNG) NGO Non-Governmental Organization NTD Neglected Tropical Diseases NTDCP Neglected Tropical Diseases Control Program PCT Preventive Chemotherapy RFA Request for Applications RTI RTI International TA Technical Assistance TBD To be Determined USAID United States Agency for International Development WHO World Health Organization

iii I. Introduction

In September 2010, FHI 360 was awarded a USAID Cooperative Agreement No. AID- OAA-A-10-00051 for a five-year period designed to help expand integrated neglected tropical disease (NTD) control efforts in highly prevalent focus countries in Asia. This Workplan Year Three outlines the goals, objectives and activities to be implemented by FHI 360 during the third year of this agreement, October 2012 to September 2013.

FHI 360’s End Neglected Tropical Diseases in Asia program (END in Asia) will focus on assisting the national NTD control program in selected countries to strengthen and expand their NTD control efforts through a variety of support activities to fill in crucial gaps in their national programs, as well as to expand mass drug administration (MDA) as preventive treatment to at-risk populations in endemic areas where needed. These efforts will focus on six of the seven priority NTDs: Lymphatic Filariasis; Soil Transmitted Helminthes (hookworm, roundworm, and whipworm); Schistosomiasis; and Trachoma. Given the absence of Onchocerciasis in Asia, efforts to control this disease will not be included in the END in Asia Program.

FHI 360 has been requested by USAID to focus activities during the third year within five countries in Asia, Bangladesh, Cambodia, Laos, Papua New Guinea, the Philippines, and Vietnam; with possible expansion into Burma depending on available resources and agreement with the host country government.

In addition, END in Asia may be given the opportunity by USAID to expand support to other national NTD programs in Asia through the funding of strategic short-term activities that respond to specific needs within the selected programs. Country programs that are being considered for this limited assistance include India and Indonesia, though other countries may be considered based on discussions with local USAID missions and WHO representatives across the region. Examples of strategic activities that could be funded include disease mapping, prevalence and other types of surveys, IEC material development, training, organizational meetings/workshops, and local or regional technical assistance, as well as the procurement of supplies and pharmaceuticals. Following assessment visits, a list of proposed activities and associated budgets will be developed for each country for review and approval by USAID before commitments are made and implementation begun.

Also included in this document is a Summary Budget (Annex I) outlining all associated costs expected during the second year of the program, a Schedule of International Travel (Annex II) proposed during the second year, and a Gantt Chart (Annex III) showing the timing of major program activities throughout the year.

Key Principles

Implementation will be guided by several key principles: • Country ownership: END in Asia will support the leadership and ownership of each national government in scaling-up integrated NTD control, through a well-

1 managed national NTD control program including the organization of an Intra- country Coordinating Committee and the development of a National NTD Strategic Plan and Annual Implementation Plans. The Program will encourage high-quality oversight, implementation and monitoring of field MDA activities. • Collaboration: END in Asia will collaborate with national NTD control programs, technical agencies and local organizations working on NTD control to strengthen integration, achieve cost efficiencies and maximize the impact of program resources. All END in Asia program strategies and activities will be linked to each country’s national strategic plan and implementation through the national program. • Transparency and accountability: END in Asia will use FHI 360’s existing performance-based grants management systems to deliver transparent and accountable results, with national governments directly involved in the process. This will be strongly linked to proactive oversight of grantee internal controls related to financial administration, implementation, and reporting to prevent and detect leakage, fraud, or misuse of program resources. • Capacity building for sustainability: the END in Asia team will encourage each national NTD program to take part in a structured approach to build their managerial capacity, including initial assessments, training and mentoring, proactive oversight, collaborative identification of Technical Assistance needs, provision of managerial and financial technical assistance; monitoring progress in building managerial capacity; and evaluation of capacity building efforts. • Additionality: END in Asia will ensure that all resources allocated to integrated NTD control in each focus country will increase the total resources allocated in the country, adding to, rather than displacing, existing resources. The key steps to ensuring additionality include a clear base-line identification of national government and donor resources allocated to NTD control in each country at the start of the Program. The effectiveness of additionality will be demonstrated through increased number of treatments, number of persons treated, and geographic coverage. • Integrated programs: END in Asia will strongly support the USAID and WHO initiative to integrate the design and management of control programs for the six selected NTDs at the national level, with an emphasis on the ambitious scale-up of the integrated approach to preventive chemotherapy (PCT) in all focus countries.

II. Goals and Objectives

Overarching

END in Asia has been designed to contribute directly to USAID’s goal to reduce the prevalence of seven of the most prevalent NTDs by at least 50% among 70% of the world’s affected populations. The program will also directly contribute to the achievement of USAID’s global target of delivering one billion treatments through integrated NTD programs by 2013.

Box 1

Overarching Objective

Significant increases in the proportion of the overall “at-risk” and “eligible” populations treated with appropriate preventive chemotherapy through the END in Asia program.

END in Asia will support and assist the national NTD control program in each focus country in its efforts to: • Promote political commitment by disease-endemic country governments to integrate formerly vertical programs and build capacity; • Establish an intra-country coordinating committee led by the local Ministry of Health; • Develop detailed annual implementation plans that highlight the role of all local implementing partners in creating a treatment delivery network that utilized existing service platforms; • Coordinate and well utilize drug donations, procurement of non-donated drugs, rational drug forecasting, and inventory and stock management; • Prepare and implement PCT, including training community health workers, community and social mobilization and information, education and communication, M&E, supply management, etc.; • Strengthen surveillance systems and capacity to assess progress towards elimination, and status post-elimination; and, • Map the prevalence of the six targeted NTDs to determine the appropriate treatment combinations for each community and to establish the baseline against which progress can be measured.

Indicators

To track the contribution of USAID through the END in Asia program toward achieving the Overarching Objective, FHI and its grantees will report on the following standard indicators:

1. Number of Persons Treated with PCT (by drug package, country and district) 2. Number of Districts Treated with PCT (by drug package, country and disease) 3. Number of Treatments Provided 4. Percent of “at-risk” and “eligible” populations treated (by drug package, disease country and district)

The Program will deliver results in four component areas to scale-up integrated National NTD Control Programs in each focus country.

(1) Grants issuance and management: END in Asia will manage a strong, transparent and accountable performance-based grants management program to ensure the effective use of USAID’s resources.

2) Coordination of support activities, technical assistance and capacity building: END in Asia will provide direct assistance to national NTD programs based on negotiated Collaborative Workplans including procurement of required drugs and test kits, local consultancy services, and printing of IEC materials. If and as requested, FHI will also provide structured managerial capacity building assistance with collaborative assessments, assistance in developing clear plans for technical assistance, and regular management reviews to ensure steady improvements in the quality of management of the integrated NTD control activities in each country.

(3) Data management, documentation and dissemination of best practices: END in Asia program will support the development of a strong foundation for data collection and evidence-based management based on the principles of country ownership, harmonized indicators, data sharing and effective data use.

(4) Collaboration and coordination: All END in Asia program activities and funding will be coordinated with government and other donor inputs through country level strategic plans under the leadership of each national NTD control program.

III. Accomplishments To Date

During Year One, END in Asia focused primarily on designing appropriate interventions with the national NTD control programs in the first three priority countries, Bangladesh, the Philippines and Vietnam; negotiating corresponding budgets; and working with USAID to develop an innovative contracting mechanism to respond to the unique situation of providing financial assistance directly to foreign government organizations. END in Asia successfully negotiated comprehensive Collaborative Workplans with the Ministry of Health in each of the three priority countries, which outline all of the activities to be implemented by the respective national NTD program, as well as the support activities to be funded directly by FHI 360 in each country. These Workplans cover a two-year period beginning in October 2011, and were the basis to develop a fixed amount reimbursement type Subagreement to fund those activities to be managed directly by the national NTD programs in Bangladesh and Vietnam.

During Year Two, END in Asia negotiated a two-year Collaborative Workplan with the Ministry of Health in Cambodia with implementation beginning in September 2012. END in Asia has also finalized a draft Collaborative Workplan with the Ministry of Health in Laos for a two year period to begin in October 2012 which is included in this Workplan Year Three for review and approval by USAID.

In addition, following a formal Scoping Mission to Papua New Guinea in October 2012, END in Asia has developed a Collaborative Workplan together with the National Department of Health and WHO outlining support to establish a pilot LF program in one province to begin in April 2013, with possible expansion during in following years.

END in Asia has also organized a Supplemental Initial Environmental Examination for each of the five priority countries based on the activities within each Collaborative Workplan, and has determined an appropriate Environmental Monitoring and Mitigation Plan and reporting format for each country.

FHI 360 has also previously negotiated a formal Subagreement with Deloitte Consulting LLP to provide financial oversight and financial technical assistance to the national NTD programs funded under END in Asia. This subagreement was terminated in September

4 2012 since Deloitte’s services were no longer required as all project finances are being administered through Fixed Obligation Grants or directly by FHI 360.

Finally, FHI 360 has recruited all required staff and established all necessary management systems to efficiently implement the END in Asia program across the region, including finance, contracting, procurement, and monitoring and evaluation mechanisms appropriate to the specific needs of END in Asia and often incorporating new and innovative solutions.

IV. Activities Planned for Year Three

Component 1: Grants Issuance and Management and Component 2: Coordination of FHI 360 Support Activities, Technical Assistance and Capacity Building

Based on a complete and careful analysis of the situation in each country, END in Asia has developed a unique strategy to assist the National NTD Program in each focus country, with all supporting activities outlined within a two-year Collaborative Workplan. (The updated Collaborative Workplans for the six priority countries may be found in Annex IV.)

Bangladesh: END in Asia will assist The National Filariasis Elimination and STH Control Program in Bangladesh to (1) strengthen monitoring and evaluation of all program activities through increased supervision, post MDA surveys, and development of a comprehensive M&E strategy; (2) implement a series of surveys to measure the changes in prevalence of Lymphatic Filariasis and STH and track the impact of the respective MDAs; (3) strengthen program management through a series of advocacy, orientation and organizational meetings; (4) pilot an innovative training in LF morbidity control for health care provides including a training of trainers; (5) expand and improve communications through the mass media and printed IEC materials based on a comprehensive communication strategy; and (6) better understand and respond to program issues through creative formative assessments.

END in Asia has executed a fixed reimbursement type Subagreement with the National Program in Bangladesh for the period October 2011 to September 2012, under which a series of six Fixed Obligation Grants were successfully administered during Year Two. The Fixed Obligation Grants will continue to be used to fund activities in Year Three. Other activities such as procurement of pharmaceuticals, printing of IEC materials, and the provision of local technical assistance will be directly administered by the FHI 360 country office.

Cambodia: In Cambodia, END in Asia will assist National Center for Malaria Control, Parasitology and Entomology (CNM) and the National Program for Eye Health (NPEH) at the Ministry of Health to fill in crucial gaps within the national control and elimination programs for Soil Transmitted Helminthiasis, Schistosomiasis, Lymphatic Filariasis and Trachoma, including supervision of MDAs, organizational meetings and refresher

5 trainings of program implementers at all levels, the development of a comprehensive communication strategy for NTDs and associated IEC materials, as well as a range of surveys and assessments to better track, understand and document the process of control and elimination.

CNM and the NPEH will continue to organize and implement all program activities, while the FHI 360 Country Office will directly administer all finances for the program.

Laos: END in Asia will assist the MOH to fill in crucial gaps within the national control and elimination programs for Soil Transmitted Helminthiasis, Schistosomiasis, Lymphatic Filariasis and Trachoma, including supervision of MDAs, organizational meetings and refresher trainings for program implementers at all levels, mapping of suspected areas, as well as a range of surveys and assessments to better track, understand and document the process of control and elimination.

The Ministry of Health will be responsible for the organization and implementation of all activities, while the FHI 360 Country Office will directly administer all finances for the program.

The Philippines: In the Philippines, END in Asia will assist The National NTD Control Program within the Department of Health to (1) strengthen their advocacy efforts with all major stakeholders within the country through the development of a comprehensive advocacy strategy and a series of national and regional advocacy meetings; (2) complete the mapping of provinces thought to be newly endemic for LF and Schistosomiasis; (3) organize and expand training programs for teachers, doctors, malacologists and other program implementers; (4) strengthen mobilization and education efforts through the printing and dissemination of IEC materials and broadcasting of radio spots; (5) procure the required pharmaceuticals required by the program including drugs to support the MDA, as well as test kits for the various surveys; (6) improve the effectiveness of monitoring activities through cost sharing of travel expenses; and (7) better understand and respond to critical program issues through creative formative assessments.

The DOH will continue to organize and implement all program activities, while the FHI 360 Country Office will directly administer all finances for the program.

Vietnam: Specifically in Vietnam, END in Asia will assist The National Institute for Malariology, Parasitology and Entomology (NIMPE) to (1) collect appropriate data to certify the elimination of Lymphatic Filariasis (LF) in the country, as well as support morbidity control among LF patients; (2) implement nation-wide prevalence surveys for Soil Transmitted Helminthes, as well as mass drug administration (MDA) in selected endemic provinces; and (3) disseminate overall program results through participation in regional and international opportunities to exchange lessons learned in NTD control and elimination. END in Asia will also assist the National Institute for Ophthalmology (NIO) to organize a national level assessment of Trachoma including the required training, supervision and dissemination of results during a national workshop.

6 END in Asia has executed a fixed reimbursement type Subagreement with the NIMPE for the period October 2011 to September 2013, under which a series of fifteen Fixed Obligation Grants were successfully administered during Year Two. The Fixed Obligation Grants will continue to be used to fund activities in Year Three. END in Asia will also enter into a new FOG with the NIO to fund their activities related to the assessment of Trachoma. Other support activities such as procurement of pharmaceuticals, printing of IEC materials, and the provision of local technical assistance will be directly administered by the FHI 360 country office.

Papua New Guinea: Following the Scoping Mission in October 2012, END in Asia as agreed to support the development of pilot comprehensive program for LF in one province, New Ireland, to begin in April 2013, with the first MDA planned for September 2013. The National Department of Health (NDOH) together with the provincial government will be responsible for sponsoring a network of village level volunteers who will distribute the appropriate treatments house-to-house throughout their respective villages. END in Asia will assist the NDOH to fund organizational workshops and volunteer training, development of appropriate IEC materials, refinement of a national recording and reporting system for the MDAs, drug logistics, monitoring and supervision, as well as base line surveys in accordance with WHO guidelines. If the pilot is successful, END in Asia will assist the NDOH to quickly expand the MDA to cover as many additional provinces as possible during following years.

The National Department of Health will be responsible for the organization and implementation of all activities, while the FHI 360 Country Office will directly administer all finances for the program.

Additional Countries: Support from END in Asia may be provided to other countries in Asia, such as Burma, during the course of Year Three, and will be dependent on an official request for assistance from the country, the availability of project funding, and the full approval of USAID.

Major Activities:

• In the two countries, Bangladesh and Vietnam, which receive funding from END in Asia under Subagreements/FOGs, FHI 360 will compile, review and track all implementation reports against negotiated milestones and targets, and execute appropriate reimbursements; as well as organize regular financial reviews of each subrecipient; • For all countries, FHI 360 will direct fund and facilitate the implementation of all support activities as identified within each Collaborative Workplan and monitor utilization by the relevant national NTD program; • For all countries, FHI 360 will monitor and track compliance with the relevant EMMP and report on findings; • For all countries, FHI 360 will organize monitoring site visits to a sample of program activities and MDA events in each country to track compliance and assess quality of implementation.

Component 3: Data Management and Dissemination of Best Practices

A major focus of this component will be the use of the standard, comprehensive Data Acquisition forms for recording and reporting NTD program data which have been developed by USAID/ENVISION/RTI and used to report into the comprehensive USAID NTD program data base managed by ENVISION. These reports will be compiled by END in Asia with the collaboration of each National NTD program within our focus countries, and reported to ENVISION on a semi-annual basis. In addition, data on all treatment and coverage attributed to USAID funding through the END in Asia program will also be reported to ENVISION using a standard format within 90 days following the completion of the MDA. FHI 360 will also work closely with each national program to develop a cost effective, user-friendly mechanism to validate the data being reported through routine, field-level site visits.

Each National NTD Program will be responsible for collecting the relevant data through the established data collection systems in their country whenever possible and where satisfactory data collection exists. In the cases of Vietnam and the Philippines where END in Asia will support MDA for STH and SCH, FHI country office staff will take the responsibility of gleaning the appropriate data to be reported from the existing data collections forms being used by the National NTD Program and entering the appropriate data into the standard USAID/RTI format. FHI will assume direct responsibility for completing the standard reporting forms, validating the numbers, and ensuring USAID attribution.

FHI will also carefully track implementation and compile all implementation reports for all activities funded through END in Asia, both by National NTD Programs under the formal subagreements as well as those funded directly by FHI 360. Implementation data will be tracked through a project wide data base, and will be used as the basis for informal monthly updates and the formal, semi-annual implementation reports to USAID.

FHI will also facilitate the organization of periodic program reviews of each country’s experience and achievements, including an analysis of program results, strengthens and weaknesses, and best practices. In the case of Vietnam, END in Asia will also assist the national NTD program to disseminate important program achievements, including the process to document the elimination of LF in the country, through participation in relevant regional and international meetings. FHI will also contribute any relevant success stories, project documents, publications and best practices to the USAID NTD website.

Major Activities:

• Compile all relevant NTD program data into the standard NTD Data Acquisition Format for each participating country, and submit to ENVISION on a semi- monthly basis;

8 • Compile all MDA treatment results attributed to USAID funding and report to ENVISION using the standard MDA reporting format; • Track implementation data from both National NTD Programs and FHI country offices; • Identify and document best practices during national review meetings and periodic program reviews; • Disseminate results and best practices through meetings, workshops, publications, and the USAID NTD website as well as the FHI360 END in Asia website.

Component 4: Collaboration and Coordination

END in Asia will take a strong, proactive approach to supporting collaboration and coordination. The resources allocated to each focus country by END in Asia will be coordinated under the country’s National NTD Strategic Plan and Annual Work Plan and will directly contribute to strengthening the local program and achieving the country’s national NTD targets. The Program will support intra-country coordination mechanisms that bring together all the stakeholders for coordinated national planning, resource allocation, management and monitoring whenever possible. END in Asia will also identify, document and promote the compelling benefits of strong collaboration – a strong sense of national ownership; the mobilization of domestic resources; increased commitment to integration; reduced costs per person treated; increased treatment coverage in endemic populations; improved disease control; declining morbidity; declining endemicity; and eventual elimination of NTDs.

Efforts will focus on establishing and maintaining strong, active collaboration with all national counterparts with a priority on the national NTD control programs and the Ministries of Health and Education, as well as any other government bodies and all other projects involved in NTD control at all levels. Collaboration will also be actively supported and maintained with the ENVISION project to ensure the uptake of technical advances and tools, improvements in mapping and surveillance, and updates to treatment protocols. FHI 360 will also actively collaborate with WHO country and regional offices in Asia, as well as any other UN agencies, donor programs or other NTD alliances or initiatives operating in the focus countries to ensure complete knowledge of all available resources, coordination of approaches, and the elimination of redundancy and conflicts. Where appropriate, FHI 360 will also facilitate collaboration with the various drug donation programs working in-country to improve demand forecasting, strengthen logistics, and jointly tackle severe adverse event management issues. Other INGOs and local NGOs will also be included in coordinated efforts to strengthen national NTD programs where they may contribute their extensive experience in such areas as early case detection and case management, improvements in safe water supply, hygiene and sanitation, housing, vector control, veterinary public health and access to essential medicines.

9 Major Activities:

• Support and assist each National NTD Program in the organization and management of national NTD coordinating committees, as requested; • Facilitate joint, collaborative monitoring of implementation in the field; • Facilitate organization of periodic program reviews in each focus country; • Establish and maintain effective communications with USAID, the END in Africa Project and the ENVISION project; • Actively participate in program review workshops in the USA; • Establish and maintain networking with WHO country and regional offices, collaborating UN agencies, donors and foundations, global drug donation programs and local and international NGOs contributing to NTD control in each country.

V. Management and Staffing

In order to effectively implement this complex program across several countries in Asia, FHI 360 has established a small, stream-lined management team of experienced professionals located in FHI 360’s Asia Pacific Regional Office (APRO) in Bangkok, Thailand. The management team will be headed by the Project Director, James Johnson. He will be assisted by a full-time Deputy Director, Shanthi Noriega, who will be responsible for assisting the Project Director in the overall management of program activities and providing technical oversight, quality control and capacity building across all focus countries. Additional part-time support will be provided by: • Senior Program Officer: Sutinee Charoenying (50% time) • Senior Finance Officer: Npa Taneepap (100% time)

This team will be augmented on a limited, as-needed basis by a Senior Grants Manager and a Travel Assistant. Other in-house technical experts will be available if and as required. Management oversight will be provided by FHI 360’s APRO Senior Director, Tony Bondurant and Deputy Director, Jackie McPherson.

Within each focus country, the relevant FHI 360 Country Office will support all in- country relationships and program activities, including the financial administration and FOG management, under the direct supervision of the Country Director with oversight from the Project Director in Bangkok.

FHI 360 has set the level of effort for FHI 360 staff in each country, based on the amount of support required from END in Asia within the negotiated Collaborative Workplan for each country, as follows:

Bangladesh: Senior Program Director 20% time

10 Cambodia: NTD Project Coordinator 100% time Program Assistant 100% time Communication Officer 100% time Laos: NTD Project Coordinator 100% time

Vietnam: NTD Program Officer 50% time

Papua New Guinea Program Manager 100% time Program Officer 100% time

In the relevant country offices, additional appropriate technical assistance will be provided by experienced staff in a variety of areas such as behavior change, communications and monitoring and evaluation, as needed to enhance END in Asia activities. All required financial and administrative support will be provided to END in Asia by the existing pool of professional administrative staff, and their time will be charged equitably to the END in Asia project based on the newly introduced Service Center concept which has been officially approved by USAID for application to all FHI 360 country offices around the globe. (Please refer to Annex V for the Organizational Chart for the Program.)

In order to effectively manage program support, international travel will be required for the Project Director and the Deputy Director to periodically monitor implementation in each of the focus countries, as well as to attend important workshops and technical and/or planning meetings in each country. In addition, travel to the USA for a Project Review Meeting at USAID is also required. One R&R trip to the USA is also budgeted for the Project Director and the Deputy Director. Finally, international travel to a selection of possible new focus countries is included in order to provide orientation to END in Asia and begin developing plans for support.

FHI 360 is committed to providing the highest quality, effective management of the program in the most cost-efficient manner possible.

VI. Performance Monitoring Plan

Overview:

As part of the END in Asia program, a transparent process has been developed to assure the availability and use of quality data on a timely basis. Performance monitoring will be used for several purposes: (1) to assure that all activities are implemented as planned within each Collaborative Workplan and subagreement executed under the project, (2) to

11 track all support activities provided by FHI to the respective national NTD program in focus countries, (3) to compile and report NTD program and MDA coverage data using USAID/ENVISION/RTI’s standard reporting format and indicators reflecting country- specific activities, (4) to monitor compliance with the approved Environmental Monitoring and Mitigation Plan for each focus country, and (5) to ensure appropriate use of USAID funding through regular financial reviews and oversight of each subagreement both by FHI 360.

Approach:

As END in Asia begins Year Three, monitoring of the implementation of each Collaborative Workplan and Subagreement will serve as the backbone to management process allowing for the timely collection and use of data to inform program planning, implementation and strengthening in order to guarantee high quality results. FHI 360 will liaise with all partner National NTD Programs to track performance and report on implementation progress; and utilize this information in the planning of subsequent activities. Within each Subagreement, specific implementation “milestones” have been determined, and reimbursement of the negotiated cost of each “milestone” will depend on the submission of a written report of the specific results of the “milestone”. FHI 360 will carefully track these reports, review each to ensure quality, and will verify a sample of each type of activity through structured site visits during implementation.

FHI 360 will also track the implementation of the variety of support activities that END in Asia will directly fund within each focus country based on the approved Collaborative Workplan, maintain appropriate documentation, and ensure that each activity is adequately integrated into the relevant national NTD program.

Monitoring of the MDA implementation supported by the project and reporting of the treatment results as well as overall NTD program data will be based on the newly developed USAID/ENVISION/RTI data acquisition format, using the standard indicators that will allow for tracking all results attributable to USAID’s investment. FHI 360 staff will take the responsibility for compiling all program reports using existing data from the government’s reporting and recording systems. Coordination will be required to assure that output data are consistent, consolidated and reported to USAID.

FHI 360 will also carefully monitor compliance with the specific Environmental Monitoring and Mitigation Plan developed for each focus country, and ensure that the appropriate environmental procedures outlined within each plan are implemented. This will include site visits during implementation to assess the level of actual compliance in the field and determine appropriate migration if required.

In addition, FHI 360 will diligently monitor all END in Asia finances, including funds managed by subrecipients as well as those managed directly by FHI 360 country office staff. Subrecipients will only be reimbursed for their expenditures, based on pre- determined costs, once implementation results have been reported and validated. FHI 360 will also organize routine financial reviews of the financial administration of project funds by each respective national NTD program, on a regular basis, to ensure that

12 international standard accounting practices are being followed. In addition, all FHI 360 financial administration at all levels will be audited on an annual basis by an accredited external auditor. Any and all deviations from standard, international accounting procedures and practices will be carefully assessed and appropriate corrective action immediately taken.

Enhancing Data Demand and Use:

A culture of data demand and use will be fostered with national partners through three mechanisms. The first will be through the technical assistance and on-going mentoring which will be required to assure that performance is adequately monitored and that the standard reporting forms for outcome monitoring are correctly used. The second mechanism will be through the feedback provided by FHI 360 to national programs as part of the semi-annual reporting process and thirdly, through the periodic program reviews within each focus country, as well as through both formal and informal coordination meetings with national NTD program staff.

During each of these different activities data will be reviewed with the respective national NTD program against country workplans. Efforts will be made to ensure that all program data is carefully analyzed and results used to inform and improve subsequent program planning.

Reporting Requirements:

All grantees will be required to submit written implementation reports at the completion of each “milestone” as identified with their respective Subagreements, which will become the basis for reimbursement of the associated activity costs. Each grantee (or FHI 360 in the case where the grantee is the government unit) will also be required to report on NTD program results and MDA coverage and treatment attributed to USAID’s contribution within 90 days following each MDA distribution. This data will be compiled by FHI 360 and reported to USAID and RTI for subsequent reporting into the global project data base.

FHI 360 will also provide an informal monthly update to USAID covering the major activities implemented during the month and identifying any issues that need to be addressed. In addition, FHI 360 will prepare a comprehensive, formal implementation report for USAID on a semi-annual basis, including progress against the established “milestones” within each subagreement, the implementation of all direct funded activities by FHI 360 as determined in each Collaborative Workplan, achievements based on the following Key Performance Indicators, and compliance with the Environmental Monitoring and Migration Plan for each focus country.

Key Performance Indicators:

Performance indicators to be used by FHI 360 to monitor the implementation process and program outcomes are listed in Table 1.

Table 1: Proposed Monitoring Indicators to be used by FHI 360

Indicator Disaggregation Source Target Responsible Party Component I: Grant Issuance and Management - Grant Monitoring

Number of Subagreements By organization program records 3 signed Number of grantees By organization program records 3 FHI 360 submitting timely implementation reports Number of National By country program records 6 Programs submitting MDA coverage data using standard reporting format Number of people trained By country, type Implementation TBD and gender Reports

Number of FHI financial By organization program records 2 per reviews successfully organization completed of subagreements Number of FHI organized By country program records 4 per and led monitoring visits to country activities Number of National By country program records 6 Programs implementing periodic program reviews Proportion of National By country country reports 100% Programs that are implementing according to the timelines established in their workplans Number of National By country Implementation 6 Programs completing 100% Reports of planned activities at year end Component II: Coordination of FHI Support, Technical Assistance and Capacity Building - Monitoring Collaboration with National NTD Programs Percentage of FHI support By country Semi Annual Reports 100% FHI 360 activities implemented at year end Number of National NTD By country Quarterly TBD Programs with Technical Assistance Plans in place (which are updated quarterly) Number of people trained in By country, TA program records TBD management (including type and sex TA M&E) and/or financing recipients Proportion of management By country and program records 100% and financial TA requests technical assistance addressed area Number of NTD specific TA By country and TA program records TBD

14 Indicator Disaggregation Source Target Responsible Party requests referred to USAID type

Component III: Data Management, Documentation and Dissemination – USAID/RTI Standard Coverage and Treatment Indicators Number of countries with By country country reports 6 FHI 360 complete, semi-annual NTD data reports Number of countries with By country country reports 6 complete MDA coverage reports Number of countries in By country EMM Reports 6 compliance with their EMMP

Annex I

Budget Summary

REVISED : END in Asia : Year Three Summary Budget

Line Core Bangladesh Cambodia Laos Philippines Vietnam PNG Total Item Amount Amount Amount Amount Amount Amount Amount Amount

A. MANAGEMENT

COSTS

I. SALARY AND BENEFITS 464,951 28,645 38,783 62,625 0 29,404 68,678 693,086 II. TRAVEL 154,838 3,624 7,920 19,631 25,567 20,539 52,655 284,774 III. OTHER DIRECT COSTS 76,817 0 15,400 2148 0 0 20509 114,874 IV. SERVICE CENTER 50,696 23,408 106,032 76,736 25,568 123,769 126,714 532,923

SUB TOTAL 747,301 55,677 168,135 161,140 51,135 173,712 268,556 1,625,657

B. PROGRAM COSTS

I. SUBAGREEMENT 0 114,729 0 0 0 667,405 0 782,134 II. FHI SUPPORT ACTIVITIES 0 373,000 1,064,700 842,000 715,000 851,600 630,000 4,476,300

SUB TOTAL 0 487,729 1,064,700 842,000 715,000 1,519,005 630,000 5,258,434 C. INDIRECT COSTS 292908 172,148 474,396 386,008 295,000 413,360 345,764 2,379,584 GRAND TOTAL 1,040,209 715,554 1,707,231 1,389,148 1,061,135 2,106,077 1,244,320 9,263,675

Annex II

International Travel Schedule

Annex II: International Travel – Year Three

Activity/Traveler Sites/Days Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Project Director: James Johnson Oversight Visits Bangkok-Dhaka 3 trips x 4 days X X X Bangkok-Manila 3 trips x 4 days X X X Bangkok-Hanoi 3 trips x 4 days X X X Bangkok-P Penh 3 trips x 4 days X X X Bangkok-Vientiane 5 trips x 4 days X X X X X Bangkok-PNG 6 trips x 6 days X X X X X X Program Management Meeting Bangkok-USA 1 trip x 5 days X R&R Bangkok-USA 1 trip X Start-up Bangkok-Rangoon 1 trip x 5 days X Deputy Director: Shanthi Noriega Oversight Visits Bangkok-Dhaka 3 trips x 4 days X X X Bangkok-Manila 3 trips x 4 days X X X Bangkok-Hanoi 2 trips x 4 days X X Bangkok-P Penh 3 trips x 4 days X X X Bangkok-Vientiane 3 trips x 4 days X X X Bangkok-PNG 3 trips x 6 days X X X R&R USA -Bangkok 1 trip Start-up Bangkok-Rangoon 1 trip x 5 days X

Annex III

Gantt Chart

20 Annex III: Gantt Chart

Activities Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Component 1 and Component 2 • In the two countries receiving X X X X X X X X X X X X funding from END in Asia under Subagreements/FOGs, FHI 360 will compile, review and track all implementation reports against negotiated milestones and targets, and execute appropriate reimbursements; as well as organize regular financial reviews of each subrecipient;

• For all countries, FHI 360 will X X X X X X X X X X X X direct fund and facilitate the implementation of all support activities as identified within each Collaborative Workplan and monitor utilization by the relevant national NTD program;

• Monitor and track compliance with X X X X X X X X X X X X the relevant EMMP and report on findings • Organize monitoring site visits to a X X X X sample of program activities and MDA events in each country to track compliance and assess quality of implementation Component 3 • Compile all relevant NTD program X X data into the standard NTD Data Acquisition Format for each participating country, and submit to ENVISION on a semi-monthly basis;

21 Activities Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep • Compile all MDA treatment results X X X X X X attributed to USAID funding and report to ENVISION using the standard MDA reporting format; • Track implementation data from X X X X X X X X X X X X both National NTD Programs and FHI country offices; • Identify and document best X X X X X X X X X X X X practices during national review meetings and periodic program reviews; • Disseminate results and best X X X X X X X X X X X X practices through meetings, workshops, publications, and the USAID NTD website Component 4 • Support and assist each National X X X X X X X X X X X X NTD Program in the organization and management of national NTD coordinating committees, as requested;

• Facilitate joint, collaborative X X X X monitoring of implementation in the field • Facilitate organization of periodic X X X X X X X X X X X X program reviews for National NTD Programs • Maintain effective communication X X X X X X X X X X X X with USAID, the END in Africa Project and the ENVISION project

• Actively participate in annual NTD X Program Review Workshop in the USA

22 Activities Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep • Establish and maintain networking X X X X X X X X X X X X with WHO national and regional offices, collaborating UN agencies, donors and foundations, global drug donation programs and local and international NGOs contributing to NTD control in each country

Annex IV

Collaborative Workplans

Bangladesh Cambodia Laos The Philippines Vietnam Papua New Guinea

Collaborative Workplan

END in Asia in Bangladesh

October 2011 to September 2013

Revised March 2013

I. Introduction

Under USAID Cooperative Agreement No. AID-OAA-A-10-00051, FHI’s End Neglected Tropical Diseases in Asia Project (END in Asia) will provide support to the National Filariasis Elimination and STH control Program, Ministry of Health of the Government of Bangladesh (the National Program) to strengthen and expand their national NTD control efforts. This Collaborative Workplan outlines the goals, objectives and activities to be implemented by the National Program with support from FHI during a two year period from October 2011 to September 2013. A proposed Comprehensive Budget may be found in Annex A, a Schedule of Implementation in Annex B, and a List of Locations/Districts in Annex C.

Background:

The National Program in Bangladesh has supported Mass Drug Administration (MDA) for Lymphatic Filariasis since 2004, and currently covers 19 out of the 34 endemic districts in the country. All 19 districts have completed three rounds of MDA each November, with 17 districts having completed four rounds. Reported coverage in 2010 was 92.75%, while a compliance survey also in 2010 found a compliance rate of 72.6%. From a base line of 10.8%, the Micro Filarial rate in 2010 was below 1.0% in ten districts while remaining above 1.0% in the other nine target districts.

The National Program has also support MDA for Soil Transmitted Helminthes since 2005, with coverage extended to the entire country, 64 districts, in 2008. MDA is held twice each year in May and November, and treatment is administered through all primary level institutions across the country. All 64 districts have now completed five rounds, with treatment coverage in 2010 reported at 98%. The corresponding STH inflection rate fell from 70.8% in 2005 to 27.2% in 2010.

Clearly great progress has been made, but problems do remain, especially related to compliance and the Mf rates that remain relatively high in several districts while responding well to the treatment program in others. The END in Asia project hopes to help fill in gaps within the National Program, and result in a very strong, successful program and a healthy population with LF eliminated and STH controlled.

Key Principles:

25 • Collaboration: END in Asia will collaborate closely and provide management support to The Ministry of Health to strengthen their national NTD control program. • Transparency and accountability: END in Asia will use a Fixed Obligation Grant mechanism to deliver funding to support the National Program’s activities in a fully transparent and accountable manner, and provide pro-active oversight to financial administration, implementation and reporting to ensure the highest quality of management. • Additionality: END in Asia will ensure that all resources allocated to NTD control in Bangladesh will increase the total resources available, adding to, rather than displacing, existing resources. • Integrated program: END in Asia will work closely with the National Program to integrate all program activities within one national program which includes support from other USAID funded programs, WHO, ADB, and other international NGOs working on NTD control in Bangladesh.

II. Goals, Objectives and Activities

Overarching Goal:

END in Asia support in Bangladesh will contribute directly to USAID’s goal to reduce the prevalence of seven of the most prevalent NTDs by at least 50% among 70% of the world’s affected populations. This program will also directly contribute to the achievements of USAID’s global target of delivering one billion treatments through integrated NTD programs by 2013.

Objectives:

Specifically in Bangladesh, END in Asia will assist The National NTD Control Program to (1) strengthen monitoring and evaluation of all program activities through increased supervision, post MDA surveys, and development of a comprehensive M&E strategy; (2) implement a series of surveys to measure the changes in prevalence of Lymphatic Filariasis and STH and track the impact of the respective MDAs; (3) strengthen program management through a series of advocacy, orientation and organizational meetings; (4) pilot an innovative training in LF morbidity control for health care provides including a training of trainers; (5) expand and improve communications through the mass media and printed IEC materials based on a comprehensive communication strategy; and (6) better understand and respond to program issues through creative formative assessments.

Activities:

Component One: With funding through a Fixed Amount Reimbursement Subagreement, the National Program will implement the following activities focusing on LF elimination and STH control.

A. Supervision. During the MDA for LF each November and the STH each May and November, END in Asia will fund a total of fifteen supervision trips per round for staff from the National Program in order to better supervise the management of the MDA at all lower levels down to the village and help to identify problems with implementation and facilitate problem solving.

26 B. Post MDA Surveys for LF. During Year One, the National Program will implement Post MDA Surveys in five districts three to five months following the MDA in order to measure the impact of the program on the prevalence of LF in these communities. Thirty villagers in each of thirty communities in each district will be tested. A short one-day orientation meeting will be organized at the national level immediately preceding the implementation of the surveys. These surveys will focus on confirming coverage and the quality of implementation, and will utilize a standard questionnaire. The National Program will use its own budget for Post MDA surveys in subsequent years. Update: Following an offer by JICA to fund the proposed surveys in Panchagarh, Thakurgaon, Nilphamari, and Lalmonirhat Districts, END in Asia will only support one survey in Kurigram District.

C. Mf Surveys in Endemic Districts. The National Program will implement a community based Mf survey in five districts endemic for LF to ascertain the prevalence on LF within the community and to provide a basis for the decision to continue or to stop MDA, as well as to document the process of elimination of the disease in each geographic area. Samples of night blood will be taken from 1,000 villagers in each area for testing. In Year Two five additional districts will be tested. All laboratory supplies required for the survey will be purchased locally. A short, one-day orientation meeting will be organized in each district immediately preceding implementation in the field.

D. TAS in Endemic Districts. Following the Mf surveys, the National Program will also implement Transmission Assessment Surveys (TAS) in the same five LF endemic districts in early 2012 to assess the impact of the MDA in each area and to provide a basis to decide if additional MDA is required, as well as to begin to document possible elimination of the disease. Because of the population size of one of the districts, two TAS surveys will be required; a total of six surveys will be implemented in Year One. A further five districts will be surveyed in Year Two (also requiring six surveys). A sample size of approximately 1,700 school aged children will be tested in each survey using ICT rapid tests. All ICT test kits will be procured by FHI, with the National Program arranging all required customs clearances. A short, one-day orientation meeting will also be organized in each district immediately preceding implementation in the field. Update: Because of recent changes in the WHO guidelines for TAS surveys as well as new population census results, the National Program will need to implement an additional TAS survey in Pubna District, for a total of seven surveys instead of the originally proposed six surveys for Year One.

E. STH Follow-up Surveys. In Year One (mid 2012), the National Program will implement STH Follow-up surveys in five districts to measure the impact of the MDA. A sample size of 250 school aged children will be tested in each district using the KatoKatz Method. A short, one-day orientation meeting will also be organized in each district immediately preceding implementation in the field.

F. Orientation Meetings for District Managers. Prior to the implementation of MDA in Year Two (in September and October 2012), the National Program will organize Division level meetings for the District level managers responsible for MDA in their respective areas to strengthen understanding of program goals, objectives, and activities and improve the quality of implementation. Four one-day meetings will be organized at the Division/National levels with approximately fifty participants in each.

G. Meeting for MDA Organizers in Priority Areas. A special one-day meeting will be organized in each of two regions where compliance and the impact of MDA has been less than expected in order to

27 discuss problems and practical approaches to strengthen implementation. Approximately fifty participants from the district level will attend each meeting. This activity will be implemented in October of each year as a follow on activity to the Orientation Meetings above. Update: Because of delays in approvals for the subagreement and FOGs, this activity was direct funded by FHI 360 in order not to compromise the quality of the MDAs which could not be rescheduled.

H. Training for Health Provides in Morbidity Control. During Year One, the National Program will pilot a new training activity for local health care providers to focus on community based morbidity control of LF and include appropriate practices to improve hygiene, exercise and prevent infection for LF patients. A one-day curriculum has been developed, and will be piloted during four training courses in three sub-districts with approximately forty to fifty participants in each course. A pre and post survey will be designed to measure impact on LF control and results will be carefully analyzed before expansion of the training into other areas. Another four trainings will be organized in Year Two in three other LF endemic districts.

I. Training of Trainers for Local Doctors. Prior to the implementation of the one-day Training of Health Providers, a special TOT for doctors will be organized each year to prepare them for active involvement in the training, as well as to provide appropriate supervision of the subsequent care, support and treatment of LF patients in the field. Approximately 50 doctors will be trained each year.

Note: Any required local IRB clearance and approval of surveys and research activities involving human subjects must be obtained before implementation may begin. It is the responsibility of the National Program to arrange these approvals.

Component Two: FHI will provide the following direct support to the National Program:

J. Orientation Meetings for District Managers. Prior to the implementation of MDA in Year One (in September 2011), FHI will provide direct funding to the National Program to support the organization of Division level meetings for the District level managers responsible for MDA in their respective areas to strengthen understanding of program goals, objectives, and activities and improve the quality of implementation. Four one-day meetings will be organized at the Division/National levels with approximately fifty participants in each.

K. Promotion of MDA through Mass Media. During the first and second year of support, FHI will procure the services of a media agent to adapt existing promotional messaging and place them on national electronic media channels, including TV, radio and cinema, as well as through appropriate print media in order to ensure community support, understanding and compliance with the national MDA for both LF and STH.

L. IEC Materials. Based on the new Communication Strategy, FHI will procure the reprinting of some existing IEC materials, as well as develop new materials focused on promoting better care for LF patients and changing critical behaviors associated with STH control through the national school system. These materials will include posters, folders, flip charts, guide books, banners and brochures.

28 FHI will also develop two videos (10 to 15 minutes each) to explain and promote efforts to control/eliminate LF and STH targeting the general public for use during trainings, workshops, meetings, community events and school sessions. In addition, FHI will assist the national Program to disseminate these materials to all relevant community health clinics in areas endemic for LF and to schools throughout seven districts (as a pilot phase to be expanded next year following assessment of their use and effectiveness).

M. Printing of Training Manual. In addition, FHI will procure the printing of the recently developed Training Manual for LF Elimination for Doctors to be used in all medical education institutions in order to support better understanding of the national elimination strategy and treatment protocols.

N. Development of a Comprehensive Communication Strategy. Also during the first year, FHI will procure the services of a local consultant or facilitate the active participation of a USAID Bangladesh BCC consultant to develop a comprehensive communication strategy for the National Program, including the identification of all relevant target groups, appropriate messaging and the most cost- effective channels to promote better knowledge and compliance of MDA for both LF elimination and STH control. This strategy will be developed in collaboration with the Health Education Unit at the Ministry of Health. All future IEC materials and behavior change communications will be designed and utilized in accordance with this comprehensive communication strategy, and further support from END in Asia for these activities will be negotiated prior to Year Two.

O. Development of a Comprehensive M&E Strategy and Operational Plan. END in Asia will also procure the services of one domestic consultant to work together with the National Program and an international M&E expert (to be provided directly by USAID) to review the existing M&E framework for the program, assess possible linkages and synergy with the MIS system at the Ministry of Health and propose a comprehensive strategy to develop a user-friendly, efficient, cost-effective approach to fulfilling the M&E needs of the program. Further support for improving the M&E system will be negotiated based on the comprehensive strategy.

P. Procurement of all Required Pharmaceuticals. FHI will be responsible for the procurement of all ICT test kits for the LF TAS surveys as required by the National Program to implement their activities outlined above. FHI will coordinate closely with the National Program to ensure that these tests are available at the appropriate time, and that the National Program utilizes them in line with the standard operating procedures from the Ministry of Health and WHO for the safe handling and disposition of medical waste.

Q. Formative Assessments. As required throughout the period of support, FHI will contract with a local research organization to design and implement qualitative assessments with a special focus on compliance of MDA for LF and/or STH at the community level. A scope of work and budget for each assessment will be developed by the National Program and approved by USAID before contracting and implementation commence.

29 III. Performance Monitoring

As required under USAID guidance, as well as within the approved Supplemental Initial Environmental Examination for Bangladesh, FHI will organize a cost-efficient and effective procedure to monitor a sample of project-funded activities in the field to ensure transparency, compliance, accuracy of reporting, and quality of implementation. Results of these monitoring visits will be carefully documented and discussed in detail with the National Program, and when appropriate shared with USAID.

IV. Reporting

On completion of each activity funded under the Subagreement, the National Program will provide a written Implementation Report including the appropriate survey results or data to FHI. FHI will carefully track the completion of each activity, reimburse the National Program for the negotiated cost, and compile results into a comprehensive, semi-annual report to USAID, including all activities funded directly by FHI.

30 ANNEX A

Proposed Budget END in Asia in Bangladesh March 2012

Activity Year One Year Two Total

National Program: Subagreement A. Supervision $17,036 $17,036 $34,072

B. Post MDA Surveys for LF 2,157 - 2,157

C. Mf Surveys in Endemic Districts 13,945 13,945 27,890

D. TAS in Endemic Districts 54,635 46,830 101,465

E. STH Follow-up Surveys 8,650 - 8,650

F. Orientation Meetings for District Managers - 17,483 17,483

G. Meetings MDA Organizers in Priority Areas 7,784* 7,784 15,568

H. Training in Morbidity Control 6,829 7,530 14,359

I. TOT for Local Doctors 3,892 4,121 8,013

FHI Support J. Orientation Meetings for District Managers 11,666 - 11,666

K. Promotion of MDA through Mass Media 50,000 60,000 110,000

L. Reprinting of IEC Materials 15,000 250,000 265,000

M. Printing of Training Manual 6,000 6,000

N. Development of Communications Strategy 10,000 10,000 20,000

O. Development of M&E Strategy 10,000 10,000

P. Procurement of Pharmaceuticals 27,000 27,000 54,000

Q. Formative Assessments 10,000 10,000

Total $228,594 $487,729 $716,323

*Direct funded by FHI 360

ANNEX B

END in Asia in Bangladesh Implementation Schedule

Activity Year One Year Two Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 National Program: FOG A. Supervision X X X X B. Post MDA Surveys for LF X X C. Mf Surveys in Endemic Districts X X X X D. TAS in Endemic Districts X X X X E. STH Follow-up Surveys X F. Orientation Meetings for Districts X G. Meetings MDA Organizers X X H. Training in Morbidity Control X X I. TOT for Local Doctors X X FHI Support J. Orientation Meetings for Districts X K. Promotion of MDA Mass Media X X X X L. Reprinting of IEC Materials X X M. Printing of Training Manual X N. Development Communication Strategy X X O. Development of M&E Strategy X X P. Procurement of Pharmaceuticals X X Q. Formative Assessments X X X X X X

32 ANNEX C:

List of Locations

Activity No. District/Division Year One B. Post MDA Surveys for Lymphatic Filariasis (LF) 1. Kurigram C. Micro Filarial (Mf) Surveys in Endemic Districts 1. Sirajgonj 2. Pirojpur 3. Pubna 4. Kustia 5. Chuadanga D. Transmission Assessment Surveys (TAS) 1. Sirajgoni (1) 2. Sirajgoni (2) 3. Pirojpur 4. Pubna (1) 5. Pubna (2) 6. Kustia 7. Chuadanga E. Soil Transmitted Helminthes (STH) Follow-up Surveys 1. Comilla 2. Bandarban 3. Cox’s Bazar 4. Sunamgonj 5. Munshigonj F. Orientation Meetings for District Managers 1. Rajshahi 2. Barisal 3. Rangpura 4, Dhaka G. Meeting for MDA Organizers in Priority Areas 1. Thakurgaon-Panchagarh 2. Nilphamari-Lalmonirhat- Kurigram H. Training in Maintenance for LF Patients 1. Sadar, Baliadangi & Horipur of Thakurgaon 2. Boda & Atwari of Panchagarh 3. Domar & Dimla of Nilphamari 4. Sadar & Sayedpur of Nilphamari I. Training of Trainers (TOT) for Local Doctors 1. Thakurgaon- Panchagarh-Nilphamari

33 Activity No. District/Division Year Two C. Micro Filarial (Mf) Surveys in Endemic Districts 1. Barisal 2. Jhalokathi 3. Lalmonirhat 4. Nilphamari 5. Thakurgaon D. Transmission Assessment Surveys (TAS) 1. Barisal (1) 2. Barisal (2) 3. Jhalokathi 4. Lalmonirhat 5. Nilphamari 6. Thakurgaon F. Orientation Meeting for District Managers 1. Chittagong 2. Sylhet 3. Khulna 4. Rajshahi G. Meeting for MDA Organizers in Priority Areas 1. Thakurgaon-Panchagarh 2. Nilphamari-Lalmonirhat- Kurigram H. Training for Health Providers in Morbidity Control 1. Tetolia of Phanchagrah & Taragoni of Rangpur 2. Kawnia & Pirgacha of Rangpur 3. Mithapukur & Badargoni of Rangpur 4. Gongachara of Rangpur & Chilmari of Kurigram I. Training of Trainers (TOT) for Local Doctors 1. Kurigram-Lalmonirhat- Rangpur

34 Collaborative Workplan

END in Asia in Cambodia

June 2012 to May 2014

Revised: March 2013

I. Introduction

Under USAID Cooperative Agreement No. AID-OAA-A-10-00051, FHI 360’s End Neglected Tropical Diseases in Asia Project (END in Asia) will provide support to the National Center for Malaria Control, Parasitology, and Entomology (CNM) and the National Program for Eye Health (NPEH) from the Ministry of Health in Cambodia to strengthen and expand their national NTD control efforts. This Collaborative Workplan outlines the goals, objectives and activities to be implemented by CNM and NPEH with support from FHI 360 during a two year period from June 2012 to May 2014. A proposed Comprehensive Budget may be found in Annex A, a Schedule of Implementation in Annex B, and a List of Locations/Provinces in Annex C.

Background:

CNM and NPEH have an impressive history of responding to the several Neglected Tropical Diseases (NTD) that were once highly prevalent in Cambodia and have long managed highly successful preventive chemotherapy interventions in all endemic areas for each of the major NTDs, most notably Soil Transmitted Helminthiasis (STH), Schistosomiasis (SCH), Lymphatic Filariasis (LF) and Trachoma. Despite significant progress, strong organization and considerable technical expertise, CNM and NPEH will benefit from additional support from USAID through END in Asia to fill important gaps in their programs resulting in stronger advocacy and organization, better promotion of appropriate behaviors, expanded training for service providers, and increased monitoring, assessment and evaluation.

Key Principles:

All collaboration and support throughout these efforts will be based on the following principles: • Country ownership: END in Asia will support the leadership and ownership of all program activities by CNM and NPEH and the Ministry of Health. • Collaboration: END in Asia will collaborate closely and provide management support to The Ministry of Health to strengthen their national NTD control program. • Transparency and accountability: END in Asia will provide support to CNM and NPEH activities in a fully transparent and accountable manner, and provide appropriate pro-active oversight of the administration, implementation and reporting of project supported activities to ensure the highest quality of management.

35 • Additionality: END in Asia will ensure that all resources allocated to NTD control in Cambodia will increase the total resources available, adding to, rather than displacing, existing resources. • Integrated program: END in Asia will work closely with CNM and NPEH to integrate all program activities within one national program which includes support from other USAID funded programs, WHO, ADB, and other international NGOs working on NTD control in Cambodia.

II. Goals, Objectives and Activities

Overarching Goal:

END in Asia support in Cambodia will contribute directly to USAID’s goal to reduce the prevalence of seven of the most prevalent NTDs by at least 50% among 70% of the world’s affected populations. This program will also directly contribute to the achievements of USAID’s global target of delivering one billion treatments through integrated NTD programs by 2013.

Objectives:

Specifically in Cambodia, END in Asia will assist CNM and NPEH to fill in crucial gaps within the national control and elimination programs for Soil Transmitted Helminthiasis, Schistosomiasis, Lymphatic Filariasis and Trachoma, including supervision of MDAs, organizational meetings and refresher trainings of program implementers at all levels, the development of a comprehensive communication strategy for NTDs and associated IEC materials, as well as a range of surveys and assessments to better track, understand and document the process of control and elimination.

Activities:

FHI 360 will provide direct funding to CNM and NPEH to implement the following major activities. CNM or NPEH will be responsible for organizing each of these activities, while FHI 360 will act as the fiscal agent and directly administer all funding support.

A. Soil Transmitted Helminthiasis (STH)

STH is endemic throughout Cambodia, with baseline prevalence in 2002 for roundworm ranging from 40% to 63%, for whipworm ranging from 15% to 60%, for hookworm from 20% to 83%, and mixed worm infections from 60% to 70%. With the collaboration of several partners including WHO and Children Without Worms over the past seven years, CNM has organized one of the largest deworming programs in the region. Since 2005, between 90.0% and 97.9% of all school aged children throughout the country were treated during Mass Drug Administration (MDAs) which continue to be organized every January and June.

END in Asia will support the following activities to strengthen STH control efforts in Cambodia:

1. Supervision of MDAs. During each round of MDA (beginning in June 2012 through January 2014), END in Asia will provide funding for a small team from CNM and the Ministry of Education together with relevant provincial level staff to monitor a sample of MDAs at the commune level. Approximately three trips per round will be funded for the team. These trips will focus on assessing the quality of implementation of the MDA, identifying any problems or bottle necks, and facilitating practical problem solving.

2. STH Coverage and KAP Surveys. STH Coverage and KAP Surveys will be organized in five provinces between July and August 2012 to better assess the impact and success of the MDAs. Questionnaires and guided interviews will be used to confirm coverage, to assess the quality of MDA management, and to better understand local knowledge, attitudes and practices related to both the MDA as well as those behaviors associated with infection. Sampling will include school teachers, school aged children, households, and commune officials in each area. The provinces to be targeted are Battambang, Kampung Cham, Svey Ring, Sihanuk and Takeo.

3. STH MDA Management Meetings. Three one-day regional management meeting will be organized each year in each of the 24 provinces throughout the country and include participants from each Operation District Health Office and District level Education Office, together with representative from the provincial level health and education offices. Approximately 60 participants will attend in each province. The major focus of these meetings will be to reinforce the importance of the MDA, review operational and management system as well as roles and responsibilities, and to stimulate increased commitment. These meetings will be organized each year between July and December.

4. Prevalence Surveys. A key priority of the STH program is to conduct nationwide prevalence surveys to reassess the level of endemicity in the country following several years of successful MDAs. Nation-wide data has not been collected for the last five years, and this important information is now required to help measure the impact of the MDAs and to determine if MDAs are still required throughout the country or only in certain geographic areas, and how often, in order to better balance available resources with necessary control efforts. WHO has only recently issued new guidance on managing MDAs for STH for school aged children, which includes a new protocol for annual surveillance at sentinel sites following several years of successful MDAs. CNM is currently reviewing these new guidelines, and will redesign their surveillance plans to include the recommended sentinel site prevalence surveys. Following intensive analysis, CNM will select 14 sentinel sites as representative of the actual situation in each of the major ecological and geographic zones of the country, and developed detailed guidance on the implementation of the new protocol. CNM will then develop a detailed Terms of Reference based on the new protocol and an associated budget for review before implementation. These sentinel site surveys will be conducted in approximately 14 sites annually between April and August.

5. STH Promotion through School. Previously Children Without Worms provide a small grant to Helen Keller International Cambodia to develop, pre-test, and pilot a training activity and supporting training materials to promote STH prevention among primary school children. The results of the pilot activity were impressive, but neither CNM nor the Ministry of Education has been able to expand the program beyond the original pilot sites because of a lack of resources. They have now requested END in Asia to fund the expansion of the program to cover the entire nation. This will involve reprinting

37 the teaching manual and organizing a national level TOT Refresher Training, followed by four regional trainings for staff from provincial level teacher training centers around the country, and 24 provincial level two-day trainings for local teachers. This activity will represent a strong collaboration effort both between CNM and the MOE as well as among CWW, HKI and END in Asia, and help expand a successful pilot activity to national scale.

6. Regional Workshops for Logistics and Reporting. CNM would like to organize three regional workshops (two days each) to update local level health staff on new procedures for drug logistics and the updated reporting and recording system for the NTD program. Approximately 120 participants will attend each session during April 2013.

B. Schistosomiasis (SCH)

Schistosomiasis endemicity in Cambodia is currently found in two provinces, Stung Treng and Kratie, in the Mekong River Basin where ecological conditions for transmission continue to exist. An estimated 82,000 people are at risk. The baseline endemicity level, before control measures were implemented, was over 70% among the school aged population and 49% in the general population. Control measures including universal treatment with Praziquantel have been implemented since 1996, with annual MDA implemented between February and May each year. With the achievement of coverage levels consistently over 80%, the prevalence of SCH had been progressively reduced to less than 1.0% by 2006. However, by 2008 a reinfection rate of 30% was found, though intensity has remained very low. This has raised concerns that if the regular mass treatment were stopped, the prevalence level could return to baseline levels within a few years, as has happened in other countries in the region.

END in Asia will support the following activities to strengthen SCH control efforts in Cambodia:

1. Mapping of Two Provinces. CNM has proposed to map the endemicity of SCH in two provinces, Kampung Cham and Ratanak Kiri, which are also within the Mekong River Basin and had previously been endemic for SCH before the MDAs were suspended. These provinces have not been surveyed for over four years, though the concern of reinfection remains high. Following WHO protocols, CNM plans to map these two provinces between August and September 2012 in order to obtain clear evidence of the current situation and adjust national SCH control efforts accordingly.

2. Sentinel Site Surveys. Regular sentinel sites surveys, using standard WHO protocols, will be organized in 17 established sentinel sites within the four target provinces (including the two provinces mentioned above) annually in January of each year. One community and three schools will be surveyed in each site. These surveys will provide the necessary evidence to track local SCH prevalence, determine the dangers of reinfection, and make crucial program decisions about maintaining or decreasing the frequency of MDAs.

3. Local Stakeholders Meetings. As local participation and ownership are extremely important to maintain field level control efforts over time, as well as to encourage and reinforce appropriate behavior change related to protecting against reinfection, CNM will organized one-day district level meetings in each of the seven districts where SCH remains a concern. Approximate 25 participants

38 will be involved, including relevant district officials, commune chiefs, local health center staff, and village heads. These meetings will be organized annual, each May.

4. Supervision of MDAs. As with STHs, END in Asia will provide funding for a small team from CMN and the Ministry of Education together with relevant provincial level staff to monitor a sample of SCH MDAs at the commune level during each round (beginning in early 2012). Approximately three trips per round will be funded for the team. These trips will focus on assessing the quality of implementation of the MDA, identifying any problems or bottle necks, and facilitating practical problem solving.

5. Formative Assessment. During 2013, CNM will identify priority issues to be investigated through appropriate formative assessments. These assessments will most likely focus on identifying local attitudes and behaviors associated with SCH infection, and gaining better understanding of how best to promote appropriate behavior changes to ensure elimination of transmission. A Terms of Reference and budget for each assessment will be developed by CNM and approved by USAID before implementation.

C. Lymphatic Filariasis (LF)

Lymphatic Filariasis caused by Wucheraria bancrofti has been endemic in four provinces. Five rounds of MDA were completed in the four endemic provinces from 2005 to 2009, with coverage rates consistently around 80.0%. Stop-MDA surveys conducted in 2010 showed that LF transmission had been reduced to below the critical threshold of 1% microfilaremia, and the national LF elimination program has now transitioned into a post intervention surveillance phase.

END in Asia will support the following activities to strengthen LF elimination efforts in Cambodia:

1. Transmission Assessment Surveys. CNM will organize the next round of post intervention surveillance using the recently revised WHO protocol for Transmission Assessment Surveys for LF. In early 2013 (January and February), four “Evaluation Units” representing the four previously endemic provinces, each with a sample size of approximately 1,600 school aged children, will be tested for LF using ICT rapid tests. If results remain negative, another round of TAS will be organized in 2015, as part of the documentation required by WHO to declare Cambodia free from LF.

2. Procurement of ICT Test Kits. END in Asia will directly procure all of the required ICT test kits, approximately 6,400 tests, for the TAS surveys in 2013; and arrange expedited delivery to Phnom Penh in time to facilitate implementation of the surveys. All customs fees, local taxes, and clearance costs will be the responsibility of CNM and the Ministry of Health.

D. Trachoma

The National Program for Eye Health (NPEH) has organized a comprehensive Trachoma control program across Cambodia since 1995, with the major emphasis on antibiotic treatment using tetracycline eye ointment for acute cases and corrective surgery for chronic cases. Prevalence surveys for trachoma were last conducted in 2004, and current prevalence is thought to be low.

39 END in Asia will support the following activities to strengthen trachoma elimination efforts in Cambodia:

1. National Assessment of Trachoma. The NPEH, with the help of an international expert on Trachoma provided by USAID, will design and implement a National Assessment of Trachoma, using a methodology and sampling strategy following WHO guidelines. END in Asia will support all required components of the assessment including training, supervision, and organization meetings, as well as the actual assessment itself. A training for the survey teams will be organized in early August 2013, with implementation to follow immediately thereafter. The entire survey is expected to take approximately six months to complete. A final workshop will also be organized to disseminate the results and plan additional action as needed.

E. General Support to the National Program

END in Asia will also provide the following general support to CNM’s national NTD control and elimination efforts:

1. National Task Force Meeting. CNM will convene a meeting of the National NTD Task Force consisting of approximately 30 members officially representing that various government units at the national level involved in NTD control efforts, including the Ministries of Health, Education, Rural Development, Agriculture and Fisheries, and Women’s Affairs. The purpose of the meeting will be to review, revise, and official adopt the new “National Guidelines for NTD Control and Elimination 2012 to 2015”. This one-day meeting will be held in Phnom Penh in November 2013.

2. Printing of the National Guidelines. Following the official adoption of the new National Guidelines for 2012 to 2015, END in Asia will procure the printing of approximately 1,000 copies for distribution throughout the country to relevant stakeholders.

3. National Conference on NTDs. Each year CNM hosts a three-day National Malaria Meeting to review the organization’s malaria control activities. Beginning in March 2014, CNM would like to add one additional day to the meeting to be devoted specifically to NTDs. Approximately 160 participants from across the country, including provincial health staff, provincial government representatives, and selected operational district health personnel, will attend. The focus of the NTD discussions will be on the review of the NTD activities to date and technical planning for the next year. All associated travel costs will be provided by the Malaria program, with END in Asia responsible for perdiems and venue costs for the one additional day. CNM proposes to repeat this mechanism for the National Conference in March 2015 as well.

4. Comprehensive Communication Strategy and IEC Materials for NTDs. END in Asia will assist CNM to develop a comprehensive communication strategy, beginning with an assessment of all current, available materials for NTDs, and including the identification of appropriate communication channels, the development of compelling messaging, and the design and pre-testing of synchronized IEC materials such as posters, leaflets, and TV and radio spots. FHI 360 will then procure the printing and placement of these IEC materials in sufficient quantities to impact on coverage of the MDAs and the required behavior change associated with the prevention of further transmission of infection.

5. International Conferences, Meetings and Training. CNM will carefully evaluate all opportunities to share best practices and lessons learned on NTD elimination and control at the regional and international levels, and will request appropriate funding to support their participation in only the most significant events from END in Asia on a case by case basis. Support of any international travel must receive prior approval from USAID based on an official written request from CNM.

6. Procurement of Equipment. FHI will procure two bi-ocular microscopes, two lap top computers, and two digital cameras for use by CNM during field surveys.

Note: All surveys and research activities involving human subjects must receive local IRB clearance and approval before implementation may begin, as required. It is the responsibility of CNM and NPEH to arrange for these approvals.

III. Performance Monitoring

As required under USAID guidance, as well as within the approved Supplemental Initial Environmental Examination for Cambodia, FHI 360 will organize a cost-efficient and effective procedure to monitor a sample of project-funded activities in the field to ensure transparency, compliance, accuracy of reporting, and quality of implementation. Results of these monitoring visits will be carefully documented and discussed in detail with CNM and NPEH, and when appropriate shared with USAID.

IV. Reporting

On completion of each activity, CNM or NPEH will provide a written Implementation Report including the appropriate survey results or data to FHI 360. FHI 360 will carefully track the completion of each activity and compile results into a comprehensive, semi-annual report to USAID, including all activities funded directly by FHI 360.

41 ANNEX A

Summary Budget: END in Asia in Cambodia Revised March 2013

Jun - Sep Oct ‘12 to Oct ‘13 to Activities Total ‘12 Sep ‘13 May ’14

A. Soil Transmitted Helminthes

1. Supervision of MDAs $1,000 $5,000 $2,000 $8,000

2. Coverage & KAP Surveys - $27,000 - 27,000

3. STH MDA Management Meetings 55,000 55,000 55,000 165,000

4. Prevalence Surveys - 110,000 110,000 220,000

5. STH Promotion through Schools - 190,000 - 190,000

6. Regional Workshops on Logistics/Reporting - 60,000 - 60,000

B. Schistosomiasis

1. Mapping - 10,000 - 10,000

2. Sentinel Site Surveys - 72,000 72,000 144,000

3. Local Stakeholder Meetings - 10,500 10,500 21,000

4. Supervision of MDAs - 2,000 2,000 4,000

5. Formative Assessments - 10,000 - 10,000

C. Lymphatic Filariasis

1. TAS Surveys - 40,000 - 40,000

2. Procurement of ICT Test Kits - 19,200 - 19,200

D. Trachoma

1. National Assessment of Trachoma - 76,000 180,000 256,000

E. General Support

1. National Task Force Meeting - - 1,000 1,000

2. Printing of National Guidelines - 3,000 - 3,000

3. National NTD Conference - - 8,000 8,000

42 4. Communication Strategy and Materials - 360,000 25,000 385,000

5. International Conferences and Training - 5,000 5,000 10,000

6. Procurement of Equipment - 10,000 - 10,000

Total $56,000 $1,064,700 $470,500 $1,591,200

43 ANNEX B

END in Asia in Cambodia Implementation Schedule

Activity FY 12 FY 13 FY 14 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

A. Soil Transmitted Helminthes 1. Supervision of MDA X X X X 2. Coverage & KAP Surveys X 3. STH MDA Meetings X X 4. Prevalence Surveys X X 5. STH Promotion through Schools X X X 6. Regional Workshops Logistics X B. Schistosomiasis 1. Mapping X 2. Sentinel Site Surveys X X 3. Local Stakeholder Meetings X X 4. Supervision of MDA X X X X 5. Formative Research X X X C. Lymphatic Filariasis 1. TAS Surveys X 2. Procurement ICT Test Kits X D. Trachoma 1. National Assessment X X X E. General Support 1. National Task Force Meeting X 2. Printing of National Guidelines X 3. National NTD Conference X X 4. Communication Strategy X X X X X X X 5. International Conferences X X X X X 6. Procurement of Equipment X

44 ANNEX C

END in Asia in Cambodia List of Locations

Activity No. Location STH Coverage and KAP Surveys 1. Battambang Province 2. Kampung Cham Province 3. Svey Ring Province 4. Sihanouk Province 5. Takeo Province STH MDA Management Meetings All 24 Provinces STH Prevalence Surveys TBD Schistosomiasis Mapping 1. Kampung Cham Province 2. Ratanak Kiri Province Schistosomiasis Sentinel Sites Surveys 17 Sites in 4 Provinces Schistosomiasis Local Stakeholder Meetings 1 Kratie (2 districts in Kratie Province and 5 districts in Stung 2 Sambo Treng province) 3 Stung Treng 4 Siembok 5 Thalaborivath 6 Seasan 7 Siempang LF TAS Surveys 2 Evaluation Units

Collaborative Workplan

END in Asia in Lao PDR

October 2012 to September 2014

Revised: March 2013

I. Introduction

Under USAID Cooperative Agreement No. AID-OAA-A-10-00051, FHI 360’s End Neglected Tropical Diseases in Asia Project (END in Asia) will provide support to the Ministry of Health in Lao PDR, including the Center for Malariology, Parasitology, and Entomology (CMPE), the Center of Ophthalmology (CO) and the National Institute of Public Health (NIOPH) to strengthen and expand their national NTD control efforts. This Collaborative Workplan outlines the goals, objectives and activities to be implemented by CMPE, CO and NIOPH with support from FHI 360 during a two year period from October 2012 to September 2014. A proposed Comprehensive Budget may be found in Annex A, a Schedule of Implementation in Annex B, and a List of Locations/Provinces in Annex C.

Background:

The MOH has an impressive history of responding to the several Neglected Tropical Diseases (NTD) that were once highly prevalent in Lao and have managed highly successful preventive chemotherapy interventions in all endemic areas for each of the major NTDs, most notably Soil Transmitted Helminthiasis (STH), Schistosomiasis (SCH), and Lymphatic Filariasis (LF). Despite significant progress, strong organization and considerable technical expertise, the MOH will benefit from additional support from USAID through END in Asia to fill important gaps in their programs. This support should result in stronger advocacy and organization, better promotion of appropriate behaviors, expanded training for service providers, extended coverage of mass treatments, and increased monitoring, assessment and evaluation.

Key Principles:

All collaboration and support throughout these efforts will be based on the following principles: • Country ownership: END in Asia will support the leadership and ownership of all program activities by the Ministry of Health. • Collaboration: END in Asia will collaborate closely and provide management support to the Ministry of Health to strengthen their national NTD control program; and work closely with all other organizations supporting NTD control in the country, including the Ministry of Education, WHO, ADB, World Vision, Fred Hollows Foundation and others. • Transparency and accountability: END in Asia will provide support to MOH activities in a fully transparent and accountable manner, and provide appropriate pro-active oversight of the

46 administration, implementation and reporting of project supported activities to ensure the highest quality of management. • Additionality: END in Asia will ensure that all resources allocated to NTD control in Lao will increase the total resources available, adding to, rather than displacing, existing resources. • Integrated program: END in Asia will work closely with the MOH to integrate all program activities within one national program which includes support from other USAID funded programs, WHO, ADB, and other international NGOs working on NTD control in Lao PDR.

II. Goals, Objectives and Activities

Overarching Goal: END in Asia support in Lao will contribute directly to USAID’s goal to reduce the prevalence of seven of the most prevalent NTDs by at least 50% among 70% of the world’s affected populations. This program will also directly contribute to the achievements of USAID’s global target of delivering one billion treatments through integrated NTD programs by 2013.

Objectives: Specifically in Lao PDR, END in Asia will assist the MOH to fill in crucial gaps within the national control and elimination programs for Soil Transmitted Helminthiasis, Schistosomiasis, Lymphatic Filariasis and Trachoma, including supervision of MDAs, organizational meetings and refresher trainings for program implementers at all levels, mapping of suspected areas, as well as a range of surveys and assessments to better track, understand and document the process of control and elimination.

Activities: FHI 360 will provide direct funding to the MOH to implement the following major activities. The MOH, including CMPE, CO, and the NIOPH, will be responsible for organizing each of these activities, while FHI 360 will act as the fiscal agent and directly administer all funding support.

A. Soil Transmitted Helminthiasis (STH)

STH is endemic throughout Lao PDR. In response, the MOH and the Ministry of Education (MOE) with strong support from WHO, UNICEF and ADB, have organized Mass Drug Administration (MDA) for school children between the ages of 6 and 11 years old through the primary school network which also include well-managed efforts to reach out-of-school children as well. The MDAs began in four provinces in 2005 and were expanded to cover the entire country in 2007. MDAs are organized twice a year, in April and October, with all drugs provided by Johnson and Johnson. A total of eight provinces hold the MDAs twice a year, with the remaining nine provinces only needing MDAs once per year. Reported coverage rates of the last round of MDA were between 90% and 99%. Routine monitoring of the program is organized every two years, with a sample size of 1,000 children within three randomly selected provinces each round. The MOH and MOE would now like to expand the MDA program to include children between the ages of 12 and 14 years old (approximately 400,000

47 individuals) through the network of junior secondary schools, in order to be in full compliance with WHO guidance.

To help further strengthen the STH control program, END in Asia will support the following activities:

1. Supervision of MDAs. During each round of MDA (beginning in October 2012 through April 2014), END in Asia will provide funding for a small team from CMPE and the Ministry of Education together with relevant provincial level staff to monitor a sample of MDAs at the local level. Approximately three trips per round will be funded for the team. These trips will focus on assessing the quality of implementation of the MDA, identifying any problems or bottle necks, and facilitating practical problem solving.

2. STH Orientation Workshops. As part of the process of expanding the MDA program to include children between the ages of 12 and 14 years old, orientation workshops will be organized in each of the 17 provinces to introduce the MDA program to the district level stakeholders who will be responsible for establishing the program throughout the network of junior secondary schools in their respective districts. Selected Education officials from all 17 provinces and 145 districts will be included in these two-day workshops. The major focus will be to explain the importance of the MDA, review operational and management system as well as roles and responsibilities, and to stimulate strong commitment. A second series of workshops will be organized in each province targeting the principals and selected teachers from every school in the province to provide a thorough orientation to the de-worming activities including an explanation of the rationale, responsibilities, process and recording and reporting systems. Representatives from over 1,400 schools will participate. Special materials will also be printed for distribution during these workshops to assist the teachers to better inform their students about the program. Both series of workshops will be organized before May 2013, with follow-up workshops in Year Two to review progress and strengthen program management.

3. Base-line Prevalence Surveys. As part of the expansion of the MDA program to include children between the ages of 12 to 14, a base-line survey will be conducted in selected sites using the standard WHO methodology in order to establish current prevalence rates among this new target group as a means to measure the impact of the future MDAs. Stool samples will be collected from students in approximately two schools in each of the three geographic regions in Lao, and examined for infection. Implementation will take place before May 2013 when the new MDAs are expected to begin.

4. Spot Check Site Surveys. Following WHO guidelines, the MOH and MOE will organize spot checks in a small random sample of schools in 6 to 7 provinces following the MDAs to verify the accuracy of reported data and validate the actual distribution of drugs in selected secondary schools. These surveys will be carried out approximately ten days following each round of MDAs.

5. IEC Materials and Mass Media Support. The MOH together with WHO and UNICEF have recently revised and updated a series of IEC materials for STH for use throughout the school system, including posters, a comic book, and two games. END in Asia will support the printing of these materials specifically for the network of junior secondary schools to support the expansion of the MDAs to include children between the ages of 12 and 14 years old, as WHO and UNICEF support is only sufficient to cover the needs of the current network of primary schools. END in Asia will also

48 support the development and broadcasting of radio spots in the three local languages to promote the MDAs and encourage greater compliance.

B. Schistosomiasis (SCH)

Schistosomiasis endemicity in Lao is currently found in two districts within the province of Champasack, along the Mekong River Basin where ecological conditions for transmission continue to exist. An estimated 84,954 people are at risk. Control measures including universal treatment with Praziquantel have been implemented between 1990 and 1998 and again from 2007 to now, with annual MDA implemented in February each year. All required drugs will be provided by World Vision Australia through 2015. With the achievement of coverage levels consistently between 80% and 93% over the last six year, the prevalence of SCH had been progressively reduced to between 7.8% and 57.2% in 2011. However, previous experience has raised concerns that if the regular mass treatments were stopped, the prevalence level could return to baseline levels within a few years, as happened following the stoppage of the MDAs between 1998 and 2007.

END in Asia will support the following activities to strengthen SCH control efforts in Lao:

1. District Level Stakeholders Meetings. As local participation and ownership are extremely important to maintain field level control efforts over time, as well as to encourage and reinforce appropriate behavior change related to protecting against reinfection, the MOH will organize a two- day district level meeting in each of the two endemic districts where SCH remains a concern. These meetings will be used to promote increased political commitment and a greater awareness of the importance of the MDAs. Approximate 30 participants will be involved, including relevant district officials, local health center staff, and village heads. These meetings will be organized annually each January.

2. Supervision of MDAs. END in Asia will provide funding for a small team from CMPE and the Ministry of Education together with relevant provincial level staff to monitor a sample of SCH MDAs at the local level during each round (beginning in early 2013). Approximately three trips per round will be funded for the team. These trips will focus on assessing the quality of implementation of the MDA, identifying any problems or bottle necks, and facilitating practical problem solving.

3. SCH Regional Workshop. END in Asia will also provide funding for approximately nine officials from the MOH to attend a two-day regional SCH workshop currently scheduled for April 2013 in Champasak province to discuss a regional strategy to eliminate SCH and encourage cross-border collaboration. The majority of the funding for this regional workshop will be provided by ABD, with END in Asia providing a cost share to ensure that all relevant officials from the MOH are able to attend this important meeting.

C. Lymphatic Filariasis (LF)

Lymphatic Filariasis caused by Wucheraria bancrofti has been found to be endemic in the five districts of Attapey Province at the extreme southern end of the country. The size of the target population in the province is 102,207 individuals. MDAs began in one district in 2007 and were expanded to include all five districts in the province in 2009, and have continued on an annual basis

49 every year between December and January, with the exception of 2011 when no funding was available and no MDAs were implemented. The reported coverage rate in 2012 was 84.5%. All required drugs are donated by WHO.

END in Asia will support the following activities to strengthen LF elimination efforts in Lao:

1. Mapping of Lymphatic Filariasis. During Year One, END in Asia will provide support for the implementation of mapping surveys for LF in the two adjacent provinces to Attapey Province, that is, Xexong Province with five districts and Champasack Province with ten districts, in order to measure the prevalence of the disease in each area and determine if MDAs would be required. A sampling methodology of approximately 100 people over 15 years of age in one selected village in each district will be tested using the ICT rapid test, following standard WHO protocols to determine prevalence. The mapping will be completed in January 2013.

2. Procurement of ICT Test Kits. END in Asia will directly procure all of the required ICT test kits, approximately 2,000 tests, for the Mapping of LF in 2013; and arrange expedited delivery to Vientiane in time to facilitate implementation of the surveys. All customs fees, local taxes, and clearance costs will be the responsibility of the Ministry of Health.

3. LF MDA Coverage Surveys. LF MDA Coverage Surveys will be organized in each district within Attapey Province between June and October 2013 to better assess the impact and success of the MDAs. Questionnaires and guided interviews will be used to confirm coverage, to assess the quality of MDA management, and to better understand the effectiveness of the MDAs. Following WHO guidelines, approximately 30 people will be interviewed in each of six villages in each of the five endemic districts. These coverage surveys will be implemented by the NIOPH to ensure an unbiased analysis by an external party.

4. Supervision of MDAs. END in Asia will provide funding for a small team from CMPE together with relevant provincial level staff to monitor a sample of LF MDAs at the local level during each round (beginning in early 2013). Two trips per round will be funded for the team. The first trip will focus on supervising the organization meeting and MDA preparations at the provincial level. The second trip will be held during the implementation of the MDA and will focus on assessing the quality of implementation of the MDA, identifying any problems or bottle necks, and facilitating practical problem solving.

D. Trachoma

The national Center for Ophthalmology (CO) has not had the opportunity to implement any mapping or other interventions for Trachoma in the country since 2000, due to a lack of resources. END in Asia will, therefore, assist the CO to organize a National Assessment of Trachoma to evaluate the current status of active Trachoma in the country as a basis to either develop appropriate interventions to provide treatment or to begin the process of documenting the elimination of the disease in Lao in accordance with WHO guidelines. With the advice of WHO and international technical assistance provided by USAID, END in Asia will assist the CO to develop a Terms of Reference and action plan for the National Assessment, with implementation, including appropriate training, organization meetings, and supervision, to begin in early 2013. During the training, a consultant from the National

50 Eye Care Program in Vietnam will be provided to share his practical, field-based experience on the implementation of Trachoma assessments and to help train the Lao ophthalmologists who will be doing the eye examinations. A workshop to report final results will also be organized following the assessment.

E. General Support to the National Program

END in Asia will also provide the following general support to the MOH’s national NTD control and elimination efforts:

1. National NTD Stakeholder Meeting. The MOH proposes to organize a national level Stakeholder Meeting to discuss the national NTD program strategy, review progress, and strengthen support for the integrated NTD control and elimination efforts. Participants will include national policy makers, relevant ministries and other government agencies, international donors and NGOs. This meeting will be held in Vientiane in July 2013, with the goal of reaching consensus on the importance of continuing support from all parties in order to achieve the control of STH and SCH and the elimination of LF and Trachoma in Lao PDR before the end of the decade.

2. International Conferences and Training. The MOH will identify appropriate opportunities to share best practices and lessons learned, as well as increase the knowledge and skills of key staff at the regional and international levels, and will request the required funding support from END in Asia on a case by case basis. Support of any international travel must receive prior approval from USAID based on a written request from the MOH.

III. Performance Monitoring

As required under USAID guidance, as well as within the approved Supplemental Initial Environmental Examination for Lao, FHI 360 will organize a cost-efficient and effective procedure to monitor a sample of project-funded activities in the field to ensure transparency, compliance, accuracy of reporting, and quality of implementation. Results of these monitoring visits will be carefully documented and discussed in detail with the MOH, CMPE, CO and NIOPH, and when appropriate shared with USAID.

IV. Reporting

On completion of each activity, the MOH, CMPE, CO or NIOPH will provide a written Implementation Report including the appropriate survey results or data to FHI 360. FHI 360 will carefully track the completion of each activity and compile results into a comprehensive, semi-annual report to USAID, including all activities funded directly by FHI 360.

51 ANNEX A

Summary Budget: END in Asia in Lao PDR March 2013 Activities Year One Year Two Total

A. Soil Transmitted Helminthes

1. Supervision of MDAs $24,000 $24,000 $48,000

2. STH Orientation Workshops 250,000 130,000 380,000

3. Base-line Prevalence Surveys 30,000 - 30,000

4. Spot Check Site Surveys 15,000 15,000 30,000

5. IEC Materials 100,000 - 100,000

B. Schistosomiasis

1. District Stakeholder Meetings 7,000 7,000 14,000

2. Supervision of MDAs 10,000 10,000 20,000

3. SCH Regional Workshop 10,000 - 10,000

C. Lymphatic Filariasis

1. Mapping of LF (14 districts) 50,000 - 50,000

2. Procurement of ICT Test Kits 6,000 - 6,000

3. MDA Coverage Surveys 35,000 - 35,000

4. Supervision of MDAs 20,000 20,000 40,000

D. Trachoma

1. National Trachoma Assessment 225,000 - 225,000

E. General Support

1. National NTD Stakeholder Meeting 50,000 50,000 100,000

3. International Conferences and Training 10,000 10,000 20,000

Total $842,000 $266,000 $1,108,000

52 ANNEX B

END in Asia in Lao PDR Implementation Schedule

Activity Year One Year Two Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 A. Soil Transmitted Helminthes 1. Supervision of MDA X X X X 2. STH Orientation Workshops X X 3. Base-line Prevalence Surveys X 4. Spot Check Site Surveys X X 5. IEC Materials X B. Schistosomiasis 1. District Stakeholder Meetings X X 2. Supervision of MDA X X 3. SCH Regional Workshop X C. Lymphatic Filariasis 1. Mapping X 2. Procurement ICT Test Kits X 3. LF MDA Coverage Surveys X 4. Supervision of MDAs X X D. Trachoma 1. National Trachoma Assessment X X E. General Support 1. National NTD Stakeholder Meeting X 2. International Conferences/Training X X X X X X X X

53 ANNEX C

END in Asia in Lao PDR List of Locations

Activity No. Location STH Orientation Workshops All 17 Provinces STH Baseline Prevalence Surveys TBD STH Spot Check Surveys TBD SCH Dist. Stakeholder Meetings 1. Champasack Province (2 districts) LF Mapping 1. Champasack Province (10 districts) 2. Xekong Province (5 districts) LF Coverage Surveys Attapey Province (5 districts) National Trachoma Assessment TBD

Collaborative Workplan

END in Asia in the Philippines

October 2011 to September 2013

October 2012

I. Introduction

Under USAID Cooperative Agreement No. AID-OAA-A-10-00051, FHI’s End Neglected Tropical Diseases in Asia Project (END in Asia) will provide support to the NTD Elimination and Control Program, Department of Health in the Philippines (the National Program) to strengthen and expand their national NTD control efforts. This Collaborative Workplan outlines the goals, objectives and activities to be implemented by the National Program with support from FHI during a two year period from October 2011 to September 2013. A proposed Comprehensive Budget may be found in Annex A, a Schedule of Implementation in Annex B, and a List of Locations/Districts in Annex C.

Background:

The National Program is currently responding to endemics of three Neglected Tropical Diseases: Lymphatic Filariasis (LF), Schistosomiasis, and Soil Transmitted Helminthes (STH). LF is endemic in 44 provinces, with seven provinces already reaching elimination and two more provinces expected to reach elimination in 2011. Schistosomiasis is endemic in 28 provinces, and despite years of effort, prevalence in these areas remains on average at 4.0% based on active case findings, with some provinces reaching over 10.0%. STH is endemic nationwide, in all 81 provinces. Mass Drug Administration (MDA) for LF is implemented routinely in October, MDA for STH in April and October, and MDA for Schistosomiasis in July. Despite significant progress, strong organization and considerable technical expertise, the National Program will benefit from additional support from USAID through END in Asia to fill important gaps in the program and result in stronger advocacy, greater coverage of IEC efforts, expanded training for service providers, and increased monitoring, assessment and evaluation.

Key Principles:

55 accountable manner, and provide pro-active oversight to financial administration, implementation and reporting to ensure the highest quality of management. • Additionality: END in Asia will ensure that all resources allocated to NTD control in the Philippines will increase the total resources available, adding to, rather than displacing, existing resources. • Integrated program: END in Asia will work closely with the National Program to integrate all program activities within one national program which includes support from other USAID funded programs, WHO, ADB, and other international NGOs working on NTD control in the Philippines.

II. Goals, Objectives and Activities

Overarching Goal:

END in Asia support in the Philippines will contribute directly to USAID’s goal to reduce the prevalence of seven of the most prevalent NTDs by at least 50% among 70% of the world’s affected populations. This program will also directly contribute to the achievements of USAID’s global target of delivering one billion treatments through integrated NTD programs by 2013.

Objectives:

Specifically in the Philippines, END in Asia will assist The National NTD Control Program to (1) strengthen their advocacy efforts with all major stakeholders within the country through the development of a comprehensive advocacy strategy and a series of national and regional advocacy meetings; (2) complete the mapping of provinces thought to be newly endemic for LF and Schistosomiasis; (3) organize and expand training programs for teachers, doctors, malacologists and other program implementers; (4) strengthen mobilization and education efforts through the printing and dissemination of IEC materials and broadcasting of radio spots; (5) procure the required pharmaceuticals required by the program including drugs to support the MDA, as well as test kits for the various surveys; (6) improve the effectiveness of monitoring activities through cost sharing of travel expenses; and (7) better understand and respond to critical program issues through creative formative assessments.

Activities:

FHI 360 will provide direct funding to the National NTD Control Program to implement the following major activities. The National NTD Control Program will be responsible for organizing each of these activities, while FHI 360 will act as the fiscal agent and directly administer all funding support.

A. Mapping of Lymphatic Filariasis. During Year One, END in Asia will provide support for the implementation of four provincial mapping surveys for LF to measure the prevalence of the disease in each area and determine if MDA would be required. A LF Deformity Survey will be implemented in each area to determine sentinel sites using a standardized questionnaire. In two provinces this will be followed by the sampling of the night blood of approximately 1,000 people aged 15 and above in the selected sites within each province following standard WHO protocols to determine prevalence. In the other two provinces where the security situation does not allow night travel, ICT rapid tests will be

56 used instead, with the test kits procured by FHI. Because of a variety of issues related to geography, security, and weather, the Mapping of Lanao Del Sur has had to be postponed until early in Year Two. Also during Year Two one additional province, Negros Occidental, will be mapped following the recent report of a number of suspected cases in the province.

B. Mapping for Schistosomiasis. Also during the first year, mapping of Schistosomiasis will be implemented in Camiguin Province where eleven new cases have recently been reported. This survey will measure prevalence of the disease and determine if MDA would be required in the area. Standard WHO protocols will be used. Beginning with the investigation of each newly identified case to determine if transmission was indigenous, a survey of the locations and level of infection within the expected vector will be conducted throughout the province, to be followed by sampling of stools using the Formalin Ether Concentration Technique and the KatoKatz method.

C. NTD Training for Teachers. The National Program in collaboration with the Department of Education will organize province level training courses for teachers and their supervisors, as well as local health workers to discuss the implementation of MDA for STH through the school system, as well as prevention measures to control the other NTDs endemic in the Philippines. In Year One, six two-day provincial trainings will be organized in Region One. Approximately 65 participants will attend each training. The END in Asia project will provide funding to cover the travel costs of the trainers from Manila, as well as the costs of the one-day training in each area. As each of these trainings will be an add on to the regular provincial teacher’s meeting organized by the Department of Education, no travel costs for the participants will be required. These courses will help to encourage a better understanding of the STH program and to motivate the teachers and their supervisors towards more active promotion of NTD prevention activities in their respective schools.

D. NTD Case Management Training for Doctors. The National Program will organize a special four- day training course on case management of Schistosomiasis and other NTDs for local doctors with funding from END in Asia. Two four-day regional level trainings will be organized during Year Two for approximately 35 doctors each. The project will cover the costs for the venue, resource persons and perdiems for each course.

E. Malacological Training for Malacologists. The National Program will also expand the implementation of technical training for rural sanitary inspectors and engineers from the provincial and municipal levels in areas endemic with Schistosomiasis to prepare them to replace the current local experts on snails (malacologists) as they are phased out of the government. During Year Two, one three-day regional course will be provided for approximately 26 participants each and will include both field and lab work.

F. Training for Problematic Provinces. The National Program will also implement a series of trainings for local doctors, nurses, paramedics and other MDA implementers in several provinces within the Autonomous Region for Muslim Mindanau (ARMM) where the implementation of MDA activities has been problematic. In Year One, one regional-level training will be organized for approximately 25 participants, and will focus on the specific local situation and stimulate practical problem solving to increase both compliance and coverage.

57 G. Development and Implementation of a National Advocacy and Social Mobilization Strategy. END in Asia will procure the services of a local consultant to assist the National Program to develop a national advocacy and social mobilization strategy, collect appropriate promotional materials for specific stakeholders, and implement advocacy at the national, regional and local levels to encourage a better understanding of the NTD program and stimulate stronger collaboration and support, including financial support, from each level of government, as well as all relevant government departments and community/religious organizations. The consultant will provide approximately six months of service each year, with all associated travel expenses provided.

H. National Stakeholder Meeting. A two-day meeting will be organized each year with the national and regional level officials from the Department of Health, the Department of Education and other relevant departments and government agencies to facilitate strong collaboration of MDA activities through the school system. The National Program will be responsible for the organization of each of the meetings, with FHI providing direct funding and administrative assistance. These Meetings will include all national stakeholders (government departments, NGOs, corporations, LGUs, etc.), with approximately 160 participants. The Department of Health will cost share this activity. END in Asia will provide funding for materials and meeting packages.

I. Program Management Meetings. A series of regional meetings will be organized during Year One to orientate all relevant partners at the regional and provincial levels on program goals, objectives and operational plans. This will also be an opportunity to identify problems with past implementation and collectively find practical solutions to strengthen upcoming rounds of MDA. The National Program will be responsible for the organization of each of the meetings, with FHI providing direct funding and administrative assistance. These meetings will respond to crucial program management issues, and will consist of an Integrated National LF and STH Program Implementation Review, A National Consultative Meeting on Schistosomiasis, and a National NTD Planning Meeting for 2013.

J. Reprinting of STH, LF and Schistosomiasis Booklets for Schools. The END in Asia project will procure the printing of three booklets developed by WHO as part of their Urbani Kits for health education in primary schools. The National Program will collaborate with the National Center for Health Promotion in reviewing and adapting the booklets, and then pre-testing the materials within a limited number of schools to ensure that they are effective in explaining NTD control and in motivating appropriate behavior change by both the teachers and students. FHI will then print sufficient copies of each of the three booklets to distribute to up to 1,000 schools during Year One and during Year Two the balance of schools in the provinces endemic for each disease.

K. Radio Spots. The END in Asia project will procure the placement of radio spots promoting the MDA throughout all target areas using local radio stations immediately preceding the implementation of each of the three annual MDA rounds.

L. Printing of IEC Materials. The National Program, with their own funds, is currently finalizing a tender to procure the services of a local organization to develop a comprehensive behavior change strategy for the program and prepare proto-types of corresponding IEC materials. The END is Asia project will print these materials in sufficient numbers to distribute throughout all target provinces to stimulate better knowledge of the program and improve compliance during the MDAs. Dissemination of these materials will be the responsibility of the National Program using their own funds.

M. Procurement of Pharmaceuticals. The END in Asia project will procure the following pharmaceuticals to support the National Program: • A total of 2,400,000 tablets of the drug, Praziquantrel, to supplement the available supply procured by the National Program for the MDA for Schistosomiasis during Year One. • A total of 2,400 ICT Rapid Test Kits for Mapping of LF in two provinces in Year One. • A total of 10,000 ICT Rapid Test Kits for TAS surveys to measure the impact of MDA for LF in five provinces in Year One and another 20,000 tests in Year Two.

N. Procurement of GPS Handsets. END in Asia will also procure a total of 29 GSP handsets (one for each province endemic with Schistosomiasis) to enable the local NTD coordinator to enter the appropriate data into the national DOH MIS data base in order to accurately and efficiently map the exact locations of vectors as the source of infection in endemic communities across their province.

O. Monitoring and Evaluation. The National Program will implement a series of LF Transmission Assessment Surveys (TAS) in twelve provinces each year to measure impact of the MDA, as well as Post Campaign Monitoring Surveys for Schistosomiasis in 14 districts. The END in Asia will supplement the funding available from the Department of Health for these surveys with the cost sharing of perdiems, travel expenses and some procurement of pharmaceuticals (see above) as needed. All surveys will utilize the appropriate WHO guidelines and protocols.

P. Formative Assessments. During Year Two, the National Program will commission a local consultant to research and develop a proposal to the national Philhealth insurance scheme to include coverage of appropriate NTD treatment and clinical care within their package of services. A terms of reference and budget for the assessment will be developed by the National Program and approved by USAID before being contracted through FHI.

Q. Integrated LF, STH, and SCH Surveillance Survey. During Year One, an integrated surveillance survey methodology will be piloted in one area in the Philippines to assess the feasibility of combining surveys for these three diseases within one survey effort. Approximately 250 students will be asked to provide both blood and stool samples. The DOH and other partners will provide a share of the costs, with END in Asia supporting travel, perdiems and some supplies.

R. National NTD Implementers Forum. This three-day meeting will be used to update all regional health coordinators and provincial health offices on the revised national policies and guidelines of LF, STH, and SCH, including reminders on several important operational issues such as reporting and recording and supervision of MDAs. Approximately 230 participants will attend this forum in Manila, which will be cost shared with the DOH.

S. Consultative Meeting with Regional DepEd. The National Program will organize a two-day meeting at the national level in Manila to orient the school network on the new policies and guidelines for NTDs and to address confusion about program responsibilities as well as recurring issues around adverse reactions. Approximately 50 participants will attend including both regional officials from the Department of Education and regional NTD coordinators from around the country. Again, this activity will be cost shared with the DOH.

T. Strategic Planning for Schistosomiasis. This activity will involve three steps. First a national level meeting will be organized for provincial and municipality officials from the Department of Health, approximately 75 representatives, to review the results of the SCH program to date and gather information on the strengths and weakness of program implementation. Then the SCH Technical Working Group will hold a series of two meeting (two days each) to review and update guidelines and policies for the SCH policy, as well as develop a Five Year Strategic Plan for SCH. Approximately 20 experts from the DOH, academia, and other relevant organizations will participate. These meetings will be cost shared with the DOH.

U. Development of TV Video for Children. A local, experienced television production house, the Knowledge Channel, will be contracted to develop three video segments on NTD specifically designed for children to be broadcast, as a cost share, on several cable television networks across the country over a ten month period, as well as over their website on demand.

V. Best Practices for NTD Control and Elimination. A local consultant will be contracted to identify and develop five case studies on best practices related to NTD control and elimination based on actual experience in the field in the Philippines. These case studies will be written in a compelling, up-beat style, and will be printed for distribution to major stakeholders at the local and regional levels to stimulate, motivate and promote improved program implementation and strengthen commitment to control and elimination efforts.

W. Updating and Printing NTD Maps. WHO has committed to support the updating and printing of NTD maps for 15 provinces during Year Two. END in Asia will contribute to updating the National NTD Map as well as the provincial maps for an additional 5 provinces, to expand the scope of this important advocacy tool. Approximately 100 copies will be printed of each provincial map and distributed to the relevant local government officials.

X. Orientation with DepEd in Camarines Sur. Because of the death of one child immediately following the MDA for STH in 2010, and the resulting legal and emotional impact on the individual teacher involved as well as the entire local school system, the National Program will organize a special two-day workshop for the teachers, school administrators and local health officials in Camarines Sur, with the goal to respond positively to local fears, reestablish a strong MDA with improved coverage, and build confidence and commitment to the value of improving children’s lives through appropriate treatment. Approximately 40 participants will be included.

Y. Workshop on QA and QC for Diagnosis and Evaluation. This workshop will be design to directly improve the analytical laboratory skills of medical technicians who are involved in testing for LF, STH and SCH on a regular basis. Hands on, practical, guided training will be provided in the use of the ICT, mf, KatoKatz, and Eliza diagnostic methods for approximately 20 participants over the six- day workshop. Trainers will be provided through the University of Philippines College of Public Health.

Z. Procurement of Laptop Computer. To enhance the computing and administrative capacity of the National Program, END in Asia will provide one laptop computer for use to manage program activities during Year Two.

AA. Workshop to Revise IHCP Guidelines. A small, two-day workshop will be organized to review and update the Integrated Helminthes Control Program Manual to reflect both the experience in the field as well as recent revisions in the WHO guidelines for STH. Approximately 15 experts from the DOH, universities and relevant organizations will be responsible to complete these new guidelines. The costs will be shared with the DOH.

BB. Workshop to Develop STH Clinical Practice Guidelines. A related effort will include a two-day meeting with the same experts as above to revise and update the STH Clinical Practice Guidelines in line with the revised IHCP Guidelines and recent revisions in the WHO guidelines. During recent meetings with STH implementers in the field, several important issues were identified that need to be address and clarified within these guidelines to help improve implementation and the quality of the interventions in the field. Again, the costs will be shared with the DOH.

III. Performance Monitoring

As required under USAID guidance, as well as within the approved Supplemental Initial Environmental Examination for the Philippines, FHI will organize a cost-efficient and effective procedure to monitor a sample of project-funded activities in the field to ensure transparency, compliance, accuracy of reporting, and quality of implementation. Results of these monitoring visits will be carefully documented and discussed in detail with the National Program, and when appropriate shared with USAID.

IV. Reporting

On completion of each activity funded under the Subagreement, the National Program will provide a written Implementation Report including the appropriate survey results or data to FHI. FHI will carefully track the completion of each activity and compile results into a comprehensive, semi-annual report to USAID, including all activities funded directly by FHI.

61 ANNEX A

Summary Budget: END in Asia in the Philippines October 2012 Activities Year One Year Two Total

A. Mapping of Lymphatic Filariasis $25,000 $20,000 $45,000

B. Mapping for Schistosomiasis 8,000 - 8,000

C. NTD Training for Teachers 37,000 - 37,000

D. NTD Case Management Training for Doctors - 17,000 17,000

E. Malacological Training for Malacologists - 21,000 21,000

F. Training for Problematic Provinces 10,000 - 10,000

G. Advocacy: Consultant 40,000 40,000 80,000

H. National Stakeholder Meeting 7,000 8,500 15,500

I. Program Management Meetings (3) 15,000 - 15,000

J. Reprinting Booklets for Schools 36,000 155,000 191,000

K. Radio Spots 8,000 8,000 16,000

L. Printing of IEC Materials 115,000 160,000 275,000

M. Procurement of Pharmaceuticals 261,000 60,000 321,000

N. Procurement of GPS Handsets 14,000 - 14,000

O. Monitoring and Evaluation 30,000 30,000 60,000

P. Formative Assessments - 10,000 10,000

Q. Integrated Surveillance Survey 10,000 - 10,000

R. National NTD Implementers Forum - 28,000 28,000

S. Consultative Meeting with DepEd - 14,000 14,000

T. Strategic Planning for Schisto - 51,000 51,000

U. Develop TV Video for Children - 20,000 20,000

V. Consultant to Develop Best Practices - 15,000 15,000

62 W. Updating and Printing NTD Maps - 35,000 35,000

X. Orientation Workshop with DepEd - 7,500 7,500

Y. Workshop on QA/QC for NTD Diagnosis - 7,500 7,500

Z. Procurement of Laptop Computer - 2,000 2,000

AA. Workshop to Revise IHCP Guidelines - 2,500 2,500

BB. Workshop to Develop STHCPG - 3,500 3,500

Total $616,000 $715,500 $1,331,500

63 ANNEX B

END in Asia in the Philippines Implementation Schedule

Activity Year One Year Two Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

A. Mapping LF X X X X B. Mapping Schistosomiasis X C. NTD Training for Teachers X D. NTD Case Management Training X E. Training for Malacologists X F. Training for Problematic Provinces X X G. Advocacy Strategy and Consultant X X X X X X X X H. National Stakeholders Meeting X X I. Program Management Meetings X X X X X J. Reprinting Booklets for Schools X K. Radio Spots X X X X X X L. Printing of IEC Materials X X M. Procurement of Pharmaceuticals X X N. Procurement of GPS Handsets X O. Monitoring and Evaluation X X X X P. Formative Assessments X X X X Q. Integrated Surveillance Survey X R. National NTD Implementers Forum X S. Consultative Meeting with DepEd X T. Strategic Planning for Schisto X U. Develop TV Video for Children X X X V. Best Practices for NTDs W. Updating NTD Maps X X X X. Orientation with DepEd X Y. Workshop on QA/QC X Z. Procurement of Laptop Computer X AA. Workshop on IHCP Guidelines X BB. Workshop on STHCPG X

64 ANNEX C

END in Asia in the Philippines List of Locations

Activity No. Province Year One A. Mapping for Lymphatic Filariasis (LF) 1. Camiguin 2. Lanao del Norte 3. Siquijor B. Mapping for Schistosomiasis 1. Camiguin C. NTD Training for Teachers 1. Alaminos 2. Dagupan 3. La Union 4. San Fernando 5. Vigan D. NTD Case Management Training for Doctors 1. Tacloban 2. Davao E. Malacological Training for Malacologists 1. Mindoro Oriental F. Training for Problematic Provinces 1. Cotabato 2. Zamboanga Year Two A. Mapping for Lymphatic Filariasis (LF) 1. Lanao del Sur 2. Negros Occidental D. NTD Case Management Training for Doctors 1. Davao or Cebu E. Malacological Training for Malacologists 1. Negros Occidental Y. Orientation Workshop with DepEd 1. Camarines Sur

65 Collaborative Workplan

END in Asia in Vietnam

October 2011 to September 2013

Revised March 2013

I. Introduction

Under USAID Cooperative Agreement No. AID-OAA-A-10-00051, FHI’s End Neglected Tropical Diseases in Asia Project (END in Asia) will provide support to the National Institute of Malaria, Parasitology and Entomology (NIMPE) and the National Institute of Ophthalmology (NIO), Ministry of Health in Vietnam to strengthen and expand their national NTD control efforts. This Collaborative Workplan outlines the goals, objectives and activities to be implemented by NIMPE and NIO with support from FHI during a two year period from October 2011 to September 2013.

Key principles that will be maintained throughout these efforts include: • Country ownership: END in Asia will support the leadership and ownership of all program activities by NIMPE and the MOH. • Collaboration: END in Asia will collaborate closely and provide management support to NIMPE to strengthen their national NTD control program. • Transparency and accountability: END in Asia will use a Fixed Obligation Grant mechanism to deliver funding to support NIMPE’s activities in a fully transparent and accountable manner, and provide pro-active oversight to financial administration, implementation and reporting to ensure the highest quality of management. • Additionality: END in Asia will ensure that all resources allocated to NTD control in Vietnam will increase the total resources available, adding to, rather than displacing, existing resources. • Integrated program: END in Asia will work closely with NIMPE to integrate all program activities within one national program which includes support from other USAID funded programs, WHO, ADB, and other international NGOs working on NTD control in Vietnam.

A proposed Comprehensive Budget may be found in Annex A, a Schedule of Implementation in Annex B, and a List of Locations/Provinces in Annex C.

II. Goals, Objectives and Activities

Overarching Goal:

END in Asia support in Vietnam will contribute directly to USAID’s goal to reduce the prevalence of seven of the most prevalent NTDs by at least 50% among 70% of the world’s affected populations. This program will also directly contribute to the achievements of USAID’s global target of delivering one billion treatments through integrated NTD programs by 2013.

Objectives:

Specifically in Vietnam, END in Asia will assist The National NTD Control Program to (1) collect appropriate data to certify the elimination of Lymphatic Filariasis (LF) in the country, as well as support morbidity control among LF patients; (2) implement nation-wide prevalence surveys for Soil Transmitted Helminthes, as well as mass drug administration (MDA) in selected endemic provinces and other support activities; and (3) disseminate overall program results through participation in regional and international opportunities to exchange lessons learned in NTD control and elimination. END in Asia will also assist the NIO to implement a national assessment of Trachoma to evaluate the status of the disease.

Activities:

Component 1: With funding through a fixed amount reimbursement Subagreement, NIMPE will implement the following activities focusing on LF elimination and STH control.

I. Lymphatic Filariasis

Background: NIMPE has managed a very strong and successful program to control and eliminate LF in the country since 1960, with special emphasis on two regions where the disease was endemic, the Red Delta region and the Central Coastal region. Although prevalence had declined steadily between 1960 and 2003, NIMPE formalized a Mass Drug Administration (MDA) based LF elimination program following WHO guidelines in 2003 which targeted a total of six districts in four provinces within the two regions. By 2008 all six districts had received five MDA rounds with treatment coverage ranging from 78% to 95%. Although prevalence rates at sentinel and spot-check sites declined to 0.0% following four rounds of MDA, a fifth round was administered in 2007-8. Following this success, WHO proposed the initiation of Transmission Assessments Surveys (TAS) to examine, using sensitive immunodiagnostic methods, if the LF active infection levels have been reduced to below threshold level after the implementation of the recommended number of MDAs so that the MDA could be stopped. In 2010-11, a school-based TAS was implemented in the four intervention units where W. bancrofti was endemic using the ICT card test. In the other two units where B. malayi was endemic, community-based microfilaria surveys were conducted on six and seven year old children, since there were no recommendations in the existing WHO guidelines on immunodiagnostic testing for B. malayi endemic areas.

A. Contact Survey and Treatment in Khanh Hoa Province. During the previous TAS in 2010, one child was found to be positive for antigenaemia in the Ninh Tay community in the Ninh Hoa district of Khanh Hoa Province, which indicates existence of low level transmission in the area. To assess the extent of transmission and eliminate any residual infection in the area, all members of the positive household and all members of 25 surrounding households will be surveyed using the ICT card test. Irrespective of the outcome of the contact survey, all members of the positive household will be treated with single dose DEC+Albendazole. If anyone in the 25 households were found to be positive in the survey, the entire community will be treated with a single dose of DEC+ALB, to ensure further

67 transmission is stopped. All required drugs and ICT test kits have been provided by WHO. END in Asia will provide the necessary travel and other operational costs to implement this survey.

B. Post MDA Surveillance. NIMPE will continue to implement the series of TAS surveys to officially document the expected elimination of LF throughout the country. Based on WHO guidelines and technical advice, NIMPE will organize a series of transmission assessment surveys over a period of at least six years following the end of MDA to ensure that LF infection continues to remain below threshold levels and that there is no resurgence of infection. In 2012, NIMPE will implement TAS surveys in two provinces, Thai Binh Province and Quang Binh Province, which were not included in the MDA but where a small number of confirmed LF cases indicate possible low levels of transmission. In 2013, NIMPE will implement TAS surveys in four provinces as representative samples of previous endemic areas which have received the full number of MDA rounds, including, Ha Nam and Hung Yen Provinces in the Red Delta region and Ninh Thuan and Khanh Hoa in the Central Coastal region. (Additional rounds of TAS surveys are planned through 2016 to fulfill the WHO requirements for certification of elimination of the disease, with funding sources as yet to be determined.)

Methodology for TAS Surveys Each TAS survey will be organized by NIMPE and be implemented by senior staff from NIMPE, one provincial staff from the local Malaria Control Center and one district level staff from the local Preventive Medicine Center, as well as staff from the local commune health center and local school. The sample size will be between 1,500 to 1,700 children between the ages of six and seven, from 40 schools in each province. The ICT test will be used in the provinces where the W. bancrofti strain had been endemic, and the Brugia rapid test will be used in provinces where the B. malayi strain had been endemic. ICT tests will be read on the spot, recorded, and disposed of using WHO guidelines for proper medical waste disposal. Blood samples for the Brugia Tests will be properly transported to a field laboratory where the serum will be separated by centrifuge for use in the testing. Again, all biological material will be disposed of using WHO approved procedures. Simple portable lab equipment including a centrifuge and micropipets will be procured to support these tests. A small incentive will be provided to each child that provides a sample. All rapid test kits will be procured directly by FHI. All results will be carefully analyzed by NIMPE staff, and shared with the MOH, USAID, WHO and other relevant stakeholders.

C. Training for LF TAS. Immediately prior to the implementation of the TAS surveys in 2013, NIMPE will organize a one-day training in the six districts within the four provinces where the TAS will be done. This training will introduce the new WHO guidelines for TAS surveys, including the new sampling methodology, as well as provide a hands-on practice of using the ICT test kits. Each training will be attended by between 40 and 70 local health staff from the provincial, district and commune levels who will be directly implementing the TAS.

D. Organization Meeting. Prior to the implementation of these TAS surveys, a small organizational meeting will be conducted for participants from NIMPE, the Ministry of Health and provincial staff to discuss necessary guidelines and protocols, and plan appropriate schedules and logistic support to facilitate the implementation of the surveys in each province. This one day meeting will include

68 participants from NIMPE and the MOH as well as two participants from each of the relevant provinces, for a total of approximately 30 participants.

E. Formative Assessment of LF Morbidity. NIMPE will implement a small formative assessment study to better understand the current status of LF patients, their living conditions, the quality of their support and care, as well as their needs and aspirations. Results will be used to design an appropriate intervention to be funded through FHI direct support (see below), most likely including training in care and maintenance, as well as the provision of some essential support materials. This quantitative study will be carried out in late 2012 by senior NIMPE staff in five provinces. Protocol and implementation details will be collaborative determined before implementation.

II. Soil Transmitted Helminthes

Background: Viet Nam has had a long history of mass de-worming programs for school age children, and a more recent record of programs for pre-school children and women of reproductive age. These programs have been funded by a large number of donors, through a variety of government agencies and local organizations, with differing target populations and geographic coverage. Most have been very successful in lowering prevalence rates immediately following MDA. There remain real gaps in coverage, and STH prevalence for school aged children in selected provinces in 2006-9 ranged from 9.2% to 74.9%.

A. Nation-wide Prevalence Surveys of Children of School Age. In order to establish a solid, evidence base for future program planning, NIMPE will implement a series of 12 provincial level STH prevalence surveys nation-wide. Based on the technical advice of a USAID consultant, they have established a sampling methodology which includes four provinces (selected randomly) in the Northern Zone where endemicity is high (Cao Bang, Lang Son, Ha Nam, and Bac Giang); four provinces in the Central Zone where endemicity is moderate (Gia Lai, Phu Yen, Quang Ngai, and Quang Binh); and four provinces in the Southern Zone where endemicity is low (Lam Dong, Long An, Tra Vinh, and Kien Giang). In each province, five districts will be selected randomly. In each of the five districts, one school will be selected randomly. Fifty children will be randomly selected per school and asked to provide samples, resulting in a sample size of 3,000 school aged children. NIMPE will organize the surveys in each of the twelve provinces in collaboration with staff from the provincial and district levels, as well as commune health staff and local teachers. Implementation will begin in November 2011 and end before the Tet holidays in February 2012. Samples will be diagnosed by experienced lab technicians at NIMPE, and disposed of following WHO guidelines for medical waste disposal.

B. MDA for School Aged Children and Women of Reproductive Age in Selected Provinces. NIMPE will use funding from END in Asia to increase the number of provinces covered in the national Mass Drug Administration (MDA) planned for late 2011 and again in late 2012 and mid 2013. The first round in 2011 will target three additional provinces for Women of Reproductive Age and ten additional provinces for School Aged Children. In October/November 2012, END in Asia will

69 support MDA for Children of School Age in twelve provinces and MDA for Women of Reproductive Age in three provinces, with NIMPE expanding their funding base to include all other provinces. In May 2013 END in Asia will support a final round of MDA for Children of School Age in ten provinces. During all of these rounds, END in Asia will provide funding for per diems and travel expenses for provincial and district staff to implement the MDA in their respective areas, small incentives for village level drug distributors and simple IEC activities in each target village. All drugs will be donated by World Vision Australia. END in Asia will also support supervision visits by NIMPE staff to selected provinces during the MDA as needed to ensure compliance with official protocols.

C. National Workshop on MDA for STH. NIMPE will organize a national workshop on STH in early 2012 following the first MDA and preceding the second. Relevant staff from all 35 provinces involved in MDA for STH, not only those funded by USAID, will be invited to attend to review results of the previous MDA; identify problems with implementation, their solutions and other lessons learned; and plan the second round. Approximately 116 participants will attend this two-day meeting in Hanoi, including all stakeholders from all collaborative organizations at the national level.

D. Sentinel Site Prevalence Surveys. Based on the newly revised WHO guidelines for STH, NIMPE will pilot the establishment of sentinel sites within selected schools in eight provinces, which will be used to track the prevalence of STH and monitor the impact of the MDAs. Stool examinations from a sample of students will be collect and examined for infection beginning in early 2013, with results reported on a regular basis in accordance with the WHO guidelines. Sentinel Sites will be expanded throughout the country in future years utilizing the experience gained from these pilot activities.

E. Workshop to Update National STH Guidelines. Because of the recent revision of the WHO guidelines for STH control, NIMPE will organize a two-day national workshop to revise and update the National STH Guidelines. This workshop will be held outside of Hanoi in November 2012 and involve approximately 30 participants from the MOH, NIMPE, WHO and other stakeholders. .

Component 2: With funding provided under a Fixed Obligation Grant, END in Asia will assist the NIO to implement a National Assessment of Trachoma to evaluate the current status of active Trachoma in the country as a basis to either develop appropriate interventions to provide treatment or to begin the process of documenting the elimination of the disease in Vietnam, in accordance with WHO guidelines. With the advice of WHO and international technical assistance provided by USAID, END in Asia will assist the NIO to finalize a Terms of Reference and action plan for the National Assessment, with implementation, including appropriate training, organization meetings, and supervision, to begin in early 2013. A workshop to report final results will also be organized following the assessment.

70 Component 3: FHI will provide the following direct support to NIMPE.

A. Procurement of all Required Pharmaceuticals. FHI will be responsible for the procurement of all pharmaceuticals required by NIMPE to implement their activities as outlined above. This will include procurement of the ICT Card Tests and Brugia Rapid Tests for the LF TAS surveys. FHI will coordinate closely with NIMPE to ensure that these pharmaceutical supplies are available at the appropriate time, and that NIMPE utilizes them in line with the standard operating procedures from the Ministry of Health and WHO for the safe handling and disposition of drugs.

B. Intervention/Training in Maintenance for LF Patients. Based on the results of the Formative Assessment for LF Morbidity, NIMPE will design an appropriate intervention to respond to the needs of current LF patients within five previously highly endemic provinces. Most likely this intervention will include a training component targeting both current LF patients and their care givers which would focus on such topics as methods of care, proper hygiene, appropriate exercise and ways to prevent opportunistic infections. The provision of appropriate IEC materials and other support materials may also be included. C. IEC Campaign for STH and Associated Materials. Based on a comprehensive communication strategy developed by the communications team at FHI/Vietnam in collaboration with NIMPE, FHI will produce and disseminate a package of IEC materials to promote both the STH MDAs as well as critical associated behaviors such as hand washing, wearing of shoes and proper defecation practices through the school system. The package will include comic books, calendars, stickers, rulers, badges, and a STH game, as well as a handbook for teachers which explains how to organize the MDAs and utilize the materials. The package will be piloted in schools throughout one province in March 2013, assessed, and then expanded to five additional provinces before August 2013. Provinces with the highest prevalence for STH and lowest reported coverage during previous MDAs will be selected for distribution of the materials, in the expectation that coverage and compliance will increase significantly. If successful, the package of materials will be disseminated to additional provinces in future years.

D. Procurement of Equipment. FHI will procure the following equipment for the newly constructed headquarters building at NIMPE: one desk top and one lap top computer; one printer; one LCD projector; one screen; one set of table and chairs; and one filing cabinet. This equipment will be provided in early 2013, as soon as the new building is ready for use.

E. Dissemination of Achievements and Capacity Building. Once appropriate opportunities are identified, FHI will work closely with NIMPE to make arrangements for selected staff from NIMPE and the Ministry of Health, as well as other national stakeholders, to participate in regional and international training opportunities, conferences, seminars, and workshops focusing on NTDs. FHI will provide all travel expenses and associated fees, and assist with registration and logistics. Prior approval from USAID will be obtained for all international travel.

III. Performance Monitoring

As required under USAID guidance as well as within the approved Supplemental Initial Environmental Examination for Vietnam, FHI will organize a cost-efficient and effective procedure to

71 monitor a sample of project-funded activities in the field to ensure transparency, compliance, accuracy of reporting, and quality of implementation. Results of these monitoring visits will be carefully documented and discussed in detail with NIMPE, and when appropriate shared with USAID.

IV. Reporting

On completion of each activity funded under the subagreement, NIMPE will provide a written Implementation Report including the appropriate survey results or coverage data to FHI. FHI will carefully track the completion of each activity, reimburse NIMPE for the negotiated cost, and compile results into a comprehensive, semi-annual report to USAID. FHI will also compile the appropriate MDA coverage and treatment data, and report the results to USAID using the standard MDA reporting format.

72 ANNEX A Proposed Budget END in Asia in Vietnam Revised: March 2013

Activity Year One Year Two Total

NIMPE: Subagreement I. Lymphatic Filariasis

A. Contact Survey and Treatment 2,092 - 2,092

B. Post MDA Surveillance 21,590 38,096 59,686

C. Training for LF TAS 9,604 9,604

D. Organization Meeting 4,785 - 4,785

E. Formative Assessment of LF Morbidity 4,326 - 4,326

II. Soil Transmitted Helminthes

A. National Prevalence Surveys of CSA 52,518 - 52,518

B. MDA for STH 216,221 418,857 635,078

C. National Workshop for STH 24,288 24,288

D. Sentinel Site Surveys 20,338 20,338

E. Workshop for National STH Guidelines 5,510 5,510

NIO: Fixed Obligation Grant

A. Trachoma Assessment 175,000 175,000

FHI Support A. Procurement of Pharmaceuticals 11,300 22,600 33,900

B. Intervention/Training in LF Morbidity - 25,000 25,000

C. IEC Strategy and Materials Development 5,000 770,000 775,000

D. Procurement of Equipment - 4,000 4,000

E. Dissemination of Achievements - 30,000 30,000

Total $342,120 $1,519,005 $1,861,125

73 ANNEX B

END in Asia in Vietnam Implementation Schedule Revised: September 2012

Activity Year One Year Two Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 NIMPE: Subagreement A. LF: Contact Survey and Treatment X B. LF: Post MDA Surveillance X X C. LF: Training in LF TAS X D. LF: Organization Meeting X E. LF: Formative Assessment of LF Morbidity X A. STH: National Prevalence Surveys of CSA X X B. STH: MDA for STH X X X X C. STH: National Workshop for STH X D. STH: Sentinel Site Surveys X E. STH: Workshop STH Guidelines X NIO: FOG A. Trachoma Assessment X X X FHI Support A. Procurement of Test Kits X X B. Intervention for LF Morbidity C. IEC Strategy and Materials Development X X X X X X D. Procurement of Equipment X E. Dissemination of Achievements X X X X X X X X

74 ANNEX C

END in Asia in Vietnam List of Locations/Provinces Revised: September 2012

Activity No. Province Lymphatic Filariasis A. Contact Survey and Treatment 1 Khanh Hoa B. Post MDA Surveillance 1 Thai Binh 2 Quang Binh 3 Ha Nam 4 Hung Yen 5 Ninh Thuan 6 Khanh Hoa C. Training for LF TAS 1 Ha Nam 2 Hung Yen 3 Kang Hoa (3) 4 Ninh Thuan D. Formative Assessment of LF Morbidity 1 Ha Nam 2 Hai Duong 3 Bac Ninh 4 Hai Duong 5 Thai Binh I. Intervention/Training in Maintenance for LF Patients 1 Bac Ninh 2 Ha Nam 3 Hung Yen 4 Hai Duong 5 Thai Binh Soil Transmitted Helminths A. Nation-wide Prevalence Surveys of Children of 1 Cao Bang School Age (CSA) 2 Lang Son 3 Ha Nam 4 Bac Giang 5 Gia Lai 6 Phu Yen 7 Quang Ngai 8 Quang Binh 9 Lam Dong 10 Tay Ninh 11 Dong Nai 12 Dong Thap

B. MDA for Children of School Aged (CSA) and Women of Reproductive Age (WRA) in Selected Provinces

75 MDA for CSA in Year One 1 Ha Giang 2 Cao Bang 3 Bac Kan 4 Hoa Binh 5 Thai Nguyen 6 Lang Son 7 Bac Giang 8 Dien Bien 9 Lai Chau 10 Son La MDA for WRA in Year One 1 Thanh Hoa 2 Tay Ninh 3 Binh Phuoc MDA for CSA in Year Two in October 2012 1 Ha Giang 2 Cao Bang 3 Hoa Binh 4 Thai Nguyen 5 Lang Son 6 Dien Bien 7 Son La 8 Bac Giang 9 Lai Chau 10 Ha Nam 11 Lao Cai 12 Quang Ngai MDA for WRA in Year Two in October 2012 1 Nam Dinh 2 Bac Ninh 3 Thai Nguyen MDA for CSA in Year Two in May 2013 1 Ha Giang 2 Cao Bang 3 Dien Bien 4 Son La 5 Bac Giang 6 Lai Chau 7 Ha Nam 8 Lao Cai 9 Nam Dinh 10 Thanh Hoa D. Sentinel Site Surveys for STH 1 Cao Bang 2 Thai Nguyen 3 Ha Nam 4 Thanh Hoa 5 Dong Thap 6 Binh Phouc 7 Dak Lam 8 Phu Yen

76 Collaborative Workplan

END in Asia in Papua New Guinea

April to December 2013

I. Introduction

Under USAID Cooperative Agreement No. AID-OAA-A-10-00051, FHI 360’s End Neglected Tropical Diseases in Asia Project (END in Asia) will provide support to the National Department of Health (NDOH) in Papua New Guinea to strengthen and expand their national NTD control efforts. This Collaborative Workplan outlines the goals, objectives and activities to be implemented by the NDOH with support from FHI 360 during a period from April to December 2013. A proposed Comprehensive Budget may be found in Annex A, a Schedule of Implementation in Annex B, and a List of Locations/Provinces in Annex C.

Background:

One of the factors impeding development in PNG is a high communicable disease burden, especially in remote populations, due to infection by neglected tropical diseases (NTDs). One of the most prevalent NTDs is lymphatic Filariasis (LF), or elephantiasis, which is endemic in at least 61 out of a total of 89 districts in PNG, with approximately 5.2 million people at risk. END is Asia will assist the NDOH to develop appropriate support systems and pilot a comprehensive LF elimination program focusing on the Mass Distribution Administration (MDA) of appropriate treatment (DEC and ALB) covering the entire population in one province, New Ireland, during 2013. If these pilot activities are successful, END in Asia will assist the NDOH to expand the program during subsequent years to cover as many of the endemic areas as possible as soon as possible with high quality, comprehensive, and well-managed control and elimination efforts.

Key Principles:

All collaboration and support throughout these efforts will be based on the following principles: • Country ownership: END in Asia will support the leadership and ownership of all program activities by the National Department of Health. • Collaboration: END in Asia will collaborate closely and provide management support to the NDOH to strengthen their national NTD control program. • Transparency and accountability: END in Asia will provide support to NDOH activities in a fully transparent and accountable manner, and provide appropriate pro-active oversight of the administration, implementation and reporting of project supported activities to ensure the highest quality of management. • Additionality: END in Asia will ensure that all resources allocated to NTD control in PNG will increase the total resources available, adding to, rather than displacing, existing resources.

77 • Integrated program: END in Asia will work closely with the NDOH to integrate all program activities within one national program which includes support from other USAID funded programs, WHO, AusAID, and other international NGOs working on NTD control in PNG.

II. Goals, Objectives and Activities

Overarching Goal:

END in Asia support in Papua New Guinea will contribute directly to USAID’s goal to reduce the prevalence of seven of the most prevalent NTDs by at least 50% among 70% of the world’s affected populations. This program will also directly contribute to the achievements of USAID’s global target of delivering one billion treatments through integrated NTD programs by 2013.

Objectives:

Specifically in Papua New Guinea, END in Asia will assist the NDOH to fill in crucial gaps within the national control and elimination program for Lymphatic Filariasis, focusing on pilot activities in one province, New Ireland1, including the implementation of base line surveys, organizational meetings and trainings of program implementers at all levels, the development of a communication strategy for LF and associated IEC materials, finalization of a reporting and recording system, assistance with drug logistics, and monitoring and supervision of the implementation of the MDAs in the field.

Activities:

FHI 360 will act as the fiscal agent and directly administer all funding support for the following activities, with the NDOH and the Provincial Government of New Ireland responsible for actual organization and implementation in the field.

Lymphatic Filariasis (LF)

Lymphatic Filariasis caused by Wucheraria bancrofti has been endemic in at least 61 districts in PNG, with eight districts still unmapped. The NDOH has selected New Ireland province to be the focus of pilot efforts to implement a comprehensive LF elimination program covering the entire population of 158,406, distributed across two Districts and over 600 villages. The provincial and district health services will be responsible for recruiting a network of village volunteers (one per village) who, in turn, will be responsible for implementing the first round of MDA in their respective villages in August/September 2013. These volunteers will be funded (including incentives and transportation costs) by the Provincial government, with assistance from WHO, during this first round of MDAs, with the expectation that sufficient funding will be allocated within the provincial recurrent budget for future rounds.

1 The pilot site for this project will be selected by NDOH and is subject to change. If the pilot site location changes END in Asia will contact USAID for concurrence to the change.

END in Asia will support the following activities to strengthen LF elimination efforts in PNG:

1. Baseline Surveys. NDOH will organize baseline surveys within the two districts in New Ireland, Kavieng and Namatanai, before the implementation of the MDAs. One Sentinel Site and one Spot Check Site will be selected in each district (Implementing Unit), and a blood sample from a finger prick will be collected from approximately 300 representative community members at each site and tested using an ICT rapid test card. The ICT test kits have been donated by JICA and are ready for use. The NDOH will also organize a short refresher training course for the survey team on the use of the ICT test cards. The information resulting from these surveys will establish the base line levels of prevalence and allow the NTD program to better track the impact of the MDAs over the life of the intervention (5 to 6 years) in these communities.

2. Organization Workshops and Training of Volunteers. END in Asia will assist the NDOH to organize two District Level Workshops for Supervisors (3 days each) in each District in order to inform the supervisors from the local health facilities about the objectives of the MDAs, explain roles and responsibilities, and discuss preparations and schedules. Approximately 25 supervisors will attend each workshop. Following the District Workshops, each supervisor will recruit one volunteer from each village in their catchment area. These volunteers will then be trained during a one-day Training in each local level government (LLG) area. Approximately 20 of these Trainings for Volunteers will be organized with an average of 30 participants each. During the training, volunteers will be instructed in the goals and objectives of the MDAs, how to register households and record the distribution of drugs, how to mobilize the community, and how to handle any adverse reactions. Training materials will be adapted from the standard WHO manuals and revised for use in PNG.

A second round of workshops (one-day each) will be organized at both the District and LLG levels following the MDAs in order to collect the completed report forms from the volunteers/supervisors, pay their incentives, identify problems and discuss suggestions for improvements during the next round of MDAs.

3. Communication Strategy and IEC Materials. END in Asia will assist the NDOH to develop a communication strategy to support the MDAs in New Ireland, beginning with an assessment of all current, available materials for LF, and including the identification of appropriate communication channels, the development of compelling messaging, and the design and pre-testing of synchronized IEC materials such as posters, leaflets, and radio spots. FHI 360 will then procure the printing and distribution of these IEC materials in sufficient quantities throughout the target areas prior to the MDAs.

4. Reporting and Recording System. The NDOH has already developed draft registration and reporting forms for use by the volunteers. END in Asia will assist the NDOH to pre-test these forms in actual field situations to ensure that they are easy to understand and user-friendly, and perhaps adding instructions in the local language, before printing in sufficient quantities for use during the MDAs in New Ireland. END in Asia will also assist in developing and maintaining a comprehensive data base and data management system for the LF program.

79 5. Drug Supply. An adequate supply of Albendazole for the entire province of New Ireland is already in country, supplied through the international drug donation program. WHO and the NDOH have taken the responsibility to decide on the most appropriate DEC dosage to use in PNG, and then to arrange for its procurement either through WHO or directly from the manufacturer. END in Asia will assist in organizing the packaging and distribution of the drugs from Port Moresby to each LLG through the provincial health services well in advance of the MDAs.

6. Monitoring and Supervision. END in Asia will also provide funding for a small team from the NDOH as well as appropriate personnel from the provincial and district health services to monitor all preparations activities as well as actual implementation of the MDAs in the field to ensure compliance, maintain quality control, and facilitate local problem solving if any issues should arise during implementation.

III. Performance Monitoring

As required under USAID guidance, as well as within the approved Supplemental Initial Environmental Examination for PNG, FHI 360 will organize a cost-efficient and effective procedure to monitor a sample of project-funded activities in the field to ensure transparency, compliance, accuracy of reporting, and quality of implementation. Results of these monitoring visits will be carefully documented and discussed in detail with the NDOH and when appropriate shared with USAID.

IV. Reporting

On completion of each activity, NDOH will provide a written Implementation Report including the appropriate survey results or data to FHI 360. FHI 360 will carefully track the completion of each activity and compile results into a comprehensive, semi-annual report to USAID, including all activities funded directly by FHI 360.

FHI will report on challenges encountered with the pilot site and propose solutions to deal with these issues in following workplans.

80 ANNEX A

Summary Budget: END in Asia in PNG April 2013

Activities Total

MDAs for LF in New Ireland Province

1. Base Line Surveys $25,000

2. Organization Workshop and Training for Volunteers 400,000

3. IEC Materials and Communications 90,000

4. Reporting and Recording System 10,000

5. Drug Supply 15,000

6. Monitoring and Supervision 90,000

Total $630,000

81 ANNEX B

END in Asia in PNG Implementation Schedule2

Activity 2013 Apr May Jun Jul Aug Sep Oct Nov Dec

MDAs for LF in New Ireland Province 1. Base Line Surveys X X 2. Workshops and Training X X X X 3. IEC Materials and Communications X X X 4. Reporting and Recording System X X X X 5. Drug Supply X X 6. Mass Drug Administration X X 7. Monitoring and Supervision X X X X X X X X

2 Due to the challenging nature of working in PNG, this Implementation Schedule is subject to change. FHI will notify USAID of changes in the schedule as they are identified.

82 ANNEX C

END in Asia in PNG List of Locations

Province District Local Level Government (LLG) New Ireland Province Kavieng District Murat Lovongai Tikana Kavieng Urban Namatanai District Namatanai Rural Sentral Niuailan Konoagil Tanir Nimamar

Annex V

Organizational Chart