Third Year’s Narrative Report of the Project: “Support for ... · NLTCP National Leprosy and...

Project Realized with the contribution of the Italian Bishops Conference (CEI)

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ASSOCIAZIONE ITALIANA AMICI DI RAOUL FOLLEREAU Organization for International Health Cooperation

Third Year’s Narrative Report of the Project:

“Support for the Strategic Plan for the Fight against Leprosy in the south-east of Liberia.”

Period: 1st October 2016- 30th September, 2017

Date Submitted: October 20, 2017

AIFO-Liberia


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ACRONYMS AIFO Associazione Italiana Amici di Raoul Follereau ALM American Leprosy Missions BU Buruli Ulcer BCCs Behavior Change Communications CHOs County Health Officers CHT County Health Team CHA Community Health Assistant CBR Community Based Rehabilitation CBOs Community Based Organizations CEO County Education Office CSOs Civil Society Organization DHOs District Health Officers DA Disability Alliance DPOs Disabled People Organizations DEOs District Education Officers EPHS Essential Package of Health Services EVD Ebola Virus Disease GLRA German Leprosy Relief Association GoL Government of Liberia GCHVs General Community Health Volunteers HDR Human Development Report HI Handicap International IGAs Income Generating Activities IEC Information Education and Communication INCHR International Commission on Human Rights IDM Integrated Disease Management LFPs Leprosy Focal Persons LDHS Liberia Demographic Health Survey LMIS Liberia Malaria Indicator Survey MoH Ministry of Health MAP Medical Assistance Program MFDP Ministry of Finance and Development Planning NLTCP National Leprosy and Tuberculosis Control Programe NCD National Commission on Disabilities NTDs Neglected Tropical Diseases NUOD National Union of the Disabled NGOs Non-Governmental Organization OICs Officer in Charge PHCs Primary Health Care Staff PIH Partners in Health PWDs People with Disabilities UNDP United Nations Development Program UNMIL United Nations Mission in Liberia SHGs Self Help Groups WHO World Health Organization


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1. PROJECT TITLE AND GENERAL INFOS

Project Title: “Support for the Strategic Plan for the Fight against Leprosy in South East Liberia”

Location: Liberia (West Africa). In 5 Counties: Nimba, Grand Gedeh, River Gee, Maryland and Bong County

Dioceses: Diocese of Gbarnga (County of Bong) and of Cape Palmas (County of Maryland).

Local partner: Congregation of the Missionary Sisters of the Consolata in Liberia.

Other partners: Ministry of Health and Social Welfare (MoHSW), and National Commission on Disabilities (NCD)

Sectors: Health, socio - economic and education.

Duration: 3 Years

Start date: 1st October, 2014

Overall objective: To contribute to strengthening the national health system in the five counties of the south-east (Grand Gedeh, River Gee, Maryland, Nimba and Bong Counties) as provided by the "Strategic Plan on Leprosy 2013-2017" of the Ministry of Health.

Specific objectives:

1) Increase the quantity, quality and access to services for the identification and treatment of leprosy provided by primary health centers in the communities involved in the project through specific training of medical and paramedical staff.

2) Develop a system of operators of RBC and health volunteers trained for the early identification of people affected by leprosy in communities, strengthening the referral system between the community and primary health centers in the area.

3) Improving education and the socioeconomic status of people affected by leprosy and persons with disabilities living in the project, with particular attention to the access of children to primary and secondary school.


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2. GENERAL OVERVIEW AND METHODOLOGY

This annual narrative report captures tangible results and sustainable activities carried out in the third and final year of the project by AIFO Liberia and its partners (the Congregation of the Consolata Sisters in Liberia, MoHSW, PIH, and NCD), in collaboration with the Dioceses of Gbarnga (County of Bong) and of Cape Palmas (County of Maryland). It focuses on five counties in Liberia namely: Maryland, Rivergee, Grand Gedeh, Nimba and Bong. The project considered a strong partnership with the Ganta Rehab, Liberia’s only Leprosy and TB Rehabilitation Center located in Ganta, Nimba County for referral of leprosy and other NTDs related cases. This center is being managed by the Consolata Sisters and the Ministry of Health. Four County Health centers namely; Phebe Hospital in Bong County, Martha Tubman Hospital in Grand Gedeh County, Fish Town Hospital in Rivergee County and JJ Dossen Hospital in Maryland County also coordinated with the project in areas of treatment and care for NTDs related cases.

The determination of the project was to support the government of Liberia in the fight against Leprosy and other Neglected Tropical Diseases such as Buruli Ulcer, Lymphodema, Elephantiasis among others. The plan provides for the decentralization of essential services for the identification, treatment and rehabilitation of people affected by these diseases. This synergy also aims to contribute significantly to the strengthening of the “National Program for Control of Leprosy and Tuberculosis” and, in particular, contribute to the realization of the Plan for Integrated IDM NTDs Case Management for 2016-2020. To a larger extent, the project helped to achieve some of the intended results of the plan and to be specific, training of Primary Health Care Workers on Leprosy and other NT Ds, Information, Education and Communication on NTDs, Vocational and Socio Economi c Opportunities for People affected with Leprosy, Education Support to Childre n of Persons affected with Leprosy among many others.

Firstly, considering that the project placed more emphasis on the early detection and treatment of leprosy and other related NTDs, CBR workers with the support of Leprosy Focal Persons detected and referred about 228 NTDs related cases with treatment provided throughout the three year period (2014-2017). IEC awareness and messages on NTDs reached more than 100,000 residents throughout the 5 counties, thanks to local community radio stations and CBR workers who worked in isolated areas to get the various messages disseminated.

Additionally, the project supported more than 300 former leprosy affected persons and people with disabilities as well as their family me mbers in various aspects of vocational training such as soap making, animal husbandry, tie and dye among others. The trainings took into consideration Small Business Management in other to enhance their managerial skills. The trainees were subsequently formed into Self Help Groups (SHGs) totaling 19. The SHGs is being utilized to also promote advocacy for social and economic inclusion of former leprosy affected persons and people with disabilities in general. As far as scholarship support is concerned, a total of 67 children of people affected with leprosy and children with disabilities benefitted from inclusive education. At least 14 CEI Project partner Schools, both private and public supported this process. Other Project Activities conducted includes; home visits, community level awareness to dispel myths and misconceptions, stigma reduction among others. As far as training of health care workers is concerned, the project provided an intensive training for more than 300 Primary Health Care and Community Workers (DHOs , CHSS, CHOs, LFP, NTDs-FPs, CBR Workers) in Integrated NTDs Case Management Training. The results of the training have been remarkable given the fast and active pace of various NTDs at the health centers in the concerned areas.

As part of efforts to ensure an effective coordination of activities in other to avoid duplication, the MoH NTDs Department during the reporting period convened series of meetings with NTDs partners to highlight the Programme planned activities and adjustments. AIFO ably participated


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to these meetings and was able to highlight the program’s implementation as well as challenges and recommendations. The contribution of CEI was always reflected in these discussions. Partners in Health, an American NGO working in Maryland County is coordinating efforts with AIFO in joint outreach on leprosy and other NTDs and providing nutritional food items for clients referred at the various health centers in the county. AIFO also played key role in the Disability Alliance during the reporting period. The Disability Alliance is a conglomeration of local and international NGOs working on disability and social inclusion issues in Liberia. It was very instrumental in engaging the National Elections Commission to ensure the full and effective participation of people with disabilities including people affected with leprosy in the October, 2017 Presidential and legislative elections which is most likely going for a runoff. For the first time in Liberia, persons with visual impairment utilized the tactile ballot to cast their votes. This report is focused on the third year intervention but a cumulative report of results for the three years are reflected in project results summary table as indicated in the below mentioned pages. The below mentioned pages will give you a clearer picture of the project’s final interventions, targets and results achieved as well as highlight the various challenges and recommendations.

3. THE CONTEXT National level Geographic Size 111,369 km2 Founded July 26, 1847 Executive President President: Ellen Johnson-Sirleaf (2018) Per Capita Gross Domestic Product US518.4 USD (2017 estimate) IMF Gross Domestic Product Annual Growth Rate

0.50% (2016) IMF

Population Living on Less than a Dollar a Day

83% (UNDP HDR 2016)

Population 4.5 million (2016) World Bank Population Growth Rate 2.6%(World Bank 2015 Population

Indicators) Life Expectancy 61.2/59.3 (WHO World Health Ranking) Under Five Mortality 94/1000 live births (2013 LDHS) Maternal Mortality Rate 725/100,000 live births (MOH 2015 estimate) According to the UNDP 2016 HDR report, average life expectancy has increased from 57 to 62 percent representing a steady increase of 5%. Mean years of schooling (which is the average number of years of education received in a life-time by people aged 25 years and older) increased by 4.4 years and expected years of schooling at 9.9 years. The serious economic challenges that usually accompany chronic conflict were also experienced in Liberia, where an estimated 63.8 per cent of the population now lives below the poverty line. The recent global economic downturn and the deadly Ebola epidemic have contributed to the slow economic recovery and will stunt future economic growth for some time. The GDP has resiliently grown at an estimated rate of 6%-7% from the end of the conflict and during the current global economic meltdown. Notwithstanding, a sharp decrease of 0.50% has been observed after the outbreak. The UN peacekeeping mission has significantly reduced and Liberia security authorities are managing key aspects of security operations in the country. The Government is taking responsibility for all aspects of Liberia’s security, including executive protection, unexploded ordinance disposal and marking of Government weapons, which were handed over in recent months. More information on this development can be found on this link: http://www.un.org/apps/news/story.asp?NewsId=54369#.V3Vj2VdEYZd


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During the reporting period, Liberia’s Mental Health Policy was also passed into law. This was a concerted effort of Carter Center, MOH, AIFO, HI and other partners working in the disability sector in Liberia. What is now needed is a robust plan and a political will for resource mobilization and management to undertake key aspects of the plan The country’s health indicators, though improving, remain unsatisfactory. According to the 2013 Liberian Demographic and Health Survey (LDHS), childhood mortality has decreased substantially. Infant mortality has drastically declined from 139 per 1000 live births to 54 per 1000 live births; under-five mortality has also drastically declined from 219 to 94 per 1000 live birth, representing an improved decline of the 1992-1996 infant and under-five mortality rates. However, Maternal Mortality Ratio according to the UNDP 2016 HDR was 725 deaths per 100,000 live births which still represent one of the highest in the world. Malaria is the leading cause of attendance in outpatient departments and is also the number one cause of inpatient deaths. Hospital records suggest that at least 33 percent of all inpatient deaths and 41 percent of inpatient deaths among children under age 5 are attributable to malaria (NMCP, 2009). This problem was exacerbated by 15 years of civil conflict that displaced populations and damaged health systems. Although curable and preventable, malaria remains a major public health problem in Liberia, where it takes its greatest toll on young children and pregnant women. Its prevalence (outpatient visits) has reduced from 66% in 2006 to 32% in 2010. According to the Liberia Malaria Indicators Survey (2011), prevalence of malaria among under-five children has reduced to 28%. The disease Leprosy continues to be a public health problem in Liberia. WHO set an elimination target prevalence rate of less than 1 case in 10 000. Liberia had a prevalence rate of 3.61 cases per 10 000 and an incidence rate of 11.8 cases per 100 000 in 2009. The trend of cases is steadily increasing with 410, 414 and 415 cases in 2007, 2008 and 2009 (National Leprosy and Tuberculosis Control Program, 2009). The response to the leprosy situation has previously been provision of care in the leprosarium. However, the provision of care is now through integrated IDM NTDs Master Plan at all facilities in all counties. Activation of mechanisms for early detection, treatment and referrals is being addressed in the Essential Package of Health Services through increased training of health workers and improved capacity to manage complications. Increased sensitization and awareness about leprosy, through community education by community health volunteers, will reduce stigma associated with the disease. The Ministry of health and partners has also prioritized the involvement of other neglected tropical diseases (NTDs) in the ongoing leprosy program. NTDs affect mostly the poor of society and the disease burden remains underestimated due to their ‘neglected’ nature. Most of these diseases take many years to show symptoms and therefore often go undiagnosed or misdiagnosed until it is too late to reverse the damage. Around the world, one billion people are infected or at risk of infection with an NTD and 500 million of these people are in Africa, living mostly in rural areas. The Ministry of Health in collaboration with partners has launched a five-year research programme funded by the UK’s Department for International Development (DFID). This research focuses on the control and elimination of key NTDs in Liberia and is firmly set within a health systems perspective. The research work seeks to understand better implementation strategies for current NTD programmes as well as reflecting on how the programme can be better owned by communities and integrated within the health system at district, county and national levels. As the health workforce is critical in NTD programme delivery, the research has therefore identified the need to appreciate and respect the experiences and training needs of health workers to ensure that the programme remains sustainable throughout the research and beyond. AIFO is fully participatory to the process. Liberia has also established a national vision of becoming a middle-income country by 2030 after successful implementation of the Poverty Reduction Strategy (PRS 1). Therefore, improving the health and social welfare status of the population are among the cardinal contributing factors of human development that will help the country to reach that vision. In that


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context, the Ministry of health led a participatory process of developing a holistic and comprehensive policy framework and plan to guide the sector over the next ten years. The process included analyzing the health and social welfare situation and lessons learned from implementing the 2007 National Health Plan, revising the National Health and Social Welfare Policy and thereby developing the 2011-2021 National Health and Social Welfare Plan, and Essential Packages of Health Services (NPHS) and (EPHS) respectively. As far as political stability is concerned, General elections were held in Liberia on 10 October 2017, electing the President and Members of the House of Representatives. No candidate won a majority in the first round of the presidential vote so a run-off will be held on 7 November 2017. The elections will be a defining moment for Liberia’s decade long peace which according to observers still remains fragile. It will be the first time in more than 40 years to have a democratically elected president turning over power to the next democratically elected leader or government. Local level The project area is located in the central and northern and south-eastern Liberia on the border with the Ivory Coast, Guinea and is composed of the counties of Grand Gedeh (125,258 inhabitants), River Gee (66,789 inhabitants), Maryland (135,938 inhabitants), Bong (328,919 inhabitants) and Nimba (462,026) for a total of about a million people (1,118,930 inhabitants to be precise) according to the latest census (LISGIS, 2008). This part of the nation especially in the South East is historically the most neglected, ignored and excluded from government policies. The lack of adequate road networks making it almost impassable during the rainy season. It’s an area devoid of almost all basic services, other than water that is hardly lacking. They lack electricity, schools and hospitals that offer levels of accessibility and adequacy. With the progressive abandonment of the area by the international NGOs, as a consequence of the end of the emergency post-conflict, the social and health conditions are likely to return to alarming levels. There are no data on the leprosy patients and people with disabilities; the only findings were the result of interviews conducted with the community during a visit in December 2012 by AIFO Liberia and the National Commission on Disability, which was precisely the aim of monitoring the situation of disability in the southeast of the country. The medical staff is not able to provide adequate services to the population affected by the situation because of the general lack of education and training. In the communities of southeast, leprosy is not only a health problem, but also social, because it is still associated with strong beliefs in witchcraft popular uprisings. People with the disease are therefore discriminated against and stigmatized. The schooling of children for families is very expensive and often not available in rural communities. There are only the fees to be paid, but also all the school supplies and uniforms are mandatory. Being the very large families is quite hard for them to meet the expenses for all the children and why the school dropout is high. Often children are forced to work for their livelihood and that of the family. The situation of children with disabilities is often dramatic. The popular belief that they see in the sign of guilt disabilities make them subject to stigma and marginalization; schools are not equipped to receive them and the teaching staff has no training. The situation of adults with disabilities is even better because of illiteracy, with the ensuing consequences. Not knowing how to read or write is a source of frustration and discrimination. Despite the new change in government, inhabitants in these counties are still almost deprived of basic services (such as water, light, hospitals, motorways). Most people find it better to leave for the Monrovia area where the services are concentrated. Sporadic cases of leprosy are pervasive and no effective system is in place to help address this


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situation. Those affected by the disease are marked by continuous social, psychological and economic problems. There is evidence of hidden cases of leprosy and other NTDs, especially in the five counties covered by this project: Bong, Nimba, River Gee, Grand Gedeh, and Maryland; There is one Government hospital in each county, which, however, have to face serious management and logistical problems, and are too far away for most people. The only referral hospital in the whole country is the Ganta Leprosy and TB Center which is miles away from the South Eastern Region. Government brags on resources as the main constraints to adequately address the situation of leprosy and other NTDs in the country even though partners like AIFO, GLRA, Ganta Rehab, MAP, PIH, ALM and the Consolata Sisters are doing their very best to help in the situation. 4. ACTIVITIES AND RESULTS In the following paragraphs a chronogram, narrative description of the activities has undergone, a table of the project implementation development and theirs indicators. Chronogram of the activities for 3rd year - 2016 in months (Gantt Chart)

Activities 2016 1 2 3 4 5 6 7 8 9 10 11 12

A) Training of health workers B) Purchase and activation of a mobile health unit

C) Facilitating the patients referral to the Ganta Rehab

X X X

D) Ensuring adequate standards of drug treatment, care and rehabilitation

X

E) Supply of mobility aids and rehabilitation tools

F) Establish a system for monitoring and follow-up for patients who were treated at Ganta Rehab and reintegrated into the community.

X

G) Training of CBR workers and community health volunteers.

H) Vocational training for former leprosy patients

I) Reintegration of former patients in the SHGs and promotion of income-generating activities.

J) Scholarship support & Material X X X


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Chronogram of the activities for 3rd year – 2017 in months (Gantt Chart)

Activities 2017 1 2 3 4 5 6 7 8 9 10 11 12

A) Training of health workers X B) Purchase and activation of a mobile health unit

X

C) Facilitating the patients referral to the Ganta Rehab

X X X X X X X


X X X X X X X

E) Supply of mobility aids and rehabilitation tools

X


X X X X X X


X


X X X X


X X X X X

J) Scholarship support & Material X X X X X


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Activities Results Achieved Previous

periods – Cumulative %

of Development 1 & 2nd Year

% Development (3rd & Final Year)

Total Cumulative % of

Development (1, 2 & 3rd Year)

Comments:

A) Training of primary health care facilities staff.

� A total of 136 PHC staff to include CHSS, OICs, DHOs, CHO, LFPs, Screeners, etc undertook an intensive training in Integrated NTDs Case Management in Bong & Grand Gedeh Counties

� Disaggregated figures: Bong: 86; Grand Gedeh:50

� The Trainings

were ably coordinated by AIFO. Training facilitations were done by MOH, GLRA, MAP and CHTs.

426.66% Target: 4 training Courses for 90 persons. Results achieved: 10 training courses for 384 primary health care workers

151.11% Target: 4 training Courses for 90 persons. Results achieved: 2 refresher training courses for 136 primary health care facilities staff.

426.66% Target: 4 training Courses for 90 persons. Results achieved: 12 training courses for 384 primary health care facilities staff.

The project surpassed the target of this particular activity. This is because training and capacity building of health workers was considered as one of the major gaps observed in the fight against leprosy and other NTDs. More to that, the involvement of other NTDs such as Hydrocele, Elephantiasis, BU, Lymphodema among others in the ongoing IDM-NTDs program triggered the need for additional training to health workers. The project consolidated on the results of the training to have multiplying effects in the communities. This was evident by the fast pace of detection of early cases of leprosy and other NTDs observed in the concerned communities.

PROJECT RESULTS SUMMARY TABLE


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B) Purchase and activation of a mobile health unit.

� 6 new TVS and ISUZUKI motorbikes were purchased for CBR workers in Bong, Nimba, Grand Gedeh, Rivergee and Maryland counties. The bikes were used to aid in the mobility of CBR workers as far as case detection and general project activities are concerned at county level. CBR workers coordinated their monthly movements along with the county health teams across the five counties.

14.25% Target: 75 Rural communities of the Counties of Grand Gedeh, Rivergee, Maryland, Nimba and Bong reached regularly by mobile clinic unit duly equipped for detection and home based care of leprosy depending on the budget Results achieved: (19) rural communities of the 5 counties have been regularly accessed by CBR workers and MOH Health personnel at county level for detection and home based care of leprosy.

14.25.% Target: 75 Rural communities of the Counties of Grand Gedeh, Rivergee, Maryland, Nimba and Bong reached regularly by mobile clinic unit duly equipped for detection and home based care of leprosy depending on the budget Results achieved: (19) rural communities of the 5 counties have been regularly accessed by CBR workers and MOH Health personnel at county level for detection and home based care of leprosy

50.66% Target: 75 Rural communities of the Counties of Grand Gedeh, Rivergee, Maryland, Nimba and Bong reached regularly by mobile clinic unit duly equipped for detection and home based care of leprosy depending on the budget Results achieved: (38) rural communities of the 5 counties have been regularly accessed by CBR workers and MOH Health personnel at county level for detection and home based care of leprosy

During the 1st and 2nd year, 19 rural communities were assessed for cases of leprosy and other NTDs. During the final year, 19 new rural and isolated communities showing signs of NTDs related cases were also assessed thus totaling 38. CBR Workers, LFPs and other PHC staff and the Field coordinator effectively worked together in identifying, referring and treating more NTDs related cases. The project could not exhaust all its targeted communities due bad road conditions which caused serious damages on the project’s vehicles and to Ebola emergency, that shifted the health priorities. Notwithstanding, a significant number of leprosy and other NTDs related cases were discovered.


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C) Facilitating the patients referral to the Ganta Rehab.

� As far as

referral of patients is concerned, the reporting period witnessed a total of 102 related NTDs cases at Ganta Rehab and other major health facilities at county level.

� Of the 102 cases referred, 20 cases were related to MB, 28 cases PB, 19 cases of wound care, 10 TB cases, 12 BU case and 13 Hydrocele cases respectively. All the cases were confirmed and referred. A significant amount of these cases have undergone treatment.

208 % Target : at least 70 related leprosy cases for referral at the Ganta Rehab and other health facilities depending on available resources Results Achieved: 171 NTDs related cases referred.

145. 71% Target: at least 70 related leprosy cases for referral at the Ganta Rehab and other health facilities depending on available resources Results Achieved: 102 NTDs related cases referred.

390% Target: at least 70 related leprosy cases for referral at the Ganta Rehab and other health facilities depending on available resources Results Achieved: 273 NTDs related cases referred.

� The referral of patients affected with leprosy and other related NTDs scored high marks in the concerned CBR project areas. This was as a result of the much training provided to health workers and CBR workers during the three year period.

� CBR workers and the focal persons at county level executed an early NTDs case detection and referral at community level.


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� Of the 102 cases referred, a total of 81 clients have been discharged from the various health centers and taken back to their respective communities. Social reintegration programs such as awareness sensitization and stigma reduction were conducted for these clients.

84% Target: at least 100 Leprosy and other NTDs related cases referred have accessed treatment, care & rehabilitation yearly. Results Achieved: At least 84 leprosy and other NTDs related cases as well as care for eye complications have all undergone some level of treatment or have been treated and rehabilitated in their respective communities.

81% Target: at least 100 leprosy and other NTDs related cases referred have accessed treatment, care & rehabilitation yearly. Results Achieved: At least 81 clients referred for treatment at the various health centers across the counties have been discharged abd sent to their respective communities.

165% Target: at least 100 leprosy and other NTDs related cases referred have accessed treatment, care & rehabilitation yearly. Results Achieved: 165 clients have obtained adequate standard of drug, treatment care and rehabilitation in the respective communities.

� CBR workers, LFPs, and Coordinators constantly provided home based service to patients and also trained parents in doing the same.

� CBR workers, LFPs, and Coordinators and partners constantly visited homes of patients in assessing the improvement during the rehabilitation process of patients.

� Two referral health centers (Ganta United Methodist Hospital & Phebe Eye Unit) both reached an agreement with AIFO during the project period to support treatment for eye complications for people affected with leprosy and people with disabilities.


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E) Supply of mobility aids and rehabilitation tools.

During the period, there were three (3) clients referred at Ganta Rehab for mobility, two of the clients were able to receive wheel chair each to make their movement smooth while the other received a pair of crushes due to his ailing condition. The activities took place on the 6th and 8th of April 2017

88% Target: At least 25 assistive devices /mobility aids of different categories distributed yearly to former leprosy persons in the concerned project areas depending on budget availability as well as conditions at Ganta Rehab. Results Achieved: 22 mobility aids were distributed during the reporting period.

0.12% Target: At least 25 assistive devices /mobility aids of Different categories distributed yearly to former leprosy persons in the concerned project areas depending on budget availability as well as conditions at Ganta Rehab. Results Achieved: 3 mobility aids were distributed during the reporting period.

33.33% Target: At least 75 assistive devices /mobility aids of Different categories distributed throughout the three years to former leprosy persons in the concerned project areas depending on budget availability as well as conditions at Ganta Rehab. Results Achieved: 25 mobility aids were distributed during the reporting period.

There is serious shortage of mobility aids in the country. All efforts with the Monrovia Rehabilitation center proved futile. Due to limited funding, the project could not set up mobility aids workshop. It is recommended that Ganta Rehab technical workshop is fully equip to address mobility aids problems at community level as there is only one Rehabilitation Center in the country which is situated in Monrovia. In fact, MRC itself lack the funding and technical support to ensure its smooth functioning.


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� A total of 50 have been discharged from the various health centers and taken back to their respective communities. Social reintegration programs such as awareness sensitization and stigma reduction were conducted for these clients

� A total of 800

persons with disabilities including ex lepers, visually impaired persons, physically challenged among others have been regularly reached throughout the reporting period

68.60% Target: At least 1500 patients who were treated including (leprosy and ex leprosy persons and other persons with disabilities) regularly reached through monitoring & follow-ups and rehabilitation Results Achieved: At least 1029 PwDs including leprosy and ex-lepers and other NTDs were regularly monitored during the reporting period.

56.66% Target: At least 1500 patients who were treated including (leprosy and ex leprosy persons and other persons with disabilities) regularly reached through monitoring & follow-ups and rehabilitation Results Achieved: At least 850 PwDs including leprosy and ex-lepers and other NTDs were regularly monitored during the reporting period.

125.26% Target: At least 1500 patients who were treated including (leprosy and ex leprosy persons and other persons with disabilities) regularly reached through monitoring & follow-ups and rehabilitation Results Achieved: A total of 1879 PwDs including leprosy and ex-lepers and other NTDs patients were regularly monitored during the reporting period.

� CBR Workers, LFPs, PIH Community Workers, & MOH on a quarterly basis carried out joint monitoring visits in the concerned project communities.

� Weekly monitoring and follow-ups of patients by CBR workers was continuously carried out during the period.


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� A total of nine (9) AIFO LIBERIA CBR Workers along with one (1) AIFO Regional Coordinator at the Women Center in Ganta, Nimba County during the period May 22-26, 2017. The main purpose of the training was to train CBR workers in NTDs Information, Education, and Communication and Social Mobilization.

19% Target: 85 CBR Workers and health volunteers trained and updated for early detection of leprosy cases and for the social rehabilitation of former patients. Results Achieved: 16 CBR workers and community health volunteers trained.

0.12% Target: 85 CBR Workers and health volunteers trained and updated for early detection of leprosy cases and for the social rehabilitation of former patients. Results Achieved: 10 CBR workers were trained in NTDs IEC during the period.

19% Target: 85 CBR Workers and health volunteers trained and updated for early detection of leprosy cases and for the social rehabilitation of former patients. Results Achieved: 16 CBR Workers and Community volunteers trained.

Considering the budget constraints, AIFO decided to recruit only 16 CBR workers, in order to guarantee their proper management, training and follow up. However, AIFO CBR Workers received support by PIH Community Workers.


� Vocational training was held for a total of 60 persons including former leprosy affected persons, family members of former leprosy affected persons and

149 % Target: 250 former leprosy patients supported in accessing vocational training and provided with small funds to

24% Target: 250 former leprosy patients supported in accessing vocational training and provided with small funds to start Income

172. 4% Target: 250 former leprosy patients supported in accessing vocational training and provided with small funds to start Income Generating Activities (IGAs)

� Regular training on Small Business Management scale was continuously carried out to help enhance the managerial skills of the trainees..

� The trainings were recommended by the SHGs members themselves.


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people with disabilities during the reporting period.

� An additional 4 newly formed SHGs (Pleebo SHG, Rock Crusher 3 SHG, Todeyville SHG and Krahville SHG partook in the training which is expected to last for a period of two months.

� The training

focus was in soap making as a result of recommendations given by the group. A new brand and quality of soap was introduced as a result of market demands.

start Income Generating Activities (IGAs) Results Achieved: 371 Persons affected with leprosy and/or family members have benefitted from training.

.

Generating Activities (IGAs) Results Achieved: 60 persons affected with leprosy and/or family members have benefitted from training.

Results Achieved: A total of 431 persons affected with leprosy and/or family members have benefitted from varieties of vocational training.


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� At least 60 newly recruited persons affected with leprosy family member and persons with disabilities have been reintegrated in the 4 newly formed SHGs for the promotion of Income Generating Activities.

149 % Target: 250 former leprosy patients supported in accessing vocational training and provided with small funds to start Income Generating Activities (IGAs) Results Achieved: 371 Persons affected with leprosy and/or family members have benefitted from training

24% Target: 250 former leprosy patients supported in accessing vocational training and provided with small funds to start Income Generating Activities (IGAs) Results Achieved: 60 persons affected with leprosy and/or family members have benefitted from training.

172.4 % Target: 250 former leprosy patients supported in accessing vocational training and provided with small funds to start Income Generating Activities. Results Achieved: 431 newly recruited former leprosy affected persons, family member and persons with disabilities have been reintegrated in the 4 newly formed SHGs for the promotion of Income Generating Activities.

The newly formed SHGs benefited from separate tranche of grants to undertake their vocational activities.

J) Scholarship support & Material

� The 2016/2017 academic progress report was submiited during the reporting period.

� Of the 67

QUANTITATIVE: 45% QUALITATIVE: 72% QUANTITATIVE

QUANTITATIVE45% QUALITATIVE: 80% QUANTITATIVE PERCENTAGE

QUANTITATIVE: 45% QUALITATIVE: 80% QUANTITATIVE PERCENTAGE

� Inclusive education awareness campaigns and constant supported care was provided to the students by the CBR workers.

� A total of 14 project partner


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students supported and reported, about 54 students recorded good grades and positive behaviors thus representing 80% of the total enrolment. About 20% of the students need constant supported care to ensure their improvement. CBR workers, family members and school authorities are supportive to the process. More campus based awareness was undertaken to promote their full involvement in the school and encourage the student populace to guarantee their rights.

PERCENTAGE TARGET: 150 (children of ex-leprosy persons and children with disabilities) supported in regular school QUALITATIVE PERCENTAGE TARGET: At least 80 percent of academic improvement realized Result Achieved: 72% of the total enrolment is recording an impressive achievement as far as grade improvements and overall performance at school is concerned. The 28% needs more support to catch up with lessons and overall class activities.

TARGET: 150 (children of ex-leprosy persons and children with disabilities) supported in regular school QUALITATIVE PERCENTAGE TARGET: At least 80 percent of academic improvement realized Results Achieved: 67 children of ex leprosy persons and/or children with disabilities are benefited from a scholarship program in the regular school System Results Achieved: 80% of the total enrolment. About 20% of the students still need constant supported care.

TARGET: 150 (children of ex-leprosy persons and children with disabilities) supported in regular school QUALITATIVE PERCENTAGE TARGET: At least 80 percent of academic improvement realized Results Achieved: 67 children of ex leprosy persons and/or children with disabilities are benefited from a scholarship program in the regular school System

school supported the process. Local county education authorities have confirmed further support to the students following the project expiration.

� CBR workers, family

members and school authorities are supportive to the process. More campus based awareness was promoted to ensure their full involvement in the school and encourage the student populace to guarantee their rights.


20

A. Training of primary health care facilities staff A total of 136 PHC staff to include CHSS, OICs & Screeners undertook an intensive training in NTDs Case Management in Bong & Grand Gedeh Counties. The training in Bong County was held from March 1-2, 2017 while the training in Grand Gedeh was held from March 19-20, 2017. Both trainings were held at the CHTs training halls in each county and was provided free of charge. Disaggregated figures: Bong: 86; Grand Gedeh: 50. The Trainings were ably coordinated by AIFO. Program Officers, Luther Mendin and Jonathan Davis. Training facilitations were done by MOH, GLRA and CHTs. The Coordinator of the NTDs Case Management at the MOH, Mr. Emerson Rogers, the Team Leader at MAP International, F. Zeela Zazay, the head of GLRA in Liberia, Dr. Anand Krishna, The head of the NTDs Department in Bong, Mr. Emmanuel Dweh and the Head of the NTDs Department in Grand Gedeh, Mr. Federick Yarsiah all facilitated the trainings. AIFO-Liberia so far is the first partner to implement the roll out of the Integrated NTDs Case Management training in the counties. Please find attached detailed listing of health workers trained: List of Health Staff Trained-Bong County:

NO. NAME POSITION HEALTH FACILITY 1. Diana Jimmy Screener Totota Clinic 2. Edwin Paye OIC Gbecohn Clinic 3. Benson Karbar 2nd Screener CB Dumbar 4. Edward Johnson Jr. OIC Shankpalai Clinic 5. Joe D. Quamellen Screener Rock Crusher Clinic 6. Joseph Y. Kerkula Screener Tokpapolu Clinic 7. Gertrude T. Kollie 2nd Screener Foequelleh Clinic 8. Kindness S. Forkpah 2nd Screener Gbartala Clinic 9. Samuel T. Kerkula OIC Fenetoli Clinic 10. D. Uriah Lipah 2nd Screener Kpaai Clinic 11. Ernestine Y. Harris Screener Gbalatuah Clinic 12. J. Emmanuel P. Kennae CHSS Salala Clinic 13. Oretha G. McGill CHSS Belefanai Clinic 14. Wilma N. Dormea OIC Naama Clinic 15. Joan J. Kennedy CHSS Gbartala Clinic 16. Elizabeth B. Wonga OIC Bahta Clinic 17. Florence N. Galama CHSS Phebe OPD 18. Abram Q.J. Kollie CHSS Salala Clinic 19. Rommina T. Yah 2nd Screener Sanoyea Clinic 20. Hannah P. Nelson CM Zeansue Clinic 21. Alfreda P. Jarwoe CHSS CB Dunbar Hospital 22. Victor T. Gwenigele CHSS Kelebei Clinic 23. Solomon G. Kwenah CHSS Sanoyea Clinic 24. Moses W. Wongan CHSS Gbarnla Clinic 25. Nathan Willie CHSS Fenutoli Clinic 26. Jestina Cole 2nd Screener Gbarnla Clinic 27. Lahai D. Freeman Screener Gbalatuah Clinic 28. Joseph Chiloplay OIC Bong Mines Clinic 29. Damadai Jallah Screener Haindii Clinic 30. Liyah M. Howe Screener Phebe OPD


21

31. Amos N. Suah Clinical Surgeon BoCHT 32. Dolo Lablah Clinician Phebe Clinic 33. Alphoneso Z. Mulbah CHSS Degei Clinic 34. Moses Kolleh CHSS Nyarta Clinic 35. Arthur D. Bee OIC Nyarta Clinic 36. Garmai B. Karbah 2nd Screener Gbonota Clinic 37. Abel M. Dakinah 2nd Screener Botota Clinic 38. Horace E. Barclay CHSS Belefanai Clinic 39. Nowai Flomo 2nd Screener Bahta Clinic 40. Emmanuel Otto OIC Yolota Clinic 41. Angeline Korsor OIC Boway Clinic 42. Precious C.J. Zorbai CHSS Bong Mine 43. Younger N. Wilson CHSS Totota Clinic 44. William SP. Howard CHSS Haindii Clinic 45. Musa Fofana CHSS Zeansue Clinic 46. Kopo Akor CHSS Gbonota Clinic 47. Annie Tokpah 2nd Screener Wainsue Clinic 48. Vera M. Joko Screener Belefanai Clinic 49. James Vaimdee PA Gbarnla Clinic 50. Saye M. Wonmei OIC Garmu Clinic 51. Nathan K. Sayuo 2nd Screener Gbecohn Clinic 52. Joe K. Tornorlah 2nd Screener Degei Clinic 53. Kebah M. Beyan Screener Zebay Clinic 54. Garmai S. Brown Screener Kpaai Clinic 55. David F. Karsor OIC Bellemu Clinic 56. Aaron Naimah 2nd Screener Samay Clinic 57. J. Mulbah Tellewy CHSS Tokpaipolu Clinic 58. Emmanuel B. Cooper OIC Botota Clinic 59. Perry Yeabarkeh OIC Zowienta Clinic 60. Kou N. Massadee OIC Palala Clinic 61. Solomane K. Swaray OIC Janyea Clinic 62. Beyan G. Kezedee 2nd Screener Shankpalai Clinic 63. Esther Wolobah 2nd Screener Palala Clinic 64. Martus M. Jackson 2nd Screener Kelebei Clinic 65. Roy T. Ford 2nd Screener Beletanda Clinic 66. Sumeiauo Z. Kesselly TB/LEP FP BoCHT 67. Kau Mulbah 2nd Screener Garmue Clinic 68. Yamah Kollie 2nd Screener Bellemue Clinic 69. James T. Nutha 2nd Screener Maamu Clinic 70. Lama G. Wonewe Screener Kpaii Clinic 71. Rebecca D. Vesselee Screener Jorquelleh Clinic 72. Jospeh K. Gbarmah OIC Zebey Clinic 73. Olivia N. Johnson OIC Jorquelleh Clinic 74. Boto T. Suah OIC Wainsue Clinic 75. Emmanuel S. Nawah CHSS Jaryea Clinic 76. Esther Harris CHSS Gborsuahloma Clinic 77. Danmie Flomo CHSS Yela Clinic 78. James F. Kollie CHSS Wainsue Clinic 79. Mulbah King Screener Belefani Clinic


22

80. Arme D. lemah Screener Zoma Clinic 81. Matthew Laslah 2nd Screener Jowah Clinic 82. Patricia Miamah CHSS Totota Clinic 83. Lorpu Johnson CHSS Rockcrusher Clinic 84. Kopru Dysney 2nd Screener Zoweinta Clinic 85. Harris Kollie Screener AFBM Clinci 86 John Gleekiah Screener BOCHT

List of Health Staff Trained-Grand Gedeh County: No Name Title or Position Health Facility # 1 TCHIEN DISTRICT: 1 Lawrence N. Lormie OIC/Physician Assistant Martha Tubman Memorial

Hospital 2 Benjamin Wesseh Second Screener/Physician

Assistant Martha Tubman Memorial Hospital

3 Menson Kotee Second Screener/RN Martha Tubman Memorial Hospital

4 Dyiah L. Beldeh Second Screener/Physician Assistant

Martha Tubman Memorial Hospital

5 S. Mark Whymah OIC/RN Gorbowrogba Clinic 6 Evelyn Gbolo Second Screener/CM Gorbowrogba Clinic 7 Antoinette Geweh OIC/RN Kumah Town 8 Mercy Saydee Second Screener/RM Kumah Town Clinic 9 Joseph K.Z. Ballawu OIC/Physician Assistant PTP Refugee Camp Clinic

10 Julius Kpoeh Second Screener/ RN PTP Refugee Camp Clinic 11 Zayzay MUlbah OIC/RN Christ The King Clinic 12 Trafene Chea Second Screener Christ The King Clinic 13 Eric Barguer OIC/RM Galapo Clinic 14 Ruth Gba Second Screener/RN Galapo Clinic 15 Samuel Goaneh OIC/Physician Assistant Toffoi Town Clinic 16 Kunnah Rue Second Screener/ RN Toffoi Town Clinic

Sub Total: 16 # 2 CAVALLA DISTRICT: 1 Tina G. Kpai Scecond Screener/RM Beh Town Town 2 Ophelia Dweh OIC/RN Beh Town Clinic 3 Lusu S. Queaneh OIC/Physician Assistant Gboleken Clinic 4 Albertine D. Kyne Second Screener/ RM Gboleken Clinic 5 Beatrice Jillah Acting OIC/RN Tuzon Clinic 6 Dorris Whenyea Second Screener/Certified Mid-

wive Tuzon Clinic

7 Mary Dickson OIC/RN Zai Town Clinic 8 Decontee Seo Second Screener/CM Zai Town Clinic


23

9 Agnes P. Gaye OIC/CM Bargblor Town Clinic 10 Hickson Y. Grear Second Screener/Nurse Aide Bargblor Town Clinic 11 Louise Buyoe Acting OIC/RN Janzon Clinic 12 Getty T. Koffa Second Screener/RM Janzon Clinic

Subtotal: 12 # 3 B’HAI DISTRICT: 1 Emmette P. Jimmy OIC/Physician Assistant Toe Town Clinic 2 Grace Nyanow Second Screener/RM Toe Town Clinic 3 James F. Fomba OIC/Physician Assistant Dougee Clinic 4 Christina Gleplay Second Screener/CM Dougee Clinic Subtotal: 4

# 4 GBAO DISTRICT: 1 George Taylor OIC/Physician Assistant Gbarzon Health Center 2 Jason Sohn Second Screener/ Physician

Assistant Gbarzon Health Center

3 Helena SamuLa Second Screener/RM Gbarzon Health Center 4 Samuel T. Flomo OIC/LPN Polar Clinic 5 Agnes N. Sohn Second Screener/CM Polar Clinic 6 John T. Flomo OIC/ RN Gbarzonjawodee 7 Yassah K. Akoi Second Screener/CM Gbarzonjawodee Subtotal: 7

# 5 PUUT DISTRICT: 1 Joshua Zlehwolo OIC/Physician Assistant Putujawodee Clinic 2 Dorris B. Folee Second Screener/CM Putujawodee Clinic 3 Miatta Zackpa OIC/RN Putupennokon Clinic 4 Elizabeth C. Browne Second Screener/CM Putupennokon Clinic 5 Tarlee Choloply Acting OIC/RM Putukarlorwleh Town Clinic 6 Albert Wenjor Second screener/N/A Putukarlorwleh Town Clinic Subtotal: 6

# 6 KONOBO DISTRICT: 1 Othello Carrjallah OIC/MHC/RN Konobo Health Center 2 Jacob S. Timmah Second Screener/ Physician

Assistant Konobo Health Center

3 Jackqueline Doe Second Screener/RN Konobo Health Center 4 Grace N.T. Jallayu OIC/RN Boundary 5 Veronica G. Broway Second Screener/CM Boundary Subtotal: 5 GRAND TOTAL: 50

B. Purchase and activation of a mobile health unit. At least 6 new TVS and ISUZUKI motorbikes were purchased for CBR workers and the Regional Coordinator during the reporting period. The bikes were used to aid in the mobility of CBR workers as far as their daily activities are concerned. At least nineteen (19) rural


24

communities throughout the 5 counties was regularly accessed by CBR workers and MOH Health personnel at county level for detection and home-based care of leprosy . C. Facilitating the patients’ referral to the Ganta Rehab.

As far as referral of patients is concerned, the reporting period witnessed a total of 102 related NTDs cases at Ganta Rehab and other major health facilities at county level. Of the 102 cases referred, 20 cases were related to MB, 28 cases PB, 19 cases of wound care, 10 TB cases, 12 BU case and 13 Hydrocele cases respectively. All the cases were confirmed and referred. A significant amount of these cases have undergone treatment.

Grand Gedeh

MB Cases 7 PB Cases 5

Children 0 Grade 2 Disability 3

Total # of Buruli Ulcer Cases Detected 0 Total # of Hydrocele Cases Detected 7

Total # of Eye cases Detected 0 Total # of TB Cases Detected 1

Total # of Patients currently on Treatment 4 Total # of Patients Treated 19

Nimba






Rivergee







25

Maryland MB Cases 1 PB Cases 2





Bong County




Total # of Eye cases Detected 0 Total # of TB Patients 3


D. Ensuring adequate standards of drug treatment, c are and rehabilitation

Of the 102 cases referred during the period, a total of 81 clients have been discharged from the various health centers and taken back to their respective communities. Social reintegration programs such as awareness sensitization and stigma reduction were conducted for these clients. E. Supply of mobility aids and tools for rehabilitatio n

During the period, there were three (3) clients referred at Ganta Rehab for mobility, two of the clients were able to received wheel chair each to make their movement smooth while the other received a crushes due to his ailing condition. The activities took place on the 6th and 8th of April 2017 F. Establish a system for monitoring and follow-up for patients who were treated at Ganta Rehab and reintegrated into the community

A total of 81 clients have been discharged from the various health centers during the reporting period and taken back to their respective communities. Social reintegration programs such as awareness sensitization and stigma reduction were conducted for these clients. A total of 800 persons with disabilities including former leprosy affected persons, visually impaired persons, physically challenged among others have been regularly reached throughout the reporting period


26

G. Training of CBR and volunteers of health at the community level

During the period under review, as far as capacity building is concerned, AIFO Liberia in collaboration with the Ministry of Health trained a total of nine (9) AIFO LIBERIA CBR Workers along with one (1) AIFO Regional Coordinator at the Women Center in Ganta, Nimba County during the period May 22-26, 2017. The main purpose of the training was to train CBR workers in NTDs Information, Education, and Communication and Social Mobilization. The training was coordinated by the MOH NTDs Regional Coordinator, Mr. Gweenue Gnangawulor and the NTDs Focal Person in Nimba County, Mr. Abednego Wright. Luther Mendin coordinated the training sessions. At the end of the training, it is anticipated that CBR workers were fully equipped to identify, refer and raise sufficient awareness on all NTDs related cases in a timely and cost effective manner. Moreover, they have been capacitated to provide further IEC and/or social mobilization training at the level of the Communities particularly for Community residents, victims of the disease and /or family. Please find below the term of reference and training outline : Term of Reference:

Terms of Reference for NTDs Case Management Trainin g for CHSS and Screeners

1.0 Context AIFO-Liberia with funding from the Italian Bishops Conference is implementing a project to support the Government of Liberia in its fight against Leprosy and other Neglected Tropical Diseases. The Plan provides for the decentralization of essential services for the identification, treatment and rehabilitation of people affected by leprosy and other neglected tropical diseases including Buruli Ulcer, Lymphodema among others. This synergy also aims to contribute significantly to the strengthening of the "National Program for Control of Leprosy and Tuberculosis" and, in particular, contribute to the realization of the Plan for Integrated IDM NTDs Case Management for 2016-2020. 2.0 Background Liberia’s Neglected Tropical Disease (NTD) Program is at a critical stage in its evolution. The Program is the first national NTD Program to plan and implement integrated IDM NTD mapping and case management as part of its national health policy. The Government of Liberia Ministry of Health’s NTD Program has developed this plan and its budget in consultation with civil society, local, and international partners. The plan has been incorporated into the revised NTD Master Plan for 2016-2020 which includes the Integrated Case Management Plan 2016-2020. It is an understatement to highlight that capacity building is cardinal to ensuring full realization of this plan. Thus, AIFO-Liberia deems it expedient to help support the plan through areas of Capacity Building. The capacity building training is geared towards upgrading the social mobilization skills of AIFO Community Based Rehabilitation Workers. CBR workers have been instrumental in detecting and referring NTDs cases in the various AIFO catchment areas. An upgraded knowledge in the basic IEC techniques is paramount to ensuring full awareness and dissemination of NTDs at community level. CBR workers are grassroots workers providing basic social services and issues related to rehabilitation. 3.0 Objectives Training Objective : The overall objective of this training is to upgrade the social mobilization skills of Community Based Rehabilitation workers as far as the IEC component of the MOH NTDs training module is concerned. In particular, the training will seek to highlight and focus among other things the following:


27

1. Information, Education, Communication(IEC) related to NTDs 2. Behaviour Change Communication(BCC) 3. Social Mobilization(SM) 4. Health Education/Advocacy 5. Barriers to change/compliance 6. Designing key NTDs messages, pretesting 7. Communications Channels :traditional and modern 8. Poster Display and discussion 9. Referral Pathway

In a nutshell, the training will seek to upgrade the social mobilization skills of CBR workers in suspecting and raising awareness for NTDs at community level. 4.0 Expected result of the training At the end of the training, it is anticipated that the trainees (CBR Workers) will be well equipped to identify, refer and raise sufficient awareness on all NTDs related cases in a timely and cost-effective manner. Moreover, they will be well capacitated to provide further IEC training at the level of the communities particularly for community residents, victims of the disease and/or family members.

5.0 Targeted group The maximum number of participants should be 10 Community Based Rehabilitation Workers (CBR Workers) from 30 cluster of communities across 5 counties namely, Grand Gedeh, Rivergee. Maryland, Nimba and Bong Counties. Additionally, 1 CBR Regional Supervisor will also be trained thus totaling 11. 6.0 Scope of workshop: AIFO-Liberia has established partnership with MOH to conduct the training. MOH will provide 1 facilitator. The overall coordination of the training will be guaranteed by AIFO-Liberia. Training methodology: Facilitation methodologies for the training will include:

• Group work • Lecture • Power point presentations • Group Discussion • Role playing • Plenary discussion

7.0 Duration of workshop

The total number of days for the training is 4 days. The actual timeframe is proposed for the period 22/05/2017 to 25/05/2017 . Of these days, MOH facilitator will be given 2 days to exhaust the aforementioned topics as the remaining 2 days will be left for AIFO program discussions.

9.0 Proposed training venue Ganta, Nimba County 10.0 Documentation : IEC Booklet and handouts on NTD


28

DAYS

DATES

TIME

SUNDAY

MAY 21,

2017

MONDAY

MAY 22, 2017

TUESDAY

MAY 23, 2017

WEDNESDAY

MAY 24, 2017

THURSDAY

MAY 25, 2017

FRIDAY

MAY 26,

2017

SAT

MAY 27,

2017

8:00AM -

8:30AM

A

R

R

I

V

A

L

B R E A K F A S T

8:30AM –

12:30PM

Introduction to

the course:

Introduction to

the course: aims,

participants’

expectations,

methodology and

expected

achievements.

Main Facilitators: Mr. Luther S. Mendin

Co-Assisted By:

Jonathan S. Davis

Training Session:

NTDs IEC Training:

Session 1:

Topics:

• Information,

Education,

Communicatio

n on NTDs

Recap of Day 1

Main Facilitator:

Mr. Gweenue

Ngangawulor

Co-Facilitator:

Mr. Abednego

Wright

Training Session:

NTDs IEC

Training:

Session 1:

Topics:

• Barriers to change/compliance

• Key Principles

• Designing Key NTDs

Recap of Day 2

Main Facilitator:

Mr. Gweenue

Ngangawulor

Co-Facilitator: Mr.

Abednego Wright

Training Session:

NTDs IEC Training:

Session 1:

Topics:

• BCC Goals

• Social

Mobilization

Recap of Day 3

Main Facilitator:

Mr. Gweenue

Ngangawulor

Training Session:

NTDs IEC

Training:

Session 1:

Topics:

• Advocacy for

NTDs

programs

• TB Health

Education

AIFO 3RD

YEAR

PROJECT

REVIEW

Discussion

Points 1:

CEI Project

Presentation

• Targets/m

atrix

achieved

as per

project

activity

• Challenges

/Gaps

• Recomme

ndations/

Way

Forward

Main

Facilitator: Mr.

J. Sylvester

COURSE

CLOSING

COMME

NTS

FACILITA

TORS

&

PARTICIPANTS


29

• Behaviour

Change

Communicatio

n(BCC)

Main Facilitators: Mr. Gweenue Ngangawulor

Co Facilitator: Mr. Abednego Wright

messages Main Facilitator: Mr. Gweenue Ngangawulor Co Facilitator: Mr. Abednego Wright

Roberts

Co Facilitator:

Mr. Luther S.

Mendin

Discussion

Points 2: CEI

Project

Presentation

• Update on

SHGs

Activities

(members

hip,

number of

groups,

profits

generated,

loan

scheme,

advocacy

&

networking

• Update on

CBR

Scholarshi

p students’

Progress

• Success

stories

A

R

R

I

V

A

L

COURSE

CLOSING

COMME

NTS

FACILITA

TORS

&

PARTICIPANTS


30

Main Facilitator:

Jonathan S.

Davis

Supported By:

CBR Workers

12:30PM-

1:30PM L U N C H

1:30 PM –

4:30PM

Training Session:

Session 2: NTDs

IEC Training:

Topics:

• BU Health

Education

• Leprosy

Health

Education

Main Facilitators: Mr. Abednego Wright

Co Facilitator: Mr. Gweenue Ngangawulor

Training Session:

Session 2: NTDs

IEC Training

Topics:

• Communication Channels: traditional and modern

• FAQ

Discussion

Main Facilitator: Mr. Abednego Wright Co Facilitator: Mr. Gweenue Ngangawulor

Training Session:

Session 2: NTDs IEC

Training

Topics:

• Lymphoedema

Health

Education

• Social

integration of

NTDs affected

patients Main Facilitator: Mr. Abednego Wright Co Facilitator: Mr. Gweenue Ngangawulor

Training Session:

NTDs IEC

Training:

Session 2:

Topics:

• Stigma reduction

Main Facilitator: Mr. Abednego Wright Co Facilitator: Mr. Gweenue Ngangawulor

Discussion

Points 3: CEI

Project

Presentation

• Monthly

Reporting

(Observatio

ns & Way

Forward)

• Information

on CBR

workers

approach to

advocacy

and

networking

(Steps

Taken,

Challenges

& Way

Forward)

• Update

from AIFO

COURSE

CLOSING

COMMEN

TS

FACILITAT

ORS

&

PARTICIPANTS


31

HQ relating

to Liberia

operations Main Facilitator: Mr. Luther S.Mendin Supported By: Mr. J. Sylvester Roberts

Close of Day!!!!!! Close of Day!!!!!! Close of Day!!! Close of Day!! Close of Day!! Departur

e


32

H. Vocational training for ex- leprosy patients Vocational training was held for a total of 60 persons including ex-lepers, family members of ex-lepers and persons with disabilities during the reporting period. At least 4 newly formed SHGs (Pleebo SHG, Rock Crusher 3 SHG, Todeyville SHG and Krahville SHG partook in the training which is expected to last for a period of three months.(March-May, 2017). The trainees were identified from the respective communities are well on course with the implementation of the training. Training materials were bought and distributed to all the centers concerned.

The training focus was in soap making as a result of recommendations given by the group. A new brand of soap was introduced as a result of market demands. I. Reintegration of former patients in the SHGs and promotion of income-generating Activities At least 60 newly recruited ex-lepers, family member and persons with disabilities have been reintegrated in the 4 newly formed SHGs for the promotion of Income Generating Activities. During the period under review, AIFO undertook a field mission in the southeastern region between April 22-26, 2017. The main intent of the mission was to distribute grants to SHGs undergoing the second IGA Training in soap making. The mission was also intended to gather information on the project activities. The training is intended to last for a period of three months (March-May, 2017) but due to the road condition especially during the rainy season, we thought it wise to provide the grants to enable the groups continue with their activities even during the rainy season. At least 8 groups each received an amount of USD 875.00 thus totaling USD 7,000.00. The eight groups are: Todeyville and Krahville SHGs in Grand Gedeh County, Jeproken and Rock crusher SH Gs in Rivergee County and Boneken Colony, Hoffman S tation, Hence Street and Harper SHGs in Maryland County respectively. The groups were evaluated based on togetherness, due payment, financial transparency, networking and lobbying. In fact, some of the groups have introduced a unique loan payment scheme and has added agricultural activities to their soap making production program. In Grand Gedeh County, Krahville SHGs has introduced a new quality of soap and is making frantic effort to arrange with small businesses in the counties to have their product sold. AIFO logo is placed on the soap and the name of the group is mentioned. The instructor is very committed in helping the group to expand their product and attract more support. The Boneken Colony SHG has resolved to embark on coal production instead of the soap making due to the market demand in that part of the county. The total inhabitants of the colony are 20. Out of this number, 5 persons are ex-leprosy persons. The rest are family members. At the grant ceremony, local authorities were invited to witness the occasion and ensure that the group’s activities are going on smoothly. Members of the SHGs thanked AIFO for their continuous support and promised to use the funds for the intended purpose. In the central region, regular SHGs activities are ongoing. Subsequent seed fund is expected to be given to groups that have ably managed previous grants and are doing pretty well. A detailed table relating to the financial activities of all the SHGs is captured below:


33

SHGs Financial Report: Latest Update as of June 30, 2017

No Co. Comm. Total Grant USD

Total Grant LD

Amt. in Bus. /soap USD

Amt. in Bus. /soap LD

Income Gen USD

Income Gen LD

Amt. in Loan USD

Amt. in Loan LD

Income Gen Amt. in Bank Total

USD LD USD LD USD

1 Nimba Wuo’s Town

800 76,800 150 14,400 50 4800 125 12000 30 2880 290 27,840 645

2 Nimba Kpain 800 76,800 100 9600 30 2880 365 35,040 75 7200 300 28,800 870

3 Nimba LPRC 800 76,800 180 17,280 69 6624 200 19,200 48 4608 350 33,600 847 4 Nimba Air Field

Zone 1 800 76,800 206 19,776 72 6912 195 18,720 42 4032 150 14,400 665

5 Bong SKT 800 76,800 177 17,000 57 5472 200 19,200 52 4992 250 24,000 736

6 Bong Colony 800 76,800 300 28,800 95 9120 250 24,000 60 5760 162 15,552 867

7 Bong Wainsue 800 76,800 150 14,400 48 4608 290 27,840 63 6048 176 16,896 727 8 Bong V.I 800 76,800 120 11,520 32 3072 230 22,080 40 3840 100 9600 522 9 Bong Lelekpayea 800 76,800 250 24,000 20 1920 175 16,800 25 2400 75 7200 545

10 Grand Gedeh

Crahville 1,675 160,800 500 48,000 167 16,032 600 57,600 130 12,480 400 38,400 1797

11 Grand Gedeh

Todey Ville 1,675 160,800 400 38,400 140 13,440 550 52,800 120 11,520 375 36,000 1585

12 Grand Gedeh

Zai Town 800 48,000 275 26,400 90 8640 200 19,200 50 4800 150 14,400 765

13 River Gee

Rock Crusher

1,675 160,800 550 52,800 185 17,760 375 36,000 80 7680 300 28,800 1490

14 River Gee

Jeproken Road

1,675 160,800 650 62,400 200 19,200 390 37,440 95 9120 295 28,320 1630

15 River Gee

Central Fish Town

800 48,000 275 26,400 90 8640 200 19,200 50 4800 150 14,400 765

16, Maryland Hoffman station

1675 160,800 700 67,200 220 21,120 250 24,000 60 5750 350 33,600 1580

17, Maryland Boneken 1675 160,800 800 76,800 250 24,000 350 33,600 80 7680 290 27,840 1770


34

18 Maryland Hence Street

1675 160,800 400 38,400 140 13,440 550 52,800 120 11,520 375 36,000 1585

19 Maryland Harper SHG

1675 160,800 690 66,240 225 21,600 500 48,000 150 14,400 150 14,400 1715

22,200 2,131,200 6,873 659,016 2,180 209,280 5,995 575,520 1370 131,510 4,668 450,048 21,106

Standard rate of 96.00


35

J. Scholarship support & Material The 2016/2017 academic progress report was submitted during the reporting period.

Of the 67 students supported and reported, about 54 students recorded good grades and positive behaviors thus representing 80% of the total enrolment. About 20% of the students need constant supported care to ensure their improvement. CBR workers, family members and school authorities are supportive to the process. More campus based awareness was undertaken to promote their full involvement in the school and encourage the student populace to guarantee their rights. A total of 14 project partner schools througout the 5 counties supported this process.

Criteria for selection of students: • A child needing the AIFO/CEI scholarship must firstly be identified as a child of a former

leprosy person or a person with disability/ies. • Priority is primarily given to children. • The living condition including family background of the beneficiary should be evidently

seen as vulnerable. • Must be justifiably nominated by members of the CBR Project Self Help Groups

established in an area a child of an ex-leprosy person or a child with disability/ies lives. • Must have the courage to act independently.

Selection & Eligibility of Schools: Selection of schools for a child of an ex-leprosy person or a child with disability depends on the proximity. The school should be closer to the child to avoid difficulties in mobility. An added advantage is the knowledge of school authorities on inclusive education especially those schools that have undergone inclusive education training under the CBR program of AIFO Liberia. Schools that have got ramps under the initiative of AIFO Liberia CBR program is also an added advantage. Benefits of the Scholarship:

• Full Payment of Registration and Tuition Fees • School materials to include book bags, uniforms and/or shoes, copy books, pens,

pencils, sharpeners and erasers. • Provision of mobility aids if needed. • Support service from CBR worker

Conditions for maintaining the scholarship: • Child must demonstrate continuous willingness to learn and adapt new skills with the

regular help of the parents and/or caregivers. • Parents and/or caregivers must ably support the regularity of their child in school by

conducting study sessions thus ensuring positive results. • Activities such as self-care, mobility or communication must be continuously provided by

the parents and/or caregivers to their child with disability mostly at home and sometimes at school.

• The full payment of the 2016/2017 academic school year as well as materials including book bags, uniforms, books among others were provided to the students.


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Children with disabilities including children of ex-leprosy persons face significant hurdles in accessing education in Liberia and a substantial number of them receive no education at all. While government boasts of free and compulsory primary education for children, there is a large gap for children with disabilities. In this regard, the AIFO/CEI scholarship scheme is geared towards igniting the consciousness of all stakeholders to include parents of children living with disabilities, local authorities, ministry of education officers, school authorities, students in general and the community in ensuring that children of ex-leprosy persons form part of the national development process. AIFO lobbied with MoE in maintaining the county scholarship scheme for its beneficiaries after the end of its scholarship program to children with disabilities. No. Of Students Name of Institution County 3 Hope Kindergaten School Nimba 4 Bethel Community School Nimba 5 John Gowans Jr& Sr High School Bong 4 Bethel Community School Nimba 3 Harriet E. Parkerson School Nimba 3 Hope Academy School Nimba 6 Solid Foundation High School Grand Gedeh 5 G. Foundation School Bong 4 AG School Rivergee 4 Fish Town Demonstration School Rivergee 8 Gboloken Public School Grand Gedeh 8 Big Town Public School Maryland 5 JS Pratt School System Maryland 5 Cape Palmas High School Maryland 67 14 Schools 5 Counties

5. INDICATORS To value efficiency, efficacy and the effects of th e action , it has been used the “input” indicators (referring to employed resources), the “output” indicators (referring to the product and to the intermediate results of the project actions); the “outcome” indicators (for the final –of the year- result of activities). Details of the below mentioned activities derived from interaction with the project field supervisors and in most instances face to face discussions with beneficiaries. Indicators (from 1 st October 2016 to 30 th September 2017)

Outcome

The annual number of new cases of leprosy and other NTDs diagnosed in the Centres of Public Health.

171

The annual number of new cases of leprosy diagnosed by operators of village.

102


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Percentage of new cases of leprosy presenting disability grade 2 at diagnosis (< 5 % at the end of the three years).

19.38%

Cohort study: percentage of cases of leprosy (PB and MB) ending treatment with PCT schedule (> 70 %).

82.62%

Number of persons who started Income Generating Activities after the attendance to vocational training courses

431

Output

Number of rural villages reached by the ambulance 38

Number of persons reached by the ambulance 1879

Number of out-patients in Ganta 42

Number of in-patients in Ganta 11

Number of local health staff persons trained 384

Number of local non-health staff persons trained 3

Number of CBR workers and Community Health Volunteers trained

16

Number of village volunteers trained 141

Input

Number of ambulance and motorbikes purchased and equipped

6

Number of sewing machines distributed 3

Number of set distributed for the production of soap 19

Number of set of consuming materials for the vocational training

38

Number of set for the realization of agriculture and breeding distributed

38

Number of information material set produced 3500


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6. WEAK POINTS AND STRONG POINTS Weaknesses: • Budget constraints for general running and management cost, compulsory for activities

organization and implementation. • No proper visibility in the project’s established communities due to budget limitation • Abrupt departure of Dr. Anand Krishna of GLRA posed some challenges at Ganta Rehab

and for training purpose Strengths:

• Good collaboration with partners and stakeholders was noteworthy • Grass-root presence in the communities through the already existing Community Based

Rehabilitation network and structures • Active participation and ownership by the communities involved • Good team work and collaboration among local staff • Establishment and availability of AIFO Liberia website • A vibrant structured office and staff • Effective supervision from AIFO Italy represented by Mrs. Simona Venturoli

7. VISIBILITY As far as visibility is concerned, the project prioritized the visibility of CEI new logo on project forms and acknowledged the financial contribution of the Italian Bishops Conference towards the project. In all of the vocational exercises, a banner demonstrating CEI’s support to the project was placed at the front view of the SHGs training sites. 8. FINAL OBSERVATIONS A huge challenge of mobility by both CBR workers and leprosy focal persons was observed. Massive awareness as it relates to the disease leprosy is lacking in the remotest parts of the counties as a result of logistical constraints. More to that, persons affected by the disease are not in the know and some considered the patches on their skin a birth mark and are refusing to accept that these signs on their bodies are something else. Recommendations In order to have a vibrant result as it relates to the fight against leprosy and other NTDs as far as MOH IDM-NTDs Master plan is concerned, we would like to recommend the following action points: � That adequate logistics be provided to both community health volunteers and focal

persons or special travelling allowances are provided on a periodic basis to allow them reach far away towns, villages, and districts.

� That plans calved by focal persons for outreach activities are ably supported by the requisite authority

� Continuous upgraded capacity building trainings and resource mobilization for program implementation be widened


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9.TABLES

Table 1: Trends of leprosy elimination indicators i n Liberia

Table 2: Burden of Leprosy in Liberia

County 2015 Population

Registered cases before ULR

New case during ULR

Registered cases after ULR

Prevalence rate per 10000

R1: Bomi 94,882 0 4 4 0.42

R1: Gbarpolu 96,874 0 1 1 0.10

R1: Grand Cape Mount

149,264 2 3 5 0.33

R2: Grand Bassa 260,047 7 1 8 0.31

R2: Margibi 230,959 0 2 2 0.09

R2: Montserado 1,324,073 45 0 36 0.27

R3: Bong 380,425 4 0 4 0.11

R3: Lofa 312,412 0 0 0 0.00

R3: Nimba 541,387 184 0 184 3.40

R4: Grand Gedeh 145,899 21 1 16 1.10

R4: Rivercess 76,175 0 0 0 0.00

R4: Sinoe 121,364 1 0 1 0.08

R5: Gand Kru 66,048 70 3 25 3.79


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R5: Maryland 157,764 37 0 17 1.08

R5: River Gee 77,859 57 0 27 3.47

TOTAL 4,035,433 428 15 330 0.82

The following leprosy data were collected during the Update of Leprosy Registers and Buruli Ulcer

Assessment in Liberia in 2015 conducted by MOH and Partners

Table 3: Status of Human Resource Training for IDM NTDs

COUNTY

DIS

EA

SE

CD

D/ C

HV

CH

A

NU

RS

ES

/PA

LAB

TE

CH

PH

YS

ICIA

N/S

UR

GE

ON

TE

AC

HE

R

OR

TH

OP

ED

IC

PH

YS

IOT

HE

RA

PIS

T

PH

AR

MA

CIS

T

Nat’l.

BU 0 0 14 2 0 42 0 0 0

Lepr 0 0 8 0 0 0 0 0 0 LF: H&L 0 0 0 0 0 0 0 0 0

Margibi

BU 0 0 36 0 0 0 0 0 0

Lepr 0 0 1 0 0 0 0 0 0

H&L 0 0 0 0 0 0 0 0 0

Montserrado

BU 0 0 156 0 0 0 0 0 0 Lepr 0 0 1 0 0 0 0 0 0 H&L

0 0 0 0 0 0 0 0 0

Grand Bassa

BU 0 0 36 0 0 0 0 0 0 Lepr 0 0 4 0 0 0 0 0 0

H&L 0 0 1 0 0 0 0 0 0

Bomi BU 0 0 38 0 0 0 0 0 0 Lepr 0 0 2 0 0 0 0 0 0

H&L 0 0 0 0 0 0 0 0 0

Cape Mount

BU 0 0 38 0 0 0 0 0 0

Lepr 0 0 2 0 0 0 0 0 0 H&L 0 0 0 0 0 0 0 0 0

Gbarpolu BU 0 0 20 0 0 0 0 0 0 Lepr 0 0 2 0 0 0 0 0 0

H&L 0 0 0 0 0 0 0 0 0

Bong BU 450 0 119 2 5 0 0 0 0 Lepr 0 0 2 0 0 0 0 0 0

H&L 0 0 3 0 0 0 0 0 0


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Lofa

BU 441 0 134 2 6 0 0 0 0

Lepr 0 0 2 0 0 0 0 0 0 H&L 0 0 0 0 0 0 0 0 0

Nimba BU 900 0 346 1 3 0 0 0 0 Lepr 40 0 173 0 0 0 0 0 0

H&L 0 0 3 0 0 0 0 0 0

Grand Gedeh

BU 0 0 26 0 0 0 0 0 0

Lepr 55 0 110 0 0 0 0 0 0 H&L 0 0 3 0 0 0 0 0 0

Grand Kru

BU 0 0 26 0 0 0 0 0 0

Lepr 0 0 84 0 0 0 0 0 0 H&L 0 0 0 0 0 0 0 0 0

Rivercess BU 0 0 25 0 0 0 0 0 0 Lepr 0 0 1 0 0 0 0 0 0

H&L 0 0 1 0 0 0 0 0 0

River Gee

BU 0 0 26 0 0 0 0 0 0

Lepr 0 0 83 0 0 0 0 0 0 H&L 0 0 3 0 0 0 0 0 0

Sinoe

BU 0 0 43 0 0 0 0 0 0

Lepr 0 0 0 0 0 0 0 0 0 H&L 0 0 0 0 0 0 0 0 0

Maryland BU 0 0 33 0 0 0 0 0 0 Lepr 71 0 109 0 0 0 0 0 0

H&L 0 0 2 0 0 0 0 0 0

Total BU 1791 0 1116 7 14 42 0 0 0 Lepr 166 0 584 0 0 0 0 0 0 H&L 0 0 16 0 0 0 0 0 0

Table 4 : IDM NTD Control Milestones, 2016 - 2020

Interventions 2016 2017 2018 2019 2020

Active Case detection in all

counties

3/15 (20%) 6/15 (40%) 9/15 (60%) 12/15 (80%) 15/15

(100%)

Passive case detection in all

of endemic counties

3/15 (20%) 6/15 (40%) 9/15 (60%) 12/15 (80%) 15/15

(100%)

Manage all patients in

peripheral health facilities

15/15

(100%)

15/15

(100%)

15/15

(100%)

15/15

(100%)

15/15

(100%)


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Refer severe and complicated

cases for management at

county hospitals and

reference centres

3/15 (20%) 6/15 (40%) 9/15 (60%) 12/15 (80%) 15/15

(100%)

Achieved 100% treatment

coverage of identified IDM

NTDs cases in the 15

counties

6/15(40%) 9/15 (60%)

12/15 (80%) 15/15(100%)

Achieved 100% treatment

coverage of identified cases

for other CM-NTDs in the 15

counties

15/15(100%) 15/15(100%) 15/15(100%) 15/15(100%)


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Table 5: D irect and Indirect Beneficiaries

Compiled by: Luther S. Mendin, National Programme and Communications Officer Revised by: J. Sylvester Roberts, National Focal Point Approved by: Simona Venturoli, AIFO HQS Project Manager

No.

Project Counties

Project Districts

Project Communities

Direct Beneficiary Population

Male

Female

Indirect Beneficiary Population

Central Region 1

Bong

Suakoko

Leprosy Rehab Colony

350

220

130

407

SKT

695

360

335

5,090

Component Total

1,045

580

465

5,497

Jorquelleh

Wainsue

359

200

159

4,400

V.I community

209

84

125

934

Lelekpayea 375 177 198 1,029 Component Total 943

461 482 6,363

Total Popn. 1,988 1,041 947 11,860

Nimba

Garr Bain

Gbeisella-Wuos' Town

102 75 27 4,200

L. P. R. C. 355 192 163 2,510 Componet Total 457 267 190 6,710 Meinpea-

Mahn Kpain 465 298 167 3,200

Component Total 465 298 167 3200 Sanniquellie

-Mahn Air Field Zone #1 100 25 75 3,000

Component Total 100 25 75 3,000 Total Popn. 1,022 590 432 12,910

South Eastern Region Grand Gedeh Cavalla Zai Town 305 87 218 1,001 Todeyville 225 102 123 945 Krahville 100 25 75 306 Total Popn. 630 214 416 2,225 Rivergee Putopo Jeproken Road 125 70 55 894 Component Total 125 70 55 894 Rock Crusher-1 175 65 110 606 Component Total 175 65 110 606 Rock Crusher-2 100 42 58 732 Component Total 100 42 58 732 Total Popn 400 177 223 2232 Maryland Harper City Harper 506 200 306 38,024 Component Total 506 200 306 38,024 Hoffman Station 75 25 50 760 Component Total 75 25 50 760 Hence Street 100 25 75 989 Component Total 100 25 75 989 Pleebo/

Sodoken Boneken Colony 50 15 35 208

Component Total 50 15 35 208 Total Population 731 265 466 39,981 Grand Total 9 19 4,771 2,287 2,484 69,208

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