Uganda Work Plan - ENVISION · Uganda Work Plan FY 2018 Project Year ... Administrative Structure...

Uganda Work Plan FY 2018

Project Year 7

October 2017–September 2018

ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred

Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision.

ENVISION is funded by the US Agency for International Development under cooperative agreement No. AID-OAA-A-11-

00048. The period of performance for ENVISION is September 30, 2011 through September 30, 2019.

The author’s views expressed in this publication do not necessarily reflect the views of the US Agency for International

Development or the US Government.

ENVISION FY18 PY7 Uganda Work Plan

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ENVISION Project Overview

The US Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to

support the vision of the World Health Organization (WHO) and its member states by targeting the

control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF),

onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm,

whipworm, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at

global and country levels and support ministries of health (MOHs) to achieve their NTD control and

elimination goals.

At the global level, ENVISION—in close coordination and collaboration with WHO, USAID, and other

stakeholders—contributes to several technical areas in support of global NTD control and elimination

goals, including the following:

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

• Capacity strengthening

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

• Disease mapping

• NTD policy and technical guideline development

• NTD monitoring and evaluation (M&E)

At the country level, ENVISION provides support to national NTD programs by providing strategic

technical and financial assistance for a comprehensive package of NTD interventions, including the

following:

• Strategic annual and multi-year planning

• Advocacy

• Social mobilization and health education

• Capacity strengthening

• Baseline disease mapping

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

• Drug and commodity supply management and procurement

• Program supervision

• M&E, including disease-specific assessments (DSAs) and surveillance

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


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TABLE OF CONTENTS ENVISION Project Overview .......................................................................................................................... ii

TABLE OF TABLES ......................................................................................................................................... iv

TABLE OF FIGURES ........................................................................................................................................ v

ACRONYMS LIST ........................................................................................................................................... vi

COUNTRY OVERVIEW .................................................................................................................................... 8

1) General Country Background .................................................................................................... 8

a) Administrative Structure ........................................................................................................... 8

b) Other NTD Partners ................................................................................................................... 9

2) National NTD Program Overview ............................................................................................ 14

a) Lymphatic Filariasis ................................................................................................................. 15

b) Trachoma ................................................................................................................................. 16

c) Onchocerciasis ......................................................................................................................... 17

d) Schistosomiasis ........................................................................................................................ 18

e) Soil-Transmitted Helminthiasis ............................................................................................... 19

3) Snapshot of NTD Status in Uganda .......................................................................................... 20

PLANNED ACTIVITIES ................................................................................................................................... 21

1) NTD Program Capacity Strengthening ..................................................................................... 21

a) Situation ..................................................................................... Error! Bookmark not defined.

b) Strategic Capacity Strengthening Approach ............................... Error! Bookmark not defined.

c) Capacity Strengthening Objectives and Interventions ............... Error! Bookmark not defined.

d) Supporting Field-based ENVISION Staff in Capacity Strengthening .......... Error! Bookmark not

defined.

e) Monitoring Capacity Strengthening ........................................................................................ 21

2) Project Assistance .................................................................................................................... 23

a) Strategic Planning .................................................................................................................... 23

b) NTD Secretariat ....................................................................................................................... 24

a) Building Advocacy for a Sustainable National NTD Program .................................................. 24

b) Mapping .................................................................................................................................. 26

c) MDA Coverage ......................................................................................................................... 26

d) Social Mobilization to Enable NTD Program Activities ............................................................ 28

e) Training .................................................................................................................................... 33

f) Drug and Commodity Supply Management and Procurement ............................................... 37

g) Supervision for MDA ............................................................................................................... 37


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h) M&E ......................................................................................................................................... 38

i) Supervision for M&E and DSAs ............................................................................................... 41

j) Dossier Development .............................................................................................................. 42

k) Short-Term Technical Assistance ............................................... Error! Bookmark not defined.

3) Planned FOGs to Local Organizations and/or Governments ...... Error! Bookmark not defined.

4) Cross-Portfolio Requests for Support ......................................... Error! Bookmark not defined.

5) Maps ........................................................................................................................................ 44

APPENDIX 1: Country Staffing/Partner Organizational Chart ........................ Error! Bookmark not defined.

APPENDIX 2: Work Plan Timeline................................................................................................................ 48

APPENDIX 3: Work Plan Deliverables............................................................. Error! Bookmark not defined.

APPENIDX 4. Table of USAID-supported Regions and Districts in FY18 ...................................................... 50

APPENDIX 5: FY17 Q1-2 Uganda SAR ............................................................. Error! Bookmark not defined.

APPENDIX 6: Program Workbook (MS Excel) ................................................. Error! Bookmark not defined.

APPENDIX 7: Disease Workbook (MS Excel) .................................................. Error! Bookmark not defined.

APPENDIX 8: Country Budget (MS Excel) ....................................................... Error! Bookmark not defined.

APPENDIX 9: UOEEAC’s OV Flag .................................................................................................................. 54

TABLE OF TABLES

Table 1: Non-ENVISION NTD partners working in country, donor support, and summarized

activities ............................................................................................................................ 13

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

2017 .................................................................................................................................. 20

Table 3: Project assistance for capacity strengthening ..................... Error! Bookmark not defined.

Table 4: USAID-supported coverage results for FY16 ........................ Error! Bookmark not defined.

Table 5: USAID-supported districts and estimated target populations for MDA in FY18 .............. 27

Table 6: Social mobilization/communication activities and materials checklist for NTD work

planning ............................................................................................................................ 30

Table 7: Training targets ................................................................................................................. 34

Table 8A: Reporting of DSA supported with USAID funds that did not meet critical cutoff

thresholds as of September 30, 2017 .................................. Error! Bookmark not defined.

Table 8B: Reporting of OV-specific DSA supported with USAID funds that did not meet critical

cutoff thresholds as of September 30, 2017 ....................... Error! Bookmark not defined.

Table 9a: Planned DSAs for FY18 by disease .................................................................................... 41

Table 9b: Planned OV-specific assessments for FY18 ....................................................................... 41

Table 10: Technical assistance request from ENVISION ...................... Error! Bookmark not defined.


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Table 11: Planned FOG recipients ....................................................... Error! Bookmark not defined.

TABLE OF FIGURES

Figure 1: Uganda regional and district maps ..................................................................................... 8

Figure 2: ENVISION-supported MDA for LF, FY12–FY16 ..................... Error! Bookmark not defined.

Figure 4: ENVISION-supported MDA for trachoma, FY12–FY16 ......... Error! Bookmark not defined.

Figure 3: ENVISION-supported MDA for Oncho, FY12–FY16 .............. Error! Bookmark not defined.

Figure 5: ENVISION-supported MDA for Schistosomiasis, FY12–FY16 Error! Bookmark not defined.

Figure 6: ENVISION-supported MDA for STH, FY12–FY16 .................. Error! Bookmark not defined.

Figure 7. Uganda LF, OV, STH, SCH, and Trachoma Endemicity Maps ............................................ 44

Figure 8. Uganda LF, OV, SCH, STH, and Trachoma Geographic Coverage Maps ............................ 44

Figure 9. Uganda Progress Toward LF Elimination Map .................................................................. 46

Figure 10. Uganda Progress Toward Trachoma Elimination Map ..................................................... 47


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ACRONYMS LIST

AE Adverse Events

AFRO WHO Regional Office for Africa

ALB Albendazole

BCC Behavior Change Communication

CAO Chief Administrative Officer

CBM Christian Blindness Mission

CCP John Hopkins School of Public Health’s Center for Communication Programs

CDD Community Drug Distributor

CFA Circulating Filarial Antigen

CHEW Community Health Extension Worker

CLTS Community-led Total Sanitation

CY Calendar Year

DDT Dichlorodiphenyltrichloroethane

DFID (United Kingdom) Department for International Development

DGHS Director General of Health Services

DHO District Health Office(r)

DRC Democratic Republic of the Congo

DSA Disease-Specific Assessments

ELISA Enzyme-Linked Immunosorbent Assay

EU Evaluation Unit

FOGs Fixed Obligated Grants

FTS Filariasis Test Strip

FY Fiscal Year

GTMP Global Trachoma Mapping Project

HAT Human African Trypanosomiasis

HMIS Health Management and Information System

HPED Health Promotion Education Division (MOH)

HSD Health Sub district

IDM Innovative and Intensified Disease Management

IEC Information, Education, and Communication

IRS Indoor Residual Spraying

ITI International Trachoma Initiative

IU Implementation Unit

IVM Ivermectin

JRSM Joint Request for Selected (PC) Medicines (WHO)

KAP Knowledge, Attitudes, and Practices (study)

LC Local Council

LF Lymphatic Filariasis

LLIN Long Lasting Insecticide Treated Net

M&E Monitoring and Evaluation

MDA Mass Drug Administration

MEB Mebendazole

Mf Microfilariae

MMDP Morbidity Management and Disability Prevention


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MOH Ministry of Health

MP Member of Parliament

NMS National Medical Stores

NOCP National Onchocerciasis Control Program

NTD Neglected Tropical Disease

NTDCP Neglected Tropical Disease Control Program

OV Onchocerciasis

PC Preventive Chemotherapy

PCR Polymerase Chain Reaction

PDC Parish Development Committee

PELF Program to Eliminate Lymphatic Filariasis

PTS Post-Treatment Surveillance

PM Program manager

PZQ Praziquantel

RDC Resident District Commissioner

RPRG Regional Program Review Group

SAC School-Aged Children

SAE Serious Adverse Event

SAFE Surgery, Antibiotics, Facial cleanliness, Environmental improvements

SAR Semi Annual Report

SAS Senior Assistant Secretary

SCH Schistosomiasis

SCI Schistosomiasis Control Initiative (Imperial College London, UK)

STH Soil-Transmitted Helminths

STTA Short-Term Technical Assistance

TA Technical Assistance

TAF Technical Assistance Facility

TAS Transmission Assessment Survey

TEO Tetracycline Eye Ointment

TF Trachomatous Inflammation - Follicular

TIS Trachoma Impact Survey

TOT Training of Trainers

Trust Queen Elizabeth Diamond Jubilee Trust

TSS Trachoma Surveillance Survey

TT Trachomatous Trichiasis

UNICEF United Nations Children’s Fund

UOEEAC Uganda Onchocerciasis Elimination Expert Advisory Committee

USAID United States Agency for International Development

VCD Vector Control Division (MOH)

VHT Village Health Team

WASH Water, Sanitation, and Hygiene

WHO World Health Organization

WVU World Vision Uganda

ZTH Zithromax®


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COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Uganda is divided into four administrative regions: Central, Western, Eastern, and Northern. These four

regions are in turn divided into districts, subcounties, parishes, and villages. In September 2015, an act

of parliament created 23 new districts to be phased in over three years, increasing the number to 116 in

2016, 122 in 2017, and 128 in 2018.

Districts are sometimes loosely grouped into one of 11 sub-regions based on names given during the

colonial period: Buganda, Busoga, Bukedi, Teso, Karamoja, Lango, Acholi, West Nile, Bunyoro, Ankole,

and Kigezi (see Ugandan regional and district maps, Figure 1). For example, Karamoja sub-region is

comprised of eight districts. Sub-regions are not active administrative or political units, although they

approximately demarcate ethnic groups and are used to refer to key targeted areas and populations for

disease control activities, such as targeting specific information, education, and communication (IEC)

materials.

Figure 1: Uganda regional and district maps

Regions of Uganda Districts of Uganda

District administration

Uganda has a decentralized administrative system with some powers devolved to the district and lower-

level local governments. The Ugandan Ministry of Health (MOH), including the neglected tropical

disease (NTD) program, conducts its activities along the same political and civil service administrative

structures found in districts, as outlined below.

Each district has an elected political head, known as the Local Council (LC) 5 chairperson, who presides

over a council of elected subcounty representatives. The LC5 chairperson selects ministers or secretaries

from the council who are responsible for specific portfolios: for example, the Secretary for Health is the


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district equivalent of the national-level Minister of Health. Other district-level leaders include the Chief

Administrative Officer (CAO)—a civil servant who is the district accounting officer and who has overall

oversight of the district civil service in the district. The Resident District Commissioner (RDC) represents

the Office of the President in the district and is responsible for the supervision of implementation of all

government programs as well as coordinating security matters. The district local government

headquarters are normally located in the biggest town or municipal council (urban center). Town and

municipal councils have their own structures similar to those of the district local administrations. In

FY18, ENVISION will support mass drug administration (MDA) and related activities in 26 districts.

County and subcounty administration

Districts used to be divided into counties; these have now been replaced by political constituencies and

are administratively non-functional save for the creation of health sub districts (HSDs), which operate at

the level of the former counties. Currently, the functional administrative unit in the local government

system is the subcounty. The subcounty is headed by a Senior Assistant Secretary (SAS), formerly titled

supcountry chief, a civil servant reporting directly to the CAO. Also at the subcounty level are LC3

chairpersons and councilors who are elected representatives. The LC3 chairperson is the political head

of the subcounty and chairs the subcounty council, while the SAS is the representative of the CAO at

that level and is responsible for the supervision of civil servants and ensuring government programs are

implemented. The LC3 chairperson and the SAS work together in program planning and implementation

at the subcounty level. In FY18, ENVISION will support MDA and related activities in 245 subcounties.

Parish and village administration

Subcounties are divided into parishes, each headed by a parish chief—a civil servant—and an LC2

chairperson—an elected political leader. Each parish has a parish development committee (PDC),

responsible for identifying priority development issues and challenges. The lowest administrative unit in

Uganda is the village, known as LC1. Some large or densely populated LC1s are subdivided into cells,

especially in urban areas. The LC1 is headed by a chairperson and assisted by an executive. At each

council level from district (LC5) to village, (LC1), women representatives are part of the configuration. In

FY18, ENVISION will support MDA and related activities in 1,171 parishes and 10,980 villages.

b) Other NTD Partners

The MOH’s NTD Control Program (NTDCP) is led by an Assistant Commissioner, Health Services who is

assisted by disease specific program managers, senior program staff, scientists, technologists/

technicians, and other support staff. For better coordination of the program, a secretariat, comprising of

all NTD partners was established and is chaired by the Assistant Commissioner assisted by program

managers (PMs). The NTDCP manages and coordinates activities against five preventive chemotherapy

(PC) NTDs (trachoma, lymphatic filariasis [LF], onchocerciasis [OV], schistosomiasis [SCH], and soil-

transmitted helminthiases [STH]), as well as the Innovative and Intensified Disease Management (IDM)

Case Management NTDs.1 The MOH sets the country’s NTD policies, includes NTDs in its annual

statement and budget to parliament, and provides an enabling environment for NTD-related program

implementation and research.

1 Including human African trypanosomiasis (HAT), leishmaniasis, jiggers, Buruli ulcer, cysticercosis, tungiasis, rabies, leprocy,

plague, and Guinea worm (which has been eliminated from Uganda). National programs for HAT, leishmaniasis, and

cysticercosis are based at the MOH Vector Control Division; the program for plague is based at Uganda Virus Research Institute

in Entebbe; and Buruli ulcer disease and jigger control are based at the MOH headquarters.


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The MOH Top Management Committee, chaired by the Director General of Health Services (DGHS),

serves as the steering committee for the entire MOH. The NTD Technical Committee (described further

in the Strategic Planning section) is also part of the MOH Top Management Committee. The MOH Top

Management Committee, through the DGHS and the Minister of Health, the State Minister for Health–

General Duties, and the State Minister for Health–Primary Health Care, conducts program-specific high-

level advocacy on behalf of the NTDCP; for example, during visits with representatives of parliament and

meetings with visiting partner delegations (e.g., US Agency for International Development [USAID], RTI

leadership, Pfizer, UK Department for International Development [DFID]) etc.

The disease-specific programs are managed by trained and experienced MOH staff, comprising program

managers, scientists, technicians, and support staff. The MOH pays salaries, provides office and

laboratory space and contributes to the procurement of laboratory equipment. At other levels of the

health system, the MOH and district local governments recruit and provide salaries for NTD

administrative and technical staff.

Clearing, handling, and transportation of NTD drugs and supplies from the port of entry to districts and

lower-level health units is handled by the National Medical Stores (NMS) through an agreement with

MOH and the National Treasury. On occasion, ENVISION hires vehicles to transport drugs to districts

when the NMS delivery schedule is not in alignment with the MDA schedule.

The major donors supporting the NTDCP are USAID, the World Health Organization (WHO), DFID, and

the Queen Elizabeth Diamond Jubilee Trust (TheTrust). Implementing partners include RTI International,

The Carter Center, Sightsavers (UK), Schistosomiasis Control Initiative (SCI, Imperial College London, UK),

and Christian Blindness Mission (CBM) International (Germany). The NTDCP has additional partners

working on water, sanitation, and hygiene (WASH) activities, many of which overlap with the trachoma

program in particular (see details in Table 1).

The Carter Center supports OV elimination activities in 21 districts (including 3 districts co-supported by

Sightsavers) with funding from USAID through ENVISION and from private sources. These activities

include MDA; targeted vector control where there is ongoing transmission; post-treatment surveillance

(PTS) where transmission has been interrupted; and knowledge, attitudes, and practices (KAP) studies in

districts where three years of PTS have been completed. The Carter Center also supports OV-related

cross-border activities between Uganda and the Democratic Republic of Congo (DRC) and South Sudan,

including activities in each of those two other countries. It is important to note that ENVISION activities

proposed by The Carter Center for FY18 are also partially funded by its other donors and are not

exclusively funded by USAID.

The Carter Center also supports the national molecular laboratory, where essential tests are performed

to verify interruption of river blindness transmission, through a collaboration with the University of

South Florida (Professor Tom Unnasch), and the Uganda Onchocerciasis Elimination Expert Advisory

Committee (UOEEAC). The UOEEAC provides technical oversight of the national OV elimination program

and guidance to the MOH.

The Trust provides financial support for the implementation of the Surgery (S), Facial cleanliness (F), and

Environmental improvements (E) components of the Surgery, Antibiotics, Facial Cleanliness, and

Environmental improvement (SAFE) strategy. The Trust’s focus is particularly on surgery, with some

complementary support for the F and E components. In Uganda, The Carter Center administers Trust

funds and manages planning and coordination; Sightsavers and CBM serve as Trust implementing

partners.

Significant Trust-supported activities include conducting Trachomatous trichiasis (TT)-only surveys

especially in districts that recorded a disparity in the TT backlog reported in earlier surveys; and large-


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scale TT surgery camps in 17 eastern districts, including all districts of Busoga and Karamoja sub-regions.

Some districts have now reached the ultimate intervention goals for trachomatous inflammation–

follicular (TF) and TT—required for elimination of trachoma. In 2017, the Trust extended these activities

to the rest of the trachoma-endemic districts in Northern, Western, and West Nile regions, reaching 31

districts.

The Trust also supports small-scale facial cleanliness and environmental improvement initiatives through

its WASH partners: Water Mission Uganda, WaterAid Uganda, Busoga Trust, Concern, World Vision, and

Welthungerhilfe. The John Hopkins School of Public Health’s Center for Communication Programs (CCP)

signed an agreement with The Carter Center and The Trust to provide them with strategic

communication technical support. CCP is finalizing a set of updated integrated IEC/behavior change

communication (BCC) materials, following a review of the existing IEC materials and communication

strategy shared with them by RTI.

CBM was one of The Trust’s two implementing partners for TT surgeries in five districts in eastern

Uganda: Napak and Nakapiripirit in Karamoja sub-region, and Bugiri, Namayingo, and Namutumba in

Busoga sub-region. However, CBM ended its TT surgical activities in Uganda and closed its field offices in

April 2017 after Uganda achieved its ultimate intervention goal for TT in these districts.

Sightsavers has long been a partner for trachoma and eye disease control. In 2006, it supported the first

trachoma baseline surveys in eastern Uganda and has for many years supported eye care services

through specialized clinics throughout the country. Sightsavers is The Trust’s other implementing

partner for TT surgeries, supporting these in 17 districts, and in June 2017 expanding the program to 14

more districts in northern and the eastern parts of the country. During fiscal year 2018 (FY18),

Sightsavers will be implementing Trust supported activities in 17 districts: Lira, Kitgum, Yumbe, Koboko,

Maracha, Arua, Nebbi, Zombo, Adjumani, Moyo, Lamwo, Gulu, Omoro, Amuru, Nwoya, Oyam, and

Pader.

Sightsavers also supports OV control/elimination in eastern Uganda, including MDA in Masindi, Buliisa,

Hoima, and Kibaale, and PTS activities in Hoima and Kibaale. Of these, ENVISION supports only Buliisa,

for SCH and/or trachoma MDA. Sightsavers will continue supporting vector control in Pader, Kitgum, and

Lamwo districts.

In FY18, Sightsavers will support the NTDCP’s LF Program by conducting a KAP study in 3 districts (Lira,

Kitgum, and Yumbe); rapid assessments of the burden of chronic manifestations of LF; and support

Morbidity Management and Disability Prevention (MMDP) activities in districts co-endemic for OV,

through hydrocelectomies and lympheodema management in 16 districts in Acholi, West Nile, and parts

of Lango sub-region..

SCI/DFID: DFID has supported SCH and STH control in Uganda since 2003 through SCI (Imperial College

London, UK), focusing on MDA, disease re-assessments, and operational research. Prior to FY16, SCI

supported MDA and assessments in districts with low SCH endemicity (prevalence of 1%–10%). In FY16,

RTI transferred STH support activities for a number of districts to SCI, with the agreement of the MOH.

In FY17, ENVISION transferred NTDCP support activities for an additional 26 districts that are endemic

for SCH/STH only to SCI. This arrangement enables SCI to support districts that are endemic for SCH and

STH only, and ENVISION to support districts that require integrated treatment.

For its operational research component, SCI collaborates with institutions supported by the European

Union, Wellcome Trust, Medical Research Council (UK), The Royal Society (UK), and Kenya Medical

Research Institute.


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WASH partners

• Water-Aid Uganda supports small-scale sanitation programs in selected subcounties and parishes in

Busoga and Karamoja sub-regions.

• Water Mission is conducting a three-year program (2016–2018) in all 10 districts (88 subcounties,

587 parishes of Busoga sub-region) in the east. The focus is improved community sanitation by

training district and subcounty leaders, teachers, religious leaders, and parish and community F and

E ambassadors of change. Participants are trained on the causes, transmission, control, and

prevention of trachoma. Water Mission also supports water harvesting for domestic use and

establishing community water points (taps) in subcounties in the districts of Buyende and

Namayingo.

• Busoga Trust supports water supply and sanitation programs in Busoga sub-region. It is managed by

the Church of Uganda.

• John Hopkins University-CCP researches communication barriers and designs appropriate IEC and

BCC materials to eliminate trachoma and control SCH. In FY17, CCP partnered with MOH, ENVISION,

and other partners to review and update IEC materials, which will be rolled out in FY18. CCP does

not have a budget to print IEC materials; therefore, ENVISION will provide that support.

• United Nations Children’s Fund (UNICEF) is one of Uganda’s key WASH partners, funding related

programs in schools and working closely with the MOH’s Health Promotion and Education Division

(HPED) and Environmental Health.

• Concern strengthens coordination and delivery of trachoma- and WASH-related messages to

promote hygiene and trachoma awareness. It also updates and prints health education materials

for the Mother Care Groups.

• World Vision Uganda (WVU) encourages schools to have WASH clubs, spurs villages to adopt

community-led total sanitation (CLTS), and promotes WASH coordination meetings in 3 districts.

WVU also trains hygiene promoters, Mother Care Group Lead Mothers, teachers, and others to

promote hygiene and increase awareness of trachoma. WVU provides health education materials

and holds community meetings/dialogues and video shows, among other media activities.

• Water-Aid Uganda installs water points in schools, trains hygiene promoters and others on

trachoma/WASH, builds latrines and handwashing facilities, and spurs villages to adopt CLTS. It also

updates materials to promote key behaviors to encourage the prevention and treatment of

trachoma.

• WHO Country Office: Globally, WHO sets the guidelines for the control and elimination of NTDs and

coordinates NTD drug donations, including albendazole (ALB) for LF and STH, mebendazole (MEB)

for STH, praziquantel (PZQ) for SCH, and ivermectin (IVM) for LF and OV. In Uganda, the WHO

Country Office participates in the NTD Technical Committee and in NTD Secretariat meetings. From

2005–2015, WHO funded a study, conducted by the MOH Vector Control Division (VCD), to assess

the impact of STH deworming in 10 districts in five regions (Karamoja, Eastern, Central, Western,

and West Nile). The districts were selected based on favorable STH transmission conditions (SCH

was not targeted, but since the diagnostic method is the same, it was also reported). The WHO

Country Office also helps the NTDCP to procure diagnostics of the proper type and quality

standards. WHO Uganda also provides technical assistance during preparation of joint applications

for donated NTD drugs, and through the Regional Program Review Group (RPRG), where it advises


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the NTDCP on implementation units to undertake transmission assessment surveys (TAS) or to stop

MDA for LF.

• Malaria Consortium Uganda is piloting podoconiosis case detection and management in Kibaale,

Kyenjojo, and Kamwenge districts, with activities that include training health workers, supportive

supervision, and community awareness-raising through mass media and production of IEC and

training materials, expected to continue into 2018. The Consortium has shown interest in supporting

MMDP activities for LF; however, no formal commitment has been made.

• Footworks conducted health worker training for podoconiosis case management in October 2015 in

Kamwenge, Kabarole, Kibaale, Ibanda (western Uganda), Kween, and Manafwa districts (eastern

Uganda). It is hoped that Footworks will extend similar support to other highly- affected districts

such as Nakapiripirit and Napak in eastern Uganda, which are co-endemic for podoconiosis and LF.

Table 1: Non-ENVISION NTD partners working in country, donor support, and summarized

activities

Partner Location Activities

List other donors

supporting these

partners/activities

The Carter Center 21 OV-endemic districts • Capacity building, planning,

support to MOH and districts for

OV MDA; vector

control/elimination;

entomological surveillance; OV

impact assessments; post-PTS

and KAP studies

• Lead agency for technical

assistance (TA) and funds

management for TT surgeries

and WASH activities for The Trust

• TT surgeries in trachoma-

endemic districts of northern and

western Uganda, beginning in

April 2017

The Trust

CBM Northern and Eastern

Uganda

CBM was an implementing partner

for TT surgery and trachoma-

related field surveys up to April

2017 when it closed its field offices

in Uganda

The Trust

Sightsavers a) Busoga sub-region in

Eastern Uganda (7

districts),

Karamoja sub-region in

Eastern Region (5

districts)

b) Bunyoro-Western (4

districts)

c) Northern Region in 4

districts

a) Technical and financial

assistance to NTDCP and district

local governments for strategic

planning, capacity building,

equipment for TT surgeries and eye

care; logistics, motorcycles, mobile

sound systems for IEC campaigns in

Karamoja sub-region where radio

services are not well developed

b) OV control and elimination

activities in 3 districts (MDA and

Simulium vector control)

c) Simulium vector control,

involving dosing of rivers with

The Trust; Standard Chartered

Bank (Uganda); Standard

Chartered Bank; DFID


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Partner Location Activities

List other donors

supporting these

partners/activities

d) Northern Uganda in 4

districts

Abate (an organophosphate)

d) MMDP activities – rapid

assessment of magnitude;

lymphedema management and

hydrocelectomies in 4 districts

SCI Central Region (districts

along the shores of Lake

Victoria and Victoria Nile

and island districts

within the Lake) and

Western Uganda

TA, capacity-building, operational

research, MDA and reassessments

of prevalence, intensity and

morbidity in SCH endemicity

districts

DFID

Trachoma WASH

partners (Water

Mission, WaterAid,

Busoga Trust,

AVSI/Italian

Cooperation, World

Vision, and John

Hopkins University

Busoga and Karamoja

regions

Financial and technical support for

trachoma-related WASH activities

and BCC

The Trust

WHO Country Office In all NTD-endemic

districts with active PC-

NTD programs

At country level, provides technical

support, coordination of capacity

building/trainings, and assessment

of interventions on STH infections

WHO Uganda, African Regional

Office, and Geneva

headquarters

Lions Club Uganda Central level Advocacy at national and district

levels

Acts as a conduit for funds to

support trachoma implementation

activities

Lions Club International

Environmental Health

Division, MOH

All regions Guidelines on sanitation;

handwashing programs in schools;

latrine coverage surveys in

districts; M&E

WHO, Danida, DFID, German

International Cooperation,

Italian Cooperation, others

Ministry of Education’s

School Health

Department

All regions Deworming, sanitation, and WASH

activities in schools

Training of teachers in charge of

pupils’ health and sanitation

Policy formulation, coordination,

advocacy, training, and M&E

UNICEF

2) National NTD Program Overview

USAID support for Uganda’s NTDCP began in 2007, and is one of the Agency’s longest-standing NTD

country program commitments. Support initially focused on the completion of mapping, the integration

of four vertical PC-NTD programs (trachoma, LF, OV, SCH), and the scale-up of MDA to all eligible

districts. Support is now focused on maintaining good MDA coverage, reaching the 2020 elimination

goals, and developing strong, sustainable disease control programs.

In all NTD-endemic districts, including those supported by USAID, the NTD Secretariat works with

districts to coordinate the range of activities necessary for MDA including but not limited to logistics


15

management, MDA implementation, social mobilization, and supervision. The NTDCP also conducts

extensive national- and district-level capacity building, including training.

a) Lymphatic Filariasis

In Uganda, LF is transmitted by the common malaria mosquitoes Anopheles gambiae and An. funestus;

the Culex mosquito is also prevalent in urban areas. Baseline epidemiological studies and rapid mapping

of LF started in 1998, using a combination of chronic clinical manifestations, circulating filarial antigen

(CFA), and night blood smears to detect microfilariae (Mf). LF was found to be highly endemic in parts of

northern and eastern Uganda, with prevalence higher than 30% in some areas. The most common

clinical manifestation was hydrocele, followed by elephantiasis. Rapid mapping using CFA in school-age

children (SAC) and adults was conducted nationwide from 2000 to 2002, demonstrating wide LF

distribution, with highly endemic areas in northern and eastern Uganda, north of the central lakes

(Kyoga and Kwania). A small focus was found in Bundibugyo and Ntoroko Districts in the west along the

DRC border, where the disease is associated with An. bwambae (of the An. gambiae species complex)

which breeds in the hot sulfur springs.

The Program to Eliminate Lymphatic Filariasis (PELF) is part of the VCD of the MOH. The national NTD

plan aims to eliminate LF by 2020 through a multi-pronged approach that includes:

• Annual MDA with IVM and ALB in all endemic districts

• MMDP to reduce the burden of LF chronic manifestations in affected populations

• Promotion of other interventions that have an impact on LF, such as long-lasting insecticide-treated

nets (LLINs) and indoor residual spraying (IRS)

PELF first conducted MDA for LF in 2002 in Lira and Katakwi districts (which have now split into 7

districts), treating more than a million people. Treatment was extended to 5, then 12 districts, with

support from WHO and the Liverpool LF Support Centre. This support was for a single round of

treatment, as partners were uncomfortable with the country’s political situation. The civil war and

insurgency that escalated in northern and eastern Uganda in 2003 interrupted treatment in that year

and again in 2006.

With the support of USAID, nationwide LF mapping was conducted in early 2010, and MDA scaled up to

100% geographical coverage by the end of the same year. Since the commencement of USAID support,

LF-endemic districts have conducted five or six rounds of MDA, although some rounds may not have not

achieved sufficient 65% epidemiological coverage in all districts. TAS conducted through FY15 indicated

that LF transmission has been interrupted in 35 districts. This equates to approximately 8.4 million

people freed from the risk of infection. An additional 8 districts passed TAS in FY16. The MOH has

submitted a request to the WHO Regional Office for Africa (AFRO) RPRG to approve these districts to

stop MDA. It should be noted that RPRG approval is not formally required to stop treatment following a

successful TAS; henceforth, NTDCP will not wait for RPRG approval following successful TAS.

In FY17, 5 further districts conducted TAS leaving 9 districts with a population of 2.5 million people still

requiring MDA. This includes Omoro, which is newly created through re-districting. In FY18, 3 districts

will conduct TAS-1 and 17 districts will conduct TAS-2, leaving only 7 districts requiring MDA (includes

Terego district which is expected to split from Arua in 2018). The country is on track to achieve

interruption of LF transmission by 2020.

The seven districts still requiring treatment include some of the most difficult populations to reach, and

there is a need for an improvement in MDA drug coverage in these areas. The most heavily affected


16

districts are in the Northern Region where, historically, the chronic manifestations of LF (hydrocele and

elephantiasis) have also been most common. This includes Gulu District, which requires an enhanced

MDA strategy to reach populations in urban settings.

Morbidity management is the second pillar of the LF elimination strategy, with related activities

supported by Sightsavers in the northern districts of Amuru, Lamwo, Pader, and Kitgum. This support

focuses on the rapid assessment of the morbidity burden, with subsequent lymphedema management

and hydrocelectomies conducted in some health facilities. In FY17, a KAP study to inform IEC materials

on morbidity management was conducted in four districts co-endemic for LF and OV. The materials will

be used for community education to increase health-seeking behaviors among people with LF morbidity.

Vector control interventions such as the use of IRS and LLINs are led by the MOH’s Malaria Control

Program and are likely to indirectly contribute to LF elimination. The MOH conducts IRS in malaria

hyper-endemic districts in the north and east where LF is co-endemic. The MOH has distributed LLINs in

all of the country’s districts. If these initiatives are sustained, they will have the ancillary benefit of

helping to reduce residual transmission of LF.

b) Trachoma

Baseline epidemiological mapping of trachoma using WHO-approved methods and supported by

Sightsavers started in 2006. The surveys covered 2 districts in Karamoja sub-region and 4 districts in

Busoga sub-region. Trachoma was found to be highly endemic in all districts surveyed, with TF rates in

children ranging from 30% to 65%. Mapping of the rest of the country commenced when the NTDCP was

established in 2007, starting with priority regions in northern and eastern Uganda. By 2011, 51 districts

originally suspected of being endemic for trachoma had been mapped, reporting TF prevalence >5%

(ranging up to 67%) in 44 districts, and TF <5% in 7 districts. In 2014, ENVISION provided technical and

financial support for a desk review of 8 districts neighboring known trachoma-endemic districts that

analyzed eye clinic and health management and information system (HMIS) records for reported eye

infections and morbidity including TF, TT, and evidence of corneal scarring. The review showed just 1

district (Pallisa) with evidence of significant active trachoma; the district subsequently registered TF of

5%–9.9% when mapped.

The WHO SAFE strategy for trachoma elimination guides NTDCP trachoma activities. The first MDA with

Zithromax® (ZTH) and tetracycline eye ointment (TEO) commenced in eastern Uganda in 2007, with

scale-up to 100% geographic coverage by 2013, thanks to support from USAID through ENVISION. The

NTDCP conducted MDA in 36 endemic districts (38 following redistricting) based on baseline TF

prevalence and impact survey results: at least one round with sufficient coverage in districts with

prevalence of 5%–9.9%, three rounds in districts with prevalence of 10%–29.9%, and at least five rounds

in districts with TF of ≥30%. In FY18, the NTDCP will conduct MDA in 3 districts (increased from 2

following redistricting) in Karamoja sub-region, with ENVISION support.

As of June 2017, the NTDCP is still conducting the trachoma impact surveys (TIS) and surveillance

surveys in 19 districts scheduled for FY17. The preliminary results indicate that Amudat and Kabong

require one more round of MDA, which will occur in October 2017 and be reported in the FY17

workbooks. In FY18, TIS will be conducted in Amudat and Kabong while trachoma surveillance surveys

(TSS) will be carried out in 13 districts (18 evaluation units [EU]).

The MOH has implemented TT surgeries in the highly endemic Busoga sub-region in Eastern Uganda

with support from Sightsavers and CBM through The Trust.


17

c) Onchocerciasis

OV, caused by the filarial worm Onchocerca volvulus, was originally endemic in 37 of the country’s then

112 districts. An estimated 2 million people are infected, and nearly 3 million people are at risk of

infection. These numbers are under review by the NTD Secretariat following successful cessation of

MDA in many foci, and may consequently be reduced. As of June 2017, 20 districts have been able to

stop MDA, with treatment continuing in only 21 districts.

OV mapping and vector surveys began in the 1940s, and large-scale OV control started in the 1950s

focused on the Victoria Nile and consisting of intermittent treatment of the River Nile with low doses of

dichlorodiphenyltrichloroethane (DDT), a chlorinated hydrocarbon insecticide. This larviciding resulted

in elimination of the S. damnosum sl vector in that focus in 1974. From 1992 to 2007, the MOH started

implementation of annual MDA with IVM.

USAID support for OV control and elimination began in 2007, when the MOH’s National Onchocerciasis

Control Program (NOCP) launched a two-pronged control and elimination strategy, as recommended by

WHO and African Program for Onchocerciasis Control. The strategy entails: (1) MDA once or twice per

year in all endemic foci, using IVM alone or in combination with ALB in areas co-endemic for LF; and (2)

vector control/elimination campaigns in all isolated foci and in some semi-isolated foci where

control/elimination was deemed feasible by the NOCP. Areas targeted for OV control conduct treatment

annually, whereas areas targeted for OV elimination conducted treatments twice per year.

Since 2007, MDA has been halted in 18 districts (10 foci) and is continuing in 21 districts in the 9

remaining foci. ENVISION funds MDA twice per year in 21 districts (led by the NOCP with support from

The Carter Center and RTI)2 and once per year in 2 districts (Yumbe and Koboko) co-endemic for LF and

confirmed as not having OV transmission the NOCP

ENVISION also supports: (1) the training cascade; (2) mobilization and sensitization (health education);

(3) MDA registration or register updates; (4) epidemiologic assessments; (5) coverage validation; (6) IEC

materials; and (7) cross-border surveillance. MDA treatment and data validation take place twice a year,

and entomological assessments are conducted monthly. Other activities are implemented annually.

The NOCP implements vector monitoring and/or vector control alongside MDA in six of the nine

remaining foci with support from The Carter Center and other partners (non-USAID funds). Sightsavers

supports vector control in the Northern Region focus, where disease endemicity and transmission

historically have been high. The NOCP conducts river-dosing activities in some foci, using Abate

insecticide as a larvicide (supported by The Carter Center, with non-USAID funds).

Analyses of fly and blood samples from residents in endemic areas is undertaken at the VCD advanced

molecular biology laboratory. Post-treatment surveillance surveys to determine recrudescence potential

and infection with OV parasites are conducted through parasitological indicators (skin snips microscopy

for Mf and OV-16 enzyme-linked immunosorbent assay [ELISA] serology for parasites in blood) and

entomological indicators (polymerase chain reaction [PCR] analysis of black flies for infective larvae).

PTS surveys have been conducted in all foci where MDA has stopped, with no positive cases or signs of

recrudescence to date. Crab trapping forms part of the surveillance of vector elimination. The fresh

water crabs (Potamonautes spp) live in phoretic association with the larvae and pupae of flies of the

S. neavei complex. Crabs are examined for the larvae, pupae, and pupal cases, which attach to the body

2 ENVISION supports a second round of OV treatment integrated with LF or STH in all 21 districts; in 3 of those (Masindi, Buliisa,

and Hoima), Sightsavers also makes a partial contribution


18

and limbs of the crabs. These are identified to species level using morphology, and then preserved. The

numbers caught are recorded to determine any changes in abundance and species composition. In some

foci, crabs have disappeared following dosing of rivers and deforestation. Human-landing catches are

also used to collect biting adult Simulium neavei sl and other fly species.

In FY18, ENVISION will continue to support monthly fly and crab captures where treatment is ongoing.

The MOH plans to continue these activities during the PTS period in selected foci; The Carter Center will

support river dosing with donated Abate with non-USAID funds.

The UOEEAC was formed in 2008 to advise the MOH on whether and when MDA can be stopped. The

UOEEAC is composed of Ugandan and international OV experts, and chaired by Prof. Tom Unnasch from

the University of South Florida. The UOEEAC’s annual meeting is financially supported by The Carter

Center and ENVISION. UOEEAC responsibilities are to:

• Review program activity reports annually from each elimination-targeted focus

• Advise the MOH on focus-specific monitoring and evaluation (M&E) activities and recommend

halting treatment when appropriate, in accordance with international and national guidelines

• Make any other recommendations to the MOH on activities needed to reach the national 2020 OV

elimination goal. (Please see Appendix 9 for the August 2017 version of the UOEEAC’s OV “flag.”)

d) Schistosomiasis

SCH, caused by Schistosoma mansoni for intestinal SCH and S. haematobium for urogenital SCH, is

endemic in 87 districts. S. mansoni is widespread, occurring in all 87 districts, while S. haematobium is

now confined to a few northern districts. In Uganda, SCH is associated with large water bodies;

permanent and semi-permanent rivers, streams, and reservoirs constructed for watering animals; and

irrigation schemes.

In high-risk (≥50% prevalence) areas, the NTDCP follows WHO guidance in treating school aged children

(SAC) and high-risk adults annually. In moderate risk areas (≥10%–<50% prevalence) SAC are treated

annually, and once every two years in low-risk (≥1%–<10% prevalence) areas, as compared to the WHO

recommended minimum of once every two years and twice during primary school ages, respectively.

The NTDCP often conducts MDA for SCH at the sub district level, resulting in more than one treatment

strategy in any given district. The NTDCP conducts SCH prevalence evaluation surveys once districts

complete their fifth or sixth round of SCH MDA and aims to adjust the district treatment strategy

depending on the findings. The surveys are based on the lot quality assurance sampling method and use

the Kato-Katz diagnostic technique. One such assessment is planned for FY17 and results will inform

FY18 treatment strategy.

Approximately 5.4 million people are infected with SCH, and 10.9 million are at risk. Of the 93 endemic

districts, 37 are considered high risk, 13 moderate risk, and 43 low risk. Reinfection rates remain high in

some districts in the Albertine Rift valley (Nebbi, Buliisa, Hoima, Ntoroko) and in the east (Namayingo

and Mayuge), with concern that infection is not falling even after several rounds of annual treatment.

Human behavior, cultural practices, poor sanitation, cross border movements in search of fish and

snails, susceptible snail hosts, and perennial transmission help maintain high SCH endemicity. Recent

studies by VCD and Medical Research Council demonstrated that in a cohort of treated school children,

almost 80% were re-infected and shedding S. mansoni eggs three weeks later. Also, up to 50% of

children under five years who are not treated through MDA for lack of pediatric formulation were

infected. Intensified efforts and operational research have been called for by the NTD Technical

Committee, national and regional meetings, and the recent joint NTDCP-SCI SCH workshop.


19

ENVISION support for SCH MDA varies by year due to the cyclical treatment schedule recommended by

WHO. ENVISION supported treatment in 32 districts in FY16, and 14 districts in FY17. In FY18, ENVISION

will support treatment in only 16 districts after transferring support for a further 26 to SCI, as discussed

with the MOH. These 26 districts were previously endemic for LF and/or trachoma and/or OV, but have

successfully passed stop-MDA surveys for these diseases. ENVISION SCH support in FY18 is, therefore,

only for districts that are co-endemic for SCH and other NTDs.

ENVISION provides financial and technical support for social mobilization activities to improve PZQ

uptake, such as community dialogue on SCH prevention practices. Major landing sites are used as

locations for discussion with community members that involve Beach Management Units3 and local

leaders. In FY18, ENVISION will continue to support these activities by providing disease-specific

assessment (DSA) for district political leaders to mobilize people for MDA and supervise MDA activities,

especially in densely populated landing sites.

e) Soil-Transmitted Helminthiasis

STH is endemic in all 128 districts. Baseline surveys showed that hookworm is relatively homogenously

distributed in the country, exceeding 60% mean prevalence in SAC. Infections with A. lumbricoides and

T. trichiura are concentrated in the southwest, where prevalence can be as high as 100%. Infections with

T. trichiura have historically been lighter, but there is some evidence of infections spreading to central

Uganda due to migration, as evidenced from recent SCH/STH re-assessment surveys.

The MOH conducts twice-yearly deworming of children aged 1–15 years across the entire country, in

April and October, during Child Health Days (which includes treatment in schools). This is coordinated by

the Child Health Division and jointly funded by the MOH’s primary health care funds and UNICEF. In

districts co-endemic for LF and STH, the MDA is integrated, so children take a combination of IVM+ALB

(or ALB alone for under-fives) during the first round of treatment and ALB alone in the second round.

The NTDCP LF program, funded by ENVISION, has contributed to control of STH.

ENVISION-supported MDA aligns with Child Health Days, thus coordinating the two programs. In districts

co-endemic for LF, the ALB required for STH is provided by PELF MDA. In cases where LF funds and/or

drugs are delayed, districts generally postpone their Child Health Days while awaiting LF MDA resources.

3 Management units of landing sites/marinas, elected by residents to implement regulation of fishing, health, and security


20

3) Snapshot of NTD Status in Uganda

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

20174

Columns C+D+E=B for each

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

MAPPING GAP

DETERMINATION MDA GAP DETERMINATION

MDA

ACHIEVEMEN

T

DSA NEEDS

A B C D E F G H I

Disease

Total

no. of

districts

in

Uganda

No. of

districts

classified

as

endemic

No. of

districts

classifie

d as

non-

endemic

No. of

districts

in need

of initial

mapping

No. of

districts

receiving

MDA

as of

09/30/17

No. of districts

expected to be

in need of MDA

at any level:

MDA not yet

started, or has

prematurely

stopped as of

09/30/17

Expected no.

of districts

where criteria

for stopping

district-level

MDA have

been met as of

09/30/17

No. of

districts

requiring DSA

as of

09/30/17 USAID

Fun-

ded

Others

Lymphatic

Filariasis

128

61 67 0 9 0 0 52

TAS1: 3

TAS2: 17

TAS3: 0

Onchocerciasis 41 85 0 215 0 0 20 0

Schistosomiasis 93 35 0 16 77 0 0 0

Soil-transmitted

helminths 128 0 0 9 119 0 0 0

Trachoma 47 81 0 56 0 0 42 TIS:27

TSS:138

4 This represents the 2018 geography of 128 districts therefore Columns C+D+E do not equal B nor do Columns F+G+H equal C 5 Two districts, Yumbe and Koboko, are no longer treating for LF and OV. Also, Sightsavers partially supports one round of OV

MDA in three districts 6 We list 5 districts because Nakapiripirit will form Nabilatuk during FY18. 7 In FY17 two districts (Amudat and Kabong) conducted TIS that resulted in TF prevalence between 5-9.9%. Both districts are

conducting MDA in October 2017 and will conduct another TIS in FY18.. 8 There are 13 districts that will require a TSS in FY18, however, 5 of them have large populations requiring them to be split into

two. Therefore, there are 18 evaluation units requiring surveillance surveys.


21

PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

In FY18, ENVISION will support capacity strengthening activities for the MOH NTD Secretariat as

described below. On a more routine basis, ENVISION’s capacity strengthening efforts are also embedded

within program activities .

Objective 1. Strengthen capacity for annual work planning and activity planning

Intervention 1: Train/orient the MOH NTDCP data manager on information systems and data

management systems: ENVISION will support the NTDCP’s data manager to take a three-week training

on information systems and database management at the Uganda Management Institute, in March

2018. This activity was planned for FY17; unfortunately, the data manager was not able to participate

due to a scheduling conflict with the coverage validation survey.

Intervention 2: Senior NTD staff training in program planning, management, financial management,

and evaluation: In FY18, ENVISION will support 10 senior MOH NTD staff to attend a two-week evening

course of program planning, management, financial management, and evaluation. The course will be

conducted at the Uganda Management Institute in Kampala. The MOH NTD Coordinator will provide

post-training monitoring for her team and check the extent to which acquired knowledge is being

utilized. The course will increase the participants’ knowledge and skills in problem analysis, M&E,

participatory approaches towards project planning and management, and procurement. It is expected

that providing this training will reduce the MOH’s reliance on RTI to plan NTD activities and improve on

the timely implementation of activities, all of which are important for program continuity.

Objective 2. Strengthen capacity to manage PC-NTD data and to use data for decision-making

Intervention 1: Training for senior NTDCP staff on the integrated NTD Database: NTDCP managers and

senior program staff were introduced to the NTD database during its development, but it is necessary to

keep training them in its use. This will help ensure they can access and extract data from the database

for programmatic decision making and to feed into the development of the LF and trachoma dossiers.

Costs include meals and refreshments.

Intervention 2: Trachoma Dossier Development: The Uganda MOH has formed a small technical

working group consisting of MOH and partner representative to develop the trachoma dossier. Instead

of using a consultant to drive this activity, RTI will support the MOH to lead this effort.

a) Monitoring Capacity Strengthening

The following indicators will be used to monitor and report on the activities described above:

Objective 1. Strengthen capacity for annual work planning and activity planning

• Timely planning and implementation of activities tracked through ENVISION’s quarterly budget

expenditure and forecast. Monthly reports and disease/program workbooks will also show timely

implementation of activities.

• Improved quality of reports and plans tracked through internal feedback from partners


22

Objective 2. Strengthen capacity to manage PC-NTD data and to use data for decision making

• NTD data accessed by all relevant personnel

• NTD database completed, verified, and regularly updated

• Programmatic decisions based on data analyzed

• Trachoma dossier developed using data in NTD database


23

2) Project Assistance

a) Strategic Planning

Activity 1: NTD Technical Committee meetings: The NTD Technical Committee, established in 2014,

provides guidance on NTD activity planning. ENVISION will support two 2-day quarterly meetings in

FY18. ENVISION will support committee members to provide technical oversight and monitoring of

activities in the field, particularly in ENVISION-supported districts. The Committee will also help guide

the transition from donor support to full government ownership. ENVISION will work with the

committee to guide the development of transition plans for districts that have stopped MDA for LF and

trachoma. Additionally, the Committee will continue using data from the Integrated NTD Database in its

discussions, and supports data use in programmatic decision making.

Activity 2: National planning and data review meeting: This meeting will address issues of data quality

and accuracy, and use this information to inform program planning and implementation. The first day

will focus on data review—specifically, the ongoing issue of data incompleteness—and how to use

district and sub district level data to inform program design. The district biostatisticians and planners

will review data processes. Days 2 and 3 will review the implementation of the FY17 recommendations,

and identify priority activities for FY19. Day 4 will focus on cross-border issues with the aim of

developing a harmonized operational plan for NTD control across national borders.

The meeting will be attended by DHOs and district NTD focal persons; NTD pprogram managers; NMS

representatives; and key partners and representatives of the National Technical Advisory Committee.

MOH representatives from DRC, South Sudan, and Kenya will be invited.

Activity 3: Regional planning and review workshop: ENVISION will support one meeting for districts still

receiving project support. This will be convened by the NTD Secretariat and involve the DHO, CAO, the

NTD focal pperson, and implementing partners. The meeting will review MDA coverage data and survey

results, discuss specific challenges and related solutions, and develop district-level plans and budgets for

FY18 including program sustainability approaches. An area of focus will be identifying and documenting

best practices to improve coverage. These work plans will inform the contents of ENVISION’s FY19 fixed

obligation grants (FOGs) to these districts. ENVISION staff will work closely with the NTD Secretariat to

jointly lead the meeting.

Activity 4: District microplanning and post-MDA feedback meetings: ENVISION will support a three-day

microplanning meeting in each of the 26 ENVISION-supported districts using the template developed in

FY17. Completed templates will be shared with the NTDCP and used by ENVISION for FOG preparation.

In order to promote ownership, the micro plan will be signed and submitted to the MOH and ENVISION

by the district CAO with a commitment note to file. Prior to these meetings, the NTD program managers

and RTI will conduct refresher training for central-level supervisors who will support district micro plan

development. Costs for this activity include per diem, meals, transport for the district and central teams,

venue rental, stationery, and coordination expenses. Additionally, each district will receive a copy of the

updated National NTD Master Plan, which will be printed by ENVISION.

Activity 5: SCH/STH transition planning (RTI): Uganda has made great progress in achieving the

elimination aims of trachoma, LF, and OV. Support for SCH and STH MDA implementation (the “control

diseases”) presently comes from three main sources: 1) USAID through funding of integrated MDA; 2)

SCI, which supports SCH/STH MDA in some parts of the country, and which in FY17 took on support for

SCH MDA from RTI in 26 districts no longer requiring integrated treatment; and 3) MOH’s Child Health

Division, with support from UNICEF, which conducts twice-yearly treatment against STH for children


24

aged 1–15 years. In FY18, ENVISION will pilot the RTI SCH/STH transition plan developed in FY17. This

will help to plan for how SCH and STH control will continue in the future, including procurement of PZQ

for adults. This will be discussed with stakeholders (MOH, Ministry of Education, SCI) at the Uganda SCH

meeting to be held in late August 2017.

Activity 6: Uganda Onchocerciasis Elimination Expert Advisory Committee meeting : In FY18,

ENVISION will support a five-day UOEEAC meeting (August 2018), with an estimated 50 participants. On

Day 1 selected vector control officers will prepare and review presentations prior to the UOEEAC. Days

2, 3, and 4 will comprise a focused review of the progress of the NOCP, including the results of the April

2017 coverage validation survey, and epidemiological and entomological surveys carried out during

FY17. Committee rrecommendations will include a clear plan for whether to stop or continue IVM

treatment in specific foci. In line with WHO’s 2016 OV elimination guidance, the Ccommittee will

recommend post-treatment surveillance in areas that stop MDA. As a best practice, the reasons for

stopping treatment will be explained to communities, along with guidance to avoid recrudescence.

Participants will be provided with copies of the report from the previous meeting and will assess the

extent to which recommendations have been implemented. On Day 5, vector control officers will review

recommendations and plan surveillance activities.

Activity 7: National Stakeholder Meeting —River Blindness Program review meetings: ENVISION will

support The Carter Center’s facilitation of two biannual OV review meetings to share field experiences,

assess progress, discuss challenges, and plan the way forward. Participants will include 42 NTD focal

persons and assistants from the 21 districts receiving treatment for OV, central-level MOH officials

including the OV Program Manager, National NTD Coordinator, and partners. These meetings will be

conducted in January and June 2018.

b) NTD Secretariat

Activity 1: Operational and program supervision support for NTDCP (RTI): In FY18, ENVISION will

continue to provide financial support to maintain office equipment and vehicles (including replacing

vehicle tires and fuel and minor repairs) for the office of the National NTD Coordinator and the PELF,

Bilharzia and Worm Control Program, NOCP, data manager, health educator, and trachoma program

managers. Per diem for program officers conducting supervisory visits will also be covered.

Activity 2: NTD Secretariat coordination meetings (RTI): The NTD Secretariat has 17 officers from: MOH

NTD (PC and IDM) program; human African trypanosomiasis (HAT), leishmaniasis, rabies, and jiggers

programs; HPED; and representatives from RTI, SCI, Sightsavers, The Carter Center, the Technical

Advisory Committee, and WHO. The national NTD Coordinator, who is also the Assistant Commissioner

of Health Services, Vector Borne Diseases Control, chairs the Secretariat. The NTD Secretariat meets

quarterly and is responsible for the overall planning, implementation, and M&E of NTD programs, which

includes but is not limited to building capacity at central and district levels, reviewing resource

allocationso NTDs, and supporting and participating in the development of guidelines, manuals, and IEC

materials. In FY18, ENVISION will provide refreshments for two meetings.

a) Building Advocacy for a Sustainable National NTD Program

In FY17, ENVISION provided technical and financial support to finalize the NTD communication strategy.

Key staff attended a workshop to review existing documents and information from past surveys to

develop this strategy. In FY18, ENVISION will support a combination of activities at national, district, and

community levels to implement this strategy to help improve MDA coverage. The strategy identifies

critical advocacy issues to increase country ownership and resource allocation; key among them are


25

increasing integration of NTD activities and budgets into district plans, strengthening enforcement of

existing by-laws promoting household and community sanitation, increasing communities’ access to

clean water, and increasing participation of community leaders in MDA activities.

In FY18, ENVISION support for advocacy will be as follows.

Activity 1: Breakfast meeting with members of parliament (MPs) from the 26 ENVISION-supported

districts: The political leaders (MPs) of ENVISION-supported districts will be targeted to inform them of

the status of NTDs in their districts, the challenges experienced in achieving acceptable treatment

coverage, and the need for NTDs to be included in national and district plans and budgets. MPs are

responsible for making decisions on national budget allocations and can influence decisions to integrate

NTDs into national and district plans, with sufficient funding from either government or partners.

ENVISION, working with the NTD Secretariat, will organize one breakfast meeting in Kampala with MPs

from these 26 districts.

Presentations on the NTD status in these districts will be made by the MOH. A district has an average of

three MPs, so 115 MPs will be invited to participate alongside representatives from WHO, The Carter

Center, Sightsavers, SCI, MOH, Ministry of Local Government, and Ministry of Education. Some members

of the national Technical Advisory Committee will participate in this meeting. Key outcomes will include:

(1) better understanding of the burden of NTDs among decision-makers; (2) an understanding of

government and partner achievements to date; and (3) explicit MP commitments, by signing a

declaration, to give voice in parliament to NTD priorities and to advocate for inclusion of the NTD

agenda in national and district plans and budgets.

Activity 2: Northern Uganda regional advocacy meeting: This meeting targets district political, civic, and

technical leaders including resident district commissioners, CAOs, DHOs, chief finance officers, assistant

DHOs, NTD focal persons, LC5 chairpersons, LC5 vice chairperson, secretaries for health, district

education officers, district inspectors of schools, district auditors, religious leaders, heads of health sub-

districts, district health educators and district planners/biostatisticians. In FY18, ENVISION will support

one regional meeting for the nine ENVISION-supported districts from northern Uganda. Topics to be

covered include timely release of FOG funds from district accounts to reduce MDA delays, and the

inclusion of NTDs in district budgets to foster sustainability. Other areas of discussion will include

improvement of data management, particularly data collection, analysis, and use for program

improvement.

Activity 3: District-level advocacy meetings: In FY17, these meetings provided an opportunity to review

district program performance and plan supportive supervision by district leaders. They also helped

identify local resources to support MDA, for example radio airtime for mobilization provided by the RDC.

In FY18, ENVISION will focus our support on the nine districts in northern Uganda where MDA coverage

has been a recurrent problem. ENVISION support will allow central-level NTDCP to conduct half-day

advocacy meetings in each district. It is expected that political, technical, and administrative district

staff, including the DHO, will provide opportunities for continued engagement to identify post-ENVISION

support for program activities..

Activity 4: News publications on NTDs: During FY17, ENVISION helped the NTD Secretariat establish

functional working relationships with the print and electronic media. This resulted in increased coverage

of NTDs in the daily newspapers with stories published weekly in the New Vision newspaper and on NBS

television. Journalists and reporters were provided with transport and per diem to travel to the field to

cover stories from the viewpoint of program beneficiaries and to interview district and community

leaders on program performance. In FY18, this partnership will be strengthened to ensure adequate

coverage of program activities, including reporting on areas that have stopped MDA to demonstrate


26

that elimination is possible. To put in more effort for MDA, ENVISION will pay for field trips for

journalists and reporters to cover and document success stories as well as report on areas that still need

support from national and local leaders. ENVISION will document success stories and distribute them to

districts, media houses, partners and the USAID Mission office.

b) Mapping

As the Uganda NTD program approaches LF and trachoma elimination, now is the appropriate time to

ensure that all geographic areas have been adequately assessed for these NTDs. Following recent

discussions with WHO and partners, the NTDCP identified additional mapping needs before reaching

elimination. In FY18, ENVISION will support the following two mapping activities to ensure this is

completed.

Activity 1: Trachoma baseline assessments and surveys: There are 18 districts that share common

borders with trachoma-endemic districts. These districts have never been surveyed for trachoma, as

they were considered unlikely to harbor infection, and a previous desk review of some of the districts

focusing on hospital records indicated that they were not endemic. In FY18, ENVISION will support

trachoma rapid assessments (TRA) in suspected endemic districts to determine where full mapping

surveys should be conducted. TRA will be performed in all suspected 18 districts. For budgeting

purposes, we estimate that 10 of these districts will require full surveys

Activity 2: LF and trachoma mapping in refugee settlements): Over the last three years, Uganda has

received an influx of refugees displaced by the civil and military conflicts in South Sudan and DRC,

particularly into the border districts of Adjumani, Koboko, Moyo, Yumbe, Kiryandongo, Arua, and

Lamwo. These districts have received almost 1 million refugees to date who have settled in an estimated

15 camps spread across these districts. The refugees arrive in transit camps for screening and are later

re-settled in camps, of which the numbers vary from district to district. The refugee settlements are

supported by the Office of the Prime Minister and the United Nations High Commission for Refugees,

with the support of local and international refugee agencies such as World Vision International, and the

respective district local governments. Many refugees originate from areas known to be endemic for PC-

NTDs (trachoma, LF, OV, SCH, STH) and sleeping sickness. There is a real concern that the influx of

refugees will increase the risk of NTD recrudescence in these districts and counteract the gains to date.

In FY18, ENVISION will support an NTD assessment for LF and trachoma in these 15 camps.

c) MDA Coverage

In FY17, ENVISION supported MDA in 55 districts: 20 received MDA in October 2017, 13 received MDA

in April 2017, and 22 in July/August 2017. In FY18 ENVISION will support MDA in 26 districts9:

• 7 districts for LF and STH (in April 2018 and October 2018)

• 3 districts for trachoma (in October 2018)

• 21 districts for OV (21 will be treated in October 2017 and 21 in April 2018)10

• 16 districts for SCH (in April 2018)

9 We recognize there are discrepancies between the narrative and workbooks. This is due to redistricting. 10 While these are tallied as 21 here, the workbook tallies 25 due to re-districting. We are awaiting confirmation of OV

endemicity of new districts.


27

ENVISION funds for LF, STH, trachoma, and SCH MDA in the 26 districts will support all pre-and post-

MDA activities, including advocacy, training of trainers (TOT), microplanning, social mobilization,

registration and facilitation of community drug distributors (CDDs) during data collection. For these

diseases, ENVISION also funds all treatment rounds. For OV, ENVISION funds all pre- and post-MDA

activities for the first round of treatment in 21districts. The UOECC approved two rounds of treatment in

21 districts; therefore, ENVISION supports The Carter Center to distribute a second round in 18 districts,

while Sightsavers funds and implements the second round in 3 districts. It should be noted that the 2

districts (Yumbe and Koboko) passed TAS1 in FY17 and will no longer be receiving treatment.

ENVISION will support enhanced supervision in the districts receiving trachoma MDA (Moroto,

Nakapiripirit, and Nabilatuk ) and the three districts receiving LF MDA that have had persistently low

MDA coverage (Gulu, Omoro and Kitgum)

Table 5: USAID-supported districts and estimated target populations for MDA in FY18

NTD

Age groups

targeted

(per disease

workbook

instructions)

Number of rounds

of distribution

annually

Distribution

platform(s)

Number of

districts to be

treated

in FY18

Total number

of eligible

people to be

targeted

in FY18

Lymphatic Filariasis Entire population 5

years and older 1

Community- and

school-based

MDA

7 1,533,919

Onchocerciasis Entire population 5

years and older

2 Community-

based MDA 21 2,350,630

Schistosomiasis Entire population 5

years and older 1

Community- and

school-based

MDA

16 2,411,467

Soil-Transmitted

Helminths

Entire population 5

years and older 1 Community MDA 7 194,047

SAC only 2 School-based

MDA 7 1,633,232

Trachoma Entire population 1

Community- and

school-based

MDA

3 299,920

Activity 1: Registration/update of treatment registers: Current treatment registers run through 2017. In

FY18, districts will be supplied with new multi-year registers, and correspondingly, fresh registration will

be conducted in all districts, except for those in the Karamoja Region, which received revised and

simplified registers in 2016. This activity will be managed by central teams who, prior to

implementation, will be dispatched to support the district teams to conduct community registration.

The number of administration units—communities, schools, parishes, subcounties, HSDs, and health

facilities—will be confirmed at that point. This is to ensure that all endemic communities/schools are

registered to help plan for adequate stocks of drugs and related logistics. The district biostatistician and

planners will be directly involved in this process to ensure the data retrieved are aligned with data

available at district level.

Activity 2: MDA LF-OV : ENVISION will support the procurement of 7,263 registers, provide airtime and

district level data validation in Nebbi, Zombo, Arua, Adjumani, Gulu, Amuru, Kitgum, Lamwo, Lira, Moyo,

Nwoya, Omoro, Pader, Kanungu, Kisoro and Rubanda. Oyam is not scheduled for validation in FY18.

This takes place in November/December and April/May, after MDA. Sightsavers will conduct data

validation in Bulisa, Hoima and Masindi.


28

Activity 3: Trachoma MDA in Amudat and Kaboong 2017 trailing costs: ENVISION will support MDA in

these two districts that had TF>5% following TIS.

d) Social Mobilization to Enable NTD Program Activities

In FY17, the NTD Secretariat and partners to finalized an NTD social mobilization strategy, providing a

framework for the design and implementation of social mobilization activities. In FY18, ENVISION will

support a combination of activities at national, district, and community levels to implement this strategy

and improve MDA coverage. These include

Activity 1: Community dialogue to improve MDA coverage : in the seven districts receiving LF and STH

MDA, CDDs and parish supervisors will engage community members in discussions of NTDs, with a focus

on NTD medicines. Drug side-effects will be discussed as well as other concerns raised by the

community. The communication gaps articulated above will form the framework for engagement. The

village LC chairpersons will mobilize household members to attend these meetings. Each village will

hold such meetings during FY18. At the end of the meeting, IEC materials will be distributed to reinforce

relevant messages. Question and answer sessions will assess the extent to which community members’

fears and perceptions have been allayed and the level of satisfaction with the exercise. CDDs will require

flip charts to help in the community education process. In low performing areas, health workers and

subcounty supervisors will reinforce the CDD teams and parish supervisors. In schools, existing clubs and

groups will be used where available to discuss NTDs and provide the required information through club

leaders and trained school teachers.

Activity 2: Multimedia campaign for PC-NTDs: ENVISION will support the NTDCP to plan and implement

a multimedia campaign using print media, radio, and TV channels during the two months prior to MDA.

The multimedia campaign will aim to normalize MDA and assure all that the MDA approach is important

for the prevention, control, and elimination of NTDs. The campaign will emphasize the safety of the

medicines and explain how, when, and by whom medicines should be taken. The NTD Secretariat will

form a task force to coordinate the multimedia campaign. Members will include representatives from

the Health Education and Promotion Division of the MOH, NTD partners, the media fraternity, and

ENVISION. Specifics of the campaign will include:

• Radio: The radio component will comprise talk shows attended by key personalities like DHOs, NTD

focal persons, NTD Secretariat members, community members who have benefited from treatment,

CDDs, and local leaders. They will be call-in shows to allow community members to ask questions.

Radio jingles and announcements will be aired around the time of MDA on local and regional

radio stations. Communities will be informed of the time when the shows will be aired through

radio announcements and by CDDs.

In addition, subcounty supervisors, parish supervisors, and CDDs will use megaphones to inform

communities about MDA and the planned radio talk shows and urge them to tune in. This

approach was used in FY17 and helped to attract community members to treatment centers.

This approach will also be used to mobilize community members for education and dialogue

meetings at village level.

• Television: Weekly panel discussions will be organized for four consecutive weeks prior to MDA.

These will be aired on three TV stations: UBC, NTV, and NBS, to allow the widest reach. During FY17

this strategy was used on one TV station (NBS) with feedback from viewers that it was well received

and long overdue. The panel discussion will cover NTDs and the prevention and control efforts the

government has put in place. The MDA schedule and locations will be communicated during these


29

discussions. Drug safety and possible side-effects will be explained. These will be call-in programs to

allow viewers and listeners to ask questions. Members of the NTD Secretariat, and other senior

MOH staff of the including the Director General of Health Services, will participate. ENVISION will

support air time for the TV stations (where applicable) and provide allowances for the participants,

especially those who are not MOH staff.

• Documentation of success stories after MDA: The district supervisors will identify one beneficiary of

trachoma and STH treatment per subcounty and document that beneficiary’s perception of MDA in

the form of a story.

Activity 3: Sensitization of sub county leadership: In FY18, ENVISION will provide technical assistance

through the NTD Secretariat to help districts sensitize health sub districts and sub county leaders on

NTDs and planned MDA. Within the local government system, the subcounty is the level at which

government programs are implemented and supervised. This level receives direct district financial

allocations. Subcounty chiefs/SASs have not been actively engaged in the NTDCP to date, and this has

led to a lack of subcounty accountability regarding implementation activities. Subcounty chiefs and

heads of health sub districts will be oriented on NTDs and their roles in the promotion of activities,

especially MDAs. Treatment targets for subcounties will be agreed upon and the chiefs will be charged

with ensuring achievement of those targets in their subcounties. Costs include per diem, vehicle hire,

and fuel for vehicles.

Activity 4: Disseminate documentaries for SCH in Albertine Region and trachoma in Karamoja Region):

In FY17, ENVISION supported the development of two documentaries; one on SCH in Albertine Region

and one on trachoma in Karamoja Region. In FY18, ENVISION will support the dissemination of these

documentaries in the form of producing 100 CDs that will be distributed to communities, including

drama groups; having the documentaries aired on TV talk shows; and discussing the documentaries on

radio.

Activity 5: OV-related health education and sensitization by community supervisors: ENVISION will

support community supervisor delivery of health education at community meetings and gatherings. IEC

materials will be used to communicate key messages. The aim is to ensure community members

understand the importance of registering themselves and family members, to understand the dangers

of not taking IVM, and the exclusion criteria for treatment, among others. This will enhance IVM uptake,

community participation, and ownership. The community supervisors will encourage their communities

to select more women to work as CDDs and supervisors at the parish and community levels.

Activity 6: Production of IEC Materials: Development of 98,000 posters and fact sheets in five local

languages. These posters were revised during the FY17 social mobilization workshop and are now ready

for printing and distribution


30

Table 6: Social mobilization/communication activities and materials checklist for NTD work

planning

Category

Key messages (in

English and local

languages11)

Target

population IEC Activity

Where/

when will

they be

distributed

Frequency

Has this

material/

message or

approach been

evaluated? If

not please detail

how that will be

addressed

Pre-MDA -It is necessary to

register

yourselves/family

for treatment.

-The risk of not

taking IVM

-Exclusion criteria

for treatment

-The utility of

selecting women

CDDs (The Carter

Center)

Eligible

population

Training

groups /

meetings

In the

communities

Once before

every MDA

Yes, it has been

evaluated and

approved by the

MOH

MDA

Participation

MDA will take place

in communities and

schools [RTI]

Community

members living

in endemic

areas,

SAC,

teachers

-Radio

-TV

-Newspapers

-Community

meetings

-School

assemblies

-Posters

Local station,

4 weeks in

advance of,

and 2 weeks

during MDA

campaign.

Weekly

newspaper

pull-outs.

Village

meetings

-4 times daily

for 20 days,

-Weekly

school

assemblies

for 4 weeks

-One

meeting per

village

before MDA

-# of times

messages aired on

radio during

reference period-

Radio broadcast

reports

-% of targeted

population who

seek NTD drugs

during MDA

-% of audience

who recall

message- coverage

survey,

local/national

omnibus survey

Length of MDA,

what diseases are

targeted, drugs and

staggering of

treatments [RTI]

-Community

members living

in endemic

areas

-SAC

-Teachers

-Sub county

chiefs

Religious

leaders Cultural

leaders

-Radio

-Community

meetings

-TV

discussions

-Flyers

-Local station

messages

twice weekly

for 4 weeks

in advance of

MDA

-TV program

for 4 weeks

preceding

MDA and

-4 times daily

for 20 days

-One

meeting per

village

before MDA

-# of times

messages aired on

radio during

reference period—

radio broadcast

reports

-# of meetings

held and

community

members attended

11 Acholi, Lango, Lugbara, Alur, Madi, Karimojong, Ateso, Kumam, Lusoga, Lunyole, Kiswahili, Lunyoro/Rutoro/Runyankole, and

Luganda


31

Category

Key messages (in

English and local

languages11)

Target


Where/

when will

they be

distributed

Frequency

Has this

material/

message or

approach been

evaluated? If

not please detail

how that will be

addressed

Local council

chairpersons

once every

week during

MDA

campaign

-% of audience

who recall

message—

coverage survey,

local/national

omnibus survey

Endemic diseases,

causes, signs and

symptoms,

prevention and

control, what is

being done including

MDA schedule [RTI]

-Community

members in

endemic areas

-SAC

-Political

leaders

-Teachers

-Radio

-Community

meetings

-Newspaper

pull outs

-TV panel

discussions

-Flyers

-Fact sheets

-Posters

-Local

station, a

few days

before MDA

-Village

meetings

-TV stations

-School

settings

-Weekly

radio

programs

-One

meeting per

village

-School

discussion

groups

-# of times

messages aired on

radio during

reference period—

radio broadcast

reports

-% of population

that believe NTDs

are not caused by

witchcraft based

on KAP survey

-% of audience

who recall

message—

coverage survey,

local/national

omnibus survey

The drugs provided

are free and safe

[RTI + The Carter

Center]

-Community

members in

endemic and

targeted

districts

-SAC

-Political

leaders

-Teachers

-Radio

-Brochures

-Newspaper

articles

-Local

station, 2

weeks in

advance of

and 2 weeks

during MDA

campaign

[RTI]

-Local station

1 week in

advance of

OV/LF MDA

campaign

[The Carter

Center]

-4 times daily

for 20 days

once

-Weekly

newspaper

articles [RTI]

-Messages

play 10 times

a day in

evening [The

Carter

Center]

-# of times

messages aired on

radio during

reference period-

—radio broadcast

reports

-% of targeted

population that

seek NTD drugs

during MDA

-% of audience

who recall

message—-

coverage survey,

local/national

omnibus survey

It is common for

drugs to have mild

side-effects.

-Community

members

targeted for

-Training

manuals

-Brochures

-District level

CDD/

teacher

-Flip charts,

VHT

handbooks &

-# of flip charts,

VHT handbooks,

and training guides


32

Category

Key messages (in

English and local

languages11)

Target


Where/

when will

they be

distributed

Frequency

Has this

material/

message or

approach been

evaluated? If

not please detail

how that will be

addressed

These are mild,

transitory, and self-

limiting.

[RTI + The Carter

Center]

MDA

-Teachers

-SAC

-CDDs

-Radio

-Newspaper

articles

-TV panel

discussions

-Testimonies

by satisfied

clients

[RTI]

-Flip chart

[The Carter

Center]

refresher

training

-Radio

-TV

-Village

meetings

[RTI]

-Subcounty

level

community

supervisors’

and CDD

refresher

training [The

Carter

Center]

training

manuals will

be

distributed

once

annually

[RTI]

-Radio and

TV panel

discussions

weekly

-Brochures

distributed in

schools and

at

community

meetings

-Flip charts

will be

distributed

once

annually

[The Carter

Center]

disseminated

during reference

period

- training

attendance list

(focal person

report) [RTI]

-# of flip charts

disseminated

during reference

period- training

attendance list

(administration

report) [The Carter

Center]

Drugs handed out at

school are safe and

keep you healthy

[RTI]

-SAC

-Teachers

-Parents and

guardians

-Brochures

-School club

discussions

-School

assemblies

-Radio panel

discussions

-Village

meetings

-VHT

handbook,

training

manual

-Teacher

refresher

training

-Schools

-Radio

-Brochures

to be

distributed

once to SAC

-Radio

announceme

nts during

the 4 weeks

before MDA

-Weekly

school club

discussions

-VHT

handbooks &

training

manuals will

be

distributed

once

annually

-# of brochures,

handbooks, and

training guides

disseminated

during reference

period- training

attendance list

(focal person

report)

-% of targeted

population who

believe drugs are

safe

Drugs handed out at

health units to

community

supervisors for their

All eligible

community

members

Posters

In the

community

and 2 weeks

before MDA

Once a year

% of audience who

recall seeing the

poster and

message—in


33

Category

Key messages (in

English and local

languages11)

Target


Where/

when will

they be

distributed

Frequency

Has this

material/

message or

approach been

evaluated? If

not please detail

how that will be

addressed

respective

communities [The

Carter Center)

coverage survey,

or at point of MDA

PTS Period -Interruption of

transmission was

declared, outlining

roles of stakeholders

at different levels

-Be on the lookout

for suspected

infections and report

them to the nearest

Local leader, health

workers, or health

unit (The Carter

Center)

Community

members and

leaders at

various levels

Jingles,

posters, and

brochures

In the

community

and various

district

offices

Once Yes, it has been

evaluated and

approved by the

MOH

e) Training

Activity 1: Training of central trainers/supervisors: ENVISION will support a three-day

refresher/retraining of 60 central trainers at VCD/MOH, with facilitation by the NTD program, ENVISION,

and other partner organizations. This will focus on the background to each disease and improvements in

supportive supervision, especially the use of the supervision checklist. Central supervisors are

responsible for providing technical guidance to districts. Their main responsibilities are to train district-

based trainers (district TOTs); conduct district advocacy, and supportive supervision; and participate in

impact assessments where appropriate. Before they are dispatched to districts, trainers and supervisors

will be equipped with up-to-date knowledge of NTDs and the tools used in the program, including NTD

factsheets and manuals.

Activity 2: Training of district NTD focal persons at VCD: ENVISION will support the three-day training of

26 district focal points at the national level. Trainers will include members of the NTD Secretariat, NTD

technical advisory committee, and the ENVISION data manager, who provides support with data tools.

The training will focus on various topics including the role of the district in the program, the use of data

for planning and evaluation, supply chain management, the use of data collection tools, reporting, and

the management of adverse events and serious adverse events (AEs/SAEs).

During training, programmatic challenges and mitigation approaches will be discussed with the focal

points. Training is required annually because the district level focal points is an assignment rather than a

full-time job, and hence there is some turnover each year.

Activity 3: Training of trainers in the districts: ENVISION will continue to support TOT in FY18. This cadre

will provide training to lower administrative levels and provide continued supportive supervision. In

FY18, ENVISION will support a total of 364 district-level trainers (10 district health teams + 4 HSDs per


34

district) to be trained for two days at each of the 26 district headquarters. The ENVISION Uganda team

will provide technical assistance to the NTD Secretariat to plan and conduct these trainings.

Activity 4: Training of trachoma graders and recorders: Prior to starting the planned surveys, the

certified graders and recorders will undergo a one-day refresher training.

Activity 5: Training of subcounty and parish supervisors, CDDs, and teachers: In the districts receiving

MDA, ENVISION will support the training of 2,342 parish supervisors (two from every parish) ,32,940

CDDs and two teachers from each school in the sub county.

Activity 6: OV-specific training of supervisors and Health workers: ENVISION will support training of

24,816 supervisors and health workers in 18 districts. Each training will take one day and include district

and subcounty staff participation. Trained supervisors then supervise CDDs.

Activity 7: OV-specific training of CDDs: ENVISION will support community-level training of 16,360 new

CDDs, and refresher training for 13,590 CDDs at the community level, in 18 districts.

Table 7: Training targets

Training groups Training topics

Number to be trained (for

The Carter Center, this

includes training supported

by all funding sources)

Number

training

days

Location of

training(s)

Name

other

funding

partner New Refresher

Total

trainees

District

TOTs [RTI]

•NTDs in Uganda

•Manifestations

•Causes and transmission

•Distribution–maps

•Control – drugs, vectors, other

•Data tools

•Dose poles use

•Adverse events and management

•Advocacy for control

•Timelines–work plan

•Allocation of drugs

•Social mobilization

•Coverage targets

•MDA, post-MDA

•Tools and how to fill

80 284 364 2 District HQ None

Health workers

[RTI]

•NTDs in Uganda

•Manifestations

•Causes and transmission

•Distribution–maps

•Control – drugs, vectors, other

•Data tools

•Dose poles use

•Adverse events and management

•Advocacy for control

•Timelines–work plan

•Allocation of drugs

•Social mobilization

•Coverage targets

•MDA, post-MDA

•Tools and how to fill

104 513 617 1 HSD None


35






Number

training

days

Location of

training(s)

Name

other

funding


Total

trainees

Health workers

[RTI]

•Clinical diagnostics

•NTD disease surveillance 1,234 0 1,234 3 National None

Subcounty

Supervisors [RTI]

•NTDs in district and subcounty

•IEC materials

•Rest as above

25 465 490 1 HSD or

County HQ None

Parish

Supervisors [RTI]

•NTDs in subcounty

•Transmission – elementary cycle

•Medicines for control

•Side-effects

•Tools for registration

•Tally sheets

•IEC materials

•Use of dose poles

•CDD supervision

•How to make a summary report from the

register

117 2,225 2,342 1 Subcounty

HQ None

CDDs [RTI]

•NTDs in area, distribution

•Drugs for control

•Registration


•Eating before treatment

•Common adverse effects

•Use of tally sheets

4,941 27,999 32,940 2 Parish None

Teachers [RTI]

•NTDs in area, distribution

•Drugs for control

•Registration


•Eating before treatment

•Common adverse effects

•Use of tally sheets

1,930 4,504 6,434 1 Schools None

NTD Focal

Persons [RTI]

•NTDs in Uganda

•Distribution, endemic areas

•Transmission

•Control

•Drugs used, quantities

•Side-effects, management

•Cascade training

•Planning MDA

•Implementation units

•Tools

•Registration

•Sensitization

•Supportive supervision

•Stock outs

•Reporting

•Financial responsibilities

3 25 28 3 Kampala,

Hotel None


36






Number

training

days

Location of

training(s)

Name

other

funding


Total

trainees

NTD Focal

Persons, Chief

Administrative

Officers, and

District Health

Officers [RTI]

•Grant management

•Questionnaires

•Anti-terrorism forms

•FOGs milestones

•Auditing

•Progress Reports

14 70 84 1 Kampala

Hotel None

Central

Trainers /

Supervisors [RTI]

As for NTD focal persons

•Supportive supervision tools 2 58 60 2

Kampala

VCD None

ENVISION staff

and MOH NTD

PMs and Senior

Staff

Program planning, management and

evaluation (including financial

management):

• Project cycle

• Problem analysis

• Needs assessments

• Logical framework

• Project design

• Project analysis

• Participatory approaches

• Reports

• M&E

• Cost structures and budgeting

• Project implementation

• Use of grant charts

• Managing procurement process

• Business investment plan

13 0 13 14

Uganda

Manageme

nt Institute

Kampala

campus

None

Graders and

Recorders

• Global Trachoma Mapping Project

methodology of TF, TT, opacity,

blindness grading and

• Data recording, transmission

10 0 10 5

Endemic

district-

Nakapiripiri

t

None

ENVISION Staff

• Financial management

• Project management and budget

monitoring

• Strategic planning & management

• Public policy analysis & evaluation

• Financial management

• Records management & microplanning

• Accurate financial statements

• Manage the audit process

• Develop budgets in support of program

needs

• USAID rules & regulations

• Grants & cooperative agreements

• USAID Project Management

• USAID TOT

• USAID proposal development

12 0 12 7 max

Kampala

and outside

Uganda

None

M&E Assistants

• Database use

• Microplanning template

• Data analysis

10 0 10 5 Kampala None


37






Number

training

days

Location of

training(s)

Name

other

funding


Total

trainees

Core District Data

Team

Development and use of integrated NTD

database 84 0 84 3 Regional None

Supervisors and

health workers for

OV MDA (The

Carter Center)

• OV as a disease

• Transmission

• Signs and symptoms

• OV endemic areas

• Life cycle of OV

• Effect of OV

• Treatment exclusion criteria

• IVM administration (e.g.,

dosing)

• Roles

• Data collection tools and

record keeping

• Community mobilization

• Recording and reporting

303 24,513 24,816 1 Subcounty

CDDs for OV MDA

(The Carter

Center)

Same as above 13,590 16,360 29,950 1 Community Sightsaver

s

f) Drug and Commodity Supply Management and Procurement

Activity 1: Drug delivery: ENVISION will continue to work closely with MOH and NMS to ensure timely

delivery of drugs to each district.

Activity 2: Reverse supply chain: Reverse logistics is fully supported by ENVISION after each MDA, and

this will continue in FY18.

g) Supervision for MDA

The NTD Secretariat, with support from RTI, will continue to conduct supportive supervision in districts

during implementation. Supervision will be increased in Gulu, Arua, and Pakwach, which have recurrent

low coverage and require close monitoring. Special attention will be given to key activities like training,

register updates, and MDA itself. During this process, the central-level supervisors will make field visits

and interact with health workers, subcounty focal persons, parish and community supervisors, teachers,

CDDs, and community members to ascertain the level of knowledge and utilization.

The central supervisors will also conduct random spot checks at all levels (district, subcounty, parish,

school, and community) during and after training. Results from these supervisory visits will be collated

through a standardized supervisory questionnaire/checklist and submitted to the NTDCP and ENVISION

for review. RTI’s M&E team will analyze the results and share with the NTD Secretariat and RTI’s senior

management for action. It is at the discretion of the central supervisor/trainer to liaise with the district

NTD focal person and the NTD Secretariat to arrange a quick, on-the-spot (re)training of cadres deemed

deficient in knowledge. Attention will be paid to areas that have repeatedly reported low coverage.


38

In FY18 RTI will support the following activities:

Activity 1: Supportive supervision during training of subcounty supervisors and health workers in 26

districts: This will be conducted by central staff from RTI and MOH. Costs include vehicle rental, fuel, per

diem, and mobile phone airtime.

Activity 2: Supervision during training of parish supervisors: This will be conducted by central staff from

RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime.

Activity 3: Supervision of registration: This will be conducted by central staff from RTI and the MOH.

Costs include vehicle rental, fuel, per diem, and mobile phone airtime.

Activity 4: Supervision during training of CDDs and teachers: This will be conducted by central staff

from RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime.

Activity 5: Supervision during MDA and data collection: This will be conducted by central staff from RTI

and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime.

Activity 6: Supportive supervision for finance: This will be conducted by central staff from RTI and the

MOH. Costs include vehicle rental, fuel, and per diem.

Activity 7: Enhanced Supervision of MDA in Gulu, Omoro and Kitgum: This will be conducted by central

staff from RTI and the MOH and will involve having a supervisor in each subcounty. Costs include vehicle

rental, fuel, and per diem.

Activity 8: Supervision of MDA for LF-OV (The Carter Center): Supervision of the distribution of the

drugs will be carried out to ensure that the drugs are distributed to the targeted communities through

the national health care services per MOH policy and per WHO guidelines (when they do not conflict

with MOH policy). After distribution, supervisory teams from the central office ensure that the eligible

populations in all targeted communities are treated with Ivermectin. They also check the quality of the

treatment through examination to check for the proper use of dose poles and the correct quantity of

drugs. The supervisory team in Kampala also checks to ensure that the drugs are accounted for. The

central office also conducts data validation to ensure the accuracy of treatment numbers that are

reported.

During the training of CDDs, emphasis is put on the usage of data collection tools, such as, registers,

data collection forms and the recording of information in the data treatment book. Additionally,

exclusion criteria are emphasized with the aim of ensuring that the correct populations are treated and

recorded. Supervision during this exercise is paramount, especially in problematic districts and

communities.

Focus group discussions/community meetings are held to establish knowledge regarding river blindness

disease, community drug distributors, treatment period, and the eligible population. These activities are

discussed in more detail in the social mobilization section.

h) M&E

ENVISION will continue to support M&E efforts in FY18 in the following ways:

Activity 1: Coverage validation surveys for LF, OV, trachoma and SCH/STH MDA (RTI–M&E): In FY17,

coverage surveys were conducted in five districts: Namayingo (LF and SCH/STH), Kasese (OV/STH), Nebbi

(LF, trachoma, SCH/STH), Kaabong (trachoma) and Kitgum (LF, OV, SCH/STH). The surveys used the WHO


39

protocol, and technical assistance was provided by WHO and RTI. Results are being analyzed, and it is

expected that lessons learned will be applied to the FY18 activities.

In FY18, coverage surveys, with a KAP component, will be conducted in another five districts: Gulu,

Lamwo, and Arua (OV, LF, and SCH/STH); and Moroto and Nakapiripirit (or the new Nabilatuk district) in

Karamoja for trachoma MDA. Some of these districts have consistently reported poor coverage,

especially Gulu and Arua, prompting the surveys. Further, some of the districts have failed to achieve

the five rounds of effective MDA coverage. The survey design used in FY17 will be adopted or modified

based on findings of the survey recently completed. Probability proportional to size methods will be

used to select parishes, and 30 randomly selected villages will be sampled per district. Details of the

sampling and survey procedures and tools are contained in the WHO protocol for validation of reported

coverages after MDA.

Activity 2: LF TAS1 stopping MDA in three districts (RTI– M&E): In FY18, TAS1 will be conducted in three

districts: Mayuge, Bugiri, and Namayingo. These have each had at least five effective rounds of MDA and

successfully passed pre-TAS. The methodology will be based on WHO guidelines and the use of the

survey sample builder.

Activity 3: LF TAS2: Post-MDA surveillance in 17 districts (RTI- M&E): In FY18, TAS2 will be conducted in

17 districts. These are Iganga, Namutumba, Luuka, Kamuli, Kaliro, Buyende, Bukedea, Kumi, Ngora,

Kaberamaido, Serere and Soroti in Eastern Region; Apac, Kole, Adjumani, Oyam, and Moyo in Northern

Region.

Activity 4: TSS in 13 districts (RTI): In FY18, ENVISION will support TSSs in 13 districts that stopped MDA

in 2016. The districts are Butaleka, Mayuge*, Namayingo, Paalisa*, Amolatar, Apac*, Kitgum, Kole,

Lamwo, Oyam*, Yumbe*, Kiryandongo and Masindi. Districts marked with an asterisk have large

populations that need to be split into two EUs.

Activity 5: TIS in two districts (RTI): In FY18, ENVISION will support TIS in two districts-Amudat and

Kaboong.

Activity 6: OV epidemiological assessment (The Carter Center): To re-affirm OV interruption,

epidemiological activities (OV16 ELISA and skin snips) will be conducted in foci that have completed

three years of PTS. The transition of some districts to post-MDA will be contingent on passing LF TAS and

therefore stopping IVM treatment. This includes Maracha and Nebbi (the latter will depend on RPRG

decisions, to be communicated in mid-2018). The assessments will include serological and entomological

surveys to determine whether OV has been eliminated. Blood samples will be collected from 7,000

children under 10 years old in the sampled communities/parishes where adult skin snips were

conducted. For cross-border foci: Uganda’s focus of Bwindi, which is in the districts of Kanungu and

Kisoro, and the cross-border areas of DRC in the district of Ruchuru-Goma will conduct skin snips in

January 2018.

Uganda’s Lubiriha focus, which includes the district of Kasese, and the cross-border area of DRC in the

district of Beni-Butembo will conduct OV16 ELISA and skin snips, assuming the security situation in DRC

remains workable around June 2018. Uganda’s West Nile focus, which includes the districts of Koboko

and Yumbe, and the cross-border area of DRC in Ituri District (northern part) and in South Sudan in the

Yei District, will conduct OV16 ELISA and skin snips depending on South Sudan’s security situation.

Uganda’s Madi–Mid North focus, including the districts of Lamwo, Moyo, Adjumani, and Amuru (among

others), will conduct cross-border OV16 ELISA and skin snipping with the county of Magwi in South

Sudan, depending on South Sudan’s security situation.


40

Additionally, entomological surveys for analysis of infective potential (vector control) of district/foci will

be conducted in Nebbi (in both the Wadelai and Nyagak-Bondo foci), Kasese (in both the Nyamugasani

and Lubiriha foci), Rubanda, Kanungu, Kisoro (Bwindi), Pader, Kitgum, Lamwo, Gulu, Amuru, Nwoya,

Oyam, Lira, Moyo, and Adjumani (Madi–Mid North) and part of Moyo (in Obongi focus), Yumbe,

Koboko (West Nile), Arua, Zombo (Nyagak-Bondo), Maracha (Maracha-Terego), Masindi, Bulisa, and

Hoima (Budongo). These activities will be partially supported with ENVISION funds and partially

supported by other Carter Center funding sources. Cross-border entomological monitoring will be

carried out in Uganda’s Kanungu and Kisoro districts (Bwindi foci) and in DRC’s Ruchuru-Goma District.

Similarly, Arua, Nebbi, and Zombo districts in Uganda’s Nyagak-Bondo foci will be included in quarterly

cross-border entomological monitoring in the southern part of DRC’s Ituri District. Uganda’s districts of

Yumbe and Koboko (West Nile foci) will be included in quarterly entomological monitoring that will also

include the northern part of Ituri District in DRC, and Yei District in South Sudan.


41

Table 9a: Planned DSAs for FY18 by disease

Disease

No. of

endemic

districts

No. of districts

planned for

DSA

No. of

Evaluation Units

planned for DSA

(if known)

Type of

assessment

Diagnostic method (Indicator:

Mf, FTS, etc.)

Lymphatic Filariasis 61

3 TAS1 LFTS for antigenemia; mf in night

blood

17 TAS2 LFTS for antigenemia; mf in night

blood

Trachoma 47 2 TIS

Clinical grading (GTMP surveys) 13 TSS

Onchocerciasis 21 21

Skin snips, OV16

ELISA blood spots,

and entomological

surveillance

Mf, positive children, crab

infestation, and fly infections

Schistosomiasis 87 0 N/A

Soil-Transmitted

Helminths 128 0 N/A

Table 9b: Planned OV-specific assessments for FY18

Focus Districts Type of assessment Diagnostic method (Indicator: Mf,

FTS, etc.)

Budongo Hoima, Masindi, & Buliisa Entomological surveillance Crab infestation and fly infections

West Nile Koboko & Yumbe Entomological surveillance Crab infestation and fly infections

Nyagak-Bondo Arua, Zombo, & Nebbi Entomological surveillance Crab infestation and fly infections

Maracha-Terego Terego Entomological surveillance Crab infestation and fly infections

Bwindi Rubanda, Kisoro & Kanungu Entomological surveillance Crab infestation and fly infections

Obongi Moyo Entomological surveillance Crab infestation and fly infections

Nyamugasani Kasese Entomological surveillance Fly infections

Madi–Mid North Moyo, Adjumani, Amuru,

Nwoya, Oyam, Gulu

Skin snips, OV16 blood

spots, and entomological

surveillance

Mf, positive children, crab infestation,

and fly infections

Lubiriha Kasese Entomological surveillance Fly infections

i) Supervision for M&E and DSAs

In FY18, ENVISION will support:

Activity 1: Supervision of coverage validation surveys (RTI): RTI and MOH will conduct supervision in

each of the five districts conducting coverage surveys. Costs will include vehicle hire and per diem.

Activity 2: Supervision of LF TAS1 (RTI): The LF program manager regularly shares plans, survey drafts,

and results with ENVISION for comment. This will continue in FY18. ENVISION staff, including the

Resident Program Advisor and Senior Technical Advisor, participate in field surveys and the training of

district staff on the use of filariasis test strips (FTS) for LF surveillance.

Activity 3: Supervision of LF TAS2 (RTI): The LF program manager regularly shares plans, survey drafts,

and results with ENVISION for comment. This will continue in FY18. ENVISION staff, including the COP

and CTA, participate in field surveys and the training of district staff on the use of FTS for LF surveillance.


42

Activity 4: Supervision of TSS (RTI): ENVISION staff and consultants are part of the planning process.

ENVISION has secured the services of a trachoma quality control consultant who is the only

ophthalmologist in the country certified to train and supervise graders and recorders. The consultant

ensures that WHO and Tropical Data gold standards are adhered to.

Activity 5: Supervision of TIS (RTI): ENVISION staff and consultants are part of the planning process.

ENVISION has secured the services of a trachoma quality control consultant who is the only

ophthalmologist in the country certified to train and supervise graders and recorders. The consultant

ensures that WHO and GTMP/Tropical Data standards are adhered to.

Activity 6: OV epidemiological assessment (The Carter Center): For OV16, sampling is carried out

directly by the Kampala headquarters. Carter Center personnel go with the teams for OV16 surveys.

Management ensures that proper protocols are observed, that quality data are obtained, and to ensure

the fidelity of geographical targets per the sampling frame.

For entomological monitoring, teams are organized by the Carter Center Kampala office, with occasional

supportive supervisory visits to ensure that proper protocols are observed as the activities are carried

out. This also ensures that quality data are received. If challenges arise (such as under-capture as a

result of fly catchers leaving early), the management team provides novel solutions to these issues.

j) Dossier Development

Activity 1: LF dossier: The MOH has requested support for the development of the LF dossier. ENVISION

will support a dossier consultant in FY18 for 30 days. As part of the final LF elimination process, the MOH

will convene a workshop of 12 participants to review historical data and begin to draft the dossier.

ENVISION will pay for the venue, refreshments and transport. ENVISION will also support the printing of

key LF MMDP assessment tools to be given to each district, this will enable the consultant to summarize

the country’s MMDP situation, MMDP services available in health units and communities which are all

key to completing the dossier.


43


44

3) Maps

Figure 7. Uganda LF, OV, STH, SCH, and Trachoma Endemicity Maps

Figure 8. Uganda LF, OV, SCH, STH, and Trachoma Geographic Coverage Maps


45


46

Figure 9. Uganda Progress towards LF Elimination Map


47

Figure 10. Uganda Progress towards Trachoma Elimination Map


48

APPENDIX 2: Work Plan Timeline

FY18 Activities

Management Support

NTD Program Capacity Strengthening

Train/Orient the MOH NTD Data Manager on information systems and data management systems (RTI)

Training in program planning, management, and evaluation—including financial management at Uganda

Management Institute (RTI)

Continued training for NTDCP senior staff on the integrated NTD database (RTI)

Project Assistance

Strategic Planning

2 NTD Technical Committee Meeting (RTI)

National Planning & Data Review Meeting (RTI)

Regional Planning & Review Workshop (RTI)

Microplanning in 26 districts (RTI)

National Stakeholder Meeting (River Blindness Program Review Meetings (The Carter Center)

UOEEAC (The Carter Center)

NTD Secretariat

Operational & program supervision support costs for NTDCP (RTI)

NTD secretariat MOH quarterly meetings (RTI)

Building Advocacy for Sustainable National NTD Program

Breakfast meeting with MPs from the 26 ENVISION-supported districts (RTI)

Northern Uganda Regional Advocacy Meeting (RTI)

District-level advocacy meetings (RTI)

News publications on NTDs (RTI)

MDA Coverage

Registration/update of treatment registers (The Carter Center):

LF and STH MDA in 7 districts (RTI)

SCH MDA in 16 districts (RTI)

Trachoma MDA in 2 districts (RTI)

OV MDA in 23 districts (RTI and TCC)

Social Mobilization to Enable NTD Program Activities

Community dialogue to improve MDA coverage level (RTI):

Multimedia campaign for PC-NTDs (RTI):

Sensitization of subcounty leadership (RTI)

Disseminate documentaries for SCH in Albertine and trachoma in Karamoja regions (RTI)

OV-related health education and sensitization by community supervisors (The Carter Center)

Training

Training of central trainers/supervisors in 26 districts (RTI):

Training of trachoma graders and recorders at VCD (RTI):

Training of district NTD focal persons at VCD(RTI):

Training of trainers (TOTs) in 26 districts (RTI:

Training of subcounty supervisors and health workers at HSDs and lower health units on MDA planning,

implementation, and reporting (RTI)

Training of parish supervisors on MDA planning, implementation, and reporting (RTI)

Training of CDDs/VHTs and teachers (RTI)

OV-specific training of supervisors and health workers (The Carter Center)

OV-specific re/training of CDDs (The Carter Center)

Supervision for MDA

Supportive supervision during training of subcounty supervisors & health workers in 26 districts

Supervision during training of parish supervisors

Supervision of registration

Supervision during training of CDDs and teachers

Supervision during MDA and data collection


49

FY18 Activities

Monitoring and Evaluations

Coverage validation surveys for LF, OV, Trachoma and SCH/STH MDAs (RT)

LF TAS 1 in 3 districts (RTI)

LF TAS 2 in 17 districts (RTI)

Trachoma Impact Survey in 2 districts (RTI)

Trachoma Surveillance Survey 13 districts (RTI)

OV16 and/or skin snips

Vector monitoring (monthly fly catching)

Vector monitoring (quarterly, based on security situation)

Supervision of M&E

Supervision of Coverage Validation Surveys (RTI)

Supervision of LF TAS1 (RTI)

Supervision of LF TAS2 (RTI)

Supervision of TSS (RTI)

Supervision of TIS (RTI)

Dossier Development

LF dossier consultant

STTA

Trachoma Quality Control Consultant (RTI)

SAE Consultant (RTI)

Cross-Border Strategic Plan Consultant (RTI)

NTD Documentary Consultant (RTI)

M&E Assistants (RTI)

LF Dossier Consultant (RTI)

*If necessary


50

APPENIDX 4. Table of USAID-supported Regions and Districts in FY18

Sn Region Health

Districts

Mapping

(list

disease(s)

Baseline

sentinel

sites (list

disease(s)

MDA DSA

(list type: TAS 2, TSS, etc.)

LF OV SCH STH TRA LF OV SCH STH TRA

1

Western

Kasese x x Entomological

surveillance

2 Buliisa x x Entomological

surveillance

3 Rubanda x Entomological

surveillance

4 Kisoro x Entomological

surveillance

5 Kanungu

6 Kiryandongo LF & TRA

TSS

7 Hoima x Entomological

surveillance

8 Masindi x Entomological

surveillance TSS

10

Eastern

Amudat TIS

11 Butaleja TSS

12 Moroto x

13 Nakapiripirit x

14 Nabilatuk x

15 Kaabong TIS

16 Kotido

17 Mayuge TAS1 TSS

18 Bugiri TAS1

19 Namayingo TAS1 TSS

20 Iganga TAS2

21 Namutumba TAS2

22 Luuka TAS2

23 Kamuli TAS2

24 Kaliro TAS2

25 Buyende TAS2

26 Bukedea TAS2

27 Kumi TAS2

28 Ngora TAS2


51

Sn Region Health

Districts

Mapping

(list

disease(s)

Baseline

sentinel

sites (list

disease(s)

MDA DSA



29 Kaberamaido TAS2

30 Pallisa TSS

31 Serere TAS2

32 Soroti TAS2

33 Busia

34 Tororo

35 Kween

36 Sironko

37 Jinja

38

Northern*

Apac TAS2 TSS

39 Kole TAS2

40 Adjumani LF & TRA x x TAS2

41 Moyo LF & TRA TAS2

Skin snips,

OV16 ELISA

blood spots,

and

entomological

surveillance

42 Koboko LF & TRA x RA Entomological

surveillance

43 Yumbe LF & TRA x RA Entomological

surveillance Assessments Assessments TSS

44 Maracha

45 Terego

46 Amuru x x

Skin snips,

OV16 ELISA

blood spots,

and

entomological

surveillance

47 Arua LF & TRA x x x x RA Entomological

surveillance

48 Omoro x x x x

49 Gulu x x x x

Skin snips,

OV16 ELISA

blood spots,


52

Sn Region Health

Districts

Mapping

(list

disease(s)

Baseline

sentinel

sites (list

disease(s)

MDA DSA



and

entomological

surveillance

50 Kitgum x x x x Assessments Assessments TSS

51 Kole TSS

52 Lamwo LF & TRA x x x RA TSS

53 Maracha x x

54 Nebbi x x Entomological

surveillance

55 Pakwach x x Assessments Assessments

56 Nwoya x x

Skin snips,

OV16 ELISA

blood spots,

and

entomological

surveillance

57 Pader x Assessments Assessments

58 Zombo

59 Adjumani Assessments Assessments

60 Moyo x x

Skin snips,

OV16 ELISA

blood spots,

and

entomological

surveillance

Assessments Assessments

61 Oyam x x TAS2

Skin snips,

OV16 ELISA

blood spots,

and

entomological

surveillance

TSS

62 Amolatar TSS

63

Central

Kiboga

64 Luwero

65 Kyankwanzi

66 Nakaseke


53

Sn Region Health

Districts

Mapping

(list

disease(s)

Baseline

sentinel

sites (list

disease(s)

MDA DSA



67 Nakasongola

68 Buikwe

64 Buvuma

65 Kayunga


54

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