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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
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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.
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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
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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.
ENVISION FY19 PY8 Uganda Work Plan
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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
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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
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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®
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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
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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
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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.
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• 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.
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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
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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
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
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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
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).
ENVISION FY19 PY8 Uganda Work Plan
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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
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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,
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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,
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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)
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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)
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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:
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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
-# of times messages
aired on the radio
during the reference
period (radio
broadcast reports)
-# of meetings held
and # of community
members who
attended
ENVISION FY19 PY8 Uganda Work Plan
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?
If no, please detail
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
(coverage survey and
local/national
omnibus survey)
Endemic
diseases,
causes, signs
and symptoms,
prevention and
control, what
is being done
including MDA
schedule [RTI]
-Community
members in
endemic
areas
-SAC
-Political
leaders
-Teachers
-Radio
-Community
meetings
-Newspaper
pull outs
-TV panel
discussions
-Flyers
-Fact sheets
-Posters
-Local station,
a few days
before MDA
-Village
meetings
-TV stations
-School
settings
-Weekly
radio
programs
-One
meeting per
village
-School
discussion
groups
-# of times messages
aired on the radio
during the reference
period (radio
broadcast reports)
-% of population that
believe NTDs are not
caused by witchcraft
based on KAP survey
-% of audience who
recall messages
(coverage survey and
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]
-# of times messages
aired on the radio
during the reference
period (radio
broadcast reports)
-% of targeted
population that seek
NTD drugs during
MDA
-% of audience who
recall messages
(coverage survey and
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]
ENVISION FY19 PY8 Uganda Work Plan
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?
If no, please detail
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
the reference period
(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
the reference period
(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,
ENVISION FY19 PY8 Uganda Work Plan
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-
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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)
ENVISION FY19 PY8 Uganda Work Plan
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.
ENVISION FY19 PY8 Uganda Work Plan
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)
ENVISION FY19 PY8 Uganda Work Plan
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
ENVISION FY19 PY8 Uganda Work Plan
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)
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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.
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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.
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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):
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 8: Supervision of OV16 assessments in 11 districts in the Madi–Mid North focus (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.
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).
ENVISION FY19 PY8 Uganda Work Plan
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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.
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3) Maps
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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
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FY19 Activities Q1 Q2 Q3 Q4
O N D J F M A M J J A S
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
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FY19 Activities Q1 Q2 Q3 Q4
O N D J F M A M J J A S
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