Indonesia Work Plan - ENVISION | ENVISION · Indonesia Work Plan ... • Management and...
Transcript of Indonesia Work Plan - ENVISION | ENVISION · Indonesia Work Plan ... • Management and...
Indonesia Work Plan FY 2018
Project Year 7
October 2017-September 2018
ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows
Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by
the U.S. 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 U.S. Agency for International Development
or the U.S. Government.
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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 (MOHs) to achieve their NTD control and elimination
goals.
At the global level, ENVISION, in close coordination and collaboration with WHO, USAID, and other
stakeholders, contributes to several technical areas in support of global NTD control and elimination
goals, including the following:
• Drug and diagnostics procurement, where global donation programs are unavailable;
• Capacity strengthening;
• Management and implementation of ENVISION’s Technical Assistance Facility (TAF);
• Disease mapping;
• NTD policy and technical guideline development; and
• NTD monitoring and evaluation (M&E).
At the country level, ENVISION supports 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 (DSAs) and surveillance.
In Indonesia, ENVISION project activities are implemented by RTI International.
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TABLE OF CONTENTS ENVISION Project Overview .......................................................................................................................... ii
LIST OF TABLES ............................................................................................................................................. iii
COUNTRY OVERVIEW .................................................................................................................................... 7
1) General Country Background ............................................................................................................ 7
a) Administrative Structure ..................................................................................................... 7
b) Other NTD Partners ............................................................................................................ 8
2) National NTD Program Overview ...................................................................................................... 9
a) Lymphatic Filariasis ............................................................................................................. 9
b) Schistosomiasis ................................................................................................................. 11
c) Soil-Transmitted Helminths .............................................................................................. 11
3) Snapshot of NTD Status in Indonesia .............................................................................................. 13
PLANNED ACTIVITIES ................................................................................................................................... 14
1) NTD Program Capacity Strengthening ............................................................................................ 14
a) Strategic Capacity Strengthening Approach ..................................................................... 14
b) Capacity Strengthening Objectives and Interventions ..................................................... 14
c) Monitoring Capacity Strengthening .................................................................................. 15
2) Project Assistance ........................................................................................................................... 18
a) Strategic Planning ............................................................................................................. 18
b) NTD Secretariat ................................................................................................................. 19
c) Building Advocacy for a Sustainable National NTD Program ............................................ 19
d) Mapping ............................................................................................................................ 19
e) MDA Coverage .................................................................................................................. 19
f) Social Mobilization to Enable NTD Program Activities ..................................................... 21
g) Training ............................................................................................................................. 22
h) Drug and Commodity Supply Management and Procurement ........................................ 23
i) Supervision for MDA ......................................................................................................... 23
j) M&E .................................................................................................................................. 24
k) Supervision for M&E and DSAs ......................................................................................... 28
l) Dossier Development ........................................................................................................ 28
APPENDIX 1: Work Plan Timeline................................................................................................................ 29
LIST OF TABLES
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Table 1. Administrative and health structure in Indonesia .............................................................. 7
Table 2. Non-ENVISION NTD partners working in country, donor support, and summarized
activities .............................................................................................................................. 8
Table 3. Snapshot of the expected status of the NTD program in Indonesia as of September 30,
2017 .................................................................................................................................. 13
Table 4. Project assistance for capacity strengthening .................................................................. 16
Table 5. USAID-supported districts and estimated target populations for MDA in FY18 .............. 19
Table 6. Social mobilization/communication activities and materials checklist for NTD work
planning ............................................................................................................................ 21
Table 7. Planned DSAs for FY18 by disease .................................................................................... 27
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ACRONYMS LIST
ALB Albendazole
BBTKL National Environmental Health Laboratory, Ministry of Health (Balai Besar Teknik
Kesehatan Lingkungan)
BINPHARM Directorate General of Pharmaceuticals and Health Supplies, Ministry of Health
BR Brugia Rapid
CDC U.S. Centers for Disease Control and Prevention
CY Calendar Year
DEC Diethylcarbamazine Citrate
DEKON Special GOI funding to support national programs at the lower levels (dekonsentrasi)
DHO District Health Office
DOLF Death to Onchocerciasis and Lymphatic Filariasis project
DOT Directly Observed Treatment
DQA Data Quality Assessment
DSA Disease-Specific Assessment
EU Evaluation Unit
FOG Fixed Obligation Grant
FTS Filariasis Test Strip
FY Fiscal Year
GOI Government of Indonesia
GSK GlaxoSmithKline
HC Health Center
HQ Headquarters
IEC Information, Education, and Communication
LF Lymphatic Filariasis
M&E Monitoring and Evaluation
MDA Mass Drug Administration
Mf Microfilaremia
MOH Ministry of Heath
NGO Non-Governmental Organization
NTD Neglected Tropical Disease
NTF National Task Force
OKU Ogan Komering Ulu
OKUT Ogan Komering Ulu Timor
PHO Provincial Health Office
PSA Public Service Announcement
Q Quarter
RPRG Regional Program Review Group
SAC School-Age Children
SAE Serious Adverse Event
SAR Semi-Annual Report
SCH Schistosomiasis
STH Soil-Transmitted Helminths
STTA Short-Term Technical Assistance
Subdit Subdirectorate for Control of Lymphatic Filariasis, Soil-Transmitted Helminths, and
Schistosomiasis, Ministry of Health
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TA Technical Assistance
TAS Transmission Assessment Survey
USAID U.S. Agency for International Development
WHO World Health Organization
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COUNTRY OVERVIEW
1) General Country Background
a) Administrative Structure
Indonesia is the fourth largest country in the world, with a population of over 262 million people spread
throughout 13,000 islands. Following years of restructuring, Indonesia is currently divided into 34
provinces and 514 districts. Administrative and health structures related to the management of the
national neglected tropical disease (NTD) program are summarized in Table 1 below.
Table 1. Administrative and health structure in Indonesia
Level Bahasa Indonesia
term
Head official Related health structure
National Negara Presiden Ministry of Health, Subdirectorate for Control
of Lymphatic Filariasis, Soil-Transmitted
Helminths, and Schistosomiasis (Subdit)
Provincial Provinsi Gubernur Provincial Health Office
District Kabupaten–rural
Kota–urban
Bupati
Walikota
District Health Office
Subdistrict Kecamatan Camat Health center (puskesmas)
Village Desa–rural
Kelurahan–urban
Kepala Desa
Lurah
Health post (posyandu)
Hamlet Rukun Warga --
^ In Papua and Papua Barat, this level is called a distrik.
The Subdit, a unit within the Directorate General of Disease Control and Environmental Health of the
Ministry of Health (MOH), is the lead for lymphatic filariasis (LF), soil-transmitted helminths (STH), and
schistosomiasis (SCH) activities. A National Task Force (NTF) exists to oversee NTD policy, plans, and
activities. It consists of MOH staff, ex-MOH staff, and academics, with multilateral agency
representatives from the World Health Organization (WHO) and United Nations Children’s Fund invited
as observers. The NTF meets at least once a year to discuss specific issues and provide technical
recommendations for improving the LF, STH, and SCH programs.
At the national level, the Subdit is responsible for determining policies and procedures for program
implementation, supervising and mentoring lower-level staff, monitoring and evaluation (M&E), and the
procurement of drugs and operational supplies, such as rapid diagnostic tests. The provincial level is
responsible for supervision and M&E, and each province has a small budget to fund these activities.
District governments are required to provide operational budgets for LF and STH mass drug
administration (MDA), including training, drug distribution, and monitoring, and are directly responsible
for program implementation in their respective areas. Each community health center (HC) is responsible
for organizing activities in its catchment area in coordination with the village government and, following
recent official clarification by the MOH, has its own operations budget that may be used to support NTD
activities. In addition, each village has a small development budget provided by the national
government, which can also be used to support the promotion of the MDA. Beginning in 2015, the MOH
has been able to provide limited funding for LF/STH MDA through a special mechanism from the central
level that is called dekonsentrasi (DEKON), which can be used to augment local budgets as needed.
These funds are provided to provincial health offices (PHOs) and have been used to support the
supervision of MDA activities by provincial staff, advocacy and review meetings at the district level, and
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MDA implementation. The use of these funds is based on gaps in local budgets and local priorities.
These DEKON funds will be available to support the 2017 LF/STH MDA but at a much lower level than in
previous years. Coordination among these separate and disparate government units is critical to ensure
that sufficient resources are available to support all required NTD work because each unit makes its own
decisions on how to allocate their own budgets.
b) Other NTD Partners
Indonesia has two primary partner organizations providing funding support for NTD work: the U.S.
Agency for International Development (USAID) and WHO (Table 2). WHO provides limited support for LF
transmission assessment surveys (TASs), strategic meetings, pilot web-based reporting system
development, supervision, and SCH elimination. Since the beginning of the LF/STH MDA program, the
MOH has accepted donations of albendazole (ALB) from GlaxoSmithKline (GSK) through WHO. In mid-
2016, following budget cuts, the Indonesia MOH accepted a large donation of diethylcarbamazine
citrate (DEC) tablets from Eisai Company, Ltd. of Japan through WHO to provide the MOH with the
necessary drugs to expand programmatic support to more endemic districts. Beginning in 2017, the
MOH has continued to utilize the WHO drug donation program to offset gaps in their own ability to
procure sufficient ALB and DEC from local manufacturers through the government procurement system.
The MOH will also continue to procure the required diagnostic tests, Brugia Rapid (BR) tests and filariasis
test strips (FTSs), for 2018 with government funds. Through the Task Force for Global Health, USAID is
supporting operational research around failed TAS3 in Alor district.
Other partners are also implementing limited activities in Indonesia. U.S. Pharmacopeia implemented a
scoping study in fiscal year 2017 (FY17) to determine the in-country capacity to manufacture NTD drugs.
Additionally, in FY17, the Bill and Melinda Gates Foundation, through Washington University’s Death to
Onchocerciasis and Lymphatic Filariasis Project (DOLF), funded OR on the safety of ivermectin, ALB, and
DEC (‘triple drug’) therapy in one district.
For STH-only MDA, the MOH procures its own ALB for distribution in those areas implementing STH-only
MDA.
Table 2. Non-ENVISION NTD partners working in country, donor support, and
summarized activities
Partner Location
(Regions/States) Activities
List other donors
supporting these
partners/activities
MOH Central, province,
and district
LF/STH MDA support in ~122 districts in 2017
including advocacy, M&E, and limited capacity
building activities.
Drug procurement of ALB and DEC, as well as FTS
and BT tests
WHO
WHO Jakarta with field
visits to
implementing
provinces/districts
Provides technical and limited financial support
for strategic planning, M&E, and
donation/importation of ALB (2016, 2017, and
2018), DEC (2016, 2017, and 2018), and FTSs/BR
tests for special activities (2017)
GSK and Eisai
Provides financial and technical support for SCH
elimination activities in two endemic districts
MOH
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Partner Location
(Regions/States) Activities
List other donors
supporting these
partners/activities
U.S.
Pharmacopeia
Jakarta Implementation of an Assessment of
Pharmaceutical Management of NTDs
USAID
University of
Indonesia:
DOLF
Jakarta with field
work
Triple drug MDA Bill and Melinda
Gates Foundation
University of
Indonesia:
Coalition for
Operational
Research on
NTDs
Alor OR to follow up on failed TAS3 USAID
2) National NTD Program Overview
a) Lymphatic Filariasis
In 2005, the Government of Indonesia (GOI) decreed filariasis elimination to be one of the national
priorities to combat communicable diseases, and fully endorsed the WHO goal of eliminating LF as a
public health problem globally by 2020. All three types of lymphatic parasites—Wuchereria bancrofti,
Brugia malayi, and Brugia timori—are prevalent in Indonesia, with B. malayi being the most widespread.
Currently, LF is considered endemic in 236 districts, with 61 million people still requiring LF MDA in 176
districts and 14,932 chronic cases of either lymphedema or hydrocele reported. Mapping of the entire
country using night blood to analyze the prevalence of microfilaremia (Mf) was completed in 2016.
Program Goal
The goal stated in the integrated NTD Plan of Action 2016–2020 was to reach 100% geographic coverage
of LF MDA in 2016 and, thereby, be able to stop mass treatment by 2020. However, the MOH fell short
of this goal because of serious financial constraints beyond its control. Four endemic districts were
unable to begin implementing their planned MDA in 2016, and several of the districts that started MDA
in 2016 did not reach sufficient coverage to meet WHO requirements. The MOH is now determined to
reach 100% geographic coverage in 2017 and has ensured that sufficient funding to support MDA is now
available from a variety of sources at every level of government, from the provincial to the village level.
Current projections indicate that the national program will be able to stop MDA in all districts after the
2021 LF/STH MDA.
Current national strategies follow the latest WHO guidance for LF (primarily that outlined in the 2011
TAS manual) and are consistent with the major recommendations from international experts provided
during WHO regional NTD expert meetings over the last two years. October has been designated as
Bulan Eliminasi Kaki Gajah (LF Elimination Month), and MDA is typically organized across most endemic
districts during this month.
The key challenges for the program in FY18 include the following:
• Meeting the 100% geographic coverage goal;
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• Ensuring that quality drugs are available in a timely fashion;
• Significantly increasing compliance; and
• Ensuring sustainable district-level budgets for MDA.
MDA
A total of 51.2 million people live in 150 districts requiring LF MDA in October 2017, and 14.7 million live
in 43 full districts and one partial district pending pre-TAS/TAS results, and 32.7 million people live in 43
full districts and two partial districts currently in post-MDA surveillance.1 In October 2016, LF/STH MDA
reached 43.8 million people in 181 LF-endemic districts (98.3% geographic coverage). The MOH is
determined to reach 100% geographic coverage in 2017 and has increased access to district and HC
funding support for LF/STH MDA. The MOH has also conducted several advocacy meetings at the
provincial and district levels across the country to ensure proper organization and management of MDA.
Although districts in Indonesia often report effective epidemiological coverage for LF/STH MDA, recent
surveys continue to show that marked differences can exist between reported coverage and the actual
proportion of people ingesting drugs. This compliance problem is common in Asia, where directly
observed treatment (DOT) is not always enforced, and presents a huge challenge for the Subdit and the
health services at the lower levels in terms of changing the attitudes of health personnel and
communities toward the importance of DOT during MDA.
TASs
TASs are implemented in Indonesia as school-based, cluster surveys using BR tests in Brugia spp. areas
and immunochromatographic tests (ICTs) (and FTSs as of January 2017) in W. bancrofti areas. Since
2009, 61 districts have implemented TAS1 to determine whether MDA can be stopped (including eight
districts that implemented a re-TAS1). Of the 61 districts that have implemented TAS1 and re-TAS1, 55
have passed (90%). Of the 32 districts that have implemented TAS2, 23 have passed (72%). Ten districts
have implemented TAS3 (90% passed).
Given the challenges associated with interpreting TAS results in Brugia spp. areas in Indonesia, a TAS
Expert Meeting was held in March 2016 to provide Indonesia with specific guidance. The experts
recommended that the critical cut-off in Brugia spp. areas, which use antibody tests to determine
prevalence, should remain the same as that recommended in the TAS manual and that the MOH should
use TAS checklists to better prepare and supervise TASs and investigate TAS failures. The experts also
recommended that all positive BR results be tested for a second time and that any discordant results be
removed from the sample. All of these measures have been incorporated into the standard practices of
the Subdit. Since that meeting, no districts have failed TAS.
During FY17, 32 districts will implement TAS (TAS1=25, TAS2=2, and TAS3=5). In FY18, 56 districts are
planning to implement a total of 59 TAS. Thirty-six (36) districts will implement 37 TAS1 surveys, 11
districts will implement a total of 13 TAS2 surveys; and 9 districts will implement a total of 9 TAS3
surveys.
USAID support
USAID support began in FY11, with financing for LF/STH MDA in 13 districts scattered throughout the
country. After a review of LF endemicity and MDA data, ENVISION, the MOH, and USAID agreed on a
1 As October 2017 MDA is reported in FY17 workbooks, the districts requiring MDA data matches with the FY17
SAR1 workbook, while the pending and post-MDA surveillance data come from FY18 work planning workbook.
ENVISION FY18 PY7 Indonesia Work Plan
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goal of LF elimination in Sumatra and Kalimantan by 2020. ENVISION scaled up LF/STH MDA in FY12 and
FY13, mostly in Sumatra, to help the MOH reach full geographic coverage in that region. ENVISION will
support LF/STH MDA activities in October 2017 working with local non-governmental organizations
(NGOs) in 28 districts, all of which received ENVISION support in the past. For the October 2018 LF/STH
MDA, ENVISION will continue its support for 16 districts.
Past ENVISION support was instrumental in assisting the MOH to complete LF mapping for the country.
ENVISION has also provided assistance and capacity building for (1) MDA implementation at the
national, district, and village levels in 51 districts; (2) pre-TAS and TAS implementation; (3) coverage
surveys, data quality assessments (DQAs), and an integrated NTD database at the national level; and (4)
overall LF/STH policy and strategies at the national, provincial, and district levels.
b) Schistosomiasis
Indonesia’s goal is to eliminate SCH, caused by Schistosoma japonicum, as a public health problem by
2020, following a strategic plan created with WHO assistance. The strategy includes surveys and
treatment of humans, vectors (snails), and animal reservoirs (rats, cattle, and dogs).
SCH is endemic in Poso and Sigi districts in Central Sulawasi province, with an at-risk population of
approximately 22,600 people. Control activities ended in 2005; however, in 2010, Kato-Katz surveys
showed a resurgence of transmission with an average prevalence of infection of 3.81% (range: 0–12.33)
at 21 sites in the two districts. These areas have restricted access to potable water and sanitation, and
few families have latrines. Although targeted MDA took place from 2010 to 2014, surveys in 2014
showed an increase in the average prevalence from 0.80% to 1.61% in Sigi and from 0.64% to 0.82% in
Poso. Selective treatment (test-and-treat positives and family members) was provided to 5,319 people
in 2016 in at-risk communities. The MOH provides the funding for the distribution and procurement of
praziquantel. Currently, the program has gaps in funding for surveys and the treatment of animal
reservoirs.
ENVISION has not supported SCH activities in the past.
c) Soil-Transmitted Helminths
Indonesia has one of the highest numbers of children requiring preventive chemotherapy for STH in the
world. In the last 15 years, 173 districts in Indonesia have been surveyed to assess STH prevalence using
Kato-Katz, and over 40,000 individuals (mostly children) have been sampled. The results show that STH
infection is widespread in the country, with an average prevalence of 28.12% (range: 0%–85%). In 2012,
the MOH released an STH policy stating that all districts should implement one annual round of STH
MDA in preschool and school-age children (SAC), unless districts have evidence showing the need for no
treatments or two annual treatments.
According to this policy, 10.1 million preschool children (1–4 years) and 16.4 million SAC (5–12 years)
need at least one round of MDA per year. The MOH’s goal is MDA coverage of at least 75% of preschool
children and SAC in all endemic districts by 2020. This goal is based, in part, on strategies in the WHO
STH Strategic Plan and the Deworming for School-Aged Children manual, although district-level
population-based cluster surveys are also recommended to measure prevalence and intensity. In
districts without LF/STH MDA, STH-only MDA for preschool children is being scaled up to be delivered
through the vitamin A or National Weighing programs, whereas STH-only MDA for SAC is implemented
through the Directorate of Child Health Support’s school health program in primary schools.
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The national STH program continues to face serious challenges in meeting its goal. In 2016, only 60% of
districts implemented STH MDA, with 35% providing STH treatment through combined LF/STH MDA and
25% through other national health programs, such as the vitamin A program.
Although considerable effort has been focused during the last year on improving coordination among
the various health programs involved in reaching preschool children through the nation-wide, village-
level integrated health posts, challenges remain, including coordination at each level of government,
logistics, training, and reporting and recording. Insufficient resources, both human and financial, also
represent challenges in strengthening school-based STH MDA in non-LF endemic areas. In the past,
ENVISION provided technical assistance (TA) and a small amount of funding for advocacy and
information, education, and communication (IEC) to kick-start STH-only MDA. Currently, all STH-only
activities are self-funded by the government.
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3) Snapshot of NTD Status in Indonesia
Table 3. Snapshot of the expected status of the NTD program in Indonesia as of
September 30, 2017
Columns C+D+E=B for each
disease* Columns F+G+H=C for each disease*
MAPPING GAP DETERMINATION MDA GAP DETERMINATION
MDA
ACHIEVEMENT
DISEASE-
SPECIFIC
ASSESSMENT
(DSA) NEEDS
A B C D E F G H I
Disease
Total No.
of districts
in country
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 MDA
as of 09/30/17
No. of districts
expected to be in
need of MDA at
any level: MDA
not yet started, or
has prematurely
stopped as of
09/30/17
Expected No. of
districts where
criteria for
stopping
district-level
MDA have been
met as of
09/30/17
No. of districts
requiring DSA
as of 09/30/17
USAID-
funded Others
LF
514
236# 278 0 28 122 0* 60^
Pre-TAS: 27
TAS1: 36
TAS2: 11
TAS3: 9
SCH 2 512 0 0 2 0 0 0
STH 514 0 0 28 122 390## 0 0
# The FY17 work plan had 239 districts endemic, but the MOH has remapped in three districts and changed their
status to ‘non-endemic’.
* 26 districts are implementing pre-TAS or TAS and are not scheduled to implement MDA in 2017; they are not
included in column F, G, or H.
^Column H includes 43 districts have passed TAS1 as of 27 July. It also includes 17 districts which will implement
TAS1 (as well as Alor and Tanjung Jabung Barat, which will implement TAS as part of OR) between July and Sept
2017 and are assumed to pass. ## As of July 2017, this includes only districts receiving LF/STH MDA in this calculation. While the MOH is planning
STH-only MDA in other districts, that specific number is not currently available or included in the FY18 workbooks.
ENVISION FY18 PY7 Indonesia Work Plan
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PLANNED ACTIVITIES
1) NTD Program Capacity Strengthening
a) Strategic Capacity Strengthening Approach
Capacity goals
The Subdit’s goal is to have in place before the end of the ENVISION project in 2019 a fully functioning
national NTD program, including the following:
• The majority of activities—if not all—funded from national and district budgets;
• Implementation of quality MDA following established best practice, including participatory
cadre training, sweeping as necessary, enforced DOT, targeted social mobilization, effective
local supervision, and a responsive SAE management system at all levels;
• Timely procurement and efficient management of drugs and other program supplies, such as
rapid diagnostic tests;
• Effective collaboration on the organization of all pre-TAS and TAS with the BBTKL and provincial
laboratories and health authorities; and
• An up-to-date, responsive, and efficient data management system that provides accurate
evidence for all reporting.
Capacity strengthening strategy
To strengthen program management, the Subdit has requested support from ENVISION to continue to
engage in three major strategic approaches this year: strengthening the quality of MDA nationally,
institutionalizing M&E capacity, and strengthening data use.
b) Capacity Strengthening Objectives and Interventions
Objective 1: Strengthen Program Capacity to Implement Quality MDA in All Districts
Special efforts will continue to assist the Subdit to consolidate the lessons learned and best practices
from the “ENVISION experience” and expand their use into non-ENVISION districts.
Intervention 1: Improving MDA Management in ENVISION-supported Districts. ENVISION will continue
to collaborate with the Subdit to improve the quality of MDA management in the 28 ENVISION-
supported districts in October 2017, with an emphasis on increased frequency and quality of supervision
by the Subdit, partner NGOs, and DHOs during MDA implementation. Visits to low-performing HCs will
be prioritized, and special activities identified to address the specific issues in the 12 low-performing
districts will be implemented. During preparations for the October 2018 MDA, ENVISION will continue
efforts to improve the quality of MDA management by focusing on strengthening DHO and HC
coordination meetings and cadre training through refined terms of reference, improved tools, and more
participatory presentations. ENVISION will also work with those districts that have relatively low
performance to adjust and adapt the standard MDA activities to better respond to the local situations.
Intervention 2: Improving MDA in non-ENVISION-supported Districts. In FY17, the updated cadre
training presentation and Cadre Handbook were presented and then electronically shared with all
districts planning MDA during the national LF program review meeting. In FY18, to reinforce the
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availability of these materials in non-ENVISION districts, they will again be shared electronically with all
districts planning LF/STH MDA. Furthermore, ENVISION will provide additional copies of both the Cadre
Handbook and the MDA Registration Book for distribution to non-ENVISION districts through the Subdit.
Similarly, in FY17, Subdit staff, funded by ENVISION, made supervision visit to 13 non-ENVISION districts
at critical times during the preparation for and implementation of MDA. This support for the supervision
and mentoring of non-ENVISION districts will continue in FY18.
Objective 2: Strengthen Interdepartmental Collaboration to Institutionalize M&E Capacity
ENVISION will continue to support the Subdit in establishing official relationships with appropriate units
within the MOH, such as the BBTKL and provincial health laboratories, to implement the various DSAs
required to document elimination and track the control of the NTDs endemic in the country.
Intervention 1: Interdepartmental Collaboration. ENVISION will work with the Subdit to organize a
national coordination meeting with the BBTKL and provincial laboratories to facilitate more realistic
scheduling, better preparation, improved implementation, and more discussion, analysis, and
dissemination of results. If possible in FY18, the collaboration will expand to include local universities—
particularly those in the more isolated parts of Indonesia—to ensure coverage in these areas.
Intervention 2: On-the-job M&E Practice. To further strengthen the effectiveness of this partnership,
ENVISION will also continue to provide on-the-job practice opportunities for selected staff from each of
these units by including them in ENVISION-funded M&E activities in the coming years. The emphasis will
be on ensuring the sustainability of these important M&E activities by helping the Subdit to collaborate
with critical partners that are already beginning to share the responsibility for funding many of the
required surveys this year.
Objective 3: Strengthen Data Management and Use
Intervention 1: Applying DQA and Coverage Survey Recommendations. ENVISION will support the
implementation of recommendations from previous DQAs and coverage surveys to strengthen the
comprehensive reporting system through regular meetings with the Subdit and DHOs, and during
supervision visits to all ENVISION-funded activities. ENVISION will also continue to model data use for
decision-making in all ENVISION-led meetings, provide coaching to selected staff on analyzing data and
applying the results to improve program implementation, continue delivering mentorship on integrated
database management while advocating on behalf of the Subdit for improved reporting functions, and
help strengthen the capacity for timely and quality reporting to WHO by the Subdit. (These activities are
all described in more detail in the M&E section below.)
Intervention 2: Subdistrict Data Analysis. Building on the success of past support, ENVISION will continue
to build capacity at all MOH levels to analyze multi-year data at subdistrict levels and thereby identify
areas with low coverage that require improved planning, training, and supervision.
c) Monitoring Capacity Strengthening
Both routine informal meetings and regularly scheduled review meetings with the Subdit will be used to
track progress made toward achieving the desired capacity strengthening outcomes using the following
indicators to measure success.
Objective 1: Strengthen Program Capacity to Implement Quality MDA in All Districts
Indicators:
• Percentage of districts with epidemiological coverage above recommended levels;
ENVISION FY18 PY7 Indonesia Work Plan
16
• Number of joint supervision visits made by ENVISION and Subdit staff and issues addressed;
• Updated WHO guidelines and recommendations translated into national policy;
• National NTD plan and annual work plan available;
• Appropriate management of all reported SAEs; and
• Number and quality of provincial/district coordination meetings held in both ENVISION and non-
ENVISION areas.
Objective 2: Strengthen Interdepartmental Collaboration to Institutionalize M&E Capacity
Indicators:
• All partners fully fluent in the guidelines and protocols for pre-TAS and TAS, including a clear
division of work involving the Subdit, BBTKLs, and provincial health laboratories, to be measured
through post-tests, supervision checklists, and monitoring visits during implementation;
• Ability to use diagnostic tools, measured using TAS training and in TAS supervisory checklists;
• Number of TASs co-supervised by ENVISION and TAS supervisors; and
• Number of TASs implemented according to WHO guidance.
Objective 3: Strengthen Data Management and Use
Indicators:
• Use of integrated database: all historical data are complete and used to prepare WHO reporting
forms and coverage reports and to inform annual planning;
• DQA and coverage survey results from previous years: survey reports available,
recommendations and related activities included in annual work plans, and outcomes of
implementing recommendations tracked; and
• Number of subdistricts implementing enhanced strategies for improving coverage.
Table 4. Project assistance for capacity strengthening
Project
assistance area Capacity strengthening interventions/activities
How these activities will help
to correct the needs identified
in the situation above
a. Strategic
planning
• Coaching, mentoring, experience sharing, and
providing opportunities for hands-on practice
in comprehensive program management,
including strategic planning to the entire
Subdit team by ENVISION
• ENVISION LF/STH project review and planning
meeting
These activities will help
strengthen national-level program
management and share the
ENVISION experience with non-
ENVISION districts.
d. Social
mobilization
• Ensuring the use of best practices in districts
by providing the LF MDA Cadre Handbook to
priority non-ENVISION districts
This activity will help share the
ENVISION experience with non-
ENVISION districts.
e. Training (please see the Training section for specific training activities)
ENVISION FY18 PY7 Indonesia Work Plan
17
i. Supervision
• Supervisory visits by MOH for 2017 LF/STH
MDA implementation and 2018 LF/STH MDA
support activities
This activity will help improve
management capacity at the
Subdit and help them share the
ENVISION experience with non-
ENVISION districts.
k. M&E (please see the M&E section for specific M&E capacity strengthening activities)
ENVISION FY18 PY7 Indonesia Work Plan
18
2) Project Assistance
a) Strategic Planning
Meetings to Develop Enhanced MDA Strategies with ENVISION-supported Districts: As discussed in the
MDA section below, ENVISION will use the results of the October 2017 MDA and previous coverage
surveys to help districts better plan and implement the next round of MDA. In preparation for the
October 2017 MDA, ENVISION worked with the DHO and partner NGO from each of 12 districts
designated as needing special attention, because of either previous low performance or inexperience in
program management, to develop innovative interventions and creatively adjust standard activities to
better respond to local opportunities for success. ENVISION will expand this approach to include all 16
districts to be supported during the October 2018 MDA, including the 12 previously low-performing
districts. ENVISION will, therefore, organize special planning meetings with each of the 16 ENVISION-
supported districts prior to the development of their FOGs and associated budgets. Provincial-level
meetings will be organized in Aceh (seven districts), South Sumatra (four districts), North Sumatra (two
districts), and the districts of Tanjung Jabung Timur, Melawi and Kota Batam, for a total of six meetings.
Each one-day meeting will include 10–30 participants from the relevant PHO, DHO and partner NGO and
ENVISION. Special efforts will be made to include other ministries, such as education and religious
affairs, in these meetings to encourage more active support and involvement in MDA. During these
meetings, the comprehensive analysis of all available data will be discussed (using the TAS failure
checklist if appropriate), possible reasons for low performance will be determined, and appropriate
strategies to respond to the local situation in each area will be developed. These strategies may include
activating the local network of religious leaders, more effectively utilizing local media, developing more
compelling IEC materials using the local language, providing additional training for cadres, training
additional cadres, increasing the involvement of local village heads and village midwives, and/or
implementing more active supervision at all levels. Once participants arrive at a consensus on
recommended strategies, the DHO and NGO will complete detailed planning at the district level. The
individual strategies will be included in the proposals to be finalized during the ENVISION Project Review
and Planning Meeting and funded within the FOG for each respective district. These meetings will be
critically important to assist the DHOs to design and implement more effective activities to support their
local MDA in collaboration with the relevant partner NGO.
ENVISION LF/STH MDA Project Review and Planning Meeting: A two-day ENVISION LF/STH MDA
Project Review and Planning Meeting is planned for March 2018, and participants will include Subdit
staff, two DHO staff from each of the 16 ENVISION-supported districts, the LF Focal Points from the
PHOs in the five associated provinces, staff from the six expected partner NGOs, and representatives
from WHO and USAID/Indonesia. The purpose of this meeting will be to evaluate the October 2017
LF/STH MDA activities, including an extensive review of all relevant data and sharing of best practices
and lessons learned, such as the results of the special interventions designed by the several low-
performing districts. This information will form the basis for determining more effective, practical
mechanisms to achieve the targeted coverage rates in 2018 and to promote DOT and improve the
management of SAEs. This meeting will also be used to review and finalize both district and NGO
budgets for activities to be funded by ENVISION within the 2018 FOGs and to determine district-level
cost share. A total of 71 participants will be included in this two-day meeting.
LF/STH MDA District Coordination Meetings: During July and August 2018, district coordination
meetings will be organized by the DHO in each of the 16 ENVISION-supported districts. These meetings
will involve relevant local stakeholders to secure annual district-level commitments to social
mobilization and cadre training activities and for the successful implementation of the LF/STH MDA.
ENVISION FY18 PY7 Indonesia Work Plan
19
ENVISION will also support the travel expenses for NGOs to attend these meetings. These meetings will
also be used to plan district-level support activities for the LF/STH MDA and to coordinate schedules and
responsibilities.
LF/STH MDA HC Coordination Meetings: After the district coordination meeting, an HC coordination
meeting will be organized in each HC within the ENVISION-supported districts during August and
September 2018. Participants will include heads of villages and representatives from health posts and
other sectors. The objectives of these meetings will include reviewing the timelines for all supporting
activities; discussing how best to promote increased social mobilization, DOT implementation, and
improved SAE management; and organizing the upcoming MDA. These meetings will be fully funded by
the respective DHO as part of their cost share with ENVISION.
b) NTD Secretariat
NTD Secretariat Office Supplies and Operational Cost Support: ENVISION will continue to provide
limited funds to support MOH operational costs, including monthly internet and national mobile phone
service within Indonesia for the Subdit. This will allow the Subdit to continue to engage the current high-
bandwidth internet service provider necessary to access and share the large amounts of data needed to
maintain the M&E database and program files. ENVISION will also provide small amounts for stationery
and office supplies.
c) Building Advocacy for a Sustainable National NTD Program
There are no ENVISION activities for building advocacy in FY18.
d) Mapping
All LF mapping and remapping for Indonesia has been completed by the Subdit, with support from
ENVISION prior to the end of 2016. No additional mapping is required this year.
e) MDA Coverage
Planned FY18 MDA Activities
Table 5. USAID-supported districts and estimated target populations for MDA in FY18
NTD
Age groups
targeted (per disease
workbook
instructions)
Number of rounds
of distribution
annually
Distribution
platform(s)
Number of
districts to
be treated
in FY18
Total # of
eligible
people to be
targeted
in FY18
LF
Entire population
between 2 and 70
years
1 Community
MDA 16 5,362,111
STH
Entire population
between 2 and 70
years
1 Community
MDA 16 5,362,111
ENVISION support to October 2017 and October 2018 LF/STH MDA
For the October 2017 LF/STH MDA, ENVISION will provide support to a total of 28 districts.
ENVISION FY18 PY7 Indonesia Work Plan
20
For the October 2018 LF/STH MDA, ENVISION will support 16 districts (Table 5). The following are the
major changes from the previous ENVISION MDA support:
• Nine districts will be implementing Pre-TAS instead of 2018 MDA.
• One district, Tanjung Jabung Timur, failed their Pre-TAS in early 2017 and will now be required
to continue LF/STH MDA for two more rounds.
It is assumed that all districts implementing final rounds of MDA in October 2017 will achieve sufficient
coverage to be eligible for Pre-TAS in FY18. If other previously ENVISION-supported districts do fail a
Pre-TAS or TAS, ENVISION will consider supporting the required continuation of their LF/STH MDA in
October 2018 if sufficient time is available to develop a FOG and obtain approval from USAID.
Support for MDA in October 2017: ENVISION has contracted with 10 partner NGOs to provide TA and fill
in funding gaps for comprehensive LF/STH MDA implementation in 28 districts. These 28 districts are
mainly on the island of Sumatra but also include a scattering of other districts across the Indonesian
archipelago. Major activities funded, either directly by ENVISION or through a DHO cost share, include
coordination meetings at the district and HC levels, M&E training, cadre training, community
registration, social mobilization, MDA implementation, sweeping, and reporting and recording.
Beginning in FY16, additional funding has also been provided to ensure stronger and more effective
supervision by both the DHO and partner NGO to all low-performing HCs and a sample of other HCs in
their area based on the standard ENVISION supervision checklists, particularly for key activities, such as
cadre training and the actual MDA implementation. Furthermore, additional support was provided to
the 12 districts classified as low performing (see above) to enable them to respond to their local issues
in creative, innovative ways and achieve significant improvements in the coverage and quality of their
MDA.
Support for MDA Preparations before October 2018: In FY18, ENVISION will engage partner NGOs to
provide continuing assistance to 16 districts using the same approach and methodology but with
additional attention given to supervising and mentoring all low-performing HCs in their respective areas.
The NGOs will also be engaged to promote the implementation of DOT during all preparation activities
and supervision visits. In addition, if previously ENVISION-supported districts fail a pre-TAS or TAS,
ENVISION will consider supporting the required continuation of their LF/STH MDA in October 2018 if
sufficient time is available.
Of the 51 districts supported by ENVISION during the October 2016 LF/STH MDA, all achieved epi
coverage rates exceeding 65%. However, while reported coverage is good, coverage survey results have
revealed problems in compliance, with a difference of up to 30 percentage points between reported
coverage and the number of people actually ingesting the drugs. To address issues of compliance in all
ENVISION-supported districts, ENVISION will focus on three activities:
1. Supervision visits will be implemented during both the 2017 MDA and the preparation activities
for the 2018 MDA by ENVISION staff, partner NGOs, PHOs, and DHOs to all HCs with low
coverage. Visits will be conducted during both the cadre training and the actual MDA
implementation and will use revised supervisory checklists.
2. The cadre training materials were updated and simplified last year to focus on the key issues of
why LF MDA is important, DOT, eligibility criteria, and communicating about adverse events
(AEs) with the community—with more time given in the agenda for answering questions from
the cadres and those that they frequently receive from their communities. Because the cadres
comprise the main point of contact with the community, it is essential that they understand and
can communicate the reasons for implementing MDA and can respond to community members’
ENVISION FY18 PY7 Indonesia Work Plan
21
most frequent reasons for refusing to participate. The revised training materials resulted in
much more effective training and will be further utilized during cadre training in FY18. In
addition, several districts will be piloting a new approach to improve the effectiveness of the
cadre training by significantly reducing the class size, which should result in more active
participation by the cadres and provide an opportunity for more focused dialogues around the
real problems they are facing in the field.
3. Attention to improving the quality of the district coordination meetings will be increased, with
ENVISION staff mentoring NGOs to develop district presentations that include analyses of past-
year MDA coverage data by HC, the importance of higher coverage targets, and the promotion
of DOT.
f) Social Mobilization to Enable NTD Program Activities
Airing of the LF/STH Public Service Announcement (PSA): During FY18, ENVISION will process the final
payment for the airing of the PSA during the LF/STH MDA in October 2017 (Table 6).
Printing and Shipping of the LF MDA Cadre Handbook and MDA Registration Books: Based on
extensive feedback from the field during supervision visits, one of the most appreciated and useful
materials has been the Cadre Handbook, which was revised in 2016 to include the promotion of DOT as
a critical priority and a clearer explanation of AEs and how to manage them. This handbook is also the
major material distributed during the cadre training and helps to reinforce all of the important issues
discussed. The MDA Registration Books are also an important tool to assist the cadres to compile lists of
all members of their communities and track the quantities of drugs needed and the uptake of the MDA.
Although these critical materials have been printed and distributed in the past, there is a need to
provide additional copies for ENVISION-supported districts to respond to cadre turnover and
compensate for the loss and very short shelf life of these materials in Indonesia’s hot and humid climate.
Table 6. Social mobilization/communication activities and materials checklist for NTD
work planning
Category Key messages Target
population
IEC activity
(e.g.,
materials,
medium,
training
groups)
Where/wh
en will they
be
distributed
Frequency
Has this
material/message
or approach been
evaluated?
If no, please detail
in narrative how
that will be
addressed.
MDA
Participation
-MDA will take
place at the local
drug post in
October.
-The drugs
provided are free
and safe.
-Some side effects
are normal, and
they will pass
-Drugs should be
swallowed in the
presence of a
health
worker/cadre.
Community
members
TV Spots National TV 300 spots
on four
national TV
stations
(September
to October
2017)
-% of audience
who recall seeing
the spot during
MDA supervision
or the coverage
survey.
-# of times
messages aired on
TV during the
reference period
(source: TV
broadcast reports)
ENVISION FY18 PY7 Indonesia Work Plan
22
MDA
Implementation
-MDA will take
place at the local
drug post in
October.
-The drugs
provided are free
and safe.
-Some side effects
are normal, and
they will pass. If
not, go to the
nearest HC.
-Ensure that drugs
are ingested in
front of you.
Cadre Cadre
Handbook
During
cadre
training
40,000 Yes, during
previous cadre
training and use in
the field
MDA
Implementation
List of community
population and
uptake of MDA
Cadre MDA
Registration
Book
During
cadre
training
40,000 Yes, during several
previous rounds of
MDA
g) Training
Training for LF/STH MDA is a cascade process that starts with NGO and district LF Focal Points, who then
train the HC staff, who then train the cadres.
NGO Training: In FY18, NGO training is planned as a two-day training that will be conducted back to
back with the ENVISION 2018 LF/STH MDA Review and Planning Meeting. Over the past several years,
ENVISION has been building local NGO capacity through training, site assessments, and on-the-job
supervision, starting with training on USAID rules and regulations and basic knowledge of LF and
continuing with training on data collection and analysis. In FY17, ENVISION focused on improving the
quality of supervision by these partner NGOs and emphasized the supervision of cadre training and MDA
implementation at low-performing HCs. Discussions also included NGO responsibilities in reporting SAEs
and how to help reduce the impact of concerns about SAEs in the community. In 2018, ENVISION will
consult with all NGO partners to identify areas of focus for the training, potentially including
organizational capacity building, better communications, the development of more strategic local
responses, continued improvements in supervision and reporting, and methods of facilitating the
implementation of DOT in all project areas. The aim is to ensure that local NGOs have the capacity to
influence local health programs and assist with meeting coverage and compliance requirements.
ENVISION will continue to apply the approach used in FY17 to actively involve NGO partners in all
presentations and discussions and encourage sharing among equals and creative problem solving.
Approximately 14 participants will be involved.
LF/STH MDA HC Staff Training: Beginning in Year 3, based on the results of the DQA, the project added
one additional day to the district coordination meeting to facilitate training HC staff on the use of
updated reporting forms. Because of the success of this training in bridging this communication gap in
the field, ENVISION will continue this activity in FY18 with a strengthened focus on implementing DOT
and improving SAE management and reporting at the HC level using the key messages from the cadre
handbook. ENVISION will work with our partner NGOs to provide appropriate materials and methods for
the DHOs to train HC staff during the ENVISION Project Review and Planning Meeting. The importance of
this training and the cadre training (described below) will be emphasized during the ENVISION Project
Review and Planning Meeting. Several sessions of the Project Review and Planning Meeting will be
devoted to sharing experiences and best practices among the NGOs and DHOs on how to adapt these
ENVISION FY18 PY7 Indonesia Work Plan
23
trainings to better respond to both the local situation in each area and the capacity/experience of the
trainees and how to better use the evidence available to stimulate greater motivation. These ideas will
be reinforced during visits by ENVISION staff to the low-performing districts for the district coordination
meetings and during regular discussions with NGO partners by telephone and email.
LF/STH MDA Cadre Training: Through local NGOs in the 16 districts where LF/STH MDA is being
supported with USAID funding in FY18, ENVISION will ensure that all cadres receive timely and adequate
training on all aspects of the LF elimination program. This training, which uses a standardized
PowerPoint and pre-/post-tests, will emphasize the need to participate in the program and how to
register the population, record treatments, supervise drug ingestion, identify and treat AEs, and refer
SAEs. The PowerPoint presentation was revised and updated for use during preparations for the
October 2016 MDA and now includes more colorful and attractive graphics and additional messages on
DOT. The presentation has also been designed to encourage more interactive discussions and enhance
the active participation of the cadres. Each HC will be encouraged to adapt the presentation to local
conditions using the local language, if appropriate, and/or local examples and to emphasize coverage
data from each health post to further stress the need for both sweeping and DOT. Three HC staff
overseeing the MDA campaign will conduct the training in each HC. The aim will be to train four cadres
per health post. Over 95% of cadres are women, and this training aims to give them the skills they need
to become respected advocates for preventive health care in their communities. Several of the districts
will also pilot a new approach for this training with significantly smaller class sizes to encourage more
active participation by the cadres and provide more opportunities for practical and realistic problem
solving for situations that cadres face in the field.
Although this will be refresher training for many of the cadres who were trained in previous years, the
fact that LF/STH MDA only occurs once a year necessitates refresher training annually to ensure that
cadres can adequately respond to the communities’ questions and report population registration and
treatment coverage data correctly.
Each DHO and partner NGO will attend the cadre trainings in each low-performing HC in their district
and in approximately 20% of the other HCs to monitor appropriate implementation using a training
supervision checklist. ENVISION has already assisted the NGOs in prioritizing HCs for supervision based
on a comprehensive review of HC-level coverage data from past MDA years.
h) Drug and Commodity Supply Management and Procurement
Shipping Drugs for LF/STH MDA to ENVISION-supported Districts: In FY18, ENVISION will continue to be
responsible for arranging the shipment of the required DEC and ALB to each of the 16 ENVISION-
supported districts, well in advance of MDA. ENVISION will also ensure that only pre-qualified drugs
from both Eisai and GSK donations are used in ENVISION-supported districts.
Procurement of FTS to Support Pre-TAS in Tasikmalaya: As an exception to the process outlined above,
ENVISION will procure the required FTSs for the pre-TAS in Tasikmalaya District because the Subdit was
not able to include the procurement of FTSs for pre-TAS within their budget this year.
i) Supervision for MDA
Supervisory Visits by NGO and DHO Staff for 2017 LF/STH MDA Support Activities: To provide
supervision assistance, the ENVISION partner NGOs will supervise and mentor the actual MDA
supervision and sweeping activities in all of the 28 ENVISION-supported districts during the 2017 LF/STH
MDA in October and November 2017. They will focus their attention on those HCs that have been
ENVISION FY18 PY7 Indonesia Work Plan
24
identified as low performing based on their historical epidemiological and program coverage numbers.
The NGOs will also be responsible for supervising an additional 20% of the HCs in each district to ensure
the maintenance of good program implementation. The NGO, together with DHO staff, will fill out
monitoring forms and checklists to assess the implementation of the various components of the MDA;
these will be submitted and reviewed by ENVISION staff. The results from these checklists will be
presented at the next ENVISION Program Review and Planning Meeting to highlight common issues,
such as the inconsistent use of DOT, appropriate management of SAEs, and reasons for non-compliance.
ENVISION staff will also review these supervisory checklists upon submission and discuss any critical
issues with central MOH staff to provide feedback to the NGO and DHO on how to resolve the issues
during future rounds of MDA.
Supervisory Visits by PHO, DHO, and NGO Staff for 2017 LF/STH MDA and 2018 MDA Support
Activities: As in previous years, ENVISION will provide funding in the FOGs for the PHO, DHO, and local
partner NGO to supervise the implementation of the 2017 MDA and preparation activities for the 2018
MDA in each of their respective areas. The results from the 2017 MDA will be used to determine priority
HCs. Priority HCs will become the focus of intensive supervision by both DHO and NGO staff during all
critical preparation activities, such as M&E training, cadre training, HC coordination meetings, and
registration. The DHO and NGO staff will also be supported to supervise a limited number of other HCs
in their respective catchment areas to encourage best practices across each district.
Supervisory Visits by the MOH for 2017 LF/STH MDA and 2018 MDA Support Activities: During the
implementation of the 2017 LF/STH MDA campaign and preparation activities to support the 2018 MDA,
Subdit staff will be provided with funding from ENVISION to supervise selected activities in selected
districts (including both ENVISION-supported districts and non-ENVISION-supported districts), with an
emphasis on those critical activities, such as district coordination meetings and cadre training in
problematic areas, where the national-level staff can be most effective. Although the Subdit does have
its own funding available for supervision, this limited amount is usually insufficient to cover all of the
travel required to adequately supervise the national program and is often not available during periods
critical to the successful implementation of MDA. Therefore, ENVISION will provide support for
approximately 30 four-day trips for Subdit staff during FY18.
Supervisory Visits by RTI ENVISION: RTI ENVISION will provide an additional level of supervision
covering many areas that need special attention and routine supervision of all ENVISION-sponsored
activities as part of our best practices to ensure proper program management at all levels. These visits
will be conducted in collaboration with the appropriate staff from the DHO, PHO, and/or MOH. All RTI
ENVISION staff use standardized supervision checklists or NGO assessment forms to collate information
and include these in their trip reports. For planning purposes, we have budgeted supervision visits to
approximately 14 districts during the implementation of the FY17 LF/STH MDA and supervision visits to
approximately 10 districts during preparations activities for the FY18 LF/STH MDA, including DHO
coordination meetings and cadre trainings. In addition, to ensure the proper management of grant
funds, ENVISION will implement grant and financial management assessments in each of the partner
NGOs selected to receive FOGs to support the FY18 LF/STH MDA.
j) M&E
Ongoing M&E TA: The ENVISION Indonesia Senior M&E Specialist and M&E Officer will continue to work
together with Subdit staff to support all M&E activities in the ENVISION work plan and assist with all
related reporting. Additionally, they will work closely with Subdit staff upon request to assist with
national-level non-ENVISION M&E activities and reporting to WHO. They will encourage the tracking of
activities against the national M&E plan included as part of the NTD Plan of Action 2016–2020.
ENVISION FY18 PY7 Indonesia Work Plan
25
Furthermore, they will ensure oversight of data entry and the analysis of results from LF sentinel and
spot-check sites and will supervise these sites and TASs whenever possible.
Integrated NTD Database: For the past several years, ENVISION has supported the rollout of the
integrated NTD database, including training Subdit staff and hiring consultants to enter historical LF
data. The Subdit continues to enter data into the database, though often inconsistently, and has used
the database on occasion to generate WHO forms, such as the Joint Reporting Form. However, the
Subdit continues to prefer to use its own methods to compile reports. To encourage the Subdit’s use
and adoption of the database, in late FY17, ENVISION plans to demonstrate new and updated features
of the integrated NTD database, including the generation of updated Joint Reporting Forms and
Epidemiological Reporting Forms. The additional reports are expected to better address the Subdit’s
reporting needs. During FY18, the ENVISION M&E Specialist and M&E Assistant will continue to be
available to work closely with the M&E Focal Person at the Subdit to build her capacity to sustain the
database, as requested.
DQA: DQAs were conducted in Indonesia in FY14 and again in FY17. As a result of recommendations
from the FY14 DQA, MDA registers were revised, and training in reporting and recording was organized
for ENVISION-supported districts. Archiving was also standardized. Clear reporting instructions based on
written guidelines have also been developed and issued by the national level, although according to
findings from the FY17 DQA, lower levels are often unaware of these instructions. During FY18,
ENVISION will continue to encourage the Subdit to expand the number of staff with a working
knowledge of the integrated database, as recommended in the FY17 DQA report, and will provide
additional training in reporting and recording to all non-ENVISION districts. ENVISION will also continue
to encourage the Subdit and PHOs and DHOs to implement other recommendations from the FY17 DQA
that have not yet been addressed, including determining deadlines for each step in the reporting cycle
and requiring all reports to be signed and dated.
LF/STH MDA Coverage Survey: ENVISION will support a coverage survey in six ENVISION-supported
districts that implemented LF/STH MDA in October 2017 and were also included in the 2015 MDA
Coverage Survey organized by the University of Indonesia with support from ENVISION. This new survey
will be used to both confirm the reported coverage numbers from the October 2017 MDA and indicate
the levels of compliance in each district. The results from this survey will be compared with those from
the 2015 Coverage Survey to track the impact of ENVISION interventions and measure compliance
following multiple rounds of MDA for the first time in Indonesia. The standard ENVISION coverage
survey protocol and methodology will be used to facilitate comparing the results of the two surveys. The
final report will include analyses of the October 2017 MDA results and comparison with the results from
the 2016 Coverage Survey. The results will be presented to the Subdit and to each of the districts
involved. All of this information will then be used to inform improvements in local strategies,
communication efforts, and program management to ensure that future MDA is of the highest quality
possible.
LF Pre-TAS Sentinel and Spot-Check Sites: Based on the latest data review with the Subdit, in FY18, out
of the 27 districts that will implement pre-TAS, ENVISION will support pre-TASs in 13 districts that have
received ENVISION support during MDA and should be able to meet the criteria of achieving at least five
rounds of MDA with epidemiological coverage above 65% following the 2017 MDA. For each pre-TAS,
data will be collected from one sentinel site and one spot-check site per district.
ENVISION FY18 PY7 Indonesia Work Plan
26
Assessments will be done following the approach below:
1. Approximately 300 samples from people aged 5–50 years should be collected from at least two
sites (villages) using blood films to detect Mf. In very difficult-to-reach W. bancrofti areas, such
as Tasikmalaya, FTSs will be used.
2. Blood collection should be performed between the hours of 10 pm and 2 am (except for the
district using FTSs, where blood collection will be conducted during the day).
3. Districts with populations <1 million will have one sentinel site and one spot-check site. Districts
with populations >1 million will have two sentinel sites and two spot-check sites.
4. Sentinel sites will be areas of known high transmission; spot-check sites will be areas at high risk
of continued transmission (e.g., because of low MDA coverage).
5. Pre-TAS sentinel and spot-check site data will be collected after the fifth effective MDA round to
determine whether the district can move to implementing a TAS. Pre-TAS sentinel sites will be
the same villages as the baseline sentinel sites.
6. All other issues relating to preparation and analysis of samples, including blood collection, slide
coloration, and microscopic examination, are addressed in the standard protocol developed
based on WHO M&E guidelines.
The sentinel and spot-check site assessments will be managed by the central-level team, and laboratory
technicians will be engaged at the provincial and district levels. The results will be entered into the
integrated NTD database and shared with the districts through a formal letter from the Subdit. Only
districts that have a result of Mf <1% or antigen <2% will pass the pre-TAS and be considered for TAS
implementation. Districts that do not meet these cut-offs will be required to continue MDA for two
additional rounds before implementing another pre-TAS. All slides will be read by lab technicians from
either the local BBTKL or the provincial laboratory. ENVISION will also arrange for cross-checking of all
positive slides and 10% of the balance at the University of Indonesia Faculty of Medicine.
LF TASs: In FY18, of the 37 TAS1 planned for FY18 by the Subdit, ENVISION will support a total of 23
TAS1 in 23 districts. (The districts planning TAS1 in FY18 are undertaking pre-TAS in Quarter [Q]3–Q4
FY17 and will only implement TAS if the pre-TAS results indicate Mf <1% or antigen <2%.) The TAS will
apply antigen testing with FTSs in W. bancrofti areas or antibody testing with BR tests in Brugia spp.
areas among SAC who are sampled according to WHO guidelines. All rapid diagnostics will be provided
by the Subdit.
TASs will be conducted among first- and second-year primary school pupils (if >75% of children in the
area attend school) or among children aged six–seven years within the community (if <75% of children
in the area attend school). The survey will use a cluster methodology.
Each TAS will be implemented by a team consisting of one PHO staff, DHO staff, two HC staff, and two
cadres per cluster and a national-level supervisor from the Subdit, BBTKL, regional health laboratory,
and/or local university, with assistance from ENVISION. In each district, four teams will implement TAS
simultaneously. The surveys will be performed between November 2017 and September 2018. All
surveys will utilize the newly developed TAS preparation and supervisory checklists for each of the
various components. In all areas, duplo testing (double testing) of all positive samples will be conducted,
and any discordant results will be considered as “undetermined” and not included in the survey sample
size. The results and next steps will be shared with the districts through a formal letter from the Subdit.
If any districts fail either the TAS2 or TAS3, ENVISION will work with the Subdit to submit a request to
ENVISION FY18 PY7 Indonesia Work Plan
27
the WHO RPRG for advice on next steps, per the guidance in the 2011 WHO LF TAS manual and the 2016
LF TAS Expert Meeting in Jakarta.
For all ENVISION-supported districts that fail either a pre-TAS or TAS, ENVISION and our partner NGOs
will work with the respective DHO and their HCs prior to the next round of MDA to (1) utilize the TAS
checklists and in-depth data review to investigate the failure; (2) where possible, organize focus groups
to collect information from cadres and/or community members; (3) enhance their local social
mobilization strategy to include more local-specific activities, such as engaging religious leaders or other
influential people, providing media in the local language, or increasing the funding for cadres to travel to
all low-performing villages; (4) increase the promotion, implementation, and monitoring of DOT; and (5)
increase the amount of active supervision of the HC, DHO, and NGO staff in low-performing areas to
assist with local problem solving and increase local motivation.
Table 7 lists the DSAs planned for FY18.
Table 7. Planned DSAs for FY18 by disease
Disease
No. of
endemic
districts
No. of districts
planned for DSA
No. of EUs
planned for
DSA (if
known)
Type of
assessment
Diagnostic method
(Indicator: e.g., Mf or
FTS)
LF 236 27 (13 with
USAID funds)
27 (13 with
USAID funds) Pre-TAS 26 Mf; 1 FTS
LF 236 36 (23 with
USAID funds)
37 (23 with
USAID funds) TAS1 3 FTS; 32 BR; 2 Mixed
LF 236 11 (0 with USAID
funds)
13 (0 with
USAID funds) TAS2 6 FTS; 7 BR
LF 236 9 (0 with USAID
funds)
9 (0 with
USAID funds) TAS3 1 FTS; 6 BR; 2 Mixed
Note: One district, Buton Tengah, has not been included as USAID-supported TAS1 in the program workbook as this change was
made after the database closed on August 3, 2017.
TAS Training for PHOs and DHOs: In August 2018, staff from the 56 districts planning TAS1 and TAS2 in
2019 together with their provincial-level counterparts will need to be trained in TAS implementation,
including eligibility, sampling, preparation, testing methodology, and the interpretation of results. To
help PHOs and DHOs understand the purpose of the surveys and the process, a three-day training on
TAS methodology and how to use the appropriate rapid tests will be conducted based on the WHO TAS
training modules. Pre- and post-tests will be used to evaluate the participants’ changes in knowledge
after training, and their abilities to use and read the rapid diagnostic tests will be assessed. ENVISION
will fund, organize, and co-facilitate the training with the Subdit. Approximately 81 participants will
attend the training.
Pre-TAS Preparation Workshop: A two-day workshop will be organized in Jakarta with participants from
the 13 districts that will be implementing pre-TAS in FY18, together with two individuals from each of
the associated provincial health services and senior managers from the relevant BBTKLs or provincial
laboratories to coordinate plans, budgets, and schedules for pre-TAS implementation. This workshop
will include an explanation of the standard protocol and budgeting and scheduling of the individual pre-
ENVISION FY18 PY7 Indonesia Work Plan
28
TAS for each district. The workshop will be organized by ENVISION in collaboration with the Subdit and
held in May 2018.
National LF M&E Coordination Meeting: ENVISION will assist the Subdit in organizing a two-day
coordination and planning meeting in Jakarta for representatives from the 10 regional BBTKLs and
approximately 10 provincial health laboratories to establish clearer guidance on the roles and
responsibilities to be shared among these organizations in pre-TAS and TAS implementation in support
of the national LF program. This meeting will focus on the practical issues related to the coordination
and implementation of these surveys, including scheduling and budgeting issues. Previous experience
from implementing the surveys in the field will also be discussed, problems identified, and best practices
shared. Approximately 40 participants will be involved, with priority given to staff who have been
previously trained as TAS supervisors and participated in supervising TAS in the field. Following this
meeting, the Subdit will request funding support from WHO to organize a similar coordination meeting
for the senior management of these various units to endorse the results of this first meeting officially.
k) Supervision for M&E and DSAs
As ENVISION staff and staff from the Subdit are directly involved in the organization and field
implementation of each of the ENVISION-supported DSAs outlined within this work plan, there is no
need to organize special, additional supervision visits. The supervision of these activities is an integral
part of the responsibilities of the ENVISION M&E team, and during this supervision, they fully ensure
that all WHO guidance is followed and that the required WHO TAS or ENVISION-created pre-TAS
supervisory checklists are completed.
l) Dossier Development
The national LF program in Indonesia will be unable to complete the implementation of LF/STH MDA
until 2021 at the earliest, and subsequently, at least five years of surveillance will be needed before a
dossier for elimination can be developed. Therefore, it is probably too soon to prioritize this process.
The Subdit is aware of the type of data that will be required for the dossier and has established
appropriate systems to collect and archive these data. ENVISION will offer to help draft the mapping
section of the dossier to capture this important information as soon as possible before institutional
memory fails. The Subdit is also aware that morbidity management must be addressed in the
elimination dossier and is beginning to establish the appropriate mechanisms to respond to the needs of
people living with chronic LF adequately. The MOH has district-level estimates of the numbers of
patients with lymphedema and hydrocele that are reported to WHO annually.
ENVISION FY18 PY7 Indonesia Work Plan
29
APPENDIX 1: Work Plan Timeline
FY18 Activities
Project Assistance
Strategic Planning
Meetings to Develop Enhanced MDA Strategies with ENVISION-supported Districts
ENVISION LF/STH MDA Project Review and Planning Meeting
LF/STH MDA District Coordination Meetings (funded in the FOGs)
LF/STH MDA HC Coordination Meetings (funded in the FOGs)
NTD Secretariat
NTD Secretariat Office Supplies and Operational Cost Support
MDA Coverage
Support for MDA in October 2017 (through FOGs)
Support for MDA Preparations before October 2018 (through FOGs)
Social Mobilization to Enable NTD Program Activities
Printing and Shipping of LF MDA Cadre Handbook and MDA Registration Books
Training
NGO Training
LF/STH MDA HC Staff Training (funded in the FOGs)
LF/STH MDA Cadre Training (funded in the FOGs)
Drug Supply Management and Procurement
Shipping of Drugs for LF/STH MDA to ENVISION-Supported Districts
Procurement of FTS for Pre-TAS in Tasikmalaya
Supervision for MDA
Supervisory Visits by NGO and DHO Staff for 2017 LF/STH MDA Support Activities (funded in FOGs):
Supervisory Visits by MOH for 2017 LF/STH MDA and 2018 MDA Support Activities
Supervisory Visits by PHO, DHO and NGO Staff for 2017 LF/STH MDA and 2018 MDA Support Activities (funded in
FOGs)
Supervisory Visits by RTI ENVISION
M&E
Ongoing M&E TA (no costs involved)
Integrated NTD Database (no costs involved)
DQA (no costs involved)