haiti work plan · envision fy18 py7 haiti work plan ii envision project overview the u.s. agency...

HAITI Work Plan FY 2018

Project Year 7

October 2017–September 2018

ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by the U.S. Agency for International Development under cooperative agreement No. AID-OAA-A-11-00048. The period of performance for ENVISION is September 30, 2011, through September 30, 2019. The author’s views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the U. S. Government.

ENVISION FY18 PY7 Haiti Work Plan ii

ENVISION Project Overview

The U.S. Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm, whipworm, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at global and country levels and support ministries of health (MOHs) to achieve their NTD control and elimination goals.

At the global level, ENVISION—in close coordination and collaboration with WHO, USAID, and other stakeholders—contributes to several technical areas in support of global NTD control and elimination goals, including the following:

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

• Capacity strengthening

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

• Disease mapping

• NTD policy and technical guideline development

• 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 Haiti, ENVISION project activities are implemented by IMA World Health.

ENVISION FY18 PY7 Haiti Work Plan iii

TABLE OF CONTENTS

ENVISION Project Overview .......................................................................................................................... ii

ACRONYMS LIST ............................................................................................................................................ v

COUNTRY OVERVIEW .................................................................................................................................... 7

1) General Country Background .................................................................................................... 7

a) Administrative Structure ........................................................................................................... 7

b) NTD Program Partners .............................................................................................................. 7

2) National NTD Program Overview ............................................................................................ 11

a) Lymphatic Filariasis ................................................................................................................. 12

b) Soil-Transmitted Helminths ..................................................................................................... 15

3) Snapshot of NTD status in Haiti ............................................................................................... 17

PLANNED ACTIVITIES ................................................................................................................................... 19

1) NTD Program Capacity Strengthening ..................................................................................... 19

a) Strategic Capacity Strengthening Approach ............................................................................ 19

b) Capacity Strengthening Objectives and Interventions ............................................................ 19

c) Monitoring Capacity Strengthening ........................................................................................ 21

2) Project Assistance .................................................................................................................... 22

a) Strategic Planning .................................................................................................................... 22

b) NTD Secretariat ....................................................................................................................... 23

c) Building Advocacy for a Sustainable National NTD Program .................................................. 23

d) Mapping .................................................................................................................................. 23

e) Social Mobilization to Enable NTD Program Activities ............................................................ 26

f) Training .................................................................................................................................. 277

g) Drug and Commodity Supply Management and Procurement ............................................... 28

h) Supervision for MDA ............................................................................................................... 29

i) M&E ......................................................................................................................................... 30

j) Supervision for M&E and DSAs ............................................................................................... 32

k) Dossier Development .............................................................................................................. 32

4) Maps ........................................................................................................................................ 33

APPENDIX 1: Work Plan Timeline................................................................................................................ 36

APPENDIX 2. Table of USAID-Supported Regions and Districts in FY18...................................................... 38

ENVISION FY18 PY7 Haiti Work Plan iv

TABLE OF TABLES

Table 1: Non-ENVISION NTD partners working in country, donor support and summarized activities................................................................................................................................... 10

Table 2: Snapshot of the expected status of the NTD program in Haiti as of September 30, 2017 ......................................................................................................................................... 17

Table 3: Project assistance for capacity strengthening ......................................................................... 22

Table 4: USAID-supported districts and estimated target populations for MDA in FY18 ..................... 25

Table 5: Planned Disease-specific Assessments for FY18 by disease .................................................... 31

ENVISION FY18 PY7 Haiti Work Plan v

ACRONYMS LIST

AE Adverse Event ALB Albendazole ASTMH American Society of Tropical Medicine and Hygiene BMGF Bill and Melinda Gates Foundation CDC U.S. Centers for Disease Control and Prevention CDD Community Drug Distributor CL Community Leader COR-NTD Coalition for Operational Research on NTDs CP Community Promoter CY Calendar Year DEC Diethylcarbamazine Citrate DELR Direction d’Epidemiologie de Laboratoire et de Recherche (Directorate of Laboratory and

Research Epidemiology) DIP Direct Inspection Protocol DQA Data Quality Assessment DSA Disease-Specific Assessment DSF Direction de Santé de la Famille (Directorate of Family Health) DSS Direction de la Santé Scolaire (Directorate of School Health) EAG Easy Access Groups EU Evaluation Unit FTS Filariasis Test Strip FY Fiscal Year GPELF Global Program to Eliminate Lymphatic Filariasis GSK GlaxoSmithKline, Inc. HNTDCP Haiti NTD Control Program HQ Headquarters HSC Hôpital Sainte Croix ICT Immunochromatographic Test IDB Inter-American Development Bank IEC Information, Education, and Communication IVM Ivermectin JRF Joint Reporting Form JRSM Joint Request for Selected Medicines KAP Knowledge, Attitudes, and Practices LF Lymphatic Filariasis LOE Level of Effort M&E Monitoring and Evaluation MDA Mass Drug Administration MENFP Ministère de l’Education Nationale et de la Formation Professionnelle (Ministry of

Education and Professional Training) Mf Microfilaremia MMDP Morbidity Management and Disability Prevention MOH Ministry of Health MSPP Ministère de la Santé Publique et de la Population (Ministry of Public Health and

Population)

ENVISION FY18 PY7 Haiti Work Plan vi

NTD Neglected Tropical Disease Q Quarter PAHO Pan-American Health Organization PAP Port-au-Prince PC Preventive Chemotherapy PROMESS Programme de Médicaments Essentiels (Essential Drug Program) RDT Rapid Diagnostic Test RPRG Regional Program Review Group SAC School-Age Children SAE Serious Adverse Event SC Spot Check SCT Supervisor’s Coverage Tool SS Sentinel Site SSB Survey Sample Builder STH Soil-Transmitted Helminths STTA Short-Term Technical Assistance TA Technical Assistance TAS Transmission Assessment Survey TCC The Carter Center TFGH Task Force for Global Health TIPAC Tool for Integrated Planning and Costing UCS Unité Communale de Santé (Communal Health Unit) UND University of Notre Dame USAID U.S. Agency for International Development WHO World Health Organization

ENVISION FY18 PY7 Haiti Work Plan 7

COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Haiti is divided into 10 departments: Artibonite, Center, Grand’Anse, Nippes, North, Northeast, Northwest, South, Southeast, and West. These departments are further divided into 140 communes and 570 communal sections (sub-districts).

The Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population [MSPP]) guides policy, planning, and monitoring and evaluation (M&E) efforts for health programs in Haiti. Within the MSPP, the Director General is the health sector lead, reporting to the Minister of Health. The Director General oversees the directors of several health priority areas including the Haiti Neglected Tropical Disease (NTD) Control Program (HNTDCP)—at the central level and all department-level health directors. At the commune level, the unités communales de santé (communal health units [UCSs]) lead all health efforts. The UCSs are decentralized administrative units that are responsible for carrying out a series of health activities with the participation of the community, and often, a UCS will oversee multiple communes. The number and location of UCSs are determined by the size of the population covered, the UCS’s jurisdiction, and geographical location.

The Ministry of Education and Professional Training (Ministère de l’Education Nationale et de la

Formation Professionnelle [MENFP]) has a similar structure to the MSPP, with a Director General who oversees all education-related work in Haiti. The Director General oversees several priority area central-level directors as well as education directors for each department. Within each department, there are principal and zone inspectors who work with the facility-level school directors.

The HNTDCP efforts require close coordination between the MSPP and MENFP. These two ministries work together to coordinate, plan, and supervise many health activities throughout the country because schools are often used as a platform for service delivery and mass drug administration (MDA). HNTDCP activities are led at the central level by the Lymphatic Filariasis (LF)/Malaria Coordinator and the technical advisor for soil-transmitted helminths (STH). These two key personnel also work closely with the central-level director within MENFP for school-based MDA-related work. Supporting the LF/Malaria Coordinator are a team of M&E staff, two entomologists, two nurses, two advisors, two communication agents, a morbidity management and disability prevention (MMDP) and pharmacovigilance focal point, and a secretary. M&E staff—who mainly support the malaria program but also work on the LF program—include a geographic information system analyst, two data assistants, and an M&E manager.

b) NTD Program Partners

The HNTDCP is supported with financial and technical assistance (TA) from partners in addition to the U.S. Agency for International Development (USAID)-funded ENVISION project (Table 1). The University of Notre Dame (UND), with financial support from the Bill and Melinda Gates Foundation (BMGF) from 2001 to 2013 and through other funders in 2014–2016, funded MDA in the communes of Gonaïves and Arcahaie; M&E activities, including pre-transmission assessment surveys (pre-TASs), in the communes of Gonaïves, Maïssade, Mirebalais, Léogâne, and Gressier; and community TAS in Saut-d’Eau in fiscal year 2016 (FY16). Because of funding constraints, UND was unable to conduct MDA in FY17 in Gonaïves and Arcahaie, which failed pre-TAS, in FY16. Thus, ENVISION implemented MDA for these two communes in FY17. During the July 2016 partners’ meeting, UND said that they had funds from a private donor to


treat Léogâne and Gressier communes in FY17, which also failed pre-TAS in the fall of 2016. UND also funded TAS1 in the 11 communes of Center Department in FY17. Preliminary results from the MSPP indicate that all communes have passed.

In FY17, The Carter Center (TCC) supported the HNTDCP to conduct 12 pre-TAS sentinel sites and spot checks (SSs/SCs) in the six Port-au-Prince (PAP) Metropolitan Area communes in November 2016. Petion-Ville commune, the only one of the six Metropolitan Area communes that passed pre-TAS, is supported by TCC, and completed and passed TAS 1 in August.

In FY17, as in previous years, the U.S. Centers for Disease Control and Prevention (CDC) partially financed MDA in the PAP/Metropolitan area. In addition, through a cooperative agreement with IMA World Health, CDC funded the STH component of pre-TAS in the six communes of the PAP/Metropolitan Area and the urban post-MDA pilot of the supervisor’s coverage tool (SCT) in Tabarre. They have also provided TA, including training on the Wb123 monoplex in one evaluation unit (EU) in North and one EU in Northeast in May 2017. CDC has indicated they will have limited funding available for FY18. Available funding will go toward MDA and/or LF “TAS failure” activities.

Through financial support from the Inter-American Development Bank (IDB), the MSPP has conducted albendazole (ALB)-only school- and community-based MDA in each of the 10 departments, targeting children ages 2 to 14 in 2,000 schools (200 schools in each department), complementing LF/STH MDA implemented by ENVISION. Starting in calendar year 2015 (CY15), the IDB provided funding for STH MDA to the Directorate of Family Health (Direction de Santé de la Famille [DSF]) for a period of three years (the project was originally two years and was extended by one year). The IDB FY runs from January to December. Thus, funding started in January 2015; funding for year two is from January to December 2016; and funding for year three is from January to December 2017. Twice-annual ALB-only MDA have been conducted in select schools in the 10 departments, except where ENVISION is treating for LF-STH; in ENVISION-supported areas, IDB provided one additional round of treatment. A third round of MDA each year was planned for Grand’Anse, given the continued high STH prevalence in that department; however, to date, the DSF has only been able to conduct two rounds there.

What IDB will support going forward remains unclear. An impact evaluation of the STH distribution with DSF is planned before the end of CY17. The funding for the above-referenced STH MDA was part of IDB’s “4th Operation” activities to improve education across the country. A “5th Operation” is in the works, and this should start sometime in late 2018; however, IDB’s efforts will only be focused on North, Northeast, Northwest, and Center. They are moving toward a more decentralized approach and will be working with the department leads rather than the central-level leads. IDB is also not clear on whether deworming will have a role in the “5th Operation.”

Hôpital Sainte Croix (HSC) continues to serve as a morbidity clinic in Haiti, delivering hydrocelectomy services and lymphedema care. HSC also provides laboratory personnel to implement SSs and SC sites and TASs across the country. CBM International provided some support for morbidity management services in Léogâne up until the end of its funding in 2015. Furthermore, IMA, through a global cooperative agreement with CDC, has funded an MMDP situation analysis and provided training in September 2016 on the direct inspection protocol (DIP) evaluation for health facilities using the WHO LF MMDP toolkit. The results from the situation analysis are being reviewed and compiled now and will be shared during the next NTD Partners’ Meeting in September.

Other partners include the World Health Organization’s Pan-American Health Organization (WHO/PAHO), which facilitates the delivery of donated ALB. Through a partnership with TOMS (a private sector company with an extensive corporate social responsibility agenda), IMA works with local NTD volunteers, the MSPP, and the MENFP to distribute donated shoes to schoolchildren. The donated shoes


leverage the efforts of the school-based MDA that are supported by ENVISION and serve as a secondary prevention method against STH. IMA has distributed a total of 329,604 shoes to schoolchildren in Southeast, South, and Grand’Anse Departments in FY17. An additional 306,870 shoes arrived in June and will be distributed in September 2017 when schools are back in session.

Haiti was selected as one of five countries to participate in a high-profile clinical safety and efficacy trial and acceptability study that will be instrumental in moving forward the global LF elimination effort and shaping WHO LF treatment guidance (“Community Based Safety Study of 2-Drug versus 3-Drug Therapy for Lymphatic Filariasis”). The results of a pilot survey conducted by the Death to Onchocerciasis and Lymphatic Filariasis project in Papua New Guinea, with funding from the BMGF, suggested that a combination of three drugs (ivermectin [IVM], diethylcarbamazine citrate [DEC], and ALB) was superior to the dual therapies currently recommended for the treatment of LF.

The primary objective of the safety study is to determine the frequency, type, and severity of adverse events (AEs) following the administration of three therapy drugs (IVM, ALB, and DEC) compared to standard treatment with two drugs (DEC and ALB) in infected and non-infected individuals in a community. A study to assess treatment acceptability in the community follows the safety study, and a 12-month follow-up is performed to assess the efficacy of the three-drug therapy. The principal MSPP investigator is Dr. Jean-Frantz Lemoine, and the principal investigator from the CDC is Dr. Christine Dubray. RTI International’s Dr. Abdel Direny is one of the co-investigators, and IMA is the implementing partner. Other partners/co-investigators include CDC and the University of Florida. IMA has hired additional research staff to ensure that this study does not affect ENVISION-related activities. The survey was conducted in the commune of Quartier-Morin in North Department, which was selected because of its baseline prevalence of 38% and evidence of ongoing transmission (failing pre-TAS in 2014 after seven rounds of consecutive MDA). Additionally, the immunochromatographic test (ICT) card prevalence found during pre-TAS was 4.2%, of which 38% were microfilaremia (Mf) positive. Of a study sample comprising 6,000 individuals, over 600 tested positive for LF and received the three-drug therapy. The follow-up study will occur in Quarter (Q) 1 of FY18.

In early 2015, BMGF began funding the Malaria Zero project for malaria and LF elimination from the island of Hispaniola. To assist Haiti and the Dominican Republic in achieving malaria elimination by the 2020 target, Malaria Zero is conducting operational research to identify geographic areas of high transmission and risk and piloting new approaches to elimination. In addition, TASs implemented in Haiti by ENVISION and UND have been integrated with malaria (with CDC funding for rapid diagnostic tests [RDTs] and additional personnel), and these results have been shared with Malaria Zero partners in support of their efforts to map areas of malaria transmission in the country.

In support of Malaria Zero’s aim of developing novel approaches to mapping areas of high transmission, IMA, with funding from Malaria Zero, is serving as the implementing partner on the Easy Access Groups (EAG) study. The overall aim of this study is to generate evidence that will allow the development of a standardized protocol for a rapid sampling method targeting EAG with sufficient sensitivity to identify areas with evidence of malaria transmission requiring targeted parasite elimination interventions. The study began in September 2016 in four communes of the Grand’Anse Department (Moron, Chambellan, Dame-Marie, and Anse-d’Hainault) but was halted a week into the study because of Hurricane Matthew in October 2016. The study restarted in May 2017 in two communes in Artibonite (La Chapelle and Verettes). The study is planned to resume in Grand’Anse in FY18.


With funding from the Task Force for Global Health (TFGH), CDC, RTI, the University of Florida, and IMA conducted TAS strengthening in Limbé, North Department, in FY16 to test the sensitivity of the TAS for detecting evidence of recent transmission in an EU. Limbé had originally passed TAS1. However, the results of the modified TAS protocol showed that Limbé should have failed. The study suggests that the MSPP and partners need to discuss modifications to the current strategy for MDA and NTD elimination effort, TAS design, and the WHO-recommended protocol (such as changing the target population or indicators measured) to create a more rigorous tool for identifying focal areas with evidence of recent transmission.

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

summarized activities

Partner Location Activities

Other donors

supporting these

partners/ activities

CDC PAP and national level

Fund part of MDA in the PAP/Metropolitan area; TA for TAS strengthening, WB123, and SCT Funding and TA for MMDP situation analysis Integrated PC-NTD/malaria surveillance performance evaluations

No

PAHO Entire country Provides ALB donated by GSK, filariasis test strips (FTSs) for TAS, and 100-mg DEC produced by Eisai

GSK and Eisai

TFGH

• Limbé

• Plaisance-du-Sud, Terrier-Rouge, Sainte-Suzanne, and Trou-du-Nord

• Funding for strengthening the TAS operational research project

• Performance comparison of FTSs and Wb123

CDC

UND West and Center In FY17, funding for MDA in Léogâne and Gressier is available.

CDC and UND private funding

IDB All 10 departments

Provides funding through the MSPP for three rounds of ALB-only MDA for SAC and pre-SAC population (ages 2–14) in Grand’Anse and two rounds in all the other departments (one round where ENVISION is treating)

IDB

HSC Léogâne LF morbidity management UND

RTI Quartier-Morin

Co-investigator for the Community Based Safety Study of 2-drug versus 3-drug Therapy for Lymphatic Filariasis and Treatment Acceptability study

BMGF through Washington University of St. Louis

IMA*

La Chapelle and Verrettes, Artibonite Department

Research coordination and field implementation of the EAG study for the Malaria Zero Project in Haiti

Tulane University/BMGF

All 10 departments Pilot MMDP situation analysis and training implementation for the DIP at the department level in FY16 (MSPP and CDC)

CDC

Quartier-Morin, North Department

Research coordination and field implementation of the Community Based

BMGF through Washington


Partner Location Activities

Other donors

supporting these

partners/ activities

Safety Study of 2-drug versus 3-drug Therapy for Lymphatic Filariasis and Treatment Acceptability study

University of St. Louis

Limbé, North Department

Coordination and field implementation of the TAS strengthening activity

TFGH/CDC

Tabarre, PAP/ Metropolitan Area (West Department)

Pilot the SCT to assess treatment coverage in an urban area immediately following MDA

CDC

Plaisance-du-Sud, North Department; Terrier-Rouge, Sainte-Suzanne, and Trou-du-Nord, Northeast Department

Compare the performance of antigen (FTS) and antibody (Wb123 monoplex) tools in programmatic settings (TAS)

TFGH/CDC

Malaria Zero** Haiti and Dominican Republic

Malaria and LF elimination strategic planning and malaria elimination programming

BMGF

TCC Six PAP/Metropolitan Area communes

In FY17, support for 12 SSs/SCs in the six PAP/Metropolitan communes and TAS in Pétion-Ville

Private funding and others

Note: GSK=GlaxoSmithKline, Inc.; PC= preventive chemotherapy; SAC= school-age children *Other partners on the study include CDC, RTI, and the University of Florida. **Formerly known as the Haiti Malaria Elimination Consortium; partners include the MSPP, the Ministry of Public Health and Social Assistance of the Dominican Republic, the CDC, the CDC Foundation, PAHO, TCC, the Clinton Health Access Initiative, the London School of Hygiene and Tropical Medicine, and the Tulane University School of Public Health and Tropical Medicine.

2) National NTD Program Overview

In line with global LF elimination goals defined by WHO, the HNTDCP’s national strategic plan targets LF elimination by 2020 and continuation of STH control activities throughout the country. Haiti follows the LF strategy for elimination through consecutive MDA rounds with DEC and ALB for at least five to six years to interrupt transmission. In 2012, the HNTDCP achieved 100% geographic coverage. Because of a gap in funding, national coverage did not continue in 2013, when 13 communes were untreated. In 2014–2015, the HNTDCP was once again able to reach 100% geographic coverage with funding and technical support from its partners: USAID (through ENVISION), UND, and CDC. In 2016, because of funding constraints UND was unable to treat Léogâne and Gressier after they failed pre-TAS, resulting in coverage of 93% (28 communes treated out of 30 planned for the country). However, UND obtained funding to treat Léogâne and Gressier in fall 2016, and treatment is planned for fall 2017.

TCC funded the pre-TAS SSs/SCs for the six communes in the PAP/Metropolitan Area. They are also supporting TAS1 in Pétion-Ville (which is the only PAP/Metropolitan Area commune which passed pre-TAS). Starting in FY17, ENVISION has provided funds to conduct MDA in Gonaïves and Arcahaie and in the PAP/Metropolitan Area for the five communes that did not pass pre-TAS.

Haiti has made incredible strides in reaching its program goals. By the start of FY17, 106 communes had completed TASs and were able to stop MDA.


a) Lymphatic Filariasis

In 2001, under the leadership of the MSPP, and with support from donors and partners, the National Lymphatic Filariasis Elimination Program was launched. In its national NTD strategic plan, and in line with the strategies outlined by WHO’s Global Program to Eliminate Lymphatic Filariasis (GPELF), the HNTDCP has a goal to eliminate LF by 2020 and continue control activities for STH throughout the country. The objectives of Haiti’s national LF elimination program, in line with the GPELF, are to achieve the following:

• Reduce the rate of microfilaremia at levels not causing more risk of transmission to the population;

• Alleviate the suffering of people with clinical manifestations of the disease; and

• Improve understanding of the relationship between good hygiene and disease.

Key strategies include MDA, support for MMDP, social mobilization and community participation, M&E, surveillance, public-private partnerships, institutional strengthening and training, and resource mobilization.

LF, which is caused by Wuchereria bancrofti and transmitted by Culex mosquitoes, is endemic throughout Haiti, as indicated by mapping completed by the MSPP and partners in 2000. Based on the prevalence at mapping, the MSPP designated communes as zones rouges (red zones, 10%–45% initial prevalence); zones bleues (blue zones, 5%–9.9%), zones vertes (green zones, 0.1%–4.9%), and zones

blanches (white zones, 0%) (see map). Approximately 15% of the country is designated as “red zone”; the MSPP initially prioritized red zones and blue zones for MDA because funds were not sufficient for full geographic coverage. MDA began in Léogâne in 2000 with funds from CDC and BMGF. In 2005, because of funding constraints, MDA was stopped, and 24 communes went untreated until 2008 (treatment had been started in these 24 communes before 2008). Later studies demonstrated that this gap in treatment led infection levels to rebound: indeed, both antigen and Mf had increased to 2003 levels.1 Based on this research, the HNTDCP works under the principle that a single year of missed treatment in Haiti equals the loss of two years of gains achieved by previous MDA.

MDA

In Haiti, integrated LF-STH MDA has been conducted using a combination of DEC and ALB distributed to target populations via joint community- and school-based posts. By the start of FY17, 106 communes in eight departments reached stop-MDA status. In FY17, 19 communes were treated: North (6), Northwest (1), West (6), West/PAP/Metropolitan Area (5), and Artibonite (1) Departments. Limbé, North Department will be treated in September 2017 following the results of the xenomonitoring component of the TAS strengthening activity supported by the TFGH (with USAID funding). Preliminary results have come in for 18 of the 19 completed rounds of MDA (by June 2017) and show over 80% coverage in seven communes in North and Northwest, with the remaining ones below 80%. However, questions arise regarding the source of the population data, which ultimately affect the epidemiological coverage rates.

The last census was completed in 2003, however, in the absence of current census data, the MSPP, ENVISION, and other national agencies calculate population differently, leading to questions on exact epidemiological coverage rates.

1 Won, K.Y., Beau de Rochars, M., Kyelem, D., Streit, T.G., and Lammie, P.J. (2009). Assessing the Impact of a Missed Mass Drug Administration in Haiti. PLoS Negl Trop Dis 3(8): e443. doi:10.1371/journal.pntd.0000443


In FY18, the HNTDCP, with ENVISION support, will treat 15 communes: Northwest (1), Artibonite (1), North (5), West (3), and PAP/Metropolitan Area (5). Depending on the results of pre-TAS, up to an additional seven communes may undergo MDA, including North (3), West (3), and PAP/Metropolitan Area (1), if it does not pass TAS1. An additional two communes (Léogâne and Gressier in West) will be treated by UND, depending on funding.

As mentioned above, following the TFGH-funded TAS strengthening survey, LF prevalence remains high in Limbé (23 positive cases among 1,351 children aged six–seven years tested in the community). The results were discussed with the MSPP and partners, and as a result, ENVISION will support MDA in FY17 and FY18.

Through a global cooperative agreement, CDC provided financial and technical support to the MSPP to use the WHO-recommended supervisor’s coverage tool (SCT) to assess treatment coverage immediately following MDA in PAP (Butte Boyer section of Tabarre commune) in May 2017. CDC trained commune-level supervisors and MSPP staff in SCT to collect information from community members about whether they had participated in an MDA. The results are pending; once available, they will be used to design any needed follow-up activities.

Pre-TAS

Haiti’s TAS strategy, which was developed in June 2013 with technical assistance (TA) from CDC, treats each red zone implementation unit as a separate EU; to date, the Regional Program Review Group (RPRG) has accepted this approach. Additional EUs were developed by grouping communes together based on initial prevalence and geographic contiguity. To determine eligibility for TAS, the HNTDCP conducts pre-TAS surveys in at least one SS and one SC within an EU. However, in each red zone, only one SS or SC survey takes place because these zones are smaller geographical areas (one commune per EU). Within larger EUs, where multiple communes are grouped together, one or two SS and/or SC surveys are performed. For example, Southeast Department forms one large EU made up of green and white zones; in this EU, pre-TASs at one SS and one SC site were conducted.

In FY17, the HNTDCP, with ENVISION support, conducted pre-TASs to determine the eligibility for TAS in eight communes (four EUs) in West Department (Petit-Goâve/Grand-Goâve, Thomazeau/Cornillon, Anse-à-Galets/Pointe-à-Raquette, and Ganthier/Kenscoff2). Of these eight communes, Anse-à-Galets/Pointe-à-Raquette (one EU) did not pass pre-TAS. Notably, the HNTDCP successfully transitioned from using ICT cards as the diagnostic tool for pre-TAS and TAS to FTSs in FY16.

In FY17, pre-TAS was planned in Quartier-Morin; however, study partners selected this commune to undergo the triple-drug therapy study, as described above. The same group will be tested a year later (November/December 2017) to examine the efficacy of the therapy.

In FY18, pre-TAS SSs/SCs are planned to cover a total of six communes. Additionally, five communes (three communes in North [Cap-Haïtien, Limonade, and Plaine-du-Nord] and two communes in West [Cabaret and Croix-des-Bouquets]) will undergo a re-pre-TAS after having failed the first in FY15. Fonds-Verrettes in West is the sixth commune planned for pre-TAS in FY18. If these six communes pass pre-TAS, they will be eligible for TAS1.

2 Ganthier and Kenscoff are now considered two separate EUs; thus, the number of TASs in West Department will still be four, even though Anse-à-Galets/Pointe-à-Raquette did not pass pre-TAS.


TAS

To date, 116 out of 140 communes (85%, or 23 EUs out of 29 total EUs that passed TAS) have passed TAS. This is a significant achievement for the country and a testament to the excellent population coverage the HNTDCP, with ENVISION’s support, has been able to attain.

In FY17, ENVISION supported 49 communes where TAS1 and TAS2 were conducted. These communes were grouped into 13 EUs, including 1 EU in Southeast Department, 1 EU in Nippes Department, 2 EUs in Northwest Department, 3 EUs in Northeast Department, 2 EUs in North Department, and 4 EUs in West Department. STH was integrated into TAS2 in Southeast Department (one EU) and North Department (two EUs). Malaria was integrated into TAS2 in Southeast Department (one EU) and TAS1 in West Department (four EUs). This allowed the national program to assess its progress toward malaria elimination, which is another priority for the country. Preliminary results show that all EUs tested have passed TAS1 and that all EUs tested (except Dondon in North Department) have passed TAS2.

In FY18, the HNTDCP, with ENVISION support, anticipates conducting TAS in up to eight EUs covering eight communes. These TASs will include TAS1 in six EUs (six communes)3 and TAS2 in two EUs (two communes). Subsequently, after a two-year interval between TASs, an additional eight EUs (55 communes) will be eligible for TAS2, including one for TAS3 in FY18. However, these TASs will be delayed approximately seven–nine months and take place in FY19 Q1 and Q2. ENVISION will conduct a TAS3 planning meeting in FY18 Q4 and hold the remaining TAS2 planning meetings in early FY19 Q1, prior to implementation.

Although the primary goal of the program is to achieve LF elimination in all districts by 2020, currently, some red zones have focal transmission (antigenicity >2%). Based on WHO recommendations, which have been adopted into the national program policy, two–three more rounds of MDA will be conducted, in addition to the three TAS activities (TAS1, TAS2, and TAS3) separated by an interval of two years. The final goal of LF elimination will likely be achieved after 2020.

Morbidity Management and Disability Prevention

The HNTDCP also works with partners to implement LF morbidity management activities, which have only been conducted in Léogâne to date. This activity includes hydrocele surgery (supported by HSC/UND). Through a cooperative agreement with CDC, IMA worked with the HNTDCP and UND to develop a MMDP national strategic plan for 2016–2020, but this plan has not yet been validated. The draft plan was submitted to Haiti’s National LF/Malaria Coordinator, Dr. Lemoine, in January 2016, and was presented at the bi-annual NTD partners’ meeting in January for feedback. The plan included a tentative timeline of activities for 2016–2020. The plan is an important component of Haiti’s national LF program and meeting WHO elimination dossier requirements, and will also be a valuable advocacy tool for the program.

Other key activities include an MMDP situation analysis assessing the services, infrastructure, materials, and supplies available for MMDP in each of the 10 departments. The situation analysis, a WHO-developed tool, was adapted and submitted to the Haitian ethics committee by the HNTDCP, CDC, IMA, and partners using funding from IMA’s CDC cooperative agreement. The situation analysis tool is used to describe the information and capacity available to measure the number of patients with lymphedema or hydrocele and their geographic distribution (also referred to as burden assessment or patient

3 Six communes (three in North and three in West) will be eligible for TAS1 if one or more pass pre-TAS early in FY18.


estimation), to identify the relevant policy frameworks necessary for effective and efficient MMDP services, and to determine the place, structure, and platforms of current and future MMDP activities. In partnership with the MSPP and CDC, IMA has been working to develop an MMDP situational analysis roadmap and schedule for the summer/fall of 2016. IMA and CDC met with the MSPP LF/Malaria Coordinator and MMDP Focal Point in May 2016 to discuss these plans and next steps.

In August 2016, CDC and IMA conducted a situation analysis and DIP training workshop for MSPP and IMA staff with CDC funding, with plans to initiate the situation analysis in September. From November 2016 through March 2017, IMA conducted the analysis in 25 health facilities in 25 communes of the 10 departments. The team found that, although all 25 health facilities have drugs available to treat patients, the patients must purchase the drugs themselves. Only eight facilities offer physiotherapy care, and only 17 have water available to take care of lymphedema. No official policy or strategy has been issued by MSPP; however, an MMDP committee has been formed to prepare a strategy to conduct advocacy and offer care.

As part of the situation analysis, the WHO DIP tool was piloted in health facilities to assess lymphedema and hydrocele services. The DIP tool supplements the situation analysis with relevant health care facility data, establishes a baseline for the quality of services (general and MMDP specific), and identifies areas in need of strengthening as part of MMDP service implementation (e.g., supplies and training).

IMA also worked with the CDC and HNTDCP to revised its MDA tools and registers for its FY16 and FY17 MDA to integrate lymphedema and hydrocele indicators, including the age and sex of MDA participants reporting either of these conditions. This has enabled the HNTDCP to integrate an MMDP burden assessment (which is an ongoing part of the situation analysis) into the communes where ENVISION has conducted MDA in FY17. ENVISION, with CDC support, also distributed job aids on MMDP to community leaders (CLs) at MDA distribution posts. Once the burden assessments for MMDP have been completed for each commune, the HNTDCP and partners will continue to advocate for funding to treat patients living with lymphedema and hydrocele.

b) Soil-Transmitted Helminths

STH is endemic throughout Haiti, as determined from the mapping conducted by MSPP and partners in 2002. The HNTDCP’s aim has been to control STH in school-age children (SAC) through annual treatment with ALB to reduce the intensity of infections and protect infected individuals from morbidity caused by STH. SAC are targeted for treatment through the DEC plus ALB MDA conducted in schools by community drug distributors (CDDs).

The largest de-worming (STH) campaigns have been conducted during the LF MDA, through which one dose of DEC and ALB is distributed to each member of the eligible population on a yearly basis. The integrated approach (LF and STH) was strongly supported by partners and donors. Additionally, USAID has played a key role by funding STH and LF MDA in a large part of the country since 2007. As LF MDA is scaling down, the MSPP, HNTDCP, and partners are continuing to discuss the best strategy to continue de-worming efforts after the interruption of LF transmission has been confirmed in program areas.

A nationwide STH survey was funded by IDB and implemented by the MSPP in October–December 2013. The results show that infections are prevalent at the national and departmental levels. The overall STH prevalence has decreased within the country, and in 9 out of 10 communes, the prevalence is at or below 25%. In Grand’Anse Department, which had an initial prevalence of 74% when surveyed in 2001, the decline was not as significant, and the prevalence of infection remains 55%. Further analysis of the data to better identify causes is ongoing. The MSPP has identified poor sanitation as a serious issue in Grand’Anse.


Following the national prevalence survey in 2013, with funding from ENVISION and CDC, the MSPP and partners performed STH assessment integrated with LF TAS. In FY17, ENVISION successfully conducted STH-TAS2 surveys in FY17 in Southeast (one EU) and North (two EUs) Departments. The preliminary results indicate that the STH prevalence in Southeast is 37%, which corresponds to an increase since 2013 (21.3%), and that the prevalence in the two EUs in North is 13%. Most children infected with STH (ascaris, trichuris, and hookworm) had a light intensity of infection (70% children with ascaris, 85% with trichuris, and 100% with hookworm). The remaining had a moderate intensity of infection. No children were found to have a heavy intensity of infection.

Starting in January 2015, the DSF, an arm of the MSPP, has carried out two yearly rounds of ALB-only school- and community-based MDA targeting children aged 2–14 in 2,000 schools in the 10 departments (200 schools in each department). This has been done with IDB support, which is available through December 2017. Although the DSF had planned to use IDB funding to complete a third annual round of ALB distribution in Grand’Anse given the continued high STH prevalence there, to date, DSF has only been able to complete two rounds because of delays stemming from political uncertainties in the past year. Where ENVISION or other partners have conducted LF-STH MDA, only one additional round of MDA was implemented by DSF using IDB funds. The MDA is supplemented by training that focuses on STH prevention, which has been rolled out for nurses, teachers, and students. Note that in FY15, ENVISION supported ALB-only MDA in addition to one round of LF-STH MDA in Grand’Anse. For FY18, coordinators for STH—the Directorate of Laboratory and Research Epidemiology (Direction

d’Epidemiologie de Laboratoire et de Recherche [DELR]) and DSF—are discussing the way forward to control STH throughout the country. ENVISION will fund a meeting in Q1 and, in collaboration with STH partners, will work to define and support the MSPP in its STH transition plan. ENVISION can leverage its available LF volunteer network to continue the STH transition and implement MDA with ALB in all communes where LF MDA has stopped. The MSPP will need to advocate for funds to support any STH MDA activity and the necessary M&E-related activities to measure results.

History of USAID support

USAID support to the HNTDCP began in late 2007 under the NTD Control Program, which was managed by RTI and implemented by IMA. Activities have continued via the ENVISION project from 2011 to date. USAID support for the HNTDCP started in 26 communes in FY08, and subsequently, support was scaled up to 106 communes in FY13. Since then, USAID has supported the program to begin scaling down as communes reached stop-MDA status and supported the treatment of 24 communes in FY16. Notably, after the devastating earthquake in January 2010, the HNTDCP was fortunately able to continue with the scheduled April/May MDA as planned. In addition, because of the large number of internally displaced persons in several locations seeking refuge from PAP, the HNTDCP had to treat even more individuals during MDA. Fortuitously, with financial support from USAID, the HNTDCP and NTD Control


3) Snapshot of NTD status in Haiti

Table 2: Snapshot of the expected status of the NTD program in Haiti as of September

30, 2017

Columns C+D+E=B for each

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

MAPPING GAP

DETERMINATION MDA GAP DETERMINATION

MDA

ACHIEVEMENT DSA NEEDS

A B C D E F G H I

Disease

Total No.

of districts

in Haiti

No. of

districts

classified

as

endemic

No. of

districts

classified

as non-

endemic

No. of

districts

in need

of initial

mappin

g

No. of

districts

receiving

MDA

as of

09/30/17

No. of

districts

expected to

be in need of

MDA at any

level: MDA

not yet

started, or

has

prematurely

stopped as of

09/30/17

Expected No. of

districts where

criteria for

stopping

district-level

MDA have been

met as of

09/30/17

No. of districts

requiring DSA

as of

09/30/17**** USAID

-

Funde

d

Other

s

Lymphatic Filariasis

140

140 0 0 20* 2** 1 117***

Pre-TAS: 6 TAS1: 6

TAS2: 56 TAS3: 1

Onchocerciasis – – – – – – – –

Schistoso-miasis

– – – – – – – –

Soil-Transmitted Helminths

140 0 0 20* 2# 118 – –

Trachoma – – – – – – – –

*In FY17, ENVISION provided MDA in 20 communes, including communes that failed pre-TAS: five communes in West-Metropolitan Area (Tabarre, Cité Soleil, PAP, Delmas, and Carrefour), two in North (Acul-du-Nord and Milot), and two in West (Anse-à-Galets and Pointe-à-Raquette). It also includes Limbé, which initially passed TAS1 but failed TAS strengthening (supported by TFGH). The remaining MDA communes include four in North (Cap-Haïtien, Limonade, Plaine-du-Nord, and Quartier-Morin), one in Northwest (Port-de-Paix), four in West (Arcahaie, Fonds-Verrettes, Cabaret, and Croix-des-Bouquets), and one in Artibonite (Gonaïves).

** Gressier and Léogâne (both funded by UND)

*** To date, 42 out of 43 communes (eight out of nine EUs) have passed TAS2. However, Dondon did not pass TAS2 and will undergo MDA in FY18. Communes that have passed TAS 1 include La Tortue (2006), 10 communes in FY14, 33 communes in FY15 (Limbe and Dondon initially passed, but is excluded in this calculation), 55 communes in FY16 and 18 communes in FY17. In FY17. UND supported TAS1 in 11 communes in Center, all of which have passed. TCC supported TAS1 in Pétion-Ville

****Re-pre-TAS: three communes/EUs in North (Cap-Haïtien, Limonade, and Plaine-du-Nord) and two communes/EUs in West (Cabaret and Croix-des-Bouquets). Pre-TAS will occur in Fonds-Verrettes; if it passes, it will go through TAS1 in FY18.

TAS1: three EUs in North (Cap-Haïtien, Limonade, and Plaine-du-Nord), three EUs in West (Cabaret, Croix-des-Bouquets, and Fonds-Verrettes) will have TAS1 only if they have passed pre-TAS.

TAS2: two EUs in South (19 communes), one EU in Grand’Anse (12 communes), two EUs in Artibonite (14 communes), one EU in Center (1 commune), and three EUs in North (10 communes).

TAS3: one EU in Northwest (La Tortue).

# IDB is providing funding for school-based STH-only MDA in 200 schools in each department. Funding for twice annual MDA (thrice-annual in Grand’Anse Department) started in January 2015 and ends in December 2017. Where ENVISION is still funding LF-STH treatment, IDB is treating with one additional round of ALB (two additional rounds in Grand’Anse).


Program/IMA were able to purchase the MDA supplies and drugs necessary to accommodate the increased population.

Since 2011, IMA has led the implementation of the USAID-funded, RTI-managed ENVISION project. Main activities include integrated MDA, advocacy, training, supervision, M&E, and social mobilization. Through 2013, USAID-funded MDA was conducted in North, Northwest, Northeast, Artibonite, South, Southeast, Nippes, and Grand’Anse Departments. In 2013, the HNTDCP experienced a gap in funding, and 13 communes in areas funded by UND were left untreated. The funding gap persisted in 2014, and at the request of the HNTDCP, ENVISION expanded its support to implement MDA in 11 additional communes within West Department. In FY16 and FY17, because of reduced levels of UND and CDC funding, USAID approved funding and implementation support for the six PAP/Metropolitan area communes, filling a key funding gap for the program.


PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

Capacity goals

ENVISION and the MSPP have identified the following priorities for capacity strengthening to ensure the continued success of efforts to address NTDs in Haiti:

• Identify and apply for new funding sources and platforms for sustained STH control and LF morbidity management

• Strengthen data management and TIPAC use

• Increase the number of trained laboratory staff

• Increase the number of national NTD staff tasked with managing M&E and surveillance activities

• Support LF dossier development

Capacity strengthening strategy

To strengthen national NTD program capacity, ENVISION will support the MSPP to work on four major objectives this year responding to areas listed above where ENVISION will have the most influence and, therefore, impact. These priorities are as follows:

• Strengthen M&E capacity to meet the need for planned TASs over the next few years

• Strengthen the use of the integrated NTD database across MSPP divisions

• Strengthen HNTDCP capacity to identify funding gaps and priorities

• Strengthen HNTDCP capacity to collect data for the LF dossier

While ENVISION recognizes that other needs, including gaining access to new funding sources and increasing the number of staff, are critical to the future of NTD control in Haiti, these objectives have been selected based on being the best fit for ENVISION’s current scope and strengths.

b) Capacity Strengthening Objectives and Interventions

Objective 1: Strengthen M&E capacity to meet the need for planned TASs over the next few years.

As time will have lapsed between TASs, ENVISION will facilitate refresher training for existing staff to further strengthen the capacity of the HNTDCP to conduct critical disease-specific assessments (DSAs) as the need is scaling up in both ENVISION and non-ENVISION-supported EUs.

Intervention 1: Provide refresher trainings to 56 existing laboratory technicians (both MSPP and non-MSPP staff).

Objective 2: Strengthen use of the integrated NTD database across MSPP divisions.

A national integrated database has been a key goal for the MSPP and partners since 2015. Although the bulk of historical data have been entered into the national database, some historical data is still missing,


and the MSPP is not yet actively using the database because it is incomplete. MSPP ownership of the database has been a primary objective in FY17 but it has not gained traction, despite a meeting in FY16 to make necessary updates to the database and plan for its continued maintenance and usage. Because of the lack of M&E staff at the MSPP who are dedicated to LF, and lack of resources to hire such staff, the MSPP has not yet identified anyone to manage the database.

Intervention 1: ENVISION will continue advocating for the integrated database to be used and will work with the MSPP to identify an M&E focal point from among its existing staff to manage the database. Once identified, ENVISION will facilitate refresher training on the database for the MSPP and work with the focal point to update the database each quarter.

Intervention 2: ENVISION will continue to provide support to the MSPP to take ownership of the database and use it to generate key program documents, such as the WHO Joint Reporting Form (JRF).

Intervention 3: ENVISION will continue to play a convening role between divisions, working with the Directorate of School Health (Direction de la Santé Scolaire [DSS]) and DSF to first convince them of the utility of the integrated NTD database as a tool to support program planning, and then to support data entry.

Objective 3: Strengthen HNTDCP’s capacity to identify funding gaps and priorities.

In August 2016, ENVISION trained MSPP staff on TIPAC. However, this tool is not used by the MSPP because of a lack of staffing. Another challenge is that the HNTDCP and/or other NTD partners in Haiti do not have detailed financial information to enter in TIPAC. ENVISION will continue advocating and will work with the MSPP to identify someone from among its existing staff to use TIPAC for accurate financial estimates and program needs. TIPAC will enable the HNTDCP to more accurately estimate the costs and funding gaps for the national NTD program. ENVISION will encourage the HNTDCP to share the TIPAC estimates with current partners at the bi-annual Haiti Partners’ Meeting.

Capacity strengthening efforts will be led by the ENVISION Haiti, a small but dynamic team with very strong technical and operations skills under the leadership of IMA’s Country Director and NTD Program Manager. The staff are competent in the use of the integrated NTD database, data quality assessment (DQA), TAS, STH-malaria TAS, and coverage surveys.

Objective 4: Strengthen HNTDCP’s capacity to collect data for the LF dossier

As the HNTDCP is progressing toward LF elimination, ENVISION will support a local external consultant to work closely with the MSPP and partners with gathering the data needed for the LF dossier. The consultant’s mandate will be first to support the MSPP staff and second to build their capacity to take over the process once his or her contract is over.

Intervention 1: A consultant will be hired during FY18 Q1 to support the HNTDCP in LF dossier development. The consultant will work with the MSPP, ENVISION, and key stakeholders to generate data from the integrated NTD database for use in the elimination dossier. S/he will produce a full draft of the pre-dossier, complete the data annex, and a list of outstanding issues.

Intervention 2: A one-day meeting with key stakeholders to orient them to the LF dossier requirements and data needed. The one-day meeting is scheduled in FY18 Q1.


c) Monitoring Capacity Strengthening

Both monthly meetings and regularly scheduled quarterly review meetings with the HNTDCP will be used to review progress toward the desired capacity strengthening outcomes using the following strategy to measure success.

Objective 1: Strengthen M&E capacity to meet the need for planned TASs over the next few years.

ENVISION will continue to meet with the LF/Malaria Coordinator and together review progress toward building the human capacity needed to implement future TAS activities. The number of projected staff for refresher training will be compared to current numbers of trained staff, and the quality of recent TASs will be discussed.

Objective 2: Strengthen the use of the integrated NTD database across MSPP divisions.

ENVISION will provide refresher training on the database for the MSPP and work with the MSPP to update the database each quarter. Once updated, key stakeholders and decision-makers will be able to use the integrated NTD database as a tool for planning, forecasting, requests, and reporting, and to generate data to evaluate the performance of indicators and for incorporation into the LF elimination dossier. ENVISION will convene stakeholders—including the various MSPP divisions, WHO, CDC, and other partners—to review progress on the completion of the database, identify obstacles to use, and propose solutions to overcome these obstacles. Feedback gathered during these meetings on how the database and other M&E tools could be made more user friendly will be provided to WHO and the ENVISION HQ M&E team. This activity will be done during the partners meeting.

Objective 3: Strengthen HNTDCP’s capacity to identify funding gaps and priorities.

Within FY18 Q1, ENVISION will provide refresher training for the MSPP disease focal points or designated staff on how to generate the TIPAC. Throughout the year, ENVISION will continue to engage both the LF/Malaria Coordinator and the DSF Coordinator and their staff on the progress toward completing data entry into the TIPAC and to review the utility of the tool in providing information to advocate for new funding sources. As for the review of progress in the use of the integrated database, obstacles to its use will be identified, and a plan will be put in place to resolve these obstacles. Feedback gathered during these meetings on how the TIPAC could be made more user-friendly will be provided to WHO and ENVISION HQ.

Objective 4: Strengthen HNTDCP’s capacity to collect data for the LF dossier.

In FY18 Q1, ENVISION will hire a consultant to help the MSPP initiate the LF dossier process, including development of a situational analysis, production of formal documentation of Haiti NTD achievements, and initial preparation of the LF elimination dossier.


Table 3: Project assistance for capacity strengthening

Project assistance

area

Capacity strengthening

interventions/activities

How these activities will help to correct the

needs identified in the situation above

a. Strategic

Planning

• Participate in developing the 2018–2023 strategic plan

• Support the MOH by organizing a de-worming partners’ meeting

• This activity will facilitate TIPAC use and the integration of PC-NTDs and non-PC-NTDs.

• This meeting will help harmonize the de-worming interventions among partners and identify other platforms to continue STH treatment where needed.

b. Building

Advocacy for a

Sustainable

National NTD

Program

• Assist the MSPP in identifying and training staff to the integrated database and TIPAC

• ENVISION HQ will assist the field team in presenting two abstracts at ASTMH.

• This will help the MSPP establish a strong M&E plan, identify gap funding, and advocate for new funding.

• This will help to build global leadership among field staff.

c. M&E Refresher training for 56 existing laboratory technicians

• This with strengthen capacity and reinforce training methods.

d. Short-term

Technical

Assistance

ENVISION will hire a consultant to assist the MSPP in gathering the information needed for the LF dossier.

• The MSPP will start working on the data needed for the LF dossier.

• The MSPP will be able to continue the process of LF dossier development after the consultant leaves.

2) Project Assistance

a) Strategic Planning

ENVISION staff work closely with the MSPP, MENFP, and other partners and donors on a regular basis to plan HNTDCP activities. This includes identifying and confirming geographic target regions for MDA and DSAs; reviewing and regularly performing data analysis for activity planning (e.g., using coverage to identify communes needing additional support and using pre-TAS data to plan for TAS); and engaging in ongoing planning, coordination, and implementation of all activities. In FY17, the HNTDCP will work with ENVISION to conduct MDA and DSAs according to the schedule of LF MDA scale-down (as noted in the LF Section), in addition to other NTD activities.

As noted in the Capacity Strengthening section, ENVISION trained key HNTDCP staff on the TIPAC tool prior to September 2016. In FY18, ENVISION will continue supporting the HNTDCP to complete the TIPAC for Haiti and start to regularly use the tool for program planning, forecasting, advocacy, and resource mobilization. A major challenge persists: the lack of personnel at the MSPP. ENVISION will work with the HNTDCP to generate accurate financial estimates for activities related to ENVISION project needs.

HNTDCP bi-annual partners’ meetings: In FY18, ENVISION will provide funds and assist the HNTDCP in organizing two partner meetings in Haiti for local and international stakeholders to ensure strong coordination among the MSPP, the MENFP, and local and international NTD partners (including CDC, TCC, the University of Florida, and others). These meeting will be led by the MSPP and are critical for the HNTDCP to establish how best to implement activities, assess overall progress toward achieving Haiti’s NTD elimination and control goals and areas requiring additional focus, identify programmatic and


funding gaps, and discuss the potential for integration with other diseases (e.g., integrating LF surveillance with malaria surveillance).

STH meeting: As LF MDA scales down, STH prevalence remains high in several departments. IDB funding is also coming to an end, and as a result, the need to focus and discuss the way forward in controlling STH throughout the country is becoming increasingly important. ENVISION plans to support the HNTDCP in organizing a separate meeting in early FY18 with STH partners, including DELR, DSF, and IDB. The HNTDCP will review lessons learned from mapping, MDA results, and surveys and develop improved strategies to reduce STH prevalence. The expected outcomes are the identification of different organizations or groups engaging in STH activities in the country, discussing potential funding for STH, and harmonizing their interventions with the STH transition plan.

b) NTD Secretariat

Haiti does not have an official NTD secretariat leading the HNTDCP. Instead, NTD control and elimination efforts are led by the LF/Malaria Coordinator, Dr. Lemoine, and the STH Coordinator, Dr. Désormeaux. All activities are conducted in close coordination with partners.

c) Building Advocacy for a Sustainable National NTD Program

The overall goal of advocacy is to ensure the sustainability of Haiti’s NTD program as current donors phase out funding. The specific objectives of these advocacy efforts are to find additional funds to support the implementation of Haiti’s MMDP plan; fill MDA, pre-TAS, and TAS funding gaps in the areas formerly supported by UND (Center Department); and to mobilize additional funds for surveillance.

TAS planning meetings. Generally, the HNTDCP collaborates with its respective NTD partners on TAS planning and assuring the implementation of LF non-integrated TAS and STH integrated TAS, in accordance with WHO recommendations. In this case, ENVISION will support TAS planning meetings in each EU where TAS1, TAS2, or TAS3 is planned for FY18. Note that TAS3 survey in La Tortue will be conducted in early FY19, but the planning meeting will occur at the end of FY18. The purpose of these meetings is to inform and sensitize the CLs, MSPP departmental and communal health and political officials, and MENFP school inspectors about the objective of TAS; to enlist their consent and support for conducting TAS; to plan the survey dates; and to collect school population data.

TAS1 in North (three EUs) and West (three EUs). Pending the passing of pre-TAS in FY18, TAS1 planning meetings will constitute an important opportunity to discuss MDA transition.

TAS2 in Center (one EU), and North (one EU). Two planning meetings are planned (one in each department). Planning meetings for Center (one EU) and North (one EU; Borgne) will occur early in FY18.

TAS3 in Northwest (one EU; La Tortue). One two-day meeting will be held in La Tortue in late FY18 to prepare for TAS3 implementation in early FY19.

The indicators for monitoring the success of the TAS planning meetings include the availability of complete school population data, consent from school directors to participate in TAS, and eventually, the successful execution of each of TAS.

d) Mapping

Haiti is fully mapped; no mapping will be supported by ENVISION in FY18.


MDA Coverage

Between April and June 2017, the ENVISION Project, in partnership with CDC, UND, and HSC, rolled out MDA in a total of 19 communes across five departments: six communes in North (Quartier-Morin, Milot, Limonade, Cap-Haïtien, Plaine-du-Nord, and Acul-du-Nord), one commune in Northwest (Port-de-Paix), one commune in Artibonite (Gonaïves), six communes in West (Cabaret, Arcahaie, Croix-des-Bouquets, Fonds-Verrettes, Anse-à-Galets, and Pointe-à-Raquette), and five communes in PAP/Metropolitan Area (Delmas, Tabarre, PAP, Cité Soleil, and Carrefour).

Immediately following MDA in Tabarre, USAID through TFGH supported an SCT study to assess the coverage of the treatment in the Butte-Boyer subsection of the commune. With the ENVISION team, CDC trained commune-level supervisors and MSPP staff to collect information from members about whether or not they participated in an MDA. Preliminary results from this activity revealed insufficient coverage throughout the subsection, with only 45% of persons interviewed having received the treatment. Those who did not ingest the treatment at the distribution post cited several reasons, including being sick during the distribution, being concerned about side effects, preferring to ingest the treatment at home with food or drink, and choosing not to take it. The teams were also unable to access private communities that were closed off by a secured gate. To address coverage rates, community promoters (CPs) interviewed for the assessment agreed that increased mobilization and promotional activities are needed, such as mass short message service (SMS) messaging, an increased number of town criers and/or the initiation of a public campaign at least a month earlier.

Preliminary results have come in for 18 of the 19 completed MDA rounds (by June 2017) and indicate over 80% coverage in seven communes in North and Northwest, with the remaining ones below 80%. These issues will be discussed during the September 2017 partners’ meeting to agree on a way forward and may represent an opportunity to implement the Data for Action Guide in Haiti.

As in these six communes/EUs (Cap Haitien, Limonade, Plaine-du-Nord, Cabaret, Croix-des-Bouquets, and Fonds-Verettes) in particular, ENVISION follows the national program’s policy of implementing MDA after pre-TAS, which has adopted WHO recommendations: two–three additional rounds of MDA are needed if a commune/EU has failed pre-TAS. If it has passed, then it will move onto TAS1. The national program policy of implementing MDA after TAS also follows WHO recommendations. After at least five rounds of MDA, and upon passing pre-TAS, TAS1, TAS2, and TAS3 must be realized separated by two–three-year intervals. If the TAS is failed, two–three more rounds of MDA must be conducted.


Planned FY18 MDA Activities

Table 4: 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

(add additional

rows for different

treatment

frequencies)

Distribution

platform(s)

Number of

districts to

be treated

in FY18

Total # of

eligible

people to be

targeted

in FY18

Lymphatic filariasis

Entire population older than two years

1 Community

MDA 22 5,217,271

Soil-Transmitted Helminths

Entire population older than two years

1 Community

MDA 22 5,217,271

It is estimated that during one MDA round, each group of three CDDs can distribute medicine to 1,000 individuals. An MDA round typically takes place over two–three weekdays (for schools) or the weekend (for distribution posts). Although there is no pre-MDA registration process, CDDs are chosen from within the community and know most community members within their distribution post area.

In FY18, MDA will take place in Northwest (one commune), Artibonite (one commune), North (five communes), West (three communes), and West–Metropolitan Area (five communes) for four days each. To address potential low coverage, the recommendations are to increase participation rates include shifting MDA to the afternoon and, in Dondon in particular, concentrating MDA activities in the city. Additional strategies to ensure high coverage rates in those areas will be discussed and validated during the September 2017 partners’ meeting.

Note that MDA coverage and related social mobilization and MDA M&E activities have not been budgeted for three communes in North (Cap-Haïtien, Limonade, and Plaine-du-Nord) and three communes in West (Fonds-Verettes, Cabaret, and Croix-des-Bouquets). These communes will be undergoing pre-TAS and, if they pass, will undergo TAS1, for which they are budgeted. If one or more communes do not pass pre-TAS, any funds from TAS1 will cover the costs for MDA.

MDA supplies. MDA kits, which are assembled in bags provided to volunteers at each distribution post and health facility, contain DEC and ALB, Aquatabs to ensure clean water, pens, cups, spoons, and Ziploc bags. Additional MDA supplies budgeted for include pens to fill out registers and bags of water to ensure that participants can swallow the pills in areas where there are chronic water shortages.

Delivery of MDA supplies. Described in detail under the Drug Supply and Management section.

Registers and reporting forms. During MDA, the CDDs typically work in groups of three. One CDD conducts promotion activities, one distributes the ALB and DEC treatments, and one fills in the register information. Registers do not record individuals’ names, but they do collect information on age and sex and the amounts of ALB and DEC given. These registers are typically on 11’’ × 14’’ sheets of paper and can hold up to 50 individual records. All CDD registers are summarized into an MSPP reporting form. ENVISION will provide funding to produce and copy registers and forms. After MDA, one of the three CDDs submits the compiled information for each distribution post where the group worked to the CL. The CL then compiles the information from all distribution posts in the geographic area for which she/he is responsible and reports to the lead MSPP communal health person. This person compiles the reports


from all CLs in the commune and then reports to the lead MSPP person at the departmental level, who compiles the information from all communal health personnel in the department to present a general report for his/her department. Note that in areas where there are UCSs, the CL reports to the responsible party in the UCS who, in turn, reports to the department lead. ENVISION collects the information at the department level and includes it in routine reporting to the HNTDCP and ENVISION. The DQA conducted in August 2015 did not lead to any changes in the data collection tools, but it did emphasize the need to ensure the availability of data summary forms at the CL and commune levels, the importance of CLs and communes keeping copies of their registers, and the need to improve the storage and organization of MDA data at the commune level.

Allowances for CLs, CPs, and CDDs. As part of the LF/STH and STH-only MDA budgets, ENVISION will fund allowances for these volunteers.

e) Social Mobilization to Enable NTD Program Activities

Development and production of health messages. ENVISION will fund the development and production of health messages in Creole for TV and radio similar to those produced in previous years, but updated with entertaining and fresh messaging and the FY18 MDA dates and times. These spots will be developed in coordination with and be approved by the MSPP and MENFP.

Information, Education, and Communication (IEC) materials for MDA. ENVISION will fund the production of IEC materials for the planned FY18 MDA. These materials will include posters, banners, flags, flyers, and T-shirts for CDDs. Banners are used to advertise the dates and locations of MDA at road intersections. Flags are displayed to identify posts. Each year, T-shirts are produced and given to CDDs, CPs, and CLs to motivate them. Additionally, the T-shirts from MDA in previous years might not be kept in perfect condition over the course of the year because ENVISION does not collect T-shirts after MDA each year. ENVISION will continue to fund posters, megaphones, and radio spots. Furthermore, ENVISION will continue to print posters and flyers that CLs and CPs use during their megaphone advertising. These posters and flyers also are important IEC materials for targeting officials and the literate population. As noted above, in the 2015 coverage survey, respondents were limited to choosing one IEC strategy, and most chose megaphones. However, the 2014 survey did indicate that other communication tools are useful, and ENVISION believes that it is important to give CLs and CPs a variety of communication tools.

Broadcasting radio/TV spots and delivering IEC materials. ENVISION will fund the delivery of IEC materials to communes and radio and TV spots to stations in the departments.

Live audio messages. The rented sound trucks and megaphones are used before and during MDA to rally communities by disseminating health messages on relevant MDA topics. These sensitization and social mobilization activities will target the entire population and can be helpful for illiterate individuals. Additional sensitization and social mobilization IEC materials are discussed in the MDA section of this work plan. Given the evidence on the effectiveness of megaphones for mobilizing the population described above, in addition to feedback from CLs and health officials that more megaphones would improve social mobilization and distribution efforts, additional megaphones will be rented and distributed to CLs, CPs, and CDDs to increase awareness of the campaigns, emphasize the safety of the drugs, and address concerns about side effects.

Printed messages. ENVISION plans to fund the printing of official government letters sent to local officials and school Directors ahead of MDA as part of sensitization and mobilization efforts. The aim of these brochures is to increase and raise awareness about LF and MDA among the general population. The brochures are professionally printed and primarily distributed in West Department communes,


which require more information because they are newer to working under the ENVISION model for MDA. The brochures will be tailored to address the needs of urban areas in particular, including information about the high prevalence in these areas, the effectiveness of the medications in preventing disability associated with LF, and the ease of taking the medications. The letters are specifically directed at CLs, such as church leaders and school directors, who are typically better educated and highly literate and aim to inform them about the purpose of MDA, to ask for permission to conduct MDA in the schools on the proposed dates, to ensure their engagement, and to encourage them to mobilize their communities for MDA.

f) Training

Printing of training materials. In departments and communes where MDA activities will continue in FY17, ENVISION will fund the printing of training materials, including posters (job aids), registers, and DVDs (including the WHO LF documentary) to use during MDA and social mobilization. The registers are used during the training to clarify the definitions of the indicators and how to fill out the forms. The DVDs (including the WHO LF documentary) are distributed during the trainings because the CLs are all present. The posters are used as job aids to help CLs and CPs explain LF and MDA and for social mobilization in the community.

Refresher training of 56 existing laboratory technicians: ENVISION will conduct refresher trainings for 56 existing laboratory technicians (MSPP and non-MSPP staff) to further strengthen the capacity of the HNTDCP to conduct DSAs in both ENVISION and non-ENVISION-supported EUs.

Conduct refresher training for CLs, CPs, and CDDs. ENVISION will organize one-day refresher trainings for CLs and CPs and half-day trainings for CDDs conducted by the MSPP central, departmental, and communal representatives with support from the ENVISION team. The refresher trainings are necessary because 10–12 months typically pass between MDA rounds, and in that time, volunteers conduct various other health-related works in their communities and can forget critical information about MDA if they are not retrained. These trainings occur in a department-by-department cascade fashion based on the MDA schedule, with the CLs training the CPs and the CPs training the CDDs. These trainings are also necessary for educating new volunteers who replace those who lost to attrition; however, it is important to note that almost 95% of volunteers continue to work with the HNTDCP.

These trainings will focus on a review of LF and STH fundamentals, disease transmission, clinical manifestations, and prevention using PowerPoint presentations and job aids/posters. They also highlight key steps of the MDA rollout, tasks of MDA implementation, and data review, reporting, and data quality. Although these refresher trainings revisit NTD and MDA overview information, they also provide an opportunity to discuss the previous MDA results, lessons learned, and any challenge areas (such as low coverage). In addition, these trainings are another opportunity to provide motivating messages to community volunteers. A particular focus of these refresher trainings will be directly observed therapy because the KAP/coverage surveys in Thomazeau and Croix-des-Bouquets in September 2015 and anecdotal evidence indicate that many community members continue to take the medications home instead of swallowing them in front of the CDDs. Further, ENVISION will continue to use the revised MDA registers validated by the MSPP last year that include indicators on the numbers of community members reporting hydrocele and lymphedema. Therefore, the refresher training will include a component on the clinical manifestations of hydrocele and lymphedema, how to ask these questions sensitively, and how to refer these patients to health centers for follow-up care where available.

To perform post-training follow-up/monitoring to ensure skills retention and application, ENVISION will conduct regular supportive supervision throughout MDA activities. In addition, ENVISION staff will


crosscheck the MDA reports received from communal and departmental health officials using a significant sample of MDA reports submitted by CLs not only to ensure that the figures are consistent and reliable but also to look for issues of completeness and accuracy. Where there are issues, ENVISION staff will take corrective action and provide additional coaching and feedback for these leaders and their CPs and CDDs.

g) Drug and Commodity Supply Management and Procurement

ALB is donated by GlaxoSmithKline, Inc. (GSK) through WHO/PAHO. After completing a report form for the ALB used in the previous year, the MSPP will submit the Joint Request for Selected Medicines (JRSM) form by August 15, 2017, to request ALB for the communes where MDA is planned. ENVISION assists the MSPP in completing the JRSM for the ENVISION-funded areas through collaborative working meetings with the MSPP and other implementing partners. ENVISION has 5.19 million tablets of ALB in stock in its own warehouse (separate from the MSPP’s warehouse), which will be sufficient to cover the MDA planned in ENVISION-supported communes for FY18.

To quantify the amounts of DEC and ALB needed for the country, the HNTDCP formally requests a meeting of the implementing partners, ENVISION, and UND. During this meeting, population figures for the communes where MDA are planned are compiled and used to forecast the quantities of drugs needed, including a 10% buffer to account for wastage and population fluctuations.

To date, no significant supply chain issues for DEC or ALB have been identified.

Both DEC and ALB are managed and stored by the Essential Drug Program (Programme de Médicaments

Essentiels [PROMESS]). After the ALB is in the country, IMA has three days to pick it up from PROMESS to avoid paying a daily fee for storage. Once the DEC tablets for FY18 are already in country, ENVISION will request the necessary quantities of 100-mg DEC tablets from the MSPP, and once approved, ENVISION will collect the drugs from PROMESS.

Drug and diagnostic clearance and storage. In FY18, ENVISION will continue to provide funds to cover the costs of the clearance, storage, and transportation of drugs and diagnostics (FTSs). ENVISION will provide FTSs for pre-TAS, and WHO will provide a donation of FTSs for TAS. ENVISION covers the packing costs for TAS materials (e.g., lancets) purchase in the U.S., shipping costs for TAS materials purchased in the U.S., and MDA drug clearance costs and transportation to the warehouse in PAP.

Drugs storage and transportation. ENVISION also funds the costs for clearance and transportation from the national warehouse to the IMA warehouse and, eventually, to the communes two weeks before MDA.

Drug repackaging into kits and delivery of MDA supplies. ENVISION funding supports the packaging of the MDA kits. Once the kits are prepared, ENVISION prepares delivery notes and receipts for the communes concerned and contacts CLs and commune and department officials to discuss the delivery schedule.

Reverse supply chain of drug and diagnostic stocks (post-MDA). Once MDA is completed, ENVISION staff will recuperate all leftover MDA treatment from the 10 communes.

National policies for the waste management of drugs/other commodities exist in Haiti. After MDA, CLs bring all unused supplies and drugs to health facilities, and IMA collects the unused supplies, conducts inventory, and rearranges them into new MDA kits that are used in the upcoming MDA and stored at the IMA warehouse. ENVISION informs the MSPP about the quantities of any remaining MDA drugs and follows any instructions given about how to manage them. However, the MSPP typically allows


ENVISION to keep the drugs in the ENVISION (IMA) warehouse until the next MDA. Any expired drugs are emptied from their bottles and stored securely and separately at the IMA warehouse until they are incinerated. Empty pill bottles are also incinerated by ENVISION/IMA.

ENVISION follows the national laboratory/pharmaceutical directives for the storage of all drugs/commodities used for MDA and M&E activities.

All CLs, CPs, and CDDs are trained by ENVISION during refresher trainings to watch for AEs and serious AEs (SAEs), although an SAE has not occurred in Haiti since the start of the program. Side effects, such as headaches, nausea, abdominal pain, fever, and nodules, are recorded. The medications needed to treat these AEs are included in MDA kits. In the rare cases that more serious complications occur, patients are transferred to hospitals for follow-up and are accompanied by CLs. If an SAE occurs, it will be reported to the HNTDCP LF/malaria coordinator, Dr. Lemoine, who will then report it to PAHO and the drug donation program. RTI will be notified by IMA within 24 hours if any SAEs occur. IMA/ENVISION has shared the French version of the SAE handbook with the MSPP and partners. In addition, during FY16, ENVISION worked with the MSPP to identify an SAE Focal Point at the HNTCDP, Murielle Gilbert, and shared with her and the national LF/Malaria Coordinator ENVISION resources and webinars on SAEs.

ENVISION has not identified any new procurement or supply chain activities for FY18 that are not already being supported by the program.

The MSPP will be requesting from PAHO a total of 35,400 FTSs for FY18: 28,800 FTS for TASs in 16 EUs and 6,600 for pre-TASs and SCs in 6 EUs. The FTSs for pre-TAS will be purchased by RTI and shipped to Haiti. The U.S. Embassy will be the consignee and clear the FTSs through customs. After they are cleared, the FTSs will be stored in the IMA office prior to use.

Additionally, IMA and MSPP will request from ENVISION a total of 12 Kato Katz kits for use in pre-TASs (six EUs), SSs/SCs (six EUs), STH-integrated TAS1 in North (three EUs) and West (three EUs)4, and TAS2 in South (one EU) and Grand’Anse (one EU). The kits will also be purchased by RTI and shipped to Haiti, with the U.S. Embassy as the consignee to clear the kits through customs. After being cleared, the kits will be stored at the IMA warehouse.

h) Supervision for MDA

The MSPP, the MENFP, and IMA staff will supervise LF/STH MDA activities with ENVISION funding. The MSPP will actively participate in training the MDA volunteers, and all volunteers must follow the training/refresher training directives prior to MDA. If a volunteer is absent during the scheduled training/refresher training, then he/she must meet with the communal head of MSPP to receive a follow-up on the missed information. If the follow-up meeting is not held, that particular volunteer will be replaced. However, the retention rate of CLs, CPs, and CDDs is very high, with most returning year after year; thus, they have a very solid level of experience and understanding of their responsibilities.

During MDA, the MSPP central-level representative accompanies IMA staff to supervise the distribution posts and school-based MDA and brings additional MDA supplies during supervision visits to replenish volunteers’ supplies if needed. Central-level staff will provide recommendations to the volunteers if necessary. At the departmental level, ENVISION covers transportation costs for the LF/STH departmental personnel to supervise the MDA. At the communal level, the MSPP representatives supervise the distribution posts and schools. Note that when different teams are in the same communes for supervision, they supervise different areas to avoid duplication.

4 Of the six communes, if one or more do not pass, they will not undergo TAS1.


Supervision by the MENFP is less active than that of the MSPP. However, an MENFP representative from the central level accompanies CLs in some communes to provide supervision in schools. At the departmental level, the principal school inspector also participates in the supervision in some schools, but at the communal level, this participation is very low.

To ensure that WHO and MSPP regulations are adhered to, ENVISION will continue to closely supervise MDA and ensure that clear reporting mechanisms are in place for CDDs, CPs, CLs, and communal health officials to report any issues that arise during the execution of MDA. Any instances of regulations not being followed will be documented, followed up on, and shared with the HNTDCP.

To identify and address any potential issues that arise during the course of MDA, ENVISION will maintain close communication with MDA volunteers and MSPP and MENFP officials. For example, in the past, some school directors have refused to allow volunteers to conduct MDA in their schools. In this case, ENVISION will call and/or meet with departmental school directors and encourage them to liaise with the school directors to explain the purpose of MDA, its importance for the health of their students and families, and the safety and effectiveness of the drugs and to address any other concerns.

Within areas that failed pre-TAS or TAS, supervision efforts will be intensified, particularly in areas that are hot spots for LF transmission based on ENVISION’s data from previous DSAs. To improve/intensify supervision, ENVISION staff and the MSPP will use a supervision checklist to better standardize supervision efforts and mentor commune and department officials on how to incorporate the supervision checklist in their work. Supervisors will also be encouraged to conduct more SCs of the social mobilization being performed by CLs and CPs in advance of MDA.

In FY18, ENVISION will also fund ENVISION/IMA staff to travel to the departments that are supported by ENVISION at the end of the LF/STH MDA to collect materials and receipts.

i) M&E

WHO Joint Application Package. ENVISION will work with the HNTDCP and other implementing partners to ensure that the application package is completed prior the deadline of August 15 and that the package is complete and accurate. This will involve in-person meetings scheduled well ahead of the final deadline. The Drug and Commodity Supply Management and Procurement section provides more details on the process for completing the WHO Joint Application Package in Haiti.

Improving TAS Outcomes Checklists for program managers. ENVISION and HNTDCP will start to systematically use the TAS Outcomes Checklists to prepare for TAS implementation and investigate any TAS failure in FY18.

WHO integrated NTD database. In FY18, ENVISION will continue to work with the HNTDCP and other implementing partners to ensure complete historical data entry into the database. This will enable HNTDCP, with ENVISION support, to complete the WHO JRF and Epidemiological Data Reporting Form using the database and, eventually, to prepare the LF elimination dossier. Historical data from 2008 to 2015 have already been entered in the database for all USAID supported communes and some non-USAID-supported communes where information was available. However, some historical data is still missing. ENVISION and the MSPP have requested pre-2008 data from other implementing partners on several occasions but have been unsuccessful. This may be attributable to an outdated database and an inability to access previous datasets; ENVISION will work with key stakeholders to extract historical data from older database programs and transfer them to the integrated NTD database. Because of the incomplete data, the MSPP has not yet actively used the database. However, ENVISION will actively


work with the MSPP to update the database quarterly, and help to identify and train existing staff dedicated to managing the database.

DSA activities (pre-TAS and TAS). Prior to conducting the pre-TAS and TAS activities, ENVISION works with MSPP and partners to ensure that TAS preparations follow the correct guidelines. As such, the country has documented and submitted a data report regarding key WHO indicators (at least 5 rounds of MDA, coverage at least 65% and Mf below 1% or antigenemia below 2%) to RPRG for approval (Table 8). Once TAS activities were approved, each partner with the support of MSPP and the MENFP, planned a meeting with CLs to collect data for schoolchildren between 6-7 years. After data collection, each partner prepared the survey sample builder (SSB) for TAS implementation. Following the identification of the number of schools and children, the SSB defined the sample size for testing and the critical cut-off indicator. The country has submitted an FTS request to WHO for the implementation of the TAS activities along with the TAS request. The only real change in the M&E strategy from previous work plans is that the country has transitioned from using ICT cards as the LF diagnostic tool to FTS. The pre-TAS and TAS activities for FY18 are as follows:

Pre-TAS. In FY18, ENVISION plans to support six pre-TASs covering six communes, including three in North (three EUs) and three in West (three EUs). ENVISION will ensure that these pre-TASs are carried out at least six months after the last MDA and that they follow all WHO and national guidelines.

SC sites. As above, ENVISION plans to conduct pre-TAS SCs in the six communes mentioned above (three communes in North and three in West)

TAS1 and TAS2. If any of the above communes passes pre-TAS, then they will be eligible to undergo TAS1. As such, ENVISION plans to conduct TAS1 in the six EUs covering six communes (three in North and three in West). TAS1 in the three EUs in North will be integrated with malaria and STH, whereas the three EUs in West will be integrated with malaria only. Implementing TAS will depend on whether one or more EU passes pre-TAS. If they do not pass, any funds related to TAS1 will be used toward MDA. TAS2 is planned in two EUs covering two communes: Center (one) and North (one). Both are non-integrated TAS. ENVISION will support TAS planning meetings in each EU where TAS1 and TAS2 are planned.

Table 5: Planned Disease-specific Assessments 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: e.g., Mf or

FTS)

Lymphatic Filariasis 140

3 3 Pre-TAS FTS

3 3 Re-Pre-TAS FTS

6 6 TAS1 FTS

2 2 TAS2 FTS

Soil-Transmitted

Helminths 140

6 NA SS Kato Katz

3 NA TAS/STH Kato Katz


j) Supervision for M&E and DSAs

ENVISION also supports the national program to conduct supervision for M&E activities, including SS surveys and TAS. The MSPP national level is actively participating in the TAS refresher trainings. To further strengthen M&E supervision, ENVISION and HNTDCP will start to systematically use the TAS Outcomes Checklists to prepare for TAS implementation and investigate any TAS failure in FY18.

Haiti uses a TAS supervision checklist wherein the MSPP and MENFP authorities participate integrally with each implementer in the supervision of TAS activities. The HNTDCP ensures that surveyors have been trained according to their roles, ensures compliance to the sample size provided by the SSB, and following the number of LF positive cases, decides if the EU has passed or failed TAS. Additionally, the HNTDCP and IMA ensure that all methodology for TAS implementation has been followed. Once TAS activities have been completed, the country develops and submits the TAS results report and submits it to WHO (RPRG).

The key challenges in TAS implementation are inadequate school enrollment data, the inaccessibility of some areas, difficulty in the integration of TAS STH (across all TAS activities, as requested by the MSPP) due to a lack of available funds, and finally, EUs not passing TAS. For FY18, to address these challenges, the following will be undertaken:

• ENVISION will request more early involvement of MENFP and MSPP authorities in the identification of children six–seven years old in primary schools.

• For STH integration, ENVISION will continue advocacy with other partners (CDC and TFGH) to identify more funds for implementing STH/LF integrated TAS, especially for training to strengthen the capacity of the MSPP.

• Regarding communes/EUs that fail TAS, the HNTDCP will encourage its partners to perform research activities to facilitate understanding the focal transmission in the areas where TAS failed and identify good strategies to decrease the LF prevalence in those areas with focal transmission.

For EUs that have failed TAS, the HNTDCP reviews the final data. Upon verifying that the number of positive cases was higher than the critical cut-off, the HNTDCP continues with two additional rounds of MDA, per WHO recommendations. During these MDA rounds, emphasis has been placed on using the door-to-door strategy to increase the coverage and reduce the transmission in areas where positive cases have been identified. After two years of additional MDA, re-pre-TAS must be conducted for a new assessment. New SSs and SCs will be selected for re-pre-TAS, concentrating on areas where low coverage or positive cases were identified during TAS. However, alternative strategies beyond high coverage and continued MDA should also be explored.

k) Dossier Development

During the last two partners’ meetings, a brief discussion has been initiated on LF elimination dossier preparation, and each partner supporting the MSPP through MDA activities is aware that they are responsible for documenting any NTD data in their implementation areas. In FY18 Q1, a consultant will be hired to support the country in pre-dossier development. A one-day meeting is scheduled in FY18 Q1 with key stakeholders to orient them to the dossier requirements and data need.


3) Maps

Note: Endemic status means requiring MDA


APPENDIX 1: Work Plan Timeline

FY18 Activities Q1 Q2 Q3 Q4

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

Project Assistance

Strategic Planning

Bi-annual NTDs partners’ meetings

NTD Secretariat

Ongoing support of operational costs and supplies to the MSPP

Building Advocacy for Sustainable National NTD Program

TAS planning meeting in Northwest (La Tortue) for TAS3 (one commune/one EU)

TAS planning meeting in Center (Saut-d’Eau) for TAS2 (one commune/one EU)

TAS planning meeting in North for TAS1 (three communes/three EUs)

TAS planning meeting in North for TAS2 (one commune/one EU)

TAS planning meeting in West for TAS1 (three communes/three EUs)

Social Mobilization to Enable NTD Program Activities

Development and production of health messages (radio and TV spots)

Dissemination of health messages

IEC materials for LF MDA (posters, flags, T-shirts, and banners)

Delivery of IEC materials and radio and TV spots

Brochures and letters to parents of SAC and churches in Northwest (Port-de-Paix), North (eight communes), and West (six communes)

Brochures and letters to parents of SAC and churches in PAP/Metropolitan Area (six communes)

Training

Refresher training for CLs in Northwest (Port-de-Paix), North (eight communes), Artibonite (Gonaïves), and West (six communes)

Refresher training for CLs in PAP/Metropolitan Area (six communes)

Refresher training for CPs in Northwest (Port-de-Paix), North (eight communes), Artibonite (Gonaïves), and West (six communes)

Refresher training for CPs in Metropolitan Area (six communes)

Refresher training for CDDs in Northwest (Port-de-Paix), North (eight communes), Artibonite (Gonaïves), and West (six communes)

Refresher training for CDDs in Metropolitan Area (six communes)

Refresher training for TAS technicians (surveyors)

MDA


FY18 Activities Q1 Q2 Q3 Q4

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

MDA in Port-de-Paix (Northwest Department)

MDA in eight communes in North Department (Cap-Haïtien, Limonade, Quartier-Morin, Milot, Dondon, Limbé, Plaine-du-Nord, and Acul-du Nord)

MDA in six communes in West Department (Arcahaie, Fonds-Verrettes, Cabaret, Croix-des-Bouquets, Anse-à-Galets, and Pointe-à-Raquette)

MDA in Gonaïves (Artibonite Department)

MDA in Metropolitan Area (six communes)

MDA press conference

Drug Supply Management and Procurement

Drug clearance, transportation to the warehouse, and transportation from warehouse to communes

Preparation of MDA materials

Drug storage

Drug packaging into kits

Delivery of MDA materials

Recuperation of MDA materials

Supervision

Supervision of LF/STH MDA in Northwest, North, West, and Artibonite

Supervision of LF/STH MDA in Metropolitan Area (six communes)

Recuperation of materials and receipts following LF/STH MDA and allowance distribution

Supervision during pre-TAS and TAS activities.

M&E

LF pre-TAS: North Department (Cap-Haïtien, Limonade, Plaine-du-Nord, Fonds-Verrettes, Cabaret, and Croix-des-Bouquets)

LF TAS1: Stop MDA in North (three EUs, integrated with STH and malaria) and West (three EUs, integrated with malaria)

LF TAS2: Stop MDA in Center (one EU, LF TAS) and North (one EU, non-integrated)

Dossier Development

Preparation of LF elimination dossier

STTA

Pre-dossier development


APPENDIX 2. Table of USAID-Supported Regions and Districts in FY18

Region Health Districts Mapping

(list disease(s))

Baseline sentinel sites

(list disease(s))

MDA DSA

LF STH LF STH

1 Artibonite Anse-Rouge

2 Desdunes

3 Dessalines

4 Ennery

5 Gonaïves X X

6 Grande-Saline

7 Gros-Morne

8 La Chapelle

9 Lestere

10 Marmelade

11 Petite Rivière de l’Artibonite

12 Saint-Marc

13 Saint-Michel-de-l’Atalaya

14 Terre-Neuve

15 Verettes

16 Center Belladère

17 Boucan-Carré

18 Cerca-Carvajal

19 Cerca-la-Source

20 Hinche

21 Lascahobas

22 Maïssade

23 Mirebalais

24 Saut-d'Eau TAS2

25 Savannette

26 Thomassique

27 Thomonde

28 Grand’Anse Abricot

29 Anse-d'Hainault

30 Beaumont

31 Bombon

32 Chambelan

33 Corail

34 Dame-Marie



(list disease(s))


(list disease(s))

MDA DSA

LF STH LF STH

35 Jérémie

36 Les Irois

37 Moron

38 Pestel

39 Roseaux

40 Nippes Anse-à-Veau

41 Arnaud

42 Fonds-des-Nègres

43 Grand-Boucan

44 L'Asile

45 Miragoâne

46 Paillant

47 Petit-Trou-de-Nippes

48 Petite-Rivière-de-Nippes

49 Plaisance-du-Sud

50 North Acul-du-Nord X X

51 Bahon

52 Bas-Limbé TAS2

53 Borgne

54 Cap-Haïtien X X Re-Pre-TAS, TAS1 SS, TAS/STH

55 Dondon X X

56 Gde Riviere Du Nord

57 La Victoire

58 Limbé X X

59 Limonade X X Re-Pre-TAS, TAS1 SS, TAS/STH

60 Milot X X

61 Pignon

62 Pilate

63 Plaine-du-Nord X X Re-Pre-TAS, TAS1 SS, TAS/STH

64 Plaisance

65 Port-Margot

66 Quartier-Morin X X

67 Ranquitte

68 Saint-Raphaël

69 Northeast Capotille

70 Caracol

71 Carice



(list disease(s))


(list disease(s))

MDA DSA

LF STH LF STH

72 Ferrier

73 Fort-Liberté

74 Les Perches

75 Mombin-Crochu

76 Mont-Organisé

77 Ouanaminthe

78 Sainte-Suzanne

79 Terrier-Rouge

80 Trou-du-Nord

81 Vallières

82 Northwest Anse-à-Foleur

83 Baie-de-Henne

84 Bassin-Bleu

85 Bombardopolis

86 Chansolme

87 Jean-Rabel

88 La Tortue

89 Môle-Saint-Nicolas

90 Port-de-Paix X X

91 Saint-Louis-du-Nord

92 South Aquin

93 Arniquet

94 Barraderes

95 Camp-Perrin

96 Cavaillon

97 Cayes

98 Chantal

99 Chardonnières

100 Côteaux

101 Île-à-Vache

102 Les Anglais

103 Maniche

104 Port-à-Piment

105 Port-Salut

106 Roche-à-Bateaux

107 Saint-Jean-du-Sud

108 Saint-Louis-du-Sud



(list disease(s))


(list disease(s))

MDA DSA

LF STH LF STH

109 Tiburon

110 Torbeck

111 Southeast Anse A Pitre

112 Bainet

113 Belle-Anse

114 Cayes-Jacmel

115 Côtes-de-Fer

116 Grand-Gosier

117 Jacmel

118 La Vallée

119 Marigot

120 Thiotte

121 West Anse-à-Galets X X

122 Arcahaie X X

123 Cabaret X X Re-Pre-TAS, TAS1 SS

124 Carrefour X X

125 Cité Soleil X X

126 Cornillon

127 Croix-des-Bouquets X X Re-Pre-TAS, TAS1 SS

128 Delmas X X

129 Fonds Verettes X X Pre-TAS, TAS1 SS

130 Ganthier

131 Grand-Goâve

132 Gressier

133 Kenscoff

134 Léogâne

135 Pétion-Ville X X

136 Petit-Goâve

137 Pointe-à-Raquette X X

138 PAP X X

139 Tabarre X X

140 Thomazeau

haiti work plan · envision fy18 py7 haiti work plan ii envision project overview the u.s. agency...

Documents