uganda work plan - envision · uganda work plan fy 2019 project year 8 october 2018–september...

Uganda Work Plan FY 2019

Project Year 8

October 2018–September 2019

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 United States Government.

ENVISION FY19 PY8 Uganda Work Plan

ii

ENVISION PROJECT OVERVIEW

The US Agency for International Development (USAID) 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), trachoma, and three soil-transmitted helminths (STH;

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

global and country levels and support ministries of health 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:

• Technical assistance

• Monitoring and evaluation (M&E)

• Global policy leadership

• Grants and financial management

• Capacity strengthening at global and country levels

• Dissemination

At the country level, ENVISION provides support to national NTD programs in 19 countries in Africa, Asia,

and Latin America by providing strategic technical, operational, and financial assistance for a

comprehensive package of NTD interventions, including the following:

• NTD program capacity strengthening

• Strategic planning

• Advocacy for building a sustainable national NTD program

• Social mobilization to enable NTD program activities

• Mapping

• Drug and commodity supply management

• Supervision

• M&E

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


iii

TABLE OF CONTENTS

ENVISION PROJECT OVERVIEW ..................................................................................................................... ii

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

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

COUNTRY OVERVIEW .................................................................................................................................... 1

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

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

b) Other NTD Partners ................................................................................................................ 2

2) National NTD Program Overview ..................................................................................................... 7

a) Lymphatic Filariasis and Soil-transmitted Helminths ............................................................. 8

b) Trachoma ............................................................................................................................. 10

c) Onchocerciasis ..................................................................................................................... 11

d) Schistosomiasis (Bilharzia) ................................................................................................... 13

3) Snapshot of NTD Status in Country ................................................................................................ 15

PLANNED ACTIVITIES ................................................................................................................................... 16

1) NTD Program Capacity Strengthening ........................................................................................... 16

a) Strategic Capacity Strengthening Approach ........................................................................ 16

b) Capacity Strengthening Objectives and Interventions ......................................................... 16

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

defined.

d) Monitoring and Evaluating Proposed Capacity Strengthening Interventions ..................... 18

2) Project Assistance .......................................................................................................................... 20

a) Strategic Planning ................................................................................................................ 20

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

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

d) Mapping ............................................................................................................................... 25

e) MDA Coverage ..................................................................................................................... 25

f) Social Mobilization to Enable NTD Program Activities ......................................................... 27

g) Training ................................................................................................................................ 32

h) Drug and Commodity Supply Management and Procurement ........................................... 35

i) Supervision for MDA ............................................................................................................ 36

j) M&E...................................................................................................................................... 38

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


iv

l) Dossier Development ........................................................................................................... 42

m) STTA ......................................................................................... 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.

APPENDIX 4: Table of USAID-supported Regions and Districts in FY19 ......... Error! Bookmark not defined.

APPENDIX 5: FY18 Q1–2 Country Semi Annual Report .................................. 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.

TABLE OF TABLES

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

activities .............................................................................................................................. 5

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

2018 .................................................................................................................................. 15

Table 3: Project assistance for capacity strengthening .................................................................. 18

Table 4: USAID-supported coverage results for FY17 ..................................................................... 26

Table 5: USAID-supported districts and estimated target populations for MDA in FY19 .............. 27

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

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

Table 7: Training targets .................................................................... Error! Bookmark not defined.

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

thresholds as of September 30, 2018 .................................. Error! Bookmark not defined.

Table 9: Planned DSAs for FY19 by disease .................................................................................... 41

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

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

Table 12: Cross-portfolio requests for support ................................... Error! Bookmark not defined.


v

ACRONYMS LIST

AE Adverse Event

ALB Albendazole

BCC Behavior Change Communication

CAO Chief Administrative Officer

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

CCT Coordinating Center Tutor

CDC Centers for Disease Control and Prevention

CDD Community Drug Distributor

CFA Circulating Filarial Antigen

CHD Child Health Days

CMD Community Medicine Distributor

CO Corneal Opacity

DDT Dichlorodiphenyltrichloroethane

DFID UK Department for International Development

DHE District Health Educator

DHIS2 District Health Information System 2

DHO District Health Office(r)

DHT District Health Team

DLG District Local Government

DRC Democratic Republic of the Congo

DSA Disease-Specific Assessments

ELISA Enzyme-Linked Immunosorbent Assay

EU Evaluation Unit

FOG Fixed Obligation Grant

FP Focal Person

FTS Filariasis Test Strips

FY Fiscal Year

GTMP Global Trachoma Mapping Project

HMIS Health Management Information System

HQ Headquarters

HSD Health Subdistrict

ICT Immunochromatographic Test

IEC Information, Education, and Communication

IU Implementation Unit

IVM Ivermectin

JAP Joint Application Package

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

KAP Knowledge, Attitudes, and Practices

LC Local Council

LF Lymphatic Filariasis

M&E Monitoring and Evaluation


vi

MDA Mass Drug Administration

mf Microfilariae

MMDP Morbidity Management and Disability Prevention

MOH Ministry of Health

MP Member of Parliament

NDA National Drug Authority

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

PELF Program to Eliminate Lymphatic Filariasis

PHASE Preventive Chemotherapy, Health Education, Access to Clean Water, Sanitation

Improvement, and Environmental Management for Snail Control

PTS Post-Treatment Surveillance

PM Program Manager

POS Powder for Oral Suspension

PZQ Praziquantel

RA Refugee Assessments

REMO Rapid Epidemiological Mapping of Onchocerciasis

SAC School-Age Children

SAE Serious Adverse Event

SAFE Surgery–Antibiotics–Facial cleanliness–Environmental improvements

SAS Senior Assistant Secretary

SC Spot Check

SCH Schistosomiasis

SCI Schistosomiasis Control Initiative

SOP Standard Operating Procedure

SS Sentinel Site

STH Soil-Transmitted Helminths

STTA Short-Term Technical Assistance

TA Technical Assistance

TAS Transmission Assessment Survey

TEO Tetracycline Eye Ointment

TF Trachomatous Inflammation–Follicular

TI Intense Trachomatous Trachoma

TIS Trachoma Impact Survey

TOT Training of Trainers

TRA Trachoma Rapid Assessment

Trust Queen Elizabeth Diamond Jubilee Trust

TSS Trachoma Surveillance Survey


vii

TT Trachomatous Trichiasis

TV Television

UIG Ultimate Intervention Goal

UNICEF United Nations Children’s Fund

UOEEAC Uganda Onchocerciasis Elimination Expert Advisory Committee

USAID US 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®


1

COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Uganda is divided into four geographical regions: Central, Western, Eastern, and Northern. These are, in

turn, divided into districts, counties (constituencies), sub counties, parishes, and villages. In September

2015, an act of parliament created 23 new districts to be phased in over 3 years between 2016 and

2018. As of August 15, 2018, there are a total of 123 districts in 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 nneglected ttropical

ddisease (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 sub county representatives. An LC5 chairperson presides over the district local

government (DLG), including the District Council of elected and nominated leaders. Other district

leaders include the Chief Administrative Officer (CAO), who is a civil servant, acts as the district

accounting officer, and has overall oversight of the district civil service; and the Resident District

Commissioner, who represents the Office of the President in the district and is responsible for

supervising the implementation of all government programs and coordinating security matters.

Three NTD-relevant positions exist at the district level: the District Health Officer (DHO) is in charge of

the health portfolio and reports to the CAO and District Council, the NTD Focal Point coordinates all NTD

activities and reports to the DHO, and the LC5 Secretary for Health is the political head of health services

in the DLG and reports to the LC5 chairperson and District Council. In fiscal year 2019 (FY19), ENVISION

will support mass drug administration (MDA) and related activities in 16 districts.

County and sub county administration

The county is an inactive administrative unit. However, it is the equivalent of a political constituency for

the election of members of parliament (MPs). Currently, the functional administrative unit for the

implementation of government programs is the sub county. The sub county is headed by a Senior

Assistant Secretary (SAS) who reports directly to the district CAO. The LC3 chairperson is the political

head of the sub county and chairs the sub county council, while the SAS is the CAO’s representative and

is responsible for the supervision of civil servants and implementation of government programs. The LC3

chairperson and SAS provide oversight of the NTD Control Program (NTDCP) and are instrumental in

managing challenges and overcoming resistance, such as in the case of serious adverse events (SAEs)

following treatment with PZQ. Each sub county has two trained NTD supervisors who work closely with

the district and lower levels.

Parish and village administration

Sub counties are divided into parishes, each headed by a parish chief and an LC2 chairperson. Each

parish has a Parish Development Committee, which is responsible for identifying priority development

challenges. In the NTDCP, each parish has two parish supervisors. The lowest administrative unit in


2

Uganda is the village, which is known as LC1. Some large LC1s are subdivided into smaller cells,

especially in urban areas. Each LC1 is headed by a chairperson who is assisted by councilors. At each

level from district (LC5) to village, (LC1), women representatives are required.

b) Other NTD Partners

The major donors supporting the NTDCP are the US Agency for International Development (USAID),

World Health Organization (WHO), UK Department for International Development (DFID), and Queen

Elizabeth Diamond Jubilee Trust (The Trust). Implementing partners include RTI International, The Carter

Center, Sightsavers, the Schistosomiasis Control Initiative (SCI), and CBM International. There are

additional partners working on water, sanitation, and hygiene (WASH) activities, many of whom overlap

with the trachoma program in particular (see details in Table 1).

The Carter Center supports onchocerciasis (OV) elimination activities in 15 districts 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 3 years of PTS

have been completed. The Carter Center supports OV-related cross-border activities involving Uganda,

the Democratic Republic of the Congo (DRC), and South Sudan, including activities in each of these two

other countries. ENVISION activities proposed by The Carter Center for FY19 are also partly funded by

other donors.

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

verify the interruption of OV transmission, through a collaboration with the University of South Florida

(Principal Investigator: 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 S, F, and E components of the SAFE

(Surgery–Antibiotics–Facial cleanliness–Environmental improvements) strategy. The Trust focuses 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 trachomatous trichiasis (TT)-only surveys in Kibuku, Moyo,

and Budaka districts, which recorded disparities with the backlog estimates reported in earlier surveys;

and large-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 (UIGs) for trachomatous

inflammation–follicular (TF) and TT, which are required for trachoma elimination. In 2017, The Trust

extended these activities to the rest of Northern, Western, and West Nile regions, reaching 31 districts.

The Trust’s funding for surgeries is expected to end in March 2019, and no information on additional

donors is currently available.

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)

provides strategic communication technical support to The Trust and The Carter Center. In FY17–FY18,

ENVISION worked with CCP to update the integrated information, education, and communication

(IEC)/behavior change communication (BCC) materials based on the NTD communication strategy

developed with financial and technical support from RTI/ENVISION. The materials were translated into


3

major languages, field-tested, and printed with financial support from ENVISION. These materials were

distributed before and during the FY18 MDA.

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. CBM ended its TT surgical activities in Uganda and closed its field offices in April

2017 after Uganda achieved its UIG 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 implements The Trust’s supported TT

surgeries in 17 districts (Lira, Kitgum, Yumbe, Koboko, Maracha, Arua, Nebbi, Zombo, Adjumani, Moyo,

Lamwo, Gulu, Omoro, Amuru, Nwoya, Oyam, and Pader), and in June 2017, it expanded to 14 more

districts in the north and east.

Sightsavers supports OV activities in eastern Uganda, including MDA in Masindi, Buliisa, Hoima, and

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

schistosomiasis (SCH). Sightsavers will continue supporting vector control in Pader, Kitgum, and Lamwo

districts.

In FY18, Sightsavers supported the Program to Eliminate Lymphatic Filariasis’s (PELF’s) morbidity

management and disability prevention (MMDP) plans by funding a KAP study in three districts (Lira,

Kitgum, and Yumbe); rapid assessments of the burden of chronic manifestations of lymphatic filariasis

(LF); and training of 12 surgeons, 12 assistant surgeons, 12 running nurses, and five anesthetists.

Sightsavers support will end in March 2019 with a possibility of extension through a new proposal to be

funded by DFID. The new proposal will aim at strengthening the health system to also address LF

MMDP. From October 2018 to March 2019, Sightsavers will support hydrocelectomies in Lira, Amuru,

Lamwo, and Pader districts and the training of subcounty supervisors from these four districts in

lymphedema management.

DFID has supported SCH control in Uganda since 2003 through SCI, focusing on MDA and disease re-

assessments. Prior to FY16, SCI supported MDA and assessments in districts with low SCH endemicity

(prevalence of 1%–10%). In FY16, RTI transferred SCH support activities for several districts to SCI, with

the agreement of the MOH. In FY17, ENVISION transferred an additional 24 districts that are endemic

for SCH/STH only to SCI. In FY19, SCI will support SCH activities in 34 districts.

WASH partners

• WaterAid Uganda installs water points in schools, trains hygiene promoters and others on

trachoma/WASH, builds latrines and handwashing facilities, and spurs villages to adopt

community-led total sanitation. It also updates materials to promote key behaviors to

encourage the prevention and treatment of trachoma. It also supports small-scale sanitation

programs in selected parishes in Busoga and Karamoja sub-regions.

• Water Mission is conducting a 3-year program (2016–2018) in the 10 districts (88 sub counties

and 587 parishes) of Busoga Sub-region. The focus is on improving community sanitation by

training district and sub county 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 sub counties in Buyende and Namayingo districts.


4

• Busoga Trust, which is managed by the Church of Uganda, supports water supply and sanitation

programs in Busoga Sub-region.

• CCP researches communication barriers and designs appropriate IEC and BCC materials to

support behavior change for the elimination of trachoma and control of SCH. In FY17, CCP

partnered with the MOH and ENVISION to update IEC materials. These materials were used in

FY18 and will be rolled out in FY19. CCP does not have a budget to print IEC materials; therefore,

ENVISION provides 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 and Environmental Health Division.

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

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

materials for Mother Care Groups.

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

community-led total sanitation, and promotes WASH coordination meetings in three 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.

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

and coordinates NTD drug donations. The WHO Country Office participates in the NTD Technical

Committee and NTD Secretariat meetings. It provides technical assistance (TA) during the

preparation of joint applications for donated NTD drugs and through the Regional Program

Review Group, where it advises the NTDCP on implementation units (IUs) to undertake

transmission assessment surveys (TASs) or to stop LF MDA for LF. During 2005–2015, WHO

funded a study, conducted by the MOH Vector Control Division (VCD), to assess the impact of

STH deworming in 10 districts. The WHO Country Office assists with the procurement of

diagnostics.

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

2015 in Kamwenge, Kabarole, Kibaale, and Ibanda districts in western Uganda and Kween and

Manafwa districts in eastern Uganda.


5

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

summarized activities

Partner Location

(Regions/States) Activities

In FY18, was

USAID providing

direct financial

support to this

partner through

ENVISION?

List other donors

supporting these

partners/activities

The Carter

Center

15 OV-endemic

districts

a) Capacity building,

planning, and support to

the MOH and districts for

OV MDA; vector

control/elimination;

entomological

surveillance; OV impact

assessments; post-PTS

and KAP studies

b) Lead agency for TA and

funds management for TT

surgeries and WASH

activities for The Trust

c) TT surgeries in

trachoma-endemic

districts of northern and

western Uganda,

beginning in April 2017

YES The Trust

Sightsavers a) Busoga Sub-

region in eastern

Uganda (seven

districts) and

Karamoja Sub-

region in eastern

Uganda (five

districts)

b) Bunyoro-

Western (four

districts)

c) Northern Region

(four districts)

a) Technical and financial

assistance to the NTDCP

and DLGs for strategic

planning, capacity

building, and equipment

for TT surgeries and eye

care; logistics,

motorcycles, and mobile

sound systems for IEC

campaigns in Karamoja

Sub-region, where radio

services are not well

developed

b) Post treatment surveys

in three districts

c) Simulium vector

control, involving dosing

rivers with Abate (an

organophosphate)

d) MMDP activities –

rapid assessment of

NO The Trust; Standard

Chartered Bank

(Uganda); Standard

Chartered Bank; DFID


6

Partner Location


In FY18, was

USAID providing

direct financial

support to this

partner through

ENVISION?

List other donors

supporting these

partners/activities

d) Northern

Uganda (four

districts)

magnitude; lymphedema

management and

hydrocelectomies in four

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, SCH

MDA, and reassessments

of prevalence, intensity,

and morbidity in SCH-

endemic districts

NO DFID

Trachoma

WASH

partners

(Water

Mission,

WaterAid,

Busoga Trust,

AVSI

Foundation,

World Vision,

and John

Hopkins

University

Busoga and

Karamoja regions

Financial and technical

support for trachoma-

related WASH activities

and BCC

NO The Trust

WHO Country

Office

All endemic

districts with

active PC NTD

programs

At the country level,

provides technical

support, coordination of

capacity

building/trainings, and

assessment of

interventions against STH

infections

NO WHO Uganda,

African Regional

Office, and Geneva

HQ

Lions Club

Uganda

Central level Advocacy at national and

district levels; acts as a

conduit for funds to

support trachoma

implementation activities

NO Lions Club

International

Environmental

Health

Division, MOH

All regions Guidelines on sanitation;

handwashing programs in

schools; latrine coverage

surveys in districts; and

M&E

NO WHO, Danida, DFID,

German

International

Cooperation, Italian

Cooperation, others

Ministry of

Education’s

All regions Deworming, sanitation,

and WASH activities in

NO UNICEF


7

Partner Location


In FY18, was

USAID providing

direct financial

support to this

partner through

ENVISION?

List other donors

supporting these

partners/activities

School Health

Department

schools; training of

teachers in charge of

pupils’ health and

sanitation; and policy

formulation, coordination,

advocacy, training, and

M&E

Note: M&E, monitoring and evaluation.

2) National NTD Program Overview

The MOH’s NTDCP is headed by the National NTD Coordinator, who is also head of the Vector Control

Department at the MOH and the NTD Secretariat. The NTD Secretariat comprises all NTD partners and

program managers (PMs). It provides an opportunity for partners and the MOH to plan the strategic

direction of the program. The Secretariat also facilitates harmonizing activities and identifying

bottlenecks to program implementation and relevant solutions.

The National NTD Coordinator is assisted by PMs, senior program staff, scientists,

technologists/technicians, and other support staff. The NTDCP coordinates activities against the five

preventive chemotherapy (PC) NTDs and the Innovative and Intensified Disease Management NTDs.1

The MOH sets the country’s NTD strategic direction, incorporates NTDs in its annual statement and

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

and research.

The MOH Top Management Committee, chaired by the Director General of Health Services, serves as

the steering committee for all health-related programs, including the NTD program. In addition, the NTD

program has a Technical Committee (described further in the Strategic Planning section), which is part

of the MOH Top Management Committee. The MOH Top Management Committee, through the Director

General of Health Services, Minister of Health, State Minister for Health–General Duties, and State

Minister for Health–Primary Health Care, conducts program-specific, high-level advocacy in support of

the NTD program, such as during visits with representatives of parliament and meetings with visiting

partner and funder delegations.

The disease-specific programs are managed by experienced MOH staff, comprising PMs, scientists, and

technicians. The MOH pays salaries, provides office and laboratory space, pays ground rates, and

contributes to the procurement of laboratory equipment. At other levels of the health system, the MOH

and DLGs recruit and provide salaries for NTD staff.

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

units are handled by the National Medical Stores (NMS). Occasionally, ENVISION hires vehicles to

1 Including human African trypanosomiasis, leishmaniasis, jiggers, Buruli ulcer, cysticercosis, tungiasis, rabies,

leprosy, plague, and Guinea worm (which has been eliminated from Uganda).


8

transport drugs to districts when the NMS delivery schedule is not in alignment with the MDA schedule.

This support will continue in FY19.

Uganda has had a long history of NTD control. The responsibility for research and control of NTDs is

vested in the MOH’s VCD. Since its inception, VCD has housed all vector-borne disease programs,

including the NTDCP. Some of these programs targeted malaria control, leishmaniasis, plague, louse-

and tick-borne diseases, and some current PC NTDs. The exceptions were programs addressing

trachoma, Buruli ulcer, and Guinea worm, all of which are housed at MOH headquarters (HQ). VCD had

at least four active vertical programs prior to the advent of the NTDCP. The main programs were the

National Onchocerciasis Control Program (NOCP), the National Program to Eliminate Lymphatic Filariasis

(PELF), the Bilharzia and Worm Control Program, and the National Sleeping Sickness Control Program.

VCD also had a School of Medical Entomology, which trained vector control specialists. In 2007, all PC

NTD programs were integrated, and the national NTDCP, based at VCD, was born, bringing together all

PC NTDs for the first time. Since then, considerable progress has been made toward the control and

elimination of targeted PC NTDs..

a) Lymphatic Filariasis and Soil-transmitted Helminths

In Uganda, LF, which is caused by Wuchereria bancrofti, is widespread and is found in the eastern,

northern, and western regions of the country. The disease is transmitted by the common malarial vector

mosquitoes Anopheles gambiae complex (comprising An. gambiae ss, An. arabiensis, and An. bwambae;

and An. funestus sibling species. In endemic urban areas, Culex quinquefasciatus also contributes to

transmission. A review of historical hospital records showed that LF was highly endemic in some districts

in northern and eastern Uganda. In those areas, demand for hydrocelectomy was high, and a

hydrocelectomy technique was developed at Lira Hospital in the 1950s.

For almost five decades, little was done on LF research and/or control. Baseline epidemiological

investigations started in 1998 in Lira, Katakwi, and Soroti districts. Clinical examinations of adults

revealed that the most common clinical manifestations were hydroceles (20% in men aged 20 years and

above) and lymphedema (approximately 5% in men and women). These surveys demonstrated

microfilaraemia in night blood samples and antigenaemia in day blood samples tested for circulating

filarial antigen (CFA) using immunochromatographic test (ICT) kits.

From 2000 to 2002, rapid nationwide mapping in primary schools using ICT kits was conducted covering

all ecological and topographical zones. This mapping demonstrated that LF was widespread and highly

endemic in parts of the north and east, especially north of the central lakes (Kyoga and Kwania), with

CFA prevalence rates exceeding 30% in some areas. A small focus was found in Bundibugyo and Ntoroko

districts in the western region along the DRC border. Here, the disease is transmitted by An gambiae ss

and An. bwambae, a vector unique to this region, found breeding in hot sulfur springs.

The PELF was established in 2002 by the MOH with support from WHO, the Mectizan® Donation

Program, and GlaxoSmithKline. The national program adopted the WHO and Global Alliance strategy for

LF elimination, as follows:

• Yearly treatment with ivermectin (IVM) and albendazole (ALB) for at least 5 years in all endemic

districts (IUs)

• Assessment of disability caused by LF and putting in place of facilities and services for MMDP to

reduce the burden of chronic manifestations of LF


9

• Introduction of supplemental interventions known to impact LF, such as deworming with ALB,

OV MDA with IVM, and integrated vector management (e.g., long-lasting insecticide-treated

nets, indoor residual spraying, larval mosquito control).

The PELF commenced MDA in 2002 in two districts of Lira (now Dokolo, Lira, Alebtong, Otuke, and

Amolatar) and Katakwi (now Amuria and Katakwi).

In 2004, the program was extended to three more districts of Kotido (Abim, Kaabong, and Kotido),

Moroto (Napak and Moroto), and Nakapiripirit (Amudat and Nakapiripirit). In 2005, five more districts

were added (Apac, Soroti, Kaberamaido, Kumi, and Kamuli). This support by WHO and the Liverpool LF

Support Centre was short lived because of the civil war and insurgency that engulfed virtually all LF-

endemic districts in the north, east, and west and interrupted treatment from 2003 to 2006.

The integrated NTDCP commenced in 2007 and received financial and technical support from USAID

through RTI. Nationwide refining of the LF distribution map was completed. MDA was rapidly scaled up,

and 100% geographical coverage was achieved by 2010. Since then, LF MDA has been conducted

consistently and with fairly high coverage except in some war-affected districts in the northern region.

By FY18, of the 58 endemic districts, 49 had stopped MDA, and a population of approximately 12.7

million now lives in areas freed from the risk of LF transmission. In FY18, the program conducted pre-

TAS in three districts and TAS2 in 17 districts.

LF treatment, through IVM/ALB, has also had a significant impact on STH prevalence and intensity,

according to MOH assessment surveys. To date, 49 districts have stopped MDA for LF, and only six will

receive MDA in FY19. However, STH control will continue as long as sanitation remains poor. These STH-

only districts are being treated through Child Health Days (CHD), with deworming conducted twice per

year in all districts, regardless of STH prevalence. However, CHD has been affected by poor

management, leading to loss of confidence and withdrawal of the major partner, UNICEF. The MOH has

now taken steps to streamline CHD management to win back the main partner.

MMDP: The burden of LF morbidity is estimated to be high based on hospital records and the few

available baseline epidemiological studies. However, no country-wide assessments have been done. As

part of the LF elimination dossier, it is necessary to put in place modalities for addressing the burden of

chronic manifestations. In 2017, PELF embarked on a KAP study on LF causes, transmission, and

manifestations/morbidity and the availability and affordability of MMDP services in Lira, Kitgum, and

Yumbe districts. This study aimed to prepare the program to implement MMDP services in the future.

In 2017 and 2018, PELF, with support from DFID through Sightsavers, embarked on piloting MMDP

activities in four districts in northern Uganda that were co-endemic with OV (Lira, Pader, Lamwo, and

Amuru). Rapid LF burden assessments were carried out using parish supervisors, village health teams

(VHTs), and health workers. They revealed a high burden of hydrocele and elephantiasis, especially in

Lira District (374 and 97 cases, respectively). Fewer cases were seen in the other districts. A skilled

surgeon was contracted to train medical officers, anesthetists, theater nurses, and clinical officers on

the latest hydrocelectomy techniques at Lira Regional Referral Hospital. Thirty-four hydrocelectomies

were performed. Because of the overwhelming number of hydroceles registered, arrangements are now

being made to offer hydrocelectomy services to the remaining confirmed cases, especially in Lira

District. It is hoped that Sightsavers will extend this support to other LF-OV co-endemic districts. There

is, however, an urgent need to cater for the remaining districts in western, northern, and eastern

Uganda that have high burdens of LF morbidity but are not endemic for OV (and, therefore, not

supported by Sightsavers). PELF has incorporated MMDP assessment questions into its pre-TAS and TAS

questionnaires. These will be administered in June and July 2018 and in surveys and will provide LF

morbidity data for planning.


10

Soil-transmitted helminths (STH), including Ascaris lumbricoides (roundworm), Trichuris trichiura

(whipworm), and Ancylostoma duodenale and Necator americanus (hookworms), are widely endemic in

Uganda. However, their geographical distributions vary and are heavily influenced by climatic

conditions, especially temperature and rainfall. Hookworm infection is the most widespread, and its

prevalence exceeded 60% in many schools surveyed prior to MDA in June 2007. In contrast, A.

lumbricoides and T. trichiura are concentrated in southwestern Uganda, where the prevalence can be as

high as 100%. However, because of the regular deworming of school-age children (SAC) and improved

sanitation, the prevalence of STH infections has decreased significantly. Currently, STH prevalence

ranges from 0 to 34%.

The MOH conducts nationwide twice-yearly deworming of children aged 1–15 years in April and

October, during CHD. This activity is coordinated by the Nutrition Division of the MOH and jointly funded

by the government through its primary health care funds and UNICEF. Mebendazole is donated by

Johnson & Johnson. However, deworming during CHD has encountered financial and management

challenges. As a result, treatment coverage in some districts has been as low as 20%. In districts co-

endemic for LF and STH, MDA is integrated, and children take a combination of IVM+ALB (or ALB alone

for children aged 1–4 years) during the first round of treatment and ALB/mebendazole in the second

round.

The NTDCP LF program, funded by ENVISION, has contributed significantly to the control of STH. A 2017

MOH evaluation of the impact of deworming on STH prevalence revealed that STH prevalence had

decreased after 10 years of deworming, particularly among children 1–14 years. WHO also funded a

study to assess the impact of IVM/ALB on STH in several LF and non-LF districts. This study was

conducted in 2016 in 12 districts, eight of which were LF endemic and four were non-LF endemic. The

baseline prevalence of STH in 2002 was as follows: 62.5% in Yumbe; 56.8% in Bundibugyo ; 54.3% in

Nakasongola; 54.1% in Mbale; 27.9% in Hoima; 12.2% in Nakapiripirit; and 16.4% in Kaliro. The study

found that the STH prevalence in non LF districts ranged between 0% and 48.3% while in LF endemic

districts the range was between 0% and 43.3%. It was noted that the LF endemic districts with the

highest STH prevalence had stopped MDA in 2014, suggesting that a cessation of LF treatment resulted

in an increase in STH prevalence.

ENVISION-supported MDA aligns with CHD, and thus, the two programs are coordinated. In districts co-

endemic for LF, the ALB required for STH is donated by GlaxoSmithKline. In cases where LF funds and/or

drugs are delayed, districts generally postpone their CHD and wait for LF MDA.

b) Trachoma

Trachoma is an infectious disease of the eyes caused by the bacterium Chlamydia trachomatis and has

been reported in Uganda since colonial days. It was once stated that “trachoma is at the bottom of

almost every eye disease which one meets in Uganda”. It was also observed that trachoma was

responsible for more ocular disability in Uganda than any other single cause. Trachoma mapping

activities started as early as the 1930s, but major advances commenced in 2006, when Sightsavers

funded baseline epidemiological surveys in four districts in Busoga Sub-region and two districts in

Karamoja Sub-region using WHO methodology. The surveys revealed that trachoma was highly endemic

in these districts, with TF prevalence in children aged 1–9 years as high as 65% in Karamoja and 30% in

Busoga.

The Trachoma Elimination Program was established in 2007 under the NTD Secretariat at VCD. It has

been receiving support from USAID through RTI since that time. In 2007, baseline epidemiological

mapping was scaled up using WHO/Global Trachoma Mapping Project (GTMP) guidelines (later


11

succeeded by Tropical Data). Trachoma mapping prioritized the eastern region, which was known to

have the highest burden, followed by the northern and then western regions. The central region

(Buganda) has no reported trachoma

The SAFE Strategy

The WHO/SAFE strategy was adopted by the Trachoma Elimination Program in 2007. The surgical

component was initially supported by Sightsavers and CBM, which were later joined by The Trust. The

partners have supported the MOH to conduct TT surgeries in the districts in eastern Uganda with high

TT burdens (estimated to be more than 100,000 cases). Many districts in the eastern region have now

reached the UIG for TT: 2 cases per 1,000 population. The TT surgery backlog has been reduced from

more than 100,000 to between 15,000 and 20,000 cases. Some of the current cases were identified in,

the recently surveyed refugee settlements and districts neighboring known endemic districts.

Trachoma MDA commenced in 2007 using Zithromax® (ZTH) tablets (250 mg) for individuals aged 5 or

above, ZTH powder for oral suspension (POS) (125 mg) for children between 6 months and 4 years, and

tetracycline eye ointment (TEO, 1% ointment) for children under 6 months, pregnant women,

individuals who are allergic to ZTH, and those who are sick. These medicines are administered by trained

community medicine distributors (CMDs), teachers, and health workers in the case of POS.

ENVISION supports MDA and baseline surveys, impact assessments, surveillance surveys, trachoma

rapid assessments (TRAs), and the purchase of TEO. All the TT data used to plan surgical activities by

other partners come from ENVISION-funded assessments.

The F and E components of the SAFE strategy are being implemented by local partners with funding

from The Trust, although their impact on overall trachoma prevalence is difficult to quantify. The

availability of clean water has improved overall, as has sanitation, according to Uganda Bureau of

Statistics surveys. However, Karamoja Sub-region still lags behind in F and E, and it is feared that these

factors might delay the elimination of trachoma in the country. Overall, F and E interventions are

generally limited in scope, are not found in all endemic districts, and do not cover whole districts where

they operate. These issues have been compounded by cross-border movement into and out of the

Pokot and Turkana areas of Kenya where trachoma is highly endemic, and MDA has not been regularly

implemented.

In FY19, with all districts having completed the required MDA, ENVISION will also support trachoma

impact surveys in three districts and trachoma surveillance surveys (TSSs) in seven districts. The Trust

will continue to support TT surgeries.

c) Onchocerciasis

OV is highly endemic and widespread, occurring in several foci across the country. The causative agent is

Onchocerca volvulus, a filarial worm that inhabits nodules found under the skin. The adult worms

produce microfilariae (mf) that migrate to the skin and eyes and cause pathology (i.e., onchodermatitis,

endemic dwarfism, leopard skin, and ocular involvements, including blindness).

Between 1995 and 1998, VCD/MOH conducted epidemiological surveys (rapid epidemiological mapping

of OV [REMO] and skin snipping), which demonstrated infection prevalence rates ranging from 10% to

nearly 100%. The community microfilarial load in adults aged above 20 years ranged from 0.93 to 132.8

mf per mg of skin. The vectors are Simulium black flies, of which S. neavei accounts for 85% of

transmission. The larval stages of the black fly develop inside fresh water crabs of the genus

Potamonautes. Therefore, OV elimination includes the testing of fresh water crabs to confirm if black


12

flies are reproducing. It should be noted that recent ecological changes and human activity have

resulted in the disappearance of some fresh water crabs and vectors.

OV is endemic in 16 foci in the eastern (one focus), northern (six foci), and western (nine foci) parts of

Uganda. A 17th focus was located on the Victoria Nile but achieved elimination of the disease in early

1970s, and verified recently (2017/18) with recent WHO verification guidelines. There are 39 OV-

endemic districts, with an at-risk population of 2.6 million and approximately 2.0 million infected

people. In two foci, Madi-Mid North and Lhubiriha in Kasese District, the vector is S. damnosum ss and

S.kilibarnum respectively . The other foci with S. damnosum sl as the vector were the Victoria Nile (from

which the vector was eliminated in 1974) , Obongi and Wadelai foci where recently transmission was

interrupted and are in post treatment surveillance (PTS) period. Regular annual monitoring of this focus

has confirmed vector elimination. In the rest of the foci in the country, S. neavei is or was the only

vector.

OV control in Uganda dates to the 1930s, when experimental control of Simulium fly vectors with

insecticides commenced. The insecticide used was dichlorodiphenyltrichloroethane (DDT) emulsifiable

concentrate applied at the headwaters of the River Nile in Jinja. Through the intermittent application of

low concentrations of DDT (0.5 ppm), Uganda managed to eliminated S. damnosum from one of the

largest foci, the Victoria Nile focus. However, this approach was found to be unsustainable in several foci

in the west and north because of budget constraints and political upheavals of the 1970s and 80s.The

work on onchocerciasisis control largely re-instated with support to the Ministry of Health from River

Blindness Foundation in 1992.

National OV mapping was conducted with the support of the African Program for Onchocerciasis Control

using REMO, and the findings were published in 1998. This mapping, which was based on onchocercal

nodules in adults, revealed the magnitude, distribution, and main foci of river blindness in the country,

and the prevalence of nodules ranged from below 1% to above 40% The REMO exercise was followed

with further refinement of the OV distribution map to include all hypo-endemic areas previously

excluded from MDA.

A national action plan was developed under the National Onchocerciasis Task Force. MDA with IVM

(Mectizan®) commenced in the highly endemic districts in western (Kisoro, Kabale, Rubanda, and Kasese

districts) and northern (Nebbi District) Uganda. MDA commenced in 1993 and continues to date in some

communities. In Kisoro and Nebbi districts, sentinel sites (SSs) were selected to facilitate monitoring the

impact of MDA after treatment. After three rounds of annual IVM treatment, the prevalence of

microfilaraemia in skin snips and the community microfilarial load had decreased significantly,

demonstrating the effectiveness of MDA. Annual MDA was scaled up gradually to cover all foci, whether

hypo- or hyper-endemic.

In 2007, the NOCP adopted an elimination policy that included 6-monthly IVM treatment and vector

control to supplement MDA. The disease and vectors have been eliminated from several foci in the

country. Seven foci, including the Victoria Nile focus, have reached elimination status; five foci have

achieved interruption of transmission; and in 3 foci, interruption of transmission is suspected. Only two

foci (Lhubiriha in Kasese District and Madi-Mid North in the northern region) have active transmission.

These two foci extend into the DRC (Lhubiriha) and South Sudan (Madi-Mid North). Efforts are underway

to curb trans-border transmission through joint action plans with these two neighbors. The plan is

already active along the DRC border, and in May 2018, a cross-border OV planning meeting was held to

develop a similar plan for South Sudan.


13

Cumulatively 9 foci: Mt. Elgon, Immaramagambo, Itwara, Victoria, Mpamba-Nkusi, Wabaya-

Rwamarongo, Kashoya-Kitoomi, Budongo and Bwindi have interrupted OV transmission.

NOCP has an active PTS plan. PTS lasts for 3 years and involves entomological surveillance, including

polymerase chain reaction (PCR) analysis of flies, monitoring OV16 prevalence, and interacting with

leaders and communities through sensitization meetings, drama, posters, and retraining of health

workers so that they can identify new cases of OV.

For more sensitive diagnostics, the program shifted from conventional invasive skin snip microscopy and

vector dissections to the sensitive methods of serology and PCR. The serological OV16 technique uses

dried blood spot samples to detect the exposure of children under 10 years to OV infection. The PCR

technique (O-150) is done on skin snips from OV16-positive children to confirm the presence of the OV

parasite. Pool screening of vectors caught during entomological monitoring is done using PCR to detect

parasite DNA in black flies. The Carter Center supports the laboratory. However, there is a need to

further strengthen laboratory capacity to identify vectors by PCR.

After 3 years of PTS, the foci are classified as having eliminated OV if no risk of recrudescence is evident

in humans and vector populations. Blood spots from at least 3,000 children are tested using OV16 and

skin snips using PCR. Vector populations are monitored. Communities are sensitized, and health workers

in district facilities are trained to detect, treat, and report any cases of suspected OV. The National

Certification Committee makes verification visits to assess the effectiveness of post-treatment and post-

elimination activities.

In the August 2018 UOEEAC meeting, two more foci, Bwindi and Budongo, were declared as having

interrupted transmission, meaning that they will conduct their last MDA in October 2018 and proceed to

PTS in January 2019. This reduces the number of districts conducting semi-annual OV MDA from 21 to 15.

In FY19, ENVISION will therefore support 15 districts for two rounds of MDA. Sightsavers will shift their

support from MDA to PTS.

d) Schistosomiasis (Bilharzia)

Uganda is endemic for both human forms of SCH: urogenital (caused by Schistosoma haematobium) and

intestinal (caused by S. mansoni). Intestinal SCH is widespread, occurring in 87 of the current 123

districts, based on the Kato-Katz diagnostic method used by the MOH. It is transmitted by several

species of Biomphalaria snails, especially Bi. pfeifferi, Bi. sudanica, Bi. stanleyi, and Bi. choanompaha.

Urogenital SCH is endemic in four districts (Kole, Oyam, Lira and Dokolo). Transmission is through

Bulinus spp, possibly including Bu. nasutus snails.

The pattern of transmission is very diverse in Uganda, ranging from small seasonal streams to large

water bodies such as Lake Victoria. The major foci of intestinal SCH are large water bodies, such as Lake

Victoria, Lake Albert, Albert Nile, and the Lake Kyoga-Kwania basin, and irrigation schemes. In contrast,

urogenital SCH has almost been eliminated from its original focus in Lango Sub-region. A 2017 survey in

100 districts using circulating cathodic antigen revealed an overall national SCH prevalence of 29%. The

survey was a collaboration between Makerere University School of Public Health, Johns Hopkins

University, and the Uganda Bureau of Statistics as part of the Performance Monitoring and

Accountability 2020 Project. In total, 5.4 million people were estimated to be infected and 12 million at

risk of contracting SCH.

Uganda initiated its SCH control program in 2003 with support from SCI. Since 2007 to 2017, RTI (with

USAID support) and SCI have been the main partners supporting SCH control. Many districts have seen

significant reductions in infection prevalence, intensity, and related morbidity. In many of these,


14

treatment is now only required for SAC, either annually or once every 2 years (e.g., Dokolo, Amolatar,

Amuru, Arua, Gulu, Kitgum, Lira, Nwoya, Omoro, and Pader). However, there are districts where several

rounds of MDA have had little impact on disease prevalence and morbidity, and pockets of life-

threatening gross morbidity, such as hepato-splenomegaly, fibrosis, and hematemesis, remain. These

cases are most often seen along the Albertine basin in the districts of Buliisa, Hoima, and Pakwach,

which have the most intense year-round transmission In such districts, MDA alone cannot control or

eliminate SCH morbidity.

Uganda is now planning to apply the PHASE approach (PC, Health education, Access to clean water,

Sanitation improvement, and Environmental management for snail control) to SCH control. All the

components of the strategy except snail control are being implemented. The MOH has already trained a

team for snail control in Zanzibar with the support of the Government of China and SCI, but the work of

this team is awaiting the availability of operational funds and purchase of molluscicides.

In high-risk areas (≥50% prevalence), the NTDCP follows WHO guidelines in treating SAC and high-risk

adults once annually. In moderate-risk areas (≥10% to <50% prevalence), SAC are treated annually, with

selective treatment of adults to prevent morbidity. In low-risk areas (≥1% to <10% prevalence),

treatment is administered once every 2 years..

In FY19, ENVISION will support SCH treatment in 13 districts (one in the west and 12 in the north).

Support for the remaining districts has been handed over to SCI and World Vision. ENVISION will provide

financial and technical support for social mobilization to improve praziquantel (PZQ) uptake, including

community dialogue on SCH prevention practices. ENVISION will continue to provide TA for monitoring

adverse events (AEs). Major landing sites will be used as focal points for engaging community leaders

(e.g., LC1s, Beach Management Units), fisher folks, schools, and mobile trans-border fish mongers. In

FY19, ENVISION will continue to support disease-specific assessments (DSAs), especially for LF and

trachoma, in selected districts to guide program planning. These are discussed in detail in the M&E

section.


15

3) Snapshot of NTD Status in Country

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

September 30, 2018

Columns C+D+E=B for each

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

MAPPING GAP

DETERMINATION MDA GAP DETERMINATION

MDA

ACHIEVEMENT DSA NEEDS

A B C D E F G H I

Disease

Total

No. of

Districts

in

COUNT

RY

No. of

districts

classified

as

endemic

**

No. of

districts

classified

as non-

endemic

**

No. of

districts

in need

of initial

mapping

No. of districts

receiving MDA

as of 09/30/18

No. of districts

expected to be

in need of

MDA at any

level: MDA not

yet started, or

has

prematurely

stopped as of

09/30/18

Expected No. of

districts where

criteria for

stopping

district-level

MDA have

been met as of

09/30/18

No. of

districts

requiring

DSA

as of

09/30/18

USAID-

funded Others

LF

123

58 65 0 9 0 0 49

Pre-TAS: 6

TAS1: 3

TAS2: 10

OV 39 84 0 15 0 0 24 0

SCH 87 36 0 13 36 38 0 0

STH 123 0 0 6 117 0 0 0

Trachoma

***

39 84 0 3 0 0 36 (i) 3 for TIS

(ii) 7 for TSS


16

PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

As part of ENVISION support to the MOH to accelerate the achievement of elimination goals, FY18

capacity strengthening objectives focused on (1) strengthening MOH capacity to conduct surveys and

use the resulting data for strategic planning and resource mobilization and (2) strengthening community

mobilization efforts in highly endemic areas with low treatment coverage (Table 3).

a) Strategic Capacity Strengthening Approach

Program capacity gaps are shared and discussed during the monthly NTD Secretariat meetings.

ENVISION will use the NTD Secretariat meetings and national annual planning meetings to work with

NTD program leadership to identify capacity strengthening gaps and priorities across technical,

managerial, financial, and operational areas. This strategy will enable ENVISION to coordinate support

with other partners to minimize duplication.

Capacity goals

The NTDCP’s goal is to ensure strong technical, financial, operational, and administrative capacities at all

levels of the health system to advance NTD control and elimination in the country.

Capacity strengthening strategy

The MOH’s priorities for NTDs are ensuring adequate human resources to treat difficult-to-reach people

and strengthening data collection and dissemination. FY19 capacity strengthening will focus on (1)

strengthening the MOH’s capacity to manage and use NTD data and (2) improving community

mobilization and health education with the ultimate goal of improving MDA coverage. This strategy will

include the following objectives and interventions.

b) Capacity Strengthening Objectives and Interventions

Total cost for activities in this section: $12,850 (RTI)

Objective 1. Strengthen the MOH’s coordination and management of NTD data

Intervention 1: Orient Program Managers and NTD district focal persons (FPs) on the district NTD

database: A key component of a mature program is a robust monitoring process. In FY18, ENVISION

worked with the MOH to develop a district database to improve MDA planning and reporting of NTD

data at the district level. During FY19, ENVISION will support the orientation of 20 national PMs and

district FPs on the district database. The initial orientation will take 2 days of hands-on training, followed

by on-the-job training for district- and community-level staff. The database is expected to become

operational during FY19.

Intervention 2: Support the inclusion of NTD indicators into DHIS2: The MOH is proposing NTD MDA

indicators to be included in District Health Information System 2 (DHIS2). Achieving this goal will require

coordination with the Resource Center, the department responsible for the national health information

system. ENVISION will provide technical support for the identification of MDA indicators to be included

in DHIS2. ENVISION will also provide financial support for MOH central supervisors to carry out MDA

process monitoring during MDA to determine the reliability of data collection processes, compilation,


17

and reporting. This monitoring will enable the reliable assessment of progress toward achieving

effective MDA coverage. Funds will include per diem and transport and are covered in the NTD

Secretariat costs.

Intervention 3: Develop data collection and reporting standard operating procedures (SOPs): The MOH

is developing SOPs that will standardize data flow from the sub district levels to the national level.

ENVISION will provide technical support to the MOH to develop SOPs to guide this flow of NTD data.

ENVISION will also provide technical support to the MOH to strengthen the use of these for

programmatic decision making using ENVISION’s data for action guide.

Intervention 4: Update the integrated NTD database: The MOH uses the integrated NTD database to

store historical NTD data. ENVISION M&E staff provide technical support to the MOH to periodically

audit the integrated NTD database and ensure that the data entered are complete, accurate, and

adequately backed-up. ENVISION will continue to support this effort in FY19.

Objective 2. Strengthen capacity to design and implement effective community mobilization activities

Effective community mobilization and education are particularly important in those districts with low

treatment coverage. Feedback from pre-MDA community dialogue sessions conducted in four districts

in FY18 demonstrated low levels of knowledge about NTDs at the community level.

Intervention 1: Review, finalization, and printing of community dialogue guidelines: Community

dialogue guidelines were drafted and pretested in FY18 in four districts conducting MDA in April 2018.

These guidelines will be tested in the 22 districts conducting MDA in October 2018 prior to their

finalization. In FY19, ENVISION will hire a social mobilization consultant to work with the MOH and

ENVISION to review and finalize these tools. The aim is to have create interactive community

mobilization approaches that will help to answer community members’ questions. ENVISION will then

print 5,000 of these tools to be used by district health educators (DHEs), sub county supervisors, and

VHTs to conduct community dialogue sessions before MDA. The same tools will be used in districts

where MDA has stopped to help communities understand why treatment has stopped. The review and

finalization process will be carried out at a 3-day workshop retreat involving 12 people led by the social

mobilization consultant and assisted by the senior health promotion and education specialist attached

to the NTD program.

Intervention 2: Orientation of District Health Educators on NTDs and NTD materials: The DHE’s role is

to coordinate the planning, implementation, and evaluation of all district health education activities,

including those targeting NTDs. However, this cadre of staff has not been exposed to NTDs to a level

where they are comfortable designing relevant health education activities. In FY19, ENVISION will

provide technical, financial, and logistical support for a 3-day orientation session for DHEs from the 16

ENVISION-supported districts. The orientation will cover NTDs, the communication strategy, community

dialogue tools/guidelines, the importance of strategic community engagement, and the integration of

NTDs in district-specific health education plans. DHEs will be provided with tools such as fact sheets,

community dialogue guidelines, and IEC materials to assist them in implementing what they learn during

the orientation. The success of this orientation will be measured by the demonstrated active

participation of DHEs in NTD activities through organizing well-thought-out community mobilization

activities.


18

c) Monitoring and Evaluating Proposed Capacity Strengthening Interventions

Objective 1: Strengthen the MOH’s coordination and management of NTD data

Indicators:

1. Availability of NTD data for selected sub district levels in the NTD district database.

Objective 2: Strengthen capacity to design and implement effective community mobilization activities

Indicators:

1. Number of DHEs who are actively involved in NTD activities.

Table 3: Project assistance for capacity strengthening

Project assistance

area Capacity strengthening interventions/activities

How these activities will help to

correct needs identified in

situation above

a. Strategic

Planning

1. NTD Technical Committee meeting

2. Cross-border meeting

3. End of Project Review meeting

4. Planning and review meetings with NMS for last mile

distribution

5. District micro-planning and post-MDA feedback

meetings

6. NTD documentation workshops for LF, trachoma, and

SCH

1. Improved program oversight

2. Coordinated NTD interventions

across borders to control cross-

border infections

3. Acceleration of elimination

efforts

4. Enhanced country ownership

5. Sharing of program successes

and experiences to enhance NTD

program visibility

b. NTD Secretariat

Build the capacity of PMs and senior program staff

through various trainings and general support for office

operation

1. Improved operational

efficiencies among PMs

2. Program-specific issues

addressed in a timely fashion by

PMs and senior program staff

c. Building

Advocacy for a

Sustainable

National NTD

Program

1. District-level advocacy with district leaders and

community-based organization and nongovernmental

organization managers

2. Dissemination of NTD program data for advocacy

3. Breakfast meeting with MPs from the 16 ENVISION-

supported districts

1. Increased knowledge and

awareness about the NTDs in the

country

2. Sustained country efforts and

support toward NTD control and

elimination

d. Mapping (Re)training of program teams on NTD disease mapping

1. Endemic areas refined

2. NTDs mapped in refugee

settlements and treatment

initiated where needed

3. Threat of reinfection addressed

e. MDA Coverage

Training of RTI and NTD Secretariat staff and

independent surveyors in coverage validation survey

methodology and implementation

Ensured MOH capacity to lead and

implement such surveys, which

are key to monitoring quality

MDA coverage

f. Social

Mobilization to

Enable NTD

1. Sensitization of leaders

2. Training of district health education teams to manage

the community dialogue process

1. Increased knowledge of NTDs

2. Adoption of appropriate health

practices

3. Improved MDA coverage


19

Project assistance

area Capacity strengthening interventions/activities

How these activities will help to

correct needs identified in

situation above

Program

Activities

3. Training of media teams/meetings with media

houses to ensure they can report on NTDs correctly

g. Training

Training of health workers and other program

implementers on NTDs:

1. General NTD program implementation and processes

2. Disease-specific training on transmission, clinical

manifestations, diagnosis, treatment, and management

of SAEs

3. Data management, including the use of the district

integrated NTD database and DHIS2

4. Capacity of health workers (at

all levels) in NTD program

management built

h. Drug Supply

and Commodity

Management and

Procurement

1. Regular meetings with NMS

2. Training/coaching of PMs on the process of preparing

the JRSM and completion of ZTH application forms

3. Training of implementers at all levels on NTD drug

quantification and reverse logistics

Strengthened drug supply,

management, and procurement

capabilities in NTD Secretariat and

districts

i. Supervision for

MDA

(Re)training of central, district, health center, and sub

county supervisors and M&E consultants

Roles and responsibilities of each

cadre clearly spelled out

j. M&E

1. Development of the NTD district database

2. Training of the district and MOH NTD teams on the

NTD district database and DHIS2

3. Training the district and MOH NTD teams on the

principals of M&E

4. Establishment of an internal policy committee in the

MOH

5. Development of training programs and manuals

6. Development of M&E capacity building framework

7. Development of criteria to identify capacity building

needs

8. Development of a knowledge assessment survey

1. Increased leadership and

implementation responsibilities of

the NTD program by the districts

and MOH, leading to program

sustainability

2. Increased competence of the

MOH and districts in

implementing the NTD program,

leading to program ownership

3. Increased partnership

collaboration

k. Supervision for

M&E and DSAs

On-the-job training and mentoring of staff at all levels

of implementation to ensure that problems are

identified quickly, and solutions implemented

Districts that have consistently

underperformed supervised

closely to ensure timely and

quality program implementation

l. Dossier

Development

Involvement of MOH and RTI program staff in the

development of dossiers for LF, trachoma, and OV

Strengthened MOH capacity to

develop dossiers

m. STTA

1. On-the-job training of trachoma teams by a

consultant during assessments

2. Training of health education teams on social

mobilization processes/activities

Staff competence will be

strengthened to conduct

assessments and social

mobilization

Note: JRSM, Joint Request for Selected (PC) Medicines; STTA, short-term TA.


20

2) Project Assistance

a) Strategic Planning

In FY19, ENVISION support will follow this same approach, focusing on the following meetings:

Activity 1: NTD Technical Committee meetings (RTI)

This committee was established in 2014 to provide technical guidance on NTD activity planning,

implementation, and monitoring. It is composed of national NTD experts and is chaired by the

Commissioner, Community Health Department.

To date, the committee has facilitated the completion of the National NTD Master Plan, the National

Communication Strategy, and the NTD registers. The mandate of the committee has expanded to

include reviewing disease elimination dossiers and advising on actions required after conducting DSAs.

In FY19, ENVISION will support two meetings for this committee and work with the MOH to review the

terms of reference of the Technical Committee to include provisions for guidance on NTD operational

research and other areas related to policy frameworks. The ENVISION team will work with the Technical

Committee on reviewing the dossiers and provide resources for meetings and retreats for these

technical reviews. Costs include per diems and transport for committee members, allowances, and other

required material support (such as stationery and airtime).

SCH/STH Subcommittee experts

In FY19, the NTD Technical Committee will establish a new SCH/STH sub-committee consisting of existing

members international SCH/STH experts. The purpose of this sub-committee is to provide guidance on

the way forward for the country’s program especially regarding implementation of the PHASE strategy

that is currently being adopted across the country. ENVISION will provide the funding to support the five

international consultants including their consulting fees and travel costs and this is budgeted under

Short-Term Technical Assistance. Specific requirements for this subcommittee include, (1) a face-to-face

discussion between USAID and MOH personnel, (2) engagement with the USAID mission, (3) agreement

on deliverables and national commitments, and (4) a written agreement between USAID and the

relevant government agencies.

Activity 2: Cross-border meeting (RTI)

Uganda neighbors several NTD-endemic countries. With the country’s goal of NTD elimination by 2020,

concerted efforts to address cross-border transmission are needed. In FY18, ENVISION supported the

development of a strategic document to guide collaboration and the coordination of NTD cross-border

activities. As part of operationalizing the strategic plan, in FY19, ENVISION will support MOH PMs and

staff to participate and share lessons and best practices in cross-border NTD meetings.

The OV program has made significant efforts to operationalize cross-border activities with DRC and

South Sudan. Epidemiological and entomological surveys have been initiated in DRC with technical

support from the Ugandan team. Activities are due to start with South Sudan in July 2018. Additionally,

occasional meetings have been held with officials from Uganda and South Sudan, supported by The

Carter Center and WHO. ENVISION has presented its NTD work in Uganda, including its support for

baseline surveys in refugee settlements hosting refugees from South Sudan.

The trachoma program established the ‘East African NTD/Trachoma cross-border partnership’ that

annually brings together MOH officials, nongovernmental organizations, and funding partners from the

seven countries in the region (Uganda, Kenya, Tanzania, Eritrea, Ethiopia, South Sudan, and Sudan). This


21

partnership allows national programs to review progress and share their experiences in program

delivery. It also enables countries to collaborate in areas of common interest. The initiative's specific

objectives are as follows:

• Create a regional platform for exchanging experiences among participating countries and their

respective partners

• Identify programmatic bottlenecks and challenges and recommend practical solutions

• Ensure that countries are adhering to WHO strategies, SOPs, and guidelines

• Assess resource gaps for SAFE implementation and advocate for resource mobilization

• Design strategies for tackling cross-border challenges.

Previous meetings have enabled reaching a consensus on several areas, including WASH indicators to be

used by the program, joint planning for MDA across borders, and technical guidance on baseline surveys

using Tropical Data. In FY19, ENVISION will support travel and per diem for MOH staff to attend these

meetings.

Activity 3: Program Review Meeting

With support from ENVISION, the Ministry of Health established an integrated platform for the control/

elimination of the 5 PCT NTDs in 2007. This support through the ENVISION project was extended to

September 2019. There have been notable achievements through the years. The country has been able

to complete mapping of NTDs thereby enabling scale up of MDAs to 100% geographical coverage in all

eligible districts. Through this, the burden of the NTDs targeted for elimination has been brought to a level

where they are no longer a public health concern. The program has also built capacity of health workers,

teachers, and community drug distributors to effectively carry out mass treatment campaigns.

Further, the capacity of MoH staff has been built to implement, evaluate and monitor progress of the

program. The country’s health system has been strengthened by assisting the MOH to implement an

integrated NTD database that captures data for all diseases into one centralized repository for better

data management and use. The program has also developed tools to help guide the implementation

process. As the current project winds up, there will be a need to share and acknowledge the successes

attained and lessons learned and ensure that any final items needing attention have been identified and

actions assigned. ENVISION will provide support for this Program Review Meeting.

Activity 4: Planning and review meetings with National Medical Stores (RTI)

The transport and storage of NTD medicines are the responsibility of NMS. However, ENVISION has

often become involved to ensure that the necessary importation documentation is submitted to NMS

and that NMS delivers the correct quantities to the districts on time. NMS delivers medicines to district

health stores, and distributing the medicines to each health facility remains the districts’ responsibility.

Previous discussions between the MOH, NMS, and ENVISION have suggested that NMS should deliver

NTD medicines to the health centers, as they do for other drugs. This strategy would ensure ownership

by NMS, with monitoring by the health committees of endemic districts. To coordinate this activity, the

NTD program will hold quarterly meetings with NMS. These meetings will review drug distribution

challenges, plan the distribution schedule, agree on drug expiry management, and discuss medicine

clearance issues at the port of entry. Costs will include refreshments for NMS staff.


22

Activity 5: District micro-planning (RTI)

Beginning in FY17, ENVISION has supported district micro-planning and feedback meetings. The aim of

these meetings is to improve MDA efficiency by reducing the duration of MDA, ensuring the proper use

of resources, and improving MDA quality by ensuring adherence to NTD guidelines and achieving

treatment targets. Prior challenges in program implementation included a lack of adherence to MDA

planning guidelines, inadequate use of district data in planning, lack of involvement of district

stakeholders, lack of assessment of district resources to support activities, and low program ownership.

During district micro-planning meetings, district treatment data compiled by the ENVISION M&E team

from district reports are discussed, challenges identified, and activities to improve coverage agreed

upon. The meetings review data from all levels of program implementation (villages, schools, parishes,

and subcounties). The meetings’ outputs are district micro-plans that define the activities to be

undertaken, by whom, when, how, and with what resources to ensure collective participation and

ownership of program activities. Meeting participants commit themselves to ensuring their plan is

implemented. Additionally, at these meetings, district leaders share the supervisory roles of program

activities to ensure ownership and improvement in treatment coverage with a focus on low-coverage

subdistricts.

In FY19, ENVISION will support a 3-day micro-planning meeting in each of the 16 ENVISION-supported

districts. Completed micro-planning templates will be shared with the NTDCP and used by ENVISION for

FOG preparation. To promote ownership, the micro-plans will be signed and submitted to the MOH and

ENVISION by the district CAOs with a commitment note to be filed. Prior to these meetings, the NTD

PMs and ENVISION will conduct refresher training for new central-level supervisors who support micro-

plan development. New members of the central-level NTD team will also need orientation on the tools.

Costs include per diem, meals, transport for the district and central teams, venue rental, stationery, and

coordination expenses.

Activity 6: Post-MDA feedback meetings (RTI)

After MDA, the 16 districts technically and financially supported by ENVISION will hold feedback

meetings to review performance. These meetings help identify specific areas of strength and encourage

district ownership of the program. Districts and the ENVISION team check whether they have met the

objectives outlined in the micro-plan. Decisions are made to conduct mop-ups or re-visit data for

specific IUs. The feedback meetings will review drug availability and AE/SAE management. Reports of

the feedback meetings will be submitted together with MDA reports to the MOH and partners. This

activity will be led by the district MOH officials, ENVISION team will supervise the activity. Costs cover

per diem and transport refund for the participants.

Activity 7: NTD documentation workshops for LF, trachoma, and schistosomiasis (RTI)

Since the start of USAID support, significant progress has been made by the Uganda NTD program. The

LF and trachoma programs entering their final stages provides an opportunity to publish country

experiences through various media channels, including peer-reviewed publications. Therefore, the NTD

Secretariat, with technical and financial support from ENVISION, will document and disseminate

progress on these three NTD programs. Three meetings of seven program staff and two ENVISION staff

will compile the necessary information and collate key program results, progress, achievements, and

challenges. A local NTD documentation consultant will be hired to write up the material in appropriate

formats for the various intended publications, including manuscripts for publication in journals,

abstracts for meetings and international workshops/conferences, and media briefs for domestic

dissemination. The ENVISION team will actively participate in the writing exercise and provide the


23

necessary data and information to fill gaps. ENVISION’s communication team will also support

publication of these articles on the RTI website and other appropriate channels.

Activity 8: MDA data review meeting at the MOH (RTI)

The NTD program does not have standardized operating procedures to guide data collection and

reporting procedures, especially for data that come in after mop-ups and scenarios where partners have

different population sources. Routine data review meetings are essential to ensure that internal quality

controls are exercised prior to archiving and using MDA data for decision making by partners and the

MOH. The process will involve identifying potential errors in MDA datasets and ensuring that districts’

MDA data are free of significant errors and that bias has not been introduced. Additionally, it will dictate

periodic reviews of data collection, management, and processing and harmonize data across partners at

any given time. This meeting will also provide the opportunity to develop and implement strategies to

address and prioritize data gaps. The MDA data review meeting will be held after MDA distribution.

Activity 9: National planning and data review meeting (RTI): In FY19, ENVISION will support a four day

meeting to address issues of data quality and accuracy, and use this information to inform program

implementation.

Activity 10: National Stakeholder Meeting—River blindness program review meetings (The Carter

Center)

ENVISION will support The Carter Center’s facilitation of two bi-annual OV review meetings to share field

experiences, assess progress, discuss challenges, and plan the way forward. Issues discussed at these

meetings form part of the agenda for the expert committee meeting described in Activity 8. These

meetings are held at the implementation level. Participants will include 30 NTD FPs and assistants from

the 15 districts receiving OV treatment; central-level MOH officials, including the OV PM and National

NTD Coordinator; and partners. The meetings will discuss agenda items for the UOEEAC meeting and be

held in January and June 2019. ENVISION will provide partial support for this activity (for 24 attendees),

with the remaining costs covered by non-ENVISION funds.

NTD Secretariat

ENVISION provides financial support to the NTD Secretariat to maintain office equipment and vehicles

for the office of the National NTD Coordinator and PMs of the PELF, SCH and worm control, OV, and

trachoma programs. In addition, ENVISION supports the secretariat in supervising NTD activities and

meeting on a monthly basis. In FY19, ENVISION will support the following:

Activities 1–7: Operational and program supervision support costs (RTI)

National PMs conduct supportive supervision to districts and health sub-districts (HSDs) outside of the

MDA campaign. This supervision is intended to ensure that districts and other administrative units are

playing their roles in the program, such as by following up on the recommendations in activity reports,

issues of financial accountability for program funds, and data-related reporting and recording

recommendations; participating in district NTD meetings; providing on-the-job training for district- and

lower-level teams; and mentoring health workers on the management of NTDs. The National NTD

Coordinator sometimes visits districts to follow up on specific programmatic issues that have been

reported to her by a PM or ENVISION. In FY19, ENVISION will provide financial support to PMs and their

staff for district supportive supervision. Per diem, vehicle hire (where necessary), and fuel will be

covered.

Activity 8: NTD Secretariat coordination meetings (RTI)


24

The NTD Secretariat meets monthly and oversees the overall implementation of the NTD program on

behalf of the MOH. The Secretariat meetings differ from the Technical Committee meetings in that the

participants are the NTD coordinator, disease-specific PMs, and NTD partners, such as RTI. In FY19,

ENVISION will provide refreshments for six Secretariat meetings. Other partners will support the other

meetings.

b) Building Advocacy for a Sustainable National NTD Program

In FY19, ENVISION will support the following advocacy activities:

Activity 1: District-level advocacy meetings (RTI)

This activity will primarily target political, professional, administrative, and civil society organizations to

widen the network of advocates for the support and sustainability of NTD programs at the district level.

These advocates will include the LC5 chairperson; Resident District Commissioner; CAO; DHO; members

of the district health teams (DHTs) (including DHEs); leaders of civil society organizations and youth and

women groups; religious leaders; and heads of departments in sectors relevant to NTD control, such as

education, water and sanitation, and environment. Issues to be discussed will include facts about NTDs

in their districts; the roles of individuals and communities in the fight against NTDs; the integration of

the NTD program, particularly SCH/STH control, into district development plans; the management of

donor funding to benefit communities; the sustainability of NTD interventions in the absence of donor

funding; and local motivation of VHTs to enhance their commitment to the program. A presentation will

highlight the NTDs prevalent in the district, what is being done, challenges the program is facing, and

expectations. Participants will be requested to identify what their role will be in sustaining NTD control

and elimination efforts.

Activity 2: NTD data dissemination meetings (RTI)

Advocacy for NTDs requires the engagement of a range of stakeholders to establish sustainable efforts

in Uganda. ENVISION has worked with the MOH to publish press releases demonstrating progress to

date. However, these have not received the level of response needed to help the program develop

mechanisms for continued support. In FY19, ENVISION will provide technical and financial support to the

MOH to hold three breakfast NTD data dissemination meetings targeting (1) the media; (2) academics

from institutions of higher learning, including researchers; and 3) professional bodies: the Uganda

Dental and Medical Professionals Council, the Uganda Nurses and Midwifery Council, the Uganda Allied

Health Workers Professionals Council, and the Uganda Workers Union. These meetings will introduce

stakeholders to NTDs and impress upon them that NTDs are compelling health problems that need

special attention and action by various groups. The MOH will bring in clients who have been affected by

NTDs so that the groups can appreciate both the impact of NTDs on individuals and communities and

the need for their active involvement in control and elimination interventions. The aim is for Uganda to

establish a coalition of multisector players who will be agents in the fight against NTDs.

Activity 3: Breakfast meeting with MPs from the 16 ENVISION-supported districts (RTI)

As progress is made toward the target of disease elimination, increased participation is needed to

ensure country ownership. The program should enhance advocacy so that resources at various levels are

allocated toward NTD control and elimination. Additionally, country policies and guidelines that guide

NTD activity implementation should be streamlined. Naturally, this process will requires a well-informed

and engaged cadre of MPs. In FY19, the program will meet with MPs from the 16 ENVISION-supported

districts at a breakfast meeting. This meeting will also involve NTD program partners and donors, senior

officials and PMs from the MOH, the Ministry of Local Government and Education and WHO. The Office


25

of the Prime Minister and UNICEF will also participate to represent refugee issues in Uganda. Costs will

include venue hire, breakfast for participants, printing of materials/fact sheets, fuel refunds, media

coverage, and allowable allowances for MPs and other participants.

c) Mapping

NTD mapping is complete across the country. However, in FY18, new mapping needs were identified in

refugee settlements as the NTD program began to draft elimination dossiers. Therefore, ENVISION

supported TRAs, trachoma baseline surveys, and LF and trachoma mapping in refugee settlements. TRAs

were conducted in 17 districts that border known endemic districts, and eight districts required full

population-based baseline surveys. All eight had TF < 5% and, thus, do not require treatment. A similar

exercise was conducted in refugee camps in six districts. Although some of the individual clusters in

refugee settlements had TF > 5% according to TRA, the full baseline surveys that followed found TF <

5%. These settlements do not, therefore, require MDA, although some do need TT surgical

interventions. LF mapping in refugee settlements was also partially completedin FY18. The Carter Center

supported OV mapping in some of these refugee settlements.

d) MDA Coverage

In FY19, ENVISION will support the following MDA activities, which are also summarized in Table 5:

Activity 1: MDA Supplies: In FY19, ENVISION will support the printing of 2,000 NTD fact sheets for each

of the 16 districts.

Activity 2: MDA registration: In FY19, ENVISION will support the transportation and per diem of the

CMDs who will conduct registration in the 16 districts conducting MDA. All MDA is scheduled for April

2019 as follows:

• Six districts for LF and STH in April 2019: Maracha, Arua, Omoro, Gulu, Kitgum, and Lamwo

• 13districts for SCH in April 2019 and August/September 2019.

• 15 districts for one round of OV MDA in April 2019 in the following districts:

1) Adjumani (Madi Mid-North Focus)

2) Amuru (Madi Mid-North Focus)

3) Gulu (Madi Mid-North Focus)

4) Omoro (Madi Mid-North Focus)

5) Kitgum (Madi Mid-North Focus)

6) Lamwo (Madi Mid-North Focus)

7) Lira (Madi Mid-North Focus)

8) Nwoya (Madi Mid-North Focus)

9) Oyam (Madi Mid-North Focus)

10) Pader (Madi Mid-North Focus)

11) Moyo (Madi Mid-North focus. The section of the district in Obongi focus does not need

MDA)


26

12) Kasese (Lhubiliha Focus. The section of the district in Nyamugasani focus does not need

MDA)

13) Nebbi (Nyagak-bondo Focus)

14) Arua (Nyagak-bondo Focus)

15) Zombo (Nyagak-bondo Focus)

Table 4: USAID-supported coverage results for FY17

NTD

# Rounds of

annual

distribution (add

additional rows for

different treatment

frequencies)

Treatment

target

(FY17)

#

DISTRICTS

# Districts

not

meeting

epi

coverage

target in

FY17*

(explain

reasons

below)

# Districts

not

meeting

program

coverage

target in

FY17*

(explain

reasons

below)

Treatment

targets

(FY17)

# PERSONS

# persons

treated

(FY17)

Percentage of

treatment

target met

(FY17)

PERSONS

LF 1 9 4 1 2,429,719 1,994,914 82.1%

OV Round 1 21 11 1 2,009,519 1,961,633 97.6%

OV Round 2 21 12 1 2,009,520 1,984,727 98.8%

SCH 1 49 15 10 5,133,897 4,618,451 90.0%

STH 1 9 3 3 2,868,090 2,469,445 86.1%

Trachoma 1 5** 2 2 605,608 485,776 80.2%

*Epi and Program coverage as defined in the workbooks

**This count includes the district of Nabilatuk, which did not exist when treatment actually occurred.


27

Table 5: USAID-supported districts and estimated target populations for MDA in FY19

NTD

Age groups

targeted

(per disease

workbook

instructions)

Number of

rounds of

distribution

annually

Distribution

platform(s)

Number of

districts to

be treated

in FY19

Total # of

eligible

people to be

targeted in

FY19

OV Round 1 Entire population 5

years and older 2

Community-

based MDA 15 1,828,191

OV Round 2 Entire population 5

years and older 2

Community-

based MDA 15 1,828,191

LF Entire population 5

years and older 1

Community- and

school-based

MDA

6 1,626,788

SCH Entire population 5

years and older 1

Community- and

school-based

MDA

13 2,146,277

STH School Aged

Children 1

Community- and

school-based

MDA

6 902,867

e) Social Mobilization to Enable NTD Program Activities

In FY19, ENVISION will finalize these tools and use them to guide community mobilization in districts

where MDA will be conducted. The planned activities include the following:

Activity 1: Production and distribution of IEC materials (RTI)

In FY19, ENVISION will support the production and distribution of 33,333 posters in different languages

on LF, trachoma, SCH, and STH. ENVISION will also procure 6,095 T-shirts for CMDs, 448 for the parish

and sub county supervisors and 3,810 for teachers. ENVISION will also procure four banners to

announce the start of MDA.

Activity 2: Orientation of facilitators (RTI)

Facilitators, primarily DHEs, will be oriented on the use of the tools and community dialogue guidelines

to build their capacity to engage communities in the dialogues. Others to be oriented will include sub

county supervisors, parish supervisors, and community development officers. These officers will, in turn,

train VHTs and community health extension workers on the guidelines to ensure adequate capacity at

the district and community levels to engage communities. The lead consultant who helped develop the

tools will co-facilitate this training with the ENVISION team.

Activity 3: Multimedia campaign for PC NTDs (RTI)

In FY18, ENVISION supported the NTDCP to plan and implement a multimedia campaigns using print

media, radio, and television (TV) channels during the 2 months prior to MDA (Table 6). The multimedia

campaigns were largely successful, considering the treatment coverage achieved and the feedback

received from the media and during district supervisory visits. In FY19, ENVISION will support the

continued use of this approach but will also include the documentation of NTD success stories in print

media. The multimedia campaign will comprise the following:


28

1. Radio: The radio component will consist of talk shows on local radio stations where

personalities such as DHOs, NTD FPs, NTD Secretariat members, community members who have

benefited from treatment, VHTs, and local leaders will be panelists. The radio program formats

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 by VHTs of the times when the shows will be aired through radio

announcements. Sub county supervisors, parish supervisors, and VHTs will use megaphones to

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

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

meetings at the village level.

2. TV: 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—for wider reach. ENVISION will fund

airtime for the TV stations (where applicable) and provide allowances for panelists who are not

MOH staff.

3. Documentation of success stories after MDA: The district FPs, working closely with sub county

supervisors, parish supervisors, and VHTs, will identify beneficiaries of trachoma, LF, SCH, and

STH treatment in selected sub counties and document their experience with and perception of

MDA in the form of personal stories. These will be shared with the media for publication and

used in project reports.

Activity 4: Dissemination of the national NTD communication strategy (RTI)

The NTD communication strategy was developed in FY17 during the ENVISION-supported social

mobilization and IEC review workshop. In FY18, the MOH approved the strategy for use by districts and

partners to develop and implement communication activities. In FY19, ENVISION will provide technical

and financial support for the dissemination of the strategy to districts and partners so that they

understand the context, content, and strategic approaches. The dissemination of the strategy will be

incorporated into other trainings and advocacy meetings. The sessions will be facilitated by the Senior

Health Educationist attached to the NTD program, ENVISION staff, and the PMs who participated in the

development of the strategy. No budget provision is required for this activity.


29

Activity 5: Sensitization of district and sub county leaders (RTI-FOGs)

This will be conducted using community dialogue techniques supported by district-specific fact sheets

that will be developed in FY19. The aim is to expose the leaders to the scale of the NTD problems in their

districts and to help mobilize their communities for MDA. The leaders to be sensitized will include the

following: LC5 councilors, religious leaders, community-based organization leaders, sub county chiefs,

LC3 chairpersons and councilors, zonal head teachers, religious leaders, women’s groups, people with

disabilities, and community savings and credit cooperative organizations. These groups are influential in

their communities, and their societal roles make them good mobilizers. The ENVISION team will co-

facilitate the sensitization exercise with the MOH central supervisors and DHT members. ENVISION will

provide learning materials, including district-specific fact sheets, brochures, posters, and community

mobilization guidelines.

Activity 6: Community dialogue to improve MDA coverage (RTI-FOGs)

In all 16 ENVISION-supported districts, CMDs and parish supervisors will engage community members in

discussions on NTDs, with a focus on the importance of taking MDA medicines. Adverse events will be

discussed, and communities will be encouraged to report any AEs promptly to the VHTs. In low-

performing areas, health workers and sub county supervisors will reinforce the VHTs 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.

Other concerns raised by communities will be discussed and solutions identified. In FY18, these

dialogues proved to be an effective means of educating the community on NTDs. In FY19, each district

will include three additional participants representing special groups: people living with disabilities,

women’s groups, and savings and credit cooperative organizations. These dialogues will be carried out

at the village level. ENVISION will provide the required materials and technical supportive supervision

during the dialogue sessions, especially in sub counties where treatment coverage has been persistently

low.


30

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

work planning

Category Key

Messages

Target

Population

IEC Activity

(e.g.,

materials,

medium,

training

groups)

Where /

when will

they be

distributed

Frequency Has this

material/message

or approach been

evaluated?

If no, please detail

in narrative how

that will be

addressed.

Pre-MDA -It is necessary

to register you

and your

family for

treatment

-The risk of not

taking IVM

-Exclusion

criteria for

treatment

How to

prevent NTDs

-The utility of

selecting

women CDDs

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

-local leaders

-Radio and

TV spots

-Newspaper

articles

-Community

meetings

-School

assemblies

-IEC

materials

-Local station,

4 weeks in

advance of

and 2 weeks

during MDA

campaigns

-Weekly

newspaper

pull-outs

-Village

meetings

-Airing of

spots four

times daily

for 20 days

-Weekly

school

assemblies

for 4 weeks

-One village

meeting per

village

before MDA

-# of times messages

aired on the radio

during the reference

period (radio

broadcast reports)

-% of the targeted

population who seek

NTD drugs during

MDA

-% of the audience

who recall messages

(coverage survey and

local/national

omnibus survey)

Length of

MDA, diseases

treated, drugs,

and staggering

of treatments

[RTI]

-Community

members

living in

endemic

areas

-SAC

-Teachers

-Subcounty

chiefs

-Radio

-Community

meetings

-TV

discussions

-Flyers

-Local station

messages

twice weekly

for 4 weeks in

advance of

MDA

-TV program

for 4 weeks

preceding

-Four times

daily for 20

days

-One

meeting per

village

before MDA


aired on the radio


period (radio

broadcast reports)

-# of meetings held

and # of community

members who

attended


31

Category Key

Messages

Target

Population

IEC Activity

(e.g.,

materials,

medium,

training

groups)

Where /

when will

they be

distributed

Frequency Has this

material/message

or approach been

evaluated?


in narrative how

that will be

addressed.

-Religious

leaders

-Cultural

leaders

-LC

chairpersons

MDA and

once every

week during

MDA

campaigns

-% of audience who

recall messages


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


aired on the radio


period (radio

broadcast reports)

-% of population that

believe NTDs are not

caused by witchcraft

based on KAP survey

-% of audience who

recall messages


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]

-Four times

daily for 20

days -Weekly

newspaper

articles [RTI]

-Messages

playing 10

times a day

in the

evening

[The Carter

Center]


aired on the radio


period (radio

broadcast reports)

-% of targeted

population that seek

NTD drugs during

MDA

-% of audience who

recall messages


local/national

omnibus survey)

It is common

for drugs to

have mild side

effects.

These are mild,

transitory, and

self-limiting.

-Community

members

targeted for

MDA

-Teachers

-SAC

-CDDs

-Training

manuals

-Brochures

-Radio

-Newspaper

articles

-TV panel

discussions

-District-level

CDD/ teacher

refresher

training

-Radio

-TV

-Flip charts,

VHT

handbooks,

and training

manuals

distributed

once

annually

[RTI]

-# of flip charts, VHT

handbooks, and

training guides

disseminated during

the reference period

-training attendance

list (FP report) [RTI]


32

Category Key

Messages

Target

Population

IEC Activity

(e.g.,

materials,

medium,

training

groups)

Where /

when will

they be

distributed

Frequency Has this

material/message

or approach been

evaluated?


in narrative how

that will be

addressed.

[RTI + The

Carter Center]

-Testimonies

from

satisfied

clients

[RTI]

-Flip charts

[The Carter

Center]

-Village

meetings

[RTI]

-Subcounty-

level

community

supervisor

and CDD

refresher

training [The

Carter

Center]

-Radio and

TV panel

discussions

weekly

-Brochures

distributed

in schools

and at

community

meetings

-Flip charts

distributed

once

annually

[The Carter

Center]

-# of flip charts

disseminated during


(training attendance

list and 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

and training

manual

-Teacher

refresher

training

-Schools

-Radio

-Brochures

distributed

once to SAC

-Radio

announcem

ents during

the 4 weeks

before MDA

-Weekly

school club

discussions

-VHT

handbooks

and training

manuals

distributed

once

annually

-# of brochures,

handbooks, and

training guides

disseminated during


(training attendance

list and FP report)

-% of targeted

population who

believe the drugs are

safe

f) Training

In FY19, ENVISION will support the following trainings:

Activity 1: Re-training of central supervisors and trainers (RTI-FOGs and Training)

This 2-day training will target national-level supervisors located within the different programs and

institutions that provide supervisory support, such as the School of Entomology, Makerere University,


33

and the Institute of Public Health. This training will include 10 district NTD FPs who have proven that

they can serve as national supervisors and trainers. From the NTD Secretariat, 20 individuals will be

selected for (re)training. The training will focus on revised data tools, micro-planning of best practices,

new registration requirements, the value of accurate data, and how to resolve common district

challenges. Consideration is being given to having a motivational speaker to engage the team on what it

means to be an effective supervisor and trainer.

Activity 2: Re-training of NTD Focal Points and District Health Officers (RTI-FOGs and Training)

FPs are responsible for the success or failure of the program in their districts. This 2-day (re)training,

which will be conducted at NTD HQ or a suitable venue in Kampala, will bring together the 16 FPs and

their DHOs. Historically, it has been attended only by the FPs. However, in FY19, the DHOs will

participate because program sustainability will be part of the agenda, and the training will help them

become fully aware of the pathways to effective MDA and what is required of them to make this

happen. Participants will be taken through the challenges in program implementation and how they can

be addressed by the DHTs and other district leaders. The meeting will review issues of district data,

medicine requirements and allocations, planning for implementation and timelines, the release and use

of funds, the participation of district leadership, community dialogue, USAID audit requirements, best

practices for MDA and monitoring, post-elimination surveillance, and the use of DHIS2 for HMIS

reporting. A total of 52 persons will be trained in FY19. Facilitators will come from the NTD Secretariat,

ENVISION, the MOH Resource Center, and the USAID Mission in Uganda.

Activity 3: Re-training of district trainers (RTI)

District trainers or trainers of trainers (TOTs) are trained annually prior to MDA activities. These trainers

are responsible for carrying out trainings and supervising lower-level cadres. They are usually headed by

the NTD FP. During the year, district TOTs are involved in many other health activities (e.g.,

immunization, CHDs, indoor residual spraying, long-lasting insecticide-treated net distribution), funded

by various partners with different implementation requirements. Therefore, it is important to bring

together all district trainers for refresher training and orientation. Pre-MDA and MDA activities will be

reviewed, new tools will be discussed, and community dialogue will be introduced to the TOTs.

Thereafter, the TOTs and district and subcounty leaders will be taken through the rationale for micro-

planning and the micro-planning template. Micro-planning is important as it allows implementers and

their supervisors (district leaders) to specify the activities to be conducted, where, when, how, by who,

and with what resources. Micro-planning also helps the district teams to identify challenges, find

solutions, and set treatment targets. A minimum of 10 TOTs will be trained per district, selected from

DHOs, DEOs, the Biostatistics Office, and HSDs. It will be at the discretion of the NTD Secretariat and

DHO to identify other district cadres for training. At least 160 TOTs will trained in the 16 districts during

FY19. This training, which is combined with the micro-planning, will take 3 days.

Activity 4: Re-training of sub county supervisors and health workers (RTI-FOGs)

The majority of sub county supervisors are health workers, mainly health assistants or community

development assistants. They are involved in the implementation of health programs, enforcement of

public health laws, and oversight of social development activities within a sub county. These are the key

persons involved in the implementation of micro-plans at the sub county and parish levels. They work

with parishes, community leaders, and schools to implement the micro-plans and supervise program

activities. Two supervisors will be trained per sub county. The 1-day training will focus on the NTDs in

their areas, the drugs used and their administration, exclusion criteria, AEs, the use of NTD data tools,

communicating with communities using the community dialogue guidelines, and supervision of all pre-


34

and post-MDA activities, including data collection and report compilation for onward transmission to the

DHO. The ENVISION team and MOH staff will co-facilitate this training and provide technical guidance on

data collection tools, community dialogue tools, supportive supervision guidelines, and reporting

formats. In FY19, ENVISION will provide financial and technical support for the training of approximately

314 sub county supervisors and 926 health workers in the 16 districts.

Activity 5: Re-training of parish supervisors (RTI-FOGs)

Parish supervisors serve as intermediaries between the community level (CMDs) and sub county

supervisors. They are usually health workers attached to health centers at the lower level as health

volunteers. In Karamoja, the parish supervisors will, starting in FY19, be parish chiefs. The advantage is

that these individuals are literate and, by nature of their assignments, move throughout their parishes,

implementing and supervising government programs. They will also be in a position to assist CMDs

(especially in Karamoja) during registration, MDA, and data compilation. The training of parish

supervisors will focus on targeted NTDs in their localities, control measures, medicines to be used, the

associated AEs and their management and reporting, registration/census updates, and NTD summary

forms I and II for the community and parish levels, respectively. In FY19, approximately 2,000 parish

supervisors will be trained from the 16 districts. The 1-day training at the sub county HQs will be

conducted by sub county supervisors and supervised by district FPs and representatives from ENVISION

and the NTD Secretariat.

Activity 6: (Re)training of CMDs/VHTs and teachers (RTI-FOGs)

This 1-day annual training is carried out prior to MDA. CMDs are trained within their parishes by sub

county supervisors, assisted by parish supervisors. Three CMDs will be trained from each community in

the local language. An estimated 23,334 CMDs will be trained in the 16 districts. In the past, teachers

used to be trained in their schools, but it was found that this training either did not take place or was

not effective. Instead, the trainers simply distributed new registers and drugs and instructed the

teachers to update the registers and start treatments.

In FY19, teachers will be trained for 1 day at their sub county HQs and provided with transport refunds

and the day’s allowance (Safari Day Allowance). The language of instruction shall be English but with

simplified content that can be understood by non-medical staff. Two teachers will be selected for

training from each school (pre-primary, primary, secondary, and tertiary; both government and private).

A representative of the DEO in the sub county, known as the Coordinating Center Tutor (CCT), will

attend. The CCT is the overall supervisor of all schools and teachers in a subcounty. It is estimated that

6,158 teachers in 1,660 schools will be trained.

The training of CMDs and teachers will focus on empowering CMDs and teachers to deliver treatments

to their communities/schools quickly and safely with minimum disruption to the community or school

routine. Training subjects will include the following: NTDs and their impact on health and cognitive

function, the transmission of endemic NTDs in their areas, medicines for treating NTDs and their doses,

the use of dose poles, registration, actual treatment, monitoring for AEs, tallying, and reporting. The

school administrations will be expected to communicate to school management and parents so that

parents provide packed lunch on the day of MDA.

Activity 7: OV-specific training of health workers (The Carter Center)

During the Carter Center review meeting held in April 2018, it was recommended that the OV program

reduce the ratio of CDDs to beneficiaries. As a result, more health workers, CDDs and supervisors will be

trained. In FY19, ENVISION will support a 1 day training of 159 health workers. An additional 1,741


35

district leaders, sub-county chiefs and parish leaders will be trained to supervise this and other trainings

in 15 districts.

Activity 8: OV-specific training of Community supervisors (The Carter Center)

Community supervisors oversee community-level activities. In FY19, ENVISION will support training of

9,218 community supervisors in 15 districts. Training will take 1 day and will be supervised by 5,008

supervisors who include district leaders, local leaders, parish supervisors and health workers. The

trained community supervisors will then supervise CDDs, a core responsibility that will help ensure that

census data are updated. They will also ensure that health education is provided and MDA implemented

and submit reports detailing these activities.

Activity 9: OV-specific training of CDDs (The Carter Center)

Still in line with reducing the ratio of CDDs to beneficiaries, in FY19, ENVISION will support community-

level training of 27,915 CDDs in 15 districts. This training will be supervised by 14,196 community

supervisors and health workers. ENVISION will pay for training supplies and per diem for the supervisors

and other non-CDDs attending the training.

Activity 10: Training of clinical and nursing staff on LF surveillance (RTI)

In FY17, laboratory staff and NTD FPs from 33 districts that have stopped LF MDA were trained on FTS to

diagnose LF infections as part of surveillance. Thereafter, it was realized that there is a need to train

clinicians (medical officers and medical clinical officers) and nurses in charge of health units on LF clinical

and laboratory diagnosis. These cadres are responsible for making requests for laboratory diagnosis.

Their training will form part of the measures to encourage sustainability and program ownership. Health

unit staff report all disease data through DHIS2/HMIS. Their training will focus on LF transmission,

clinical manifestations, diagnosis methodology using night blood and daytime blood (FTS), drugs used,

treatment doses, AEs, the benefits of the drugs, surveillance activities, and the capturing and reporting

of LF data. In FY19, 110 participants will be trained, split into three training clusters/centers. ENVISION

will support FTS kits, per diems, transport refunds, vehicle hire and fuel costs, communications, venue

hire, and other related costs.

g) Drug and Commodity Supply Management and Procurement

In FY19, ENVISION will support the following:

Activity 1: Drug transport from national warehouse to regions (RTI)

ENVISION will provide financial support to hire a truck to transport NTD drugs to three regions before

MDA begins.

Activity 2: Drug transport from region to distribution points (RTI)

ENVISION will provide financial support to hire a truck to transport NTD drugs from each of the three

regions to the designated distribution point(s).

Activity 3: Reverse supply chain of drug and diagnostic stocks (post-MDA) (RTI)

ENVISION will provide financial support to hire a truck to transport NTD drugs from each of the 16

districts back to the national warehouse.

Activity 4: Drug storage (RTI)


36

ENVISION will provide financial support to store drugs stored at NMS, VCD or district stores.

Activity 5: Drug repackaging (RTI)

ENVISION will provide financial support to buy the necessary boxes to re-package NTD drugs at the

national warehouse so they can be easily transported to the districts. ENVISION also provides the per

diem for the workers who load and unload the trucks.

h) Supervision for MDA

In FY19, RTI will continue to support the following activities:

Activity 1: Supportive supervision for FY18 MDA carry-over in 21 districts

The FY18 MDA is scheduled to be completed after September 30, 2018. Supervision for data collection,

which is expected to continue into the first quarter of FY19, is budgeted here.

Activity 2: Supportive supervision during the training of sub county supervisors and health workers in

16 districts

Supportive supervision will be conducted by staff from the NTD program and ENVISION. This supervision

will be implemented to ensure that all trainings follow training guidelines and cover the necessary

content for each level. The team will be provided with logistical and financial support in the form of

transport, per diem, and airtime to enable communication with relevant persons to seek information or

advice. The training will be conducted by TOTs at the HSD level, and two sub county supervisors will be

trained per sub county. The number of training sessions will depend on the number of HSDs in the

district. One health worker per health unit, preferably those in charge of the health center at the lower

level, will be trained to support MDA activities at all levels. The DHO and FP will be directly involved in

the supervision of these trainings.

Activity 3: Supervision during the training of parish supervisors in 16 districts

The central team of supervisors from ENVISION and the MOH will oversee and support the training of

parish supervisors, during which two supervisors per parish will be trained by sub county supervisors.

The trainings will take place at the sub county level. The parish supervisors will be taken through data

tools, including the registers, tally sheets, and summary forms. The training will include the

quantification of medicines and the use of dose poles. The team will be provided with the required

logistics and finances, including transport, per diem, and airtime.

Activity 4: Sensitization of district and sub county leaders (RTI-FOGs)

The central team of supervisors from ENVISION and the MOH will co-facilitate and supervise the

sensitization meetings with districts and sub county leaders. ENVISION will support the transportation

and per diems for this activity.

Activity 5: Supervision during the training of CMDs and teachers

The ENVISION and MOH teams will provide supportive supervision during the training of CMDs in all

ENVISION-supported districts. This supervision will ensure adherence to training guidelines and content.

Three CMDs per village will be trained at their respective parish HQs to minimize travel. They will be

trained by sub county supervisors, supported by parish supervisors. The district FP and health workers

from the nearest health facilities will also take part in the training to discuss medicines and AEs. Drug

packages, AEs and their management, and the use of data collection tools, such as registers and data

collection forms, will be emphasized. Exclusion criteria for specific drug packages will be discussed.


37

Activity 6: Supervision of registration

Registration determines the success of MDA. ENVISION and MOH staff will supervise and support the

district staff to make sure that registration is completed accurately. Registration is expected to last for 2

weeks, and subsequently, the VHTs and their supervisors will calculate the total eligible population

registered. These data will enable the VHTs and parish supervisors to accurately quantify medicines. The

DHO and other members of the DHT will be part of the supervision team, alongside biostatisticians and

LC1 members. For effective registration, the following guidelines will be followed:

• Registration will be carried out 1 month before MDA begins.

• Registration will be performed house to house to make sure all household members are

registered and will take at least 2 weeks.

• Data collection tools (i.e., NTD registers, tally sheets, and summary forms) will be available in

adequate quantities prior to registration.

• Supportive supervision of registration will be conducted by district and local leaders (e.g., a

district official will be allocated a sub county to supervise and work with LCs).

• LC1 executives will verify the population and households registered by CMDs/VHTs before data

are submitted to the parish level.

• All old registers will be retrieved and kept in a safe place, preferably at health facilities.

Activity 6: Supervision during MDA and post-MDA data collection

ENVISION and NTD program staff will carry out supportive supervision during MDA implementation and

data collection in all ENVISION-supported districts. A district supervisory team will include the DHT, FP,

TOTs, S/C supervisors, and district leaders and use the supervisory checklist. MDA implementation will

be conducted by teachers and VHTs/CMDs who will collect the medicine from a nearby health facility.

The central and district supervisory teams will be in charge of post-MDA monitoring of SAEs. SAE forms

will be provided to health units during the training of supervisors. These will be completed by the In-

Charges of the HU in case of any SAE and verified by DHOs.

During data collection and compilation, VHTs/CMDs and teachers will fill the tally sheets with the

information from registers. The parish supervisors will use the tally sheets to complete the parish

summary forms which will feed into the sub county summary forms. The sub county summary sheets

will help generate the final district data report that will be submitted to the center. DHOs, FPs, TOTs, sub

county supervisors, central-level supervisors, and ENVISION’s M&E assistants will closely supervise this

exercise to ensure compliance and adherence to fiscal and implementation guidelines. Most

importantly, M&E assistants will ensure data completeness and accuracy. Coverage validation after MDA

will help identify and address any shortcomings that arise during the MDA process.

Drug balances and wastages will be submitted alongside the reports at every stage and stored at the

district stores. Costs for this exercise will include vehicle hire, fuel, per diem, and mobile phone airtime.

Activity 7: Supportive supervision for finance

ENVISION and NTD program finance staff will carry out financial supervision of NTD funds in the 16

ENVISION-supported districts. This supervision will include districts using FOGs and those using direct

implementation. The aim of this process is to ensure that all funds and supportive logistics are put to the

right use. Costs include vehicle rental, fuel, and per diem.

Activity 8: Enhanced MDA planning in six districts (RTI)


38

In FY19, all districts conducting LF MDA will receive enhanced MDA planning as follows:

• One central supervisor will cover four sub counties during pre-MDA, MDA implementation, and

post-MDA. Supervisors will use the existing supervisory checklists to ensure that all activities are

implemented

• Village- and school-level data will be analyzed to identify villages that are having difficulty

attaining target coverage and to tailor approaches.

• VHTs will be given household targets to ensure all households are covered. Central supervisors,

supported by the parish and sub county supervisors, will review VHT coverage every evening to

monitor VHT performance.

• Mop-up will be conducted in cases of low coverage. Mop-up needs will be determined during

the post-MDA feedback meeting immediately after MDA is completed and data collected from

all IUs. Only areas with low coverage will receive mop-up.

• Community dialogue will be carried out prior to and during MDA to increase treatment uptake.

Activity 9: Supervision before, during, and after MDA (The Carter Center)

Supervising medicine distribution will help ensure that drugs are distributed to the targeted

communities through the national health care services per MOH policy. After distribution, supervisory

teams from The Carter Center’s central office and regional office will ensure that the eligible populations

in all targeted communities are treated with IVM. They will check the quality of treatment by examining

registers to check for the correct use of dose poles and quantity of drugs. The supervisory team in

Kampala will also check that drugs are properly accounted for. The central office will conduct data

validation to ensure the accuracy of reported treatment numbers. ENVISION will provide the financial

support for this activity.

Activity 10: Supervision during training (The Carter Center)

During CDD training, the use of data collection tools, such as registers, data collection forms, and the

data treatment book, is emphasized. Additionally, exclusion criteria are highlighted with the aim of

ensuring that the correct populations are treated and recorded. Supervision during this exercise is

critical, especially in problematic districts and communities. ENVISION will provide the financial support

for this activity.

i) M&E

In FY19, ENVISION will provide financial and supervisory support for the following surveys:

Activity 1: LF pre-TAS assessment in six districts (RTI)

Arua, Maracha, Kitgum, Lamwo, Gulu, and Omoro districts will undergo pre-TAS to determine if they can

proceed to conduct TAS1. Data from the MOH show that these districts began MDA as early as 2009,

and although not all have achieved five effective rounds of MDA, baseline antigenemia prevalence was

between 1.6% and 5.8%. Additionally, vector control efforts are ongoing in the districts. Therefore, it is

possible that these districts have effectively reduced mf. A pre-TAS will confirm whether this is the case

and potentially allow all six to proceed to TAS1 by FY20. FTS kits for the detection of CFAs will be used in

the assessments, and day time blood samples will be analyzed. The pre-TAS will target a sample size of

approximately 300 residents aged 5 years and above who have lived in that area for at least one year.

From each original district (e.g., Arua, Maracha), one SS and two spot check (SC) sites will be visited, and


39

blood samples will be collected. Districts that pass pre-TAS will be eligible for TAS1. All six districts are

co-endemic with OV. Pre-TAS surveys will be conducted 6 months after MDA, in April 2019.

Activity 2: LF TAS1 in three districts (RTI)

Bugiri, Namayingo, and Mayuge districts are conducting pre-TAS in August 2018. If they pass, they will

then undergo TAS1 in July 2019 to determine if MDA can be stopped. The WHO Sample Builder will be

used to determine the survey size and methodology, and electronic data collection will be used. The

protocol will be shared with RTI one month before the activity.

Activity 3: LF TAS2 in 10 districts (RTI)

Nebbi, Zombo, and Pakwach (one evaluation unit [EU]); Yumbe and Koboko (one EU); and Paliisa,

Budaka, Kibuku, Butebo, and Butaleja (one EU) districts are due for TAS2. In Nebbi District, which is

OV/LF co-endemic and receiving ongoing treatment for OV, TAS2 will be done in April 2019. The rest of

the districts will conduct TAS2 in June 2019. The methodology for TAS2 is the same as for TAS1,

including the use of the WHO Survey Sample Builder, the age groups to be tested, the use of FTS kits for

antigenaemia, and cut-offs values for positives to determine whether the LF elimination threshold has

been reached.

For the above LF activities (Activities 1-3), ENVISION will support vehicle hire and fuel costs, diagnostic

supplies (FTS kits), field consumables, stationery, central-level per diems, per diems for field guides, and

half per diems for district vector control officers as TAS1 and TAS2 will require them to travel away from

their duty stations.

Activity 4: Trachoma Impact Survey in three districts (RTI)

In FY19, ENVISION will support TISs in Moroto, Nakapiripirit and Nabilatuk districts. Each survey team

will have an ENVISION M&E assistant to serve a liaison and ensure that the survey is implemented as

planned. In each district, 24 clusters (parishes) will be randomly selected. From each cluster, a village

will be selected at random, and from the village, 35 households will be randomly selected. In each

household, all children aged 1–9 years will be examined for TF, and adults will be examined for TT. The

sample size is typically 3,000 individuals per EU.

All cases of TF and other eye infections will be treated with TEO or ZTH. All data will be captured using

Android phones and uploaded directly to the Tropical Data server in the US. Tropical Data will analyze

the data and determine whether the overall TF prevalence is above or below 5%. Simultaneously, data

will be provided on the prevalence of trichiasis to determine whether the UIG for TT has been reached

or if more surgeries are required. The survey teams comprise graders who are trained ophthalmic

clinical officers, most of whom are deployed in DLGs; recorders; MOH supervisors; and an overall

supervisor. The overall supervisor is a consultant ophthalmologist contracted by ENVISION to conduct

training prior to every survey, supervise the grader/recorder teams, and ensure strict adherence to all

Tropical Data guidelines and best practices during the surveys. The consultant ophthalmologist is a

Tropical Data-certified trainer and supervisor.

Activity 5: TSS in seven districts (RTI)

In FY19, the trachoma program will conduct TSS in Abim, Adjumani (which will be split into two EUs

because of its population size), Buliisa, Napak, Nebbi, Pakwach, and Kotido. The protocol to be used is

the same as described for the TIS above. Likewise, all data will be sent to Tropical Data for analysis and

interpretation. The survey personnel are the same as those involved in TIS.

Activity 6: Post-PTS assessments in one district (The Carter Center)


40

To confirm OV interruption, epidemiological surveys (using OV16 enzyme-linked immunosorbent assay

[ELISA]) will be conducted in Moyo District in Obongi focus which has completed 3 years of PTS. The

assessment will be a serological survey to determine whether OV has been eliminated. Blood samples

will be collected from 4,784 children under 10 years old in the sampled communities/parishes.

ENVISION funds will cover the collection of samples including the transportation and per diem of survey

teams and laboratory technicians. The Carter Center will also use un-restricted funds particularly for the

entomological components of the survey.

Activity 7: OV16 assessments in four cross-border foci covering 3 districts in DRC and 2 counties in RSS

(The Carter Center)

In FY19, blood spots will be collected from the three foci of Nyagak-Bondo, Bwindi and Lhubiriha

(covering Nebbi, Zombo and Arua districts in Uganda and the districts of Ruchuru, Beni-Butembo and

Ituri-Goma in DRC. Additionally, blood spots will be collected from Madi–Mid North focus (covering

Lamwo, Moyo, Adjumani, and Amuru in Uganda, and Magwi County in Imatong state and Kajokeji

County in Yei State both in South Sudan).

The Carter Center works closely with the MOHs in DRC and South Sudan to ensure that these countries

participate in this cross-border work. Additionally, as described in the Strategic Planning section,

ENVISION has provided funds to ensure that Uganda’s MOH can participate in cross-border meetings to

share the results and agree on next steps. ENVISION fund will cover the collection of samples including

the transportation and per diem of survey teams and laboratory technicians. The Carter Center will also

use un-restricted funds particularly for the entomological components of the survey.

Activity 8: OV16 impact assessments in 11 districts in the Madi–Mid North focus: In FY19, blood spots

to monitor impact of ongoing OV MDA will be collected from all 11 districts in the Madi–Mid North focus

that will receive MDA. The 11districts include Lamwo, Adjumani, Amuru, Gulu, Nwoya, Kitgum, Pader,

Oyam, Lira, Moyo and Omoro. ENVISION fund will cover the collection of samples including the

transportation and per diem of survey teams and laboratory technicians. The Carter Center will also use

un-restricted funds particularly for the entomological components of the survey.

Activity 9: Vector Surveillance (fly collection) in 4 foci (The Carter Center): In FY19, flies will be collected

in Budongo, Bwindi, Madi-Mid North, and Lhubiriha foci, all of which are active transmission zones.

ENVISION funds will cover the collection and screening for flies in these foci.


41

Table 7: Planned DSAs for FY19 by disease

Disease

No. of

endemic

districts*

No. of districts

planned for DSA

No. of EUs

planned

for DSA (if

known)

Type of

assessment

Diagnostic method

(Indicator: Mf, FTS,

etc.)

LF 9

6 6 EUs Pre-TAS (SS/SC) FTS (antigenaemia

positivity)

LF 9

3 2 EUs TAS1 FTS (antigenaemia

positivity)

LF 9 10 3 EUs TAS2 FTS (antigenaemia

positivity)

OV 15 1 N/A Post-PTS OV16-ELISA

OV 15 11 N/A

Impact

Monitoring/

Baseline

OV16-ELISA

Trachoma 3 3 3 TIS

Eye examination for TF,

TI, TT, and Corneal

Opacity (CO) based on

GTMP/Tropical Data

methods

Trachoma 3 7 8 TSS

Eye examination for TF,

TI, TT, and CO based on

GTMP/Tropical Data

methods

*These are the number of currently endemic districts, as of October 2018.

Note: CO, corneal opacity; TI, intense trachomatous trachoma.

j) Supervision for M&E and DSAs

In FY19, ENVISION will support:

Activity 1: Supervision of LF pre-TAS (RTI)

The LF PM regularly shares plans, survey protocols, and results with ENVISION for input. This practice

will continue in FY19. ENVISION staff, including the Resident Program Advisor and Technical Advisors,

will participate in field surveys and the training of district staff on the use of FTS.

Activity 2: Supervision of LF TAS1 (RTI)

The LF PM regularly shares plans, survey protocols, and results with ENVISION for input. This practice

will continue in FY19. ENVISION staff, including the Resident Program Advisor and Technical Advisors,

will participate in field surveys and the training of district staff on the use of FTS.

Activity 3: Supervision of LF TAS2 (RTI)

The LF PM will share plans and requests for TAS2, and the ENVISION M&E team will join the survey

teams to supervise. The results will be shared with ENVISION for review.


42

Activity 4: 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 will ensure that WHO and GTMP/Tropical Data

standards are adhered to.

Activity 5: Supervision of TSS (RTI)

ENVISION staff and M&E consultants will be part of the supervision teams. ENVISION will secure 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 will ensure adherence to WHO

and Tropical Data gold standards.

Activity 6: Supervision of post-PTS assessments in one district (The Carter Center)

The Carter Center personnel will join the OV16 survey teams to ensure that appropriate protocols are

followed, quality data obtained, and the fidelity of geographical targets per the sampling frame

maintained.

Activity 7: Supervision of OV16 assessments in four cross-border foci covering 3 districts in DRC and 2

counties in RSS

(The Carter Center):



maintained.

Activity 8: Supervision of OV16 assessments in 11 districts in the Madi–Mid North focus (The Carter

Center):



maintained.

k) Dossier Development

Activity 1: LF draft dossier (RTI)

The LF program has been conducting MDA since 2002. Of the 57 LF-endemic districts, 48 have stopped

MDA, and the remainder are due to undertake pre-TAS and TAS1. The program is optimistic that by the

end of FY19, all 57 endemic districts will have interrupted LF transmission and commenced surveillance.

Therefore, it is time to develop the LF dossier. The LF dossier development process started in

2017/2018, when ENVISION contracted a consultant from Kenya Medical Research Institute to help PELF

with the dossier. The consultant (Prof. Njenga Sammy) visited the country in November 2017 and took

the PELF and RTI team through the dossier template and other relevant documents, including the MS

Excel data sheets. He also interacted with ENVISION and NTDCP leadership, WHO, and MOH staff.

Additionally, the consultant visited Lira and Kaberamaido districts in the northern and eastern regions,

respectively; examined the available evidence; and obtained grassroots views on LF elimination

activities. These two districts were highly endemic for LF at baseline and have been reported to have

very high burdens of chronic LF manifestations (especially hydroceles).


43

The consultant produced and circulated the first draft of the dossier, in which several sections were

incomplete. It was decided that the home team (MOH and ENVISION) would complete the remaining

sections of the dossier, focusing on the narrative and database sections. The consultant’s visit built the

capacity of the PELF and ENVISION teams to complete the dossier. Therefore, a 1-week LF dossier

retreat was held in Jinja in March 2018 and was attended by four PELF officials and three ENVISION staff.

A draft dossier narrative was produced, circulated to the NTD Secretariat, and shared with ENVISION

HQ. In FY’19, ENVISION will support field assessments in the Northern, Southern and Western regions.

ENVISION will also provide technical support to complete the MS Excel files and the global positioning

system coordinates in the dossier.

Activity 2: Trachoma draft dossier (RTI)

Thirty-four of the 38 trachoma-endemic districts have now stopped MDA by reducing TF prevalence

below 5%, and the remaining districts are due to undertake TIS in FY19. Furthermore, most of these

districts have achieved the UIG for TT: 2 cases per 1,000 population. Therefore, it is time to prepare the

trachoma elimination dossier. Trachoma elimination has been supported by several implementing

partners, including Sightsavers, CBM, John Hopkins, and The Trust/ The Carter Center. Some partners

have finished activities and reported on their components; for example, CBM completed the sections of

the trachoma dossier that cover surgeries. However, the A component of the SAFE strategy supported

by ENVISION has not yet been addressed. In May 2018, the NTD Secretariat agreed that the trachoma

team, with the technical and financial support of ENVISION, should proceed with the drafting of the A

component of the dossier. A 4-day retreat was held in Jinja and attended by four representatives of the

Trachoma Program (MOH), a trachoma quality consultant, and an ENVISION representative. The group

reviewed the available literature on trachoma in Uganda and neighboring countries (some historical

publications were obtained through the RTI Regional Office in Dar es Salaam, Tanzania). The team also

reviewed the WHO narrative template and MS Excel database on all surveys and MDA. A draft A

component of the dossier was produced and is now being reviewed. Currently, it is planned that a larger

team comprising MOH staff and representatives of SAFE implementing partners will come together and

complete the S, F and E sections of the dossier. They will also review the whole dossier document before

it is submitted to the National Certification Committee and MOH for endorsement. The MOH and RTI

will take the lead in this exercise. ENVISION funds will support the venue, meals for all participants and

per diem and transport refunds for MOH and district participants, if any.


44

3) Maps


45


46


47


48

APPENDIX 2: Work Plan Timeline

FY19 Activities Q1 Q2 Q3 Q4

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

Management Support

NTD Program Capacity Strengthening

Review, finalize, and print the NTD supportive supervision

checklist x x

Update the integrated NTD Database x x x x

Review, finalization and printing of community dialogue

guidelines x x

Orient DHEs on NTDs and NTD materials x

Project Assistance

Strategic Planning

NTD Technical Committee meetings x x

Cross-border meeting x x

Planning and review meetings with NMS for last mile distribution x x

District micro-planning x x

Post-MDA feedback meetings x

NTD documentation workshops for LF, trachoma, and

schistosomiasis x x

MDA Data review meeting at the MOH x

National Planning and Data Review Meeting x

UOEEAC meeting (The Carter Center) x

National stakeholder meeting–River blindness program review

meetings (The Carter Center) x

NTD Secretariat

Operational and Program-specific supportive supervision x x x x x x x x x

NTD Secretariat coordination meetings x x x x x

Building Advocacy for a Sustainable National NTD Program

District-level advocacy meetings x

NTD Data dissemination meetings x x

Breakfast meeting with MPs from the 16 ENVISION-supported

districts x

MDA Coverage

MDA supplies x x

MDA registration x

Social Mobilization to Enable NTD Program Activities

Production and distribution of IEC materials x

Orientation of facilitators x

Multimedia campaigns for PC NTDs x

Dissemination of the national NTD communication strategy x x

Sensitization of district and subcounty leaders x

Community dialogue to improve coverage x

Community meetings (The Carter Center) x x x

Training


49



Re(training) of central supervisors and trainers x

Re(training) of NTD FPs and DHOs x

Re(training)of district trainers x

Re(training) of subcounty supervisors and health workers x

Re(training) of parish supervisors x

Re(training) of CMDs/VHTs and Teachers x

OV-specific training of parish supervisors and health workers

(The Carter Center) x x

OV-specific training of health workers (The Carter Center) x x

OV-specific training of CDDs (The Carter Center) x x

Training of clinical and nursing staff on LF surveillance x x

Drug Supply and Commodity Management and Procurement

Drug transport from national warehouse to regions x

Drug transport from regions to distribution points x

Reverse supply chain of drugs and diagnostic stocks post-MDA x

Drug Storage x

Drug Repackaging x

Supervision for MDA

Supportive supervision for FY18 carryover in 21 districts x

Supportive supervision during the training of subcounty

supervisors and health workers in 16 districts x

Supervision during the training of parish supervisors in 16

districts x

Supervision during the training of CMDs and teachers x

Supervision of sensitization of district and subcounty leaders x

Supervision of registration x

Supervision during MDA and post-MDA data collection x

Supportive supervision for finance x

Enhanced MDA in six districts x

Supervision before, during and after MDA (The Carter Center) x x x

Supervision during training (The Carter Center) x


50



M&E

LF pre-TAS assessments in six districts x

LF TAS1 in three districts x

LF TAS 2 in 10 districts x

Trachoma Impact Survey in three districts x

TSS in seven districts x

Post-PTS assessments in two districts (The Carter Center) x x x

OV16 assessments in two cross-border foci (The Carter Center) x x x

Vector Surveillance (fly collection) in 4 foci ( The Carter

Center) x x x

Supervision for M&E

Supervision for LF pre- TAS x

Supervision for LF TAS1 x

Supervision for LF TAS2 x

Supervision for TSS x

Supervision of TIS x

Supervision of post-PTS assessments in two districts (The Carter

Center) x x x

Supervision of OV16 assessments in two cross-border foci (The

Carter Center) x x x

Supervision of Vector Surveillance (fly collection) in 4 foci (

The Carter Center) x x x

Dossier Development

LF draft dossier x x x x x

Trachoma draft dossier x x x x x

STTA

Trachoma quality control consultant x x

Trachoma dossier consultant x

M&E assistants x x x x x x x x x

Social Mobilization Consultant x x

NTD Technical Committee, STH/ SCH experts x

uganda work plan - envision · uganda work plan fy 2019 project year 8 october 2018–september...

Documents