All'rcan Programnte tbr Onchocerclasts Control Prograrnme afircatn de luttc contre I'onchocercose JOINT ACTION FORUM JAF-F'AC FORUM D'ACTION COMMLINE Offrce of the Chairman Bureau du Presrdent JOINT ACTION FORUM JAI'5/INF/DOC.2 Frfth sessron ORIGINAL: ENGLISH The Hasue. 8-10 December 1999 September 1999 REPORT ON APOC/NOTF WORKSHOP ON REASSESSMENT OF THE 1998 INDEPENDENT MONITORING OF CDTI PROJECTS a A I?ITI CAN I'IIOG ITAI\{ i\,I E ITOIT ONCHOCE,RCIASIS CONTROL (APOC) RE,PORT ON APOC/NOTF WORKSHOP ON REASSESSMENT OF THtr 1998 INDEPENDENT MONITORING OF CDTI PROJECTS I t , K.\ l],,\ L [1, tr (;,\ \ l).{ 1\,1A \' 3-8, I ggg TABLE OF CONTENTS Table of Contents I Acknowledgements ii List of Acronyms iii Executive Summary 1 Summary of Recommendations and Conclusions 2 Background to the Workshop 8 Opening 9 Objectives 1l Expected Outcomes t2 Special Plenary - Difference Between CBIT and CDTI 13 Session I - Community Involvement in CDTI/ Health Education 15 Session 2 - Training of CDDs l7 Session 3 - Recording and Reporting Procedures 18 Session 4 - Training Health Personnel on CDTI/Supervision 20 Session 5 - Reporting Treatment Coverage Rates 22 Session 6 - Community Support for CDDs: Incentives 24 Session 7 - Involvement of State/District Health Services 26 Special Session - Women's Participation in CDTI 29 Special Session - Other Matters 31 Closing Remarks JJ Appendices 1. Mobilisation Structure 34 2. Guidelines for Effective N{obilisation 35 3. Mectizan Treatment Register 37 4. Guide for Training and Retarining CDDs 38 5. Checklist for Trainers of Health Personnel 40 6. Checklist for Supervision of Health Personnel 4t 7. Action Plan: Summarl, ol Activities (June - December 1999) 42 8. Steps Leading to Disbursement of APOC Funds 43 9. Workshop Agenda 44 10. List of Participants 50 Acknorvledgements The participants wish to thank the Govemment of Uganda for hosting the APOC/NOTF Workshop on Reassessment of the 1998 Independent Monitoring of CDTI Projects in Malawi, Nigeria, Sudan and Uganda from 3-8 May 1999, at the Kabale District, Uganda. We wish to express our profound appreciation to the Uganda people for their warrn hospitality during this period. Our special thanks go to the Honourable Minister of Health, Dr. C.W.C.B. Kiyonga, for his kind patronage in the provision of funds for the organisation of the workshop, and l-ris personal participation in its opening ceremonies. We thank the Director of Health Services, Clinical and Community Health and the Commissioner of Health Services, National Diseases Control, for their organisational and moral supporl. Our very special thanks go to our colleagues and members of the National Onchocerciasis Task Force, Uganda, for their secretarial and logistic assistance. We particularly thank the National Coordinator, Dr. R. Ndyomugyenyi, the Deputy Coordinator, Mr. T. Lakwo and the NGDO Coalition Chairman, Mr. M. Katabarwa, for their hard work and input in making this workshop a huge success. We are grateful to Dr. H. Njie, the Representative of the World Health Organization in Uganda, and his staff for logistic, administrative and material support during the entire period. We fully appreciate the efforts of the facilitators, Dr. U. Amazigo, Mr. Y. Aholou and Ms. P. Mensah of APOC, Ouagadougou, Dr. R. Befidi-Mengue, Dr. O.B. Akogun, Mr. M. Katabarwa, and National Coordinators - Dr. J. Jiya, Dr. R. Ndyomugyenyi, and Mr. P. Tambala for their invaluable contributions at the various sessions. Our gratitude also goes to the Kabale Local Council 5 Chairman, Dr. F . Rumuni, and his district liealtli staff, for their warmth and the generosity of their friendship during our memorable stay at Kabale. Our field trip to Mburamaizi village was facilitated by the participatory interest they took in our activities. Finally, we owe an immense debt of gratitude to our team of rapporteurs - Mr. J. Watson, Mr. o. obono, Prof. o. Nwaorgu, and Mr. U. oyenne - whose diligence made the preparation and finalisation of this report possible even before we departed Uganda. ll ACRONYMS APOC African Prograntme for Onchocerciasis Control CBIT Community Based Ivermectin Treatment CBM Christoffel Blindenmission CBO Community Based Organisation CDD Community Directed Distributor CDTI Cornmunity Directed Treatment with Ivermectin GRBP Global 2000 River Blindness Programme IEC Information, Education and Communication JAF Joint Action Forum LC Local Council LGA Local Govemment Area LOCT Local Government Area Oncho Control Teal MDP Mectizan@ Donation Program MIS Management Information System MOH Ministry of Health NCR Net Treatment Coverage Rates NGDO Non-Government Development Organization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PHC Primary Health Care REA Rapid Epidemiological Assessment RAM Rapid Assessment Method REMO Rapid Epidemiological Mapping of Onchocerciasis SOCT State Oncho Control Team SSI Sight Savers International TCC Technical Consultative Committee TCR Treatment (Gross) Coverage Rates TDR Tropical Disease Research TOT Training of Trainers UNDP United Nations Development Programme wHo World Health Organization WR WHO Representative llt EXECU'II\'E SUNTMARY The Managentent ttf' the Afl-rcan Programme fbr Onchocerclasls Control (APOC), rn close collaboration u'tth the Mtntstt'y'of Ilealth (MOH) and the non-governmental development organrsations (NGDOs) rn Uganda, organtzed a mr"tltr-country Reassessment Workshop on the 1998 rndependent monrtoring of CDTI proJects tn Ntgerta, Sudan and Uganda. The purpose of the workshop was twofold. Firstly, rt provrded an opportunlty for prolect trnplementors, tncludrng district/state onchocerciasis project coordinators, to drscuss key tssues and concerns a rnvolving programme planning and implementation of the CDTI process. Secondly, tt served as forum where the particrpants and monitors could review and improve upon the rnstruments used rn the 1998 Independent Monrtonng of CDTI proJects. The Communrty-Dtrected Treatment with Ivermectrn (CDTI) approach is the pnncipal control strategy of APOC. It ts a process of acttve community participation in drug delivery and reporting. The approach recognlses deciston-makrng and problem-solving by communities and health services as crucial towards tnstallation of sustainable tvermectin treatments. Followrng the recommendations of the independent monttors, responses from the NOTFs and the request of the governtng body (JAF4) concerning the monttoring exercrse of 1998, APOC management decided to bring project implementors to a forum to share lessons learnt from the exerctse. Similar workshops are envisaged annually for the review of projects monrtored the prevrous year. The objectives of the 1999 monitoring review workshop were to . Share lessons learned from monitoring CDTI projects in 1998 and agree on central issues to be addressed in subsequent monitoring exercises o Review the process and instruments for monrtoring CDTI projects o Improve the participation of the NOTFs, the state/districts and communities in project monitoring. The workshop was held rn the Kabale Drstrict of Uganda from 3 to 8 May, 1999, and drew 66 participants from Malawi, Nigena, Sudan and Uganda (Appendrx 10). The sessions covered the following topics: . The Differences Between CBIT and CDTI approaches in onchocerciasis control r Involvement of Communities/ Health Services rn CDTI and Health Education e Trainrng of CDDs; Record Keeping and Reportrng Treatment Coverage o Trarning Health Personnel on CDTI and Supervision of CDDs o Communrty Support of CDDs and Incenhves o Women's Partrcrpatron rn CDTI and Other Matters The agenda adopted at the workshop focused on key issues faced by projects whrle implementing CDTI process rn the communltles and reassessment of all the 1998 monitoring instruments. Presentations by facrlitators were followed by lively and pa(icipatory group discussions designed to elucidate rssues of concern and proffer soluttons to the problems that rndrvrdual countries face rn programme implementation. As a result of these discussrons, each workrng group (by country) presented an outlrne of the problems and recot-nmendattons and f-eedback on monitortng rnstruments to the full group. In addrtron, each project wrote up actlon plans on how tt planned to improve on rts CDTI activities within the next srx months. Thrs report hrghhghts the key J)ornts that rvcrc brought out dunng the srx day workshop. STININ,IT\IIY OF RECOMNIENDATIONS BY SESSION Plenary Session: Differences Betu,een CDTI and CBIT Conclusions and Recommendations (Major points are in box) a Budgets for communrty mobilisation and health education should contain a clear description of the target groups in the community (teachers, women's groups, religious organisations, youth associations and other community based organisations) a NOTFs should play a ntore assertive role in directing the policy thrusts and orientation of APOC partnership as well as ensuring that the counterpart funding (cash) by government is released a Necessary policies should be formulated to ensure the release of budget funds for the CDTI programme from govemment a There is need to intensify the training of health staff especially with regard to their entry behaviour into the communtty and mobilisation of local groups in support of CDTI implementation in the community a NOTFs should identily and submit research proposals on issues that require scientific investigation at the district/state levels that might help improve the implementation of CDTI programme Sessionl: Communit],InvolvementinCDTI/HealthEducation