ENVISION Project Overview - Homepage 2017 | · Web viewTEOTetracycline Eye Ointment TFTrachomatous Inflammation–Follicular (active trachoma) TIPACTool for Integrated Planning and

GUINEA Work PlanFY 2017Project Year 6

October 2016–September 2017

ENVISION Project Overview

1

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

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

ENVISION PROJECT OVERVIEW

The U.S. Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm, whipworm, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at global and country levels and support Ministries of Health (MOH) to achieve their NTD control and elimination goals.

At the global level, ENVISION—in coordination and collaboration with WHO, USAID, and other stakeholders—contributes to several technical areas in support of global NTD control and elimination goals, including the following:

Drug and diagnostics procurement, where global donation programs are unavailable;

Capacity strengthening;

Management and implementation of ENVISION’s Technical Assistance Facility (TAF);

Disease mapping;

NTD policy and technical guideline development; and

NTD monitoring and evaluation (M&E).

At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including the following:

Strategic annual and multi-year planning;

Advocacy;

Social mobilization and health education;

Capacity strengthening;

Baseline disease mapping;

Preventive chemotherapy (PC) or mass drug administration (MDA);

Drug and commodity supply management and procurement;

Program supervision; and

M&E, including disease-specific assessments (DSA) and surveillance.

In Guinea, ENVISION project activities are implemented by Helen Keller International.

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TABLE OF CONTENTSPage

ENVISION Project Overview.......................................................................................................................... i

Acronyms List.............................................................................................................................................. iv

Country Overview........................................................................................................................................6

1) General Country Background...........................................................................................................6

a) Administrative Structure..............................................................................................................6

b) NTD Program Partners.................................................................................................................6

c) Ebola Virus Disease (EVD) Epidemic.............................................................................................7

2) National NTD Program Overview.....................................................................................................8

a) Lymphatic Filariasis......................................................................................................................9

b) Trachoma...................................................................................................................................10

c) Onchocerciasis...........................................................................................................................11

d) Schistosomiasis..........................................................................................................................13

e) Soil transmitted Helminths........................................................................................................13

3) Snapshot of NTD status in Guinea.................................................................................................15

Planned Activities......................................................................................................................................16

1) NTD Program Capacity Strengthening...........................................................................................16

a) Strategic Capacity Strengthening Approach..............................................................................16

b) Capacity Strengthening Interventions.......................................................................................16

c) Monitoring Capacity Strengthening...........................................................................................17

2) Project Assistance..........................................................................................................................17

a) Strategic Planning......................................................................................................................17

b) Advocacy for Building a Sustainable National NTD Program......................................................18

c) Social Mobilization to Enable NTD Program Activities...............................................................18

d) Training......................................................................................................................................21

e) Mapping.....................................................................................................................................22

f) MDA Coverage and Challenges..................................................................................................22

g) Drug and Commodity Supply Management and Procurement..................................................22

h) Supervision................................................................................................................................23

i) M&E...........................................................................................................................................24

3) Maps..............................................................................................................................................26

Appendix 1. Work Plan Timeline................................................................................................................31

Appendix 2.................................................................................................................................................34

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TABLE OF TABLESTable 1: Snapshot of the expected status of the NTD program in Guinea as of September 30, 2016.......15

Table 2: Project assistance for capacity strengthening..............................................................................16

Table 3: Social mobilization/communication activities and materials checklist for NTD work planning....20

Table 4: Planned DSAs for FY17, by disease...............................................................................................25

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ACRONYMS LIST

ALB AlbendazoleAPOC African Programme for Onchocerciasis ControlAPROSAG Association for Health Promotion in GuineaASTMH American Society of Tropical Medicine and HygieneCDD Community Drug Distributor CDTI Community-Directed Treatment with IvermectinCLTS Community-Led Total SanitationCRS Catholic Relief ServicesCTC Technical Coordination CommitteeDFID U.K. Department for International DevelopmentDQA Data Quality AssessmentEND Fund End Neglected Tropical Diseases FundEVD Ebola Virus DiseaseFOG Fixed Obligation GrantFPSU Filarial Programmes Support UnitHD Health DistrictHKI Helen Keller International IEC Information, Education, and CommunicationITI International Trachoma Initiative IVM IvermectinJAP Joint Application PackageLF Lymphatic FilariasisLOE Level of EffortM&E Monitoring and EvaluationMDA Mass Drug AdministrationMOH Ministry of HeathNGO Non-governmental OrganizationNTD Neglected Tropical DiseaseOCP Onchocerciasis Control Program in West AfricaOMVS Senegal River Basin Development Organization OPC Organization for the Prevention of BlindnessOV OnchocerciasisPC Preventive Chemotherapy PCG Central Pharmacy of GuineaPGIRE Integrated Water Resources Management ProjectPNLOC/MTN National Program for Control of Onchocerciasis and Blindness/Neglected Tropical

DiseasesPZQ PraziquantelSAC School-age Children SAE Serious Adverse EventsSAFE Surgery–Antibiotics–Facial cleanliness–Environmental improvementsSCH SchistosomiasisSCI Schistosomiasis Control InitiativeSIAPS MSH Systems for Improved Access to Pharmaceuticals and Services

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SNSSU National School and University Health ServiceSTH Soil-Transmitted HelminthsTAP Trachoma Action PlanTAS Transmission Assessment SurveyTEO Tetracycline Eye Ointment TF Trachomatous Inflammation–Follicular (active trachoma)TIPAC Tool for Integrated Planning and CostingTIS Trachoma Impact SurveyTT Trachomatous TrichiasisUSAID United States Agency for International DevelopmentWHO World Health OrganizationZTH Zithromax

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COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Guinea is located on the Atlantic coast of West Africa, with an area of 245,857 square kilometers, bordered to the north by Guinea-Bissau, Senegal, and Mali; to the east by Mali and Côte d’Ivoire; and to the south by Liberia and Sierra Leone. Guinea is divided into four ecological/geographical regions: Lower Guinea (Basse-Guinée) located on the coast; Middle Guinea (Moyenne-Guinée), which is a region of plateaus and forest; Upper Guinea (Haute-Guinée), which is a region of savannah and plateaus; and Forest Guinea (Guinée forestière). Based on the recent, third national census conducted in 2014, the population of Guinea is 10,991,383 inhabitants in 2016. Using an annual growth rate of 2.2%, the total estimated population of Guinea for 2017 is 11,233,194.

Guinea’s administrative structure is composed of 8 regions: Boké, Faranah, Kankan, Kindia, Labé, Mamou, N’Zérékoré, and the specific area of the capital city of Conakry. Conakry is divided into communes, while each region outside of the capital is divided into prefectures. In total, there are five communes in Conakry and 33 prefectures, comprising 38 health districts (HDs) in the country. Each prefecture is further divided into urban and rural communes (defined by neighborhoods in urban areas and “administrative districts” in rural areas), called sub-prefectures. In total, there are 343 urban and rural communes, including the 5 communes of Conakry. Guinea has a total of 925 health outposts, 410 health centers, 5 higher-level health centers, 33 prefectural hospitals, 7 regional hospitals, and 3 national hospitals.

b) NTD Program Partners

In addition to funding from the U.S. Agency for International Development (USAID) through ENVISION, the Ministry of Health and Public Hygiene (MOH)’s National Program for Control of Onchocerciasis and Blindness/Neglected Tropical Diseases (PNLOC/MTN) receives funding from the following donors (see also Tables 1a and 1b):

Filarial Programmes Support Unit (FPSU), with funding from the U.K. Department for International Development (DFID), formerly Centre for Neglected Tropical Diseases: FPSU funds lymphatic filariasis (LF) and onchocerciasis (OV) elimination activities in border regions along the Mano River in Guinea, Liberia, and Sierra Leone. FPSU/Liverpool School Tropical Medicine supported mass drug administration (MDA) in six HDs for fiscal year 2016 (FY16)—to avoid interruption of MDA (the Senegal River Basin Development Organization [OMVS] will take over support for these HDs in FY17)—and developed a national strategic plan to support morbidity associated with LF.

Sightsavers, with its own funding, supports community-directed treatment with ivermectin (CDTI) for OV control in 1 HD, surgery for trachomatous trichiasis (TT) in 10 HDs, preventive health awareness-raising campaigns, and development of trachoma action plans (TAPs).

Organization for the Prevention of Blindness (OPC), with funding from the Sight First Initiative (Lions Clubs International Foundation) and Coopération Française supports CDTI for OV control in three HDs. OPC is a French non-governmental organization (NGO) working in francophone

ENVISION FY17 PY6 GUINEA Work Plan6

Africa, with specific expertise in ocular public health. It provides technical and financial support for CDTI implementation.

OMVS’s Integrated Water Resource Management Project (PGIRE), funded by the World Bank, launched a call for applications in 2016 and Catholic Relief Services (CRS) was chosen as the organization to execute Phase II of its program. It is anticipated that PGIRE will support MDA for LF, OV, schistosomiasis (SCH), soil-transmitted helminths (STH), and trachoma, as well as procurement and distribution of bed nets for malaria, in six HDs located in the Senegal River Basin. This activity will be carried out in the Senegal River Basins of Mali, Mauritania, and Senegal as well, with different implementing partners. CRS has been retained to execute Phase II in Guinea for the next three years and will start with SCH MDA in two HDs in October 2016. Although initially proposed for 10 HDs, during the FY17 work plan workshop, it was decided that CRS will start working in 6 HDs. The number of HDs supported by CRS could be gradually increased, assuming available capacity and funds. The support of CRS will be assessed at the end of the MDA campaign in FY17 internally and then with the MOH and the partners.

Plan Guinea supports the construction of latrines, boreholes, and wells and increases awareness among communities on good hygiene and sanitation practices through community-led total sanitation (CLTS). It also supports a one-off SCH MDA according to the availability of resources and needs within the HDs where it implements activities. During the 2016 MDA campaign, Plan Guinea organized the distribution of praziquantel (PZQ) in some schools in two HDs in the forest area through the School Health Service without coordination with the PNLOC/MTN. The PNLOC/MTN, Helen Keller International (HKI) and partners discussed this during the ENVISION work planning meeting held in Guinea in July 2016 and it was decided that Plan Guinea will coordinate with PNLOC/MTN on continued treatment in these HDs in FY17.

Ministry of Education’s National School and University Health Service (SNSSU): Depending on availability of funds, the SNSSU will support PZQ distribution in those districts that are not funded for this activity, and a second round of albendazole (ALB) treatment for STH in the HDs that are funded by ENVISION for only one annual round of treatment. Eight HDs will not be covered for SCH if funding is not available. For STH, SSNSU will support the 8 HDs with their own funding. The MOH is under discussion with Sightsavers to provide SCH support in FY17.

c) Ebola Virus Disease (EVD) Epidemic

Guinea has experienced unprecedented issues with the outbreak of Ebola. These issues impeded planned scale-up of MDA and delayed other key activities such as mapping and disease-specific assessments (DSAs) that are necessary to reach national goals in FY14, FY15, and to a lesser extent in FY16. Now that the disease is under control and WHO has declared Guinea Ebola-free in FY16, activities can be scaled up; however, the population continues to have doubts and misgivings about any type of health activity, and communication needs to take this context into account. Although the population still has some fear of Ebola, activities are returning to normal, and the strategies addressing the remaining Ebola-related issues (described below) have been very useful.


2) National NTD Program Overview

NTDs are a recognized priority by the MOH in Guinea, as evidenced by the Strategy for the Reduction of Poverty (DSRP III 2013–2015); the National Plan for Health Development 2015–2024, which includes NTDs among the country’s priority diseases; and the NTD Strategic Plan 2016–2020, which is being finalized and should be completed before the end of September 2016. Among those NTDs recognized by WHO, eight are endemic in Guinea:

Three NTDs are addressed through a case management strategy managed by separate programs within the MOH: leprosy, Buruli ulcer, and human African trypanosomiasis (sleeping sickness).

Five NTDs are addressed through a preventive chemotherapy (PC) strategy, implemented as part of an integrated program: LF, OV, SCH, STH, and trachoma.

In May 2004, the PNLOC was formed to lead the fight against blinding diseases in Guinea, including OV and trachoma. Historically, activities related to SCH and STH were the responsibility of the MOH’s Disease Prevention Division and the Ministry of Education’s SNSSU, with LF falling under this purview in 2010. Following the development of the first NTD Strategic Plan (2008–2012) in 2009, the PNLOC became the PNLOC/MTN, with an expanded mandate to address LF, SCH, and STH. Within the PNLOC/MTN, the NTD Coordinator (who also serves as the trachoma focal point) oversees four other disease-specific focal points for SCH-STH, OV, LF, and blindness.

With the start of USAID funding for integrated NTD control in Guinea in 2011, the MOH developed an NTD Strategic Plan for 2011–2015, addressing case management and NTDs treated through PC. For PC NTDs, the Plan adopted the PC and transmission control strategy, endorsed by WHO, which targets these five diseases as a package because they tend to overlap geographically, can be targeted with a similar preventive treatment approach using MDA, and are targeted with drug combinations that can often allow for concurrent treatment.

The Strategic Plan also established the PNLOC/MTN and a steering committee that guides the Plan’s implementation. A workshop was organized in February 2016 to review and update the Plan for the 2016–2020 period, taking into account new data and progress made to date. The Strategic Plan is expected to be validated by the end of FY16. Overall, the country’s strategic objectives for the PC NTDs are the following:

(1) Eliminate LF, OV, and blinding trachoma by 2020; and

(2) Control SCH and STH by 2025.

In FY16, the PNLOC/MTN had planned MDA campaigns for LF, OV, and STH in all eligible HDs; for trachoma in HDs that have a trachomatous inflammation–follicular (TF) prevalence ≥10%; and for SCH in all HDs with a moderate to high risk of infection with the support of partners and in collaboration with the Ministry of Education. To date, the MDA campaigns for LF, OV, and STH have been carried out in all HDs that are supported only by USAID. The MDA for SCH in 15 out of 21 HDs (of which 7 are USAID financed) and for LF, OV, and STH in 2 out of 24 endemic HDs (financed by FPSU) were not completed to date due to delays in ALB and ivermectin (IVM) delivery. For FY17, ENVISION is supporting an earlier drug order to attempt to avoid these issues. The drug order was submitted on the 10 th of August 2016

For FY17, the national program objective is to conduct MDA campaigns for LF, OV, STH, and trachoma in all endemic HDs and for SCH in all high- and low-prevalence HDs plus two HDs that have prevalence


close to 50%—with support from current and new partners. CRS has confirmed and have signed with OMVS. The other organizations are in the midst of planning their activities.

In FY17, ENVISION will implement NTD activities in 19 HDs: 5 HDs in Kankan region, 4 HDs in Faranah region, 3 HDs Boké region, 1 HD in Labé region, 3 HDs in Kindia region, and 3 HDs N’Zérékoré region. All 19 HDs are endemic for LF, trachoma, or both (see Appendix 4).

The Guinean government ensures funding for the salaries of PNLOC/MTN staff, for the staff involved in the various surveys and MDA campaigns, and for treatment and management of adverse events during MDAs.

a) Lymphatic Filariasis

Overall, 24 HDs are endemic for LF; of these HDs, 20 are co-endemic with OV, 21 with SCH, 15 with STH, and 16 with trachoma. Guinea’s goal is to eliminate LF by 2020. Specific objectives of the PNLOC/MTN are to interrupt transmission of LF, with a minimum of 65% epidemiological coverage in all endemic HDs, and to prevent and manage complications of the disease. However, two endemic HDs (Forécariah and Télimélé) have not yet started MDA. These HDs will be treated in FY17 with ENVISION support and so will not have completed the required five rounds of treatment, pre-TAS, and TAS by the 2020 elimination deadline.

Because the clinical expression of LF is so debilitating, Guinean health services have long been aware of the disease, and cases were historically reported in 10 HDs.

In 2005, a WHO-funded baseline mapping of LF endemicity was conducted in 46 villages in 24 HDs in the eight administrative regions where no previous data existed on the disease. This mapping survey identified 15 HDs as endemic. From 2011 to 2013, the MOH mapped the aforementioned 10 districts where clinical cases had been reported historically; this was carried out with support from the USAID-funded RTI-managed NTD Control Program through HKI in 2011, and with support from the ENVISION project through HKI in FY12–13. This additional round of mapping confirmed a further nine HDs as endemic. The country’s four remaining LF-endemic HDs, all in the capital city Conakry, have not and will not be mapped because an entomological survey (insect dissection and polymerase chain reaction testing, supported by FPSU) conducted in 2013 in Conakry showed no ongoing disease transmission in the capital. The LF program is still at its early phase in Guinea. It is anticipated that when most of the LF districts reach the TAS stage in three years; when needed TAS would then be also conducted in areas suspected endemic including Conakry to be part of an EU. But for now the entomology data is a valuable documentation for future LF dossier. The upcoming annual review meeting will discuss these LF endemicity issues.

The endemic HDs are located within the regions of Boké, Faranah, Kankan, Kindia, Labé, Mamou, and N’Zérékoré, with an at-risk population of 7,319,176, of which 80% are considered eligible for MDA treatment.

The PNLOC/MTN conducted baseline microfilaraemia sentinel site surveys with ENVISION support in 2012 and 2013. The 2012 surveys were conducted in four sites—Gandjin, Koundou Toh, Sounsoun, and Sinthiou—and the 2013 surveys in seven HDs in the regions of Boké, Faranah, Kankan and Mamou. In 2013, with support from FPSU, a microfilaraemia survey was carried out along the border of the Mano River Union countries in sentinel sites in Faranah, Kankan, Kindia, Mamou, and N’Zérékoré. The last series of sentinel sites completed set-up in FY16 in four HDs (Kindia, Lélouma, Siguiri, and Beyla) with ENVISION support. Immunochromatographic test cards were used for the surveys. By grouping the HDs based on contiguity, similar characteristics, and considering a total population of less than 1 million,


parasitological data were collected in 17 sites that will serve as sentinel sites to monitor the success of the program in all 24 endemic HDs.

Guinea’s first LF treatment was conducted in FY14 in four HDs co-endemic for both LF and OV: Koundara in Boké Region, Dabola and Dinguiraye in Faranah Region, and Guéckédou in N’Zérékoré Region. In FY15, the MOH conducted MDA in 9 of the 24 endemic HDs, 4 of which reported low coverage due to the EVD epidemic (Dabola, Dinguiraye, Kouroussa, and Dalaba). To date in FY16, the MOH has conducted MDA in 22 HDs, with epidemiological reported coverage rates of >70% in all HDs.

The creation of a strategic plan for the management of LF-associated morbidity is underway, with the financial and technical support of FPSU/Sightsavers. This plan, once validated, will serve as an advocacy tool in the search for additional funding. In view of this plan, community drug distributors (CDDs) conducted a census of LF morbidity cases during the LF MDA in FY16.

For FY17, ENVISION will support LF MDA in 19 endemic HDs out of the total of 24. The other five LF- endemic HDs will be supported by OMVS/CRS.

b) Trachoma

Guinea’s national strategy for trachoma is elimination as a public health problem by 2020. Trachoma elimination is achieved through implementation of the WHO-recommended SAFE (Surgery–Antibiotics–Facial cleanliness–Environmental improvements) strategy. In Guinea, trachoma-endemic areas are located in Upper Guinea and the northern part of Middle Guinea—areas with the country’s highest poverty rates.

Baseline mapping of trachoma—conducted by the MOH with support from Sightsavers—in 10 HDs of Upper Guinea in 2001 showed an average prevalence of 33% for active trachoma among children aged 1–9 years and 2.7% for trachomatous trichiasis (TT) among women older than 15 years.

The MOH completed mapping in 31 HDs (trachoma rapid assessments had been conducted in some of the HDs in 2002) with USAID funding through the NTD Control Program (2011) and ENVISION (2012–2016). These surveys confirmed that 18 districts are endemic; the breakdown is provided in Table 2b. TF prevalence of ≥30% in 5 HDs; TF prevalence of between 10% and 29.9% in 4 HDs; and TF of between 5% and 9.9% in 9 HDs. The current population at risk of trachoma in the 18 HDs with a TF prevalence of ≥5% is estimated at 5,568,411. None of these 18 HDs have stopped MDA yet. Of these 18 trachoma-endemic HDs, 16 HDs are co-endemic with LF, 13 HDs with OV, 16 HDs with SCH, and 9 HDs with STH.

The country has implemented several components of the SAFE strategy since 2012:

Sightsavers provides support that focused on the “S” component—training surgeons for TT surgery; training health center supervisors, workers for the Expanded Program of Immunization, and those in charge of community-based services in screening and case referral of TT; and organizing surgical camps for TT in Boké, Faranah, and Labé regions.

ENVISION has supported the PNLOC/MTN with the “A” component of the strategy since FY13 —in nine districts with TF prevalence of ≥10%—with Zithromax (ZTH) and tetracycline eye ointment (TEO) MDA. In FY14 and FY15, ENVISION conducted MDA in eight and seven of the nine HDs, respectively; the MDA in the remaining HDs was postponed due to the EVD epidemic. Despite this delay, ENVISION conducted MDA in all nine HDs in FY16 with good coverage rates (all nine HDs achieved the minimum programmatic coverage required).


Plan Guinea supports some activities of the “F” and “E” components through CLTS, notably for latrine construction and borehole and well installation, and also by increasing the population’s awareness for practicing good hygiene and sanitation. However, it must be noted that these activities are conducted within projects aimed at children and not directly for trachoma and without PNLOC/MTN consultation.

The PNLOC/MTN is developing a TAP with the support of Sightsavers and ENVISION (data sharing and participation in the workshop). A workshop was organized by PNLOC/MTN in November 2015. The participants included all stakeholders, plus ENVISION staff.

In FY17, with ENVISION support, the PNLOC/MTN plans to conduct MDA for trachoma in 9 HDs (including 3 HDs with a TF prevalence between 5% and 9.9% which will be treated for the first time) and to complete trachoma impact surveys in 3 HDs with a TF prevalence 10%-%29.9 (Kankan, Siguiri and Mandiana) that have had three rounds of treatment and in 1 HD with initial mapping prevalence of 5% to 9.9% (Koundara, for which the mapping data is more than three years old). The PNLOC/MTN will use the results of the surveys to decide whether or not to stop or to start MDA in these HDs. No HDs have met the criteria to stop trachoma MDA to date, but it is expected that at least the three HD in which three rounds of MDA have already been conducted will pass in FY17. Furthermore, CRS will support trachoma MDA in three HDs in FY17. The PNLOC/MTN has requested support for the treatment of the two remaining HDs (Boffa and Fria) from ENVISION.

c) Onchocerciasis

The current national strategy is to eliminate OV by the year 2020, with continued treatment and entomological and epidemiological assessments to show the impact of treatment on reaching the criteria to stop MDA. Guinea has been on track to achieve this goal with consecutive treatments taking place for more than 20 years in some areas.

OV is endemic in 24 HDs, in seven of the eight regions. Of the 24 OV-endemic HDs, 20 are co-endemic with LF, 23 with SCH, 14 with STH, and 13 with trachoma. Currently, the total population in endemic HDs is estimated to be 6,781,592. A total of 8,229 OV-endemic villages were surveyed, with support from the Onchocerciasis Control Program in West Africa (OCP). From 1996 to 2002, with OCP support, the MOH conducted annual CDTI in all 24 endemic HDs in the regions of Boké, Faranah, Kankan, Kindia, Labé, Mamou, and N’Zérékoré. From calendar year 2002 to 2012, support for OV activities in Guinea were provided by WHO through the African Program for Onchocerciasis Control (APOC) in areas qualified as Special Intervention Zones, including Faranah, Dabola, Dinguiraye, Kissidougou, Kouroussa, Siguiri, Forécariah, Kindia, and Mamou. OV activities in areas not classified as Special Intervention Zones were funded by Sightsavers and OPC.

Since 1980, at sentinel sites for epidemiological monitoring surveys in 531 villages in 11 river basins, HDs have been identified and assessments conducted using the skin-snip technique, with support from OCP and then from APOC, and then later (FY12–14) from USAID. No surveillance activities were undertaken in 2015.

In FY12-13, an OV epidemiological surveillance survey conducted with ENVISION support in a total of 56 villages showed some signs of recrudescence of OV in some villages (Milo/Dion basin, Niger/Mafou basin, and Mongo/Kaba basin). These historical data will be collected and entered into the Integrated NTD Database because at present they are not available at the central level. It is suspected that the recrudescence may be due to irregularity in treatment in neighboring countries (due to periods of conflict). In response to this, the PNLOC/MTN started discussions with FPSU about a cross-border


treatment strategy. HKI will suggest and advocate for cross-border discussions to restart (at the Mano River Union meetings); these discussions had stopped due to the Ebola epidemic. Furthermore, it is suspected that the CDTI strategy may not have been rigorously implemented due to insufficient supervision. The PNLOC/MTN plans to reinforce supervision, especially in the areas with integrated treatment with LF.

In FY14, ENVISION planned to support epidemiological evaluations in 11 HDs. A total of 55 substitute villages were selected to be surveyed in other HDs in N’Zérékoré Region. The results of these evaluations showed a prevalence of between 0% and 7.6% using the skin-snip technique. In FY16, all HDs reported sufficient programmatic coverage, indicating that low coverage from issues caused by Ebola had been resolved.

After almost 20 years of IVM treatment, the question of stopping drug distribution has been raised. A consortium, composed of End Neglected Tropical Diseases (END) Fund, FPSU, Sightsavers, the Mectizan® Donation Program, and eminent OV researchers, initiated a process to support the MOH to conduct monitoring activities (epidemiological and entomological) in five countries, including Guinea. The consortium has planned monitoring activities in Guinea, particularly entomological surveys from 2016 to 2017.

A national OV elimination committee should be created to provide technical advice on OV elimination. The role of this committee would be as follows:

Support the development of a national guideline and road map.

Analyze the national program data and confirm that the program is on track to reach the criteria for the interruption of transmission.

Recommend to the MOH areas where IVM can be stopped safely.

Prepare the elimination dossier for verification when the elimination criteria have been reached.

It is expected that the committee will be made up of national members (representatives from the MOH, NGOs involved in OV elimination in Guinea, WHO, university and science researchers, people of influence or resource persons with capacities who can assist) and international members (representative from the above-mentioned consortium of experts, imminent researchers, ENVISION staff). The committee will meet regularly to review data and progress toward elimination (details such as the frequency of meetings will be decided in FY17). With Sightsavers’ support, the PNLOC/MTN initiated a process to establish the OV elimination committee; a workshop to develop the background documentation was held in July 2016, working toward creating the national committee to oversee OV and LF elimination. ENVISION staff participated in this workshop, and a ENVISION staff member will be identified to join the committee. Some members of the consortium mentioned above will also be members of the elimination committee, thereby linking the consortium and the committee.

In FY16, the PNLOC/MTN conducted OV MDA in 15 HDs with ENVISION support, MDA in another 5 HDs were supported by FPSU, and 4 HDs implemented CDTI with support from Sightsavers (1HD) and OPC (3 HD). All HDs reported sufficient programmatic coverage in FY16.

In FY17, the PNLOC/MTN plans to conduct MDA in all 24 HDs: 17 HDs with ENVISION support, 1 HD with Sightsavers support, 3 with OPC support, and 3 with OMVS support (to be confirmed). The timeline for elimination will be confirmed based on the result of the surveillance activities that will be planned by the consortium.


d) Schistosomiasis

Guinea plans to control SCH in the 31 endemic HDs by the year 2025. SCH is co-endemic with LF in 21 HDs, with OV in 23 HDs, with STH in 15 HDs, and with trachoma in 16 HDs. The current implementation strategy for the national program is morbidity control through MDA with PZQ distribution targeting school-age children (SAC) in school- and community-based MDA (with a focus on school-based MDA). The MOH recognizes that elimination may not be possible through MDA alone, and that continuous treatment and further scale-up have been impeded by political instability (2013) and the EVD outbreak.

Mapping in the regions of Faranah, Labé, and Mamou in 2009 and 2010 was carried out with support from OMVS. Mapping in the regions of N’Zérékoré in 2010 and Kindia in 2011 was conducted with funding from Rio Tinto, with technical support from HKI. Mapping of the remaining 33 HDs was completed from 2011 to 2014 with support from USAID’s NTD Control Program (2011) and ENVISION (2012–2014). Overall, 31 out of 38 HDs are endemic (prevalence >0%) for SCH, with a current population of 9,852,248 at risk. Specifically, 12 HDs are high risk (prevalence of ≥50%), 7 are moderate risk (prevalence of ≥10% and <50%), and 12 are low risk (prevalence of <10%). Among the endemic HDs, 17 have been treated at least once with PZQ since 2010, but these treatments were irregular. The MDA rounds from 2013 to 2015 did not take place due to operational constraints directly linked to national elections and the Ebola epidemic. The PNLOC/MTN decided that SCH control efforts will be conducted in collaboration with those of STH in those HDs where both diseases are co-endemic and where no LF MDA has been implemented.

In FY16, the MOH conducted SCH MDA in 6 HDs (ENVISION-supported) out of 21 that were planned. The PNLOC/MTN continues to maintain contact with the SNSSU and is advocating for the remaining 15 HDs to receive the planned MDA before the end of the calendar year. To simplify logistics in this post-Ebola period, and taking into consideration the limited availability of PZQ for adults (currently WHO-donated PZQ does not take adults into account), the MOH has targeted only SAC, even in HDs with a high risk, where treatments of high-risk adults would be justified according to WHO guidelines.

In FY17, the PNLOC/MTN plans to conduct MDA in 16 HDs with ENVISION support, treating only SAC (of the 26 HDs planned for treatment in FY17, see Table 2d). HDs with moderate prevalence are treated every two years, and HDs with low prevalence are treated every third year.

e) Soil transmitted Helminths

Guinea’s goal is to control STH as a public health problem (reducing prevalence to <20% and therefore classifying HDs as no longer needing MDA) by 2025; however, the government is aware that control may not be possible with once-yearly MDA alone and without significant improvements in hygiene and sanitation. Similar to the other NTDs, with the challenges faced during the past three years due to political instability and the outbreak of EVD, treatment schedules have been irregular.

Mapping of Guinea’s 38 HDs for STH was completed in 2014 using the WHO recommended Kato Katz thick smear, in conjunction with SCH mapping as described above: 9 HDs are moderate risk (prevalence of ≥20% and <50%) and 8 HDs are high risk (prevalence of ≥50%). The at-risk population requiring MDA is estimated at 5,182,942. Of the 17 endemic HDs, 15 HDs are co-endemic with LF, 14 with OV, 15 with SCH, and 9 with trachoma.

Since 2010, 17 HDs have received one or more rounds of treatment for STH. MDA did not take place in 2013 due to operational constraints linked to national elections. In FY14, just one of the 15 HDs targeted


for STH treatment (Guéckédou) received MDA due to the EVD outbreak. In FY15, the PNLOC/MTN conducted STH MDA in four HDs through the LF MDA.

In FY16, the PNLOC/MTN implemented STH MDA through the LF MDA in 13 HDs out of 17 planned: 10 HDs received treatment with ENVISION support and 3 with FPSU support. (The remained four HDs are planned to be completed before the end of FY16: two HDs will be treated by FPSU in July 2016 and two HDs will be treated by the SNSSU by the end of FY16).

In FY17, the PNLOC/MTN, with ENVISION, plans to conduct STH MDA in 13 HDs (FPSU will no longer support the 3 HDs from FY16, consequently ENVISION will take over support in FY17). Among those 13 HDs, 7 have a prevalence requiring two rounds of treatment per year. These HDs are co-endemic with LF—an integrated treatment for LF-STH will be implemented (namely ALB-IVM). Support from ENVISION will cover only one round of treatment. The PNLOC/MTN will conduct advocacy activities to ensure the second round of treatment occurs.

Plan Guinea is supporting the construction of latrines, boreholes, and wells in N’Zérékoré, Faranah, and Kindia, which supports, indirectly, the goals of the PNLOC/MTN for STH control.


3) Snapshot of NTD status in Guinea

Table 1: Snapshot of the expected status of the NTD program in Guinea as of September 30, 2016

Columns C+D+E=B for each disease* Columns F+G+H=C for each disease*

MAPPING GAP DETERMINATION MDA GAP DETERMINATION MDA

ACHIEVEMENT DSA NEEDS

A B C D E F G H I

Disease

Total No. of

Districts in Guinea

No. of districts

classified as

endemic**

No. of districts

classified as non-

endemic**

No. of districts in need of initial mapping

No. of districts receiving MDAas of 09/30/16

No. of districts expected to be in need of MDA at

any level: MDA not yet started, or has

prematurely stopped as of

09/30/16

Expected No. of districts where

criteria for stopping

district-level MDA have been

met as of 09/30/16

No. of districts requiring DSAas of 09/30/16USAID

-funded

Others

LF

38

24 14 0 16 6 21 0 Pre-TAS: 0TAS: 0

OV 24 14 0 15 8 12 0 03

SCH 31 7 0 64 0 254,5 0 0

STH 17 21 0 10 3 46 0 0

Trachoma 18 20 0 9 0 97 0 51 HDs that have delayed MDA for several months in FY16 due to insufficient funds from FPSU 2 HDs treated in the preceding years but not treated in FY16 due to funding issues (MDA LF/OV in one HD).3 Entomological and epidemiological surveys are planned by the consortium in FY17, but the district where the activities will be implemented are not yet known.4 13 HDs were planned for FY16, but 6 HDs were treated in FY16 and 7 HDs will be treated in FY17 (due to late drug delivery).5 17 HDs treated once in FY12, 1 (Kindia) has never been treated, and 7 HDs will be treated in October 2016 (FY17).6 2 HDs have never been treated and 2 others were only treated in FY12.7 Of these 9, only 7 may need MDA (based on the TIS results).


PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

To assist the PNLOC/MTN Programs ENVISION will focus on the following actions to be taken:

Improve supply chain management for MDA drugs

Operationalize an M&E staff at PNLOC/MTN to manage M&E and surveillance activities

Three main objectives are identified to strengthen the PNLOC/MTN program:

Objective 1: Improve supply chain management for MDA drugs: Almost every year, MDA is delayed in Guinea. One main reason is the late submission of the Joint Request for Selected Medicines (JRSM) to WHO. Fortunately, the SCM training conducted in August 2016 included strong participation of PNLOC/MTN staff, which will benefit the programs. ENVISION will work with the PNLOC Coordinator to assign the duty of filling the JRSM to the MOH Pharmacist focal point. ENVISION will work with the Pharmacist focal point at MOH to develop a recuperation plan for the unused drugs from the lower levels to the central level after MDA is completed.

Objective 2: Strengthen PNLOC/MTN M&E capacity: In addition to funding a consultant to complete historical data entry, ENVISION will train two PNLOC/MTN staff on the integrated database and these staff will continue to enter the data when the consultant contract is ended. In about two years, several HDs will be ready for pre TAS and subsequently for TAS. Currently, the PNLOC/MTN does not have a dedicated M&E team to conduct such activities. In FY17, ENVISION will work with the PNLOC/MTN Coordinator to identify M&E focal point and lab technicians to be trained in FY18 to manage M&E and surveillance activities.

b) Capacity Strengthening Interventions

Table 2: Project assistance for capacity strengtheningProject assistance

areaCapacity strengthening interventions How these will help to correct

needs identified

a- Strategic planning Assist the MNLOC/MTN in entering data into the TIPAC Help the PNLOC/MTN to identify the funding gaps and use that tool to advocate for additional funds from donors.

b-M&E Assist the PNLOC/MTN in entering historical data for all NTDs into the integrated database.

Identifying M&E focal point at PLNOC/MTN and inventorying lab technicians

Data will be used to complete the WHO Joint Reporting Form and the LF dossier when needed M&E staff will be necessary for NTDs surveillance activities.

c- Drug supply management and procurement

Mentoring MOH Pharmacist focal point in filling and submitting the JRSM to WHO 6 months before MDA and developing a strategy to recuperate the unused drugs after MDA is completed.

Avoid MDA delay secondary to late submission of JAP to WHO.


c) Monitoring Capacity Strengthening

Informal meetings, e-mails, phone calls, as well as regularly scheduled quarterly review meetings with the PNLOC/MTN will be used to review progress made towards achieving the planned capacity strengthening outcomes, using the following strategy to measure success.

Objective 1: Improve supply chain management for MDA drugs

ENVISION will meet quarterly with the Pharmacist focal point of the MOH for a physical stock inventory. Seven months prior to the MDA planned in 2018, ENVISION will ensure both Drug Supply Manager and Pharmacist focal point start compiling the information needed for the JRSM, to ensure the document is ready to be signed and submitted on time (6 months prior to planned MDA) by the PNLOC/MTN Coordinator to the WHO.

Objective 2: Strengthen PNLOC/MTN M&E capacity

ENVISION will meet with the PNLOC/MTN Coordinator and together identify an M&E focal point and inventory the lab human resources at the MOH, given the need to implement future TAS activities and other surveillance activities. ENVISION will convene the various stakeholders, including the different MOH divisions and other partners to review progress in completion of the database, identify obstacles to its usage, and propose solutions to overcome these. Feedback gathered during these meetings on how the database and other M&E tools could be made more user friendly will be provided to WHO and to the ENVISION HQ M&E team.

2) Project Assistance

a) Strategic Planning

i) Meeting of the NTD Steering Committee

The NTD Steering Committee is chaired by the National Director for Prevention and Community Health or the Secretary General of the MOH. Committee members include representatives of the PNLOC/MTN, SNSSU, WHO, HKI, Sightsavers, OPC, and Plan Guinea. The committee may invite other organizations if necessary. In FY17, actors from the water, sanitation, and hygiene sectors and OMVS are scheduled to be invited.

ii) Quarterly Coordination Meetings

The PNLOC/MTN will organize quarterly meetings with support from ENVISION/HKI, SNSSU, Plan Guinea, Sightsavers, OPC, and OMVS to ensure strong coordination for field monitoring operations. The meetings will focus on implementation of the integrated MDA campaign where several NTDs are co-endemic and coordinate the partners’ interventions to support standardization, complementarity, and synergies. With support from HKI through ENVISION, the PNLOC/MTN will ensure that the status of TIPAC data integration is discussed and resolved at one of these meetings. Some other non-PC NTD programs have delays in data collection and it is hoped that meeting together will help resolve any issues.


iii) Annual NTD Program Review

An annual meeting to assess the NTD program will be held when the drug distribution campaigns end (June 2017), with the participation of all partners supporting the national NTD program, including the Prefectural Heath Directors and the Regional Health Directors.

iv) TIPAC

The national NTD program and ENVISION staff received TIPAC training in August FY15. The project plans to support the NTD programs during the coordination meetings in order to continue inputting data to TIPAC. This activity will incur no costs to ENVISION. TIPAC implementation will help with MDA implementation, including planning for the drug order, identifying funding gaps (which can be used as advocacy to find additional funding), facilitating identification of integration opportunities, and annual planning of NTD control programs.

b) Advocacy for Building a Sustainable National NTD Program

In FY17, PNLOC/MTN and HKI staff members will continue to advocate with the Ministry to release the allocation intended to support NTD control/elimination activities. This advocacy will include the following:

1) Awareness-raising with the Minister of Health and his cabinet, such as during the partners’ meeting or during a Technical Coordination Committee (CTC) meeting (no additional costs to ENVISION);

2) A presentation on NTDs at the National Assembly to encourage them to incorporate NTD activities into the national development budget (no additional costs to ENVISION);

3) Participation of high-level MOH representatives in NTD activities, including the participation of the Secretary General at the Steering Committee meetings (no additional costs to ENVISION);

4) Invitation of key individuals who can influence the MOH’s decision-making process to attend the launch of the MDA campaign (no additional costs to ENVISION).

These sessions will serve as a platform to discuss the importance of this MOH funding and regular funding from the partners to the PNLOC/MTN, as well as the activities carried out, results obtained, and obstacles faced.

c) Social Mobilization to Enable NTD Program Activities

i) Training Workshop for Leaders

As was done during the last FY, the HD teams will invite a group of community and religious leaders from the sub-prefectures and health centers to participate in an HD-level training workshop. This workshop, primarily created to improve awareness of the NTD program during the EVD outbreak, proved very useful beyond its original scope. ENVISION plans to continue this workshop in FY17. The workshop will provide more information on the targeted NTDs (including the symptoms of NTDs and drug adverse events) and messages that can be used to counter the rumors/misinformation that arose during the Ebola epidemic, along with techniques for these leaders to use in transmitting messages and answering questions within their respective communities. Information on ways to minimize the adverse events of PZQ—ensuring that children do not take the drug on an empty stomach—will be provided. The


leaders who are trained will then train community leaders (including members of parents’ groups and school inspectors) in their sub-prefectures to distribute the messages.

ii) MDA Campaign Launch Ceremonies

The FY17 MDA campaign will be preceded by the following activities:

An official national launch to inform the general population about NTDs, disseminate details on the MDA campaign, and support advocacy efforts.

This launch will take place in Kindia. It is intended to create high levels of public and government participation in the MDA campaign. It is also a platform to encourage government decision makers and companies to take NTDs into account in their development plans.

iii) Production and Use of Information, Education, and Communication Materials

ENVISION will also provide financial support to the PNLOC/MTN to produce pictures (used by community leaders, CDDs, and supervisors) and banners and posters that will be posted in public places during social mobilization activities in the HDs. T-shirts for the CDDs and supervisors will be produced for the MDA campaigns. These T-shirts will be a way to recognize the actors involved in distribution and social promotion and encourage awareness of the NTD program. In the past, these garments have drawn people’s attention to the distribution underway.

To measure the impact of IEC on social mobilization for MDA coverage, HKI will support additional questions in the coverage and independent monitoring surveys to gather information on the execution of the campaigns and, specifically, to identify the best channels of communication. Following that analysis, changes to IEC materials may be made for FY18. Table 4 summarizes the social mobilization and communication activities and materials.


Table 3: Social mobilization/communication activities and materials checklist for NTD work planning

Category Key Messages

Target Populatio

n

IEC Strategy (material

s, medium, activity

etc.)

Where/when will

they be distributed

Frequency

Is there an indicator/

mechanism to track this

material/activity? If yes, what?

Other Comment

s

MDA Participation

The MDA will be carried out in the 19 health districts over five days (February to April).

Individuals ≥ 5 years of age for LF/OV, school-age children (SAC) for SCH, and the entire population for trachoma

PostersBanners

Posters are displayed in public places

five days before the campaigns

begin;

Displayed before

each MDA

During the campaigns, the

supervisors monitor the existence of posters and

banners

Will be done through coverage survey

Images Images (Cards with

pictures) are distributed to

community leaders two days before

the campaigns

begin

During the MDAs

Supervisors monitor the use of Images during

the MDA campaigns

Images are laminated and can be used multiple times

The drugs distributed are free and innocuous

Entire community

Radio Rural and community

radio stations before and during the campaigns

Messages are

broadcast twice/day before and during the

MDAs

A questionnaire survey during the

independent monitoring

include from which

communication channel the

communities received MDA

information


The drugs may have minor adverse events that will disappear.

Health centers,

CDDs

Training module

and Radio

Training for supervisors,

CDDs

Modules are

distributed during

supervisor training

and Messages broadcast before and during the

MDAs

Independent monitoring

provides the information on

the message broadcasted


The drugs distributed in schools are

free and pose

SACParents of students

Rural and community

radio stations

In schools and radio

before and during MDA

Before and during the

MDA

Independent monitoring

provides the information on

Will be done through coverage


Category Key Messages

Target Populatio

n

IEC Strategy (material

s, medium, activity

etc.)

Where/when will

they be distributed

Frequency

Is there an indicator/

mechanism to track this

material/activity? If yes, what?

Other Comment

s

no danger. They will

keep children healthy and

thus improve their school

performance.

the message broadcasted

survey to encourage parents of children not in school

Disease Prevention

NTDs can be prevented with 1) medications that need to be taken each year by all communities, 2) individual and environment hygiene

All Radio In the community, before and during the MDA campaigns

Before and during the MDA

A questionnaire survey during the independent monitoring will include what message has been broadcasted

CDDs and supervisors will use the picture cards to inform interested people.

Other Promoting visibility of NTD Program

All T-shirts with messages and logos

Where there is an MDA (worn by CDDs)

During each MDA

Number of T shirts produced

d) Training

i) Training of Supervisors and Independent Monitors of the MDA

HKI staff will hold training in Conakry for a supervisor-trainer for each targeted HDs. Supervisors will be trained to conduct independent monitoring for the LF/OV and trachoma MDA. After this training, these supervisors will hire and train independent monitors to be deployed at the health centers during the LF/OV/STH and trachoma-only MDA. Independent monitoring is not planned for the SCH MDA because the strategy is school-based and easy to supervise. These monitors and supervisors will be drawn from an experienced local NGO specializing in evaluation that has been under contract with WHO to perform independent monitoring since 2009 (the organization conducted this activity since FY14), with support from ENVISION). Most of the monitors will be the same as those hired in prior years; the training will be a refresher course for them.

ii) Training of trachoma survey graders

In FY17, the trachoma MDA impact survey will be conducted in four HDs (Kankan, Siguiri, Mandiana, and Koundara). The survey protocol requires that the investigators be trained in gathering data in accordance with WHO guidelines. Twelve people will be trained, one team of three for each HD. The


trainers of these investigators have received Tropical Data training from July 25 to 29 in Dakar on this survey protocol.

The PNLOC/MTN and HKI will supervise the quality of all the trainings.

Problems observed will be corrected immediately. The lessons from these observations will be shared at subsequent training sessions to ensure that they are incorporated in the future.

e) Mapping

Guinea has completed the mapping of the five PC NTDs to date.

f) MDA Coverage and Challenges

i) MDA

For FY17, the PNLOC/MTN plans to conduct the following MDAs with support from ENVISION:

LF MDA in 19 HDs. Of these districts, 17 received one or two treatments between 2014 and 2016. Of the three new districts to be covered by ENVISION, Kindia will receive its second round and the other two (Forécariah and Télimélé) will receive their first (see Table 2e).

OV MDA as part of the LF MDA in 17 LF co-endemic HDs.

Trachoma MDA will be conducted in 9 HDs where TF baseline prevalence was ≥ 5%. Six of these districts will receive (at least) their third round of treatment, while two will receive their first and only round of treatment required.

SCH MDA in 18 HDs: Nine districts with ≥ 50% prevalence among SAC, two with prevalence of nearly 50% (Siguiri [49.2%] and Macenta [46.3%]), and five with low prevalence plus two that were supposed to be treated in FY16. Low-prevalence HDs will receive their first round of treatment, while the others will receive their second round of consecutive treatment. Five HDs will be treated twice during FY17, but at least 6 months apart.

STH will be treated through the LF MDA, which combines IVM and ALB. In FY17, 13 of the 17 HDs with STH prevalence ≥20% (7 HDs with prevalence ≥50%) will receive ENVISION support for only one round of MDA. STH treatment in 13 districts will be integrated with LF treatment (IVM + ALB). The second round of MDA for the seven HDs with prevalence ≥50% will be covered by SNSSU, pending funding availability.

ii) MDA materials production

In FY17, ENVISION will support the financing and assist in the production of the dosing poles, distribution registers, and various cards needed to conduct the MDA.

g) Drug and Commodity Supply Management and Procurement

HKI supported PNLOC/MTN in preparing its orders for certain drugs (IVM, ALB, and PZQ) by completing the joint WHO, which has been submitted on the 10th of August 2016. The form will be completed using demographic projection data from the national census (the CDDs’ census data will be used in the future when available). The PNLOC/MTN orders ZTH separately. Pfizer supplies the ZTH and the International Trachoma Initiative (ITI) delivers it to Guinea. Guinea’s 2017 order will be placed when ITI requests the


form; the number of tubes requested will cover 18 districts with TF prevalence of ≥5%. RTI ENVISION provides the TEO for trachoma, for its intervention areas. There is no additional cost to ENVISION for the TEO drug delivery.

i) Recovery of medicines after MDA

After the MDA campaign, the heads of the health centers will return the remaining quantity of drugs and tools two weeks after the HD evaluation meetings. The PNLOC/MTN team will conduct the physical inventory of the remaining drugs at that time. The head of the HD will send the remaining drugs and the drug management reports to the regions. A collection team from HKI Guinea will recover any drugs after the MDA and bring them to Conakry just after the mop-up period (if one is needed). The drugs will be stored in a warehouse in Conakry until the next campaign, and each report will be reviewed and analyzed (including for use and percentage of waste) by the regional and central teams of the MOH to assess the quality of management and to take any corrective measures necessary.

The multi-country Supply Chain Management Training scheduled for August 2016 will strengthen the supply chain management capacity of the program and the ENVISION staff (costs covered by USAID’s Systems for Improved Access to Pharmaceuticals and Services [SIAPS] project).

NTD SAEs are very rare in Guinea. For the most part, only minor adverse events have been reported since MDA began. Although MDA SAEs are very unlikely, all staff involved in MDA are trained to make sure that every SAE is reported within 24 hours to the PNLOC/MTN National Coordinator through the community health center, HD, and regional level. The PNLOC/MTN will inform WHO, the drug company, and the international donors about the medication SAE. Simultaneously, HKI Guinea will inform HKI headquarters, which will then notify RTI. The HKI Guinea staff will work closely with the PNLOC/MTN to ensure that SAEs are reported immediately to WHO, the drug donation program, and the drug company. The PNLOC/MTN, MOH and ENVISION staff participated in a supply chain management course in August 2016 where this was discussed. The PNLOC/MTN and HKI ENVISION will support the strategy to improve the hope that the notification system because following an investigation, several SAE notifications were found to be false alarms caused by community members who tried to obtain free treatment for pre-existing illnesses.

h) Supervision

i) MDA Supervision

At the national level, PNLOC/MTN supervisor teams will be deployed in each HD where a campaign is planned. These national supervisors will oversee preparation meetings, training for health center workers, drug distributions, and the prefectural summary at the end of the campaign.

At the regional level, a team of regional supervisors (with support from national supervisors) will oversee the training, distributions, and make recommendations to their HD.

At the HD level, the district team’s members will supervise the heads of the health centers, who will supervise the CDDs. The supervision of the MDA conducted by the CDDs may be done jointly with the national-, regional-, and HD-level supervisors. There is one supervisor on average for 33 teams (each team is composed of two CDDs). The distribution team’s role is, first, to measure the height of the person to be treated, administer the drug, and, last, record the cases. However, based on the new


strategy that uses the CDDs’ census, the roles will be redefined, using one person specifically for the census and two others to measure and treat (3 CDDs per team).

The PNLOC/MTN team will ensure that supervision is performed in a rigorous manner. The team will support this supervision by helping the HDs prepare action plans and updating the monitoring tools for the supervision visits to include Ebola-related questions and incorporate the lessons learned in prior years so that the most relevant aspects of the MDA are monitored and reported on and, in particular, the appropriate corrective measures are taken.

i) M&E

i) Implementing Epidemiological and/or Entomological Assessments for OV

The consortium (Sightsavers, END Fund, FPSU, and several prominent OV researchers) planned to conduct monitoring (epidemiological and entomological) by the end of 2016 or the beginning of 2017 calendar year (with non-ENVISION funds). Existing data being compiled in the integrated NTD database with support from ENVISION, including data from sentinel sites established under the OCP, will be used. The consortium will build the MOH capacity to use OV16 ELISA for this survey. The national program and ENVISION will participate in the planning meeting and in implementation of activities when they are better defined. The information provided by the monitoring will be used by the national OV elimination committee to make decisions about treatment (stopping or not) and will help with preparation of the elimination dossier.

ii) WHO Integrated NTD Database

This activity started in August 2016 with the consultant. ENVISION will monitor and provide support to the national program for regular updates of the database in FY17 and following years. The consultant chosen for this activity had already been trained (in Bamako) and is familiar with NTD programs.

iii) Data Quality Assessment (DQA)

The activity is planned to start on the 5th until the 25th of September 2016 (FY16); the national program is awaiting technical assistance from RTI. The report will be finalized in FY17. The results from the DQA will inform the quality assurance systems, improving the tools in use.

iv) Quality Assurance System by Level

At each level there is a system to check the data obtained during the MDA. Routinely, the CDD completes a register and a summary sheet. The supervisor checks if both sheets are the same. All the summary sheets are compiled at the health center level and the supervisor checks that these numbers match those from the field. There is some cross checking carried out at the HD level during review meetings and with supervisors. The national NTD program is set up with HKI support to collect reliable MDA coverage data. This approach reduces errors and fraud. The data calculation sheet has been designed to automatically provide average drug consumption and coverage by health center, thus avoiding the need for manual calculation. However, problems calculating coverage rates persist because of the unreliable national census data when it is used at the sub-regional or sub-district level. ENVISION will examine, using the coverage surveys, discrepancies between coverage calculated using census data and the coverage resulting from the survey.


v) Independent Monitoring

Independent monitors will visit a defined number of urban and rural sectors, selected based on knowledge of prior satisfactory coverage data, and including difficult-to-reach areas, to calculate coverage among those surveyed. The questionnaire used will also help to identify barriers to access, issues in the quality of implementation and best practices, factors ensuring good coverage, and management of SAEs.

vi) Trachoma Impact Survey

Surveys will be conducted in four HDs with ENVISION support: three in Kankan region (Kankan, Siguiri, and Mandiana) where the mapped TF prevalence rates were between 10% and 30% and that have received three years of the SAFE Strategy, and one HD with a prevalence rate between 5% and 9.9% (data from 2012), Koundara. The PNLOC/MTN and HKI Guinea have been trained in the new WHO Tropical Data system, which will be used for future TIS.

ENVISION will support M&E activities to ensure that the impact of the MDA on the disease burden is evaluated using high-quality methodology.

vii) Post MDA Coverage Survey

Post MDA coverage surveys will be carried out in four HDs: two districts with poor coverage and two with good coverage. These surveys will be useful in assessing and validating the reported rates and coverages in changing denominators over time. This survey will allow the project to determine whether using the 2014 census data had an impact on the good coverage rates recorded in the FY16 MDA.

Table 4: Planned DSAs for FY17, by disease

Disease No. of endemic districts

No. of districts planned for

DSA

Type of assessment Diagnostic method

Trachoma 18 4 TIS Clinical grading

viii) Development of the PNLOC/MTN M&E Plan

ENVISION through its field-based M&E officer will work with the PNLOC/MTN to finalize the M&E plan throughout FY17. The plan will be presented to partners during one of the partners’ workshops.


3) Maps




Planned FY17 DSAs for Trachoma



APPENDIX 1. WORK PLAN TIMELINE

31

FY17 Activities

Capacity Strengthening StrategyProject AssistanceStrategic PlanningCoordination meetingSteering committeeNTD partners’ forumFY18 planning workshopAnnual review of NTD activitiesNTD Program Manager meeting NTD Secretariat (purchase of screen and desktop/server)Building Advocacy for Sustainable National NTD ProgramAdvocate for access to BND CTC/Annual review meeting with Minister of HealthPreparatory MDA meetings with community leadersSocial Mobilization to Enable NTD Program ActivitiesProduction of IEC materialsNTD Open House DayTraining workshop of leadersMDA Launch in the HD of Kindia Campaign Launch in health districtsPosters and banners bill-postingBroadcasting short messages by Local RadioBroadcasting messages by Mobile Sound System in urban areasBroadcasting messages by Public Town Crier in rural areas TrainingTraining of Trainers for LF and trachoma MDAsTraining of supervisors and CDDs for LF and trachoma MDAsTraining of Trainers for SCH-STH MDATraining of supervisors, teachers and CDDs for SCH-STH MDAMappingTrachoma re-mapping of KoundaraRegistrationProduction of MDA ToolsMDASCH MDA in 7 HD (Dinguiraye, Faranah, Kissidougou, Kérouané, Siguiri, Kankan and Kouroussa)LF/OV MDA in 19 HD (Boké, Gaoual, Koundara, Dabola, Dinguiraye, Faranah, Kissidougou, Kankan, Kérouané, Kouroussa, Mandiana, Siguiri, Lélouma, Beyla, Kindia, Forecariah, Telimele, Guéckédou and Macenta)Trachoma MDA in 9 HD (Faranah, Kissidougou, Dabola, Dinguiraye, Kérouané, Kouroussa, Boké, Forecariah and Telimele)SCH MDA in 16 HD (Gaoual, Boké, Dinguiraye, Faranah, Kissidougou, Dabola, Kérouané, Mandiana, Siguiri, Lélouma, Kindia, Forécariah, Telimele, Beyla, Guéckédou and Macenta)

APPENDIX 2.

Table of USAID-supported Provinces/States and Districts

Region Health Districts LF MDA OV MDA TRACHOM

A MDASTH

MDASCH

MDATRACHOMA

DSA

Boké

Boffa XBoké X X XFria X

Gaoual X X XKoundara X X X

Conakry

DixinnKaloumMatamMatotoRatoma

Faranah

Dabola X X X X

Dinguiraye X X X X*

Faranah X X X X X*

Kissidougou X X X X X*

Kankan

Kankan X X X X X

Kérouané X X X X X*

Kouroussa X X X X X

Mandiana X X X X X

Siguiri X X X* X

Kindia

CoyahDubréka

Forécariah X X X X X

Kindia X X X XTélimélé X X X X

Labé

KoubiaLabé

Lélouma X X X XMali

Tougué

MamouDalabaMamou

32

Region Health Districts LF MDA OV MDA TRACHOM

A MDASTH

MDASCH

MDATRACHOMA

DSAPita

N’Zérékoré

Beyla X X X X

Guéckédou X X X X

LolaMacenta X X X X

N'Zérékoré

YomouTOTAL 38 19 17 9 13 18 4

*HDs that will be treated twice in FY17 MDA will be at least 6 months apart.

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Documents

ENVISION Project Overview - Homepage 2017 | · Web viewTEOTetracycline Eye Ointment TFTrachomatous Inflammation–Follicular (active trachoma) TIPACTool for Integrated Planning and