Togo FY2018 - END in Africa€¦ · NATIONAL NTD PROGRAM OVERVIEW ... research in Togo in 2016 and...

Control of Neglected Tropical Diseases Annual Work Plan 1 October, 2017 – 30 August, 2017 4 August, 2017 Submitted to: Bolivar Pou Project Director End in Africa Project FHI360 [email protected] Submitted by: HDI For further information, please contact: Rachel Bronzan, MD, MPH Medical Epidemiologist and Technical Lead HDI +1 360-550-1005 [email protected]

Togo FY2018

mailto:[email protected]

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Table of Contents

ACRONYMS ..................................................................................................................................4

COUNTRY OVERVIEW ...................................................................................................................5 GENERAL COUNTRY BACKGROUND ..........................................................................................5 NATIONAL NTD PROGRAM OVERVIEW .....................................................................................7 SNAPSHOT OF NTD STATUS IN COUNTRY ................................................................................ 11

PLANNED ACTIVITIES .................................................................................................................. 12 CAPACITY STRENGTHENING STRATEGY ................................................................................... 12 PROJECT ASSISTANCE ............................................................................................................. 13

Strategic Planning ....................................................................................................................... 13 NTD Secretariat ........................................................................................................................... 14 Building Advocacy for a Sustainable National NTD Program ...................................................... 14 Mapping ...................................................................................................................................... 15 MDA Coverage ............................................................................................................................ 15 Social Mobilization to Enable NTD Program Activities ................................................................ 18 Training ....................................................................................................................................... 22 Drug Supply and Commodity Management and Procurement ................................................... 24 Supervision of MDA ..................................................................................................................... 25 Monitoring and Evaluation ......................................................................................................... 27 Supervision for Monitoring and Evaluation and DSAs ................................................................. 30 Dossier Development ................................................................................................................... 30 Short-term Technical Assistance ................................................................................................. 31

PLANNED FOGs TO LOCAL ORGANIZATIONS AND/OR GOVERNMENTS ..................................... 33 CROSS-PORTFOLIO REQUESTS FOR SUPPORT .......................................................................... 33 MAPS .................................................................................................................................... 35

APPENDICES .............................................................................................................................. 40 Appendix 1. HDI Organizational Chart ..................................................................................... 41 Appendix 2. Timeline ............................................................................................................. 42 Appendix 3. Work Plan Deliverables ....................................................................................... 43 Appendix 4. Table of USAID-supported districts marked by disease/activity ............................ 45

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ACRONYMS

APOC African Programme for Onchocerciasis Control BCC Behavior Change Communication CAMEG Centrale d’Achats des Médicaments Essentials et de Consommables Medicaux (Central Medical Stores) CDC Centers for Disease Control and Prevention CDD Community Drug Distributor CDTI Community directed treatment with ivermectin DQA Data Quality Assessment DSA Disease specific assessment FHI360 Family Health International 360 FY Fiscal Year HDI Health & Development International IEC Information, Education, and Communication IU Implementation Unit JRSM WHO Joint Request for Selected Medicines LF Lymphatic filariasis M&E Monitoring and evaluation MDA Mass Drug Administration MDP Mectizan Donation Program MMDP Morbidity management and disability prevention MOE Ministry of Education MOH Ministry of Health and Social Protection NBPP National Blindness Prevention Program NOCP National Onchocerciasis Control Program NTD Neglected Tropical Diseases NTDP Neglected Tropical Disease Program OEC Onchocerciasis Elimination Committee Ov16 RDT Ov16 rapid diagnostic test for onchocerciasis PHU Peripheral Health Unit PTS Post-treatment surveillance RPRG Regional Program Review Group (WHO) SAC School-age children SAE Severe adverse events SCM Supply chain management STH Soil-transmitted helminths TA Technical assistance TAS Transmission Assessment Survey TIPAC Tool for Integrated Planning and Costing TF Trachomatous inflammation – follicular TT Trachomatous trichiasis UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development WASH Water, Sanitation and Hygiene WHO World Health Organization

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COUNTRY OVERVIEW

GENERAL COUNTRY BACKGROUND

Government and health structure of Togo

Togo is a West African country with an area of 56,600 km2, located between Benin (to the east), Ghana

(to the west), Burkina Faso (to the north) and the Atlantic Ocean (to the south). Its population was 6,191,155 inhabitants in 2010, according to the national census, with a growth rate of 2.84% per year. The population is estimated to be 7,284,397 in 2017, with 51.4% women and 48.6% men1. There are two main climatic zones in Togo: an equatorial climate in the southern half of the country, with two dry seasons and two rainy seasons, and a humid tropical climate in the north characterized by a single rainy season and a single dry season. The country is divided into six health regions containing a total of 40 districts, of which 35 are outside the capital area, Lomé-Commune. Togo has a decentralized health system, with regional and district offices, and the 40 districts are in turn served by more than 1286 public and private peripheral health units (PHUs). Of these, the 667 public PHU located outside of the capital are involved in the annual mass drug administration (MDA). Each PHU typically serves between one and ten villages. This health system structure is important for understanding the door-to-door community-based distribution platform used for the integrated MDA for neglected tropical diseases (NTDs). The implementation unit for distribution of preventive chemotherapy varies according to the target disease; implementation occurs at the district level for soil-transmitted helminths (STH), at the PHU level for schistosomiasis and at the village level for onchocerciasis. NB: Four new administrative districts were recently created, but the Ministry of Health and Social Protection (MOH) has not yet created the corresponding health districts, nor have the district health positions been filled, so implementation of health activities still falls under the health departments of their old, parent districts. However, once the district-level health personnel are in place in the new districts, this will result in an increase of the total number of health districts to 44. The budgets take this eventual increase in the number of districts into account. Other NTD partners in country Fiscal year (FY) 2018 is the ninth year of integrated NTD control in Togo with United States Agency for International Development (USAID) funding through Health & Development International (HDI) and the seventh year through assistance from Family Health International (FHI360). Led by the Togo MOH, many partners and programs have contributed to the success of Togo’s Integrated Program for the Control of NTDs. In addition to USAID, major NTD donors in recent years include (in alphabetical order): Bill & Melinda Gates Foundation, GlaxoSmithKline, Liverpool School of Tropical Medicine, Mectizan Donation Program (MDP), Merck KGaA, NTD Support Center (Atlanta), PATH, Sightsavers, The Task Force for Global Health, United Nations International Children’s Emergency Fund (UNICEF), and the World Health Organization (WHO). The WHO office in Togo has provided important logistical support. Other organizations that have partnered with the NTD Program in the past, or are likely to partner with the NTD program in the near

1 Report of the 4th general population census of Togo, 2010.

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future, include IMA World Health, Croix Rouge, Handicap International, and Plan International-Togo. The United States Centers for Disease Control and Prevention (CDC) partnered with the National Onchocerciasis Control Program (NOCP) to conduct programmatically pertinent onchocerciasis research in Togo in 2016 and 2017 and is partnering with the National Blindness Prevention Program (NBPP) on operational research on trachoma in late FY2017. Table 1: Non-ENVISION/END in Africa NTD partners working in country, donor support and summarized activities

Partner Location (Regions/ States)

Activities

In FY17, was USAID providing direct financial support to this partner through END in Africa?

List other donors supporting these partners/ activities

Bill & Melinda Gates Foundation

Nationwide Provides support for identification of individuals with trichiasis or hydrocele; supports surgeries for individuals with trichiasis/hydrocele

No Sightsavers (trichiasis)

Liverpool School of Tropical Medicine/Filarial Programmes Support Unit

8 districts Supporting entomological surveys to further substantiate the elimination of lymphatic filariasis as a public health problem in Togo

No WHO

Sightsavers 32 districts Supports epidemiological and entomological surveillance, cross-border meetings, program reviews and trainings for onchocerciasis

No None

The Task Force for Global Health

9 districts Supports surveillance by providing financing and technical assistance for Ov16 ELISA (onchocerciasis) and Wb123 ELISA (lymphatic filariasis). Provides technical support for an STH operational research project.

No None

UNICEF Nationwide Provides and distributes albendazole and Vitamin A for preschool children through Child Health Days

No None

WHO Nationwide Provides technical and financial support for implementation of multiple NTD activities

No Sightsavers

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NATIONAL NTD PROGRAM OVERVIEW

History of USAID support USAID funding for integrated NTD work in Togo began in the latter part of FY 2009. In FY 2010, USAID provided funding for the nationwide integrated mapping of schistosomiasis, STH and trachoma followed by integrated MDA for schistosomiasis, onchocerciasis and STH in the northern three regions of the country (Savanes, Kara and Centrale). Funding was also provided for lymphatic filariasis (LF) post-MDA surveillance activities and lymphedema morbidity management. In FY 2011 funding was expanded and, with the additional support of the National Malaria Control Program, the Global Fund (through Plan-International), UNICEF and the National Nutrition Program, Togo conducted a nationwide integrated MDA for schistosomiasis, onchocerciasis and STH, including vitamin A and albendazole for pre-school children and bed net distribution to all households. USAID also funded LF surveillance and lymphedema morbidity management (providing training, soap and supplies for lymphedema care) in 2011. In FY 2012, USAID additionally supported expanded preventive chemotherapy for schistosomiasis for children living in PHUs with schistosomiasis prevalence from 1 to 9.9%. During FY 2013, support for integrated MDA continued, with the addition of praziquantel treatment for high risk adults in areas of moderate schistosomiasis prevalence (10-49.9%), and LF surveillance continued, but funding for LF morbidity management ceased. Other activities supported by USAID include LF transmission assessment surveys (TAS) in FY 2012 and FY 2015 to confirm elimination of LF; coverage validation surveys in FY 2013 and FY 2015; an onchocerciasis program review in FY 2013 (to make recommendations for accelerating prevalence reduction in the few remaining villages with persistent high prevalence of onchocerciasis and for moving to onchocerciasis elimination in other areas); and in FY 2015 a nationwide integrated disease-specific assessment (DSA) for STH, schistosomiasis, onchocerciasis and LF. The STH and schistosomiasis results were used to revise the drug distribution plan for the two diseases, starting with the December MDA in 2015. The onchocerciasis component of the DSA utilized the Ov16 rapid test, providing information on the seroprevalence of antibodies to Ov16 in school-age children nationwide; onchocerciasis data from this assessment were incorporated into the recommendations of Togo’s Onchocerciasis Elimination Committee (OEC) in Togo, established in March 2016. The OEC is funded by USAID. In FY 2017 USAID funded a stop-MDA assessment for onchocerciasis in Maritime region, the southernmost region of the country. In March 2017, USAID supported a meeting of partners on trachoma elimination in Lomé that included the MOH, WHO, Sightsavers, USAID, FHI360, and HDI. This meeting resulted in a road map for trachoma elimination, including a trachoma mapping activity in seven districts, launched in August 2017, which will define the final steps necessary to achieve trachoma elimination in Togo. HDI has also supported trainings for accountants and training on the Tool for Integrated Planning and Costing (TIPAC), as well as travel to international meetings to present data on Togo’s successes. The USAID-funded integrated MDA platform has also been used to leverage funding from other partners for operational research and for trichiasis and hydrocele surgery. National NTD Program Overview Togo is currently operating off a five-year strategic plan for NTD control and elimination for 2016-2020. Togo MOH control and elimination strategies for the targeted NTDs are described below (see also Table 2). All drug distribution activities are implemented through door-to-door distribution in the

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community, and distribution is integrated across the three diseases targeted with MDA: onchocerciasis, schistosomiasis, and STH. The implementation unit (IU) for onchocerciasis is the village, the IU for schistosomiasis is the PHU, and the IU for STH is the district.

Lymphatic filariasis: Togo is proud and greatly honored to be the first country in sub-Saharan Africa to eliminate lymphatic filariasis (LF) as a public health problem. On March 22, 2017, Togo received a letter from WHO Director General Dr. Margaret Chan stating that, based on the recommendation of an external validation committee convened by the WHO, the WHO officially confirms elimination of LF as a public health problem in Togo. This achievement was celebrated at the international NTD Summit in Geneva in April and will be celebrated again in Togo in the near future. Togo continues to seek funding to maintain surveillance for LF, particularly in selected high-risk populations that pose a potential risk of reintroduction of LF into Togo. Togo’s MOH also continues efforts to provide care for lymphedema patients and surgery for hydrocele patients. Onchocerciasis: The onchocerciasis program has a long history, beginning with larviciding in 1975, the addition of ivermectin treatment in selected communities in 1988, expansion to widespread community-directed treatment with ivermectin (CDTI) in 1997, and finally, in 2010, serving as the platform onto which integrated MDA for other NTDs was added. Reported and measured coverage for ivermectin has been very high, and there are currently only eighteen communities known to have a prevalence of onchocerciasis >5% by skin snip. In October 2014, Togo’s Onchocerciasis Control Programme (PNLO) drafted and approved its Five-Year Plan for Onchocerciasis Elimination (2015-2019). The objective is to reduce prevalence to below 1% microfilariae (Mf) in 100% of eligible villages through MDA. MDA will be closely scrutinized in areas with prevalence >5% through intensified supervision to ensure all people eligible for treatment are identified and treated, including any groups who are seasonally present during transmission season but away when MDAs normally occur; these areas are already targeted for treatment twice per year. The program will also continue with information, education and communication (IEC) activities and behavior change communication (BCC). In FY 2016, USAID supported onchocerciasis surveillance activities previously supported by the African Programme for Onchocerciasis Control (APOC). The MOH, with support from partners, conducted surveillance at sentinel sites in 20 districts as part of its onchocerciasis elimination plan2. These surveys employed skin snip and Ov16 RDT (rapid diagnostic test) to help establish baseline data on Ov16 seroprevalence. In March 2016, the MOH established an Onchocerciasis Elimination Committee as part of its commitment to onchocerciasis elimination. Having held a preparatory meeting in April with partner support (WHO, Sightsavers, USAID, etc.), the committee held its first full meeting at the end of July 2016, which included international onchocerciasis experts. In February 2017, at its third meeting, the Committee recommended a stop-MDA assessment in the southernmost region of Maritime and a rapid evaluation in the far north of the country to see if that area is ready for a full stop-MDA assessment. Fieldwork for the epidemiological component of the stop-MDA assessment was completed in July with technical support from HDI and the samples will be analyzed in the laboratory of the National Institute of Health in Lomé in August and September using Ov16 ELISA as recommended by the WHO. The entomological piece will be launched in September. Both components of this stop-MDA assessment are supported by USAID. A rapid assessment in the far north of the country will also be implemented in September 2017, with support from USAID and Sightsavers, to determine whether a full stop-MDA assessment is needed.. In the three regions in the

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middle of the country, the recommendation was to expand the scope of drug distribution; previously, only communities with population <2000 were targeted under the control program, and in the future the MOH will ensure that all communities are targeted with ivermectin, even those with population >2000. Because drug orders were already submitted for FY 2017, the expanded treatment regimen will begin in FY 2018. USAID currently supports MDA for onchocerciasis (as part of Togo’s nationwide integrated MDA) in 32 of the 40 districts in Togo, and a second round of treatment in 15 districts. Based on the results of the stop-MDA assessment in Maritime region, the number of districts targeted for ivermectin may be reduced in FY 2018. Togo’s NOCP will revise its Five-Year Plan for Onchocerciasis Elimination in FY 2018, based on the new WHO recommendations on onchocerciasis elimination that were released in early 2016. All onchocerciasis activities are being implemented in accordance with WHO’s 2016 “Guidelines for stopping mass drug administration and verifying elimination of human onchocerciasis” and in consultation with the Onchocerciasis Elimination Committee and the WHO. Schistosomiasis: Nationwide schistosomiasis mapping (excluding Lomé) was conducted in 2009 and MDA started in 2010 according to WHO treatment thresholds. The mapping provided data on the prevalence of schistosomiasis at the PHU level (a total of 30 children in each PHU were tested for S. mansoni and S. haematobium). Because of the focal nature of schistosomiasis, the decision was made to select the PHU as the implementation unit, to best target those people at risk and to minimize over- and under-treatment of individuals. Mapping of S. mansoni was conducted in Lomé region in 2013 and demonstrated disease prevalence below the WHO threshold for MDA. Treatment for adult women in areas of moderate prevalence (10%-49%) began in FY 2014 because their daily household activities place them at high risk due to frequent contact with water. A DSA was conducted in early 2015, after four to five years of MDA for schistosomiasis, and the results demonstrated that the prevalence of schistosomiasis was significantly reduced nationwide, from 23% to 5%, and the intensity of infection is low in infected individuals. The goal now is to reduce or maintain the prevalence of S. haematobium and S. mansoni in school age children (SAC) below 10% in all areas. The strategy is to continue MDA according to disease prevalence in the PHU, and the target populations and frequency of treatment have been updated based on the results of the FY 2015 DSA and according to the 2006 WHO guidelines for Preventive Chemotherapy in Human Helminthiasis. In a small minority of PHU, the frequency of treatment for schistosomiasis will be increased to two times per year, according to WHO guidelines for post-assessment MDA. The program will continue with IEC and BCC activities and promotion of water, sanitation, and hygiene (WASH) principles. USAID currently supports MDA for schistosomiasis in 35 of Togo’s 40 districts. Togo is developing a transition plan to support schistosomiasis control with long-term, sustainable funding. Soil transmitted helminths: As with schistosomiasis, the baseline national STH mapping was conducted in 2009 and MDA was started in 2010 according to WHO treatment thresholds. UNICEF has been treating pre-school age children nationwide for STH since before 2009. STH mapping of Lomé was conducted in 2013 by an implementing partner (Hope Education Foundation) and showed the prevalence of STH was below the WHO threshold for MDA. The 2015 DSA showed an overall reduction in the prevalence of STH among school children from 33% to 11.6% after 4 to 5 years of MDA, and those infected mostly have light infections. The goal now is to reduce or maintain the prevalence below 20% in all areas. Activities will include MDA with IEC and BCC and promotion of WASH. Togo’s strategic plan for NTD control calls for all children to receive treatment with albendazole at least once per year, but one district does not qualify for ALB donation through WHO (baseline STH prevalence <20% without a history of ALB MDA). USAID currently supports MDA for STH in 34 of Togo’s 40 districts

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according to the MOH policy of treating all children in districts with STH prevalence ≥1%. Togo is developing a transition plan to support STH control with long-term, sustainable funding. Trachoma: In FY 2017, Togo took a definitive step toward elimination of trachoma by convening a meeting of partners on trachoma elimination in Lomé in March, 2017, that included the MOH, WHO, Sightsavers, USAID, FHI360, and HDI. This meeting resulted in a road map for trachoma elimination in Togo. At the meeting, all existing trachoma data were reviewed, and opportunities to extract additional information from existing databases and treatment logs were identified. A final review of all those data at a meeting of the same partners (minus Sightsavers) in April, 2017, led to a recommendation to conduct a trachoma survey in seven districts in Togo. This survey is being implemented in August 2017 with support from Tropical Data and USAID. The results will indicate what work is needed, if any, particularly with regard to morbidity management, in order for Togo to submit a dossier of elimination to WHO. The goal in FY 2018 will be to submit a dossier to the WHO for validation of trachoma elimination. Togo’s National Blindness Prevention Program continues to work with multiple partners to address morbidity due to trachoma by promoting appropriate WASH practices for prevention and by identifying and treating persons with trichiasis. Outside funding was secured in FY 2015 from the Bill & Melinda Gates Foundation to identify individuals with eye diseases during the June-July 2015 MDA and treat cases of trichiasis. During the July 2017 MDA, cases of trichiasis will again be sought, and this BMGF funding will continue into FY 2018.

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SNAPSHOT OF NTD STATUS IN COUNTRY

Table 2: Snapshot of the expected status of the NTD program in COUNTRY as of September 30, 2017

Columns C+D+E=B for each

disease Columns F+G+H=C for each disease

MAPPING GAP

DETERMINATION MDA GAP DETERMINATION

MDA ACHIEVEMENT

DSA NEEDS

A B C D E F G H I

Disease

Total No. of District

s in COUNT

RY

No. of districts classifie

d as endemi

c

No. of districts

classified as non-

endemic

No. of district

s in need of

initial mappin

g

No. of districts receiving MDA as of 09/30/17

No. of districts expected to be in need of MDA at any level: MDA

not yet started, or has prematurely

stopped as of 09/30/17

Expected No. of districts where

criteria for stopping

district-level MDA have been

met as of 09/30/17

No. of districts requiring DSA as of 09/30/17

USAID- funded

Others

Lymphatic filariasis

40

8a 32 0 0 0 0 8 Pre-TAS: 0 TAS: 0

Onchocerciasis 32 8 0 32 0 0 0b 28c

Schistosomiasis 40 0 0 35d 0 5e 0 0

Soil-transmitted helminths

40 0 0 35f 40g 5e 0 0

Trachoma 0 40 0 0 0 0 0 0h

a There were originally 7 LF endemic districts but due to redistricting in 2012 one of the original LF endemic districts was divided in two, giving a total of 8 previously endemic districts. All 8 endemic districts have successfully passed three TAS. b The stop-MDA assessment in the region of Maritime has been completed but results are not yet available at the time of writing of this document. If successful, four districts will have met the criteria for stopping MDA as of 9/30/17. c The 28 districts that did not receive onchocerciasis DSA in FY 2017 will eventually require it, but in FY 2018 a maximum of four districts will warrant a DSA, pending the results of the rapid onchocerciasis assessment in the north at the end of FY 2017. d All 35 districts outside of Lomé have ongoing MDAs for schistosomiasis. Schistosomiasis is present in the five districts in Lomé-Commune but at prevalence below the WHO treatment threshold. Treatment is based on prevalence at the PHU level, as determined during the 2015 DSA and according to WHO’s 2011 “Helminth control in school-age children”. Pages 73 & 75. Some PHU with poor response to treatment are now targeted twice per year. Treatment of moderate and low prevalence areas occurs in even years in the northern three regions and in odd years in the southern two regions (excluding Lomé). The low prevalence areas are treated every two years rather than every three years to maintain a simpler two-year cycle of treatment nationwide rather than the six-year cycle of treatment that would be required if low prevalence areas were treated every three years while moderate prevalence areas were treated every two years. Consequently, in FY 2018, all but four of the 35 endemic districts (all but Avé, Bas-Mono, Danyi and Yoto in the south of the country) will have MDA for schistosomiasis. In these four districts, all endemic areas received treatment in 2017 and they do not have any PHUs where treatment is warranted based on the WHO algorithm for treatment after an impact assessment; see details regarding PHU-level implementation for schistosomiasis in the previous section. e The five districts of Lomé-Commune are not treated for STH or schistosomiasis; these five districts have prevalence <20% for STH and <10% for schistosomiasis f In accordance with Togo’s Five Year Plan for NTD Control, all SAC in Togo should be treated for STH at least once per year, however, Danyi district is unique in that it had a baseline prevalence <20% and no history of prior treatment with ALB (e.g. through LF MDA), so Danyi alone does not qualify for donated ALB from GSK through WHO. Therefore, in spite of being targeted for treatment, Danyi did not receive MDA with ALB in 2017 as no ALB was available. g Pre-school age children in all 40 districts are treated with ALB through UNICEF.

h In FY 2017, trachoma mapping was conducted in 7 districts to confirm the expected absence of active trachoma and to estimate the prevalence of TT in preparation for writing and submitting a dossier for WHO validation of trachoma elimination in Togo.

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PLANNED ACTIVITIES

CAPACITY STRENGTHENING STRATEGY

In early 2017, the MOH elected a new Integrated NTD Program Coordinator and a new Onchocerciasis Control Program Coordinator after the previous coordinators retired. The new coordinators are bright, dynamic, hardworking and motived to advance their respective programs. Both coordinators have juggled many activities since taking charge and have made much progress in a short time, indicating that Togo currently has excellent management capacity in these NTD programs. There is also an entirely new team of equally dynamic and motivated people within the secretariat of the NTD Program who are committed to NTD control and elimination in Togo. Because the NTD team is almost entirely new, they will need assistance in understanding the historical progress and background of the program, understanding and meeting needs and expectations of donors and collaborating partners with respect to supply chain and data management, and executing certain monitoring and evaluation activities. A key need in 2018 is to enhance autonomous functioning and financing of the program for long-term sustainability. 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

a. Strategic Planning

In-depth review of the Integrated NTD five-year strategic plan and the Onchocerciasis Elimination five-year strategic plan. Review and update the TIPAC, particularly for planning over the next several years.

Ensure clear programmatic planning with sufficient associated funding to help Togo progress with onchocerciasis elimination, maintain progress against STH and schistosomiasis, and prevent re-introduction or resurgence of LF and trachoma.

b. NTD secretariat

Briefing and review of new staff on the evolution of the NTD program under USAID support, and on donor needs and expectations regarding data management and reporting (led by HDI and FHI360)

Bring the new, committed team up to date

c. Building Advocacy for a Sustainable National NTD Program

Technical assistance from Deloitte on the implementation of an advocacy plan (previously developed with assistance from Deloitte).

Improve the sustainability of the program and develop local capacity to solicit funds locally.

h. Drug Supply and Commodity Management and Procurement

Strengthen capacity for supply chain management at the regional and district levels. Train staff on WHO forms and workbooks used for ordering drugs

Address problems identified concerning collection, monitoring, and management of medications after the MDA. Assist the new NTD team with drug order for MDA.

j. Monitoring and Evaluation (M&E)

Technical assistance for implementing the DQA in the field. Additional training on the utilization of the WHO database of NTD data.

Assist the new NTD team with program management and improve the capacity of the team to respond to future challenges of the program.

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k. Supervision for M&E and DSAs

Assistance implementing the DQA in the field

Develop independent capacity within the new NTD team for program monitoring and evaluation

l. Dossier Development

Support with the development of the trachoma dossier

Ensure that the NTD team has the support needed to complete a successful trachoma elimination dossier.

PROJECT ASSISTANCE

Strategic Planning (Budget tabs: Microplanning, Oncho Meeting, Strategic Planning, Secretariat. Total cost for activities in this section: $80,470)

• Togo has a five-year strategic plan for the integrated control of NTDs (2016-2020) in place that includes updated goals and strategies for onchocerciasis elimination, updated strategies for onchocerciasis surveillance, and plans for the long-term management of STH and schistosomiasis. HDI will review this plan and work with the MOH to update it as needed. This will be a critical activity in the event that USAID funding does not continue after FY 2018. (No associated budget)

• Togo also has a five-year strategic plan for onchocerciasis elimination (2015-2019), and this plan will be updated in FY 2018 to reflect the latest WHO guidelines for onchocerciasis elimination. HDI will help coordinate and will participate in collaborative efforts with multiple partners (Togo MOH, USAID, FHI 360, WHO, CDC, Sightsavers, and other collaborators/scientific researchers) to review available onchocerciasis data, conduct epidemiological and entomological surveys for making decisions on stopping MDA, investigate problem areas, and implement post-MDA surveillance. As with the Integrated NTD Strategic plan, the onchocerciasis strategic plan will be particularly important for ensuring that Togo makes continued progress towards elimination of onchocerciasis. (No associated budget)

• HDI will support one annual program review of the Integrated NTD Program/microplanning meeting per year. The microplanning component of the meeting will consolidate stakeholder support for integrated NTD activities; inform participants about the objectives, targets, and process of the MDA; outline a general action plan for the MDA; review and refine the budget based on contributions from all partners; and identify synergistic activities or additional opportunities for integration of programs. Attendees will include the Secretary General for health, the coordinator of each NTD program, the Directorate in charge of planning, the Coordinator for the Integrated NTD program, the regional director for all six health regions in Togo, district directors, the head of the Division of Sanitation and Environmental Health, representatives from the WASH Program, the Nutrition Program, the Malaria Control Program, the Ministry of Education (MOE), the Ministry of Social Action, and other partners (e.g. Sightsavers, etc.; 97 people for 5 days). The program review includes analysis of the results, successes and challenges associated with MDAs, DSAs, post-MDA surveillance, and/or evaluation of progress against annual and longer-term strategic goals. An HDI representative will attend these meetings to ensure that progress is being made and long-term strategic goals are being met, particularly with regard to USAID-funded activities. (Microplanning)

• HDI will provide support to three meetings of the OEC, which will be comprised of onchocerciasis experts within Togo and, for one meeting per year, experts from outside Togo, including representatives from USAID, FHI 360, and other partners (30 people for 3 days). At these meetings,

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experts will review progress made on action points recommended at the most recent meeting, review the most recent onchocerciasis data from Togo, and outline specific next steps on the road to elimination. The committee will also serve to coordinate partners’ contributions to elimination and solicit external expert input into strategic planning. HDI will support the travel of four external experts for participation in these meetings. HDI staff will provide secretarial, technical and logistical assistance to these meetings, including review, analysis and presentation of data, coordination of experts, and support for implementation of recommendations from the OEC. (Oncho meeting)

• As in past years, HDI will support one work planning meeting to assemble USAID, FHI 360, HDI and in-country partners to develop the annual work plan for integrated NTD control activities that are supported by funding from USAID (30 participants for 4 days). (Strategic Planning - Work Plan meeting)

• HDI will support two cross-border meetings (one with Benin, one with Ghana). These meetings will include NTD partners within Togo and representatives from neighboring countries to develop effective interventions for border areas and collaborative monitoring and evaluation (M&E) strategies in anticipation of a transition away from external funding in the future. These meetings will include up to 20 people for 3 days and will address a range of cross-border issues (e.g. problem areas, synchronized treatments, approaches to M&E). (Strategic Planning – Cross-border meetings)

• The MOH has recently updated the TIPAC and has conducted an in-depth analysis of the resulting data, with support from Deloitte. The outputs from the TIPAC are used for program planning. In FY 2018, HDI will support an annual meeting to update the TIPAC (25 people for 6 days), identify funding gaps, and elaborate and execute a plan for addressing those gaps. (STTA – no associated country budget).

• HDI will support a meeting to update the 2018 Annual Operational Plan of the Integrated NTD Control Program. This meeting will consist of representatives of all the NTD programs, the directorate in charge of planning at the MOH, and selected regional and districts personnel (19 people for 3 days). The Annual Operational Plan will be particularly critical in FY 2018 in the event that USAID funding ceases in FY 2019. (Strategic Planning – Operational Plan Meetings)

NTD Secretariat (Budget tabs: Secretariat; Equipment – MOH, Office expenses – Internet MTN Togo. Total cost for activities in this section: $16,678) HDI will support four meetings (one per quarter) of the NTD secretariat, which are held for planning and coordinating NTD program activities (18 people for 1 day). An HDI representative will attend these meetings. HDI also provides reliable internet access and office supplies to the Secretariat office. A series of activities are planned to strengthen the skills and knowledge of the new secretariat of the NTD Program: train new members on the TIPAC, implementation of a DQA, M&E of PCT-targeted diseases, analysis of data for decision-making, and development of enduring collaborations with a range of partners.

Building Advocacy for a Sustainable National NTD Program (Budget tabs: Strategic Planning - Stakeholders Meeting. Total cost for activities in this section: $2,235)

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In FY 2017, with technical assistance, the NTD Program has developed an advocacy plan to help improve sustainability the NTD Program. Key target audiences include the private sector, civil society/groups, religious/denominational groups and organizations, and other health programs within the MOH. The plan includes efforts to identify and capitalize on areas of mutual benefit. The success of the NTD program provides an opportunity for positive marketing for private sector enterprises, while supporting ongoing NTD control and elimination activities. The plan also includes advocating for additional support from the government of Togo, in order to ensure the durability of the program. Success in eliminating target diseases can have a lasting beneficial economic impact that justifies investment in NTD control and elimination efforts. Potential barriers to the implementation of this plan include limited government resources and competition of different Ministries for those resources, prioritization of diseases other than NTDs within the Ministry of Health, and lack of advocacy experience within the NTD program, particularly given the new NTD team. Advocacy activities in FY 2018 will therefore focus on implementation of the previously developed advocacy plan, to develop the skills of the new team while achieving the stated goals of the plan. The private sector will be engaged by marketing the success of the NTD program as a platform for advertising campaigns from appropriate businesses. Other ministries (e.g. Ministry of Education) and other programs within the MOH will be engaged to strengthen existing activities or develop new platforms through synergistic activities that produce cost-savings and economies of scale. The success of the program and its resulting economic impact will be used to lobby for additional government resources to solidify gains. Civil and denominational organizations will be engaged to promote local disease control efforts and self-sufficiency within communities. Finally, Togo’s success with lymphatic filariasis elimination and strong collaborative and research skills may provide an opportunity to lobby for funds to push for further successes, and to implement proof-of-concept projects for the elimination of other NTDs. End in Africa has shared with government leadership the need for a robust transition strategy from USAID support to country government support, but this conversation needs to continue in more detail as the advocacy plan is implemented in FY2018.

Mapping (No associated budget) Mapping for all diseases is complete and no further mapping is planned in FY 2018.

MDA Coverage (Budget tabs: HDI MDA – Community Sensitization in 18 high-prevalence onchocerciasis villages, Total cost for activities in this section: $6,483) Reported MDA coverage has been excellent in Togo (Table 4). The primary areas of concern are those villages with onchocerciasis prevalence above 5% in recent years, in spite of decades of treatment with ivermectin with good reported coverage. Ahead of the FY 2017 MDA there was an intensive

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community sensitization and mobilization effort in 18 villages with onchocerciasis prevalence ≥5%. This activity consisted of a preliminary meeting with the village chief and village elders, followed by a community meeting held in conjunction with the chief, to describe the current situation with onchocerciasis and its potential for elimination in Togo, and highlight the importance of community participation in the MDA, and the impact of that participation, for both the immediate community and communities across Togo. This was followed by a focus-group type of discussion with key persons in the field – village chiefs, community drug distributors (CDDs), nurse heads of peripheral health units – to try to elucidate possible causes for the poor response to MDA (are some individuals not taking the drugs, is directly-observed therapy being used, are there migrant populations who are being missed, are there minority populations who are not being reached?). The results of this investigation were not yet available at the time of drafting of this document, however, the current plan is to implement this approach again in FY 2018 in all problem areas. (HDI MDA – Community Sensitization in 18 high-prevalence onchocerciasis villages) An integrated coverage validation survey will be conducted in areas with demonstrated persistence of onchocerciasis, schistosomiasis or STH where reported coverage has been good. Coverage for all three diseases will be assessed simultaneously. This will complement other work that the MOH is doing to determine causes of poor response to MDA. (Coverage Validation Survey) Table 4: USAID supported coverage results for FY16a

NTD # Rounds of

annual distribution

Treatment target (FY16) # DISTRICTS

# Districts not

meeting epi

coverage target in

FY16b

# Districts not

meeting program coverage target in

FY16c

Treatment targets (FY16)

# PERSONS

# persons treated (FY16)

Percentage of treatment target met

(FY16)

LF 0 0 N/A N/A 0 N/A N/A

OV 1 32d 0 0 2,961,648 2,879,395 97.2%

OV 2 15 1 0 1,403,831 1,298,664 92.5%

SCH 1 ---b 0 0 1,985,173 1,944,701 98.0%

STH 1 35e 0 0 1,955,633 1,942,971 99.4%

STH 2 6 0 0 412,128 413,550 100.4%

TRA 0 0 N/A N/A 0 N/A N/A aAll data in this table are from FY 2016. The FY 2017 had not been completed at the time this work plan was written. b Epi coverage is as defined in the disease workbook. The target epi coverage for onchocerciasis is 65%, and for STH the target epi coverage is 25% (given an estimated 30% of the population is SAC). Epidemiological coverage is not a meaningful measure for schistosomiasis treatment in Togo; within a given district, the target population of the different PHUs can include school-age alone, school-age children plus adult women at high risk due to their household activities, all persons age 5 years and older, or nobody at all. Therefore, there is no concise or useful way to calculate the epidemiological coverage for a district for all populations. c Program coverage is as defined in the disease workbook. The target program coverage for onchocerciasis, STH and schistosomiasis is 80%. d For onchocerciasis, when reporting data from those who received one round of annual distribution, we have included all districts that received at least one round of treatment, so this line includes the 15 districts that also received a second round of treatment. e For STH, when reporting data from those who received one round of annual distribution, we have included all districts that received at least one round of treatment, so this line includes the 6 districts that also received a second round of treatment

MDA plans for FY18

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In FY 2018, Togo will implement integrated nationwide MDA for onchocerciasis, schistosomiasis and STH through USAID funding. There will be several changes to the MDA implementation plan in FY 2018. The national integrated MDA that is usually implemented in March/April will be implemented region by region, and according to the realities of each district’s situation, while respecting the implementation period defined by the national coordinating body of the NTD Program. Implementation will begin in March 2018 in the south and will advance towards the north, in accordance with the progression of the rainy season. Drug distribution will be completed in two rather than four weeks. This somewhat decentralized approach will allow for better preparation for the MDA, and will simplify logistics and supervision of the fieldwork. This national distribution is considered the “first” round of treatment in calendar year 2018, but is the second round of treatment that occurs in FY 2018; see also Table 5. This target date comes slightly earlier in the year than usual, in order for all activities to be completed by the end of the grant period: June 30, 2018. Current targets for this “first” round are:

• Onchocerciasis – 3,132,379 million people/32 districts;

• Schistosomiasis – 3,145,948 million people/29 districts;

• STH – 2,053,591 million SAC/34 districts;

• 100% geographic coverage of at-risk areas. If the results of the onchocerciasis stop-MDA assessment in late FY 2017 are favorable, four of the 32 districts targeted for treatment in March 2018 will not be included; however, because those four districts are targeted for STH and schistosomiasis treatment as well, the four districts will be retained in the distribution plan at this time. A second round of integrated MDA for calendar year 2017 (the first round of treatment that occurs in FY 2018) will be conducted for onchocerciasis, schistosomiasis and STH in high prevalence areas in November 2017. All of these districts are also targeted during the larger, nationwide MDA starting in March 2018. Targets are:

• Onchocerciasis – 1,492,530 people/15 districts;

• Schistosomiasis – 626,831 SAC/19 districts/73 PHU;

• STH – 435,868 SAC/6 districts. Togo has always targeted high-risk adults for treatment with praziquantel for schistosomiasis, according to WHO guidelines, but donated medication will no longer be available for adults. Togo has already begun outreach to identify other sources of PZQ for high-risk adults and will continue to do so as necessary in FY 2018. Table 5: USAID-supported districts and estimated target populations for MDA in FY18

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Column definitions correspond to those found in the workbooks

NTD

Age groups targeted

(per disease workbook

instructions)

Number of rounds of

distribution annually

Distribution platform(s)

Number of districts to be treated

in FY18

Total # of eligible

people to be targeted in FY18

Lymphatic filariasisa None 0 None 0 0

Onchocerciasis Entire population age 5 and older

1

Integrated Community

MDA (door-to-door)

17b 1,639,849

Onchocerciasis Entire population

age 5 years or older

2


MDA (door-to-door)

15 1,492,530

Schistosomiasis SAC 1


MDA (door-to-door)

29 districts 2,519,117

Schistosomiasisd SAC 2


MDA (door-to-door)

73 PHU in 19 districts

626,831


SAC 1


MDA (door-to-door)

28 1,617,723


SAC 2


MDA (door-to-door)

6 435,868

Trachoma None 0 None 0 0

SAC=school-age children a LF has been eliminated as a public health problem in Togo. b Pending the results of the FY 2017 stop-MDA assessment, the number of districts to be treated in FY 18 may be 13. c Target age group depends on PHU-level prevalence and treatment follows WHO guidelines for treatment post-assessment. d From 2009 to 2015, schistosomiasis was targeted for treatment one time per year at the most, however, according to the results of the 2015 DSA, and WHO guidelines, there will be 73 PHUs in 19 districts that will be targeted for a second round of treatment in FY 2018.

Social Mobilization to Enable NTD Program Activities (Budget tabs: FOGs – FOGS 2 Social Mobilization; HDI MDA – MDA Kickoff, Community Sensitization in 18 high-prevalence onchocerciasis villages. Total cost for activities in this section: $42,766) Social mobilization prior to the MDA will continue to utilize town criers and local radio spots, which have been highly effective for publicizing the MDA. Togo’s 2012 coverage survey found that town criers were the most common source of information about the MDA, with nearly half of respondents having heard about the MDA from a town crier, followed by CDDs themselves and radio

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announcements as the second and third most common sources. Town criers, as well as religious and traditional leaders, will communicate the time and date of the MDA, goals of the MDA, and benefits of participation, both prior to and during the MDA, using the local language of the village. Radio announcements are broadcast in French and local languages. (FOGs – FOG 2 Social Mobilization) The nationwide MDA is begun with a high-profile celebration, generally featuring a high-level politician announcing the start of the MDA and taking the medications as part of a televised press conference. (HDI MDA – MDA Kick-off) The primary IEC materials used during the MDA are laminated flip charts, with photos on one side and short, educational messages for the CDDs to read out loud on the back (see Annex 9). These flip charts were updated in 2016 to simplify the messages about proper health and hygiene practices. The 2012 coverage survey also found that respondents who reported having been shown a flip chart by their CDD could list more health and hygiene practices for preventing NTD infection than could those who did not report having seen a flip chart. (No associated budget) In addition to the routine social mobilization activities, there will be intensive community sensitization and mobilization in villages with onchocerciasis prevalence ≥5%. This activity will consist of a preliminary meeting with the village chief and village elders, followed by a community meeting held in conjunction with the chief, to describe the current situation with onchocerciasis and its potential for elimination in Togo, and highlight the importance of community participation in the MDA, and the impact of that participation, for both the immediate community and communities across Togo. (HDI MDA – Community Sensitization in 18 high-prevalence onchocerciasis villages)

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Table 6: Social Mobilization/Communication Activities and Materials Checklist for NTD work planning

Category Key

Messages Target

Population

IEC Activity (e.g.,

materials, medium, training groups)

Where/when will they be distributed

Frequency

Has this material/message or

approach been evaluated?

If no, please detail in narrative how that will be addressed.

MDA Participation

MDA will take place during XXX dates.

Community members

Radio broadcast

Nationwide (in French and local languages) before and during the April MDA

At least three times daily x 5-6 weeks

Yes, in the 2012 coverage survey – radio broadcast was the third most commonly reported way that individuals learned about the MDA

MDA is taking place tomorrow/ today

Community members

Town criers In villages the day before and day of the MDA

Several times each day x 2 day

Yes, in the 2012 coverage survey – town criers were the most commonly reported way that individuals learned about the MDA

MDA is beginning and will continue over the next two weeks

Community members, press

Television Local television on day of and day after launch of MDA

Several times each day x 2 days

Yes, in the 2012 coverage survey

Take the medications to prevent certain diseases (pictured on the flip charts)

Community members

Flip charts Shown to household members by the CDDs when they visit each household

Once during the drug distribution and education activity

Flip charts were evaluated in the 2012 coverage survey, but not specifically to assess whether those shown flip charts were more likely to take the MDA medications

Disease Prevention

Engage in these practices (wash hands; wash face; sleep under LLIN; use latrine; take MDA medications)

Community members

Flip charts Shown to household members by the CDDs when they visit each household

Once during the drug distribution and education activity

Yes, in the 2012 coverage survey – individuals shown flip charts could cite more healthy practices that help prevent NTD infections than could those who were not shown flip charts.

Intensified community outreach in villages with oncho prevalence ≥5% by skin snip

Information on onchocerciasis infection, disease, and elimination, and the key role of MDA in

Communities with high onchocerciasis prevalence

Community meetings held in conjunction with village chiefs; flip charts

Held 1-2 weeks prior to the MDA in target villages

One meeting with village chief/elders, followed by one community meeting

The first instance of implementing this approach was in the 2017 MDA, which had not been completed at the time this document was drafted

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prevention/elimination

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Training (Budget tabs: Supervisor Training; FOGs – FOGS 2 – Nurse Training, CDD Training, Social Mobilization - Town Crier Briefing, Religious/traditional leaders; Supervisor Training, HDI MDA – Nurse Training, CDD Training, SCM Training. Total cost for activities in this section: $355,014) Trainings planned for FY 2018 are as follows: MDA Implementation (rows 1-6 of Table 7) Central, regional, district, and peripheral level personnel, including CDDs, will be trained on MDA implementation. These trainings are conducted every year, and for most participants this will be a refresher training, but because the MDA is a critical activity for this program, and because certain aspects of implementation change every year, including the distribution plan for many PHU, it is important to provide refresher training for all experienced participants, as well as training for new participants. (Supervisor Training; FOGs – FOG 2 – Nurse Training, CDD Training; HDI MDA – Nurse Training, CDD Training) Supply Chain Management (row 7 of Table 7) Personnel from different levels (central, regional, district, PHU) will receive training on supply chain management (SCM), to improve adherence to recommended best practices for drug management and timely return of medications and data after the MDA. This should also help address some of the issues with drug management identified during the May 2016 MDA (see Drug and Commodity Supply Management and Procurement). District level personnel have not previously received training specifically on SCM. (HDI MDA – SCM Training)

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Table 7: Training targets

Training Groups Training Topics Number to be Trained Number

Training Days

Location of training(s)

Other funding partners New Refresher

Total trainees

MOH/MOE at Central Level

Supervision skills; how to train trainers, SCM skills

0 12 12 2 Lomé None

Trainers Supervision skills; how to train trainers, SCM skills

0 150 150 3 Regional HQ

None

Supervisors / PHU nurses

MDA procedures; training of CDDs, SCM skills

0 667 667 3 District HQ None

CDDs IEC and drug distribution procedures for NTDs, and IEC for WASH

502 10,652 11154 2 PHU None

Town criers Standardization of the message disseminated by the town criers

7,000 0 7,000 1 PHU None

Religious and traditional leaders

Standardization of the messages leaders share with the community

1334 0 1334 1 TBD at local level

None

Training on logistics/ supply chain management (central and district level)

Capacity building on logistics and supply chain management

42 0 42 5 To be determined

None

NTD program data managers (central level)

Training on ArcGIS and graphic presentation of data (emphasis on oncho)

8 0 8 5 Lomé None

NTD data managers at the district and regional levels (from M&E section)

Standardization of data entry for the MDA, for utilization of district level data for national database


TIPAC Review TIPAC, analyze gaps, develop strategies to address gaps


Data analysis for decision making (Excel)

Using budget data to make resource decisions


Resource Mobilization

Ecosystem mapping, partners prioritization and business case development for resource mobilization (including proposal writing)


Training on WHO NTD database and Dz and Program workbooks

Train new NTD team on data management and WHO NTD database


DQA implementation in the field

Practical training first DQA field implementation

9 0 9 10 TBD None

M&E for USAID-targeted NTDs

Capacity building for M&E: concepts, selecting Indicators, conceptual and logical frameworks, impact evaluations, etc.


Onchocerciasis Program workers

Entomologic sampling and capture of black flies

0 5 5 1 Kara None

Onchocerciasis program workers

Implementation of epidemiological surveys

0 16 16 1 Kara None

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Drug Supply and Commodity Management and Procurement (Budget tabs: Drug Delivery, Data Collection, Adverse Events, Supervisor Training. Total cost for activities in this section: $65,311) In FY 2017, the albendazole delivery for the MDA arrived in July and cleared customs in August, nearly four months after the desired delivery date. The initial request for all three drugs (praziquantel, ivermectin and albendazole) was submitted on time in August, 2016. Unfortunately, a letter sent in October, 2016, to Togo’s Integrated NTD Coordinator from WHO’s Regional Program Review Group (RPRG), which requested information on the amount of ALB remaining in stock in Togo, was either not received or not acknowledged. New leadership took over the Integrated NTD Program in February, 2017, without any knowledge of this letter. In April, the new NTD Program Coordinator sent a letter of inquiry about the albendazole order to WHO and then learned of the missing information. Although the Coordinator responded quickly with the number of ALB tablets remaining in stock, the information was not sent in Excel format as the RPRG desired. After another delay and a second inquiry by the NTD Coordinator, this error was identified, the order was completed and the albendazole was received in Togo in August. This troubling chain of events resulted in a significant delay to the MDA and affected the timing of efforts to synchronize drug distribution with neighboring countries, as well as the planning of other NTD activities in Togo. Ultimately, all activities were successfully completed as originally planned, though not within the intended time frame. It is not possible to determine how the original letter from the RPRG went astray and did not receive an immediate response, nevertheless, the primary lesson from this experience is to reply immediately and completely to all inquiries and communications, and to follow up to confirm that replies sent have been received and are deemed complete. HDI will also continue their practice of reviewing the WHO Joint Request for Selected Medicines (JRSM) and other documentation for drug procurement prior to its submission to WHO. All other aspects of Togo’s procurement and supply management proceeded smoothly in FY 2017, as in previous years. Togo’s medication requirement is calculated based on the village populations enumerated during the MDA; every village is enumerated during every MDA, and the drug needs for a given year are determined by taking the larger of the two most recent population estimates for each village (adjusted to account for population growth) and summing those figures at the appropriate geographic levels to determine drug needs. The JRSM for FY 2018 has been submitted. The drug distribution guide, which indicates which populations are to receive which medications in each peripheral health unit, is drawn up by the MOH in close collaboration with HDI. Because of the complexity of Togo’s distribution plan, to ensure accuracy, the guide is reviewed by multiple people at the MOH and HDI.

Drugs are delivered from Lomé to each district by the MOH. Each PHU then collects its supply of drugs from the district and distributes the drugs to individual CDDs. (Drug Delivery)

At each step, drugs are dispatched with an inventory form stating the name of each drug, the quantity being distributed at that level (district, PHU, or village), the date the drugs are being distributed to that level, the lot number, and the expiration date. The signatures of both the person delivering and the person receiving the order are included at each transfer point. At the end of the MDA the inventory form must be returned to the next level up with an indication of how many doses of each drug were used, along with any unused drugs. (Data Collection)

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Unused drugs are returned to the district level by district transport, and collected by central level vehicles and returned to Lomé; however, ivermectin is stored at the regional level. Unused drugs that can be used in the next MDA are stored at Centrale d’Achats des Medicaments Essentials Generiques et des Consommables Medicaux (CAMEG) in Lomé. Once unused drugs are returned to the central level, HDI conducts the physical inventory of drugs with MOH personnel. Damaged drugs and any other waste materials from the MDA are collected and incinerated according to official national procedures. HDI will support the training of two teams from the NTD Program at the central and regional levels in the logistical management of the MDA medications (SCM). (Supervisor Training) Adverse events Identification, management, and reporting of adverse events are taught at the trainings. The CDD refers the patient immediately to the PHU dispensary closest to his locality. All adverse events are managed in accordance with Togo’s national system of pharmacovigilance. Serious cases are hospitalized. All cases are to be reported to the district supervisor and regional supervisor and notification of the case is to be sent by email or fax. The regional supervisor reports any severe adverse events (SAE) immediately by phone to the HDI office in Lomé and the MOH at the central level. To ensure complete reporting of all SAEs to all appropriate parties, HDI is responsible for reporting SAEs to parties outside of Togo. HDI will notify the Project Director for END in Africa at FHI 360 Headquarters and relevant medication donation programs by email within 24 hours of learning of any SAE. The latest WHO guidelines on management of SAEs have been incorporated into the Togo system for managing and reporting SAEs. Although the FY 2017 national MDA had not yet occurred as of this writing, reporting of adverse events worked well during the May 2016 MDA, when there were two SAEs reported, as well as in December 2016, when there was one SAE reported. Initial reporting was timely, an investigation of the situation was completed and all appropriate paperwork was completed and forwarded to the WHO and drug companies. All of the patients made a full recovery. (Adverse Events)

Supervision of MDA (Budget tabs: FOGs – FOG1 MDA Implementation (November), FOG 3 MDA (April), Rapid Evaluation; HDI MDA – MDA, MDA 2 (Fall); Data Collection, Supervisor Training. Total cost for activities in this section: $639,634) In FY 2018, as in past years, HDI staff will support the NTD program in conducting supervision by attending the training of supervisors and actively participating in supervision in the field during each of the MDAs. Primary responsibility for supervision lies with the districts. The PHU nurse is responsible for assuring effective rollout of the MDAs in their PHU. During the MDAs, district supervisors (three per district) visit PHU dispensaries, receive feedback from PHU nurses, visit any problem areas identified by the PHU chiefs, and select a subset of CDDs to follow and assess. The regional supervisors visit any problem areas identified by district supervisors and make additional supervisory visits as necessary. HDI and national level supervisors (including those from the Division of Pharmacy, Laboratory, and Technical Equipment, as well as representatives from each of the NTD programs)

26

make spot checks and visit problem areas as needed. (FOGs – FOG 1 MDA 2 (November), FOG 3 MDA (April), Rapid Evaluation; HDI MDA – MDA, MDA 2 (Fall)). Drug shortages are communicated from CDDs to PHU nurses to district level supervisors. Issues or bottlenecks that arise in terms of drugs or other supplies are addressed within the PHU, if possible (for example, drug shortage for one CDD can be resolved by drawing surplus drugs from another CDD in the same PHU). Larger scale issues can be resolved by having the PHU representative contact the district supervisor to arrange for inter-PHU movement of drugs or other supplies within the district, but to date there have not been supply issues above the level of the PHU. Field supervision during the MDA starting in March 2018 will also include a rapid evaluation, conducted by central level MOH supervisors toward the end of the MDA. Through the rapid evaluation, data on key aspects of implementation are collected to provide a snapshot of the distribution process that allows immediate intervention if problems are identified. The rapid evaluation questionnaire is used to ask individuals who are targeted for treatment whether they have received the drugs, for what reasons (if any) they did not receive the drugs (allows identification of unreported stock-outs), whether there were any adverse effects (allows identification of mild adverse effects), where they received the drugs (to confirm that distribution is occurring door-to-door), and where they heard about the MDA (which provides information on the effectiveness of the various methods of social mobilization that can be used to amend messages or change social mobilization approaches as needed in the future). (FOGs – FOG 3 Rapid Evaluation, HDI MDA – Rapid Evaluation) Typically, at the end of the MDA, a team of supervisors (one person from the central level and the regional focal point for NTDs) travels to each district and collects the treatment reporting forms and all unused drugs after validating quantity of stock remaining against the amount recorded on inventory records. They review forms for consistency and accuracy while in each district and ensure that any errors or omissions are corrected before forwarding the forms to the next higher level. The supervisory team brings copies of the PHU-level forms to Lomé for data entry and analysis. However, a new approach is planned for FY 2018. In FY 2018, HDI will work with the MOH to develop a more integrated and less expensive and time-consuming approach to data entry. All districts routinely enter their own data from the NTD MDA for their own use in the districts, but these data have not been used at the central level, rather, the village-level summarized data have been entered anew at the central level. But at the central level it has been necessary to hire external data entry personnel for the NTD MDA because there are not enough staff available at the MOH and DISER. In FY 2018, the plan is to obtain the district level data that have been entered and compile them at the central level for analysis. This will require standardization of the data entry template and the data entry methodology, which will require a one-time training. In preparation for the transition to this new approach, during the main FY 2017 MDA (not yet completed at the time of this writing), HDI will work with the MOH to collect and examine the files of data entered at the district level and will compare them to the centrally-entered data, to prepare for the training and identify any challenges. (Data Collection, Supervisor Training) After data have been entered and analyzed, the supervisors review reported geographic, epidemiological and programmatic coverage and investigate any unusual findings. HDI ensures that WHO distribution guidelines are adhered to by carefully reviewing the drug distribution guide (showing how many tablets should be delivered to each PHU) and by reviewing the MDA data to make sure that the correct populations were treated with the correct drugs in each village and PHU. Any

27

areas where treatment guidelines were not followed will be contacted through the supervisory chain and, if needed, drug distributors will revisit those areas and correct treatments will be given. Any errors in the distribution are specifically addressed in the training for the next year’s MDA.

Monitoring and Evaluation (Budget tabs: Maritime Epi Eval, Savanes Stop MDA Survey, Savanes Stop MDA Ento, Epi Eval Kara-Centrale-Plateaux, Coverage Validation Survey, SCH STH eval, Supervisor Training. Total cost for activities in this section: $360,733) The priority areas for M&E in FY 2018 will be determined in part by the results of two onchocerciasis DSAs, for which the data will not be available until the very end of FY 2017. Pending successful results from the stop-MDA assessment for onchocerciasis in Maritime region in the south, and the rapid onchocerciasis evaluation in the north, the priority areas for M&E in FY 2018 will be a need to develop and implement post-treatment surveillance (PTS) for onchocerciasis in Maritime region, and implement a full stop-MDA assessment in three districts in Savanes, the northernmost region of Togo. Implementation of a Data Quality Assessment (DQA) will also be important, especially in relation to the changes in data entry proposed (see Supervision for MDA section). Post-Treatment Surveillance (PTS) If the FY 2017 stop-MDA assessment in Maritime region is successful, MDA will be stopped in that region and there will be a need to develop and implement PTS. The approach will be developed in consultation with Togo’s OEC. While the details of the methodology are not yet described, and may be influenced by findings from the stop-MDA assessment, the approach would ideally entail both entomological assessments and Ov16 serologic testing in children, the latter likely using both sentinel sites and random “spot checks” in the four districts that will have stopped MDA in Maritime region. The PNLO has been working with Sightsavers to plan a definitive survey to ensure that all fly breeding sites have been identified in Togo, which will provide critical entomological information for PTS. The PNLO/NTD Program will need to seek funding outside of USAID to support PTS in flies. The epidemiological component of PTS is included in the budget accompanying this work plan, and will be particularly important if funding for the entomological PTS proves elusive. (Maritime Epi Eval) PTS for LF is a critical activity to ensure that Togo’s success with LF elimination is preserved. There is a real risk of reintroduction from endemic countries in the region, as evidenced by the fact that four of the five cases of microfilariae detected through PTS since MDA was stopped in 2009 were imported from endemic West African countries. Togo will additionally seek funding for its currently dormant PTS sentinel site program, composed of 40 laboratories and 20 health facilities. Disease-Specific Assessments (DSA) As with the stop-MDA assessment, the pending results of the rapid onchocerciasis evaluation in three districts in the north will determine next steps for those districts. If the rapid onchocerciasis evaluation using the Ov16 rapid diagnostic test (Ov16 RDT) in the north shows no evidence of active infection, then a full-scale stop-MDA assessment will be warranted. Although there is no certainty that Togo will “pass” either the stop-MDA or the rapid assessment, planning for FY 2018 is proceeding on the assumption that they will succeed. (Savanes Stop MDA Survey, Savanes Stop MDA Ento)

28

In the three central regions of Togo, Kara, Centrale and Plateaux, where MDA with IVM is ongoing but evidence suggests that there are still focal areas of onchocerciasis transmission, epidemiological surveillance has been conducted annually using skin snips as recently as December 2015. No routine surveillance was conducted in these areas in FY 2017, but in FY 2018 Ov16 serologic surveillance will be conducted at sentinel and “spot check” sites in these areas. Because the WHO does not specify how surveillance should be conducted prior to stop-MDA surveys, the details of the sampling and methodology will be discussed and reviewed with Togo’s OEC. (Epi Eval Kara-Centrale-Plateaux) An integrated DSA for schistosomiasis and STH was conducted in 2015, and no additional DSA is needed for these diseases in FY 2018. A trachoma survey implemented in August 2017 will provide the data required for moving forward with trachoma elimination in Togo and no additional DSA for trachoma is needed. The three LF TAS are the only DSAs conducted in Togo to date for which there is a critical cutoff and the results are available, and the cutoff was met in all three TAS; in Table 9 there is therefore no DSA that failed to meet its critical cutoff threshold. Coverage Validation Survey An integrated coverage validation survey will be conducted in areas with demonstrated persistence of onchocerciasis, schistosomiasis or STH where reported coverage has been good. Coverage for all three diseases will be assessed simultaneously. This will complement other work that the MOH is doing to determine causes of poor response to MDA. (Coverage Validation Survey) Data Quality Assessment (DQA) The MOH received training on the Data Quality Assessment tool in FY 2017. The DQA tool provides a standardized means of evaluating the quality of the NTD Program’s data and assists with tracking improvements in the program and identifying persistently problematic areas, neither of which are currently rigorously tracked. In FY 2018 the MOH has requested technical assistance for implementation of the DQA in the field. (STTA) Management of MDA data: As described above in the Supervision section, in FY 2018 HDI will work with the MOH to capitalize on existing decentralized data entry activities by compiling MDA data entered at the district level into a central-level database. The goal is to establish a standardized approach to data entry across districts that will be less costly and therefore more sustainable than the current practice, which entails expending resources to outsource data entry at the central level when those same data have already been collected and entered at the district level. As mentioned in the Supervision section, this will require standardization of the data entry template and the data entry methodology and a one-time training. In preparation for the transition to this new approach, during the main FY 2017 MDA (not yet completed at the time of this writing), HDI will work with the MOH to collect and examine the data entered at the district level and will compare them to the centrally-entered data, to prepare for the training and identify any challenges. (Supervisor Training) National Database Roll-out The new team at the NTD Program will receive training on the WHO’s National NTD Database, which they will then be able to use independently. (STTA) Other M&E activities

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Finally, a specific M&E need in FY 2017 is to investigate the reason for the persistent high prevalence of schistosomiasis in Ogou district and of STH in Ogou and Haho districts. Although the 2015 DSA for STH and schistosomiasis demonstrated a significant decrease in the overall prevalence of both diseases after five years of MDA, these two districts did not experience the same decrease and an in-depth investigation is needed to determine why. This activity was planned for FY 2017 but with the change in personnel and multiple evaluations and special activities during the year, the team did not have the opportunity to conduct the investigation. HDI will provide TA for this work. (SCH STH Eval) Table 9: Reporting of DSA supported with USAID funds that did not meet critical cutoff thresholds as of September 30, 2017

NTD

Number of remaining endemic districts (same as Table2)

Type of DSA carried

out (add extra rows as needed for

each type)

Number of DSAs

conducted with USAID

support

Number of EU that did not meet critical

cutoff thresholds

Why did the EU

not “pass”

the DSA?

Post-DSA failure

activities (be specific

about timeframes)

Lymphatic filariasis

8 TAS 3a 0 N/A N/A

Onchocerciasis 32 Stop-MDA

assessment 1 Data pendingb N/A N/A

Onchocerciasis 32

Rapid evaluation

(oncho “pre-TAS”)

1 Data pendingc N/A N/A

Trachoma 0 TF and TT

surveyd 1 Data pendinge N/A N/A

a Three TAS with four evaluation units each have been conducted, in 2009 (funded by LF Support Centre for Africa) and in 2012 and 2015 (supported by USAID). b Seven districts in the south of Togo were evaluated in June-August 2017; results are pending as of the drafting of this document. c Three districts in Savanes region in the far north of Togo are being evaluated in August 2017 using the Ov16 RDT and ELISA as a means of quickly assessing whether that area is ready for a full stop-MDA assessment; results are pending as of the drafting of this document. Funding is through both Sightsavers and USAID. d TF=trachomatous inflammation, follicular; TT=trachomatous trichiasis e A trachoma cluster survey of TF and TT prevalence was conducted in seven districts in August 2017 with support from USAID and Tropical Data, to provide the final key data needed to proceed with trachoma elimination in Togo; results are pending as of the drafting of this document.

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Table 10: Planned Disease-specific Assessments for FY18 by Disease

Disease No. of

endemic districts

No. of Evaluation

Units

No. of Evaluation

Units planned for

DSA

Type of assessment

Diagnostic method (Indicator: Mf, FTS, etc)

Onchocerciasis 32 Not

established 1a Stop-MDA

Ov16 ELISA and O-150 PCR


established 1

Post-MDA surveillance

Ov16 ELISA


established 3

Surveillance in high-risk

villages Ov16 Rapid test

a This survey is planned pending the results of the rapid evaluation in the north of Togo in September 2017.

Supervision for Monitoring and Evaluation and DSAs (No associated budget) For onchocerciasis, HDI worked closely with Togo’s MOH, WHO-Geneva, CDC, and members of the OEC to review Togo’s data in detail and develop a stop-MDA assessment study design and sampling that adheres to WHO guidelines. These collaborations were critical because while the WHO Guidelines for Stopping Mass Drug Administration stipulate what testing is needed to demonstrate elimination of onchocerciasis, they do not provide details on survey implementation. HDI will similarly work with these groups to develop PTS for onchocerciasis that is comprehensive and robust, because while WHO mandates PTS they do not specify how it should be implemented. An integrated coverage validation survey will be conducted in areas with demonstrated persistence of onchocerciasis, schistosomiasis or STH. Togo has expertise implementing and supervising coverage surveys.

Dossier Development (No associated budget) In FY 2017 Togo made great progress toward trachoma elimination by outlining the necessary remaining steps at an international meeting of experts in March 2017, followed by trachoma mapping in August 2017 in the seven districts where data indicate investigation is warranted. We anticipate that, based on the results of the trachoma survey that will be available early in FY 2018, the only remaining public health intervention needed before submitting a dossier will be morbidity reduction through trichiasis surgeries. HDI will work with the MOH to draft the narrative for the dossier. The Coordinator of the Integrated NTD Program in Togo has received the outline of the trachoma dossier and is aware of the process of requesting validation from WHO. Togo can additionally draw on the experience and success of those in the LF program who have been through the process of dossier submission, as Togo did encounter some delays related to the fact that the validation process was also new to many at the AFRO office. Given that all necessary data for the trachoma dossier will be available as of the beginning of FY 2018,

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and most of the data have been previously summarized and presented, the goal will be to have a draft of the dossier completed by the beginning of the third quarter of FY 2018, ready for submission once the burden of trichiasis has been reduced below the level necessary for declaring elimination of trachoma as a public health problem.

Short-term Technical Assistance (Budget tabs: Travel. Total cost for activities in this section: $11,114) Short-term technical assistance will be requested for updating the TIPAC, training on M&E of PCT-targeted diseases, training on implementation of the DQA tool in the field, training on completion and utilization of the WHO database for NTDs, advocacy and stakeholder outreach, foundations of data analysis for budget decision-making using Excel, ArcGIS, and expert technical advice on onchocerciasis elimination activities at one OEC meeting.

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Table 11: Technical Assistance request from END in Africa

Task-TA needed (Relevant Activity

category)

Why needed

Technical skill required (source

of TA (CDC, RTI/HQ, etc))

Number of Days required and

anticipated quarter

Funding source (e.g., country

budget, overall budget, CDC

funding)

Internal support (e.g., RTI/HQ, USAID, CDC) Follow-up training from Deloitte to update the TIPAC for FY18 (Strategic Planning)

The Neglected Tropical Disease Program (NTDP) would like assistance in the analysis and utilization of the data emerging from the TIPAC

Expertise on TIPAC (Deloitte)

1 week, Q1 of FY18 END in Africa overall budget

Training on completion and utilization of the WHO NTD database

Update the new team on program data management and improve capacity for responding to future challenges in the program

Expertise in the WHO NTD database


Implementation of the DQA in the field

Assist new NTD team with the first instance of field implementation of the DQA tool

Expertise in the DQA tool


M&E on PCT-targeted diseases

Update new team on the correct completion, interpretation and use of the USAID Disease and Program Workbooks

Expertise on M&E for NTDs, and on Disease and Program Workbooks


Ecosystem mapping, partners prioritization and business case development for resource mobilization (including proposal writing)

The NTDP would like technical assistance on advocacy and stakeholder outreach

Expertise on advocacy (Deloitte)


Foundations of data analysis for decision-making using Excel

The NTDP would like technical assistance on using data for decision making

Deloitte 1 week, Q2 of FY18 End in Africa overall budget

Training on ArcGIS and graphic presentation of data

The NTD Program, would like to have the capacity to independently graph their epi and entomology data, particularly to help with onchocerciasis elimination

Expertise in training on ArcGIS; can train in French (FHI360)


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Task-TA needed (Relevant Activity

category)

Why needed

Technical skill required (source

of TA (CDC, RTI/HQ, etc))

Number of Days required and

anticipated quarter

Funding source (e.g., country

budget, overall budget, CDC

funding) External support (e.g., hired consultants) External expert participation at Togo’s OEC meeting

Although Togo has many highly accomplished oncho experts, additional input from WHO, MDP, and entomology and oncho elimination experts is needed at one OEC meeting during the year

Expertise in onchocerciasis and onchocerciasis elimination (WHO/CDC, MDP, Carter Center)

Travel support for four people x 1 week, Q1 of FY18

Country budget

PLANNED FOGs TO LOCAL ORGANIZATIONS AND/OR GOVERNMENTS

Table 12 lists the three fixed obligation grants (FOGs) to the Togo MOH that are planned for FY 2018. Table 12: Planned FOG recipients—include for all subpartners as well.

FOG recipient (split by type of

recipient)

No. of

FOGs Activities

Target Date of FOG application

to USAID Togo MOH 2 • Social mobilization activities and training of nurses and CDDs in

advance of the March 2018 MDA

• Planning and implementation of the March 2018 MDA, including the development of a detailed distribution plan, and submission of a final report of the MDA

• Rapid evaluation during the March 2018 MDA

Dec 2017

Togo MOH 1 • Implementation of the November 2017 MDA Nov 2017

CROSS-PORTFOLIO REQUESTS FOR SUPPORT

The most significant gap in Togo’s program is funding for trichiasis surgery to reduce the burden below the threshold necessary to achieve elimination of trachoma as a public health problem. Some support for this was obtained through the Bill & Melinda Gates Foundation, and other long-term partners of the MOH such as Sightsavers also support blindness prevention, but additional funding is needed. The MOH has also proposed an investigation into the possibility of hookworm resistance to albendazole as a cause for the poor response to MDA with albendazole in Haho district. In Haho, in 2009, the prevalence of STH among SAC was 30%, and after four years of MDA prevalence was still 27.4%. In contrast, the prevalence of schistosomiasis was reduced from 42% to 11.9%, suggesting that MDA coverage is an unlikely reason for the poor response to albendazole. The Coordinator of

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the LF Elimination Program, also Chief of Laboratories, has proposed a study to examine whether the discrepancy could be due to albendazole resistance among hookworm. Finally, the LF Elimination Program continues to search for funding for morbidity management and disability prevention for LF, as well as for post-elimination surveillance.

Table 13: Cross-Portfolio Requests for Support

Identified Issue/Activity for which support is requested.

Which USAID partner would likely be best positioned to provide this support?

Estimated time needed to address activity

Trichiasis surgeries To be determined One year

Investigation of the possibility of hookworm resistance to albendazole in the district of Hahoa

Task Force for Global Health 4 months

LF morbidity management and disability prevention (MMDP) activities

To be determined Ongoing

LF post-elimination surveillance To be determined Ongoing a See Appendix 10.

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MAPS

The following five maps show disease presence by district, districts undergoing MDA, districts that are currently undergoing or will undergo onchocerciasis DSA, districts that are currently undergoing TAS DSA, and previously endemic LF districts. Map 1: Disease presence by district, Togo. Note: this map may change if four districts in the south pass the onchocerciasis stop-MDA assessment at the end of FY 2017.

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Map 2: Target districts for integrated MDA with USAID funding, Togo. Note: this map may change if four districts in the south pass the onchocerciasis stop-MDA assessment at the end of FY 2017. All districts also receive ALB MDA for pre-school age children through UNICEF.

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Map 3: Onchocerciasis DSA in Togo supported by USAID. Note: Of the districts highlighted for onchocerciasis DSA in higher prevalence villages, not every district will be included in FY2018. The specific villages to be evaluated will be determined by the Onchocerciasis Elimination Committee at its meeting in October 2017.

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Map 4: Trachoma DSA in Togo supported by USAID. Note: The districts shown are currently being surveyed in August 2017. No additional trachoma DSA is planned for FY 2018.

39

Map 5: LF districts that have passed two post-MDA TAS. Togo has received a WHO letter of verification of elimination of trachoma as a public health problem.

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APPENDICES

1. Country staffing/HDI organizational chart 2. Work plan timeline 3. Work plan deliverables 4. Table of USAID-supported provinces/states and districts marked by disease/activity 5. FY17 Q1-2 Country SAR 6. Program Workbook 7. Disease Workbook 8. Country budget 9. Proposal on investigation of possible resistance of hookworm to albendazole

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Appendix 1. HDI Organizational Chart

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Appendix 2. Timeline

FY2017-2018

StrategicPlanning O N D J F M A M J J A S

MeetingofNationalOrganizingCommittee X X X X X X X X X

NTDSecretariatmeetings X X X

WorkPlanningmeetingforFY2019 X

Cross-bordermeetings(Ghana,Benin) X

Firstdraft/finaldrugapplicationsforFY2018 X

MonthlyFinancialReporting X X X X X X X X X X X

VATReport X

CostShareReporting X X

Semi-annualreports X X

ReviseMDAtools X X X

Reproducedosepoles,printmaterialsforMDA X X X

Programreview/finalizemicroplans X

Receivemedications X X

Revise,producemessagesforsocialmobilization X

Implementsocialmobilizationactivities/IEC2 X X X

Distrib.suppliesanddrugstodistricts&PHUs X X

Briefingofsupervisors X X

Cascadetraining(trainers,nurses,CDDs) X

MDAimplementation,supervision,surveillanceforadverseeffects,rapidevaluation X X X X

Tally,synthesize,andvalidatedataatPHUs X X X X

Collectdrugsandfinancialdocuments X X X X

CompileMDAdataenteredatdistrictlevelintonationaldatabase X X X X

M&E–GeneratereportofMDA X X

Coveragesurvey X

Comm.Sensitizationhighprevonchovillages X

OnchocerciasisstopMDAsurvey X

Onchocerciasispost-MDAevaluation X

Onchocerciasissurv.–atrisk/higherprevzones X

Onchocerciasisentomologicalsurveys(stop-MDAsurveyinMaritime-activitycontinuedfromFY

2017)X X

Onchocerciasiseliminationcommitteemtgs X X X

SCH/STHinvestigation X

Dossierpreparation X X X X X X X X X

WHOdrugorderform X

WHOdatabaseandDiseaseworkbook X

WHODQA X

M&EforPCT-targeteddiseases X

TIPAC X

Resourcemobilization X

Supplychainmanagement X

ArcGIS X

Month(October-September)

Onchocerciasis

MassDrugAdministration

Trachoma

Training

Schisto/STH

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Appendix 3. Work Plan Deliverables

HDI will provide the following deliverables in FY 2018:

Mass Drug Administrations

• March-May 2018: One nationwide mass drug administration of ivermectin (IVM), praziquantel (PZQ), and albendazole (ALB) for onchocerciasis, schistosomiasis, and soil transmitted helminths (STH), respectively, to all persons in all endemic areas according to disease prevalence, WHO guidelines, and Togo’s Five Year strategic Plan for NTDs. Targets are:

o Onchocerciasis – 3,132,379 million people/32 districts; o Schistosomiasis – 3,145,948 million people/29 districts; o STH – 2,053,591 million SAC/34 districts; o 100% geographic coverage of at-risk areas.

• November-December 2017: One mass drug administration of IVM, PZQ and ALB in those districts warranting a second round of mass drug administration according to WHO guidelines and disease prevalence. Targets are:

o Onchocerciasis – 1,492,530 people/15 districts; o Schistosomiasis – 626,831 SAC/19 districts/73 PHU; o STH – 435,868 SAC/6 districts.

Surveillance, Monitoring and Evaluation Onchocerciasis

• Epidemiological evaluation in 75 villages in areas of higher onchocerciasis prevalence

• Epidemiological evaluation for stop-MDA decision in all 4 districts of Savanes region

• Epidemiological evaluation post-MDA in 20 villages in Maritime district STH/schistosomiasis

• Evaluation of poor impact of MDA – Haho and Ogou districts Other

• Implementation of DQA tool in the field

• Integrated coverage validation survey focusing on high-risk/higher prevalence onchocerciasis areas

Strategic Planning

• Support quarterly NTD secretariat meetings

• Three meetings of the onchocerciasis elimination committee; one with international experts

• One work planning meeting (with MOH, FHI360, USAID, and other partners)

• Review and revise NTD five-year strategic plan

• Review and revise, according to new WHO guidelines, the Five Year Strategy for Elimination of Onchocerciasis

• Two cross-border meetings (Ghana and Benin) to address cross-border issues, particularly for onchocerciasis

• Three meetings of the Onchocerciasis Elimination Committee

• Meeting to support development of NTD Program Annual Operational Plan

• Meeting to review TIPAC, analyze gaps, and develop strategy for addressing those gaps

Training

• Train more than 12,000 persons on MDA implementation;

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• Train more than 7,000 town criers on goals/timing of MDA;

• Train more than 1,300 religious and traditional leaders on goals of MDA;

• Train onchocerciasis field workers on entomologic (5 people) and epidemiologic (16 people) field practices;

• Train more than 40 district-level people on supply chain management

• Train 25 people on analysis of TIPAC

• Train 10 people on using data for decision making

• Train 10 people on resource mobilization

• Train 10 people on completion and use of the WHO NTD database

• Train 9 people on the field implementation of the DQA tool

• Train 15 people on M&E for PCT-targeted NTDs

• Train 8 people on Arc-GIS

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Appendix 4. Table of USAID-supported districts marked by disease/activity

Region Health

Districts Oncho MDA

SCH MDA

STH MDA

Oncho epi surv: high risk/prev

villages

Oncho stop MDA

assessment

Oncho post-MDA

epi eval SCH/STH

evaluation

1

Centrale

Blita X X X X

2 Sotouboua X X X X

3 Tchamba X X X X

4 Tchaoudjo X X X X

5

Kara

Assoli X X X X

6 Bassar X X X X

7 Binah X X X X

8 Dankpen X X X X

9 Doufelgou X X X X

10 Keran X X X X

11 Kozah X X X X

12

Lomé

Lomé 1

13 Lomé 2

14 Lomé 3

15 Lomé 4

16 Lomé 5

17

Maritime

Avé X X X X

18 Bas Mono X X X X

19 Golfe X X

20 Lacs X X

21 Vo X X

22 Yoto X X X X

23 Zio X X X X

24

Plateaux

Agou X X X X

25 Akébou X X X X

26 Amou X X X X

27 Anie X X X X

28 Danyi X X X

29 Est Mono X X X X

30 Haho X X X X X

31 Kloto X X X X

32 Kpele X X X X

33 M. Mono X X X X

34 Ogou X X X X X

35 Wawa X X X X

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Savanes

Cinkassé X X X X

37 Kpendjal X X X X

38 Oti X X X X

39 Tandjoaré X X X X

40 Tone X X X X

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