Indonesia Work Plan - ENVISION · Indonesia Work Plan FY 2016 Project Year 5 October...
Transcript of Indonesia Work Plan - ENVISION · Indonesia Work Plan FY 2016 Project Year 5 October...
Indonesia Work Plan FY 2016
Project Year 5
October 2015–September 2016
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 29, 2016.
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.
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ENVISION PROJECT OVERVIEW
The US Agency for International Development (USAID)’s ENVISION project (2011–2016) 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), trachoma, and three soil-transmitted helminthiases (STH;
roundworm, whipworm, hookworm). 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 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:
• 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:
• Strategic annual and multi-year planning
• Advocacy
• Social mobilization and health education
• Capacity strengthening
• Baseline disease mapping
• Preventive chemotherapy (PC) or mass drug administration (MDA)
• Drug and commodity supply management and procurement
• Program supervision
• M&E, including disease-specific assessments (DSA) and surveillance.
In Indonesia, ENVISION project activities are implemented by RTI International (RTI).
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TABLE OF CONTENTS Page ENVISION PROJECT OVERVIEW ..................................................................................................................... II
ACRONYMS LIST ............................................................................................................................................ V
INDONESIA COUNTRY OVERVIEW ................................................................................................................. 7
1) General Country Background ............................................................................................................ 7
a) Administrative Structure ........................................................................................................... 7
b) NTD Program Partners .............................................................................................................. 7
2) National NTD Program Overview ...................................................................................................... 8
a) Lymphatic Filariasis ................................................................................................................... 9
b) Schistosomiasis ....................................................................................................................... 12
c) Soil-Transmitted Helminthiases .............................................................................................. 12
3) USAID History of Support ................................................................................................................ 13
a) Snapshot of NTD Status in Indonesia ...................................................................................... 13
PLANNED ACTIVITIES ................................................................................................................................... 14
1) Project Assistance ........................................................................................................................... 14
a) Strategic Planning ................................................................................................................... 14
b) NTD Secretariat ....................................................................................................................... 15
c) Advocacy ................................................................................................................................. 15
d) Social Mobilization .................................................................................................................. 16
e) Capacity Building/Training ...................................................................................................... 17
f) Mapping .................................................................................................................................. 18
g) MDA ........................................................................................................................................ 18
h) Drug and Commodity Supply Management and Procurement .............................................. 19
i) Supervision .............................................................................................................................. 20
j) Short-Term Technical Assistance ............................................................................................ 21
k) M&E ........................................................................................................................................ 22
2) Maps................................................................................................................................................ 26
TABLE OF TABLES
Table 1. Administrative and health structure in Indonesia .......................................................................... 7
Table 2. NTD partners working in country, donor support, and summarized activities ............................... 8
Table 3. Snapshot of the expected status of NTD program in Indonesia as of Sept. 30, 2015 ................... 13
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Table 4. USAID-supported districts and estimated target populations for MDA in FY16 ........................... 19
Table 5. Technical assistance (TA) request from ENVISION ........................................................................ 21
Table 6. Planned disease-specific assessments for FY16, by disease ......................................................... 26
LIST OF FIGURES
Figure 1. Stopping MDA TAS results in Indonesia, 2011 to mid-2015 ........................................................ 11
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ACRONYMS LIST
ALB Albendazole
ALPEN Aliansi Perempuan Sulawesi Tenggara
B-Trust Bandung Advisory Trust
BELKAGA Bulan Eliminasi Kaki Gajah (LF elimination month)
BinFar Subdirektorat Bina Obat Publik (Subdirectorate for Public Drug Awareness)
BR Brugia Rapid tests
BTKLPL Technical Office of Environment Health and Disease Control
CDC Communicable Disease Control
DEC Diethylcarbamazine
DKAP Kelompok Dukungan Sebaya Pekanbaru
DQA Data Quality Assessment
DSA Disease-Specific Assessment
EU Evaluation Unit
FIRD Flores’ Institute for Resources Development
FY Fiscal Year
GoI Government of Indonesia
GSK GlaxoSmithKline
ICT Immunochromatographic Test
IEC Information, Education, Communication
IR Intermediate Result
IU Implementation Unit
LASP Yayasan Lembaga Analisis Social dan Pembangunan
LF Lymphatic Filariasis
M&E Monitoring and Evaluation
MDA Mass Drug Administration
Mf Microfilaremia
MOE Ministry of Education
MOH Ministry of Heath
NGO Nongovernmental Organization
NIHRD National Institute of Health Research and Development
NTF National Task Force
NTD Neglected Tropical Disease
PC Preventive Chemotherapy
PKBI Perkumpulan Keluarga Berencana Indonesia
PHO Provincial Health Office
PreTAS pre Transmission Assessment Survey
PSA Public Service Announcement
PZQ Praziquantel
RPRG WHO Regional Program Review Group
SAC School-Age Children
SAE Serious Adverse Event
SCH Schistosomiasis
STH Soil-Transmitted Helminthiases
STTA Short-Term Technical Assistance
Subdit Subdirectorate for Control of LF, STH and SCH
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TA Technical Assistance
TAF Technical Assistance Facility
TAS Transmission Assessment Survey
TIPAC Tool for Integrated Planning and Costing
TOT Training of Trainers
UI University of Indonesia
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
USCDC United States Centers for Disease Control and Prevention
WCC Women Crisis Center
WHO World Health Organization
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INDONESIA COUNTRY OVERVIEW
1) General Country Background
a) Administrative Structure
Indonesia is the fourth largest country in the world, with a population of over 255 million people spread
throughout thousands of islands. Indonesia is in the midst of redistricting; in 2012, the country had 33
provinces and 497 districts. By the end of 2015, Indonesia will have 34 provinces and 514 districts. The
Indonesia administrative and health structure is summarized below (Table 1).
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 LF, STH and SCH (“Subdit”)
Provincial Provinsi Gubernur Provincial Health Office (PHO)
District Kabupaten – rural
Kota – urban
Bupati
Walikota
District Health Office (DHO)
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.”
Mass drug administration (MDA) is carried out by health center staff and “cadres,” who are community
members that help government health workers with activities such as weighing children, immunization
campaigns, and Vitamin A distribution.
The Indonesian Ministry of Health (MOH) procures some diethylcarbamazine citrate (DEC) for lymphatic
filariasis (LF) MDA, albendazole (ALB) for soil-transmitted helminthiases (STH)-only MDA, procures some
rapid diagnostics for LF mapping and surveys, and supports supervisory visits by the national team to
oversee activities. Provinces are responsible and have small budgets for supervision and monitoring and
evaluation (M&E) activities. District governments are required to provide operational budgets for LF and
STH MDA, including training, drug distribution, and monitoring.
b) NTD Program Partners
Indonesia has a few players involved in neglected tropical disease (NTD) work, with USAID and the
World Health Organization (WHO) being the largest contributors (Table 2). WHO provides support for LF
transmission assessment surveys (TASs), MDA campaign month launching, and schistosomiasis (SCH)
elimination. The United Nations Children’s Fund (UNICEF) provides limited technical support for the
distribution of ALB through the Vitamin A program. Since the beginning of the LF MDA program, the
MOH has accepted donations of ALB from GlaxoSmithKline through WHO. In calendar year 2015,
following budget cuts, the Indonesia MOH accepted a large donation of 151 million DEC tablets to
enable the Ministry to expand programmatic support to more endemic districts, which included all of
the USAID-funded districts. This support from WHO/Eisai will be reduced in calendar year 2016, due to
need to comply with MOH regulations regarding use of locally made pharmaceuticals. However, the
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MOH budget likely will not be enough to support local procurement for all districts implementing LF/STH
MDA in 2016, so some donated DEC will be requested.
Table 2. NTD partners working in country, donor support, and summarized activities
Partner Location
(Regions/States) Activities
Is USAID
providing
direct
financial
support to
this partner?
Other
donors
supporting
these
partners/
activities?
RTI/ENVISION
Indonesia
Jakarta with field
support visits to
implementing
provinces/districts
Provides direct technical assistance to
the MOH in strategic planning, M&E,
advocacy, and capacity building. Yes
No
Supports MDA implementation in 50
districts through local NGOs No
MOH Central, Province,
District
LF/STH MDA support in ~80 districts in
2015; provides direct technical support
for strategic planning, M&E, advocacy,
capacity building
Drug procurement for LF/STH MDA and
STH-only MDA
No Yes
WHO
Jakarta with field
visits to
implementing
provinces/districts
Provides technical and limited financial
support for strategic planning, M&E and
importation of ALB and DEC No
Yes
Provides financial and technical support
for the elimination activities of SCH in
two endemic districts
Yes
Eisai Jakarta
Will donate some DEC for 2016 LF/STH
MDA, capacity building by developing
internship opportunities for medical
students, IEC
No No
Fit for School West Java Provides support to school health,
including deworming in 2 districts No Yes
2) National NTD Program Overview
Lymphatic filariasis (LF), soil-transmitted helminthiases (STH), and SCH are endemic in Indonesia. With
its large population, Indonesia has one of the heaviest burdens of NTDs globally, spread throughout all
514 districts. In calendar year 2014, LF/STH MDA reached 20.5 million people in 75 LF-endemic districts,
with 8 districts implementing partial coverage. LF/STH MDA coverage was estimated to include
approximately 1.5 million preschool (1–4 years) and 3.2 million school-aged children (5–12 years) at risk
of STH. In addition, approximately 1 million children were dewormed through STH-only MDA in
coordination with Vitamin A and school health programs. A detailed plan to eliminate SCH, which affects
a small area of 20,000 people in two districts, Poso and Sigi, in Central Sulawesi province, is being
implemented by the Indonesia MOH.
The Subdirectorate for Control of LF, STH and SCH (Subdit), a unit within the Directorate General of
Disease Control and Environmental Health of the MOH, is the lead for LF, STH, and SCH activities. A
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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 (WHO, UNICEF) being 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.
Control and Elimination Strategies
An integrated five-year plan of action for five NTDs including LF, STH, SCH, yaws, and leprosy was
prepared in 2010, with assistance from WHO, UNICEF, USAID, the Australian Agency for International
Development (now the Australian Department of Foreign Affairs and Trade), Johnson & Johnson, and
RTI International. The integrated NTD Plan of action is currently being updated with support from
ENVISION and WHO to encompass activities planned between 2016 and 2020. It includes an ambitious
goal of elimination of LF as a public health problem by 2020. It also incorporates the 2012 STH strategic
plan’s goal of MDA coverage of at least 75% of preschool and school-age children in all endemic districts
by 2020. Strategies follow the latest WHO guidance for LF (primarily guidance outlined in the 2011 TAS
manual) and STH (outlined in the STH Strategic Plan and Deworming for School Aged Children manual).
As a step towards having the resources to scale up LF/STH MDA to full geographic coverage, the 2016–
2020 plan of action proposes an LF MDA campaign plan, which includes a rapid scale-up of MDA as well
as an attempt to designate October as Bulan Eliminasi Kaki Gajah (BELKAGA) or “LF elimination month,”
instead of having districts implement MDA on their own schedules.
The Government of Indonesia (GoI) continues to provide strong support for NTDs at both the central
and district levels. However, there still remains a large funding gap that prevents Indonesia from
reaching full-scale MDA in time to meet 2020 goals of LF elimination and STH geographic coverage.
a) Lymphatic Filariasis
In 2005, the GoI decreed filariasis elimination to be one of the national priorities to combat
communicable diseases and agreed to the global WHO goal of eliminating LF as a public-health problem
by 2020. All three types of lymphatic parasites—namely Wuchereria bancrofti, Brugia malayi, and Brugia
timori—are prevalent in Indonesia, with B. malayi the most widespread. In 2014, a total of 14,932
chronic cases of either lymphedema or hydrocele were reported.
GoI’s LF program objectives are to reduce and eliminate transmission of LF through MDA, and to reduce
and prevent morbidity in affected persons. The central government is responsible for ensuring the
procurement of drugs, developing strategies, and monitoring and evaluating the program, while the
local government is expected to contribute the operational and maintenance budget. Given that district
governments do not always include MDA activities in their annual budgets, the central MOH has
difficulty strategically scaling up and ensuring their strategic plans are implemented. Without further
support, the GoI will not be able to meet the 2020 elimination goal, given that approximately 80 districts
have not started MDA nor currently have budgets to support MDA.
In order to fill this gap, the Subdit has conducted several advocacy meetings for provincial and district
level in order to increase local support. The Subdit also has developed the President’s Instruction for LF
MDA (IMPRES), which is a national policy that stating that endemic districts must use their local budgets
to conduct LF MDA; however, it allows them to use non-health unrestricted funds to support MDA. This
policy should be finalized by end of 2015.
As another approach to increase district support, the MOH developed the BELKAGA campaign approach
to intensify its elimination efforts. The core principles of this approach to be implemented in 2015
include:
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• making LF elimination a national movement and initiating a campaign month for drug
distribution (October), with approximately 144 districts conducting MDA in 2015
• streamlining the coordination of the implementation of national LF elimination program at all
stages—planning, preparation, execution, and evaluation; and
• enhancing the efficiency and effectiveness of the social mobilization campaigns in order to
achieve high treatment coverage in every village.
In addition, Indonesia is on schedule to complete all mapping activities by the end of September 2015,
including 5 districts WHO recommended be re-mapped. TAS to determine whether MDA can be stopped
were completed in 66 districts from 2011 to mid-2015, with 25 districts currently in the post-MDA
surveillance phase (Figure 1). Of those districts implementing TAS1, 34 of 47 passed. Of those
implementing TAS2, 10 of 18 passed. Of those implementing TAS3, 0 of 1 passed. Those districts that
failed TAS1 were either (1) not eligible (but implemented with district/provincial budgets); (2) reported
adequate MDA coverage and <1% microfilaremia (Mf) in PreTAS sentinel and spot-check sites; however,
the MDA coverage numbers were likely a reflection of drugs distributed and not drugs consumed;
and/or (3) were Brugian districts that, following WHO guidelines, used antibody testing, resulting in a
more conservative threshold for passing TAS than the Bancrofti districts that used antigen testing. Of
those that failed TAS2, 7 had used the COMBO test (tests used to detect antibodies to Wuchereria
bancrofti and Brugia malayi) during TAS1 (before WHO guidelines were available), which could be a less
sensitive test than the Brugia Rapid. Districts that did not pass TAS1, TAS2, or TAS3 will seek WHO advice
on next steps or continue with two further rounds of MDA.
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Figure 1. Stopping MDA TAS results in Indonesia, 2011 to mid-2015
In fiscal year 2015, 18 districts have implemented TAS (TAS1=3, TAS2=14, TAS3=1). In FY16, 33 districts
are planning to implement TAS. Fifteen districts will implement 15 TAS1 surveys, 14 districts (one of
which has 1 EU which is implementing TAS1) are implementing 15 TAS2 surveys, and 5 districts are
implementing 5 TAS3 surveys.
USAID support started in FY2011, with financing of LF/STH MDA in 13 districts (2 of which now use their
own budgets), scattered throughout the country. After a review of LF endemicity and MDA data,
ENVISION scaled up in FY2012 and FY2013, mostly in Sumatra, to help the MOH reach full geographic
coverage in that region. ENVISION will support calendar year 2015 LF/STH MDA activities through
October 2015, through support to local nongovernmental organizations (NGOs) in 50 districts, including
11 new districts in Sumatra. Eight of these districts are implementing MDA for the first time and need
support for five rounds of MDA, while 3 failed TAS and need support for two additional rounds. For
calendar year 2016 LF/STH MDA, ENVISION will continue its support in 50 districts: 45 districts that have
previously received ENVISION support and 5 new districts that will be supported for the first time in
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FY2016 (Aceh Timur, Kota Banda Aceh, Kota Sabang, Nagan Raya, and Lahat). Five districts that received
past ENVISION support for five rounds of MDA will implement PreTAS in FY16 and TAS in FY17 (October–
December 2016).
Recognizing that USAID has not in the past supported full geographic coverage of LF/STH MDA,
ENVISION support has focused on completing LF mapping so that the MOH can accurately estimate the
burden of disease, plan advocacy measures with districts to support LF/STH MDA, and advocate to other
donors and to the GoI for support. ENVISION has provided capacity building for (1) MDA implementation
at national, district, and village levels in 50 districts; (2) mapping of LF; (3) TAS at national, provincial,
and district levels; (4) data quality assessment (DQA) and an integrated NTD database at the national
level; and (5) overall LF/STH policy and strategies at national, provincial, and district levels. ENVISION
has also provided support to the MOH in implementation of LF sentinel and spot-check site assessments,
TAS, DQA, and data review.
b) Schistosomiasis
SCH, due to Schistosoma japonicum, is endemic in Poso and Sigi districts in Central Sulawasi province,
with an at-risk population of 20,500 people. Indonesia’s goal is elimination of SCH as a public health
problem by 2020. Control activities had ended in 2005; however, 2010 surveys showed a resurgence of
transmission with an average prevalence of infection of 3.81% (range: 0-12.33) in 21 sites in the two
districts. These areas have restricted access to potable water and sanitation, with few families having
latrines. The GoI has designed an elimination strategy along with WHO that includes surveys and
treatment of humans, vectors (snails), and animal reservoirs (rats, cattle, and dogs). The GoI provides
the funding for the distribution and procurement of praziquantel. Selective treatment (test and treat of
positives and family members) occurred twice in 2013, with 91% and 100% coverage of total population
in at-risk communities in Poso and Sigi districts, respectively. Surveys in 2014 showed an increase in
average prevalence from 0.80% to 1.61% in Sigi and from 0.64% to 0.82% in Poso. Currently, the
program has gaps in funding for surveys and treatment of animal reservoirs.
c) Soil-Transmitted Helminthiases
Indonesia has one of the highest numbers of children requiring preventive chemotherapy for STH in the
world. In the last 15 years, 173 districts have been surveyed in Indonesia to assess STH prevalence. Over
40,000 individuals (mostly children) were involved. Results show that STH infection is widespread in the
country, with an average of 28.12% prevalence (range: 0%-85%). In 2012, the MOH released a new STH
policy. It states 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. This policy results in 19.7 million preschool children (1–4 years) and 39.6 million SAC
(5–12 years) needing at least one round of MDA per year. In districts without LF/STH MDA, STH-only
MDA for preschool children will be delivered through the Vitamin A or National Weighing Programs and
STH-only MDA for SAC will be implemented through the Directorate of Child Health Support’s school
health program in primary schools.
Currently, coverage of preSAC and SAC with STH is at approximately 11%. Given delays with local
procurement of ALB by the MOH, STH-only MDA has been slow to scale up. In calendar year 2014, 12
districts in the mostly non-LF-endemic provinces of Bali and Nusa Tenggara Barat reported STH-only
MDA. After provincial coordination meetings in calendar years 2013 or 2014, Jawa Tengah, Jawa Timur,
Sulawesi Utara, and Sulawesi Selatan also are supposed to implement STH-only MDA between August
and December 2015. In calendar year 2016, non-LF districts in the provinces of Yogyakarta, Lampung,
ENVISION FY16 PY5 Indonesia Work Plan
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Sumatra Barat, and Sumatra Utara should implement STH-only MDA. ENVISION has provided technical
assistance and a small amount of funding for advocacy and information, education, and communication
(IEC) to kick-start STH-only MDA, which will be fully supported by MOH and MOE after the first year of
activities in each province.
3) USAID History of Support
a) Snapshot of NTD Status in Indonesia
Table 3. Snapshot of the expected status of NTD program in Indonesia as of Sept. 30, 2015
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
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 09/30/15
No. of districts
expected to be in
need of MDA at
any level: MDA not
yet started, or has
prematurely
stopped as of
09/30/15
Expected no. of
districts where
criteria for
stopping
district-level
MDA have been
met as of
09/30/15
No. of districts
requiring DSA
as of 09/30/15
USAID-
funded Others
Lymphatic
filariasis
514
243 268 0 50 81 82^ 25^^
Pre-TAS:8
TAS1:15
TAS2:14
TAS3:5
Onchocerciasis N/A N/A N/A N/A N/A N/A N/A N/A
Schistosomiasis 2 512 0 0 2 0 0 0
Soil-
transmitted
helminthiases#
514 0 0 50 212 252 0 0
Trachoma N/A N/A N/A N/A N/A N/A N/A N/A
* 3 districts in Maluku Utara province will have LF mapping results by end of September 2015 and are not included in columns C
and D above. 6 districts in Jawa Timur province that are currently non-endemic will be re-assessed to ensure the non-endemic
status by September 2015; they are currently included in the non-endemic column. 4 currently endemic districts (Kota Banda
Aceh, Karimun, Jakarta Selatan, and Kota Balikpapan) will be re-assessed in 2016 due to district refusal of endemic status; they
are currently included in the endemic column.
** Column F for LF includes districts planning 2015 LF/STH MDA for Sept–Nov 2015.
^ 5 districts will not have LF/STH MDA because of pending TAS1 implementation (Oct–Dec 2015). They are not included in the
gap in column G.
^^ Column H for LF includes 1 district implementing TAS1 between July–Sept 2015 with assumption that it will pass.
* Treatment for SCH has always been at a subdistrict rather than district level. # 129 districts will do deworming through LF/STH 2015 MDA, which starts in Sept–Oct 2015. 131 districts in Bali, Nusa Tenggara
Barat, Sulawesi Utara, DI Yogyakarta, Jawa Tengah, Jawa Timur, and Sulawesi Selatan provinces should be implementing STH-
only MDA in calendar year 2015.
Due to reporting timeframe and budgetary reasons, FY16 workbooks capture calendar year 2015 LF/STH MDA for GoI-funded
districts, FY2016 LF/STH MDA for USAID-funded districts, and calendar year 2016 STH-only MDA for GoI-funded districts.
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PLANNED ACTIVITIES
In FY16, USAID support to Indonesia’s NTD National Program will continue through ENVISION. The
Subdit will continue leading the planning and implementation process, with support from ENVISION at
district, province, and national levels. Activities outlined in this work plan contribute to the following
ENVISION objectives in support of the national program:
• Technical assistance and funding for NTD control and elimination activities
• Capacity development for NTD control and elimination
• Improved M&E for NTD program activities
1) Project Assistance
a) Strategic Planning
NTD Plan of Action Printing and Shipping: Following up on ENVISION’s support for development of the
NTD Plan of Action 2016–2020 in FY15, ENVISION will support the printing and shipping of the Plan of
Action document to all provinces and districts. A first draft of the Plan of Action will be finalized by end
of September, reviewed by the Subdit, and presented at a small stakeholders meeting with the MOH
and WHO to finalize. Then the Subdit will get endorsement from the Ministry of Health. Included in the
Plan of Action is the BELKAGA approach to achieving scale up goals through standardizing time of MDA
and increasing the cohesiveness of a national program. It is being distributed to all endemic districts in
an effort to reinforce global standards and strategies, advocate for scale-up of MDA, and standardize
local Indonesian LF elimination strategies. This plan will be used over the next five years to gauge annual
progress.
TIPAC Update: With technical assistance from the Indonesia ENVISION team, the Subdit will update the
TIPAC with calendar year 2016 activity plans and budget information in January–February 2016. The
results will be used for advocacy purposes, including being presented at the national NTD stakeholders
meeting in April 2016. No budget is needed for this activity.
BELKAGA 2015 LF/STH MDA Coordination Meeting with Provinces: A two-day strategy meeting for
representatives from all 34 provinces will be conducted in Jakarta in February 2016. The purpose of the
meeting is to advocate for the BELKAGA strategy throughout Indonesia and discuss any issues that arose
during calendar year 2015 LF/STH MDA. While one round of BELKAGA will have taken place in 2015, the
Subdit requested support to continue to advocate to provinces on the importance of LF/STH MDA and
the strategy to meet the 2020 goals. ENVISION team members will provide support for the development
of the meeting agenda, planning, and logistical assistance in advance of this meeting, as well as provide
technical assistance during the meeting.
BELKAGA National Coordination Meetings: Two one-day planning meetings will be conducted in Jakarta
in March and July 2016 to prepare for calendar year 2016 LF/STH MDA scale up. The participants of the
meetings will be the representatives from the Ministry of Religious Affairs, the MOE, and the MOH,
including the Subdit, as well as the School Age and Adolescent Health, Under Five, and Nutrition
subdirectorates, and participants from NTF, the University of Indonesia (UI), USAID, ENVISION, Eisai, and
other stakeholders.
ENVISION LF/STH MDA Project Review and Planning Meeting: The ENVISION LF/STH MDA project
review and planning three-day meeting is planned for March 2016. The participants of the meeting
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include the Subdit staff, 2 DHO staff from each of the 50 districts, the LF focal points from the PHOs in
17 provinces, and NGO representatives, as well as representatives from WHO and USAID/Indonesia. The
purpose of this meeting will be to evaluate calendar year 2015 LF/STH MDA activities, including
documenting lessons learned. Data gathered from NGOs on social mobilization and MDA supervision will
be presented with the MDA coverage data (at district and health center levels) during the review
meeting in an effort to discuss and find ways of improving these activities through refined plans of
action.
LF/STH MDA District Coordination Meetings: During May and June 2016, district coordination meetings
will be organized by the district health officer with relevant stakeholders to secure annual district-level
commitment for social mobilization and cadre training activities. ENVISION will finance district
coordination meetings in districts where this is a financial gap. ENVISION will support the travel
expenses for NGOs to attend these meetings at the district level and will provide a standardized MDA
data template for presentation at the district coordination meeting.
LF/STH MDA Health Center Coordination Meetings: After the district coordination meeting, a health
center coordination meeting will be organized in each health center in June and July 2016 with heads of
villages and representatives from health posts and other sectors to review timelines of activities.
ENVISION will help finance these meetings in districts where this is an identified financial gap.
b) NTD Secretariat
ENVISION will continue to provide limited funds for the MOH operational costs, including monthly
internet and national mobile phone service within Indonesia for the Subdit. This is to allow for a network
among team members to access the M&E database and program files and to improve data sharing.
ENVISION will also provide small amounts for stationery and supplies.
c) Advocacy
STH-only MDA Provincial Advocacy/Coordination Meetings: The MOH has developed a strategy for
scaling up the STH-only MDA by conducting advocacy meetings one year prior to the districts
implementing STH-only MDA activities. ENVISION will fund advocacy or coordination meetings in
January and February 2016 at the provincial level in three provinces (Banten, Gorontalo, and Jawa Barat)
in which many districts are preparing to transition from LF/STH MDA to STH-only MDA. The advocacy
meetings are critical to ensure commitment from provincial and district levels and to secure the
availability of STH MDA operational budget allocation, as well as provide half-day training of trainers
(TOT) for district staff on STH background, MDA logistics, serious adverse events (SAEs), and reporting.
The implementation of STH-only MDA will begin in the following year. The participants in these
advocacy meetings will be PHO (child health, nutrition, and communicable disease control [CDC]
sections) staff, the provincial education officer, provincial government staff, DHO (CDC and maternal
and child health sections) staff, and the district education officer. ENVISION will measure the success of
these meetings by collecting plans of action from each province that include district-level commitments.
National NTD Stakeholders Meeting: Indonesia is planning to conduct a one-day national NTD
stakeholders meeting to be held in Jakarta in March 2016 including the relevant subdirectorates in MOH
and MOE, WHO, UNICEF, USAID, Eisai, German Society for International Cooperation, Save the Children,
and other potential partners and donors including the private sector. The meeting will present updates
to the overall LF BELKAGA strategy and updated TIPAC results for calendar year 2016. The MOE, Ministry
of Environment, Nutrition subdirectorate, Vector Control subdirectorate, Subdit, WHO, Eisai,
ENVISION FY16 PY5 Indonesia Work Plan
16
ENVISION/USAID, and other identified partners will present current activities and identify areas for
integration and further planning. ENVISION completely funds this meeting as costs are minimal and
provides technical assistance in the planning and preparation for this meeting. A BELKAGA secretariat
funded by WHO has been established with a role to follow up with stakeholder commitments, including
pledges made during the annual stakeholders meeting. ENVISION will measure the success of this
meeting by collecting a plan of action that will include proposed funding or activities supported by
stakeholders. ENVISION will work with the Subdit and the BELKAGA Secretariat to ensure that these
donations are captured in the TIPAC for historical records.
Supply Chain Management Meeting: There is a need to strengthen the supply chain management for
the LF/STH Program at the national level, including coordination amongst the Subdit, Subdirektorate
Bina Obat Publik (Binfar), Eisai, and WHO. ENVISION has not supported SCM activities in the past in
Indonesia. With the Government of Indonesia decreasing the procurement budget, and therefore
needing Eisai donations, it has become a more complex issue and the Subdit has asked for ENVISION’s
support. (Please see Procurement of DEC section for more information.) This meeting will include
developing a plan for calendar year 2016 activities including a review of 2015 activities, coordination
mechanisms and developing a timeline for 2016. ENVISION will support a one-day meeting at the
national level, which WHO will facilitate.
MDA Advocacy Package Development: ENVISION recognizes the challenges that the GoI faces with
helping districts commit operational budgets to support LF/STH or STH-only MDA. ENVISION has
supported district-level advocacy meetings in the past, at which districts commit to fund 5 years of
LF/STH MDA. Unfortunately, even with this commitment, their budgets often are slashed or priorities
change, and they still have gaps in implementing all the activities needed for effective MDA. Instead of
supporting district-level advocacy meetings, ENVISION will produce an advocacy package (in conjunction
with the advocacy activity discussed in the global ENVISION work plan) that will be tailored to Indonesia
and will provide it to the Subdit; the Subdit can present the package to districts that have not started
MDA. It can also be used by national experts or provincial staff to discuss with districts that have failed
TAS and need additional MDA. ENVISION will identify a local consultant to tailor the global advocacy
package to the Indonesia context. The cost for a consultant to develop the MDA advocacy package is
captured under STTA.
d) Social Mobilization
BELKAGA Launch: In Year 5, ENVISION will provide minimal support for supplies and advocacy materials
to the BELKAGA launching in early October for 2015 LF/STH MDA. In preparation of the launch,
ENVISION will fund the development and distribution of a national-level press release.
LF/STH MDA IEC Materials and Shipping: In Year 4 ENVISION supported the development of an LF/STH
IEC package using standardized language for messaging throughout Indonesia, which includes more
specific messages about SAEs, eligibility, and the need for increased community involvement to reach
coverage targets. The IEC electronic package, which will be sent to all districts prior to 2015 MDA,
includes redesigned pamphlets, posters, and MDA post banners, as well as newly created cadre
handbooks, flip charts, fact sheets, t-shirt designs, promotional pins, press releases, patient testimonials,
radio spots, and photo booth backdrops. ENVISION will also produce a fake lymphedema leg to use
during advocacy meetings to help convince decision-makers of the severity of lymphedema and the
need to eliminate transmission to protect future generations from disease.
ENVISION FY16 PY5 Indonesia Work Plan
17
ENVISION will continue to support printing and shipping of limited IEC materials (posters, pamphlets,
banners, and flip charts) for calendar year 2016 LF/STH MDA activities. Other items provided in the
electronic IEC package such as radio messages, press releases, t-shirt designs, etc., are for districts to
utilize with their own funding. ENVISION did an extensive cost comparison to determine whether
printing in provinces or districts was cheaper than printing in Jakarta and shipping. The cost comparison
showed that printing in Jakarta and shipping to districts was less expensive.
LF/STH MDA Public Service Announcement (PSA): In 2014 and 2015, ENVISION aired a PSA on national
TV and on local TV in ENVISION districts to raise awareness of LF/STH as well as improve coverage in
poor performing districts. To evaluate the reach of the PSA after 2014 MDA, ENVISION added questions
onto a survey on LF/STH MDA best practices and compliance implemented in December 2014 by the UI
in three districts (1 ENVISION-supported district—Kota Batam, and 2 non-ENVISION-supported
districts—Agam and Kota Depok). The survey included 1,218 respondents and found that the PSA had a
positive impact on awareness and behavior, with a significant association between seeing the PSA and
complying with MDA, awareness of MDA, and influencing drug taking behavior in others. Depending on
the district, between 22% and 49% of people reported they had seen the PSA.
Additionally, the analysis showed that people did not participate in the MDA because they were fearful
or indifferent to taking the drugs, attributes that were associated with higher incomes and, in the case
of indifference, higher education levels. However, many of these respondents had not seen the PSA,
perhaps because it was shown mostly on local TV. Because TV viewership usually is higher amongst the
more educated in Indonesia, PSAs may be a good way to reach these non-participators, providing that
the timing and channel are modified to be more appropriate to their viewing habits.
In Year 5, following the positive feedback from the survey, ENVISION will air the PSA in the weeks before
the calendar year 2016 LF/STH MDA, concentrating on coverage on national stations at prime time. Due
to low viewing of local stations, the MOH decided that airing the PSA on a national station in Indonesia
Bahasa would be more effective than translating to local languages and airing on local stations. Costs for
revising and airing the PSA are captured on the social mobilization tab in the budget. The PSA will
accompany a social media strategy by the MOH involving Facebook and Twitter announcements.
e) Capacity Building/Training
NTD Partner Team Building: ENVISION will support a team building exercise for the Subdit, WHO and
ENVISION to strengthen relationships and improve communication. A local management consultant will
be used to facilitate this exercise.
NGO Training: In Year 5, NGO training is planned as a one-day training, conducted back to back with the
ENVISION 2015 LF/STH MDA review and planning meeting. Over the past three 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 a basic knowledge of LF and continuing with
training on data collection and analysis. In FY16, ENVISION will conduct a survey with the NGOs to
identify areas of focus for the training, potentially including organizational strategic planning, financial
capacity building, or proposal writing. The aim is to ensure the local NGOs have the capacity to influence
local health programs and find continuing funding after ENVISION ends.
Training for LF/STH MDA
Training for the LF/STH MDA is a cascade process that starts with refreshing of knowledge and skills of
PHO and DHO staff at the ENVISION project review and planning meeting. The DHO staff then train the
health center staff, who then train the cadres.
ENVISION FY16 PY5 Indonesia Work Plan
18
LF/STH MDA Health Center Staff Training: In Years 3 and 4, based on the results of the DQA, the project
added one additional day to the district coordination meeting to facilitate training of health center staff
in 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 Year 5 with a strengthened focus on improved
SAE management and reporting at the health center level. ENVISION will work with the Subdit to
provide SAE training for DHOs and NGOs, as well as provide the materials for the DHOs to train health
center staff, in the ENVISION project review and planning meeting.
LF/STH MDA Cadre Training: Through local NGOs in the 50 districts where LF/STH MDA is being
supported with USAID funding, ENVISION will ensure that all the cadres receive timely and adequate
training on all aspects of the LF elimination program (Table 4). The training, which uses a standardized
powerpoint and pre/post-tests, will emphasize the need to participate in the program, how to register
the population and record treatments, supervised distribution of the drugs, identification and treatment
of side effects, and referral and documentation of SAEs. Three health center staff overseeing the MDA
campaign will conduct the training. The aim will be to train four cadres per health post. Over 95% of
cadres are women and this training aims to give them skills to become respected advocates for
preventive health care in their communities.
While this will be refresher training for many of the cadres who were trained in previous years, the high
turnover of cadres and the fact that LF/STH MDA only happens once a year necessitates refresher
training annually in order to ensure cadres can adequately respond to the communities’ questions and
report population registration and treatment coverage data correctly.
Local NGOs will attend approximately 20% of cadre trainings in each district in order to monitor
appropriate implementation using a training supervision checklist. NGOs will choose the 20% to attend
based on conversations with DHOs, with an aim to include health centers that could need extra support
because of past performance or difficulty in logistics. ENVISION will work with NGOS to prioritize health
centers for supervision, sharing reviews of health center-level coverage data from past MDA years.
f) Mapping
There are no mapping activities included in this work plan or budget. Reassessment with a mini-TAS
protocol is included under M&E activities.
g) MDA
Mass Drug Administration: ENVISION will fill the funding gaps in district budgets for LF/STH MDA in 50
districts. The cadres will conduct the LF/STH MDA with the target population in the community under
the supervision of the health center. Five previously supported ENVISION districts will be preparing for
PreTAS and TAS in FY2016 so will not be included in calendar year 2016 MDA activities. In place of these
5 districts, ENVISION will support 5 new districts in Sumatra that have partial local government funding,
but still have some gaps. Seven districts that have received ENVISION support for five MDA rounds do
not have adequate coverage in all years, and therefore did not meet the criteria qualifying them for TAS.
These districts will receive one additional round of MDA in calendar year 2016. With effective coverage
in calendar year 2016, these districts will qualify for pre-TAS and TAS activities in calendar year 2017.
Population Registration
In July and August 2016, ENVISION will support population registration activities in all 50 ENVISION-
supported LF/STH MDA districts through local NGOs (Table 4). One week after the cadre training, cadres
ENVISION FY16 PY5 Indonesia Work Plan
19
will collect information on their allocated households, including village name, age and sex of household
members (stratified by <2 years, 2–5 years, 6–14 years, and >14 years). This registration will help ensure
that if adequate numbers of drugs are not available in the health centers, PHOs or DHOs can deliver
more drugs before the start of LF/STH MDA. In addition, cadres use these household visits to deliver
flyers and verbal messages about the logistics of and benefits of participating in the MDA.
Table 4. USAID-supported districts and estimated target populations for MDA in FY16
NTD
Age groups
targeted (per disease
workbook
instructions)
Number of rounds
of distribution
annually
Distribution
platform(s)
Number of
districts to
be treated
in FY16
Total # of
eligible
people
targeted
in FY16
Lymphatic
filariasis
Entire population
from the ages of 2
to 70
1
Community and
door-to-door
MDA
50 15,862,249
Soil-transmitted
helminths
Entire population
from the ages of 2
to 70
1
Community and
door-to-door
MDA
50 15,862,249
h) Drug and Commodity Supply Management and Procurement
Procurement of DEC (no associated budget): The Subdit procures DEC for the LF/STH MDA through
WHO donations and its own government (GoI) budget. The procurement process is initiated through a
request for a budgetary allocation by the LF/STH Subdit through the director of the Vector Borne
Disease Control Program. The Subdit calculates the number of tablets required (and their cost) to treat
the population targeted for the next round of MDA across the entire country. The Subdit then submits
annual needs to BinFar, which initiates the purchase process. Drugs are purchased through an open
tender system and there is no pre-qualification of bidders except that they should be good
manufacturing practices certified. At least three companies must submit a bid for the initiation of the
next steps. The tendering process takes approximately 45 days from the time the tender is announced
to the time a contract is signed with the successful bidder. The supplier usually seeks 2–3 months for the
supply of the drug. Suppliers are required to deliver the drug to the districts.
Starting in Year 2, the tendering for drugs switched to online processing, aiming for time efficiency, but
the shifting from manual to the online system caused delays in Year 2. In Year 3, the delay was caused
by the cut-off of the central government budget just before BinFar initiated the purchase process. The
budget cut-off not only affected the time of purchasing the drugs, but also forced a decrease in the
number of drugs purchased for program implementation. To prevent the DEC stock-out for Year 4, the
Subdit used Eisai’s donation for the remaining DEC. In 2016 the Subdit will apply for Eisai’s donation in
early 2016, after the remaining stock from 2015 MDA is known and the 2016 MDA need can be
estimated. This donation will include supplies for all ENVISION-supported districts.
Procurement of Albendazole (no associated budget): The Subdit procures ALB for LF/STH MDA and STH-
only MDA through WHO donations and its own government (GoI) budget. The Subdit submits the Joint
Application Form and the Joint Reporting Form to WHO for LF/STH MDA. WHO makes a
recommendation to GlaxoSmithKline (GSK) on the number of ALB tablets to be shipped for the LF/STH
MDA in Indonesia. GSK delivers the donated ALB to Jakarta. The Subdit then approaches BinFar for the
release of the drug. The donated ALB takes approximately two weeks to be cleared by customs. For STH-
ENVISION FY16 PY5 Indonesia Work Plan
20
only MDA, the Subdit usually procures through BinFar, which initiates the process described under DEC
procurement above.
Drug Shipment from Jakarta to 50 Districts: At the central level, drugs are stored in the MOH drug
storage facility located at the BinFar offices in Jakarta, Indonesia. For calendar year 2016 MDA,
distribution for non-ENVISION districts will be covered by GoI and distribution for ENVISION-supported
districts will be covered under the FY16 budget. Once received at the provincial level, provinces
distribute the drugs to the DHO, using district funds. The DHO repackages the drugs and distributes to
health centers; a process taking approximately two weeks. Storage facilities located at the provincial and
district health offices are generally in good condition and are usually a storage room connected to the
health office and managed by a designated staff member. Drugs are stored at the health centers until
distributed in the MDA; the conditions of these facilities vary by district. LF/STH drugs are generally
picked up by the health center staff from the DHO once per year before MDA and stored at the Health
Center level until distributed in the MDA.
After the completion of MDA, an inventory of the remaining drugs is made at the district level and
consolidated at the national level. The number of tablets available, including those stored at the
provincial level, after the completion of the MDA is taken into account in making purchases of DEC and
preparing the reapplication for ALB.
Serious Adverse Events (no associated budget): Importantly, as part of the LF/STH MDA campaigns, the
cadre and health center staff will monitor for SAE and report and refer any patients with serious
concerns to health professionals. The triage will initially be to local doctors/nurses, followed by the
district or the provincial hospital if indicated. Cases of SAE that are referred to the district hospital will
be reported to the central MOH to monitor and to manage any negative impact. Training of central and
provincial staff, district staff, and health center staff and cadres will include the updated
modules/messages from the new global SAE guidance. ENVISION will continue to persuade districts to
report any SAEs that might occur to the Subdit and work with the Subdit to report any SAEs to RTI,
WHO, GSK, and Eisai.
i) Supervision
LF/STH MDA Supervision: During the LF/STH MDA campaign, staff from the DHO, PHO, and MOH will
support the cadres and monitor coverage. ENVISION pays for supervisory visits by MOH staff to 20% of
USAID-supported districts for MDA, including travel expenses and per diems. MOH staff fill out
supervisory checklists and submit trip reports to ENVISION, which are reviewed by ENVISION Indonesia
staff. Due to the large number of implementing districts, support from the central level government
unfortunately cannot be conducted in all implementing districts around Indonesia. RTI ENVISION will
provide additional level supervision covering many areas that may not be reached by the DHO, PHO and
MOH. RTI EVISION operations and finance team will also provide financial support supervision to
districts during field visits. All RTI ENVISION staff use standardized supervision checklists or NGO
assessment forms to collate information and include these in their trip reports.
LF/STH MDA Supervision by NGOs: To provide supervision assistance, local NGOs selected to assist with
MDA activities will attend activities in at least 20% of subdistricts in each of their respective districts in
order to monitor progress. ENVISION works with local NGOs and DHOs to help prioritize
subdistricts/health centers that have had problems in the past. 20% is a feasible goal in terms of staff
time, travel necessary (particularly as a NGO is responsible for more than one district and MDA is
happening simultaneously), and budget. The NGO will fill out monitoring forms and checklists with DHO
staff to assess the implementation of the MDA; these are submitted and reviewed by ENVISION staff.
ENVISION FY16 PY5 Indonesia Work Plan
21
Results from these checklists are presented at the ENVISION program review and planning meeting to
highlight common issues, such as inconsistent use of directly-observed treatment, misclassification of
eligible people, and reasons for non-compliance. ENVISION staff will review these supervisory checklists
upon submission and discuss any critical issues immediately with central MOH staff in order to quickly
give feedback to the NGO and DHO on how to resolve the issues.
Coverage Supervisory Tool Implementation: In Year 4, during the provincial NTD focal point training,
provincial staff were trained in how to use routine DQA, a coverage supervisory tool, and supervisory
checklists in order to improve the quality of their supervision. During the calendar year 2015 MDA
ENVISION will implement a coverage supervisory tool in two districts (Siak and Tasikmalaya) that will
help identify weaknesses in early MDA implementation so that quick remedies can be identified and
instituted prior to annual MDA activities ending. This tool—which interviews one person in each of 20
villages in a subdistrict within 2 weeks of MDA in order to get an estimate of whether the subdistrict has
reached the effective coverage threshold—has been developed by the Task Force for Global Health. The
results of ENVISION’s piloting this tool in Indonesia will be shared with the Task Force in order to
improve the tool. ENVISION staff will be conduct this supervision in conjunction with the previously
trained PHO staff, as well as NGO and DHO staff, in the first quarter of Year 5.
j) Short-Term Technical Assistance
Table 5. Technical assistance (TA) request from ENVISION
Task-TA needed
(Relevant Activity
category)
Why needed
Technical skill
required; (source
of TA (CDC,
RTI/HQ, etc.)
Number of days required
and anticipated quarter
Provision of on-
the-job training
for integrated
TAS/STH
assessments
(M&E)
Although Indonesia
piloted the integrated
TAS/STH assessment
methodology, there is
a need for a
consultant to provide
on-the-job training
for this integrated
survey in the two
districts
implementing it in
FY16
Expertise in TAS
and STH
assessment
methodology,
facilitating on-the-
job training (local
consultant)
10 days in Q1
TAS and Post-MDA
Surveillance
Expert Meeting
(M&E)
Review TAS results
and support the
development of
protocol specific to
Indonesia for post-
MDA surveillance
Expertise in NTDs,
TAS, M&E
(international LF
experts, likely CDC
and/or Vector
Control Research
Centre)
14 days in Q2
Technical
supervisor for
MDA, TAS and
M&E activities
Supervision of MDA
and M&E Activities
Expertise in NTDs,
TAS, M&E (local
consultant)
6 months in Q1 and Q4
(20 days per month per 6
months )
ENVISION FY16 PY5 Indonesia Work Plan
22
(M&E)
Data quality
assessment (DQA)
(M&E)
Supervision and
implementation of
DQA
Supervision and
implementation
of DQA (local
consultant)
21 days in Q1
MDA advocacy
package
development
(Advocacy)
Adaptation of global
advocacy package to
Indonesian context
Expertise in
advocacy; MDA
strategy; program
development;
local experience
(local consultant)
20 days, Q1 and Q2
ENVISION will hire consultants to help provide on-the-job training during the roll out of the TAS/STH
assessment integrated surveys; help Indonesia review TAS results and develop a post-MDA surveillance
protocol; assist with the supervision of MDA and M&E activities; implement a DQA in two districts; and
develop an MDA advocacy package. Further information about these activities is included in the M&E
and advocacy sections of the work plan.
k) M&E
Integrated NTD Database: In Year 3, ENVISION supported the rollout of the integrated NTD database,
including training of the Subdit staff and hiring consultants to enter historical LF data. The Subdit is using
the database to generate WHO forms, such as the Joint Reporting Form. In Year 4, the ENVISION M&E
Specialist and M&E Assistant will work closely with the newly appointed M&E focal person at the Subdit
to build her capacity to sustain the database. This will be accomplished through established monthly
(and more often during periods of heavy activity) meetings to provide on-the-job training on the
integrated NTD database, including ensuring a review of data received from the field and timely entry
into the database.
Data Quality Assessment: In Year 3, ENVISION conducted a DQA in two project districts to assess the
strengths and weaknesses of data management related to LF/STH MDA at health posts, health centers,
DHOs, PHOs, and the national level. The DQA helped MOH staff at all levels (1) understand the strengths
and weaknesses of data management and reporting system, and (2) make action plans to improve the
system. Since the DQA, ENVISION has taken steps to help the MOH correct errors in the reporting and
archiving procedures as well as providing more training to DHOs. To help the MOH continue to monitor
and improve its data quality, ENVISION will support the implementation of the DQA, using the same
WHO/RTI DQA protocol piloted in Year 3, in two non-ENVISION-supported LF/STH MDA districts,
Karawang (Jawa Barat) and Barito Kuala (Kalimantan Selatan) in Year 5.
LF Transmission Assessment Surveys (TAS) and STH Assessments: In FY16, TAS will be conducted in
districts/municipalities which have conducted five rounds of MDA with greater than 65% coverage of
total population and have sentinel and spot-check site assessments showing <1% Mf prevalence. The
TAS is required to determine whether or not to stop MDA, with MDA to be stopped if the number of
positive results is less than or equal to the critical cut-off point determined by WHO guidelines. The
evaluation will apply antigen testing with immunochromatographic tests (ICTs), or filariasis test strips (if
available) in Bancrofti areas, or antibody testing with Brugia Rapid tests in Brugian areas among SAC
who are sampled according to WHO guidelines.
ENVISION FY16 PY5 Indonesia Work Plan
23
TAS will be conducted among first- and second-year primary school pupils (if >75% of children in the
area attend school) or among children aged 6-7 years within the community (if <75% of children in the
area attend school). The survey will use a cluster methodology.
In Year 5, ENVISION will support a total of 17 TAS in 15 districts. TAS1 will be conducted in 7 districts
(Kote Tidore, Mappi, Agam, Kuantan Singingi, Kota Bukit Tinggi, Lebak,1 Bogor); TAS2 will be conducted
in 6 districts (Merauke, Pelalawan, Poliwali Mandar, Parigi Mountong, Labuhan Batu, and Rote Ndao
(carried over from FY15)); and TAS3 will be conducted in 2 districts (Kolaka Utara and Bombana). STH
assessments will be integrated with TAS1 in two districts (Kote Tidore and Kuantan Singingi), following
the new WHO protocol. All other diagnostics tests will be procured by GoI. TAS will be implemented by a
team consisting of one PHO staff, DHO staff, two health center staff and two cadres per cluster, as well
as a national level supervisor from Subdit, National Institution of Health Research and Development
(NIHRD), Technical Office of Environment Health and Disease Control (BTKL), or ENVISION. In each
district, there will be four teams implementing TAS simultaneously. The surveys will be implemented
between October 2015 and April 2016. Results and next steps will be shared with the districts through a
formal letter from the Subdit. If any districts fail these TAS2 or TAS3, ENVISION will work with the Subdit
to submit a request to the WHO RPRG for advice on next steps, per the guidance in the 2011 WHO LF
TAS manual.
LF PreTAS Sentinel and Spot-Check Sites: Based on the latest data review with the MOH, provinces and
districts, ENVISION will support eight districts (Aceh Jaya, Pidie, Subang, Melawi, Kote Tidore Kepuluan,
Kuantan Singingi, Donggala, Pasaman Barat) to collect data in one PreTAS sentinel site and one PreTAS
spot-check site per district.
Assessments will be done following the approach below:
• Approximately 300 samples from people aged 5–50 using blood films to detect Mf should be
collected from at least two sites (villages). In Kote Tidore, ICT/FTS will be used instead of Mf.
• Blood collection should be done between the hours of 10pm and 2am.
• Districts with population <1 million will have 1 sentinel site and 1 spot-check site. Districts with
population >1 million will have 2 sentinel sites and 2 spot-check sites.
• Sentinel sites will be areas of known high transmission; spot-check sites will be areas at high risk
of continued transmission, e.g., due to low MDA coverage.
• PreTAS sentinel and spot-check site data will be collected after the 5th effective MDA round to
determine whether the district can move to implementing a TAS. PreTAS sentinel sites are the
same villages as the baseline sentinel sites.
• All other issues with finger blood preparation collection, coloration, and examination follow the
standard protocol that was developed based on WHO M&E guidelines.
The sentinel and spot-check site assessments will be managed by the central level team, engaging
technicians at the provincial and district levels. Results will be entered into the integrated NTD database
and shared with the districts through a formal letter from the Subdit.
LF/STH MDA Coverage Surveys: ENVISION will support a coverage survey in eight 2015 MDA districts
that implemented MDA activities for the first time. In particular the surveys will help confirm if reports
of numbers of drugs distributed are similar to survey responses of numbers of drugs ingested. The
1 Support is needed for 1 evaluation unit (EU); the other 4 EUs in this district will be supported by the Task Force for operational
research purposes, per WHO recommendations.
ENVISION FY16 PY5 Indonesia Work Plan
24
questionnaires will include simple questions, using clear photos, about whether people in the household
have lymphedema or hydrocele. The district estimates generated by these surveys can then be
compared to the health facility listing of known patients to determine whether health facilities are truly
capturing all patients.
ENVISION will engage the UI to implement the surveys in eight districts and will conduct the surveys
using mobile devices. The UI team will consist of eight interviewers who have previously conducted
interviews using mobile technology and will not require much training for this activity. The interviewers
will work with both province- and district-level MOH personnel to implement the questionnaires. With
technical support from the Task Force for Global Health, ENVISION will pilot different methodologies for
conducting enumeration of households in three districts in order to inform WHO global guidance on
NTD coverage survey methodology. Once the data collection is completed, the UI researchers will
analyze the data and submit a final analysis and report. UI will also present the results to the Subdit and
provinces, which will then disseminate the results to the districts.
Mini-TAS Reassessment Surveys: A mini-TAS, using the protocol developed by the Task Force for Global
Health and approved by WHO, will be implemented in February 2016 in four districts: Kota Banda Aceh
(Aceh), Karimun (Kepulauan Riau), Jakarta Selatan (DKI Jakarta), and Kota Balikpapan (Kalimantan
Timur), which refuse advocacy or implementation of MDA. Results of the mini-TAS survey will be used
either to declare them non-endemic (if lower than the critical threshold) or as advocacy to show the
DHOs and mayors’ offices that transmission is still occurring and MDA must be implemented. Kota
Banda Aceh is included on the list of districts that ENVISION will support for LF/STH MDA in 2016 as it is
expected that it will be classified as endemic. If it is not endemic, ENVISION will work with the Subdit to
choose another district in need of support for 2016 MDA.
TAS and Post-MDA Surveillance Expert Meeting: Since 2012, when the first TAS failures occurred,
ENVISION has been working with WHO, CDC and the Task Force for Global Health to better understand
the causes of the failures. First, ENVISION has worked with the Subdit to critically review eligibility data,
which has reduced the number of districts implementing TAS which were not eligible. Second, ENVISION
has collaborated with the Task Force to implement operational research to better understand antibody
results in three study areas (non-endemic, post-MDA, failing TAS, passing TAS). These results showed
that antibody prevalence was higher in all ages in the district which failed TAS versus the districts that
either passed TAS or were non-endemic. The results also showed that results in 6- and 7-year olds
accurately reflected community results. Unfortunately, only one microfilaremia positive was found in
this research, so antibody and microfilaremia prevalence could not be compared. Third, all TAS results
are being analyzed now for presentation at ASTMH and further discussion at the meeting in January.
Finally, the recent TAS2 failure in Tanjung Jabung Barat, a district with low baseline prevalence which
based TAS1 with only 3 positives, will be explored in collaboration with the Task Force, through
collection of Brugia Rapid tests and dried blood spots from communities with the most positive antibody
results in TAS2. Unlike ICTs, positive Brugia Rapid tests cannot be collected for PCR analysis; however, it
is hoped that the dried blood spot analysis will provide some clarity into the accuracy of the Brugia
Rapid tests.
Due to the TAS failures, the Subdit and the NTF were convinced of the need to message correctly about
the importance of full geographic coverage, DOTs, and 65% epidemiological coverage. However, in non-
ENVISION-supported districts that implemented most rounds of MDA before hearing these messages,
they could still be at risk for failing TAS. The key issue in Indonesia now is being able to better predict
which districts will fail TAS, so that the Subdit can convince the other districts to continue and better
implement MDA. ENVISION is continuing to negotiate with the Subdit, with support from WHO, to
ENVISION FY16 PY5 Indonesia Work Plan
25
collect Brugia Rapid data during Pre-TAS sentinel and spot-check sites in order to understand how
community level antibody levels can predict TAS outcome.
In January 2016, Indonesia will hold a technical working group meeting to review Indonesia’s TAS results
and post-MDA surveillance strategy and set new guidelines for surveillance activities moving forward.
The meeting will include WHO Geneva, WHO SEARO, WHO Indonesia, RTI DC/Indonesia, Subdit, NTF, UI,
the Association for Parasitology, the Association of Entomology, and international experts in post-MDA
surveillance and vector control/monitoring. The first day will be a small group review of TAS results, with
a meeting planned with local stakeholders for the second and third days to present the results and
discuss post-MDA surveillance, and the fourth day dedicated to making a draft surveillance action plan
with a small group. ENVISION will support the four-day meeting in Jakarta.
TAS Training for PHOs and DHOs: In 2017, approximately 42 districts are planning to conduct TAS1 to
determine whether they are eligible to stop LF MDA. Districts to be trained come from the following
provinces: Bangka Belitung (5), Bengkulu (3), Jambi (3), Jawa Barat (1), Jawa Tengah (1), Kalimantan
Barat (1), Kalimantan Selatan (1), Kalimantan Tengah (2), Kalimantan Timur (3), Kalimantan Utara (1),
Lampung (1), Aceh (1), NTT (1), Papua (1), Papua Barat (1), Riau (7), Sulawesi Selatan (1), Sulawesi
Tengah (1), Sumatra Barat (2), Sumatra Selatan (1), and Sumatra Utara (4). The Subdit and PHOs are the
levels in the Indonesian health system responsible for conducting TAS. While most of the focal points at
the provincial level have been trained to conduct TAS in earlier fiscal years, there is often turnover of
provincial focal points and a need for refresher training (particularly for Bancrofti areas, which will need
to be trained on the filariasis test strip). In addition, districts that will be implementing TAS1 in 2017
must be trained on eligibility, planning, methodology, and interpretation of results in 2016. To help
PHOs and DHOs understand the purpose of the surveys and the process, a two-day training on TAS
methodology and how to use rapid tests will be conducted in one of the Brugia districts, modeled on the
WHO TAS training modules. A pre- and post-test will be used to evaluate the participants’ change in
knowledge after training. ENVISION will fund, organize, and co-facilitate with the MOH the training, to
be held in August 2016.
TAS Supervisor Training: The number of districts implementing post-MDA surveillance is growing each
year. With limited personnel at the central and PHO levels to supervise pre-TAS and TAS activities (as
has been done in the past), there is an increasing demand for new supervisors to be trained who can
assist the Subdit in conducting the large number of surveys each year. In FY16 ENVISION will support a
training in February 2016 with personnel from BTKL (regional laboratories in Kep Riau, Sumatra Selatan,
Sumatra Utara, Jakarta, Java Timur, DIY, Kalimantan Selatan, Sulawesi Selatan, Sulawesi Utara, and
Maluku) and NIHRD. These personnel will be trained as supervisors and will help conduct TAS activities
in 2016.
Table 6 shows planned assessments, by disease, for FY16.
ENVISION FY16 PY5 Indonesia Work Plan
26
Table 6. Planned disease-specific assessments for FY16, by disease
Disease No. of endemic
districts
No. of districts
planned for
DSA
Type of
assessment
Diagnostic method
(Indicator: Mf, ICT,
hematuria, etc.)
LF 243 15 TAS ICTs, Brugia Rapids
STH 514 2
STH impact
assessment (in
conjunction
with TAS)
Kato Katz
LF 243 8 Pre-TAS Mf
LF 243 4 Mini-TAS
reassessment ICTs
LF/STH 243/514 8 Coverage survey N/A
2) Maps
ENVISION FY16 PY5 Indonesia Work Plan
30
Appendix 1. FY16 Indonesia Work Plan Activities
National Program Implementation
Management Support
NTD Secretariat Support
Strategic Planning
NTD Plan of Action Printing and Shipping
TIPAC Update
BELKAGA 2015 LF/STH MDA Coordination Meeting with Provinces (National
and Provinces)
ENVISION 2015 LF/STH MDA Project Review and Planning Meeting
BELKAGA National Coordination Meetings
2016 LF/STH MDA District Coordination Meetings in 50 districts
2016 LF/STH MDA Health Center Coordination Meetings in 50 districts
Advocacy
STH-only MDA Provincial Advocacy/Coordination Meetings in 3 Provinces
National NTD Stakeholders Meeting
Supply Chain Management Meeting
MDA Advocacy Package Development
Social Mobilization
BELKAGA Launch
Airing PSAs for 2015 LF/STH MDA
Revising PSA for 2016 MDA
Airing PSAs for 2016 LF/STH MDA
Printing and Shipping of 2016 LF/STH IEC Materials to 50 districts
Capacity Development for Integrated NTD Control (training and systems
strengthening)
NTD Partner Team Building
NGO Training
ENVISION FY16 PY5 Indonesia Work Plan
31
2016 LF/STH MDA Health Center Staff Training
2016 LF/STH MDA Cadre Training
Mapping
N/A
Drug Logistics and Supply Chain management
Shipping of Drugs for LF/STH MDA to 50 districts
Registration
Population Registration for 2016 LF/STH MDA in 50 districts
Drug distribution
2015 LF/STH MDA in 50 districts
2016 LF/STH MDA in 50 districts
MDA Supervision
Supervisory Visits by MOH and NGO Staff for 2015 LF/STH MDA
Supervisory Visits by MOH and NGO Staff for 2016 LF/STH MDA
Coverage Supervisory Tool Implementation (2 districts)
Short-Term Technical Assistance
Consultant to Provide On-the-Job Training for the 2 TAS/STH Integrated
Assessments
Experts to Attend TAS and Post-MDA Surveillance Meeting
Consultant to Help Supervise MDA and M&E Activities
Consultant to Supervise DQA
Consultant to Develop MDA Advocacy Package
Improved M&E for NTD Program Activities
Integrated NTD Database Support
DQA in 2 Districts
TAS in 15 Districts
STH Assessments in 2 Districts (Integrated with TAS)
LF PreTAS Sentinel and Spot-Check Site Surveys in 8 Districts
ENVISION FY16 PY5 Indonesia Work Plan
32
2015 LF/STH MDA Coverage Surveys in 8 districts
Mini-TAS Reassessment Surveys in 4 districts
TAS and Post-MDA Surveillance Expert Meeting
TAS Training for PHOs and DHOs
TAS Supervisor Training
ENVISION FY16 PY5 Indonesia Work Plan
33
Appendix 2. Table of USAID-supported Provinces and Districts
LF/STH MDA
(round 6)
LF/STH MDA
(round 5)
LF/STH MDA
(round 4)
LF/STH MDA (round 2)
LF/STH MDA
(round 1)
Disease Specific Assessments Disease Specific
Assessments
(continued)
Bengkulu
1. Bengkulu
Utara
Kalimantan
Utara
2. Nunukan
Kalimantan
Timur
3. Kutai Barat
Sulawesi
Tenggara
4. Kolaka
5. Kolaka
Timur
NTT
6. Ende
Papua
7. Supiori
Sumatra Utara
1. Gunung Sitoli
Riau
2. Indragiri Hulu
3. Indragiri Hilir
4. Rokan Hilir
5. Bengkalis
6. Siak
7. Kep Meranti
Kep Riau
8. Kota Batam
Jambi
9. Tanjung Jabung
Timur
10. Batang Hari
11. Merangin
Sumatra Selatan
12. Banyuasin
Bengkulu
13. Bengkulu Selatan
14. Muko-muko
Lampung
15. Lampung Timur
Kalimantan Timur
16. Mahakam Hulu
Riau
1. Kampar
Kep Riau
2. Lingga
Sumatra Selatan
3. Muara Enim
4. PALI
5. OKI
6. Musi Banyuasin
Bengkulu
7. Kaur
8. Seluma
Jawa Barat
9. Tasikmalaya
Sumatra Barat
10. Kota Sawahlunto
11. Sijunjung
Aceh
1. Aceh Barat
2. Aceh Besar
3. Aceh Utara
4. Bireuen
Sumatra Barat
5. Pasaman Barat
Sumatra Selatan
6. Musi Rawas
7. Ogan Komering
Ulu
8. Ogan Komering
Ulu Timur
Sumatra Utara
9. Batubara
10. Serdang
Bedagai
11. Tapanuli
Selatan
Aceh
1. Aceh Timur
2. Kota Banda
Aceh*
3. Kota Sabang
4. Nagan Raya
Sumatra Selatan
5. Lahat
* If remapping
results show
endemicity.
Pre-TAS SS/SC Assessments
Aceh
1. Aceh Jaya
2. Pidie
Jawa Barat
3. Subang
Kalimantan Barat
4. Melawi
Maluku Utara
5. Kote Tidore Kepulauan
Riau
6. Kuantan Singingi
Sulawesi Tengah
7. Donggala
Sumatra Barat
8. Pasaman Barat
TAS and STH Assessments
Maluku Utara
1. Kota Tidore (TAS1 + STH
Assessment)
Papua
2. Mappi (TAS1)
3. Merauke (TAS2)
Riau
4. Kuantan Singingi( TAS1 + STH
Assessment)
5. Pelalawan (TAS2)
Sulawesi Barat
6. Poliwali Mandar (TAS2)
Sulawesi Tengah
7. Parigi Moutong (TAS2)
Sulawesi Tenggara
8. Kolaka Utara (TAS3)
9. Bombana (TAS3)
Sumatra Barat
10. Agam (TAS1)
11. Bukit Tinggi (TAS1)
Sumatra Utara
12. Labuhan Batu (TAS2)
Mini TAS
Aceh
1. Kota Banda Aceh
Kepulauan Riau
2. Karimun
Kalimantan Timur
3. Kota Balikpapan
DKI Jakarta
4. Jakarta Selatan
DQA
Jawa Barat
1. Karawang
Kalimantan Selatan
2. Barito Kuala
Coverage Surveys
Aceh
1. Aceh Barat
2. Aceh Utara
3. Bireuen
Sumatra Selatan
4. Musi Rawas
5. Ogan Komering
Ulu
(OKU)
6. Ogan Komering
Ulu Timur
(OKUT)
Sumatra Utara
7. Batubara
8. Serdang Bedagai