NIGERIA Work Plan - ENVISION · DFID U.K. Department for ... to MITOSATH for interventions in Ekiti...

NIGERIA Work Plan FY 2017 Project Year 6 October 2016‒September 2017

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 United States Agency for International Development or the United States Government.

ENVISION FY17 PY6 Nigeria Work Plan i

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 the global and country levels and support Ministries of Health (MOHs) in achieving 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

disease mapping

NTD policy and technical guideline development

NTD monitoring and evaluation (M&E).

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

strategic annual and multi‐year planning

advocacy

social mobilization and health education

capacity strengthening

baseline disease mapping

preventive chemotherapy (PC) or mass drug administration (MDA)

drug and commodity supply management and procurement

program supervision

M&E, including disease‐specific assessments (DSAs) and surveillance.

In Nigeria, ENVISION project activities are implemented by The Carter Center and RTI International.

ENVISION FY17 PY6 Nigeria Work Plan ii

TABLE OF CONTENTS Page ENVISION Project Overview ........................................................................................................................... i

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

Country Overview (narrative format) ........................................................................................................... 1

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

a) Administrative Structure ............................................................................................................... 1

b) NTD Program Partners .................................................................................................................. 2

2) National NTD Program Overview ...................................................................................................... 5

a) Lymphatic Filariasis (LF) ................................................................................................................ 5

b) Onchocerciasis (OV) ...................................................................................................................... 6

c) Schistosomiasis (SCH).................................................................................................................... 7

d) Soil‐Transmitted Helminths (STH) ................................................................................................. 7

e) Trachoma ...................................................................................................................................... 8

3) Snapshot of NTD status in Nigeria (Table 2) ..................................................................................... 9

Planned Activities ........................................................................................................................................ 10

1) NTD Program Capacity Strengthening ............................................................................................ 10

a) Strategic Capacity Strengthening Approach ............................................................................... 10

b) Capacity Strengthening Interventions (Table 3) ......................................................................... 11

c) Monitoring Capacity Strengthening ............................................................................................ 12

2) Project Assistance ........................................................................................................................... 14

a) Strategic Planning ....................................................................................................................... 14

b) NTD Secretariat ........................................................................................................................... 16

c) Advocacy for Building a Sustainable National NTD Program ...................................................... 16

d) Social Mobilization to Enable NTD Program Activities ............................................................... 17

e) Training ....................................................................................................................................... 21

f) Mapping ...................................................................................................................................... 26

g) MDA Coverage and Challenges ................................................................................................... 26

h) Drug and Commodity Supply Management and Procurement .................................................. 31

i) Supervision .................................................................................................................................. 32

j) M&E ............................................................................................................................................ 33

3) Maps ............................................................................................................................................... 36

Appendix 1. Work Plan Timeline ................................................................................................................. 40

ENVISION FY17 PY6 Nigeria Work Plan iii

Appendix 2. Table of USAID‐supported Provinces/States and Districts ..................................................... 42

LIST OF TABLES

Table 1. NTD partners working in country, donor support, and summarized activities ............................... 2

Table 2. Snapshot of the expected status of the NTD program in Nigeria as of July 2016¹ ......................... 9

Table 3. Project assistance for capacity strengthening .............................................................................. 11

Table 4. Social mobilization/communication activities and materials checklist for NTD work planning ... 19

Table 5. Training targets ............................................................................................................................. 22

Table 6. USAID‐supported coverage results for FY15** and targets for FY17 ........................................... 31

Table 7. Planned DSAs for FY17 by disease................................................................................................. 35

ENVISION FY17 PY6 Nigeria Work Plan iv

ACRONYMS LIST

AE Adverse Event ALB Albendazole APOC African Programme for Onchocerciasis Control CBM Christian Blind Mission CDD Community Drug Distributor CIFF Children’s Investment Fund Foundation CRS Cross River State CS Community Supervisor CST Coverage Supervision Tool CY Calendar Year DFID U.K. Department for International Development DQA Data Quality Assessment DSA Disease‐Specific Assessment END Fund End Neglected Tropical Disease Fund EPIRF PC Epidemiological Data Reporting Form (WHO) EU Evaluation Unit FCT Federal Capital Territory FMOH Federal Ministry of Health FTS Filariasis Test Strip FY Fiscal Year HKI Helen Keller International IEC Information, Education, and Communication IU Implementation Unit IVM Ivermectin JAM Joint Application Matrix (WHO) JRF Joint Request Form (WHO) JRSM Joint Request for Selected PC Medicines (WHO) LF Lymphatic Filariasis LGA Local Government Area LIHT Local Government Integrated Health Team M&E Monitoring and Evaluation MDA Mass Drug Administration MEB Mebendazole Mf Microfilaraemia MITOSATH Mission To Save The Helpless MOE Ministry of Education MOH Ministry of Health NGDO Non‐Governmental Development Organization NOEC National Onchocerciasis Elimination Committee NTD Neglected Tropical Disease OV Onchocerciasis PC Preventive Chemotherapy

ENVISION FY17 PY6 Nigeria Work Plan v

PFSA Port Facility Security Assessment PZQ Praziquantel RAPLOA Rapid Assessment Procedure for Loiasis RPA Resident Program Advisor RTI RTI International SAC School‐Aged Children SAFE Surgery–Antibiotics–Face cleanliness–Environmental improvements SAE Serious Adverse Event SAR Semi‐annual Report SCH Schistosomiasis SCI Schistosomiasis Control Initiative SCM Supply Chain Management SIHT State Integrated Health Team SMO Social Mobilization Officer SMOH State Ministry of Health SOP Standard Operating Procedure STH Soil‐Transmitted Helminths SUBEB State Universal Basic Education Board TAC Technical Advisory Committee TAS Transmission Assessment Survey TEMF Trachoma Evaluation and Monitoring Form TF Trachomatous Inflammation–Follicular The Trust The Queen Elizabeth Diamond Jubilee Trust TIPAC Tool for Integrated Planning and Costing TIS Trachoma Impact Survey TOT Training of Trainers TSS Trachoma Surveillance TT Trachomatous Trichiasis TV Television UNICEF United Nations Children’s Fund USAID U.S. Agency for International Development WASH Water, Sanitation, and Hygiene WHO World Health Organization

ENVISION FY17 PY6 Nigeria Work Plan 1

COUNTRY OVERVIEW (NARRATIVE FORMAT)

1) General Country Background

a) Administrative Structure

Nigeria is the most populous African nation: Its population is currently estimated at 160 million people and is expected to reach 260 million by 2025. The country comprises six zones representing 36 states and a Federal Capital Territory (FCT). In total, there are 774 Local Government Areas (LGAs) that serve as the primary implementation units (IUs) for the neglected tropical disease (NTD) control and elimination program. ENVISION funding is currently focused in 10 states, with 9 supported through The Carter Center and 1 supported by RTI International (RTI). These 10 states receive project funding in 190 LGAs (The Carter Center: 172; RTI: 18).

The shift in 2007 to integrated programming for NTDs in Nigeria promoted more effective collaboration among partners to reduce the burden of disease and contribute to the achievement of the Sustainable Development Goals. The Federal Ministry of Health (FMOH) leads and coordinates the integrated control of NTDs in collaboration with non‐governmental development organizations (NGDOs), United Nations agencies, and other stakeholders, including the private sector. The FMOH is responsible for defining the criteria for partnership, expanding the partnership base, and streamlining partners’ activities to avoid duplication of efforts. The FMOH has also worked to ensure that all partners modify their existing mandate from vertical approaches to integrated approaches, particularly for interventions focused on co‐existing diseases. The State Ministries of Health (SMOHs) are responsible for establishing state NTD Steering Committees who, in turn, appoint state‐level NTD focal managers. The SMOHs also ensure that policies and guidelines are being adapted and implemented to meet local needs in the LGAs. These committees ensure that sufficient technical and supportive supervision is provided so that NTD activities are integrated into state and LGA health facilities.

The LGA is the IU of the National NTD Program. Within each LGA, NTD focal points supervise front line health facilities and community‐level activities, mobilize resources, ensure the prompt release of counterpart funds for NTD intervention implementation, and are responsible for general disease surveillance and health system response. These functions are complemented by Education Secretaries who essentially direct all school‐based, NTD‐related activities and provide supervisory oversight for the teachers in schools across each LGA.

The comprehensiveness of service delivery and reporting of all NTD activities at the LGA level hinges mainly on the coordinated and collaborative relationship between the Education Secretary and the NTD Coordinator of the LGA. This dual coordination is expressed at the lowest level of operations in the schools or communities. Teachers essentially play the same role as community drug distributors (CDDs); indeed, both are responsible for operationalizing all interventions at the grass roots level to ensure impact. The teachers support all the activities relating to mobilizing school‐aged children (SAC) for school‐based deworming; water, sanitation, and hygiene (WASH) education; and data reporting from the schools to the Education Secretary. At the community level, the CDDs, who are selected and maintained through varied resource support by the community, ensure that all mobilization, medicine distribution, and primary data generation and reporting to the health facility are conducted in a timely manner. These foot soldiers are highly critical to intervention activities, and without them, program delivery would not be possible.


b) NTD Program Partners

Major donors for NTDs in Nigeria include the U.S. Agency for International Development (USAID), the U.K. Department for International Development (DFID), and the Children’s Investment Fund Foundation (CIFF). USAID funding for NTDs is contributed through the ENVISION project, which has provided assistance to Nigeria’s NTD Program at the federal and state levels. Since January 2013, RTI has directly deployed resources to the FMOH to boost the capacity of the state and federal cadres in various aspects of NTD program management, including work planning and costing, the establishment of the integrated NTD Database at the national and state levels, strategic planning, monitoring and evaluation (M&E), reporting and data management, training modalities, and general technical guidance roles for the National NTD Program. At the state level, The Carter Center has led the ENVISION project’s support in nine states (Abia, Anambra, Delta, Ebonyi, Edo, Enugu, Imo, Nasarawa, and Plateau) for mapping, MDA, and M&E since 2013. Additionally, in fiscal year 2016 (FY16), RTI expanded the project’s support into Cross River State, leveraging additional support from Evidence Action, starting in April 2016, to provide funding and technical support for deworming in schools.

Nigeria has a strong coalition of NGDOs providing technical and capacity building support to the FMOH to control NTDs. RTI, Sightsavers, Christian Blind Mission (CBM) International, Health and Development Support, Helen Keller International (HKI), The Carter Center, and Mission To Save The Helpless (MITOSATH) are the major NTD‐focused NGDOs in the country and draw their funding from various donors. During FY16, the End Neglected Tropical Disease Fund (END Fund) provided additional resources to MITOSATH for interventions in Ekiti and Ondo States and to the Amen Health Foundation working in Gombe State, with additional resources also extended to HKI to support some LGAs in Akwa Ibom State and full support in Borno and Adamawa States. These NGDOs meet twice a year—prior to the National Steering Committee meetings—with the FMOH, SMOHs, and each other to facilitate coordination. Additionally, overlap and duplication of efforts are prevented because each NGDO provides support to specific states. The distribution and roles of these partners across Nigeria are highlighted in Table 1.

Table 1. 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?

Health and Development Support of CBM

Jigawa, Kano, and Yobe States and FCT

Direct support to SMOHs for surveys, MDA interventions, capacity building, and M&E for five PC diseases. DfID’s UNITED project, led by Sightsavers began providing support to Kano State through CBM in October 2014.

No Yes, UNITED in Kano State

HKI Adamawa, Akwa Ibom, Borno, and Katsina States

Direct support to SMOHs for surveys, MDA interventions, capacity building, and M&E for five PC diseases. The Queen Elizabeth Diamond Jubilee Trust (The Trust) has supported trachomatous trichiasis (TT) surgery in Katsina

No

Yes, The Trust and UNITED in Katsina State and END Fund in Borno, Adamawa and Akwa Ibom States.


Partner Location


Is USAID providing


partner?



since September 2013, and UNITED support began in Katsina State in October 2014.

Sightsavers Kebbi, Kogi, Kwara, Kaduna, Sokoto, and Zamfara States

UNITED Project lead and direct support to SMOHs for surveys, MDA interventions, capacity building, and M&E for five PC diseases. UNITED has focused on Zamfara State since September 2013.

No Yes, UNITED in Zamfara State

MITOSATH Ekiti, Lagos Niger, Ondo, and Taraba states

Direct support to SMOHs in some LGAs of these states for surveys, MDA interventions, capacity building, and M&E for five PC diseases. The three‐year period of UNITED support to Niger State commenced in May 2015.

No

Yes, UNITED in Niger State and the END Fund in Ekiti and Ondo States.

RTI FMOH, Zonal Offices, and SMOHs, including in Cross River State

ENVISION Project lead. Capacity Building Initiatives, including training and implementation of the Tool for Integrated Planning and Costing (TIPAC), data quality assessments (DQAs), World Health Organization (WHO) Integrated NTD Databases, and WHO Integrated NTD Program Managers Training. Also, support to the FMOH to coordinate major NTD meetings and technical workshops, such as the Annual Review meeting, Zonal Mid‐year Review Meetings, and Steering Committee meetings. Support to the FMOH in developing the Disease and Program Work Book for effective data consolidation and use.

Yes

Yes, all partners collaborate by supporting the needs of the states in which they are present.

The Carter Center

Abia, Anambra, Delta, Ebonyi, Edo, Enugu, Imo Nasarawa and Plateau States

ENVISION‐supported MDA: LF MDA in 111 LGAs; STH MDA Round 1 in 146 LGAs and Round 2 in 37 LGAs; OV MDA (annual round) in 12 LGAs; and SCH MDA in 78 LGAs. Also,

Yes Yes1,2

1 Izumi Foundation, which also supports SCH MDA in the South and South‐East, will target 54 LGAs in FY17. 2 Sir Emeka Offor Foundation: Direct support through The Carter Center for surveys, MDA interventions, capacity building, meetings, and M&E for non‐ENVISION supported OV activities in Abia, Anambra, Delta, Ebonyi, Edo, Enugu, and Imo States and some funding in ENVISION‐supported OV activities in Nasarawa and Plateau States.


Partner Location


Is USAID providing


partner?



support for sensitization meetings and MDA trainings.

Sightcare Two LGAs in Oyo State

Direct support to the local government for surveys, MDA interventions, capacity building, and M&E for five PC diseases in two LGAs.

No Yes, UNICEF support to the state MOH

Amen Health Foundation

Gombe State Direct support to SMOH for surveys, MDA interventions, capacity building, and M&E for five PC diseases.

No. END Fund


2) National NTD Program Overview

a) Lymphatic Filariasis (LF)

Nigeria ranks third in the world for its LF disease burden, with approximately 123 million people currently at risk. Mapping for the disease is nearly complete, except in 13 LGAs in Borno State because of security concerns. Overall, 75% (574/774) of the LGAs in the country are LF endemic, and out of these 574 endemic LGAs, 30 (5%) have stopped MDA. The Nigeria NTD Master Plan, in accordance with the Global Alliance for the Elimination of Lymphatic Filariasis and WHO, set 2020 as the target date to eliminate LF. A minimum of five effective years of MDA with good coverage (>65%) is required before pre‐transmission assessment surveys (pre‐TAS) can be performed. Including both ENVISION and non‐ENVISION supported States, 122 LGAs have conducted one round, 158 LGAs have conducted two rounds, 17 LGAs have conducted three rounds, 23 LGAs have conducted four rounds, 94 LGAs have conducted five rounds, 35 LGAs have conducted six rounds, 7 LGAs have conducted seven rounds, and 2 LGAs have conducted eight rounds. In FY17, through ENVISION, The Carter Center and RTI will be supporting MDA activities in 121 (21.0%) of the 574 endemic LGAs, not including the 30 LGAs of Nasarawa and Plateau States that have stopped treatment since 2012. In collaboration with the FMOH, The Carter Center has successfully completed five years of MDA in Plateau (17 LGAs) and Nasarawa (13 LGAs) States, impact assessment at selected sentinel sites, and TAS. Additionally LF treatment in 30 LGAs was ceased after they successfully passed their TASs. Post‐treatment surveillance is not yet implemented in any of the LGAs of Plateau and Nasarawa States and is not planned for any of the states that will meet the elimination criteria in the immediate future. Achieving the scale‐up needed to address the remaining 409 LGAs faces many challenges, including dependency on the OV community‐directed treatment with IVM platform to conduct MDA. However, OV is not co‐endemic with LF in many LGAs, particularly in the north, and the community‐directed treatment with IVM platform does not address urban areas. According to the FMOH, as much as 40% of the population targeted as the ultimate treatment goal for LF currently resides in these urban areas.

In 2016, the FMOH determined that LF evaluation units (EUs) should be based on senatorial districts, with one sentinel site selected per district. Sentinel sites will be used to establish baselines by assessing microfilaria rates at each site and monitored before the first, fourth (optional), and sixth MDA rounds. The indicators to be monitored are microfilaraemia (Mf; assessed using blood smear microscopy) or antigenemia (assessed using immunochromatographic cards) or filariasis test strips (FTSs). Blood samples for both are obtained via finger prick. For LF pre‐TAS guidelines, the target is less than 2% antigenemia (immunochromatographic cards or FTSs) or less than 1% Mf to qualify a district for TAS. Sample sizes are expected to be approximately 300 persons.

In general, the scale‐up of LF treatment has been slow in Nigeria because of the risk of Loa loa‐related serious adverse events (SAEs) in IVM‐naïve areas. Nigeria currently endorses the Rapid Assessment Procedure for Loiasis (RAPLOA) as a tool to determine which LGAs are at risk. For this assessment, field teams interview people in randomly selected communities using a questionnaire to determine the history of L. loa infection in the area. In coordination with STH/SCH surveys, ENVISION supported wide‐scale RAPLOA mapping in IVM‐naïve areas in the nine USAID‐supported states in 2013. This was the first large‐scale implementation of the RAPLOA tool in Nigeria. Only 10 LGAs in Delta and Imo States collected more than 40% positive responses on the RAPLOA questionnaire (the level at which IVM should not be administered). There are two points worth mentioning: first, because the RAPLOA is subjective and open to error, that both The Carter Center and the L. loa Working Group have opted to


take more conservative threshold of 20% and 1% respectively. Second, that a study is currently being conducted to determine if, despite the results of the RAPLOA, the intensity of Loa loa infections in Nigeria are too low to cause adverse events and ivermectin can be safely distributed . Although this finding does not change the number of LGAs and states to be covered, the treatment strategy can be tailored based on the prevalence level and co‐endemicity of each LGA and, thus, their drug combination requirements and quantification. In areas where L. loa has been determined to be a threat, the WHO NTD Strategic Technical and Advisory Group decided in 2013 to recommend albendazole (ALB) monotherapy for LF once or twice a year. In addition to long‐lasting insecticidal bed net distribution and health education, this strategy is expected to facilitate achieving the 2020 LF elimination goals in L. loa‐endemic areas. The FMOH implemented this strategy for the first time in FY15 with support from ENVISION through The Carter Center. WHO provided assistance to the FMOH to conduct RAPLOA mapping in almost all states in the southern part of the country. Thus, the RAPLOA mapping needs of the country were met while enabling IVM‐MDA to occur where appropriate.

b) Onchocerciasis (OV)

WHO estimates that Nigeria has the highest at‐risk population for OV in the world, with approximately 27 million persons at‐risk in more than 36,000 communities in 32 states. OV is prevalent in all states in Nigeria except Lagos, Katsina, Bayelsa, and Rivers. Additionally, until recently, it was a major cause of blindness in many rural communities across the nation. OV is currently the most developed NTD program in Nigeria, largely because of the over 20 years of assistance provided by the former African Programme for Onchocerciasis Control (APOC) and other partners, including The Carter Center. The work against this disease constitutes an impressive demonstration of Nigeria’s capacity to provide national‐scale MDA. The percentage of the annual intervention goal achieved since 2012 is relatively robust, especially when compared with that of the newer LF program. In 2015, the FMOH adopted the WHO recommendation and redirected its focus from control to elimination by the year 2025. OV elimination in Nigeria is defined according to the following WHO‐APOC Onchocerciasis Framework: 3

Interventions have reduced Onchocerca volvulus infection and transmission below the point at which the parasite population is believed to be irreversibly moving toward extinction.

Interventions have been stopped.

Post‐intervention surveillance for an appropriate period has demonstrated no recrudescence of transmission to a level suggesting recovery of the O. volvulus population.

Additional surveillance remains necessary for the timely detection of recurrent infection.

At the National program Steering Committee meeting in September 2014, the formal adoption of a bi‐annual treatment strategy in hypoendemic areas was discussed, as well as areas that are playing “catch up” because of the recent determination of high OV prevalence or missed MDA rounds, and areas that have good MDA coverage but poor impact.. A technical working group drawn from national and international experts met late in 2014 to integrate the OV elimination guidelines into Nigeria’s NTD Master Plan and review LGAs regarding the need for bi‐annual treatment on a case‐by‐case basis. Consequently, the Minister of Health launched the National Onchocerciasis Elimination Committee (NOEC) on May 22, 2015, with a specific mandate to work toward eliminating OV in Nigeria. This committee has been meeting ever since and has mapped out the responses to such programmatic

3 WHO‐APOC. 2010. Conceptual and operational framework of onchocerciasis elimination with Ivermectin treatment. Retrieved from http://www.who.int/apoc/Oncho_elimination_report_english.pdf


requirements as the delineation of OV‐endemic LGAs and establishing the criteria for identifying LGAs requiring twice‐a‐year treatment and those that can stop MDA.

c) Schistosomiasis (SCH)

In conjunction with the STH mapping initiatives mentioned below, SCH has been mapped throughout the country, except in 50 LGAs in Yobe, Adamawa, and Borno states. The National Master Plan supports the SCH MDA control strategy that calls for the treatment of SAC and high‐risk groups with varying treatment intervals depending on prevalence. Additionally, a school‐based treatment program has been adopted, with non‐enrolled SAC being captured in the school treatment through community mobilization or targeted during community‐level MDA. In Nigeria, large‐scale resource development projects, including irrigation, fishing, and hydro‐electricity, have created ideal conditions for snail populations in endemic foci: Biomphalaria pfeifferi and Biomphalaria sudanica for Schistosoma mansoni and Bulinus abssynicus and B. africanus for S. hemotobium. Although the FMOH is willing to conduct vector control involving the application of molluscides, funding for this activity is currently unavailable.

Since August 2014, FY14, ENVISION has planned to assist the FMOH to develop a comprehensive STH/SCH strategic plan using the completed mapping results. However, because of the outstanding SCH mappings of 50 LGAs in three states (Yobe, Borno, and Adamawa) in the Northeast Zone resulting from insecurity, the National SCH Program has deferred this activity to FY17, when mapping is expected to be completed. Subsequently, the results could then be included in the overall national database. It should be noted that such comprehensive national data will enhance the use of this strategic plan to mobilize resources, integrate interventions, and strengthen partnerships with various sectors, such as agriculture, water and sanitation, and environmental management.

If requests for funding and drug donation quantities are realized, in conjunction with the completed data analysis, Nigeria will be on track to achieve 100% geographic coverage of the targeted communities by FY17.

d) Soil‐Transmitted Helminths (STH)

The STH control strategy stipulated in the National NTD Master Plan supports the use of mebendazole (MEB)/ALB treatment for SAC and high‐risk groups. It also stipulates the need for widespread health education and collaboration with other sectors, particularly the Federal Ministry of Education (MOE) and the Federal Ministry of Water Resources. Different mapping initiatives supported by ENVISION, DFID, and CIFF have recently completed mapping for STH/SCH for the entire country, except for 50 LGAs that are inaccessible because of security concerns in Yobe (2 LGAs), Adamawa (21 LGAs), and Borno (27 LGAs) States. As mentioned above, ENVISION supported the FMOH in mapping the remaining LGAs in Ondo and Cross River States for STH and SCH in FY14. The CIFF‐supported mapping report and those for Ondo and Cross River States were recently released in June 2015 and demonstrated that most of the country’s LGAs urgently need STH control interventions. Before FY15, no large‐scale STH control efforts had been conducted in Nigeria; indeed, only small initiatives with limited geographic and therapeutic coverage has been implemented up to that point. STH control continues to benefit primarily from its linkage to LF treatments and the integrated MDA approach, and as a result, a massive scale up targeting 7.5 million SACs was implemented and will result in high geographic and therapeutic coverage from FY16 onward. Because 74% of the LGAs in the country are endemic for LF, any effort to meet the 2020 LF elimination goals will have the ancillary benefit of addressing most of the STH in the country. Similarly, STH control will benefit from any co‐endemicity with trachoma because the “F” (hand washing in this case) and “E” (environmental improvements) components of trachoma’s Surgery–Antibiotics–


Face cleanliness–Environmental improvements (SAFE) strategy also address STH. The FMOH has sustained its vigorous engagement of the WASH stakeholders through its WASH Stakeholders’ Forum. This forum is linked to the national NTD Steering Committee’s call for WASH stakeholders to ensure that their participation in helping to support efforts to eliminate NTDs is visible.

e) Trachoma

Nigeria’s elimination goal for blinding trachoma continues to be 2020, although current levels of funding from the FMOH and partners appear insufficient to achieve this aim. During 2016, 45% (50/112) of Nigeria’s endemic LGAs were targeted for annual MDA. Numerous LGAs have trachomatous inflammation–follicular (TF) prevalence exceeding 30%, requiring a minimum of five years of treatment.

The effort to scale‐up MDA since 2010 has resulted in the completion of three successive annual rounds of treatment (coverage >80%) through ENVISION support of The Carter Center to use Pfizer‐donated Zithromax® in Plateau, Nasarawa, and Kebbi States by 2012 and an additional nine LGAs in three other states (Jigawa, Zamfara, and Sokoto) by 2014. The DFID‐funded Global Trachoma Mapping Project started in 12 states in Nigeria in February 2013. In coordination with this initiative, ENVISION provided resources, including training, participants’ travel and per diem, tools, and consultant fees for trachoma mapping in Ebonyi, Enugu, Anambra, and Edo states through The Carter Center. Although the FMOH was concerned that these areas were endemic for trachoma given their proximity to the Nigeria’s “trachoma belt”, none were assessed to have TF ≥5%. ENVISION provided resources to the FMOH in FY16 to conduct a trachoma impact assessment in the one outstanding LGA—Wase—in Plateau State, which was omitted in FY14 because of security issues. The survey results show that Wase LGA has a TF prevalence <5% and will require a trachoma surveillance survey (TSS) to be conducted in FY18.

Plateau and Nasarawa States have now completed trachoma impact surveys (TISs) in all LGAs and have since stopped MDA; the first post‐treatment surveillance surveys were initiated in FY16 using the WHO Tropical Data system in the six LGAs of Plateau and Nasarawa States. The results of this survey demonstrated that the sustained control of trachoma in Plateau and Nasarawa States is a feat attainable by all other endemic states in the country and underlines the need for a strong WASH component to provide the ‘F’ and ‘E’ components that will consolidate the gains of this successful intervention.

Earlier mapping results showed that some LGAs in Ebonyi and Edo States have TF prevalence of 5%‒10%. Because these LGAs share borders with the then‐unmapped states of Benue, Kwara, and Kogi, all three were mapped by the Global Trachoma Mapping Project in July 2014. In FY17, it is expected that the FMOH will conclude trachoma mapping in the outstanding 48 LGAs in Borno and Adamawa States with support from Sightsavers.

In August 2013, ENVISION supported the FMOH to create a Trachoma Action Plan to organize all of the data collected during mapping to help inform a strategy to achieve trachoma elimination by 2020. With support from WHO and The Trust, the FMOH is now addressing the estimated backlog of 291,615 trichiasis cases with the goal of achieving the ultimate intervention goals relating to the surgical backlog in all states by 2018. Since 2014, 97 LGAs in 7 out of 15 states are currently covered with the TT surgical intervention, and 8,210 and 11,411 surgeries were performed in 2014 and 2015, respectively. ENVISION will support the FMOH to quantify and forecast its drug needs up to 2018 through its drug application request to the International Trachoma Initiative.

The provision of all elements of the SAFE strategy in Nigeria, specifically TT surgeries, water, and sanitation, is daunting. Against this backdrop, the FMOH is making renewed efforts to engage and strengthen collaboration with the WASH sector to mainstream its mandate in the NTD‐related


implementation areas. In so doing, this integration will help to sustain the gains of PC interventions, which have been the mainstay of the National NTD Program.

3) Snapshot of NTD status in Nigeria (Table 2)

Table 2. Snapshot of the expected status of the NTD program in Nigeria as of July 2016¹

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 Nigeria

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 June 30,

2016

No. of districts expected to be in need of MDA at any level: MDA not yet started or

prematurely stopped as of September 30,

2015

Expected no. of districts where criteria for stopping

district‐level MDA have been

met as of September 30,

2015

No. of districts requiring DSA

as of September 30,

2015 USAID‐ funded

Others

LF

774

574 187 13 121 458 290 30

TAS3: 26 Pre‐TAS: 1

OV 473 301 0 27 303 143 0 12

SCH 615 109 50 87 280 248 0 48

STH

431 293 50 164 267 0 0 0

Trachoma 115² 611 48 0 47 42 26 8

¹The table reflects the best information known for the entire country, including states that are not currently captured in ENVISION workbooks ²Information on the status of all 115 LGAs is still being collected by the FMOH. # LGAs ≥ 10% TF; # LGAs 5‐9.9% TF 3ENVISION workbooks will reflect all 774 LGAs, which includes non‐ENVISION supported States, by October 29th 2016.


PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

During the past four years, ENVISION and national‐level managers have carefully monitored the capacity and needs of the NTD program using the results from DQAs, TIPAC, and other M&E tools to highlight operational and technical gaps. In FY17 ENVISION will leverage previous investments and promote data ownership and use by Federal, State, and LGAs by facilitating opportunities for data use and analysis with the integrated NTD Data base as well as other key M&E tools that improve drug supply management and the quality of supervision. In FY17, this approach will include:

1. Provide updated technical materials and on the job training to key FMOH, SMOH, and LGA officials through seconded Zonal Coordinators and/or ENVISION country staff. Data‐driven decision making will be reinforced by exposing NTD focal points to the principals and protocols described in the Data Action Planning Guide and the IEC and Social Mobilization for NTDs Guide. Where appropriate, States will be encouraged to produce monthly reports from the integrated NTD database on key indicators to demonstrate data use. SMOHs will also be requested to review the IEC and Social Mobilization Guide and use provided templates to demonstrate the alignment of communication strategies with reasons for low coverage in specific geographic areas.

2. Provide Communiques and Recommendations from technical reports to influence policies and procedures for monitoring and improving drug supply management. This will include the provision of guidelines on supply chain management, deployment of the standard operating procedures (SOPs) for Drug Management up to Health Facility Levels, and following‐up on recommendations proposed during the Supply Chain Management (SCM) workshop which will be disseminated as part of cascade trainings.

3. Introducing supportive supervisory approaches and tools to ensure higher drug coverage rates. This includes the introduction of supervisory monitoring forms, MDA Best Practices Guide, and the expanded introduction of the Coverage Supervision Tool (CST) during cascading trainings.

These approaches are expected to extend beyond the USAID‐assisted states to reach all six geopolitical zones through the leadership and uptake of the FMOH and dissemination to other states. Overall, the national program has benefited immensely from the deployment of systematic and uniformed program approaches that can be generally and effectively utilized to manage the program across the country.


b) Capacity Strengthening Interventions (Table 3)

Table 3. Project assistance for capacity strengthening

Project assistance

area Capacity strengthening interventions/activities

How these activities will help to correct needs identified in situation above

Strategic planning

a. Introduce and facilitate the use of the Data

Action Planning Guide by the FMOH and Zonal Coordinators as an integral part of strategic meetings and trainings provided to the state and LGA levels

b. Completion of IEC and Social Mobilization Guide by each State requesting ENVISION support for the production of information, education, and communication (IEC) materials (flipcharts, posters, flyers).

d. Strengthen Feed‐back mechanism to lower level for Program intervention outcome and share NTD Integrated Database at the lower (Regional and District and Health Facility) levels.

improvement in the timeliness and quality of data reported, including access and use of that data at lower levels

Provide uniform indicators across the country

ensure that the FMOH is sharing the results and analysis from the integrated NTD database

Ensure the consistent update of the National database for the eventual preparation of elimination dossiers

Provide Feedback system mechanism to lower levels

Strengthen capacity of personnel at lower level to own, manage and maintain and make decisions using their level of Program data.

Enable regions to store and track their own data to make evidence‐based decisions.

e. Training (please see the Training section for specific Training activities.)


Project assistance

area Capacity strengthening interventions/activities

How these activities will help to correct needs identified in situation above

Drug supply management & procurement

a. facilitate FMOH communication to states and LGAs about Commodity Management Tools and Guidelines/SOPs; includes timeline and expectations for the preparation, submission, and monitoring of the Joint Application Package (JAP) and Trachoma Evaluation and Monitoring Form (TEMF) to ensure earlier submission

b. encourage “viewing parties” of the JAP webinar at various levels

c. Follow‐up on preliminary recommendations from MSH Nigeria NTD SCM Workshop

d. coach on the use of SCM tools and protocols at state and LGA levels through cascade trainings

Improvement in drug supply management, including addressing chronic problems with drug forecasting

Will create a linkage and common understanding between the Port Facility Security Assessment (PFSA), FMOH and Implementing partners

Provide Training on SCM to lower levels;

Produce and disseminate to lower levels SOPs and LMIS documents

Provide training on Use of Guidelines/SOPs and compliance.

Supervision

a. introduce FMOH and Zonal Coordinators to supervisory monitoring forms, MDA Best Practices Guide, and CST methodology to be part of the “curriculum” used on cascading trainings

b. standardize supervisory tools and protocols for quality supervision that can be used during supervisory visits

c. provide uniform indicators to state and LGA supervisors to ensure that issues of coverage are critically assessed and linked to Communication strategies

improvement in the quality of supervision, including the ability to identify and immediately address factors that could negatively affect coverage rates

• Ensure that supervisors are

provided with data outputs to inform supervisory visits

Continuous Training of Personnel at supervisory levels on the use of Checklist at lower levels;

Provide checklist in appropriate number for use at supervisory/lower levels.

Strengthen capacity on use of Coverage Survey Tools;

Provide Coverage Survey Tools; Support conduct of Coverage Survey to

inform program improvement.

c) Monitoring Capacity Strengthening

ENVISION will continue to interact with the National NTD team to regularly assess the impact of capacity building efforts at the state and LGA levels. These interactions will occur through zonal reviews, quarterly and Annual Review meetings, and state‐level trainings during which the timing and availability of drugs to target populations will be assessed, key indicators of project success will be reported by supervisors at the state and LGA levels, the availability of technical protocols and tools will be determined, and the progress toward MDA coverage goals will be shared.

ENVISION will monitor the following indicators:


Strategic planning

Access to disease‐specific strategic and annual work plans during supervisory visits by State and LGA NTD Focal Points (Y/N)

Percent of LGAs with epidemiological coverage above recommended disease specific benchmarks

Information on current funding and funding gaps being fed into advocacy materials and actively disseminated

Drug supply management & procurement

Timely and high‐quality submission of JAP/TEMF. Drugs and diagnostics are estimated accurately and ordered on time (as determined by time of submission and number of error‐free {‐<3} submissions)

Joint Request for Selected PC Medicines (JRSM) generated using TIPAC

Joint Request Form (JRF) and PC Epidemiological Data Reporting Form (EPIRF) generated through the Integrated NTD Database

Timing (# of days) between when the drugs arrive in country and the planned start times for MDA campaigns in individual LGAs

Supervision

Monitoring the timing of MDAs within communities and schools and the appropriateness of distribution platform. Is population aware of MDA in advance?

Understanding key elements of successful MDA programs

Knowledge on key M&E indicators ‐ Number drug stock outs and % drug wastage

Knowledge on how to manage SAEs. In case of SAEs, appropriate parties were notified in timely manner

Number and percent of all of persons trained and provided with required follow‐up support, by job type and topic (e.g. support to enter historical data in database, access to helpdesk for TAS or TIPAC) –


2) Project Assistance

a) Strategic Planning

Zonal mid‐year reviews: Nigeria is divided into six geopolitical zones, each of which represents a cluster of five‒six states. The FMOH has requested a three‐day zonal mid‐year review meeting to address NTD issues that are more directly pertinent to a particular zone. The aim of this meeting is to review the implementation status of the NTDs plan in relation to NTD Data Base and TIPAC contents, identify gaps in financial support, and suggest ways forward to overcome funding deficiencies. Presentations will also include a review of the data on treatment and the activities conducted and an assessment of the coordination among state Technical Advisory Committees (TACs) and implementing partners. It will also be used as an opportunity for the FMOH, ENVISION, and other implementing partners to evaluate the status and results of the Integrated NTD database (including areas of low coverage) and to address challenges with data reporting tools, training guides, protocols, SOPs, and supervisory checklists. ENVISION Nigeria’s Resident Program Advisor (RPA) and M&E Specialist attend these meetings to provide technical insight and guidance. ENVISION will support the three Zones currently receiving USAID funding, including lodging and meals for participants, per diem, and travel to the venue in the Zone. The last day will include SCM officers and Chairpersons of state TACs, who will share their experiences and review the results of operational research, SCM issues, and best practices in the management of state TACs.

Annual Review meeting: The Annual Review meeting draws together the FMOH, SMOHs, and implementing partners to assess the previous and current years’ activities. This meeting is a platform to review the implementation status of the national and state work plans; improve modalities for coordination at all levels of operation; review the status and results of the integrated NTD database, including areas of low coverage; plan modalities for effective data management at all levels; follow‐up on the status of recommendations from the last Annual Review meeting; identify remaining challenges; and plan a way forward for control and elimination activities nationwide. It is also a platform to distribute materials, announce any changes in protocol, and update state NTD Master Plans. ENVISION always participates in the Annual Review meeting to provide technical insights, identify implementation challenges, and provide recommendations in cases when ENVISION and WHO’s NTD tools may be useful. In FY17, ENVISION staff will work with the FMOH to synthesize data from the integrated NTD database using the Data Action Planning Guide, and these data will be presented during the Annual Review meeting. ENVISION has fully supported this event since FY13 and proposes continuing to support travel and per diem costs for participants from the FMOH and ENVISION‐supported states; other partners will support participants from their respective states and cover venue costs. This national meeting is attended by 160 persons.

ENVISION Program Review: The ENVISION Program Review and FY planning is scheduled to occur either before or after the Annual Review meeting and provide an opportunity to review ENVISION‐supported activities and decide on priority interventions for the following year in a data‐driven fashion. ENVISION will provide support for travel costs and meals for FMOH and Cross River State (SMOH) participants, as applicable. Participation by Carter Center staff is usually at their own cost.

State strategic planning meetings: In FY17, ENVISION will organize state‐level strategic planning meetings in each of the nine The Carter Center priority states (Abia, Anambra, Delta, Ebonyi, Edo, Enugu, Imo, Nasarawa, and Plateau) and Cross River State. In each state, the respective Directors of Public Health/Primary Health Care, Executive Secretary of State Primary Health Care Development Agency, LGA Directors of Primary Health Care, Local Government Chieftaincy Affairs Ministry, State


Integrated Health Teams (SIHTs), Local Government Integrated Health Teams (LIHTs), LGA Social Mobilization Officers (SMOs), and State Universal Basic Education Board (SUBEB) officials are expected to attend the meeting. In the 9 Carter Center supported states the total number of people involved includes participants from The Carter Center, Department of Primary Health Care, NTD Managers, SUBEB, LGA Departments of Primary Health Care, SMOs, SIHTs, LIHTs, and drivers. In Cross River State, RTI will support a Strategic Planning meeting as well as an annual review for state participants, including zonal office staff and supporting NGDOs. In preparation of these meeting micro‐planning meetings will be supported in Cross River State among the 18 LGAs. ENVISION partners will attend these meetings to provide technical guidance and identify implementation challenges for which ENVISION support and WHO NTD tools may be useful.

During the strategic planning and annual review meetings, ENVISION‐supported technical advisors from RTI and The Carter Center will do the following:

review state‐ and LGA‐specific annual work plans derived from State NTD Master Plans and present data from the Integrated NTD Database to frame work planning/strategic planning discussions

continue to hone disease‐specific target populations by LGA that were previously clarified by the community census conducted in FY15 and FY16 and discuss the effects of the TIPAC training on state planning and costing

outline MDA targets and approaches for LF and OV elimination and SCH and STH control in the context of scaling up and down treatment for LF

verify and finalize village listings, wards in semi‐urban/urban areas, and updates

review and update the drug algorithms and MDA strategies by LGA

discuss planning treatments in specific months to allow for better planning, particularly in twice‐per‐year areas

confirm strategic plans and timelines for FY17 implementation at the state and LGA levels

update state advocacy kits, health education materials, social mobilization strategy kits, and behavior change communication messages adapted to local languages that are evidence based and that are aligned with the priorities of the ENVISION project

plan for population‐based coverage surveys for the 2017 MDA in selected LGAs

review state five‐year strategic plans to synchronize with USAID’s support and timeline, including aligning NTD implementation timelines with the U.S. Government’s FY (October to September) using the TIPAC

review performance against MDA coverage targets, identify challenges/constraints, and offer solutions; where possible, review data at the sub‐LGA level to more precisely determine where low drug coverage might be a problem (see the MDA Challenges section)

discuss and incorporate results from the DQA into strategic planning discussions and planned activities, as appropriate.

Nigeria Onchocerciasis Elimination Committee Meeting: The NOEC meeting, which was inaugurated in 2015, has been held to provide clear directions regarding and focus on the disease elimination process in Nigeria. The NOEC is composed of national and international experts and is tasked with providing the FMOH with a road map to the nationwide interruption of OV transmission by 2020. This Committee will


continue its twice‐yearly meetings. Additionally, its sub‐committees will also meet because states will require support to conduct epidemiological and entomological assessments to obtain the information needed to re‐classify them according to their elimination status. In 2017, the Committee may recommend stopping treatment in five states.

Having a technical working group reporting to the Ministry of Health (MOH) on disease impact and related decision‐making (such as stopping treatment and initiating post‐treatment surveillance) has proved to be crucial to progress in other countries. In FY16, the NOEC met twice, and it plans to meet twice in FY17. This body represents an important step toward in‐country capacity building, allowing the country to take charge of its own OV agenda. During this meeting, The Carter Center will support 17 participants to attend each three‐day meeting with ENVISION and other donor funds, including covering the costs of venue rental, refreshments, per diem, transport, and materials.

Trachoma Action Plan/Production Meeting: The FY16 work plan had included funding for the production of a TAP document for dissemination to key stakeholders. This activity has been on hold because the committee responsible for finalizing the TAP has not convened to finalize the document. In order to move forward in finalizing and producing the TAP document the program would like to convene the committee members in the first quarter of FY17 to finalize the document.

b) NTD Secretariat

ENVISION provides basic transportation and communication support for the Head of Administration‐NTD FMOH and Zonal Program Manager which allows them to facilitate meetings between the MOH (according to zones) and the NTD Secretariat (bi‐annual meeting) and collaboration around NTD activities. These meetings help improve communication and manage immediate issues and challenges as they arise. Costs include transport to meetings and to the RTI office for meeting preparation as well as some telecommunication funds.

c) Advocacy for Building a Sustainable National NTD Program

State government leadership sensitization meetings: ENVISION’s support will target state‐level meetings with the governors of each of the nine USAID‐priority states, the governors’ executive councils, and other state‐level stakeholders, including SMOHs. Advocacy kits promoting the programs (developed during strategic planning) will be delivered to key officials, and data on the diseases and population affected will be presented. The goal of these meetings is to advocate for not just verbal or written commitments but for follow‐through by the government leadership to provide more financial support and buy‐in for NTD interventions. Success will be measured in terms of increased financial support. In general, state‐level contributions are collected each year and comparisons made with previous year’s contributions; often pre‐sensitization contributions are zero. Meetings will stress the expectation that ENVISION support will transition away from control diseases in areas where diseases targeted for elimination have stopped MDA and that the need for government financial support will be greater than ever. ENVISION will, as applicable, subsidize the venue and per diem costs for the participants. These meetings will comprise six attendees and last two days/state for each of the nine states managed by The Carter Center.

For Cross River State, ENVISION’s support will target the state governor and his Executive Council. This will be the first time that advocacy kits promoting the programs (developed during strategic planning) will be delivered and that data on the diseases and population affected will be presented.


LGA sensitization meetings: In the nine ENVISION‐supported states, The Carter Center and the MOH will undertake advocacy visits to the Association of Local Governments of Nigeria to inform LGA Chairmen and their Directors of NTD activities in their domain and solicit their support. The goal of these meetings is to follow‐through with the government leadership to provide more financial support and buy‐in for NTD interventions. The plan to follow‐up with officials on promises made will be emphasized. Where information is available, success will be measured in terms of the monetary value of support provided by LGAs in subsequent years. The meetings will stress the expectation that ENVISION support will transition away from control diseases in areas where diseases targeted for elimination have stopped MDA and that the need for government financial support will be greater than ever. In addition, The Carter Center and MOH staff will meet with Traditional Councils and other leadership groups to solicit their support in mobilizing endemic communities through LGA meetings, town hall meetings, village meetings, and meetings with special groups, such as women’s fellowship, internally displaced persons, and professional groups. ENVISION funds will cover per diem and fuel costs as needed. The Carter Center is also conducting OV sensitization meetings in the seven SS/SE States; however, these activities are covered through other donor funds.

The Cross River State (CRS) NTD Program will undertake advocacy visits to the Chairmen of Local Governments to inform and solicit support from the LGA Chairmen and their Directors and the leadership of the LGA Legislature of NTD in terms of financial commitments and programmatic collaboration and their support in mobilizing endemic communities. In addition, CRS and MOH staff will meet with Chiefs’ Traditional Councils to solicit their support for program ownership and community mobilization. These meetings will involve a team of two state staff across 13 LGAs over a period of four weeks and will be conducted through the following means:

LGA meetings

town hall meetings

village meetings

meetings with special groups, e.g., women’s fellowship, internally displaced persons, and professional groups

audio‐visual aids, including presentations, posters, flip charts, brochures, and handbills, as needed.

d) Social Mobilization to Enable NTD Program Activities

IEC and social mobilization strategy review for ENVISION: In FY17, ENVISION states will be requested to submit a completed form generated from the proposed ENVISION guidelines for assessing IEC and the social mobilization strategy. Where gaps in the data needed to inform the development of IEC materials are identified, additional information will be gathered via knowledge, attitudes, and practices surveys to assess the effectiveness of the current strategies for influencing MDA uptake. ENVISION will work closely with the M&E Team of the FMOH to gather all‐supported materials and assess the deployment of strategies, messaging, and MDA uptake. FMOH will share templates generated from the IEC and Social Mobilization Guide for NTDs, and request States to complete those forms for review before any additional materials are procured.


Production and delivery of IEC materials: Funding for the production and delivery of IEC materials, specifically flipcharts, will be dependent of the review and completion of the IEC and Social Mobilization for NTDs Guide. At the conclusion of the State level IEC materials and strategy review by the FMOH, the resulting recommendations will help standardize selection of regional‐level IEC materials of high quality and proven effectiveness for production, including delivery of materials, as appropriate. Some funds have been budgeted for the production of selected materials, and the types and quantities will be refined after the review is complete.

Dissemination of health messages: Social mobilization is a vital part of the activities required to prepare new populations that have never received MDA and reinvigorate communities that have participated in previous MDA campaigns. The goal of mobilization is to increase MDA participation and, thereby, increase overall MDA coverage. ENVISION funding for social mobilization primarily supports the dissemination of key health messages via radio and through IEC materials when appropriate. However, social mobilization is also conducted using a variety of activities and media with support from other funders and local support enlisted from youth associations, town unions, village/ward development committees, migrant populations, ethnic and religious groups, and other community stakeholders. Women’s groups are also utilized. Both Christian and Muslim groups have powerful and influential associations that are being used to mobilize and educate family members regarding health education and MDA activities. Additionally, these faith‐based organizations have been very influential in conducting behavior change communication through the deployment of key messages provided by the state programs to the faith‐based organization and which are then disseminate during their worship services. In the southeast, women’s groups hold annual meetings during August in every village and in churches. Therefore, for example, the program gives health talks and provides behavior change communication during this period, which has been helpful in supporting CDDs.

In FY17, ENVISION will support bilingual radio spots that will run before and during MDA activities in each of the nine The Carter Center ‐assisted states (Table 4). Radio messages will be broadcast twice a day in the nine states over a six‐month period in 2017. Radio spots are typically set to upbeat local music and include descriptions of the diseases in question, the purpose of treatment, and the name(s) of the drug(s) to be taken. Messages are recorded in the languages most relevant to each area. With ENVISION funding, The Carter Center will also enlist support from 712 town announcers, especially in some 4,000 hard‐to‐reach areas prior to the beginning of MDA to notify communities, news and print media, and community theater/dramas. Success will be measured in terms of treatment coverage and the results of coverage surveys, which will include questions regarding awareness about program activities to determine the success of the messages.

ENVISION will also support the Cross River State NTD Program in broadcasting radio messages twice a day across the state for the entire month of the MDA activities in FY17. Additionally, there will be a monthly airing of re‐enforcement radio jingles, which are recorded in the languages most relevant to each area, and additional funding will be provided to support the dissemination of key messages through television (TV) public service announcements. CRS will also deploy the use of speaker‐mounted mobile vans, town criers, news and print media, and community theater/dramas as part of Flag‐off events prior to MDA to notify communities and engage Opinion leaders, community/gate keepers, beneficiaries, and policy makers.


Table 4. Social mobilization/communication activities and materials checklist for NTD work planning

Category Key messages Target

population

IEC strategy (e.g.,

materials, medium,

and activity)

Where/when will they be distributed?

Frequency

Is there an indicator/mechanis

m to track this material/activity? If

yes, what?

Other comments

MDA Participation

Plateau and Nasarawa States: LF transmission has been interrupted and treatment halted. To prevent re‐infection, sleep under a bed net every night. Southeast: Take ALB and Mectizan® at least once a year to kill worms transmitted by the bite of infected mosquitoes and blackflies and to prevent lymphedema and hydrocele. ALB and Mectizan® are distributed free of charge by village health workers in villages, churches, and neighborhoods.

Endemic community members

Radio/stakeholders meeting

Local stations play twice per day for six months in 2017

Messages played twice per day, typically in the morning and evening

Two slots per day for six months out of a year of messages aired on radio during the reference period (radio broadcast reports) Two slots × 180 days × nine states = 3,240

Yes. It will bevalidated through coverage surveys/ongoing monitoring. Increase in % program and epi coverage (routine reporting forms and coverage surveys)

Cross River State MDA Participation

The drugs provided are free and safe and needed once a year.

Community members

Radio and Cross River TV

On a local station during all four weeks of the month of MDA, beginning two days before training and retraining and two weeks in advance of the OV/LF MDA campaign

Messages play twiceper day for the entire MDA week and in two slots per week per month all year round.–

# of times messages aired on the radio during the reference period (Radio broadcast reports)


Category Key messages Target

population

IEC strategy (e.g.,

materials, medium,

and activity)

Where/when will they be distributed?

Frequency

Is there an indicator/mechanis

m to track this material/activity? If

yes, what?

Other comments

Drugs handed out at school are safe and keep you healthy

SAC School song book/exercise books

Selected LGA /Community /School of choice

% of audience who recall message (coverage survey)

Other Promoting NTD Program visibility

Opinion leaders, community/gate keepers, beneficiaries, and policy makers.

Annual NTD MDA Week/Flag‐off event.

Selected LGA/Community/School of choice.

One week annually # of times messages aired on radio/TV during the reference period (Radio broadcast reports) % of audience who recall message (coverage survey, local/national omnibus survey)

Opinion Leaders, community/gate keepers, beneficiaries, and policy makers

Town announcers at religious and community events/speaker‐mounted vans, among others

Adaptable to local situations to maximize impact

One week annually


e) Training

Training and retraining of trainers (TOT and re‐TOT, respectively): TOTs supported by ENVISION target SIHTs, LIHTs, LGA SMOs, and health facility staff, and include modules that sensitize trainers on gender mainstreaming, particularly recruiting female CDDs and supervisors. In these annual TOTs, the content is designed to respond to any new issue on program strategy, lessons‐learnt from the previous year’s treatment that will improve service delivery and coverage; modules are included that sensitize trainers on gender “mainstreaming”, particularly recruiting female CDDs and supervisors. The Carter Center began tracking female involvement in drug distribution in 2001 (when the percentage of female CDDs was approximately 35%), and now, roughly 51% of CDDs and 52% of Community Supervisors (CSs) are women. In CRS, ENVISION supported re‐TOTs also target SIHTs, LIHTs, LGA SMOs, and health facility staff. The program retrains annually as the duties are complex and certain requirements change each year. Retraining is crucial to ensure supervisors are able to keep the CDDs on track. The 1 day re‐TOTs will include modules that also sensitize trainers on gender mainstreaming, particularly recruiting female community implementers and supervisors. CRS will track female involvement in drug distribution beginning in FY17 after determining the gender ratios of community implementers from FY16.

A total of 22 state staff and 988 health facility workers will be trained to roll out the FY17 treatment cycle in the CRS, and 6,089 health facility workers and 1,656 SIHTs/LIHTs will be trained in the nine Carter Center‐assisted states. ENVISION will support per diem, transportation, and refreshments.

MDA training for supervisors, teachers/health workers, and CDDs: Cascade trainings for MDA occur annually, typically a month or two prior to the first treatments of the year. Trainings are provided for both new and returning supervisors, teachers, health workers, and CDDs. This annual training ensures that skills are retained and that MDA coverage remains high. Training results are monitored by tracking the success of coverage and the timeliness of treatment activities. In areas that consistently report low treatment coverage, additional refresher training sessions will be provided and tailored to address the specific reasons for low coverage; this requires supervisors to use all available data, including reports from DQAs, coverage surveys, and knowledge, attitudes, and practices surveys to guide appropriate interventions to address low coverage in a given area.

In areas with high attrition of CDDs or difficult terrains or are classified as hard‐to‐reach areas, two‐day training sessions rather than just one‐day sessions are planned to account for both travel but the time needed for CDDs to absorb the materials and ask questions. ENVISION’s RPA and M&E Officer will spot check various trainings and provide supportive supervision and technical insight as needed. A total period of seven days will be spent by each of two officers spread across the training period in the respective states as required.

In the nine Carter Center‐assisted states, the number of people to be trained will include 10,370 CSs, 62,076 CDDs, and 11,195 teachers. ENVISION will support per diem, transportation, and refreshments. A total of 2,460 teachers and 14,950 CDDs will be trained in CRS to support FY17 treatments.


Zonal Cascade Training on SCM: The FMOH has requested support to roll out this cascade training in each of 6 geopolitical Zones. RTI ENVISION proposes to support the training in South‐East zone. Training is based on recommendations from the West Africa SCM Training meeting in Accra, Ghana to disseminate and train lower levels on SCM Standards of Practice and use of the Guidelines on NTD Programs.

Training of LGA Commodity Managers in Cross River State: The July‐August 2016 MDA in Cross River state was the first time the school and community based distributions were simultaneously conducted. To better prepare NTD logistics mangers at State and LGA level for the FY17 MDA schedule, the SMOH has requested support to provide and improve their skills on NTD Logistics Management in order to improve the coordination and timing of distributions over two different platforms (school and community) and to verify the accuracy of drug stock requirements.

Table 5. Training targets

Training groups

Training topics

No. to be trained No. of train‐ing days

Location of

trainings

Name of other funding partner

New Re‐

fresherTotal

Cross River State

SIHT/LIHT

integrated NTD overview

PC algorithm

MDA strategies

treatment: determining dosage with a pole

management of SAEs

social mobilization, health education, and advocacy skills

record keeping: data collection and use of FMOH NTD data capture tools

reporting

monitoring, supervision, and use of the supervisory checklist

TIPAC update

training on the new FMOH reporting forms.

0 22 22 1

LGA secretariat, hired function space

None


Training groups

Training topics


Location of

trainings


New Re‐

fresherTotal

CDDs/CS


key health education messages and

community mobilization with

use of flipchart for demonstration

drugs:

‐ what drugs to use ‐ dosage, including the use of dose

poles ‐ how to administer.

exclusion criteria

adverse event (AE) management and referral

MDA registration: census update

filling out village register and village summary forms


0 14,950 14,950 2 Health facility level, LGAs

None

Health workers, health facility staff


key health education messages with

use of flipchart for demonstration

MDA strategy

drugs:


poles

how to administer

exclusion criteria

AE management and referral

record keeping and reporting


0 988 988 2 MOH and LGA secretariat

None


Training groups

Training topics


Location of

trainings


New Re‐

fresherTotal

Teachers


Key health education messages and

community mobilization with use of

the flipchart for demonstration

drugs



Exclusion criteria


Filling out school register and school summary form

Training on the new FMOH reporting forms.

0 2,460 2,460 2 Various LGA function spaces

None

Nine Priority States

SIHT/LIHT

integrated NTD Overview

PC algorithm

MDA strategies

treatment: determining dosage with a pole

management of SAEs

social mobilization, health education, and advocacy skills

record keeping: data collection and use of FMOH NTD data capture tools

reporting

monitoring, supervision, and use of the supervisory checklist

TIPAC update.

0 1,656 1,656 1

LGA secretariat, hired function space

The Carter Center


Training groups

Training topics


Location of

trainings


New Re‐

fresherTotal

CDDs/ CS



community mobilization with the use

of flipcharts for demonstration

drugs



exclusion criteria


MDA registration: census update

filling out village register and village summary forms


5,338 (CDDs)

56,738 (CDDs)

10,370 (CSs)

62,076 (CDDs)

10,370(CSs)

2 Health facility level, LGAs

The Carter Center

Health workers, health facility staff


key health education messages, with

the use of flipcharts for

demonstration

MDA strategy

drugs



exclusion criteria


record keeping and reporting


0 6,089

6,089

2 MOH and LGA secretariat

The Carter Center

Teachers integrated NTD overview 2,696

8,499

11,195 2

Various LGA function spaces

The Carter Center


Training groups

Training topics


Location of

trainings


New Re‐

fresherTotal


community mobilization with the use

of flipcharts for demonstration

drugs:



exclusion criteria


filling out school register and school summary forms


f) Mapping

ENVISION‐supported baseline mapping is complete, and no other areas within the 10 USAID‐supported states require baseline prevalence determination.

g) MDA Coverage and Challenges

i) MDA Challenges

Timing of drug delivery:

Despite submission of drug orders by the FMOH before the August 15th deadline, drugs for 2015 arrived more than halfway through the calendar year (CY). In FY17, persistent tracking of the JAP submission will also be supported by verifying treatment figures between The Carter Center reports, ENVISION workbooks, and FMOH integrated database to triangulate data gaps that may delay the submission of forms or undermine the quality of those submissions.


Rain and flooding: Delayed treatment increases the likelihood that certain communities will not be accessible because of rain. Should this become an issue, ENVISION‐supported MDA activities will be conducted where possible, and MDA campaigns planned for inaccessible communities will be rescheduled.

Insecurity: Ethnic, religious, and oil‐based conflicts, in addition to other issues of insecurity, prevent MDA at times.). In these cases, the program must wait until safety is restored. If MDA is not feasible because of security concerns, the program will not include the affected LGA in the overall coverage rate calculation but will consider each situation on a case‐by‐case basis and address the MDA coverage rates in these LGAs separately.

Population movement: Migratory populations make maintaining high coverage difficult. CDD registers allow ENVISION to accommodate changes in population and to track them each year when the CDD returns to the community.

Lack of support for CDDs by communities and CDD attrition: The FMOH and SMOH programs continue to hone training materials in an effort to show CDDs (and their communities) the importance of their work. Although some CDDs remain in their positions for long periods and the program has been successful in recruiting new CDDs when needed, attrition does still occur, affecting the program’s ability to mobilize communities during MDA. The program is instating a new policy of two‐day CDD trainings to improve their comprehension of complex forms and, therefore, reduce attrition. The program is also now requiring CDDs who report to training to bring certificates from their village leadership to convey that they have been selected for this role to increase accountability and, it is hoped, reduce attrition.

Changing strategies: Some areas have delivered SCH and STH treatment through communities. Recently, changed policies at the state and federal levels now dictate that these treatments must be delivered through schools whenever possible. This shift in strategy could affect the MDA coverage because school‐based platforms are often subject to delays, such as teacher strikes, school cancelations (for example, many schools closed during the Ebola crisis), and school holidays. The program has been closely monitoring the potential impact of this policy decision on SCH and STH treatment coverage and will be compiling results to make appropriate recommendations to the national program.

Accurate census data: The Nigerian NTD Program currently uses the 2006 population census data projected by 2.5% yearly for all NTD activities and data reporting. Thus, the denominator appears to be “exaggerated” when compared with the expected actual population on the ground, and as a result, the therapeutic coverage values are severely reduced after adjusting the calculations. In addition, the new NTD Integrated M&E tool has not been made available to many state program staff in sufficient quantities, making data capturing very difficult at all levels. This inconvenience negatively affects the data quality at all levels, thereby compounding the existing poor data management skills observed among technical staff in most states. In FY17, ENVISION is amenable to supporting the FMOH in conducting monitoring, evaluation, and data management trainings to address this challenging gap in capacity. This is in addition to the FMOH’s requests submitted to the appropriate partners in the affected states to respond to the urgent need for data tools in these states.

Data quality: The National NTD Program adopted a purposive sampling method for the 2015 DQA, which included the presence and absence of NGDO support, state‐level performance, and endemicity of selected NTDs (including trachoma), and selected Cross River and Sokoto States. Two LGAs were selected from each of the states, in consultation with the State Coordinators: Shagari LGA (high performing) and Tureta LGA (low


performing) were selected from Sokoto State, and Bekwara LGA (high performing) and Yala LGA (low performing) were selected from Cross River State. In consultation with LGA Coordinators in the selected LGAs, two front line health facilities and four service delivery points (community and school) were randomly selected for the assessment (eight communities and eight schools in total). The DQA results will be used to strengthen data quality by communicating the DQA findings and recommendations to all states nationwide and partners while following up with the respective states on their implementation to ensure that corrective and/or improvement actions are put into place, as needed.

ii) MDA

Nine Priority States MDA (OV, LF, STH, and SCH): Overall, 133 LGAs in the nine The Carter Center‐assisted states will receive some form of MDA in FY17, and 32 of those LGAs will hold a second round of bi‐annual MDA for STH or LF. MDA will occur within the community, at local schools, or some combination thereof. Community‐based treatment is performed in LGAs with an elimination program (LF and/or OV), whereas school‐based treatment is used in LGAs with control programs (STH and SCH). In LGAs with both elimination and control programs, the first round of treatment (MDA 1) is typically community based, and the transportation costs are covered under training. In contrast, the second round (MDA 2) is school based, and the transportation costs are covered. These approaches may change as the LGAs determine their preferences. Both MOH and MOE personnel will be involved in MDA, but logistics and supervision will continue to be facilitated through the MOH with The Carter Center support. The Carter Center will work with states and LGAs to conduct MDA campaigns in specific months instead of rolling MDA, as in the past. ENVISION will support the training and supervision of a second round of MDA interventions for LF and STH as required by prevalence and in locations where other NTDS are co‐endemic. Activities that support MDA include the following:

Updating village registers: The SMOHs and LGAs, with The Carter Center support, will continue improving registers through increased supervision and training and by rolling out new, more durable registers. These activities will be implemented during CDD training.

Co‐administration of IVM, ALB, and PZQ where appropriate: In communities where one round of stand‐alone PZQ MDA and one round of stand‐alone IVM or IVM/ALB MDA has already occurred, the worm burden has been reduced enough to prevent SAEs, and the medicines can be administered together rather than via multiple single‐drug distributions. The Carter Center has determined the locations of these communities and will provide training and supervision to supervisors and CDDs in these areas. A WHO‐sponsored study in 2006 showed that co‐administration is safe,4 and it is a useful strategy to maximize resources. The FMOH, with support from The Carter Center, successfully piloted safe co‐administration in Plateau State in 2006. The results were published,5 and The Carter Center has since used triple drug administration whenever possible in its assisted states.

4 Na‐Bangchang, K., Kietinun, S., Pawa, K. K., Hanpitakpong, W., NaBangchang, C., & Lazdins, J. (2006). Assessments of pharmacokinetic drug interactions and tolerability of albendazole, praziquantel and Ivermectin combinations. Trans R Soc Trop Med Hyg, 100, 335–345. 5 Eigege, A., Pede, E., Miri, E., Umaru, J., Ogbu, P., Jinadu, M. Y., & Njepuome, AN. (2008) Triple drug administration (TDA), with praziquantel, Ivermectin and albendazole, for the prevention of three neglected tropical diseases in Nigeria. Trans R Soc Trop Med Hyg, 102, 177–179.


Monitor and supervise CDDs on providing the appropriate dosage and monitoring AEs: A reporting system for recording dosages and AEs has been established and will continue to be monitored by The Carter Center, RTI, and FMOH and SMOH personnel in all 10 USAID‐supported states.

ALB monotherapy: The 2013 WHO NTD Strategic Technical Advisory Group recommended once‐ or twice‐per‐year ALB monotherapy treatment in IVM‐naïve areas at risk for L. loa. The FMOH, through The Carter Center, is providing ALB monotherapy in 32 IVM‐naïve, LF‐endemic LGAs, primarily targeting twice‐per‐year LF treatments.

MDA supplies (The Carter Center‐assisted states): In FY17, ENVISION funding will be used to procure essential supplies for the successful implementation of MDA, including 10,000 dose poles, 6,089 reporting forms, and 10,000 t‐shirts.

iii) MDA

Cross River State MDA (OV, LF, STH, and SCH): Eighteen LGAs in Cross River State will receive some form of MDA in FY17. MDA will occur within the community, at local schools, or some combination thereof. Community‐based treatment is performed in LGAs with an elimination program (LF and/or OV), whereas school‐based treatment is used in LGAs with control programs (STH and SCH). The approach to supporting community and school‐based distributions in CRS may change as the LGAs determine their preferences. Both MOH and MOE personnel will be involved in MDA, but logistics and supervision will continue to be facilitated through the MOH with RTI support through ENVISION. RTI will work with the state and LGAs to conduct MDA in a specific month; this strategy was demonstrated to be successful in FY16 compared to the previous approach of conducting rolling MDA. RTI will support the training and supervision required for a second round of MDA interventions for LF and STH as required by prevalence and in locations where other NTDS are co‐endemic. Activities that support MDA include the following:

Updating village/school registers: The LGAs, with partner support, will continue improving registers by increasing supervision and training and deploying new integrated registers as needed, distributing them during teacher/CDD training.

Co‐administration of IVM, ALB, and PZQ where appropriate: In communities in which one round of stand‐alone PZQ MDA and one round of stand‐alone IVM or IVM/ALB MDA have already occurred, the worm burden has been reduced sufficiently to prevent SAEs, and the medicines can be administered together rather than via multiple single‐drug distributions. ENVISION will work with the SMOH to determine the locations of these communities and will provide training/supervision to supervisors and CDDs in these areas to enable triple drug administration wherever applicable and possible in the state.

MDA supplies (RTI‐assisted State): In FY17, ENVISION funding will be used to procure essential supplies for successful MDA implementation, including 3,000 dose poles and 15,000 T‐shirts for CDDs.


Eighty‐three ENVISION‐funded LGAs in the seven southeast states did not meet their LF treatment targets in FY15 because of a shortage of ALB in the country. Additionally, second‐round tablets were delivered too late for second‐round treatment to occur.

Seven ENVISION‐funded LGAs in Plateau and Nasarawa States (Kokona, Lafia, Bassa, Bokkos, Jos East, Kanke, and Pankshin) did not meet their OV targets in FY15 because of delayed drug supplies, which reduced the number of months during the fiscal year in which treatment could be provided. This accounted for the perceived low coverage. However, additional treatments in the same LGAs were carried out from October‐December 2015 that were captured in FY16 workbooks. (This practice of capturing one round of MDA in two different fiscal years is being corrected for the future.)

Six ENVISION‐funded LGAs did not meet their FY15 SCH targets because of delayed drug supplies, which reduced the number of months in which treatment could be provided the reporting period. This delay accounted for the perceived low coverage results because some treatments occurred during October‒December 2015. These treatments were not included in the FY15 workbooks (In Ebonyi, Ikwo, Izzi, and Ohaozara LGAs have 0% coverage in the FY15 workbook as treatments did not happen at all until the first quarter of FY16. In Plateau State, Kanam, Pankshin, and Riyom LGAs had coverage levels between 60% and 70%.)

Clearer guidelines are being produced by the ENVISION project to ensure that cross fiscal year treatment scenarios still count treatments as part of the fiscal year they were planned. Months targeted for MDA in the workbooks are sometime not updated when such delays occur which can confound the interpretation of how drug delays are affecting MDA coverage. As previously stated, The Carter Center and RTI are working with LGAs to conduct treatments in certain months to improve this aspect of reporting in the future. The Carter Center will improve LGA‐level data collection methods/tables in FY17 to ensure better clarity of reported figures; retroactive changes to the monthly 2015 data or change which year the data is reported would be difficult at this point to tease out.


Table 6. USAID‐supported coverage results for FY15** and targets for FY17

NTD # of rounds of

annual distribution

Treatment target (FY16) # of

districts

# of districts not meeting epi coverage

target (FY15*)

# of districts not meeting program coverage

target (FY15)

# of treatment‐targeted persons (FY15)

# of treated Persons (FY15)

% of treatment target met (FY15)

(persons)

# of districts targeted

for treatment (FY17)

# of persons targeted

for treatment (FY17)

LF 1 111 52 77 822,867 699,437 83.30% 121 21,370,657

OV 1 12 11 7 1,909,363 1,836,810 96.20% 27 3,378,473

SCH 1 35 3 5 2,511,331 1,542,987 63.53% 59 3,463,267

STH 1 131 103 83 8,092,032 6,917,435 85.50% 131 8,085,773

STH 2 35 0 0** 2,254,126 1,086,672 48.21% 38 2,271,627

Trachoma

None n/a n/a

*Epi and program coverages as defined in the workbooks ** Round 2 Treatment did not occur due to late commencement of round 1.

h) Drug and Commodity Supply Management and Procurement

Drug ordering is conducted using the WHO JRF. This ordering is based on states’ and partners’ quantifications using the TIPAC during strategic planning meetings which usually take place in the first quarter of the fiscal year. The quantities of unused drugs returned to the state following MDA are deducted when submitting the subsequent year’s drug requests. The quantification process follows the standard guideline of 2.8 tablets of PZQ for SCH, 2.5 tablets of IVM for OV, and 1 tablet of ALB or MEB for either LF or STH, as applicable, and these quantities are deployed to the target population for disease treatment. Based on this approach, the FMOH team typically works to ensure accuracy in the reported stock‐on‐hand and census update data received from the IUs through the reporting channels all the way up to the national level. ENVISION’s Senior M&E Specialist provides technical assistance to the M&E team of the FMOH in data‐cleaning processes and provides guidance during data entry into the database and subsequent application tool population. As indicated above, the FMOH team works together to use the available data in the NTD Database and TIPAC to populate the JRSM.

The FY17 JAP requests IVM for OV, ALB for LF, PZQ for SCH, and MEB for STH. The ancillary benefit of ALB in areas endemic for STH is accommodated during MDA, whereas in non‐LF communities, MEB is deployed. The forecasting and quantification of these medicines were achieved using the consolidated FY15 treatment data. For trachoma, the TEMF is used to request Zithromax® via a separate application process.

Reverse logistics: This follows the return of the treatment data collection tools at the end of MDA. Unused drugs are returned to the state by the schools and communities through the health facilities according to specific guidelines regarding the inventory of opened and unopened bottles of each specific drug that must be documented.


ENVISION’s activities are limited to ensuring the availability of tools for reporting SAEs and the delivery of adequate content during pre‐MDA trainings for teachers and health workers at their respective levels. Further, the various health facilities are supported with reasonable stocks of medicine for SAE management.

Drug transportation from Lagos to 9 states and drug storage): ENVISION will support the transport/storage costs required to deliver IVM, ALB, MEB, and PZQ from the central medical store in Oshodi, Lagos, where drugs are received, to two main Carter Center ‐drug storage hubs in Owerri (Imo State) and Jos (Plateau State) and to the SMOH drug storage facility in Calabar (Cross River State). From this point, the nine Carter Center‐supported SMOHs will collect the drugs and distribute them to the targeted LGAs and communities. In contrast, in Cross River State, RTI/ENVISION will support delivery to the 17 LGAs from the state store in Calabar and distribution to the targeted frontline health facilities and communities/schools. The costs associated with the loading and unloading of the drugs will also be supported by ENVISION.

Distribution of National Supply Chain Management SOPs and Guidelines: ENVISION has recognized the dearth of operating tools throughout the National NTD Program and proposes supporting the printing and distribution of SCM SOPs and guidelines. Indeed, the FMOH has requested assistance for the printing of 600 copies of the SOPs and 1,000 copies of the SCM guidelines targeting the 10 USAID‐supported states. Printing of these documents will support recommendations that were developed from the Anglophone West Africa SCM Training meeting in Accra, Ghana, supported by USAID. The SCM SOPS have already been provided by Crown Agents to the six (6) DFID‐UNITED States. Additional resources to service other States nationwide will be made available through the partners supporting those other states.

i) Supervision

MDA Supervision

During the course of supervisory visits, the FMOH will collect treatment reports, assist endemic states in updating their treatment progress report data, conduct supportive supervision, provide lessons learned on good data management, recommend corrective actions for the identified problems undermining proper data collection and management, and contribute to filling staff knowledge gaps in the use of data inventory tools, treatment registers, and reporting forms. The expected outcomes will include assessments of treatment reports, updated treatment progress reports, and lessons learned regarding good data management.

The pre‐MDA training content is designed to ensure that all aspects of the MDA activity are captured and that participants recognize the training focus at their levels of function and responsibility. To this end, the supervisory checklist is discussed at the training and is also made available for use during the cascade training. Every implementer, including health workers and teachers, should thus be appropriately guided regarding their role and the requirement of full compliance with WHO/National Guidelines. Reporting and the relevant channels constitute a means of ensuring the sound execution of MDA based on the guidelines and supervision reports.

The Carter Center staff and the FMOH use accepted protocols and standardized forms for monitoring MDA, including random visits during the MDA period (several per day) to health facilities and villages, where staff examine registers and question residents about MDA uptake. By comparing the two sources of information, staff can track MDA progress throughout a community and determine whether registration is


accurate. Staff communicate these results to their supervisors throughout the health system and provide feedback to CDDs in person and at periodic review meetings.

Supervision of MDA round 1: Supervision is provided by trained state, LGA, health facility, MOE, SUBEB, and community personnel in collaboration with The Carter Center, RTI, and Evidence Action staff. All levels of training include details on WHO and MOH regulations for the different diseases. The Carter Center and RTI staff will engage in frequent communication via the phone and in person with state‐ and LGA‐level MOH staff to remain informed of any challenges that arise during MDA and to preempt any delays or challenges affecting treatment. Monthly reporting of the LGAs and states to The Carter Center, and RTI will also include descriptions of any issues that arise. Drug inventory checks at the state and LGA levels pre‐ and post‐MDA will be conducted by The Carter Center, RTI, and SMOH staff. During the in‐person supervision visits to LGAs before, during, and after MDA, SMOH, SUBEB, The Carter Center, and RTI staff will spot‐check registries and databases to ensure that data collection complies with the relevant protocols. ENVISION will support allowances for field personnel, transport costs, fuel, and the production of supervisory checklists to ensure that tasks are implemented as planned.

Supervision of MDA round 2: The same activities proposed for MDA round 1 will be implemented for the supervision of round 2. No additional material costs are expected for round 2 that were not already covered in round 1.

j) M&E

Integrated NTD database: Review and update meetings: The National NTD Program has received all available historical and current data up to December 2015 from all states and has uploaded them into the national database. Additionally, ENVISION assisted the National NTD Program in successfully establishing state‐level WHO integrated databases in all 36 states and FCT during FY15. The FMOH, and disease‐specific programs in particular, continuously receives data from states concerning various NTD activities for entry into the national database and continues to encourage the states to populate their databases with both historical and current data. Technical support by RTI’s Senior M&E Specialist to enable appropriate completion of the NTD Database in the states has been ongoing and will continue for states to fully establish their database and manage own data. This support will include support for two in‐country review meetings among State and Federal data managers to harmonize data entry across federal and state databases.

MDA coverage surveys Nine Priority States: The results of coverage surveys beginning in the Southeast Zone in FY16 will be used to adjust program trainings, health education strategies, and logistical activities in FY17 so that MDA interventions can be implemented efficiently and effectively. Additional coverage surveys are planned in selected LGAs in Southeast, Plateau, and Nasarawa in FY17. Many communities in the Southeast have not seen the impact of the program on disease transmission as well as those in Plateau and Nasarawa States. Thus, these surveys represent an excellent opportunity to double check the distribution and tracking aspects of the program, mobilize communities, and address any concerns. The methodology will yield precise estimates of LGA‐level coverage and will be applied to 45 LGAs identified among The Carter Center‐supported states to validate coverage rates.


School‐based surveys of SCH and STH treatment coverage are planned for FY17 in Plateau and Nasarawa States. The previous strategy focused on the community‐based treatment of these diseases in these states. Therefore, the new practice of delivering treatment through schools must be evaluated. The methodology will yield precise estimates of LGA‐level coverage.

The results of the school‐based survey will facilitate a more efficient delivery of treatment (for example, achieving better alignment with lessons and school calendar and reaching unenrolled children) and better advocating for programs within the Nigerian government. In the past, when The Carter Center discovered areas of poor coverage, ENVISION staff conducted additional follow up (either by phone or in person) with MOH staff (state and LGA) and led retraining for community distributors and teachers to improve coverage. This strategy will be used again as needed. In FY17, this survey is expected to be implemented in four LGAs practicing school‐based MDA.

In all of these surveys, LGAs “of interest” are selected based on high and low coverage, and the study sample size (about 900 persons per LGA sampled) was developed to allow 95% confidence, ±5% margin of error.

MDA coverage surveys Cross Rivers State: Coverage surveys are planned for early FY17 to evaluate Q4 FY16 MDAs and again in Q4 of FY17 to assess MDAs that are expected to occur during the first part of Q4. The Coverage Evaluation Survey will be a community‐based survey based on the WHO Coverage Evaluation Tool and will capture school aged children covered during the MDA.

LF TAS 3 In 2017, 26 LGAs in Plateau and Nasarawa will be eligible for TAS‐3 survey. Following a minimum of five years of MDA, 5 of the 26 LGAs met the criteria for stopping ALB‐IVM MDA for LF through a community‐based ‘PacELF survey’ conducted in 2007‐2008. These LGAs stopped ALB MDA in 2010, but continued IVM MDA due to co‐existence of onchocerciasis. The other 21 LGAs met the criteria for stopping ALB‐IVM MDA for LF through a 2012 TAS‐1 survey, and stopped MDA the following year, 2013. WHO guidelines recommend two cross‐sectional TAS be conducted 2‐3 years apart and 2‐3 years after the last round of MDA to verify the absence of LF transmission. These 26 LGAs, grouped into 6 evaluation EUs, passed a school‐based TAS‐2 post‐treatment surveillance survey in 2015. In 2017, we plan to repeat the 6‐EU study design, which requires a total target sample size of 10,008 6‐7 years old children (approximately 1,692 children per EU).

OV entomology : OV entomology will be conducted in 34 sites (18 in Plateau State and 16 in Nasarawa State) using 80 traps. The personnel involved will include four The Carter Center staff, 17 LGA supervisors, and 60 trap attendants. The WHO guidelines for the elimination of OV require entomological assessments to demonstrate the interruption of (and, later, elimination of) disease transmission. The Nigeria NTD Master Plan aims to eliminate OV by 2020, and with technical support from The Carter Center, ENVISION can help support this national goal for Nigeria. The specific protocol for conducting entomological assessments will be discussed and decided upon by ENVISION, USAID, The Carter Center, and the FMOH prior to implementation.

OV stop‐MDA survey: OV impact assessments are needed in Plateau and Nasarawa States once the FMOH issues the stop‐treatment guidelines. All indicators suggest that OV has been interrupted in these states. It is critical that, once the FMOH agrees on what is required, all necessary data can be gathered to present this case so that the ENVISION‐assisted areas can cease OV treatment and begin post‐treatment surveillance. Currently, Nigeria is aiming for OV elimination by 2020 and urgently needs to demonstrate that progress can and is being made toward this goal.


Supervision of DSAs The Country Representative, RPA, Program Directors, Program Administrators, NTD Coordinators, Program Officers, SIHT and LIHT members, health facility staff, and school supervisors at the state and district levels all provide supervision, and therefore, their allowances will be accurately budgeted.

The use of the supervisory checklist provided in April 2015 will enable effective supervisory action throughout the supervision. This tool is activity‐ and level‐specific, and thus, it provides guidance regarding the program issues to be addressed at any specified point during a visit. The responses obtained at the per‐visit level enable defining program issues and providing troubleshooting to elicit the necessary next steps for corrective action. A tracking section is provided in the checklist to document the issues, challenges, and supervisor responses as a record for future reference.

Table 7. Planned DSAs for FY17 by disease

Disease No. of endemic LGAs No. of LGAs planned

for DSA Type of assessment

Diagnostic method (Indicator: e.g., Mf, FTS, or hematuria)

The Carter Center‐supported States (nine)

LF 111 26 TAS3 FTS

OV 121 12 OV entomology and OV stop‐MDA assessment

OV16 enzyme‐linked immunosorbent assay and MX poolscreen


3) Maps


Note: FY17 DSAs indicated in the map reflect all planned DSA which may include DSAs supported by other partners in addition to those supported by USAID ENVISION's project.

Trachoma TSS surveys in FY17 postponed to FY18

FMOH planning on treating LGAs highlighted in green in FY18. These districts were assessed to have some sub‐LGA areas to have TF prevalence >5% in 2013.

Note: FY17 DSAs indicated in the map reflect all planned DSA which may include DSAs supported by other partners in addition to those supported by the ENVISION project.


APPENDIX 1. WORK PLAN TIMELINE

FY17 Activities

Project Assistance

Strategic planning

Trachoma Action Plan/Production Meeting (RTI)

Zonal mid‐year reviews (RTI)

Annual Review meeting (RTI)

ENVISION Program Review (RTI)

Onchocerciasis elimination plan development and printing (The Carter Center)

Technical working group meeting–NOEC (The Carter Center)

State strategic meetings (The Carter Center) State strategic planning (RTI)

NTD Secretariat

NTD Secretariat

Advocacy for Building a Sustainable National NTD Program

State government leadership sensitization meetings (The Carter Center, RTI)

LGA sensitization meetings (The Carter Center, RTI)

Social Mobilization to Enable NTD Program Activities

Dissemination of health messages (The Carter Center, RTI)

Production of IEC materials (The Carter Center, RTI)


FY17 Activities

Training

Zonal Cascade Training on SCM(RTI)

Training of LGA Commodity Managers in Cross River State (RTI)

TOT and re‐TOT (The Carter Center, RTI)

MDA training for supervisors, teachers/health workers, and CDDs (The Carter Center, RTI)

Development and printing of training materials (The Carter Center, RTI) Mapping

MDA

MDA (OV, LF, STH, and SCH) (The Carter Center) MDA (OV, LF, STH, and SCH) (RTI)

Drug and Commodity Supply Management and Procurement

Drug transportation from Lagos to Owerri and Jos and drug storage (The Carter Center) Reverse logistics (RTI)

Printing of SCM protocols and guidelines (RTI)

Supervision

Supervision of MDA round 1 (The Carter Center)

Supervision of MDA round 2 (The Carter Center)

Supervision of MDA round 1 (RTI)

STTA

M&E

MDA coverage survey (The Carter Center, RTI)

LF TAS 3 (The Carter Center)

OV entomology (The Carter Center) OV stop‐MDA survey (The Carter Center)

Integrated National NTD database: Review and update meeting (RTI)

Supervision of DSAs (The Carter Center/RTI)


APPENDIX 2. TABLE OF USAID‐SUPPORTED PROVINCES/STATES AND DISTRICTS

region name district name MDA(177)

pre_tas tas1 tas2 tas3 (26)

tis tss OV assessments

Abia Aba North X

Abia Aba South X

Abia Arochukwu X

Abia Bende X

Abia Ikwuano X

Abia Isiala Ngwa North X

Abia Isiala Ngwa South X

Abia Isuikwuato X

Abia Obi Ngwa X

Abia Ohafia X

Abia Osisioma X

Abia Ugwunagbo X

Abia Ukwa East X

Abia Ukwa West X

Abia Umu Nneochi X

Abia Umuahia North X

Abia Umuahia South X

Anambra Aguata X

Anambra Anambra East X

Anambra Anambra West X

Anambra Anaocha X

Anambra Awka North X

Anambra Awka South X

Anambra Ayamelum X

Anambra Dunukofia X





Anambra Ekwusigo X

Anambra Idimili North X

Anambra Idimili South X

Anambra Ihiala X

Anambra Njikoka X

Anambra Nnewi North X

Anambra Nnewi South X

Anambra Ogbaru X

Anambra Onitsha North X

Anambra Onitsha South X

Anambra Orumba North X

Anambra Orumba South X

Anambra Oyi X

Cross River Abi X

Cross River Akamkpa X

Cross River Akpabuyo X

Cross River Bakasi X

Cross River Bekwara X

Cross River Biase X

Cross River Boki X

Cross River Calabar South X

Cross River Etung X

Cross River Ikom X FY18

Cross River Obanliku X

Cross River Obubra X

Cross River Obudu X

Cross River Odukpani X

Cross River Ogoja X





Cross River Yakuur X

Cross River Yala X

Delta Aniocha North X

Delta Aniocha South X

Delta Bomadi X

Delta Burutu X

Delta Ethiope East X

Delta Ethiope West X

Delta Ika North East X

Delta Ika South X

Delta Isoko North X

Delta Isoko South X

Delta Ndokwa East X

Delta Ndokwa West X

Delta Okpe X

Delta Oshimili North X

Delta Oshimili South X

Delta Patani X

Delta Sapele X

Delta Udu X

Delta Ughelli North X

Delta Ughelli South X

Delta Ukwuani X

Delta Uvwie X

Delta Warii North X

Delta Warri South X

Delta Warri South West X

Ebonyi Abakaliki X





Ebonyi Afikpo North X

Ebonyi Afikpo South X

Ebonyi Ebonyi X

Ebonyi Ezza North X

Ebonyi Ezza South X

Ebonyi Ikwo X

Ebonyi Ishielu X

Ebonyi Ivo X

Ebonyi Izzi X

Ebonyi Ohaozara X

Ebonyi Ohaukwu X

Ebonyi Onicha X

Edo Akoko‐Edo X

Edo Egor X

Edo Esan Central X

Edo Esan North‐East X

Edo Esan South‐East X

Edo Esan West X

Edo Etsako Central X

Edo Etsako East X

Edo Etsako West X

Edo Igueben X

Edo Ikpoba Okha X

Edo Oredo X

Edo Orhionmwon X

Edo Ovia North‐East X

Edo Ovia South‐West X

Edo Owan East X





Edo Owan West X

Edo Uhunmwonde X

Enugu Aninri X

Enugu Awgu X

Enugu Enugu East X

Enugu Enugu North X

Enugu Enugu South X

Enugu Ezeagu X

Enugu Igbo Ekiti X

Enugu Igbo Eze North X

Enugu Igbo Eze South X

Enugu Isi Uzo X

Enugu Nkanu East X

Enugu Nkanu West X

Enugu Nsukka X

Enugu Oji River X

Enugu Udenu X

Enugu Udi X

Enugu Uzo Uwani X

Imo Aboh Mbaise X

Imo Ahiazu Mbaise X

Imo Ehime Mbano X

Imo Ezinihitte X

Imo Ideato North X

Imo Ideato South X

Imo Ihite/Uboma X

Imo Ikeduru X

Imo Isiala Mbano X





Imo Isu X

Imo Mbaitoli X

Imo Ngor Okpala X

Imo Njaba X

Imo Nkwerre X

Imo Nwangele X

Imo Obowo X

Imo Oguta X

Imo Ohaji/Egbema X

Imo Okigwe X

Imo Orlu X

Imo Orsu X

Imo Oru East X

Imo Oru West X

Imo Owerri Municipal X

Imo Owerri North X

Imo Owerri West X

Imo Unuimo X

Kogi Bassa X

Nasarawa Akwanga X X x

Nasarawa Awe X

Nasarawa Doma X x

Nasarawa Karu X X

x

Nasarawa Keana X

Nasarawa Keffi X

Nasarawa Kokona X X

x

Nasarawa Lafia X X x

Nasarawa Nasarawa X





Nasarawa Nasarawa Egon X X

x

Nasarawa Obi X

Nasarawa Toto X X

x

Nasarawa Wamba X X

x

Plateau Barkin Ladi X

Plateau Bassa X

x

Plateau Bokkos X X

x

Plateau Jos East X X

x

Plateau Jos South X X

Plateau Kanam X

x

Plateau Kanke X X x

Plateau Langtang North X

Plateau Langtang South X

Plateau Mangu X

Plateau Mikang X X

Plateau Pankshin X X x

Plateau Qua'an Pan X X

Plateau Riyom X X

Plateau Shendam X X

Plateau Wase X X FY18 x

NIGERIA Work Plan - ENVISION · DFID U.K. Department for ... to MITOSATH for interventions in Ekiti...

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Transcript of NIGERIA Work Plan - ENVISION · DFID U.K. Department for ... to MITOSATH for interventions in Ekiti...