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Uganda Work Plan FY 2018
Project Year 7
October 2017–September 2018
ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred
Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision.
ENVISION is funded by the US Agency for International Development under cooperative agreement No. AID-OAA-A-11-
00048. The period of performance for ENVISION is September 30, 2011 through September 30, 2019.
The author’s views expressed in this publication do not necessarily reflect the views of the US Agency for International
Development or the US Government.
ENVISION FY18 PY7 Uganda Work Plan
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ENVISION Project Overview
The US Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to
support the vision of the World Health Organization (WHO) and its member states by targeting the
control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF),
onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm,
whipworm, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at
global and country levels and support ministries of health (MOHs) to achieve their NTD control and
elimination goals.
At the global level, ENVISION—in close coordination and collaboration with WHO, USAID, and other
stakeholders—contributes to several technical areas in support of global NTD control and elimination
goals, including the following:
• Drug and diagnostics procurement, where global donation programs are unavailable
• Capacity strengthening
• Management and implementation of ENVISION’s Technical Assistance Facility (TAF)
• Disease mapping
• NTD policy and technical guideline development
• NTD monitoring and evaluation (M&E)
At the country level, ENVISION provides support to national NTD programs by providing strategic
technical and financial assistance for a comprehensive package of NTD interventions, including the
following:
• Strategic annual and multi-year planning
• Advocacy
• Social mobilization and health education
• Capacity strengthening
• Baseline disease mapping
• Preventive chemotherapy (PC) or mass drug administration (MDA)
• Drug and commodity supply management and procurement
• Program supervision
• M&E, including disease-specific assessments (DSAs) and surveillance
In Uganda, ENVISION project activities are implemented by RTI International and The Carter Center.
ENVISION FY18 PY7 Uganda Work Plan
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TABLE OF CONTENTS ENVISION Project Overview .......................................................................................................................... ii
TABLE OF TABLES ......................................................................................................................................... iv
TABLE OF FIGURES ........................................................................................................................................ v
ACRONYMS LIST ........................................................................................................................................... vi
COUNTRY OVERVIEW .................................................................................................................................... 8
1) General Country Background .................................................................................................... 8
a) Administrative Structure ........................................................................................................... 8
b) Other NTD Partners ................................................................................................................... 9
2) National NTD Program Overview ............................................................................................ 14
a) Lymphatic Filariasis ................................................................................................................. 15
b) Trachoma ................................................................................................................................. 16
c) Onchocerciasis ......................................................................................................................... 17
d) Schistosomiasis ........................................................................................................................ 18
e) Soil-Transmitted Helminthiasis ............................................................................................... 19
3) Snapshot of NTD Status in Uganda .......................................................................................... 20
PLANNED ACTIVITIES ................................................................................................................................... 21
1) NTD Program Capacity Strengthening ..................................................................................... 21
a) Situation ..................................................................................... Error! Bookmark not defined.
b) Strategic Capacity Strengthening Approach ............................... Error! Bookmark not defined.
c) Capacity Strengthening Objectives and Interventions ............... Error! Bookmark not defined.
d) Supporting Field-based ENVISION Staff in Capacity Strengthening .......... Error! Bookmark not
defined.
e) Monitoring Capacity Strengthening ........................................................................................ 21
2) Project Assistance .................................................................................................................... 23
a) Strategic Planning .................................................................................................................... 23
b) NTD Secretariat ....................................................................................................................... 24
a) Building Advocacy for a Sustainable National NTD Program .................................................. 24
b) Mapping .................................................................................................................................. 26
c) MDA Coverage ......................................................................................................................... 26
d) Social Mobilization to Enable NTD Program Activities ............................................................ 28
e) Training .................................................................................................................................... 33
f) Drug and Commodity Supply Management and Procurement ............................................... 37
g) Supervision for MDA ............................................................................................................... 37
ENVISION FY18 PY7 Uganda Work Plan
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h) M&E ......................................................................................................................................... 38
i) Supervision for M&E and DSAs ............................................................................................... 41
j) Dossier Development .............................................................................................................. 42
k) Short-Term Technical Assistance ............................................... Error! Bookmark not defined.
3) Planned FOGs to Local Organizations and/or Governments ...... Error! Bookmark not defined.
4) Cross-Portfolio Requests for Support ......................................... Error! Bookmark not defined.
5) Maps ........................................................................................................................................ 44
APPENDIX 1: Country Staffing/Partner Organizational Chart ........................ Error! Bookmark not defined.
APPENDIX 2: Work Plan Timeline................................................................................................................ 48
APPENDIX 3: Work Plan Deliverables............................................................. Error! Bookmark not defined.
APPENIDX 4. Table of USAID-supported Regions and Districts in FY18 ...................................................... 50
APPENDIX 5: FY17 Q1-2 Uganda SAR ............................................................. Error! Bookmark not defined.
APPENDIX 6: Program Workbook (MS Excel) ................................................. Error! Bookmark not defined.
APPENDIX 7: Disease Workbook (MS Excel) .................................................. Error! Bookmark not defined.
APPENDIX 8: Country Budget (MS Excel) ....................................................... Error! Bookmark not defined.
APPENDIX 9: UOEEAC’s OV Flag .................................................................................................................. 54
TABLE OF TABLES
Table 1: Non-ENVISION NTD partners working in country, donor support, and summarized
activities ............................................................................................................................ 13
Table 2: Snapshot of the expected status of the NTD program in Uganda as of September 30,
2017 .................................................................................................................................. 20
Table 3: Project assistance for capacity strengthening ..................... Error! Bookmark not defined.
Table 4: USAID-supported coverage results for FY16 ........................ Error! Bookmark not defined.
Table 5: USAID-supported districts and estimated target populations for MDA in FY18 .............. 27
Table 6: Social mobilization/communication activities and materials checklist for NTD work
planning ............................................................................................................................ 30
Table 7: Training targets ................................................................................................................. 34
Table 8A: Reporting of DSA supported with USAID funds that did not meet critical cutoff
thresholds as of September 30, 2017 .................................. Error! Bookmark not defined.
Table 8B: Reporting of OV-specific DSA supported with USAID funds that did not meet critical
cutoff thresholds as of September 30, 2017 ....................... Error! Bookmark not defined.
Table 9a: Planned DSAs for FY18 by disease .................................................................................... 41
Table 9b: Planned OV-specific assessments for FY18 ....................................................................... 41
Table 10: Technical assistance request from ENVISION ...................... Error! Bookmark not defined.
ENVISION FY18 PY7 Uganda Work Plan
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Table 11: Planned FOG recipients ....................................................... Error! Bookmark not defined.
TABLE OF FIGURES
Figure 1: Uganda regional and district maps ..................................................................................... 8
Figure 2: ENVISION-supported MDA for LF, FY12–FY16 ..................... Error! Bookmark not defined.
Figure 4: ENVISION-supported MDA for trachoma, FY12–FY16 ......... Error! Bookmark not defined.
Figure 3: ENVISION-supported MDA for Oncho, FY12–FY16 .............. Error! Bookmark not defined.
Figure 5: ENVISION-supported MDA for Schistosomiasis, FY12–FY16 Error! Bookmark not defined.
Figure 6: ENVISION-supported MDA for STH, FY12–FY16 .................. Error! Bookmark not defined.
Figure 7. Uganda LF, OV, STH, SCH, and Trachoma Endemicity Maps ............................................ 44
Figure 8. Uganda LF, OV, SCH, STH, and Trachoma Geographic Coverage Maps ............................ 44
Figure 9. Uganda Progress Toward LF Elimination Map .................................................................. 46
Figure 10. Uganda Progress Toward Trachoma Elimination Map ..................................................... 47
ENVISION FY18 PY7 Uganda Work Plan
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ACRONYMS LIST
AE Adverse Events
AFRO WHO Regional Office for Africa
ALB Albendazole
BCC Behavior Change Communication
CAO Chief Administrative Officer
CBM Christian Blindness Mission
CCP John Hopkins School of Public Health’s Center for Communication Programs
CDD Community Drug Distributor
CFA Circulating Filarial Antigen
CHEW Community Health Extension Worker
CLTS Community-led Total Sanitation
CY Calendar Year
DDT Dichlorodiphenyltrichloroethane
DFID (United Kingdom) Department for International Development
DGHS Director General of Health Services
DHO District Health Office(r)
DRC Democratic Republic of the Congo
DSA Disease-Specific Assessments
ELISA Enzyme-Linked Immunosorbent Assay
EU Evaluation Unit
FOGs Fixed Obligated Grants
FTS Filariasis Test Strip
FY Fiscal Year
GTMP Global Trachoma Mapping Project
HAT Human African Trypanosomiasis
HMIS Health Management and Information System
HPED Health Promotion Education Division (MOH)
HSD Health Sub district
IDM Innovative and Intensified Disease Management
IEC Information, Education, and Communication
IRS Indoor Residual Spraying
ITI International Trachoma Initiative
IU Implementation Unit
IVM Ivermectin
JRSM Joint Request for Selected (PC) Medicines (WHO)
KAP Knowledge, Attitudes, and Practices (study)
LC Local Council
LF Lymphatic Filariasis
LLIN Long Lasting Insecticide Treated Net
M&E Monitoring and Evaluation
MDA Mass Drug Administration
MEB Mebendazole
Mf Microfilariae
MMDP Morbidity Management and Disability Prevention
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MOH Ministry of Health
MP Member of Parliament
NMS National Medical Stores
NOCP National Onchocerciasis Control Program
NTD Neglected Tropical Disease
NTDCP Neglected Tropical Disease Control Program
OV Onchocerciasis
PC Preventive Chemotherapy
PCR Polymerase Chain Reaction
PDC Parish Development Committee
PELF Program to Eliminate Lymphatic Filariasis
PTS Post-Treatment Surveillance
PM Program manager
PZQ Praziquantel
RDC Resident District Commissioner
RPRG Regional Program Review Group
SAC School-Aged Children
SAE Serious Adverse Event
SAFE Surgery, Antibiotics, Facial cleanliness, Environmental improvements
SAR Semi Annual Report
SAS Senior Assistant Secretary
SCH Schistosomiasis
SCI Schistosomiasis Control Initiative (Imperial College London, UK)
STH Soil-Transmitted Helminths
STTA Short-Term Technical Assistance
TA Technical Assistance
TAF Technical Assistance Facility
TAS Transmission Assessment Survey
TEO Tetracycline Eye Ointment
TF Trachomatous Inflammation - Follicular
TIS Trachoma Impact Survey
TOT Training of Trainers
Trust Queen Elizabeth Diamond Jubilee Trust
TSS Trachoma Surveillance Survey
TT Trachomatous Trichiasis
UNICEF United Nations Children’s Fund
UOEEAC Uganda Onchocerciasis Elimination Expert Advisory Committee
USAID United States Agency for International Development
VCD Vector Control Division (MOH)
VHT Village Health Team
WASH Water, Sanitation, and Hygiene
WHO World Health Organization
WVU World Vision Uganda
ZTH Zithromax®
ENVISION FY18 PY7 Uganda Work Plan
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COUNTRY OVERVIEW
1) General Country Background
a) Administrative Structure
Uganda is divided into four administrative regions: Central, Western, Eastern, and Northern. These four
regions are in turn divided into districts, subcounties, parishes, and villages. In September 2015, an act
of parliament created 23 new districts to be phased in over three years, increasing the number to 116 in
2016, 122 in 2017, and 128 in 2018.
Districts are sometimes loosely grouped into one of 11 sub-regions based on names given during the
colonial period: Buganda, Busoga, Bukedi, Teso, Karamoja, Lango, Acholi, West Nile, Bunyoro, Ankole,
and Kigezi (see Ugandan regional and district maps, Figure 1). For example, Karamoja sub-region is
comprised of eight districts. Sub-regions are not active administrative or political units, although they
approximately demarcate ethnic groups and are used to refer to key targeted areas and populations for
disease control activities, such as targeting specific information, education, and communication (IEC)
materials.
Figure 1: Uganda regional and district maps
Regions of Uganda Districts of Uganda
District administration
Uganda has a decentralized administrative system with some powers devolved to the district and lower-
level local governments. The Ugandan Ministry of Health (MOH), including the neglected tropical
disease (NTD) program, conducts its activities along the same political and civil service administrative
structures found in districts, as outlined below.
Each district has an elected political head, known as the Local Council (LC) 5 chairperson, who presides
over a council of elected subcounty representatives. The LC5 chairperson selects ministers or secretaries
from the council who are responsible for specific portfolios: for example, the Secretary for Health is the
ENVISION FY18 PY7 Uganda Work Plan
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district equivalent of the national-level Minister of Health. Other district-level leaders include the Chief
Administrative Officer (CAO)—a civil servant who is the district accounting officer and who has overall
oversight of the district civil service in the district. The Resident District Commissioner (RDC) represents
the Office of the President in the district and is responsible for the supervision of implementation of all
government programs as well as coordinating security matters. The district local government
headquarters are normally located in the biggest town or municipal council (urban center). Town and
municipal councils have their own structures similar to those of the district local administrations. In
FY18, ENVISION will support mass drug administration (MDA) and related activities in 26 districts.
County and subcounty administration
Districts used to be divided into counties; these have now been replaced by political constituencies and
are administratively non-functional save for the creation of health sub districts (HSDs), which operate at
the level of the former counties. Currently, the functional administrative unit in the local government
system is the subcounty. The subcounty is headed by a Senior Assistant Secretary (SAS), formerly titled
supcountry chief, a civil servant reporting directly to the CAO. Also at the subcounty level are LC3
chairpersons and councilors who are elected representatives. The LC3 chairperson is the political head
of the subcounty and chairs the subcounty council, while the SAS is the representative of the CAO at
that level and is responsible for the supervision of civil servants and ensuring government programs are
implemented. The LC3 chairperson and the SAS work together in program planning and implementation
at the subcounty level. In FY18, ENVISION will support MDA and related activities in 245 subcounties.
Parish and village administration
Subcounties are divided into parishes, each headed by a parish chief—a civil servant—and an LC2
chairperson—an elected political leader. Each parish has a parish development committee (PDC),
responsible for identifying priority development issues and challenges. The lowest administrative unit in
Uganda is the village, known as LC1. Some large or densely populated LC1s are subdivided into cells,
especially in urban areas. The LC1 is headed by a chairperson and assisted by an executive. At each
council level from district (LC5) to village, (LC1), women representatives are part of the configuration. In
FY18, ENVISION will support MDA and related activities in 1,171 parishes and 10,980 villages.
b) Other NTD Partners
The MOH’s NTD Control Program (NTDCP) is led by an Assistant Commissioner, Health Services who is
assisted by disease specific program managers, senior program staff, scientists, technologists/
technicians, and other support staff. For better coordination of the program, a secretariat, comprising of
all NTD partners was established and is chaired by the Assistant Commissioner assisted by program
managers (PMs). The NTDCP manages and coordinates activities against five preventive chemotherapy
(PC) NTDs (trachoma, lymphatic filariasis [LF], onchocerciasis [OV], schistosomiasis [SCH], and soil-
transmitted helminthiases [STH]), as well as the Innovative and Intensified Disease Management (IDM)
Case Management NTDs.1 The MOH sets the country’s NTD policies, includes NTDs in its annual
statement and budget to parliament, and provides an enabling environment for NTD-related program
implementation and research.
1 Including human African trypanosomiasis (HAT), leishmaniasis, jiggers, Buruli ulcer, cysticercosis, tungiasis, rabies, leprocy,
plague, and Guinea worm (which has been eliminated from Uganda). National programs for HAT, leishmaniasis, and
cysticercosis are based at the MOH Vector Control Division; the program for plague is based at Uganda Virus Research Institute
in Entebbe; and Buruli ulcer disease and jigger control are based at the MOH headquarters.
ENVISION FY18 PY7 Uganda Work Plan
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The MOH Top Management Committee, chaired by the Director General of Health Services (DGHS),
serves as the steering committee for the entire MOH. The NTD Technical Committee (described further
in the Strategic Planning section) is also part of the MOH Top Management Committee. The MOH Top
Management Committee, through the DGHS and the Minister of Health, the State Minister for Health–
General Duties, and the State Minister for Health–Primary Health Care, conducts program-specific high-
level advocacy on behalf of the NTDCP; for example, during visits with representatives of parliament and
meetings with visiting partner delegations (e.g., US Agency for International Development [USAID], RTI
leadership, Pfizer, UK Department for International Development [DFID]) etc.
The disease-specific programs are managed by trained and experienced MOH staff, comprising program
managers, scientists, technicians, and support staff. The MOH pays salaries, provides office and
laboratory space and contributes to the procurement of laboratory equipment. At other levels of the
health system, the MOH and district local governments recruit and provide salaries for NTD
administrative and technical staff.
Clearing, handling, and transportation of NTD drugs and supplies from the port of entry to districts and
lower-level health units is handled by the National Medical Stores (NMS) through an agreement with
MOH and the National Treasury. On occasion, ENVISION hires vehicles to transport drugs to districts
when the NMS delivery schedule is not in alignment with the MDA schedule.
The major donors supporting the NTDCP are USAID, the World Health Organization (WHO), DFID, and
the Queen Elizabeth Diamond Jubilee Trust (TheTrust). Implementing partners include RTI International,
The Carter Center, Sightsavers (UK), Schistosomiasis Control Initiative (SCI, Imperial College London, UK),
and Christian Blindness Mission (CBM) International (Germany). The NTDCP has additional partners
working on water, sanitation, and hygiene (WASH) activities, many of which overlap with the trachoma
program in particular (see details in Table 1).
The Carter Center supports OV elimination activities in 21 districts (including 3 districts co-supported by
Sightsavers) with funding from USAID through ENVISION and from private sources. These activities
include MDA; targeted vector control where there is ongoing transmission; post-treatment surveillance
(PTS) where transmission has been interrupted; and knowledge, attitudes, and practices (KAP) studies in
districts where three years of PTS have been completed. The Carter Center also supports OV-related
cross-border activities between Uganda and the Democratic Republic of Congo (DRC) and South Sudan,
including activities in each of those two other countries. It is important to note that ENVISION activities
proposed by The Carter Center for FY18 are also partially funded by its other donors and are not
exclusively funded by USAID.
The Carter Center also supports the national molecular laboratory, where essential tests are performed
to verify interruption of river blindness transmission, through a collaboration with the University of
South Florida (Professor Tom Unnasch), and the Uganda Onchocerciasis Elimination Expert Advisory
Committee (UOEEAC). The UOEEAC provides technical oversight of the national OV elimination program
and guidance to the MOH.
The Trust provides financial support for the implementation of the Surgery (S), Facial cleanliness (F), and
Environmental improvements (E) components of the Surgery, Antibiotics, Facial Cleanliness, and
Environmental improvement (SAFE) strategy. The Trust’s focus is particularly on surgery, with some
complementary support for the F and E components. In Uganda, The Carter Center administers Trust
funds and manages planning and coordination; Sightsavers and CBM serve as Trust implementing
partners.
Significant Trust-supported activities include conducting Trachomatous trichiasis (TT)-only surveys
especially in districts that recorded a disparity in the TT backlog reported in earlier surveys; and large-
ENVISION FY18 PY7 Uganda Work Plan
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scale TT surgery camps in 17 eastern districts, including all districts of Busoga and Karamoja sub-regions.
Some districts have now reached the ultimate intervention goals for trachomatous inflammation–
follicular (TF) and TT—required for elimination of trachoma. In 2017, the Trust extended these activities
to the rest of the trachoma-endemic districts in Northern, Western, and West Nile regions, reaching 31
districts.
The Trust also supports small-scale facial cleanliness and environmental improvement initiatives through
its WASH partners: Water Mission Uganda, WaterAid Uganda, Busoga Trust, Concern, World Vision, and
Welthungerhilfe. The John Hopkins School of Public Health’s Center for Communication Programs (CCP)
signed an agreement with The Carter Center and The Trust to provide them with strategic
communication technical support. CCP is finalizing a set of updated integrated IEC/behavior change
communication (BCC) materials, following a review of the existing IEC materials and communication
strategy shared with them by RTI.
CBM was one of The Trust’s two implementing partners for TT surgeries in five districts in eastern
Uganda: Napak and Nakapiripirit in Karamoja sub-region, and Bugiri, Namayingo, and Namutumba in
Busoga sub-region. However, CBM ended its TT surgical activities in Uganda and closed its field offices in
April 2017 after Uganda achieved its ultimate intervention goal for TT in these districts.
Sightsavers has long been a partner for trachoma and eye disease control. In 2006, it supported the first
trachoma baseline surveys in eastern Uganda and has for many years supported eye care services
through specialized clinics throughout the country. Sightsavers is The Trust’s other implementing
partner for TT surgeries, supporting these in 17 districts, and in June 2017 expanding the program to 14
more districts in northern and the eastern parts of the country. During fiscal year 2018 (FY18),
Sightsavers will be implementing Trust supported activities in 17 districts: Lira, Kitgum, Yumbe, Koboko,
Maracha, Arua, Nebbi, Zombo, Adjumani, Moyo, Lamwo, Gulu, Omoro, Amuru, Nwoya, Oyam, and
Pader.
Sightsavers also supports OV control/elimination in eastern Uganda, including MDA in Masindi, Buliisa,
Hoima, and Kibaale, and PTS activities in Hoima and Kibaale. Of these, ENVISION supports only Buliisa,
for SCH and/or trachoma MDA. Sightsavers will continue supporting vector control in Pader, Kitgum, and
Lamwo districts.
In FY18, Sightsavers will support the NTDCP’s LF Program by conducting a KAP study in 3 districts (Lira,
Kitgum, and Yumbe); rapid assessments of the burden of chronic manifestations of LF; and support
Morbidity Management and Disability Prevention (MMDP) activities in districts co-endemic for OV,
through hydrocelectomies and lympheodema management in 16 districts in Acholi, West Nile, and parts
of Lango sub-region..
SCI/DFID: DFID has supported SCH and STH control in Uganda since 2003 through SCI (Imperial College
London, UK), focusing on MDA, disease re-assessments, and operational research. Prior to FY16, SCI
supported MDA and assessments in districts with low SCH endemicity (prevalence of 1%–10%). In FY16,
RTI transferred STH support activities for a number of districts to SCI, with the agreement of the MOH.
In FY17, ENVISION transferred NTDCP support activities for an additional 26 districts that are endemic
for SCH/STH only to SCI. This arrangement enables SCI to support districts that are endemic for SCH and
STH only, and ENVISION to support districts that require integrated treatment.
For its operational research component, SCI collaborates with institutions supported by the European
Union, Wellcome Trust, Medical Research Council (UK), The Royal Society (UK), and Kenya Medical
Research Institute.
ENVISION FY18 PY7 Uganda Work Plan
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WASH partners
• Water-Aid Uganda supports small-scale sanitation programs in selected subcounties and parishes in
Busoga and Karamoja sub-regions.
• Water Mission is conducting a three-year program (2016–2018) in all 10 districts (88 subcounties,
587 parishes of Busoga sub-region) in the east. The focus is improved community sanitation by
training district and subcounty leaders, teachers, religious leaders, and parish and community F and
E ambassadors of change. Participants are trained on the causes, transmission, control, and
prevention of trachoma. Water Mission also supports water harvesting for domestic use and
establishing community water points (taps) in subcounties in the districts of Buyende and
Namayingo.
• Busoga Trust supports water supply and sanitation programs in Busoga sub-region. It is managed by
the Church of Uganda.
• John Hopkins University-CCP researches communication barriers and designs appropriate IEC and
BCC materials to eliminate trachoma and control SCH. In FY17, CCP partnered with MOH, ENVISION,
and other partners to review and update IEC materials, which will be rolled out in FY18. CCP does
not have a budget to print IEC materials; therefore, ENVISION will provide that support.
• United Nations Children’s Fund (UNICEF) is one of Uganda’s key WASH partners, funding related
programs in schools and working closely with the MOH’s Health Promotion and Education Division
(HPED) and Environmental Health.
• Concern strengthens coordination and delivery of trachoma- and WASH-related messages to
promote hygiene and trachoma awareness. It also updates and prints health education materials
for the Mother Care Groups.
• World Vision Uganda (WVU) encourages schools to have WASH clubs, spurs villages to adopt
community-led total sanitation (CLTS), and promotes WASH coordination meetings in 3 districts.
WVU also trains hygiene promoters, Mother Care Group Lead Mothers, teachers, and others to
promote hygiene and increase awareness of trachoma. WVU provides health education materials
and holds community meetings/dialogues and video shows, among other media activities.
• Water-Aid Uganda installs water points in schools, trains hygiene promoters and others on
trachoma/WASH, builds latrines and handwashing facilities, and spurs villages to adopt CLTS. It also
updates materials to promote key behaviors to encourage the prevention and treatment of
trachoma.
• WHO Country Office: Globally, WHO sets the guidelines for the control and elimination of NTDs and
coordinates NTD drug donations, including albendazole (ALB) for LF and STH, mebendazole (MEB)
for STH, praziquantel (PZQ) for SCH, and ivermectin (IVM) for LF and OV. In Uganda, the WHO
Country Office participates in the NTD Technical Committee and in NTD Secretariat meetings. From
2005–2015, WHO funded a study, conducted by the MOH Vector Control Division (VCD), to assess
the impact of STH deworming in 10 districts in five regions (Karamoja, Eastern, Central, Western,
and West Nile). The districts were selected based on favorable STH transmission conditions (SCH
was not targeted, but since the diagnostic method is the same, it was also reported). The WHO
Country Office also helps the NTDCP to procure diagnostics of the proper type and quality
standards. WHO Uganda also provides technical assistance during preparation of joint applications
for donated NTD drugs, and through the Regional Program Review Group (RPRG), where it advises
ENVISION FY18 PY7 Uganda Work Plan
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the NTDCP on implementation units to undertake transmission assessment surveys (TAS) or to stop
MDA for LF.
• Malaria Consortium Uganda is piloting podoconiosis case detection and management in Kibaale,
Kyenjojo, and Kamwenge districts, with activities that include training health workers, supportive
supervision, and community awareness-raising through mass media and production of IEC and
training materials, expected to continue into 2018. The Consortium has shown interest in supporting
MMDP activities for LF; however, no formal commitment has been made.
• Footworks conducted health worker training for podoconiosis case management in October 2015 in
Kamwenge, Kabarole, Kibaale, Ibanda (western Uganda), Kween, and Manafwa districts (eastern
Uganda). It is hoped that Footworks will extend similar support to other highly- affected districts
such as Nakapiripirit and Napak in eastern Uganda, which are co-endemic for podoconiosis and LF.
Table 1: Non-ENVISION NTD partners working in country, donor support, and summarized
activities
Partner Location Activities
List other donors
supporting these
partners/activities
The Carter Center 21 OV-endemic districts • Capacity building, planning,
support to MOH and districts for
OV MDA; vector
control/elimination;
entomological surveillance; OV
impact assessments; post-PTS
and KAP studies
• Lead agency for technical
assistance (TA) and funds
management for TT surgeries
and WASH activities for The Trust
• TT surgeries in trachoma-
endemic districts of northern and
western Uganda, beginning in
April 2017
The Trust
CBM Northern and Eastern
Uganda
CBM was an implementing partner
for TT surgery and trachoma-
related field surveys up to April
2017 when it closed its field offices
in Uganda
The Trust
Sightsavers a) Busoga sub-region in
Eastern Uganda (7
districts),
Karamoja sub-region in
Eastern Region (5
districts)
b) Bunyoro-Western (4
districts)
c) Northern Region in 4
districts
a) Technical and financial
assistance to NTDCP and district
local governments for strategic
planning, capacity building,
equipment for TT surgeries and eye
care; logistics, motorcycles, mobile
sound systems for IEC campaigns in
Karamoja sub-region where radio
services are not well developed
b) OV control and elimination
activities in 3 districts (MDA and
Simulium vector control)
c) Simulium vector control,
involving dosing of rivers with
The Trust; Standard Chartered
Bank (Uganda); Standard
Chartered Bank; DFID
ENVISION FY18 PY7 Uganda Work Plan
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Partner Location Activities
List other donors
supporting these
partners/activities
d) Northern Uganda in 4
districts
Abate (an organophosphate)
d) MMDP activities – rapid
assessment of magnitude;
lymphedema management and
hydrocelectomies in 4 districts
SCI Central Region (districts
along the shores of Lake
Victoria and Victoria Nile
and island districts
within the Lake) and
Western Uganda
TA, capacity-building, operational
research, MDA and reassessments
of prevalence, intensity and
morbidity in SCH endemicity
districts
DFID
Trachoma WASH
partners (Water
Mission, WaterAid,
Busoga Trust,
AVSI/Italian
Cooperation, World
Vision, and John
Hopkins University
Busoga and Karamoja
regions
Financial and technical support for
trachoma-related WASH activities
and BCC
The Trust
WHO Country Office In all NTD-endemic
districts with active PC-
NTD programs
At country level, provides technical
support, coordination of capacity
building/trainings, and assessment
of interventions on STH infections
WHO Uganda, African Regional
Office, and Geneva
headquarters
Lions Club Uganda Central level Advocacy at national and district
levels
Acts as a conduit for funds to
support trachoma implementation
activities
Lions Club International
Environmental Health
Division, MOH
All regions Guidelines on sanitation;
handwashing programs in schools;
latrine coverage surveys in
districts; M&E
WHO, Danida, DFID, German
International Cooperation,
Italian Cooperation, others
Ministry of Education’s
School Health
Department
All regions Deworming, sanitation, and WASH
activities in schools
Training of teachers in charge of
pupils’ health and sanitation
Policy formulation, coordination,
advocacy, training, and M&E
UNICEF
2) National NTD Program Overview
USAID support for Uganda’s NTDCP began in 2007, and is one of the Agency’s longest-standing NTD
country program commitments. Support initially focused on the completion of mapping, the integration
of four vertical PC-NTD programs (trachoma, LF, OV, SCH), and the scale-up of MDA to all eligible
districts. Support is now focused on maintaining good MDA coverage, reaching the 2020 elimination
goals, and developing strong, sustainable disease control programs.
In all NTD-endemic districts, including those supported by USAID, the NTD Secretariat works with
districts to coordinate the range of activities necessary for MDA including but not limited to logistics
ENVISION FY18 PY7 Uganda Work Plan
15
management, MDA implementation, social mobilization, and supervision. The NTDCP also conducts
extensive national- and district-level capacity building, including training.
a) Lymphatic Filariasis
In Uganda, LF is transmitted by the common malaria mosquitoes Anopheles gambiae and An. funestus;
the Culex mosquito is also prevalent in urban areas. Baseline epidemiological studies and rapid mapping
of LF started in 1998, using a combination of chronic clinical manifestations, circulating filarial antigen
(CFA), and night blood smears to detect microfilariae (Mf). LF was found to be highly endemic in parts of
northern and eastern Uganda, with prevalence higher than 30% in some areas. The most common
clinical manifestation was hydrocele, followed by elephantiasis. Rapid mapping using CFA in school-age
children (SAC) and adults was conducted nationwide from 2000 to 2002, demonstrating wide LF
distribution, with highly endemic areas in northern and eastern Uganda, north of the central lakes
(Kyoga and Kwania). A small focus was found in Bundibugyo and Ntoroko Districts in the west along the
DRC border, where the disease is associated with An. bwambae (of the An. gambiae species complex)
which breeds in the hot sulfur springs.
The Program to Eliminate Lymphatic Filariasis (PELF) is part of the VCD of the MOH. The national NTD
plan aims to eliminate LF by 2020 through a multi-pronged approach that includes:
• Annual MDA with IVM and ALB in all endemic districts
• MMDP to reduce the burden of LF chronic manifestations in affected populations
• Promotion of other interventions that have an impact on LF, such as long-lasting insecticide-treated
nets (LLINs) and indoor residual spraying (IRS)
PELF first conducted MDA for LF in 2002 in Lira and Katakwi districts (which have now split into 7
districts), treating more than a million people. Treatment was extended to 5, then 12 districts, with
support from WHO and the Liverpool LF Support Centre. This support was for a single round of
treatment, as partners were uncomfortable with the country’s political situation. The civil war and
insurgency that escalated in northern and eastern Uganda in 2003 interrupted treatment in that year
and again in 2006.
With the support of USAID, nationwide LF mapping was conducted in early 2010, and MDA scaled up to
100% geographical coverage by the end of the same year. Since the commencement of USAID support,
LF-endemic districts have conducted five or six rounds of MDA, although some rounds may not have not
achieved sufficient 65% epidemiological coverage in all districts. TAS conducted through FY15 indicated
that LF transmission has been interrupted in 35 districts. This equates to approximately 8.4 million
people freed from the risk of infection. An additional 8 districts passed TAS in FY16. The MOH has
submitted a request to the WHO Regional Office for Africa (AFRO) RPRG to approve these districts to
stop MDA. It should be noted that RPRG approval is not formally required to stop treatment following a
successful TAS; henceforth, NTDCP will not wait for RPRG approval following successful TAS.
In FY17, 5 further districts conducted TAS leaving 9 districts with a population of 2.5 million people still
requiring MDA. This includes Omoro, which is newly created through re-districting. In FY18, 3 districts
will conduct TAS-1 and 17 districts will conduct TAS-2, leaving only 7 districts requiring MDA (includes
Terego district which is expected to split from Arua in 2018). The country is on track to achieve
interruption of LF transmission by 2020.
The seven districts still requiring treatment include some of the most difficult populations to reach, and
there is a need for an improvement in MDA drug coverage in these areas. The most heavily affected
ENVISION FY18 PY7 Uganda Work Plan
16
districts are in the Northern Region where, historically, the chronic manifestations of LF (hydrocele and
elephantiasis) have also been most common. This includes Gulu District, which requires an enhanced
MDA strategy to reach populations in urban settings.
Morbidity management is the second pillar of the LF elimination strategy, with related activities
supported by Sightsavers in the northern districts of Amuru, Lamwo, Pader, and Kitgum. This support
focuses on the rapid assessment of the morbidity burden, with subsequent lymphedema management
and hydrocelectomies conducted in some health facilities. In FY17, a KAP study to inform IEC materials
on morbidity management was conducted in four districts co-endemic for LF and OV. The materials will
be used for community education to increase health-seeking behaviors among people with LF morbidity.
Vector control interventions such as the use of IRS and LLINs are led by the MOH’s Malaria Control
Program and are likely to indirectly contribute to LF elimination. The MOH conducts IRS in malaria
hyper-endemic districts in the north and east where LF is co-endemic. The MOH has distributed LLINs in
all of the country’s districts. If these initiatives are sustained, they will have the ancillary benefit of
helping to reduce residual transmission of LF.
b) Trachoma
Baseline epidemiological mapping of trachoma using WHO-approved methods and supported by
Sightsavers started in 2006. The surveys covered 2 districts in Karamoja sub-region and 4 districts in
Busoga sub-region. Trachoma was found to be highly endemic in all districts surveyed, with TF rates in
children ranging from 30% to 65%. Mapping of the rest of the country commenced when the NTDCP was
established in 2007, starting with priority regions in northern and eastern Uganda. By 2011, 51 districts
originally suspected of being endemic for trachoma had been mapped, reporting TF prevalence >5%
(ranging up to 67%) in 44 districts, and TF <5% in 7 districts. In 2014, ENVISION provided technical and
financial support for a desk review of 8 districts neighboring known trachoma-endemic districts that
analyzed eye clinic and health management and information system (HMIS) records for reported eye
infections and morbidity including TF, TT, and evidence of corneal scarring. The review showed just 1
district (Pallisa) with evidence of significant active trachoma; the district subsequently registered TF of
5%–9.9% when mapped.
The WHO SAFE strategy for trachoma elimination guides NTDCP trachoma activities. The first MDA with
Zithromax® (ZTH) and tetracycline eye ointment (TEO) commenced in eastern Uganda in 2007, with
scale-up to 100% geographic coverage by 2013, thanks to support from USAID through ENVISION. The
NTDCP conducted MDA in 36 endemic districts (38 following redistricting) based on baseline TF
prevalence and impact survey results: at least one round with sufficient coverage in districts with
prevalence of 5%–9.9%, three rounds in districts with prevalence of 10%–29.9%, and at least five rounds
in districts with TF of ≥30%. In FY18, the NTDCP will conduct MDA in 3 districts (increased from 2
following redistricting) in Karamoja sub-region, with ENVISION support.
As of June 2017, the NTDCP is still conducting the trachoma impact surveys (TIS) and surveillance
surveys in 19 districts scheduled for FY17. The preliminary results indicate that Amudat and Kabong
require one more round of MDA, which will occur in October 2017 and be reported in the FY17
workbooks. In FY18, TIS will be conducted in Amudat and Kabong while trachoma surveillance surveys
(TSS) will be carried out in 13 districts (18 evaluation units [EU]).
The MOH has implemented TT surgeries in the highly endemic Busoga sub-region in Eastern Uganda
with support from Sightsavers and CBM through The Trust.
ENVISION FY18 PY7 Uganda Work Plan
17
c) Onchocerciasis
OV, caused by the filarial worm Onchocerca volvulus, was originally endemic in 37 of the country’s then
112 districts. An estimated 2 million people are infected, and nearly 3 million people are at risk of
infection. These numbers are under review by the NTD Secretariat following successful cessation of
MDA in many foci, and may consequently be reduced. As of June 2017, 20 districts have been able to
stop MDA, with treatment continuing in only 21 districts.
OV mapping and vector surveys began in the 1940s, and large-scale OV control started in the 1950s
focused on the Victoria Nile and consisting of intermittent treatment of the River Nile with low doses of
dichlorodiphenyltrichloroethane (DDT), a chlorinated hydrocarbon insecticide. This larviciding resulted
in elimination of the S. damnosum sl vector in that focus in 1974. From 1992 to 2007, the MOH started
implementation of annual MDA with IVM.
USAID support for OV control and elimination began in 2007, when the MOH’s National Onchocerciasis
Control Program (NOCP) launched a two-pronged control and elimination strategy, as recommended by
WHO and African Program for Onchocerciasis Control. The strategy entails: (1) MDA once or twice per
year in all endemic foci, using IVM alone or in combination with ALB in areas co-endemic for LF; and (2)
vector control/elimination campaigns in all isolated foci and in some semi-isolated foci where
control/elimination was deemed feasible by the NOCP. Areas targeted for OV control conduct treatment
annually, whereas areas targeted for OV elimination conducted treatments twice per year.
Since 2007, MDA has been halted in 18 districts (10 foci) and is continuing in 21 districts in the 9
remaining foci. ENVISION funds MDA twice per year in 21 districts (led by the NOCP with support from
The Carter Center and RTI)2 and once per year in 2 districts (Yumbe and Koboko) co-endemic for LF and
confirmed as not having OV transmission the NOCP
ENVISION also supports: (1) the training cascade; (2) mobilization and sensitization (health education);
(3) MDA registration or register updates; (4) epidemiologic assessments; (5) coverage validation; (6) IEC
materials; and (7) cross-border surveillance. MDA treatment and data validation take place twice a year,
and entomological assessments are conducted monthly. Other activities are implemented annually.
The NOCP implements vector monitoring and/or vector control alongside MDA in six of the nine
remaining foci with support from The Carter Center and other partners (non-USAID funds). Sightsavers
supports vector control in the Northern Region focus, where disease endemicity and transmission
historically have been high. The NOCP conducts river-dosing activities in some foci, using Abate
insecticide as a larvicide (supported by The Carter Center, with non-USAID funds).
Analyses of fly and blood samples from residents in endemic areas is undertaken at the VCD advanced
molecular biology laboratory. Post-treatment surveillance surveys to determine recrudescence potential
and infection with OV parasites are conducted through parasitological indicators (skin snips microscopy
for Mf and OV-16 enzyme-linked immunosorbent assay [ELISA] serology for parasites in blood) and
entomological indicators (polymerase chain reaction [PCR] analysis of black flies for infective larvae).
PTS surveys have been conducted in all foci where MDA has stopped, with no positive cases or signs of
recrudescence to date. Crab trapping forms part of the surveillance of vector elimination. The fresh
water crabs (Potamonautes spp) live in phoretic association with the larvae and pupae of flies of the
S. neavei complex. Crabs are examined for the larvae, pupae, and pupal cases, which attach to the body
2 ENVISION supports a second round of OV treatment integrated with LF or STH in all 21 districts; in 3 of those (Masindi, Buliisa,
and Hoima), Sightsavers also makes a partial contribution
ENVISION FY18 PY7 Uganda Work Plan
18
and limbs of the crabs. These are identified to species level using morphology, and then preserved. The
numbers caught are recorded to determine any changes in abundance and species composition. In some
foci, crabs have disappeared following dosing of rivers and deforestation. Human-landing catches are
also used to collect biting adult Simulium neavei sl and other fly species.
In FY18, ENVISION will continue to support monthly fly and crab captures where treatment is ongoing.
The MOH plans to continue these activities during the PTS period in selected foci; The Carter Center will
support river dosing with donated Abate with non-USAID funds.
The UOEEAC was formed in 2008 to advise the MOH on whether and when MDA can be stopped. The
UOEEAC is composed of Ugandan and international OV experts, and chaired by Prof. Tom Unnasch from
the University of South Florida. The UOEEAC’s annual meeting is financially supported by The Carter
Center and ENVISION. UOEEAC responsibilities are to:
• Review program activity reports annually from each elimination-targeted focus
• Advise the MOH on focus-specific monitoring and evaluation (M&E) activities and recommend
halting treatment when appropriate, in accordance with international and national guidelines
• Make any other recommendations to the MOH on activities needed to reach the national 2020 OV
elimination goal. (Please see Appendix 9 for the August 2017 version of the UOEEAC’s OV “flag.”)
d) Schistosomiasis
SCH, caused by Schistosoma mansoni for intestinal SCH and S. haematobium for urogenital SCH, is
endemic in 87 districts. S. mansoni is widespread, occurring in all 87 districts, while S. haematobium is
now confined to a few northern districts. In Uganda, SCH is associated with large water bodies;
permanent and semi-permanent rivers, streams, and reservoirs constructed for watering animals; and
irrigation schemes.
In high-risk (≥50% prevalence) areas, the NTDCP follows WHO guidance in treating school aged children
(SAC) and high-risk adults annually. In moderate risk areas (≥10%–<50% prevalence) SAC are treated
annually, and once every two years in low-risk (≥1%–<10% prevalence) areas, as compared to the WHO
recommended minimum of once every two years and twice during primary school ages, respectively.
The NTDCP often conducts MDA for SCH at the sub district level, resulting in more than one treatment
strategy in any given district. The NTDCP conducts SCH prevalence evaluation surveys once districts
complete their fifth or sixth round of SCH MDA and aims to adjust the district treatment strategy
depending on the findings. The surveys are based on the lot quality assurance sampling method and use
the Kato-Katz diagnostic technique. One such assessment is planned for FY17 and results will inform
FY18 treatment strategy.
Approximately 5.4 million people are infected with SCH, and 10.9 million are at risk. Of the 93 endemic
districts, 37 are considered high risk, 13 moderate risk, and 43 low risk. Reinfection rates remain high in
some districts in the Albertine Rift valley (Nebbi, Buliisa, Hoima, Ntoroko) and in the east (Namayingo
and Mayuge), with concern that infection is not falling even after several rounds of annual treatment.
Human behavior, cultural practices, poor sanitation, cross border movements in search of fish and
snails, susceptible snail hosts, and perennial transmission help maintain high SCH endemicity. Recent
studies by VCD and Medical Research Council demonstrated that in a cohort of treated school children,
almost 80% were re-infected and shedding S. mansoni eggs three weeks later. Also, up to 50% of
children under five years who are not treated through MDA for lack of pediatric formulation were
infected. Intensified efforts and operational research have been called for by the NTD Technical
Committee, national and regional meetings, and the recent joint NTDCP-SCI SCH workshop.
ENVISION FY18 PY7 Uganda Work Plan
19
ENVISION support for SCH MDA varies by year due to the cyclical treatment schedule recommended by
WHO. ENVISION supported treatment in 32 districts in FY16, and 14 districts in FY17. In FY18, ENVISION
will support treatment in only 16 districts after transferring support for a further 26 to SCI, as discussed
with the MOH. These 26 districts were previously endemic for LF and/or trachoma and/or OV, but have
successfully passed stop-MDA surveys for these diseases. ENVISION SCH support in FY18 is, therefore,
only for districts that are co-endemic for SCH and other NTDs.
ENVISION provides financial and technical support for social mobilization activities to improve PZQ
uptake, such as community dialogue on SCH prevention practices. Major landing sites are used as
locations for discussion with community members that involve Beach Management Units3 and local
leaders. In FY18, ENVISION will continue to support these activities by providing disease-specific
assessment (DSA) for district political leaders to mobilize people for MDA and supervise MDA activities,
especially in densely populated landing sites.
e) Soil-Transmitted Helminthiasis
STH is endemic in all 128 districts. Baseline surveys showed that hookworm is relatively homogenously
distributed in the country, exceeding 60% mean prevalence in SAC. Infections with A. lumbricoides and
T. trichiura are concentrated in the southwest, where prevalence can be as high as 100%. Infections with
T. trichiura have historically been lighter, but there is some evidence of infections spreading to central
Uganda due to migration, as evidenced from recent SCH/STH re-assessment surveys.
The MOH conducts twice-yearly deworming of children aged 1–15 years across the entire country, in
April and October, during Child Health Days (which includes treatment in schools). This is coordinated by
the Child Health Division and jointly funded by the MOH’s primary health care funds and UNICEF. In
districts co-endemic for LF and STH, the MDA is integrated, so children take a combination of IVM+ALB
(or ALB alone for under-fives) during the first round of treatment and ALB alone in the second round.
The NTDCP LF program, funded by ENVISION, has contributed to control of STH.
ENVISION-supported MDA aligns with Child Health Days, thus coordinating the two programs. In districts
co-endemic for LF, the ALB required for STH is provided by PELF MDA. In cases where LF funds and/or
drugs are delayed, districts generally postpone their Child Health Days while awaiting LF MDA resources.
3 Management units of landing sites/marinas, elected by residents to implement regulation of fishing, health, and security
ENVISION FY18 PY7 Uganda Work Plan
20
3) Snapshot of NTD Status in Uganda
Table 2: Snapshot of the expected status of the NTD program in Uganda as of September 30,
20174
Columns C+D+E=B for each
disease* Columns F+G+H=C for each disease
MAPPING GAP
DETERMINATION MDA GAP DETERMINATION
MDA
ACHIEVEMEN
T
DSA NEEDS
A B C D E F G H I
Disease
Total
no. of
districts
in
Uganda
No. of
districts
classified
as
endemic
No. of
districts
classifie
d as
non-
endemic
No. of
districts
in need
of initial
mapping
No. of
districts
receiving
MDA
as of
09/30/17
No. of districts
expected to be
in need of MDA
at any level:
MDA not yet
started, or has
prematurely
stopped as of
09/30/17
Expected no.
of districts
where criteria
for stopping
district-level
MDA have
been met as of
09/30/17
No. of
districts
requiring DSA
as of
09/30/17 USAID
Fun-
ded
Others
Lymphatic
Filariasis
128
61 67 0 9 0 0 52
TAS1: 3
TAS2: 17
TAS3: 0
Onchocerciasis 41 85 0 215 0 0 20 0
Schistosomiasis 93 35 0 16 77 0 0 0
Soil-transmitted
helminths 128 0 0 9 119 0 0 0
Trachoma 47 81 0 56 0 0 42 TIS:27
TSS:138
4 This represents the 2018 geography of 128 districts therefore Columns C+D+E do not equal B nor do Columns F+G+H equal C 5 Two districts, Yumbe and Koboko, are no longer treating for LF and OV. Also, Sightsavers partially supports one round of OV
MDA in three districts 6 We list 5 districts because Nakapiripirit will form Nabilatuk during FY18. 7 In FY17 two districts (Amudat and Kabong) conducted TIS that resulted in TF prevalence between 5-9.9%. Both districts are
conducting MDA in October 2017 and will conduct another TIS in FY18.. 8 There are 13 districts that will require a TSS in FY18, however, 5 of them have large populations requiring them to be split into
two. Therefore, there are 18 evaluation units requiring surveillance surveys.
ENVISION FY18 PY7 Uganda Work Plan
21
PLANNED ACTIVITIES
1) NTD Program Capacity Strengthening
In FY18, ENVISION will support capacity strengthening activities for the MOH NTD Secretariat as
described below. On a more routine basis, ENVISION’s capacity strengthening efforts are also embedded
within program activities .
Objective 1. Strengthen capacity for annual work planning and activity planning
Intervention 1: Train/orient the MOH NTDCP data manager on information systems and data
management systems: ENVISION will support the NTDCP’s data manager to take a three-week training
on information systems and database management at the Uganda Management Institute, in March
2018. This activity was planned for FY17; unfortunately, the data manager was not able to participate
due to a scheduling conflict with the coverage validation survey.
Intervention 2: Senior NTD staff training in program planning, management, financial management,
and evaluation: In FY18, ENVISION will support 10 senior MOH NTD staff to attend a two-week evening
course of program planning, management, financial management, and evaluation. The course will be
conducted at the Uganda Management Institute in Kampala. The MOH NTD Coordinator will provide
post-training monitoring for her team and check the extent to which acquired knowledge is being
utilized. The course will increase the participants’ knowledge and skills in problem analysis, M&E,
participatory approaches towards project planning and management, and procurement. It is expected
that providing this training will reduce the MOH’s reliance on RTI to plan NTD activities and improve on
the timely implementation of activities, all of which are important for program continuity.
Objective 2. Strengthen capacity to manage PC-NTD data and to use data for decision-making
Intervention 1: Training for senior NTDCP staff on the integrated NTD Database: NTDCP managers and
senior program staff were introduced to the NTD database during its development, but it is necessary to
keep training them in its use. This will help ensure they can access and extract data from the database
for programmatic decision making and to feed into the development of the LF and trachoma dossiers.
Costs include meals and refreshments.
Intervention 2: Trachoma Dossier Development: The Uganda MOH has formed a small technical
working group consisting of MOH and partner representative to develop the trachoma dossier. Instead
of using a consultant to drive this activity, RTI will support the MOH to lead this effort.
a) Monitoring Capacity Strengthening
The following indicators will be used to monitor and report on the activities described above:
Objective 1. Strengthen capacity for annual work planning and activity planning
• Timely planning and implementation of activities tracked through ENVISION’s quarterly budget
expenditure and forecast. Monthly reports and disease/program workbooks will also show timely
implementation of activities.
• Improved quality of reports and plans tracked through internal feedback from partners
ENVISION FY18 PY7 Uganda Work Plan
22
Objective 2. Strengthen capacity to manage PC-NTD data and to use data for decision making
• NTD data accessed by all relevant personnel
• NTD database completed, verified, and regularly updated
• Programmatic decisions based on data analyzed
• Trachoma dossier developed using data in NTD database
ENVISION FY18 PY7 Uganda Work Plan
23
2) Project Assistance
a) Strategic Planning
Activity 1: NTD Technical Committee meetings: The NTD Technical Committee, established in 2014,
provides guidance on NTD activity planning. ENVISION will support two 2-day quarterly meetings in
FY18. ENVISION will support committee members to provide technical oversight and monitoring of
activities in the field, particularly in ENVISION-supported districts. The Committee will also help guide
the transition from donor support to full government ownership. ENVISION will work with the
committee to guide the development of transition plans for districts that have stopped MDA for LF and
trachoma. Additionally, the Committee will continue using data from the Integrated NTD Database in its
discussions, and supports data use in programmatic decision making.
Activity 2: National planning and data review meeting: This meeting will address issues of data quality
and accuracy, and use this information to inform program planning and implementation. The first day
will focus on data review—specifically, the ongoing issue of data incompleteness—and how to use
district and sub district level data to inform program design. The district biostatisticians and planners
will review data processes. Days 2 and 3 will review the implementation of the FY17 recommendations,
and identify priority activities for FY19. Day 4 will focus on cross-border issues with the aim of
developing a harmonized operational plan for NTD control across national borders.
The meeting will be attended by DHOs and district NTD focal persons; NTD pprogram managers; NMS
representatives; and key partners and representatives of the National Technical Advisory Committee.
MOH representatives from DRC, South Sudan, and Kenya will be invited.
Activity 3: Regional planning and review workshop: ENVISION will support one meeting for districts still
receiving project support. This will be convened by the NTD Secretariat and involve the DHO, CAO, the
NTD focal pperson, and implementing partners. The meeting will review MDA coverage data and survey
results, discuss specific challenges and related solutions, and develop district-level plans and budgets for
FY18 including program sustainability approaches. An area of focus will be identifying and documenting
best practices to improve coverage. These work plans will inform the contents of ENVISION’s FY19 fixed
obligation grants (FOGs) to these districts. ENVISION staff will work closely with the NTD Secretariat to
jointly lead the meeting.
Activity 4: District microplanning and post-MDA feedback meetings: ENVISION will support a three-day
microplanning meeting in each of the 26 ENVISION-supported districts using the template developed in
FY17. Completed templates will be shared with the NTDCP and used by ENVISION for FOG preparation.
In order to promote ownership, the micro plan will be signed and submitted to the MOH and ENVISION
by the district CAO with a commitment note to file. Prior to these meetings, the NTD program managers
and RTI will conduct refresher training for central-level supervisors who will support district micro plan
development. Costs for this activity include per diem, meals, transport for the district and central teams,
venue rental, stationery, and coordination expenses. Additionally, each district will receive a copy of the
updated National NTD Master Plan, which will be printed by ENVISION.
Activity 5: SCH/STH transition planning (RTI): Uganda has made great progress in achieving the
elimination aims of trachoma, LF, and OV. Support for SCH and STH MDA implementation (the “control
diseases”) presently comes from three main sources: 1) USAID through funding of integrated MDA; 2)
SCI, which supports SCH/STH MDA in some parts of the country, and which in FY17 took on support for
SCH MDA from RTI in 26 districts no longer requiring integrated treatment; and 3) MOH’s Child Health
Division, with support from UNICEF, which conducts twice-yearly treatment against STH for children
ENVISION FY18 PY7 Uganda Work Plan
24
aged 1–15 years. In FY18, ENVISION will pilot the RTI SCH/STH transition plan developed in FY17. This
will help to plan for how SCH and STH control will continue in the future, including procurement of PZQ
for adults. This will be discussed with stakeholders (MOH, Ministry of Education, SCI) at the Uganda SCH
meeting to be held in late August 2017.
Activity 6: Uganda Onchocerciasis Elimination Expert Advisory Committee meeting : In FY18,
ENVISION will support a five-day UOEEAC meeting (August 2018), with an estimated 50 participants. On
Day 1 selected vector control officers will prepare and review presentations prior to the UOEEAC. Days
2, 3, and 4 will comprise a focused review of the progress of the NOCP, including the results of the April
2017 coverage validation survey, and epidemiological and entomological surveys carried out during
FY17. Committee rrecommendations will include a clear plan for whether to stop or continue IVM
treatment in specific foci. In line with WHO’s 2016 OV elimination guidance, the Ccommittee will
recommend post-treatment surveillance in areas that stop MDA. As a best practice, the reasons for
stopping treatment will be explained to communities, along with guidance to avoid recrudescence.
Participants will be provided with copies of the report from the previous meeting and will assess the
extent to which recommendations have been implemented. On Day 5, vector control officers will review
recommendations and plan surveillance activities.
Activity 7: National Stakeholder Meeting —River Blindness Program review meetings: ENVISION will
support The Carter Center’s facilitation of two biannual OV review meetings to share field experiences,
assess progress, discuss challenges, and plan the way forward. Participants will include 42 NTD focal
persons and assistants from the 21 districts receiving treatment for OV, central-level MOH officials
including the OV Program Manager, National NTD Coordinator, and partners. These meetings will be
conducted in January and June 2018.
b) NTD Secretariat
Activity 1: Operational and program supervision support for NTDCP (RTI): In FY18, ENVISION will
continue to provide financial support to maintain office equipment and vehicles (including replacing
vehicle tires and fuel and minor repairs) for the office of the National NTD Coordinator and the PELF,
Bilharzia and Worm Control Program, NOCP, data manager, health educator, and trachoma program
managers. Per diem for program officers conducting supervisory visits will also be covered.
Activity 2: NTD Secretariat coordination meetings (RTI): The NTD Secretariat has 17 officers from: MOH
NTD (PC and IDM) program; human African trypanosomiasis (HAT), leishmaniasis, rabies, and jiggers
programs; HPED; and representatives from RTI, SCI, Sightsavers, The Carter Center, the Technical
Advisory Committee, and WHO. The national NTD Coordinator, who is also the Assistant Commissioner
of Health Services, Vector Borne Diseases Control, chairs the Secretariat. The NTD Secretariat meets
quarterly and is responsible for the overall planning, implementation, and M&E of NTD programs, which
includes but is not limited to building capacity at central and district levels, reviewing resource
allocationso NTDs, and supporting and participating in the development of guidelines, manuals, and IEC
materials. In FY18, ENVISION will provide refreshments for two meetings.
a) Building Advocacy for a Sustainable National NTD Program
In FY17, ENVISION provided technical and financial support to finalize the NTD communication strategy.
Key staff attended a workshop to review existing documents and information from past surveys to
develop this strategy. In FY18, ENVISION will support a combination of activities at national, district, and
community levels to implement this strategy to help improve MDA coverage. The strategy identifies
critical advocacy issues to increase country ownership and resource allocation; key among them are
ENVISION FY18 PY7 Uganda Work Plan
25
increasing integration of NTD activities and budgets into district plans, strengthening enforcement of
existing by-laws promoting household and community sanitation, increasing communities’ access to
clean water, and increasing participation of community leaders in MDA activities.
In FY18, ENVISION support for advocacy will be as follows.
Activity 1: Breakfast meeting with members of parliament (MPs) from the 26 ENVISION-supported
districts: The political leaders (MPs) of ENVISION-supported districts will be targeted to inform them of
the status of NTDs in their districts, the challenges experienced in achieving acceptable treatment
coverage, and the need for NTDs to be included in national and district plans and budgets. MPs are
responsible for making decisions on national budget allocations and can influence decisions to integrate
NTDs into national and district plans, with sufficient funding from either government or partners.
ENVISION, working with the NTD Secretariat, will organize one breakfast meeting in Kampala with MPs
from these 26 districts.
Presentations on the NTD status in these districts will be made by the MOH. A district has an average of
three MPs, so 115 MPs will be invited to participate alongside representatives from WHO, The Carter
Center, Sightsavers, SCI, MOH, Ministry of Local Government, and Ministry of Education. Some members
of the national Technical Advisory Committee will participate in this meeting. Key outcomes will include:
(1) better understanding of the burden of NTDs among decision-makers; (2) an understanding of
government and partner achievements to date; and (3) explicit MP commitments, by signing a
declaration, to give voice in parliament to NTD priorities and to advocate for inclusion of the NTD
agenda in national and district plans and budgets.
Activity 2: Northern Uganda regional advocacy meeting: This meeting targets district political, civic, and
technical leaders including resident district commissioners, CAOs, DHOs, chief finance officers, assistant
DHOs, NTD focal persons, LC5 chairpersons, LC5 vice chairperson, secretaries for health, district
education officers, district inspectors of schools, district auditors, religious leaders, heads of health sub-
districts, district health educators and district planners/biostatisticians. In FY18, ENVISION will support
one regional meeting for the nine ENVISION-supported districts from northern Uganda. Topics to be
covered include timely release of FOG funds from district accounts to reduce MDA delays, and the
inclusion of NTDs in district budgets to foster sustainability. Other areas of discussion will include
improvement of data management, particularly data collection, analysis, and use for program
improvement.
Activity 3: District-level advocacy meetings: In FY17, these meetings provided an opportunity to review
district program performance and plan supportive supervision by district leaders. They also helped
identify local resources to support MDA, for example radio airtime for mobilization provided by the RDC.
In FY18, ENVISION will focus our support on the nine districts in northern Uganda where MDA coverage
has been a recurrent problem. ENVISION support will allow central-level NTDCP to conduct half-day
advocacy meetings in each district. It is expected that political, technical, and administrative district
staff, including the DHO, will provide opportunities for continued engagement to identify post-ENVISION
support for program activities..
Activity 4: News publications on NTDs: During FY17, ENVISION helped the NTD Secretariat establish
functional working relationships with the print and electronic media. This resulted in increased coverage
of NTDs in the daily newspapers with stories published weekly in the New Vision newspaper and on NBS
television. Journalists and reporters were provided with transport and per diem to travel to the field to
cover stories from the viewpoint of program beneficiaries and to interview district and community
leaders on program performance. In FY18, this partnership will be strengthened to ensure adequate
coverage of program activities, including reporting on areas that have stopped MDA to demonstrate
ENVISION FY18 PY7 Uganda Work Plan
26
that elimination is possible. To put in more effort for MDA, ENVISION will pay for field trips for
journalists and reporters to cover and document success stories as well as report on areas that still need
support from national and local leaders. ENVISION will document success stories and distribute them to
districts, media houses, partners and the USAID Mission office.
b) Mapping
As the Uganda NTD program approaches LF and trachoma elimination, now is the appropriate time to
ensure that all geographic areas have been adequately assessed for these NTDs. Following recent
discussions with WHO and partners, the NTDCP identified additional mapping needs before reaching
elimination. In FY18, ENVISION will support the following two mapping activities to ensure this is
completed.
Activity 1: Trachoma baseline assessments and surveys: There are 18 districts that share common
borders with trachoma-endemic districts. These districts have never been surveyed for trachoma, as
they were considered unlikely to harbor infection, and a previous desk review of some of the districts
focusing on hospital records indicated that they were not endemic. In FY18, ENVISION will support
trachoma rapid assessments (TRA) in suspected endemic districts to determine where full mapping
surveys should be conducted. TRA will be performed in all suspected 18 districts. For budgeting
purposes, we estimate that 10 of these districts will require full surveys
Activity 2: LF and trachoma mapping in refugee settlements): Over the last three years, Uganda has
received an influx of refugees displaced by the civil and military conflicts in South Sudan and DRC,
particularly into the border districts of Adjumani, Koboko, Moyo, Yumbe, Kiryandongo, Arua, and
Lamwo. These districts have received almost 1 million refugees to date who have settled in an estimated
15 camps spread across these districts. The refugees arrive in transit camps for screening and are later
re-settled in camps, of which the numbers vary from district to district. The refugee settlements are
supported by the Office of the Prime Minister and the United Nations High Commission for Refugees,
with the support of local and international refugee agencies such as World Vision International, and the
respective district local governments. Many refugees originate from areas known to be endemic for PC-
NTDs (trachoma, LF, OV, SCH, STH) and sleeping sickness. There is a real concern that the influx of
refugees will increase the risk of NTD recrudescence in these districts and counteract the gains to date.
In FY18, ENVISION will support an NTD assessment for LF and trachoma in these 15 camps.
c) MDA Coverage
In FY17, ENVISION supported MDA in 55 districts: 20 received MDA in October 2017, 13 received MDA
in April 2017, and 22 in July/August 2017. In FY18 ENVISION will support MDA in 26 districts9:
• 7 districts for LF and STH (in April 2018 and October 2018)
• 3 districts for trachoma (in October 2018)
• 21 districts for OV (21 will be treated in October 2017 and 21 in April 2018)10
• 16 districts for SCH (in April 2018)
9 We recognize there are discrepancies between the narrative and workbooks. This is due to redistricting. 10 While these are tallied as 21 here, the workbook tallies 25 due to re-districting. We are awaiting confirmation of OV
endemicity of new districts.
ENVISION FY18 PY7 Uganda Work Plan
27
ENVISION funds for LF, STH, trachoma, and SCH MDA in the 26 districts will support all pre-and post-
MDA activities, including advocacy, training of trainers (TOT), microplanning, social mobilization,
registration and facilitation of community drug distributors (CDDs) during data collection. For these
diseases, ENVISION also funds all treatment rounds. For OV, ENVISION funds all pre- and post-MDA
activities for the first round of treatment in 21districts. The UOECC approved two rounds of treatment in
21 districts; therefore, ENVISION supports The Carter Center to distribute a second round in 18 districts,
while Sightsavers funds and implements the second round in 3 districts. It should be noted that the 2
districts (Yumbe and Koboko) passed TAS1 in FY17 and will no longer be receiving treatment.
ENVISION will support enhanced supervision in the districts receiving trachoma MDA (Moroto,
Nakapiripirit, and Nabilatuk ) and the three districts receiving LF MDA that have had persistently low
MDA coverage (Gulu, Omoro and Kitgum)
Table 5: USAID-supported districts and estimated target populations for MDA in FY18
NTD
Age groups
targeted
(per disease
workbook
instructions)
Number of rounds
of distribution
annually
Distribution
platform(s)
Number of
districts to be
treated
in FY18
Total number
of eligible
people to be
targeted
in FY18
Lymphatic Filariasis Entire population 5
years and older 1
Community- and
school-based
MDA
7 1,533,919
Onchocerciasis Entire population 5
years and older
2 Community-
based MDA 21 2,350,630
Schistosomiasis Entire population 5
years and older 1
Community- and
school-based
MDA
16 2,411,467
Soil-Transmitted
Helminths
Entire population 5
years and older 1 Community MDA 7 194,047
SAC only 2 School-based
MDA 7 1,633,232
Trachoma Entire population 1
Community- and
school-based
MDA
3 299,920
Activity 1: Registration/update of treatment registers: Current treatment registers run through 2017. In
FY18, districts will be supplied with new multi-year registers, and correspondingly, fresh registration will
be conducted in all districts, except for those in the Karamoja Region, which received revised and
simplified registers in 2016. This activity will be managed by central teams who, prior to
implementation, will be dispatched to support the district teams to conduct community registration.
The number of administration units—communities, schools, parishes, subcounties, HSDs, and health
facilities—will be confirmed at that point. This is to ensure that all endemic communities/schools are
registered to help plan for adequate stocks of drugs and related logistics. The district biostatistician and
planners will be directly involved in this process to ensure the data retrieved are aligned with data
available at district level.
Activity 2: MDA LF-OV : ENVISION will support the procurement of 7,263 registers, provide airtime and
district level data validation in Nebbi, Zombo, Arua, Adjumani, Gulu, Amuru, Kitgum, Lamwo, Lira, Moyo,
Nwoya, Omoro, Pader, Kanungu, Kisoro and Rubanda. Oyam is not scheduled for validation in FY18.
This takes place in November/December and April/May, after MDA. Sightsavers will conduct data
validation in Bulisa, Hoima and Masindi.
ENVISION FY18 PY7 Uganda Work Plan
28
Activity 3: Trachoma MDA in Amudat and Kaboong 2017 trailing costs: ENVISION will support MDA in
these two districts that had TF>5% following TIS.
d) Social Mobilization to Enable NTD Program Activities
In FY17, the NTD Secretariat and partners to finalized an NTD social mobilization strategy, providing a
framework for the design and implementation of social mobilization activities. In FY18, ENVISION will
support a combination of activities at national, district, and community levels to implement this strategy
and improve MDA coverage. These include
Activity 1: Community dialogue to improve MDA coverage : in the seven districts receiving LF and STH
MDA, CDDs and parish supervisors will engage community members in discussions of NTDs, with a focus
on NTD medicines. Drug side-effects will be discussed as well as other concerns raised by the
community. The communication gaps articulated above will form the framework for engagement. The
village LC chairpersons will mobilize household members to attend these meetings. Each village will
hold such meetings during FY18. At the end of the meeting, IEC materials will be distributed to reinforce
relevant messages. Question and answer sessions will assess the extent to which community members’
fears and perceptions have been allayed and the level of satisfaction with the exercise. CDDs will require
flip charts to help in the community education process. In low performing areas, health workers and
subcounty supervisors will reinforce the CDD teams and parish supervisors. In schools, existing clubs and
groups will be used where available to discuss NTDs and provide the required information through club
leaders and trained school teachers.
Activity 2: Multimedia campaign for PC-NTDs: ENVISION will support the NTDCP to plan and implement
a multimedia campaign using print media, radio, and TV channels during the two months prior to MDA.
The multimedia campaign will aim to normalize MDA and assure all that the MDA approach is important
for the prevention, control, and elimination of NTDs. The campaign will emphasize the safety of the
medicines and explain how, when, and by whom medicines should be taken. The NTD Secretariat will
form a task force to coordinate the multimedia campaign. Members will include representatives from
the Health Education and Promotion Division of the MOH, NTD partners, the media fraternity, and
ENVISION. Specifics of the campaign will include:
• Radio: The radio component will comprise talk shows attended by key personalities like DHOs, NTD
focal persons, NTD Secretariat members, community members who have benefited from treatment,
CDDs, and local leaders. They will be call-in shows to allow community members to ask questions.
Radio jingles and announcements will be aired around the time of MDA on local and regional
radio stations. Communities will be informed of the time when the shows will be aired through
radio announcements and by CDDs.
In addition, subcounty supervisors, parish supervisors, and CDDs will use megaphones to inform
communities about MDA and the planned radio talk shows and urge them to tune in. This
approach was used in FY17 and helped to attract community members to treatment centers.
This approach will also be used to mobilize community members for education and dialogue
meetings at village level.
• Television: Weekly panel discussions will be organized for four consecutive weeks prior to MDA.
These will be aired on three TV stations: UBC, NTV, and NBS, to allow the widest reach. During FY17
this strategy was used on one TV station (NBS) with feedback from viewers that it was well received
and long overdue. The panel discussion will cover NTDs and the prevention and control efforts the
government has put in place. The MDA schedule and locations will be communicated during these
ENVISION FY18 PY7 Uganda Work Plan
29
discussions. Drug safety and possible side-effects will be explained. These will be call-in programs to
allow viewers and listeners to ask questions. Members of the NTD Secretariat, and other senior
MOH staff of the including the Director General of Health Services, will participate. ENVISION will
support air time for the TV stations (where applicable) and provide allowances for the participants,
especially those who are not MOH staff.
• Documentation of success stories after MDA: The district supervisors will identify one beneficiary of
trachoma and STH treatment per subcounty and document that beneficiary’s perception of MDA in
the form of a story.
Activity 3: Sensitization of sub county leadership: In FY18, ENVISION will provide technical assistance
through the NTD Secretariat to help districts sensitize health sub districts and sub county leaders on
NTDs and planned MDA. Within the local government system, the subcounty is the level at which
government programs are implemented and supervised. This level receives direct district financial
allocations. Subcounty chiefs/SASs have not been actively engaged in the NTDCP to date, and this has
led to a lack of subcounty accountability regarding implementation activities. Subcounty chiefs and
heads of health sub districts will be oriented on NTDs and their roles in the promotion of activities,
especially MDAs. Treatment targets for subcounties will be agreed upon and the chiefs will be charged
with ensuring achievement of those targets in their subcounties. Costs include per diem, vehicle hire,
and fuel for vehicles.
Activity 4: Disseminate documentaries for SCH in Albertine Region and trachoma in Karamoja Region):
In FY17, ENVISION supported the development of two documentaries; one on SCH in Albertine Region
and one on trachoma in Karamoja Region. In FY18, ENVISION will support the dissemination of these
documentaries in the form of producing 100 CDs that will be distributed to communities, including
drama groups; having the documentaries aired on TV talk shows; and discussing the documentaries on
radio.
Activity 5: OV-related health education and sensitization by community supervisors: ENVISION will
support community supervisor delivery of health education at community meetings and gatherings. IEC
materials will be used to communicate key messages. The aim is to ensure community members
understand the importance of registering themselves and family members, to understand the dangers
of not taking IVM, and the exclusion criteria for treatment, among others. This will enhance IVM uptake,
community participation, and ownership. The community supervisors will encourage their communities
to select more women to work as CDDs and supervisors at the parish and community levels.
Activity 6: Production of IEC Materials: Development of 98,000 posters and fact sheets in five local
languages. These posters were revised during the FY17 social mobilization workshop and are now ready
for printing and distribution
ENVISION FY18 PY7 Uganda Work Plan
30
Table 6: Social mobilization/communication activities and materials checklist for NTD work
planning
Category
Key messages (in
English and local
languages11)
Target
population IEC Activity
Where/
when will
they be
distributed
Frequency
Has this
material/
message or
approach been
evaluated? If
not please detail
how that will be
addressed
Pre-MDA -It is necessary to
register
yourselves/family
for treatment.
-The risk of not
taking IVM
-Exclusion criteria
for treatment
-The utility of
selecting women
CDDs (The Carter
Center)
Eligible
population
Training
groups /
meetings
In the
communities
Once before
every MDA
Yes, it has been
evaluated and
approved by the
MOH
MDA
Participation
MDA will take place
in communities and
schools [RTI]
Community
members living
in endemic
areas,
SAC,
teachers
-Radio
-TV
-Newspapers
-Community
meetings
-School
assemblies
-Posters
Local station,
4 weeks in
advance of,
and 2 weeks
during MDA
campaign.
Weekly
newspaper
pull-outs.
Village
meetings
-4 times daily
for 20 days,
-Weekly
school
assemblies
for 4 weeks
-One
meeting per
village
before MDA
-# of times
messages aired on
radio during
reference period-
Radio broadcast
reports
-% of targeted
population who
seek NTD drugs
during MDA
-% of audience
who recall
message- coverage
survey,
local/national
omnibus survey
Length of MDA,
what diseases are
targeted, drugs and
staggering of
treatments [RTI]
-Community
members living
in endemic
areas
-SAC
-Teachers
-Sub county
chiefs
Religious
leaders Cultural
leaders
-Radio
-Community
meetings
-TV
discussions
-Flyers
-Local station
messages
twice weekly
for 4 weeks
in advance of
MDA
-TV program
for 4 weeks
preceding
MDA and
-4 times daily
for 20 days
-One
meeting per
village
before MDA
-# of times
messages aired on
radio during
reference period—
radio broadcast
reports
-# of meetings
held and
community
members attended
11 Acholi, Lango, Lugbara, Alur, Madi, Karimojong, Ateso, Kumam, Lusoga, Lunyole, Kiswahili, Lunyoro/Rutoro/Runyankole, and
Luganda
ENVISION FY18 PY7 Uganda Work Plan
31
Category
Key messages (in
English and local
languages11)
Target
population IEC Activity
Where/
when will
they be
distributed
Frequency
Has this
material/
message or
approach been
evaluated? If
not please detail
how that will be
addressed
Local council
chairpersons
once every
week during
MDA
campaign
-% of audience
who recall
message—
coverage survey,
local/national
omnibus survey
Endemic diseases,
causes, signs and
symptoms,
prevention and
control, what is
being done including
MDA schedule [RTI]
-Community
members in
endemic areas
-SAC
-Political
leaders
-Teachers
-Radio
-Community
meetings
-Newspaper
pull outs
-TV panel
discussions
-Flyers
-Fact sheets
-Posters
-Local
station, a
few days
before MDA
-Village
meetings
-TV stations
-School
settings
-Weekly
radio
programs
-One
meeting per
village
-School
discussion
groups
-# of times
messages aired on
radio during
reference period—
radio broadcast
reports
-% of population
that believe NTDs
are not caused by
witchcraft based
on KAP survey
-% of audience
who recall
message—
coverage survey,
local/national
omnibus survey
The drugs provided
are free and safe
[RTI + The Carter
Center]
-Community
members in
endemic and
targeted
districts
-SAC
-Political
leaders
-Teachers
-Radio
-Brochures
-Newspaper
articles
-Local
station, 2
weeks in
advance of
and 2 weeks
during MDA
campaign
[RTI]
-Local station
1 week in
advance of
OV/LF MDA
campaign
[The Carter
Center]
-4 times daily
for 20 days
once
-Weekly
newspaper
articles [RTI]
-Messages
play 10 times
a day in
evening [The
Carter
Center]
-# of times
messages aired on
radio during
reference period-
—radio broadcast
reports
-% of targeted
population that
seek NTD drugs
during MDA
-% of audience
who recall
message—-
coverage survey,
local/national
omnibus survey
It is common for
drugs to have mild
side-effects.
-Community
members
targeted for
-Training
manuals
-Brochures
-District level
CDD/
teacher
-Flip charts,
VHT
handbooks &
-# of flip charts,
VHT handbooks,
and training guides
ENVISION FY18 PY7 Uganda Work Plan
32
Category
Key messages (in
English and local
languages11)
Target
population IEC Activity
Where/
when will
they be
distributed
Frequency
Has this
material/
message or
approach been
evaluated? If
not please detail
how that will be
addressed
These are mild,
transitory, and self-
limiting.
[RTI + The Carter
Center]
MDA
-Teachers
-SAC
-CDDs
-Radio
-Newspaper
articles
-TV panel
discussions
-Testimonies
by satisfied
clients
[RTI]
-Flip chart
[The Carter
Center]
refresher
training
-Radio
-TV
-Village
meetings
[RTI]
-Subcounty
level
community
supervisors’
and CDD
refresher
training [The
Carter
Center]
training
manuals will
be
distributed
once
annually
[RTI]
-Radio and
TV panel
discussions
weekly
-Brochures
distributed in
schools and
at
community
meetings
-Flip charts
will be
distributed
once
annually
[The Carter
Center]
disseminated
during reference
period
- training
attendance list
(focal person
report) [RTI]
-# of flip charts
disseminated
during reference
period- training
attendance list
(administration
report) [The Carter
Center]
Drugs handed out at
school are safe and
keep you healthy
[RTI]
-SAC
-Teachers
-Parents and
guardians
-Brochures
-School club
discussions
-School
assemblies
-Radio panel
discussions
-Village
meetings
-VHT
handbook,
training
manual
-Teacher
refresher
training
-Schools
-Radio
-Brochures
to be
distributed
once to SAC
-Radio
announceme
nts during
the 4 weeks
before MDA
-Weekly
school club
discussions
-VHT
handbooks &
training
manuals will
be
distributed
once
annually
-# of brochures,
handbooks, and
training guides
disseminated
during reference
period- training
attendance list
(focal person
report)
-% of targeted
population who
believe drugs are
safe
Drugs handed out at
health units to
community
supervisors for their
All eligible
community
members
Posters
In the
community
and 2 weeks
before MDA
Once a year
% of audience who
recall seeing the
poster and
message—in
ENVISION FY18 PY7 Uganda Work Plan
33
Category
Key messages (in
English and local
languages11)
Target
population IEC Activity
Where/
when will
they be
distributed
Frequency
Has this
material/
message or
approach been
evaluated? If
not please detail
how that will be
addressed
respective
communities [The
Carter Center)
coverage survey,
or at point of MDA
PTS Period -Interruption of
transmission was
declared, outlining
roles of stakeholders
at different levels
-Be on the lookout
for suspected
infections and report
them to the nearest
Local leader, health
workers, or health
unit (The Carter
Center)
Community
members and
leaders at
various levels
Jingles,
posters, and
brochures
In the
community
and various
district
offices
Once Yes, it has been
evaluated and
approved by the
MOH
e) Training
Activity 1: Training of central trainers/supervisors: ENVISION will support a three-day
refresher/retraining of 60 central trainers at VCD/MOH, with facilitation by the NTD program, ENVISION,
and other partner organizations. This will focus on the background to each disease and improvements in
supportive supervision, especially the use of the supervision checklist. Central supervisors are
responsible for providing technical guidance to districts. Their main responsibilities are to train district-
based trainers (district TOTs); conduct district advocacy, and supportive supervision; and participate in
impact assessments where appropriate. Before they are dispatched to districts, trainers and supervisors
will be equipped with up-to-date knowledge of NTDs and the tools used in the program, including NTD
factsheets and manuals.
Activity 2: Training of district NTD focal persons at VCD: ENVISION will support the three-day training of
26 district focal points at the national level. Trainers will include members of the NTD Secretariat, NTD
technical advisory committee, and the ENVISION data manager, who provides support with data tools.
The training will focus on various topics including the role of the district in the program, the use of data
for planning and evaluation, supply chain management, the use of data collection tools, reporting, and
the management of adverse events and serious adverse events (AEs/SAEs).
During training, programmatic challenges and mitigation approaches will be discussed with the focal
points. Training is required annually because the district level focal points is an assignment rather than a
full-time job, and hence there is some turnover each year.
Activity 3: Training of trainers in the districts: ENVISION will continue to support TOT in FY18. This cadre
will provide training to lower administrative levels and provide continued supportive supervision. In
FY18, ENVISION will support a total of 364 district-level trainers (10 district health teams + 4 HSDs per
ENVISION FY18 PY7 Uganda Work Plan
34
district) to be trained for two days at each of the 26 district headquarters. The ENVISION Uganda team
will provide technical assistance to the NTD Secretariat to plan and conduct these trainings.
Activity 4: Training of trachoma graders and recorders: Prior to starting the planned surveys, the
certified graders and recorders will undergo a one-day refresher training.
Activity 5: Training of subcounty and parish supervisors, CDDs, and teachers: In the districts receiving
MDA, ENVISION will support the training of 2,342 parish supervisors (two from every parish) ,32,940
CDDs and two teachers from each school in the sub county.
Activity 6: OV-specific training of supervisors and Health workers: ENVISION will support training of
24,816 supervisors and health workers in 18 districts. Each training will take one day and include district
and subcounty staff participation. Trained supervisors then supervise CDDs.
Activity 7: OV-specific training of CDDs: ENVISION will support community-level training of 16,360 new
CDDs, and refresher training for 13,590 CDDs at the community level, in 18 districts.
Table 7: Training targets
Training groups Training topics
Number to be trained (for
The Carter Center, this
includes training supported
by all funding sources)
Number
training
days
Location of
training(s)
Name
other
funding
partner New Refresher
Total
trainees
District
TOTs [RTI]
•NTDs in Uganda
•Manifestations
•Causes and transmission
•Distribution–maps
•Control – drugs, vectors, other
•Data tools
•Dose poles use
•Adverse events and management
•Advocacy for control
•Timelines–work plan
•Allocation of drugs
•Social mobilization
•Coverage targets
•MDA, post-MDA
•Tools and how to fill
80 284 364 2 District HQ None
Health workers
[RTI]
•NTDs in Uganda
•Manifestations
•Causes and transmission
•Distribution–maps
•Control – drugs, vectors, other
•Data tools
•Dose poles use
•Adverse events and management
•Advocacy for control
•Timelines–work plan
•Allocation of drugs
•Social mobilization
•Coverage targets
•MDA, post-MDA
•Tools and how to fill
104 513 617 1 HSD None
ENVISION FY18 PY7 Uganda Work Plan
35
Training groups Training topics
Number to be trained (for
The Carter Center, this
includes training supported
by all funding sources)
Number
training
days
Location of
training(s)
Name
other
funding
partner New Refresher
Total
trainees
Health workers
[RTI]
•Clinical diagnostics
•NTD disease surveillance 1,234 0 1,234 3 National None
Subcounty
Supervisors [RTI]
•NTDs in district and subcounty
•IEC materials
•Rest as above
25 465 490 1 HSD or
County HQ None
Parish
Supervisors [RTI]
•NTDs in subcounty
•Transmission – elementary cycle
•Medicines for control
•Side-effects
•Tools for registration
•Tally sheets
•IEC materials
•Use of dose poles
•CDD supervision
•How to make a summary report from the
register
117 2,225 2,342 1 Subcounty
HQ None
CDDs [RTI]
•NTDs in area, distribution
•Drugs for control
•Registration
•Use of dose poles
•Eating before treatment
•Common adverse effects
•Use of tally sheets
4,941 27,999 32,940 2 Parish None
Teachers [RTI]
•NTDs in area, distribution
•Drugs for control
•Registration
•Use of dose poles
•Eating before treatment
•Common adverse effects
•Use of tally sheets
1,930 4,504 6,434 1 Schools None
NTD Focal
Persons [RTI]
•NTDs in Uganda
•Distribution, endemic areas
•Transmission
•Control
•Drugs used, quantities
•Side-effects, management
•Cascade training
•Planning MDA
•Implementation units
•Tools
•Registration
•Sensitization
•Supportive supervision
•Stock outs
•Reporting
•Financial responsibilities
3 25 28 3 Kampala,
Hotel None
ENVISION FY18 PY7 Uganda Work Plan
36
Training groups Training topics
Number to be trained (for
The Carter Center, this
includes training supported
by all funding sources)
Number
training
days
Location of
training(s)
Name
other
funding
partner New Refresher
Total
trainees
NTD Focal
Persons, Chief
Administrative
Officers, and
District Health
Officers [RTI]
•Grant management
•Questionnaires
•Anti-terrorism forms
•FOGs milestones
•Auditing
•Progress Reports
14 70 84 1 Kampala
Hotel None
Central
Trainers /
Supervisors [RTI]
As for NTD focal persons
•Supportive supervision tools 2 58 60 2
Kampala
VCD None
ENVISION staff
and MOH NTD
PMs and Senior
Staff
Program planning, management and
evaluation (including financial
management):
• Project cycle
• Problem analysis
• Needs assessments
• Logical framework
• Project design
• Project analysis
• Participatory approaches
• Reports
• M&E
• Cost structures and budgeting
• Project implementation
• Use of grant charts
• Managing procurement process
• Business investment plan
13 0 13 14
Uganda
Manageme
nt Institute
Kampala
campus
None
Graders and
Recorders
• Global Trachoma Mapping Project
methodology of TF, TT, opacity,
blindness grading and
• Data recording, transmission
10 0 10 5
Endemic
district-
Nakapiripiri
t
None
ENVISION Staff
• Financial management
• Project management and budget
monitoring
• Strategic planning & management
• Public policy analysis & evaluation
• Financial management
• Records management & microplanning
• Accurate financial statements
• Manage the audit process
• Develop budgets in support of program
needs
• USAID rules & regulations
• Grants & cooperative agreements
• USAID Project Management
• USAID TOT
• USAID proposal development
12 0 12 7 max
Kampala
and outside
Uganda
None
M&E Assistants
• Database use
• Microplanning template
• Data analysis
10 0 10 5 Kampala None
ENVISION FY18 PY7 Uganda Work Plan
37
Training groups Training topics
Number to be trained (for
The Carter Center, this
includes training supported
by all funding sources)
Number
training
days
Location of
training(s)
Name
other
funding
partner New Refresher
Total
trainees
Core District Data
Team
Development and use of integrated NTD
database 84 0 84 3 Regional None
Supervisors and
health workers for
OV MDA (The
Carter Center)
• OV as a disease
• Transmission
• Signs and symptoms
• OV endemic areas
• Life cycle of OV
• Effect of OV
• Treatment exclusion criteria
• IVM administration (e.g.,
dosing)
• Roles
• Data collection tools and
record keeping
• Community mobilization
• Recording and reporting
303 24,513 24,816 1 Subcounty
CDDs for OV MDA
(The Carter
Center)
Same as above 13,590 16,360 29,950 1 Community Sightsaver
s
f) Drug and Commodity Supply Management and Procurement
Activity 1: Drug delivery: ENVISION will continue to work closely with MOH and NMS to ensure timely
delivery of drugs to each district.
Activity 2: Reverse supply chain: Reverse logistics is fully supported by ENVISION after each MDA, and
this will continue in FY18.
g) Supervision for MDA
The NTD Secretariat, with support from RTI, will continue to conduct supportive supervision in districts
during implementation. Supervision will be increased in Gulu, Arua, and Pakwach, which have recurrent
low coverage and require close monitoring. Special attention will be given to key activities like training,
register updates, and MDA itself. During this process, the central-level supervisors will make field visits
and interact with health workers, subcounty focal persons, parish and community supervisors, teachers,
CDDs, and community members to ascertain the level of knowledge and utilization.
The central supervisors will also conduct random spot checks at all levels (district, subcounty, parish,
school, and community) during and after training. Results from these supervisory visits will be collated
through a standardized supervisory questionnaire/checklist and submitted to the NTDCP and ENVISION
for review. RTI’s M&E team will analyze the results and share with the NTD Secretariat and RTI’s senior
management for action. It is at the discretion of the central supervisor/trainer to liaise with the district
NTD focal person and the NTD Secretariat to arrange a quick, on-the-spot (re)training of cadres deemed
deficient in knowledge. Attention will be paid to areas that have repeatedly reported low coverage.
ENVISION FY18 PY7 Uganda Work Plan
38
In FY18 RTI will support the following activities:
Activity 1: Supportive supervision during training of subcounty supervisors and health workers in 26
districts: This will be conducted by central staff from RTI and MOH. Costs include vehicle rental, fuel, per
diem, and mobile phone airtime.
Activity 2: Supervision during training of parish supervisors: This will be conducted by central staff from
RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime.
Activity 3: Supervision of registration: This will be conducted by central staff from RTI and the MOH.
Costs include vehicle rental, fuel, per diem, and mobile phone airtime.
Activity 4: Supervision during training of CDDs and teachers: This will be conducted by central staff
from RTI and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime.
Activity 5: Supervision during MDA and data collection: This will be conducted by central staff from RTI
and the MOH. Costs include vehicle rental, fuel, per diem, and mobile phone airtime.
Activity 6: Supportive supervision for finance: This will be conducted by central staff from RTI and the
MOH. Costs include vehicle rental, fuel, and per diem.
Activity 7: Enhanced Supervision of MDA in Gulu, Omoro and Kitgum: This will be conducted by central
staff from RTI and the MOH and will involve having a supervisor in each subcounty. Costs include vehicle
rental, fuel, and per diem.
Activity 8: Supervision of MDA for LF-OV (The Carter Center): Supervision of the distribution of the
drugs will be carried out to ensure that the drugs are distributed to the targeted communities through
the national health care services per MOH policy and per WHO guidelines (when they do not conflict
with MOH policy). After distribution, supervisory teams from the central office ensure that the eligible
populations in all targeted communities are treated with Ivermectin. They also check the quality of the
treatment through examination to check for the proper use of dose poles and the correct quantity of
drugs. The supervisory team in Kampala also checks to ensure that the drugs are accounted for. The
central office also conducts data validation to ensure the accuracy of treatment numbers that are
reported.
During the training of CDDs, emphasis is put on the usage of data collection tools, such as, registers,
data collection forms and the recording of information in the data treatment book. Additionally,
exclusion criteria are emphasized with the aim of ensuring that the correct populations are treated and
recorded. Supervision during this exercise is paramount, especially in problematic districts and
communities.
Focus group discussions/community meetings are held to establish knowledge regarding river blindness
disease, community drug distributors, treatment period, and the eligible population. These activities are
discussed in more detail in the social mobilization section.
h) M&E
ENVISION will continue to support M&E efforts in FY18 in the following ways:
Activity 1: Coverage validation surveys for LF, OV, trachoma and SCH/STH MDA (RTI–M&E): In FY17,
coverage surveys were conducted in five districts: Namayingo (LF and SCH/STH), Kasese (OV/STH), Nebbi
(LF, trachoma, SCH/STH), Kaabong (trachoma) and Kitgum (LF, OV, SCH/STH). The surveys used the WHO
ENVISION FY18 PY7 Uganda Work Plan
39
protocol, and technical assistance was provided by WHO and RTI. Results are being analyzed, and it is
expected that lessons learned will be applied to the FY18 activities.
In FY18, coverage surveys, with a KAP component, will be conducted in another five districts: Gulu,
Lamwo, and Arua (OV, LF, and SCH/STH); and Moroto and Nakapiripirit (or the new Nabilatuk district) in
Karamoja for trachoma MDA. Some of these districts have consistently reported poor coverage,
especially Gulu and Arua, prompting the surveys. Further, some of the districts have failed to achieve
the five rounds of effective MDA coverage. The survey design used in FY17 will be adopted or modified
based on findings of the survey recently completed. Probability proportional to size methods will be
used to select parishes, and 30 randomly selected villages will be sampled per district. Details of the
sampling and survey procedures and tools are contained in the WHO protocol for validation of reported
coverages after MDA.
Activity 2: LF TAS1 stopping MDA in three districts (RTI– M&E): In FY18, TAS1 will be conducted in three
districts: Mayuge, Bugiri, and Namayingo. These have each had at least five effective rounds of MDA and
successfully passed pre-TAS. The methodology will be based on WHO guidelines and the use of the
survey sample builder.
Activity 3: LF TAS2: Post-MDA surveillance in 17 districts (RTI- M&E): In FY18, TAS2 will be conducted in
17 districts. These are Iganga, Namutumba, Luuka, Kamuli, Kaliro, Buyende, Bukedea, Kumi, Ngora,
Kaberamaido, Serere and Soroti in Eastern Region; Apac, Kole, Adjumani, Oyam, and Moyo in Northern
Region.
Activity 4: TSS in 13 districts (RTI): In FY18, ENVISION will support TSSs in 13 districts that stopped MDA
in 2016. The districts are Butaleka, Mayuge*, Namayingo, Paalisa*, Amolatar, Apac*, Kitgum, Kole,
Lamwo, Oyam*, Yumbe*, Kiryandongo and Masindi. Districts marked with an asterisk have large
populations that need to be split into two EUs.
Activity 5: TIS in two districts (RTI): In FY18, ENVISION will support TIS in two districts-Amudat and
Kaboong.
Activity 6: OV epidemiological assessment (The Carter Center): To re-affirm OV interruption,
epidemiological activities (OV16 ELISA and skin snips) will be conducted in foci that have completed
three years of PTS. The transition of some districts to post-MDA will be contingent on passing LF TAS and
therefore stopping IVM treatment. This includes Maracha and Nebbi (the latter will depend on RPRG
decisions, to be communicated in mid-2018). The assessments will include serological and entomological
surveys to determine whether OV has been eliminated. Blood samples will be collected from 7,000
children under 10 years old in the sampled communities/parishes where adult skin snips were
conducted. For cross-border foci: Uganda’s focus of Bwindi, which is in the districts of Kanungu and
Kisoro, and the cross-border areas of DRC in the district of Ruchuru-Goma will conduct skin snips in
January 2018.
Uganda’s Lubiriha focus, which includes the district of Kasese, and the cross-border area of DRC in the
district of Beni-Butembo will conduct OV16 ELISA and skin snips, assuming the security situation in DRC
remains workable around June 2018. Uganda’s West Nile focus, which includes the districts of Koboko
and Yumbe, and the cross-border area of DRC in Ituri District (northern part) and in South Sudan in the
Yei District, will conduct OV16 ELISA and skin snips depending on South Sudan’s security situation.
Uganda’s Madi–Mid North focus, including the districts of Lamwo, Moyo, Adjumani, and Amuru (among
others), will conduct cross-border OV16 ELISA and skin snipping with the county of Magwi in South
Sudan, depending on South Sudan’s security situation.
ENVISION FY18 PY7 Uganda Work Plan
40
Additionally, entomological surveys for analysis of infective potential (vector control) of district/foci will
be conducted in Nebbi (in both the Wadelai and Nyagak-Bondo foci), Kasese (in both the Nyamugasani
and Lubiriha foci), Rubanda, Kanungu, Kisoro (Bwindi), Pader, Kitgum, Lamwo, Gulu, Amuru, Nwoya,
Oyam, Lira, Moyo, and Adjumani (Madi–Mid North) and part of Moyo (in Obongi focus), Yumbe,
Koboko (West Nile), Arua, Zombo (Nyagak-Bondo), Maracha (Maracha-Terego), Masindi, Bulisa, and
Hoima (Budongo). These activities will be partially supported with ENVISION funds and partially
supported by other Carter Center funding sources. Cross-border entomological monitoring will be
carried out in Uganda’s Kanungu and Kisoro districts (Bwindi foci) and in DRC’s Ruchuru-Goma District.
Similarly, Arua, Nebbi, and Zombo districts in Uganda’s Nyagak-Bondo foci will be included in quarterly
cross-border entomological monitoring in the southern part of DRC’s Ituri District. Uganda’s districts of
Yumbe and Koboko (West Nile foci) will be included in quarterly entomological monitoring that will also
include the northern part of Ituri District in DRC, and Yei District in South Sudan.
ENVISION FY18 PY7 Uganda Work Plan
41
Table 9a: Planned DSAs for FY18 by disease
Disease
No. of
endemic
districts
No. of districts
planned for
DSA
No. of
Evaluation Units
planned for DSA
(if known)
Type of
assessment
Diagnostic method (Indicator:
Mf, FTS, etc.)
Lymphatic Filariasis 61
3 TAS1 LFTS for antigenemia; mf in night
blood
17 TAS2 LFTS for antigenemia; mf in night
blood
Trachoma 47 2 TIS
Clinical grading (GTMP surveys) 13 TSS
Onchocerciasis 21 21
Skin snips, OV16
ELISA blood spots,
and entomological
surveillance
Mf, positive children, crab
infestation, and fly infections
Schistosomiasis 87 0 N/A
Soil-Transmitted
Helminths 128 0 N/A
Table 9b: Planned OV-specific assessments for FY18
Focus Districts Type of assessment Diagnostic method (Indicator: Mf,
FTS, etc.)
Budongo Hoima, Masindi, & Buliisa Entomological surveillance Crab infestation and fly infections
West Nile Koboko & Yumbe Entomological surveillance Crab infestation and fly infections
Nyagak-Bondo Arua, Zombo, & Nebbi Entomological surveillance Crab infestation and fly infections
Maracha-Terego Terego Entomological surveillance Crab infestation and fly infections
Bwindi Rubanda, Kisoro & Kanungu Entomological surveillance Crab infestation and fly infections
Obongi Moyo Entomological surveillance Crab infestation and fly infections
Nyamugasani Kasese Entomological surveillance Fly infections
Madi–Mid North Moyo, Adjumani, Amuru,
Nwoya, Oyam, Gulu
Skin snips, OV16 blood
spots, and entomological
surveillance
Mf, positive children, crab infestation,
and fly infections
Lubiriha Kasese Entomological surveillance Fly infections
i) Supervision for M&E and DSAs
In FY18, ENVISION will support:
Activity 1: Supervision of coverage validation surveys (RTI): RTI and MOH will conduct supervision in
each of the five districts conducting coverage surveys. Costs will include vehicle hire and per diem.
Activity 2: Supervision of LF TAS1 (RTI): The LF program manager regularly shares plans, survey drafts,
and results with ENVISION for comment. This will continue in FY18. ENVISION staff, including the
Resident Program Advisor and Senior Technical Advisor, participate in field surveys and the training of
district staff on the use of filariasis test strips (FTS) for LF surveillance.
Activity 3: Supervision of LF TAS2 (RTI): The LF program manager regularly shares plans, survey drafts,
and results with ENVISION for comment. This will continue in FY18. ENVISION staff, including the COP
and CTA, participate in field surveys and the training of district staff on the use of FTS for LF surveillance.
ENVISION FY18 PY7 Uganda Work Plan
42
Activity 4: Supervision of TSS (RTI): ENVISION staff and consultants are part of the planning process.
ENVISION has secured the services of a trachoma quality control consultant who is the only
ophthalmologist in the country certified to train and supervise graders and recorders. The consultant
ensures that WHO and Tropical Data gold standards are adhered to.
Activity 5: Supervision of TIS (RTI): ENVISION staff and consultants are part of the planning process.
ENVISION has secured the services of a trachoma quality control consultant who is the only
ophthalmologist in the country certified to train and supervise graders and recorders. The consultant
ensures that WHO and GTMP/Tropical Data standards are adhered to.
Activity 6: OV epidemiological assessment (The Carter Center): For OV16, sampling is carried out
directly by the Kampala headquarters. Carter Center personnel go with the teams for OV16 surveys.
Management ensures that proper protocols are observed, that quality data are obtained, and to ensure
the fidelity of geographical targets per the sampling frame.
For entomological monitoring, teams are organized by the Carter Center Kampala office, with occasional
supportive supervisory visits to ensure that proper protocols are observed as the activities are carried
out. This also ensures that quality data are received. If challenges arise (such as under-capture as a
result of fly catchers leaving early), the management team provides novel solutions to these issues.
j) Dossier Development
Activity 1: LF dossier: The MOH has requested support for the development of the LF dossier. ENVISION
will support a dossier consultant in FY18 for 30 days. As part of the final LF elimination process, the MOH
will convene a workshop of 12 participants to review historical data and begin to draft the dossier.
ENVISION will pay for the venue, refreshments and transport. ENVISION will also support the printing of
key LF MMDP assessment tools to be given to each district, this will enable the consultant to summarize
the country’s MMDP situation, MMDP services available in health units and communities which are all
key to completing the dossier.
ENVISION FY18 PY7 Uganda Work Plan
43
ENVISION FY18 PY7 Uganda Work Plan
44
3) Maps
Figure 7. Uganda LF, OV, STH, SCH, and Trachoma Endemicity Maps
Figure 8. Uganda LF, OV, SCH, STH, and Trachoma Geographic Coverage Maps
ENVISION FY18 PY7 Uganda Work Plan
45
ENVISION FY18 PY7 Uganda Work Plan
46
Figure 9. Uganda Progress towards LF Elimination Map
ENVISION FY18 PY7 Uganda Work Plan
47
Figure 10. Uganda Progress towards Trachoma Elimination Map
ENVISION FY18 PY7 Uganda Work Plan
48
APPENDIX 2: Work Plan Timeline
FY18 Activities
Management Support
NTD Program Capacity Strengthening
Train/Orient the MOH NTD Data Manager on information systems and data management systems (RTI)
Training in program planning, management, and evaluation—including financial management at Uganda
Management Institute (RTI)
Continued training for NTDCP senior staff on the integrated NTD database (RTI)
Project Assistance
Strategic Planning
2 NTD Technical Committee Meeting (RTI)
National Planning & Data Review Meeting (RTI)
Regional Planning & Review Workshop (RTI)
Microplanning in 26 districts (RTI)
National Stakeholder Meeting (River Blindness Program Review Meetings (The Carter Center)
UOEEAC (The Carter Center)
NTD Secretariat
Operational & program supervision support costs for NTDCP (RTI)
NTD secretariat MOH quarterly meetings (RTI)
Building Advocacy for Sustainable National NTD Program
Breakfast meeting with MPs from the 26 ENVISION-supported districts (RTI)
Northern Uganda Regional Advocacy Meeting (RTI)
District-level advocacy meetings (RTI)
News publications on NTDs (RTI)
MDA Coverage
Registration/update of treatment registers (The Carter Center):
LF and STH MDA in 7 districts (RTI)
SCH MDA in 16 districts (RTI)
Trachoma MDA in 2 districts (RTI)
OV MDA in 23 districts (RTI and TCC)
Social Mobilization to Enable NTD Program Activities
Community dialogue to improve MDA coverage level (RTI):
Multimedia campaign for PC-NTDs (RTI):
Sensitization of subcounty leadership (RTI)
Disseminate documentaries for SCH in Albertine and trachoma in Karamoja regions (RTI)
OV-related health education and sensitization by community supervisors (The Carter Center)
Training
Training of central trainers/supervisors in 26 districts (RTI):
Training of trachoma graders and recorders at VCD (RTI):
Training of district NTD focal persons at VCD(RTI):
Training of trainers (TOTs) in 26 districts (RTI:
Training of subcounty supervisors and health workers at HSDs and lower health units on MDA planning,
implementation, and reporting (RTI)
Training of parish supervisors on MDA planning, implementation, and reporting (RTI)
Training of CDDs/VHTs and teachers (RTI)
OV-specific training of supervisors and health workers (The Carter Center)
OV-specific re/training of CDDs (The Carter Center)
Supervision for MDA
Supportive supervision during training of subcounty supervisors & health workers in 26 districts
Supervision during training of parish supervisors
Supervision of registration
Supervision during training of CDDs and teachers
Supervision during MDA and data collection
ENVISION FY18 PY7 Uganda Work Plan
49
FY18 Activities
Monitoring and Evaluations
Coverage validation surveys for LF, OV, Trachoma and SCH/STH MDAs (RT)
LF TAS 1 in 3 districts (RTI)
LF TAS 2 in 17 districts (RTI)
Trachoma Impact Survey in 2 districts (RTI)
Trachoma Surveillance Survey 13 districts (RTI)
OV16 and/or skin snips
Vector monitoring (monthly fly catching)
Vector monitoring (quarterly, based on security situation)
Supervision of M&E
Supervision of Coverage Validation Surveys (RTI)
Supervision of LF TAS1 (RTI)
Supervision of LF TAS2 (RTI)
Supervision of TSS (RTI)
Supervision of TIS (RTI)
Dossier Development
LF dossier consultant
STTA
Trachoma Quality Control Consultant (RTI)
SAE Consultant (RTI)
Cross-Border Strategic Plan Consultant (RTI)
NTD Documentary Consultant (RTI)
M&E Assistants (RTI)
LF Dossier Consultant (RTI)
*If necessary
ENVISION FY18 PY7 Uganda Work Plan
50
APPENIDX 4. Table of USAID-supported Regions and Districts in FY18
Sn Region Health
Districts
Mapping
(list
disease(s)
Baseline
sentinel
sites (list
disease(s)
MDA DSA
(list type: TAS 2, TSS, etc.)
LF OV SCH STH TRA LF OV SCH STH TRA
1
Western
Kasese x x Entomological
surveillance
2 Buliisa x x Entomological
surveillance
3 Rubanda x Entomological
surveillance
4 Kisoro x Entomological
surveillance
5 Kanungu
6 Kiryandongo LF & TRA
TSS
7 Hoima x Entomological
surveillance
8 Masindi x Entomological
surveillance TSS
10
Eastern
Amudat TIS
11 Butaleja TSS
12 Moroto x
13 Nakapiripirit x
14 Nabilatuk x
15 Kaabong TIS
16 Kotido
17 Mayuge TAS1 TSS
18 Bugiri TAS1
19 Namayingo TAS1 TSS
20 Iganga TAS2
21 Namutumba TAS2
22 Luuka TAS2
23 Kamuli TAS2
24 Kaliro TAS2
25 Buyende TAS2
26 Bukedea TAS2
27 Kumi TAS2
28 Ngora TAS2
ENVISION FY18 PY7 Uganda Work Plan
51
Sn Region Health
Districts
Mapping
(list
disease(s)
Baseline
sentinel
sites (list
disease(s)
MDA DSA
(list type: TAS 2, TSS, etc.)
LF OV SCH STH TRA LF OV SCH STH TRA
29 Kaberamaido TAS2
30 Pallisa TSS
31 Serere TAS2
32 Soroti TAS2
33 Busia
34 Tororo
35 Kween
36 Sironko
37 Jinja
38
Northern*
Apac TAS2 TSS
39 Kole TAS2
40 Adjumani LF & TRA x x TAS2
41 Moyo LF & TRA TAS2
Skin snips,
OV16 ELISA
blood spots,
and
entomological
surveillance
42 Koboko LF & TRA x RA Entomological
surveillance
43 Yumbe LF & TRA x RA Entomological
surveillance Assessments Assessments TSS
44 Maracha
45 Terego
46 Amuru x x
Skin snips,
OV16 ELISA
blood spots,
and
entomological
surveillance
47 Arua LF & TRA x x x x RA Entomological
surveillance
48 Omoro x x x x
49 Gulu x x x x
Skin snips,
OV16 ELISA
blood spots,
ENVISION FY18 PY7 Uganda Work Plan
52
Sn Region Health
Districts
Mapping
(list
disease(s)
Baseline
sentinel
sites (list
disease(s)
MDA DSA
(list type: TAS 2, TSS, etc.)
LF OV SCH STH TRA LF OV SCH STH TRA
and
entomological
surveillance
50 Kitgum x x x x Assessments Assessments TSS
51 Kole TSS
52 Lamwo LF & TRA x x x RA TSS
53 Maracha x x
54 Nebbi x x Entomological
surveillance
55 Pakwach x x Assessments Assessments
56 Nwoya x x
Skin snips,
OV16 ELISA
blood spots,
and
entomological
surveillance
57 Pader x Assessments Assessments
58 Zombo
59 Adjumani Assessments Assessments
60 Moyo x x
Skin snips,
OV16 ELISA
blood spots,
and
entomological
surveillance
Assessments Assessments
61 Oyam x x TAS2
Skin snips,
OV16 ELISA
blood spots,
and
entomological
surveillance
TSS
62 Amolatar TSS
63
Central
Kiboga
64 Luwero
65 Kyankwanzi
66 Nakaseke
ENVISION FY18 PY7 Uganda Work Plan
53
Sn Region Health
Districts
Mapping
(list
disease(s)
Baseline
sentinel
sites (list
disease(s)
MDA DSA
(list type: TAS 2, TSS, etc.)
LF OV SCH STH TRA LF OV SCH STH TRA
67 Nakasongola
68 Buikwe
64 Buvuma
65 Kayunga
ENVISION FY18 PY7 Uganda Work Plan
54
APPENDIX 9: UOEEAC’s OV Flag