· Web viewWuchereria bancrofti and transmitted by Anopheles mosquitoes in Africa, by the year...

MALI Work PlanFY 2017Project Year 6

October 2016-September 2017

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 United States Agency for International Development or the United States Government.

ENVISION Project Overview

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

At 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:

Drug and diagnostics procurement, where global donation programs are unavailable, Capacity strengthening, Management and implementation of ENVISION’s Technical Assistance Facility (TAF), Disease mapping, NTD policy and technical guideline development, and NTD monitoring and evaluation (M&E).

At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including:

Strategic annual and multi-year planning Advocacy Social mobilization and health education Capacity strengthening Baseline disease mapping Preventive chemotherapy (PC) or mass drug administration (MDA) Drug and commodity supply management and procurement Program supervision M&E, including disease-specific assessments (DSA) and surveillance

In Mali, ENVISION project activities are implemented by Helen Keller International.

ENVISION FY17 PY6 Mali Work Planii

TABLE OF CONTENTSPage

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

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

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

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

b) NTD Program Partners.................................................................................................................2

2) National NTD Program Overview.....................................................................................................4

a) Lymphatic Filariasis (combined with STH if appropriate).............................................................6

b) Trachoma.....................................................................................................................................6

c) Onchocerciasis.............................................................................................................................7

d) Schistosomiasis...............................................................................................................................8

e) Soil-transmitted Helminths..........................................................................................................8

PLANNED ACTIVITIES.................................................................................................................................11

1) NTD Program Capacity Strengthening...........................................................................................11

a) Strategic Capacity Strengthening Approach..................................................................................11

b) Capacity Strengthening Interventions.......................................................................................11

c) Monitoring Capacity Strengthening...............................................................................................12

Project Assistance......................................................................................................................................13

a) Strategic Planning......................................................................................................................13

b) Advocacy for Building a Sustainable National NTD Program......................................................14

c) Social Mobilization to Enable NTD Program Activities...............................................................15

d) Training......................................................................................................................................17

e) Mapping.....................................................................................................................................18

f) MDA Coverage and Challenges..................................................................................................18

g) Drug and Commodity Supply Management and Procurement..................................................19

h) Supervision................................................................................................................................20

i) M&E...........................................................................................................................................21

2) Maps..............................................................................................................................................24

Appendix 1. Work plan Timeline.................................................................................................................2

Appendix 2. Table of USAID-supported Provinces/States and HDs.............................................................5

TABLE OF TABLE

ENVISION FY17 PY6 Mali Work Planiii

S

Table 1: Administrative division of Mali in 2016..........................................................................................2

Table 2: Drug packages distributed in MDA.................................................................................................5

Table 3: Snapshot of the expected status of the NTD program in Mali as of September 30, 2016...........10

Table 4: Project Assistance for Capacity Strengthening.............................................................................12

Table 5: Social mobilization/communication activities and materials checklist for NTD work planning....16

Table 6: USAID supported coverage results for FY15 and targets for FY17...............................................19

Table 7: Planned disease-specific assessments for FY17 by disease..........................................................23

ENVISION FY17 PY6 Mali Work Planiv

ACRONYMS LIST

ALB AlbendazoleASTMH American Society of Tropical Medicine and Hygiene CDC U.S. Centers for Disease Control and PreventionCDD Community Drug DistributorsCHW Community Health WorkerCNHF Conrad N. Hilton Foundation CNIECS Centre National d’Information, d’Education et Communication pour la Santé (National

Center for Health Information, Education, and Communication)CSCOM Centre de Santé Communautaire (Community Health Center)CSREF Centre de Santé de Référence (Referral Health Center)DNS Direction Nationale de la Santé (National Health Directorate)DPLM Division de la Prévention et de la Lutte Contre la Maladie (Division of Disease Prevention

and Control)DQA Data Quality AssessmentDRS Direction Régionale de la Santé (Regional Health Directorate)DSA Disease-Specific AssessmentDTC Directeur Technique du Centre (Technical Director of the Health Center)END Fund Ending Neglected Diseases FundFELASCOM Fédération Locale de l’Association de Santé Communautaire (Local Federation of

Community Health Associations)FOG Fixed Obligation Grant FTS Filariasis Test StripFY Fiscal YearHD Health DistrictHKI Helen Keller InternationalICT Immunochromatographic Test IEC Information, Education, CommunicationINRSP National Institute of Research and Public HealthIVM IvermectinJAP Joint Application PackageJRSM Joint Request for Selected MedicineLF Lymphatic FilariasisM&E Monitoring and EvaluationMCD Médecin-Chef de District (Health District Chief Medical Officer)MDA Mass Drug AdministrationMOH Ministry of Heath

ENVISION FY17 PY6 Mali Work Planv

MSHP Ministère de la Santé et de l’Hygiène Publique (Ministry of Health and Public Hygiene)NGO Nongovernmental OrganizationNTD Neglected Tropical DiseaseOMVS Organisation pour la Mise en Valeur du Fleuve Sénégal (Organization for the

Development of the Senegal River)ORTM l’Office de Radiodiffusion Télévision du Mali (Office of Radio and Television of Mali)OV OnchocerciasisPC Preventive ChemotherapyPCR Polymerase Chain ReactionPGIRE Le Programme de Gestion Intégrée des Ressources en Eau et de Développement des

Usages Multiples (Integrated Water Resource Management Project)PNEFL National Program for the Elimination of Lymphatic FilariasisPNLO National Onchocerciasis Control ProgramPNSO National Program for Eye HealthPSI Population Services InternationalPZQ PraziquantelRPRG Regional Program Review Group SAC School-Aged ChildrenSAFE Surgery–Antibiotics–Face cleanliness–Environmental improvementsSCH SchistosomiasisSCI Schistosomiasis Control InitiativeSTH Soil-Transmitted HelminthsSTTA Short-Term Technical AssistanceTAF Technical Assistance FacilityTAS Transmission Assessment SurveyTCC The Carter Center TEO Tetracycline Eye OintmentTF Trachomatous Inflammation—Follicular (active trachoma)TIPAC Tool for Implementation Planning and CostingTIS Trachoma Impact Survey TSS Trachoma surveillance survey TOT Training of TrainersTT Trachomatous Trichiasis USAID United States Agency for International DevelopmentWB World BankWHO World Health OrganizationZTH Zithromax

ENVISION FY17 PY6 Mali Work Planvi

COUNTRY OVERVIEW

1) General Country Background

Mali’s neglected tropical disease (NTD) program began in 2007 as one of the original fast-track countries funded by the U.S. Agency for International Development (USAID). In 2009, the country reached full geographic scale (61 health districts [HDs]) for all of the preventive chemotherapy (PC) NTDs. Significant gains have been made since 2012 in stopping HD-level mass drug administration (MDA) for trachoma in 51 (HD), and 2 districts for lymphatic filariasis (LF) and onchocerciasis (OV). In addition, in 2016, 32 HDs achieved the criteria to stop MDA for LF with Regional Program Review Group approval. Review of data from schistosomiasis (SCH) evaluations in 28 HDs showed that 8 HDs achieved the criteria for disease control (less than 5% of heavy intensity infections in sentinel populations) and 8 HDs achieved the criteria for disease elimination as public health problem (less than 1% of heavy infections in sentinel populations). For soil-transmitted helminths (STH), 27 out of 28 HDs evaluated in 2014 and 2015 were shown to have zero prevalence in school aged children examined. Epidemiological and entomological surveys carried out in 2015 demonstrated progress towards OV elimination in 5 HDs. However, confirmation with additional studies using new techniques such as OV16 ELISA and O-150 PCR (in flies) will be needed for the timely detection of new infection and disease transmission.

Growing political instability since 2012 interrupted the distribution of drugs in certain regions. Security and political problems contributed to the suspension of MDA in the three northern regions of Gao, Kidal and Tombouctou and in three HDs in Mopti region (Douentza, Teninkou and Youwarou). The ENVISION objective for fiscal year 2016 (FY16) was to treat 100% of the eligible HDs with MDA. In FY17, USAID funding will support MDA in all 65 HDs and the following surveys: LF pre-transmission assessment surveys (pre-TAS), SCH (sentinel and spot check site surveys), STH (sentinel and spot check site surveys) and OV (epidemiological survey) as well as data quality assessments (DQAs). Trachoma impact surveys (TIS) and trachoma surveillance surveys (TSS) will be supported by the Conrad N Hilton Foundation (CNHF).

a) Administrative Structure

Mali is a large West African country located in the Sudano-Sahelian zone, covering 1,246,040 square kilometers. It is bordered in the north by Algeria; in the east by Niger and Burkina Faso; in the west by Senegal and Mauritania; and in the south by Guinea, Côte d’Ivoire, and Burkina Faso. The climate in Mali is characterized by two seasons, a dry season (9 months) and a rainy season (3 months, Aug-Oct). It is also crossed by two major rivers, the Niger and the Senegal. Dams were built on both rivers, and fishing and rice cultivation areas create ecological areas where certain NTDs thrive. Mali is endemic for the following PC NTDs: LF, OV, SCH, STH, and trachoma. The population in Mali is estimated to be 18,875,999 people in 2017, with most of the population concentrated in the south and the center of the country.1

Mali’s administrative and political structure is divided into 10 regions (two new regions were created in 2016) and the District of Bamako, 59 prefectures, and 703 rural and urban communes. The health system structure is delineated differently and has the following structure, as of 2016.

1 Direction Nationale de la Statistique et de l'Informatique du (National Directorate of Statistics and Information of) Mali.

ENVISION FY17 PY6 Mali Work Plan1

Table 1: Administrative division of Mali in 2016Administrative structure Number of administrative structure

Regions 101

Prefectures 59Rural and urban communes 703Health districts 652

Health regions 9Community health centers 1,240

1 Mali created 2 new regions in 2016: Menaka from Gao and Taoudeni from Tombouctou. 22 new HDs were created in 2016 in Kayes region. The two new districts are from the Kita district and are called Sefeto and Sagabari.

Nine health regions 65 HDs 1,240 community health centers

Within Mali’s health system, there are four levels of health facilities:

(1) Community Health Centers, which offer basic preventive and therapeutic services at the local level

(2) HD level (Referral Health Centers)(3) Regional level(4) National level

Community health centers (Centres de Santé Communautaire [CSCOMs]) fall under the referral health centers (Centres de Santé de Référence [CSREFs]) which are the first level of referral and are typically located at the HD headquarters level. The CSREFs fall under the regional hospitals, the second level of referral. The third level of referral hospitals are the six national hospitals located in Bamako (5) and Kati (1). Regional and HD-level directors and staff members of the CSREFs and CSCOMs provide oversight to public health initiatives occurring within their catchment area. The National Health Directorate (Direction Nationale de la Santé [DNS]) develops the elements of the national policy on public health and safety, and ensures the coordination and supervision of regional services. The DNS is organized centrally and has five divisions and one unit: Reproductive Health, Nutrition, Regulation of Health Institutions, Public Health and Food Safety, and Disease Prevention and Control (DPLM) and the Unit of Training, Planning and Public Health Information.

The NTD program and disease-specific programs operate under the purview of the DPLM. Each region, including the District of Bamako, has a Regional Health Directorate (DRS) that is responsible for adapting DNS’s policies to meet local needs; therefore, each DRS provides technical and institutional support to HDs at an intermediary level. Within each DRS, there is a regional-level NTD Focal Point who is responsible for matters under the supervision of the Regional Director of Health. At the HD level, there is also an NTD Focal Point who oversees and coordinates NTD activities under the supervision of the Chief District Medical Officer. The Regional NTD Focal Points are the direct line of communication with the national disease program coordinators under the leadership of the Chief of the DPLM, who reports to the National Director of Health. At the health area level, the Technical Directors of Health Centers (DTCs) are in charge of the implementation of activities at the health center and village level.

b) NTD Program Partners


USAID’s history of supportMali began integrated NTD control in 2007 as a fast-track country of the USAID-funded, RTI-managed NTD Control Program, uniting already-existing vertical, disease-specific programs into integrated NTD treatment strategies. In 2008, Helen Keller International (HKI) became the sub-grantee providing technical assistance to the Ministry of Health and Public Hygiene (MSHP) in Mali in support of the integrated national NTD program. From 2007 to 2011, Mali scaled up treatments across the country for the five target NTDs: LF, OV, SCH, STH, and trachoma. Significant progress was made, with 100% geographic coverage reached for all five NTDs, adequate program and epidemiological coverage sustained over time, and disease-specific assessments (DSAs) providing evidence to stop MDA and begin post-endemic surveillance for LF and trachoma in certain areas. A military coup d’état from March 22nd 2012 led to the suspension of USAID funding.

In September 2012, HKI signed a memorandum of understanding with the Ending Neglected Diseases Fund (END Fund), which provided funding support from October 2012 through April 2013. With the funding from the END Fund through HKI, and continued assistance from the other partners to the Mali NTD program, including the Carter Center (TCC) and Sightsavers, MDA took place in July–August 2012 (for trachoma) and in October–December 2012 (for LF, OV, SCH, and STH) in the regions of Bamako, Kayes, Koulikoro, Mopti, Ségou, and Sikasso; the MDA did not take place in the three northern regions of Gao, Kidal and Tombouctou due to logistical and security reasons.

During the suspension of USAID funding, the END Fund awarded HKI a follow-on grant for the period April 2013–March 2014, to support the remaining calendar year 2013 MDA in the six southern regions and selected impact assessments for LF and SCH/STH. END Fund’s support of MDA activities ended in 2013. Since then, trachoma MDA, TIS and sentinel site surveys have been supported by HKI, TCC, and Sightsavers with a grant from the CNHF.

On September 6, 2013 the U.S. Department of State lifted restrictions on bilateral assistance to Mali, which allowed USAID to resume funding through ENVISION. This funding resumed in January 2014 and included support for LF, OV, SCH, and STH MDA (May–June 2014). In FY14, two of the three northern regions (Kidal and Tombouctou) conducted MDA for the first time since the 2012. Gao was unable to conduct MDA in 2014 due to continued violence in the region in mid-May 2014. Currently, all endemic HDs are receiving MDA. Activities in all nine health regions of Mali will take place with technical and financial support from the USAID-funded ENVISION project in FY17.

Donor Financial Support

The Government of Mali provides support to the national NTD program by paying staff salaries and providing office space and meeting rooms. In addition to funding from USAID through the ENVISION project, the following donors are currently supporting NTD activities in Mali. Table 2 provides more detail on partner activities implemented with these funds.

The CNHF funds trachoma elimination through HKI, TCC, and Sightsavers, supporting mainly the S, F and E components of the Surgery–Antibiotics–Facial cleanliness–Environmental improvements (SAFE) strategy, and also some targeted MDA, TIS, and pre-validation of trachoma elimination.

Sightsavers provides MDA treatments for OV/LF/STH in partnership with HKI in 14 HDs (in Koulikoro and Sikasso). SS will treat OV in partnership with WB in two HDs of Sikasso region (Sikasso and Kolondièba)

The Carter Center provides technical and financial assistance to MSPH for morbidity management and disability prevention for trachoma (S, F, and E components of the SAFE strategy) and for TIS. It also provides the tetracycline eye ointment (TEO) during the trachoma MDA.


U.S. Centers for Disease Control and Prevention (CDC) funds treatment of LF morbidities (lymphedema) in the Sikasso and Koulikoro regions, providing direct support to the National Program for the Elimination of Lymphatic Filariasis (PNEFL) with training and washing kit supplies for lymphedema patients.

END Fund supports the management of LF morbidity, notably hydrocele surgery and lymphedema management, in the regions of Sikasso, Ségou, Koulikoro, Mopti and Tombouctou through HKI. The current grant period is from January 2016 – February 2017.

SAHEL Project – World Bank (WB) is going to support NTD activities in the 12 border HDs with Burkina Faso and Niger (Sikasso, Kadiolo, Koutiala, Yorosso, Tominian, Bankass, Koro, Douentza, Gourma-Rharous, Ansongo, Menaka, and Tin Essako) with funding provided directly to the government. They plan to support MDA and LF morbidity management. Research projects and NTD activities are planned in 4 other non-border HDs (Bougouni, Yanfolila, Kita and Kolondiéba). The WB will support these activities with the malaria PC treatment for children in all these HDs. MDA activities will be co-financed with Sightsavers in two HDs (Kolondièba and Sikasso). ENVISION will deliver the MDA drugs to these specific HDs but will not provide MDA campaign funding.

Organization for the development of the Senegal River (OMVS) – OMVS’s Integrated Water Resource Management Project (PGIRE), funded by the WB, is projected to launch phase II in July 2016. It is anticipated that PGIRE will support MDA for SCH and STH as well as distribution of long lasting insecticide treated nets in the HDs situated in the Senegal River basin including those in Mali. OMVS intends to finance MDA activities in 10 HDs in the Kayes region (2 new HDs were created in FY16) and in 7 HDs in Koulikoro region in 2017. The nongovernmental organization (NGO) Population Services International (PSI) will be the implementing partner in Mali. OMVS (and as of June 22nd 2016, with PSI) is going to support the national program by providing praziquantel (PZQ) for the treatment of school-aged children (SAC) and adults at risk and also the additional PZQ required for a second round of MDA in three HDs with high SCH prevalence (Bafoulabé, Diéma and Kenièba). OMVS/PGIRE will support also stand-alone STH treatment in two HDs (Nara and Yelimane). The treatment for OV and STH will be carried out by Sightsavers, and HKI in Koulikoro. OV will be treated by HKI alone in Kayes region (with the exception of the HD of Kita which will be supported by the World Bank).

2) National NTD Program Overview

Mali has been implementing an integrated NTD control program since 2007, integrating the efforts of strong vertical, disease-specific programs with well-established elimination strategies for LF, OV, and trachoma, and control strategies for SCH and STH. These vertical programs include PNEFL, National Onchocerciasis Control Program (PNLO), National Program for SCH/STH, and National Program for Eye Health (PNSO).

Mali currently distributes three drug packages consecutively: Zithromax (ZTH) and TEO for trachoma; ivermectin (IVM) and albendazole (ALB) for the treatment of LF, OV and STH; and PZQ for the treatment of SCH. It should be noted that STH treatment will be associated with SCH treatment in areas where LF and OV treatment has stopped and where OV is not endemic (then the drugs given are PZQ and ALB). In HDs where the 3 drugs are administered, the treatment strategy is shown below (Table 3). In HDs where only 1 or 2 drug packages are given, the order is maintained with the exclusion of drug package(s) not being given (the DRS may change this order based on drug availability).


Table 2: Drug packages distributed in MDAFive days Three days Five days Three days Five days

ZTH + TEO --- IVM + ALB --- PZQ

MDA uses a community-based strategy—community drug distributors (CDDs) and community health workers (CHWs) distribute drugs to eligible individuals in the communities either house-to-house, at a fixed location, or using a mobile strategy for nomadic populations. In some areas, teachers help distribute the drugs to school-aged children aged 5-14 years (SAC) while CHWs distribute drugs to other members of the community. Combining PZQ into LF/OV MDA will be discussed with MOH during the upcoming annual review, though there are concerns about the use of two different dose poles by the CDDs at the same time and the potential for mixing up the poles.

In FY17, the following NTD MDA objectives are planned:

LF: 16 HDs will be treated

OV: 20 HDs will be treated

SCH: 36 HDS will be treated

STH: 65 HDs will be treated, 13 HDs will be treated only with ALB. The remaining districts will be treated with LF in 16 HDs and 16 with SCH and 20 with OV.

Trachoma: Depending on the results of the evaluations, 2 HDs may be treated. The Carter Center will support treatment by providing the TEO and HKI will seek funding from the CNHF for the MDA. ENVISION will not support trachoma MDA in FY17 unless other donor funding is not available.


a) Lymphatic Filariasis (combined with STH if appropriate)

The national strategy is to eliminate LF, caused by Wuchereria bancrofti and transmitted by Anopheles mosquitoes in Africa, by the year 2020 with yearly treatment of IVM and ALB according to WHO guidelines. LF is endemic throughout Mali’s 65 health districts according to the mapping done by PNEFL in 2004 using immunochromatographic test (ICT) cards. MDA with IVM and ALB began in 2005 in the Sikasso region to treat LF and OV. Over time, scale up of treatment continued, first in the OV co-endemic HDs and then in other HDs. In 2009, 100% geographic coverage was reached. This coverage was maintained until 2012 when serious insecurity in the northern 13 HDs in the regions of Gao, Kidal, and Tombouctou prevented MDA from taking place. Additionally, during the 2012 MDA, three HDs in the Mopti region were also inaccessible because of security concerns and therefore MDA activities were not conducted; MDA activities resumed in these three HDs in 2013. MDA restarted in Kidal and Tombouctou regions in 2014 and in Gao in 2015. In Kidal, the MDA was successfully integrated into the national immunization days in 2014 and 2015. In 2015 6 HDs in Bamako and 2 HDs in Kayes (Nioro and Kita) were not treated due to the limited availability of ALB in Mali.

Thirty-two HDs achieved the criteria to stop LF treatment according to the latest TAS-1 results in addition to the 2 HDs in Sikasso which achieved the stop criteria in 2012. A total of 34 HDs will not be treated for LF in FY17 in the regions of Sikasso (10 HDs), Koulikoro (10 HDs), Bamako (6 HDs) and Ségou (8 HDs).

Pre-TAS are planned in 16 HDs in 4 regions: 4 in Gao, 5 in Tombouctou, 4 in Kidal and 3 in Mopti. If these HDs pass pre-TAS, TAS1 are planned in early FY18.

With the support of END Fund and the CDC, morbidity management activities are underway in Mopti, Sikasso, Koulikoro, Ségou and Tombouctou until 2017. The World Bank will support the LF morbidity mapping (a census at national level) and management in their HDs. TAS is not scheduled in FY17.

b) Trachoma

Mali was historically a country with a heavy disease burden of trachoma. The national strategy is to eliminate trachoma by 2018. Mali is currently implementing the SAFE strategy for the elimination of trachoma as a public health problem, according to WHO guidelines and recommendations. Nationwide baseline mapping in the late 1990s found active trachoma prevalence ranging from 23.1% to 46.7% and an overall trachomatous trichiasis (TT) prevalence of 2.5%. Evidence of widespread endemicity led to the launch of a trachoma control program through the National Program for Blindness Prevention (now called PNSO) in 1998, with the first round of ZTH distributed in 2002.

After more than 10 years in the fight against trachoma, 51 of the 57 endemic HDs have reached the criteria to stop MDA. Six HDs remain under MDA currently. However, four HDs in Kidal and one in Gao await impact surveys with CNHF funding, which are planned in 2016 and will determine if they have reached the criteria to stop MDA. The final HD is Oussoubidiagna in Kayes region, where a sub-HD level survey in 2013 showed that 9 zones did not reach the criteria to stop MDA. According to the current WHO guidelines, these 9 areas were treated in February 2016 and an impact assessment will be carried out 6-8 months later to determine whether will continue; this assessment will be supported by CNHF funding.

Since 2009, the PNSO has reduced its trichiasis surgical backlog to fewer than 11,150 cases through an intense TT surgery outreach with implementation and technical support from TCC, HKI (non-ENVSION),


and Sightsavers. With funding from the CNHF, the PNSO believes it has the necessary resources to reach its Ultimate Intervention Goal for trichiasis surgery within the next year. In FY16, the attention shifted to HDs with lower backlogs and those beginning surveillance as the search for the final cases intensifies.

There are plans to establish a national trachoma elimination committee to guide Mali towards elimination and eventual dossier submission.

c) Onchocerciasis

The current national objective is the elimination of OV by 2025 using annual regular ivermectin treatment with a minimum requirement of 80% therapeutic coverage. OV is endemic in 35 HDs in the regions of Kayes, Koulikoro, Sikasso, Ségou and Mopti, of which 20 HDs are currently under IVM treatment jointly with LF MDA and the other 15 are under epidemiological surveillance.

After more than 30 years of efforts against OV, the PNLO has achieved the WHO control objectives (the original control objectives) in 20 HDs which have been confirmed by the epidemiological and entomological surveys. In FY15 the prevalence of OV by skin snip was zero in the HDs of Kati and Kolokani (3422 persons sampled) and in Bougouni (1741 sampled). Entomological surveys revealed no infection in blackflies in the HDs of Bougouni, Yanfolila, Kalabancoro and Selingué.

To consolidate the achievements, the PNLO will focus epidemiological and entomological surveys to confirm whether transmission has been interrupted and post treatment surveillance can be stopped using new diagnostic techniques in line with the newly published WHO guidelines. To accelerate achievement of the national elimination of OV, the PNLO envisages creating a National Committee for the Certification of the Elimination of Onchocerciasis. ENVISION will support these meetings during FY17. ENVISION will support a workshop to review OV data in order to identify appropriate plans and strategies needed to achieve the 2025 national elimination goal.

With ENVISION support, epidemiological evaluations were carried out in 2 HDs (Yanfolila and Bougouni) in FY15. Two other HDs (Kita and Kéniéba) are to be evaluated in 2016. In FY17 ENVISION will support epidemiological evaluations in 18 HDs and another 2 HDs will be supported by Sightsavers, using OV16 as recommended in the new WHO guidelines. Schistosomiasis

The current strategy for SCH in Mali, according to the National Schistosomiasis Strategic Plan, is control of morbidity by 2020, in line with existing WHO guidelines. The national program for SCH/STH was established in 1982, and two national surveys were subsequently conducted (1984–1989 and 2004–2006) confirming urogenital and intestinal SCH endemicity in Mali. Treatment targeting SAC and high-risk adults in all endemic regions was established in 2005 with support from the Schistosomiasis Control Initiative (SCI). This treatment strategy continued as part of the integrated effort since 2007 with funding from USAID, OMVS and Sightsavers.

Almost 10 years of integrated NTD control has had an impact on SCH morbidity. A review of survey results from 2014 to 2015 of sentinel sites in 28 HDs was used to measure the impact of the interventions. Thus, 8 HDs have achieved the criteria for elimination (less than 1% of heavy-intensity infections in sentinel populations) and another 8 have achieved the criteria for disease control (less than 5% of heavy-intensity infections in sentinel populations). The review also allowed the adjustment of the categorization of HDs for MDA in accordance with WHO guidelines: 16 HDs were categorized as A (one treatment per year); 35 HDs were categorized as B (one round of treatment every 2 years); and 11 were categorized as D (2 rounds of treatment per year).


In FY17, 36 HDs are targeted for MDA, of which 4 are in Kidal which did not receive PZQ treatment in the preceding 7 years. ENVISION will support 19 HDs in FY17, 4 of which will be co-financed by Sightsavers. All of the evaluations planned for FY16 (11 HDs) were conducted with the exception of a survey in Youwarou in Mopti region. The program has requested to delay this survey until FY17 due to the insecurity in the region. In FY17, the program is planning to conduct SCH/STH surveys in 12 HDs: 2 in Sikasso, 3 in Kayes, 3 in Koulikoro and 4 in Mopti.

d) Schistosomiasis

The current strategy for SCH in Mali, according to the National Schistosomiasis Strategic Plan, is control of morbidity by 2020, in line with existing WHO guidelines. The national program for SCH/STH was established in 1982, and two national surveys were subsequently conducted (1984–1989 and 2004–2006) confirming urogenital and intestinal SCH endemicity in Mali. Treatment targeting SAC and high-risk adults in all endemic regions was established in 2005 with support from the Schistosomiasis Control Initiative (SCI). This treatment strategy continued as part of the integrated effort since 2007 with funding from USAID, OMVS and Sightsavers.

Almost 10 years of integrated NTD control has had an impact on SCH morbidity. A review of survey results from 2014 to 2015 of sentinel sites in 28 HDs was used to measure the impact of the interventions. Thus, 8 HDs have achieved the criteria for elimination (less than 1% of heavy-intensity infections in sentinel populations) and another 8 have achieved the criteria for disease control (less than 5% of heavy-intensity infections in sentinel populations). The review also allowed the adjustment of the categorization of HDs for MDA in accordance with WHO guidelines: 16 HDs were categorized as A (one treatment per year); 35 HDs were categorized as B (one round of treatment every 2 years); and 11 were categorized as D (2 rounds of treatment per year).

In FY17, 36 HDs are targeted for MDA, of which 4 are in Kidal which did not receive PZQ treatment in the preceding 7 years. ENVISION will support 19 HDs in FY17, 4 of which will be co-financed by Sightsavers. All of the evaluations planned for FY16 (11 HDs) were conducted with the exception of a survey in Youwarou in Mopti region. The program has requested to delay this survey until FY17 due to the insecurity in the region. In FY17, the program is planning to conduct SCH/STH surveys in 12 HDs: 2 in Sikasso, 3 in Kayes, 3 in Koulikoro and 4 in Mopti.

e) Soil-transmitted Helminths

The current strategy for STH in Mali is control of morbidity by 2020, by reaching 75% coverage of SAC and pre-SAC according to WHO guidance. The entire 65 HDs received at least 5 rounds of MDA against STH. During the 2004–2006 surveys for SCH (noted above), data were also collected on STH prevalence and showed that STH was endemic across Mali. From 2004 to 2007, the national NTD program began treatment with albendazole (ALB), coupled with SCH MDA. Since the start of the integrated program, STH treatment has been coupled with the MDA for LF and all HDs have received at least 5 rounds of MDA. In FY16, 53/65 STH endemic HDs were treated with ENVISION support. Twelve (12) other HDs were not treated due to the lack of drug availability. The most recent results available to date are from the SCH-STH surveys conducted in 2014 and 2015 which showed that 27 out of 28 HDs evaluated had a zero prevalence in school age children examined. A data review recommended carrying out additional surveys to confirm these results and to integrate future evaluations with TAS-1 surveys.

In FY17, STH treatment with ALB will be conducted alone in 10 HDs, integrated with LF MDA in 31 HDs (depending on TAS-1 results in 15 HDs), with the OV MDA in 13 HDs and with the SCH MDA in 11 HDs


Table 5). If the 15 HDs under LF TAS-1 survey reach the MDA stopping criteria, the treatment will be associated with OV in 7 HDs in Kayes region, 5 HDs with PZQ and 3 will be treated alone with ALB. In those HDs where STH treatment will not be associated with LF or OV MDA, only SAC will receive ALB. Sentinel site surveys will be conducted in 12 HDs: 2 in Sikasso, 3 in Kayes, 3 in Koulikoro and 4 in Mopti.


Table 3: Snapshot of the expected status of the NTD program in Mali as of September 30, 2016

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

DiseaseTotal no. of HDs in

Mali

No. of HDs ever classified

as endemic

**

No. of HDs

classified as non-

endemic**

No. of HDs in

need of initial

mapping

No. of HDs receiving MDA

as of September 30,

2016

No. of HDs expected to be in need of MDA at

any level: MDA not yet started or prematurely stopped as of

September 30, 2016

Expected no. of HDs where the

criteria for stopping HD-

level MDA have been met as of September 30,

2016

No. of HDs requiring DSA

as of September 30,

2016USAID-funded Others

LF

63

63 0 0 16a 0 47bPre-TAS: 16c

OV 20 43d 0 18e 0 0 2 18f

SCH 63 0 0 42g 8 13h 0 12i

STH 63 0 0 63j 0 0 0 12

Trachoma 57 6 0 0k 1k 1 55 15l

a) 4 out of 16 HDs will be treated with co-financing from WB (Ansongo, Menaka, Tin Essako, and Gourma Rharous).b) 47 HDs have passed TAS1: the results of 31 HDs have been approved by the RPRG. The report on the other 16 HDs is

expected in August 2016 however preliminary results indicate that they have passed TAS-1.c) 16 HDs (5 in Tombouctou, 4 in Gao, 4 in Kidal and 3 in Mopti)d) 13/43 HDs are hypoendemic and under surveillance. They are not treated specifically for OV but received treatment

through LF MDA. Most of them will not be treated in FY17 because these HDs reached the criteria to stop LF MDA. e) 18 HDs will be treated: 4 HDs financed by ENVISION, 1 will be co-financed by ENVISION and the WB, 2 with ENVISION,

Sightsavers and WB); 11 HDs by ENVISION and Sightsavers.f) Of the 34 HDs planned for MDA, 13 will be co-financed with partners: 10 by OMVS and 3 WB. 15 HDs financed by

ENVISION (; 5 HDs by WB; 10 HDs by OMVS; 4 HDs by ENVISION and Sightsavers g) 29 HDs are endemic for SCH but will not undergo MDA this year according to their treatment cycle (categories B & C).

16 HDs were categorized as A (one treatment per year); 35 HDs were categorized as B (one round of treatment every 2 years); and 11 were categorized as D (2 rounds of treatment per year). Despite the varying treatment schedules, the 13 HDs listed here have not been treated for the past four years.

h) 12 HDs are planned for SCH/STH evaluation in FY17 i) STH treatment in 29 HDs will be co-financed with partners: WB, Sightsavers and OMVS. 10 HDs with ALB alone (5 of

these HDs by ENVISION, 4 HDs by WB and 1 by OMVS)j) MDA carried out in Oussoubidiagna in FY16 and will be surveyed in FY17 with CNHF funding. Menaka will receive MDA

in FY17.k) 15 HDs to be evaluated (Bafoulabe, Koutiala, Kolondièba, Yorosso, San, Oussoubidiagna, Diema, Kita, Kenieba,

Yelimane, Kayes Nioro, Ansongo, Borem, Menaka and Niafunké) by TIS or TSS.


PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

ENVISION and the MOH in Mali identified the following priorities to be focused on to strengthen the capacity of the MOH in order to continue the successful effort to eliminate and control NTDs in Mali:

Increase MOH Mali staffing

Identify and apply for new funding sources, and develop mechanism for sustained STH/SCH control

Strengthen supply chain management

Increase lab technicians capacity

Strengthen data management and use

While ENVISION recognizes that the priorities mentioned above are critical for the MOH, both parties (ENVISION and MOH) have selected four objectives which fit ENVISION current scope and strengths to be reach in FY17:

1- Strengthen supply chain management

2- Increase lab technicians skills to perform FTS

3- Strengthen data management and use

4- Improve annual plan implementation and budgeting

b) Capacity Strengthening Interventions

Objective 1: Strengthen supply chain management: ENVISION will be more actively involved in helping the MOH to fill out the WHO JRSM and submit it on time (submission must be done at least 8 months before MDA), and coaching the MOH to make regular follow up with WHO regional and central levels on the status of the request submitted. ENVISION will also assist the new Drug Supply Manager in developing a drug delivery and recuperation plan to be executed before and after MDA. This plan will be shared with the regional and HD levels of the MOH and will be used to mitigate drug management issues during and after MDA.

Objective 2: Increase lab technician skills to perform FTS: ENVISION plans to train the lab technician team on FTS by using the WHO video showing how to perform the test properly and will practice the test use in a pilot area in Bamako. This will further strengthen the capacity of the MOH to carry out critical DSA (Pre TAS and TAS). The budget for this objective is included in the Training section.

Objective 3: Strengthen data management and use: As noted above, there has been strong interest in the national integrated database. Most of historical data has been entered and confirmed by the disease specific coordinators. ENVISION will continue to provide support to the MOH to take ownership of the database and use it to generate key program documents, such as the WHO Joint Reporting Form. In addition, ENVISION will continue to play a convening role between divisions, working with the MOH to sell them on the utility of the integrated NTD database as a tool to support program planning and then


to support data entry. The only cost for this activity is ENVISION staff time, no additional costs are anticipated.

Objective 4: Improve annual plan implementation and budgeting: Through the Tool for Integrated Planning and Costing (TIPAC), ENVISION will assist the MOH in planning NTD activities over the next five years. A detailed five-year plan will allow the MOH to capture all the NTD activities to be conducted and will more easily identify where the needs are to provide additional support. The TIPAC training is scheduled for Q2. The cost for this activity is on the Strategic planning section.

Table 4: Project Assistance for Capacity Strengthening

Project assistance area Capacity strengthening interventions/activities

How these activities will help to correct needs identified in situation

above

Drug supply management & procurement

Mentoring MOH and Supply Drug Manager in filling and submitting the JRSM to WHO 6 months before MDA and developing a strategy to recuperate the unused drugs after MDA is completed.

Avoid MDA delay secondary to late submission of JRSM to WHO

Strategic planning

Develop NTD five-year strategic plan and training on Tool for Integrated Planning and Costing (TIPAC)

Proper allocation of resources to activities; ensure resources are available in a timely manner; Help identify program costs and funding gaps

M&E

Assist the MOH and other implementing partners to ensure complete historical data entry into the database

Data will be used when completing the WHO Joint Reporting Form and Epidemiology Reporting Form, when compiling the LF dossier, and in planning for the STH/SCH transition.

Training Training of lab technicians on FTS Will allow lab technicians to perform properly FTS

c) Monitoring Capacity Strengthening

Informal meetings, e-mails, phone calls, as well as regularly scheduled quarterly review meetings with the MOH will be used to review progress made towards achieving the planned capacity strengthening outcomes, using the following strategy to measure success.

The planned capacity strengthening outcomes will be monitored through informal meetings, e-mails, phone calls, as well as regularly scheduled quarterly coordination meetings with the MOH to measure their success.

Objective 1: Strengthen supply chain management:


ENVISION will meet quarterly with the Drug Supply Manager point of contact at the MOH for a physical stock inventory. About 8-9 months prior to the MDA planned in 2018, ENVISION will ensure the information needed for the JRSM are compiled, to ensure the document is ready to be signed and submitted on time (8 months prior to planned MDA) by the NTD Coordinator to the WHO. ENVISION will organize a quarterly meeting with WHO Representative in Mali, MOH and Partners to review available data needed to fill up the JRSM and JRSM status. ENVISION will ensure at least two weeks prior drug delivery to Regional and HDs levels, the regional and HDs Coordinator are informed and will follow up the week after MDA is completed that all unused drugs are recuperated from the field.

Objective 2: Increase lab technician skills to perform FTS: ENVISION is scheduling to train the labs technicians in Q1 of FY17 on FTS to accurately and efficiently meet assessment demands.

Objective 3: Strengthen data management and use:

ENVISION will convene the various stakeholders including the different MOH divisions and Disease specific Coordinators, Sightsavers, TCC, World Bank, OMVS, and other partners to review progress in completion of the database, identify obstacles to its usage, and propose solutions to overcome these. Feedback gathered during these meetings on how the database and other M&E tools could be made more user friendly will be feedback to WHO and to the ENVISION HQ M&E team.

Objective 4: Improve annual plan implementation and budgeting:

A draft of the five-year strategic plan will be completed by the end of Q1 of the FY17. TIPAC training for the MOH and partners is scheduled for Q2 of the FY17. ENVISION will convene MOH staff and partners on the progress toward completing data entry into the TIPAC, and to review the utility of TIPAC in providing useful information for advocacy of new funding sources. As with review of progress in use of the integrated database, obstacles to its usage will be identified and a plan put in place to resolve these. Feedback gathered during these meetings on how TIPAC could be made more user friendly will be fed back to WHO and to ENVISION HQ.

Project Assistance

a) Strategic Planning

Activity 1: National Stakeholders’ Meeting (Operational Planning Workshop) and NTD Annual Review

These two meetings will be combined in FY17 as many of the stakeholder are involved in both. The total meeting duration will be five days. The operational planning workshop is held annually to discuss the prior fiscal year’s activities and plan the next year’s. At this meeting, the national NTD program defines its annual NTD control and elimination objectives. The schedule of program activities for each disease is discussed, particularly the implementation dates for the MDA activities, impact evaluations, and research studies at the national and regional levels. This planning also includes budgeting for activities at all levels, including all partners and funding sources.

Activity 2: NTD Technical Coordination Committee Meetings and NTD Steering Committee meetings

The NTD Technical Coordination Committee is a technical body responsible for implementing NTD-related activities. This committee plans activities, conducts active monitoring of implementation, and validates the results of the NTD MDA or DSA. It meets quarterly and also holds special meetings up to twicea year. The DNS chairs the Committee meeting. Members include the DPLM, the NTD program coordinators, representatives of the National Health Information, Education, and Communications Center (CNIECS), the National Institute for Public Health Research (INRSP), the Faculty of Medicine and


Dentistry (Faculté de Médecine et d’OdontoStomatologie)/Malaria Research and Training Center (MRTC), HKI, and other partners. The new partners will be invited as well. ENVISION will support participant transportation and refreshments.

The NTD Steering Committee meets every six months to review and validate the results of the NTD MDA campaigns. One of the steering committee meetings is held at the end of the annual review (above). The Secretary-General of the MSHP chairs the Steering Committee. It is composed of a member of the cabinet of the MSHP, the National Director of Health, the head of the DPLM, the head of the section responsible for combatting the disease, the NTD program coordinators, the Health Planning, Training and Information Planning Unit, the Public Health and Hygiene Division (DHPA), INRSP, the Faculty of Medicine and Dentistry/Malaria Research and Training Center, HKI, and other partner representatives. ENVISION provides technical and financial support for the meetings.

Activity 3: Meeting to review onchocerciasis strategy and OV elimination committee meetings

As Mali moves towards OV elimination, it is necessary to review the current strategy and ensure that activities are fully described to maintain momentum and prepare for eventual OV elimination. Part of this review will be to plan for an elimination committee, select members from the MOH, national OV experts and international OV researchers. ENVISION will participate in this meeting.

The committee will include members from the MOH, national experts and researchers in OV, international experts in OV and will invite the WHO to attend. This meeting will ensure progress to elimination is moving forward, data review (from surveys), data are collected and complete and to prepare the eventual submission of an elimination dossier to the WHO. This meeting will aid in decision making and strategy as Mali reaches its elimination targets.

Activity 4: TIPAC training

This training was planned in FY16 but due to the lack of availability of a Francophone trainer, the training will now take place in October FY17.

Activity 5: Develop a new 5-year strategic plan

With the 2012–2016 strategic plan coming to an end, the MOH plans to evaluate the plan and develop a new one for 2017–2021. The new strategic plan will include a monitoring and evaluation (M&E) plan. The evaluation of the five-year strategic plan will provide an opportunity to introduce and train appropriate country officers on the TIPAC to help develop treatment and scale-down projections.

b) Advocacy for Building a Sustainable National NTD Program

Activity 1: Mobile Telephone Company Advocacy MeetingThe purpose of this meeting is to advocate for mobile telephone companies for in-kind contributions in sending SMS information to the targeted population at no cost. This meeting will be organized by the CNIECS (which has experience with these types of meetings and has been successful in ensuring attendance and engagement) with the national NTD program and with ENVISION support. The company representatives will meet with the NTD program managers and ENVISION Text messaging to the community will be a useful tool to increase awareness of the MDA campaign as well as for other campaigns such as malaria. From this advocacy with the mobile phone companies, we anticipate a commitment to send text message to their customers about the MDA campaign free of charge.


The NTD program will also work with the Minister for Education to create model lessons in schools for the national campaign launch day.

c) Social Mobilization to Enable NTD Program Activities

Activity 1: Design and distribution of the messages:First, a workshop will be held to develop and validate the messages/materials for the NTD control efforts. Participants will include CNIECS (the Mali media specialists) and DNS agents, technical and financial partners, researchers involved in NTDs, and any other individuals who can help design innovative messages/materials. After the messages/materials are developed and tested in a population sample, they will be translated and recorded into local languages. Next, they will be sent to the audio-visual media for local and national distribution.

At the local level, in addition to local radio, other mobilization channels – such as public criers, traditional and religious leaders, managers of women’s and youth organizations and other groups - will be used to ensure that the messages are distributed widely to the population. They will thus be asked to distribute the awareness messages at places of worship, in neighborhoods/villages, during meetings, and to households. Appropriate materials will be used to provide the information distributed through these channels (advice cards, images, comic books, posters, brochures, and banners– available from FY16 and no need to re-print). A supply of these materials is available in certain regions and may be redeployed in the HDs and health areas where the need exists. These materials will facilitate the communities’ understanding of the topics related to the targeted NTDs, the importance of participating in the mass drug administration, and the availability of free treatment for certain complications. At the national level, the messages will be distributed via ORTM TV. To ensure that these messages are effective, supervision teams will conduct missions in problem HDs both to ensure that the communication/mobilization activities are implemented and to talk with the populations about the impacts of these messages on changing their behavior.

Activity 2: National MDA campaign launch The goal of the National Launch is to give the MDAs a “seal of approval” that can encourage greater population mobilization through wide press coverage via national news outlets. The launch will be organized and chaired by a high-ranking official of the Ministry of Health. Administrative and local government authorities will also be present. This provides an opportunity to involve community leaders, including village/neighborhood and religious leaders and managers of women’s and youth groups. To enhance visibility, printed fabrics, T-shirts, and caps will also be produced and distributed to administrative authorities, local governments, and community leaders

Activity 3: Monitoring/supervision of communications activitiesThe national mixed teams, composed of the CNIECS, DNS, and the programs, will travel to the problem HDs during the campaigns to help them prepare and implement successful communications activities. They will make courtesy calls to administrative, political, and socio-health authorities. They will also visit the participating radio stations, community, religious, and association leaders, and all the actors involved in mobilizing the population to assess the situation, by using a checklist, in terms of strengths and areas for improvement. They will verify the general impacts of the messages on the population using a standardized questionnaire developed by ENVISION. Next, they will develop relevant recommendations to resolve problems experienced at the various levels of the health pyramid.


Table 5: Social mobilization/communication activities and materials checklist for NTD work planning

Category Key Messages Target Population

IEC Strategy (materials, medium,

activity etc.)

Where/when will they be distributed

Frequency

Is there an indicator/

mechanism to track this

material/activity? If yes, what?

Other Comments

MDA Participation

Announcement of the date, location, and duration of the campaign

General population

TV and local radio ads and sketches to announce campaign

One week before the start of the campaign and during the campaign.Radio – three days before the start of the campaign.

Twice daily for 14 days on TVTwice daily for 30 days on local radio

% of the population who reported hearing about the campaign on local radio and were persuaded to participate in MDA by the messages on radio

% of people who had knowledge of MDA due to messages

Will be done during the post MDA coverage survey

Drugs are available and of high quality

General population

Localradio

Throughout the entire campaign

Twice daily for 14 days

% of people who knew about drug availability, free, of charge, and are high quality% of people who participated in MDA due to hearing this message


Certain side effects are normal and will pass andManagement of normal side effects

General population

Localradio

During the campaign


% of people who participated in MDA due to hearing this message% of people who participated in MDA because they know certain side effects are normal and will take care by the health facilities free of charge


Will be done during the post MDA coverage

Safe drugs will be distributed to pupils in your school to

School children (5-14 years)

Model lessons in schools

Day of the national launch

Once during the campaign

% of school children (5-14 years)


Category Key Messages Target Population

IEC Strategy (materials, medium,

activity etc.)

Where/when will they be distributed

Frequency

Is there an indicator/

mechanism to track this

material/activity? If yes, what?

Other Comments

fight NTDs survey

Disease Prevention

Taking drugs during MDA and follow up of hygiene measure will prevent NTD burden and eliminate these diseases

General population

Local radio Before, during and after the campaign


% of people who participated in MDA due to hearing this message% of people who participated in MDA because they know about disease prevention


Promoting visibility of NTD Program

MDA campaign launching ceremony Media coverage (TV, Radio) Banners

General population

1st day of the campaign

Once at central level, once at regional level

Increased number of participants attending MDA and receiving drugs over FY16.% of people who participated in MDA due to hearing/seeing these messages


d) Training

Activity 1: MDA training:To ensure that staff members participating in NTD-related activities understand the targeted diseases and to ensure that the preferred MDA practices are implemented, they will participate in annual training and refresher sessions. The objective of the trainings is to increase knowledge of NTDs, particularly with regard to MDA implementation, ensure proper completion of the data collection tools, and strengthen management of the NTD drug supply chain. These trainings will target health workers at the various levels of the health pyramid, including physicians, pharmacists, and the health centers’ technical directors. Community health workers and other social service professionals. In HDs where several


partners are involved (WB, Senegal River Development Organization, or OVMS, and Sightsavers), the training will be conducted jointly.

Activity 2: Supply Chain training:In FY16, the program coordinators and the pharmacist responsible for NTD drug management received training in NTD drug and input logistics management from an international consultant hired by ENVISION. This integrated training (an extra day added to the training of trainers) is scheduled to be scaled up to the regions and HDs in FY17. In FY16, the actors (at central level NTDs program managers, and pharmacists, the Directorate of Pharmacies and Medicines (Direction de la Pharmacie et du Médicament), the regional pharmacist and NTDs partners) must validate the logistics management manual that the consultant developed at that time.

e) Mapping

Mali completed the mapping of all NTDs before the series of MDA began. Consequently, no mapping activities are scheduled for FY17.

f) MDA Coverage and Challenges

Activity 1: MDA census:

In FY17a population census will be conducted simultaneously with the treatment campaign for HDs in Kidal region (Abeibara, Kidal, Tessalit, and Tin-Essako). This census will help to determine the total population present during the campaign, which is important because the denominator was over-estimated based on the 2009 general census population figures.

Activity 2: Mop-up campaign:

In addition, all HDs are encouraged to ask the low-coverage areas identified during the MDA campaign outcome feedback sessions to carry out mop-up activities. This will help to improve the coverage rate in time and before presenting the outcomes at the regional or central level.

Activity 3: Independent Monitoring:

ENVISION will organize independent monitoring during the campaign in three HDs (two in the north and one in the south) so that coverage and other quality problems in campaign implementation can be corrected in real time. As this is a new strategy, three HDs were chosen for initial roll out and these HDs were chosen due to their persistent lower coverage rates. GPS and cell phones will be used to conduct the independent monitoring (and coverage surveys).


Table 6: USAID supported coverage results for FY15 and targets for FY17

NTD# Rounds of

annual distribution

Treatment target (FY15)# HDs

# Districts not meeting epi coverage

target in FY15*

# HDs not meeting program coverage target in

FY15*

(FY15)#

Treatment targets

PERSONS

(FY15)# treated PERSONS

(FY15) %

of treatment target metPERSONS

FY17 treatment

targets# HDs

FY17 treatment

targets # PERSONS

LF 1 53** 18 17 11,246,446 9 728 705 86.5 % 16 1,874,213OV 1 18 0 3 3, 871, 494 3 609 973 93.24% 18 2,955,713SCH 1 36*** 0 14 3, 375, 801 3,191,708 94.5% 34 2,909,564STH 1 53** 18 17 11,246,446 9,728,705 86.5 % 63 15,250,037TRA 0 0 0 0 0 0 0 0 0

*Epi and Program coverage as defined in the workbooks** 2 HDs stopped treatment and 8 HDs were not treated due to lack of drug. *** 6 HDs were not treated due to lack of drug (six districts of Bamako).

g) Drug and Commodity Supply Management and Procurement

Drug ordering for FY17: Joint Application Process

In FY17, as was the case in FY16, HKI, through ENVISION, will support the programs to develop and monitor the joint request, if necessary, with the WHO, the donation program, and all the other stakeholders. The FY17 drug order was placed in July 2016, unlike in prior years, when it was placed in August. By submitting the request earlier, the country should avoid the delay in receiving ALB. The order had to be placed before the final 2016 MDA campaign outcomes were available because the campaign is still underway.

Despite the partners’ support for the national NTD program in recent years, drug supply chain management is still inadequate. These weaknesses may be due, in part, to human resources (quantity) and logistics.

These weaknesses will be corrected by using the manual and the NTD drug management plan developed in January 2016. ENVISION provided technical assistance to develop the manual and the management plan. The national workshop held to validate the manual and the cascade training on the manual, which is scheduled for the regions and health districts, will further strengthen the drug management capacity of all actors involved. ENVISION will also support a supply chain management training in FY 16 attended by members of the MOH.

Activity 1: Drug transport from national warehouse to regions

The HKI team will meet regularly with the DNS to review and handle the MDA logistics needs and will work with the DNS to ensure adequate monitoring and drug supplies. The drug supply plan will be prepared during a meeting of the Technical Coordination Committee and validated by the DNS. The MOH and WHO will inform the HKI team when orders are placed so that it can support the NTD national program during its interactions with WHO regarding drug supplies.

After the MDA drugs provided/contributed arrive in the country, they are stored in the NTD national program’s main warehouses. With technical support from HKI via ENVISION, the national NTD program is responsible for supplying the regions, which, in turn, supply the HDs with the necessary drugs.


ENVISION provides technical support to the MSHP coordinators to complete the drug request forms and financial support to the national NTD program to transport the drugs from the central warehouse in Bamako to the health districts and health areas. ENVISION will also provide the technical assistance necessary to conduct physical inventories at the regional level during supervision and feedback.

Activity 2: Reverse Logistics from Region to National WarehouseWhen the MDA end, the community health workers must return the remaining supplies to the health centers, which then send the supplies to the health district and, then, to the regional level for physical inventory.

Mali has policy documents governing biomedical waste management. Wastes produced during the campaign are managed pursuant to the standards and procedures in effect in the country. Empty azithromycin bottles are returned to the health center to be destroyed and incinerated.

With ENVISION support, the DNS has had an NTD drug and input storage warehouse since 2010. In FY15, this warehouse was supplied with an extinguisher and fans to increase security and proper drug conservation. The pharmacist responsible for the warehouse conducts an inventory regularly and shares the results with HKI to improve NTD drug monitoring.

The ICT cards for the National Program to Eliminate Lymphatic Filariasis (PNELF) are stored in DNS cold rooms. The pharmacist monitors them and shares the results with HKI.

Adverse drug events in Mali are reported during the campaign. There were 2,976 adverse events associated with IVM/ALB and 22,156 with PZQ in FY15. None were serious and were mostly headache, nausea or vomiting. An adverse event reporting template is in place and adverse events are reported at the health zone, HD and regional level. Materials have been developed to collect this information (type of reaction and treatment) by drug administered. The cascade trainings emphasize the appropriate behavior in case of undesirable events (minor or serious).

Activity 3: Validation of drugs logistics manual

A three-day meeting will be held to validate the drugs logistics manual produced by the MoH (supported by ENVISION). This reference document will be used at all levels of the health system for drug management before, during and after the MDA campaigns.

h) Supervision

Activity 1: Supervision of the National Level MDA

The NTD national program coordinators will conduct supervision activities in the regions to ensure that distribution campaigns comply with treatment directives. In collaboration with the Regional Directorates and the Referral and Community Health Centers, the central level will review the documents concerning the management of drugs received, outcomes obtained by the health centers, and problems identified. In addition to supervision at the regional level, the NTD national program coordinators will go to health areas and villages to observe the MDA in order to offer solutions to specific problems.

Activity 2: Supervision of the Regional Level MDA

The DRSs will supervise the health districts during the MDA campaign. In collaboration with the chief medical officers and the NTD focal points, they will review documents on the management of drugs received, results obtained by the health center, and all problems encountered. The recommendations will be made on site and the problems identified will be discussed during the annual review meetings. They will ensure that the data-gathering has been conducted and the report forms maintained properly.


This strengthened supervision plan (more teams) will enable the regional supervisors to supervise the training of the DTCs and the community drug distributors, in addition to the MDA activities in certain health areas.

Activity 3: Supervision at the HD Level MDA

The chief medical officers and NTD Focal Points will provide supervision in the health areas where the distribution is taking place. The HD’s NTD focal points will choose the health areas to be supervised. In collaboration with the chief medical officers, they will review documents on the management of drugs received, results obtained by the health center, and problems identified. They will also examine the documents regarding the distribution scorecards, distribution supplies, and supervision programs in the villages and direct a physical drug inventory.

Activity 4: Supervision of the CSCOM Level (Local)

The DTCs will conduct supervision activities in villages where the MDA is being held. They will observe the MCDs during distribution and will make recommendations and proposals for solutions to problems encountered. This supervision will confirm the DMCs’ knowledge of NTDs, the protocols for drug distribution and supply and drug management, and their data collection and transmission skills. The supervisors will also hold interviews with village and community leaders to assess the coverage of the target population in a given area. They will prepare a supervision report and send it to the district chief medical officer. They report will note all areas where proper implementation practices were not followed.

Activity 5: Independent monitoring (Country Management, MDA Supervision)

In addition to the supervision cascade conducted by the Ministry of Health and HKI ENVISION team, independent monitoring of the implementation of MDA activities will be conducted in the HDs of Diré (Tombouctou), Gao (Gao region) and Kéniéba (Kayes). These HDs were selected based on the recurrent low coverage and the existence of hard-to-reach areas. The contexts of these HDs are different: Gao is the regional capital, in Kéniéba there are a lot of gold panning sites and in Diré there are a lot of remote hard-to-reach areas with security problems. The objective of this independent monitoring is to detect deficiencies of geographic and therapeutic coverage in real time.

Supervisors of independent monitors will be medical doctors or pharmacists with experience in the organization of the mass treatment campaign. They will go in all health areas of their HD to inquire about the proper conduct of the campaign and see the monitors at work. He will himself be trained in the use of smartphones and oriented on NTDs by HKI.

i) M&E

Activity 1: Improving TAS Outcomes Checklists for Program Managers

Mali’s LF program has not used the TAS checklist prior to planning and implementing TAS activities or after conducting the TAS, although HKI monitors to ensure compliance with WHO standards. However, the protocol used for the TAS evaluations is approved by the main NTD technical advisor of HKI’s Africa office. The checklist developed by WHO recently was shared with the LF program and HKI ENVISION team will encourage the program to use it with future evaluations.

Activity 2: Implementing epidemiological and/or entomological assessments for OV


The FY15 OV evaluations could not be conducted as planned. Consequently, they were carried out in the current fiscal year. The evaluations scheduled for FY16 have not yet been conducted because the program wants to change the design of the evaluation, using OV16 ELISA in place of skin snip.

Together with the program, HKI plans to hold a data review workshop, with the participation of international experts, to define needs in terms of interventions and to create an implementation plan.

Activity 3: WHO Integrated NTD Database

Thanks to funding from ENVISION, in September 2015, the programs and partners (The Carter Center and Sightsavers) were trained in the use of the NTD integrated database. The consultant had the historical data validated from SCH/STH, LF and Trachoma for several modules. This activity will continue into FY17. To create a sustainable database, the MOH have requested that ENVISION fund two database updates per annum (each likely requiring one month’s work). A refresher training on the database for the stakeholders will be carried out in FY17, possibly by the consultant who has been working on compiling the database.

Activity 4: MDA Coverage Surveys (M&E)

The MDA coverage survey conducted in FY15 in two HDs provided satisfactory results on IVM/ALB treatment coverage, but raised many questions regarding PZQ treatment coverage, such as a higher survey coverage rate than the post-MDA coverage rate. In FY17, a post-MDA coverage survey will be conducted in two HDs in the Ségou and Mopti regions.

Activity 5: Pre-TAS (sentinel and spot check sites)

The WHO recommends a pre-TAS after five rounds of LF treatment. The program plans to conduct pre-TAS surveys in 16 health districts in the Gao, Tombouctou, Kidal, and Mopti regions. Mass drug administration began in 2008 in Tombouctou and in 2009 in Kidal, Gao and Mopti. These HDs were affected by the security crisis, which meant that three Mopti districts (Youwarou, Teninkou and Douentza) did not have MDA for one year, five Tombouctou districts (Diré, Tombouctou, Goundam, Nianfunké, and Gourma Rarhous) and the four Kidal health districts (Kidal, Abeibara, Tinessako and Tessalit) did not have MDA for two years, and the four Gao districts (Gao, Ménaka, Ansongo and Bourem) did not have MDA for three years. However, all of these HDs districts have had at least five rounds of MDA. The decision has been made to conduct pre-TAS in these HDs, in spite of the fact that the five rounds of MDA were not consecutive and did not reach effective coverage, because they had low baseline antigen during the mapping and the low coverage is due to the insecurity. The HDs in the Gao, Tombouctou, and Kidal regions do not have sentinel site data dating from before the first treatment round. The existing prevalence data are those from the baseline mapping.

The Tenenkou HD has a sentinel site for the Mopti HDs districts. The data from this sentinel site will be used for all three health districts in Mopti. Additional spot check site will be selected in Tenenkou HD. In HDs without a sentinel site, the program will choose two spot check sites for each HD in coordination with the regions.

Activity 6: Sentinel/Control Evaluations for SCH/STH and re-evaluation surveys SCH/STH mapping was conducted in Mali between 2004 and 2005 with funding and protocols from SCI. The PZQ MDA began in 2005, targeting primarily school-age children and high-risk adults. WHO guidelines recommend that sentinel and control sites are evaluated and treatment strategies modified subsequently for HDs that have completed five to six rounds of MDA. A sentinel and control site survey is planned for 12 districts in FY17. Ten of them have completed at least five rounds of MDA. They include


HDs of Kayes region (Kita, Sagabari, and Séféto); three in the Koulikoro region (Kolokani, Kati, and Dioïla); and four in the Mopti region (Bankass, Douentza, Koro, and Youwarou). The two HDs in Sikasso region (Koutiala and Yorosso), which received only one treatment (FY16), will be evaluated to estimate the prevalence and intensity of the infection as their data prevalence data was calculated some years ago

STH prevalence will also be evaluated during these surveys because the same methodology applies to SCH and STHs. The results regarding STH morbidity load will be used to review endemicity classification and treatment strategy, if necessary.

Activity 7: OV Epidemiological Survey In FY16, with support from ENVISION, epidemiological evaluations were conducted in two health districts (Bougouni and Yanfolila). These evaluations, conducted using the skin biopsy technique, showed zero prevalence. However, the results are not sufficient to stop the treatment (skin biopsy is not sensitive enough). To consolidate the results and refocus the strategy on new elimination objectives, 20 OV-endemic health districts will continue to receive IVM/ALB until the elimination criteria are met in all these districts. Most of the LF- and OV- endemic health districts met the criteria to stop LF MDA (13/20 health districts).

Table 7: Planned disease-specific assessments for FY17 by disease

Disease No. of endemic HDs

No. of HDs planned for

DSA

Type of assessment

Diagnostic method (Indicator: Mf, FTS,

hematuria, etc.)LF 65 16 Pre TAS FTS

LF* 65 16 TAS1 (if timing allows) FTS

SCH 65 12 Parasitology Urinary infiltrationKato-Katz

STH 65 12 Parasitology Kato-Katz

OV 35 18 Epidemiology OV16 ELISA and OV16 RDTOV* 35 2 Entomologic O-150 PCR

Trachoma** 59 15 TIS and TSS TF and TT* TAS1 can be carried out in the same year as the pre-TAS. RPRG approval is needed to conduct TAS1.** These evaluations are not funded by USAID. The entomological surveys/evaluations will be funded by Sightsavers. The CNHF will fund the trachoma evaluations. With 2 new HDs created in FY16, the total number of HDs is 65.


2) Maps


Note: FY17 DSAs indicated in the map reflect all planned DSA which may include DSAs supported by other partners in addition to those supported by USAID ENVISION's project.


Appendix 1. Work plan Timeline


FY17 Activities

Capacity Strengthening StrategySteering committeeJAM filled out and submitted to WHODevelop drug delivery and recuperation planTraining of lab technicians on FTSProject AssistanceStrategic PlanningNational stakeholders’ meeting and NTD Annual ReviewTechnical Coordination Committee meetings and NTD Steering Committee meetingsRegional review meetings (NTD MDA Campaign)Meeting to review onchocerciasis strategy and Oncho Elimination Committee MeetingWorkshop to review training manuals and data collection support.Building Advocacy for Sustainable National NTD ProgramMobile Telephone Company Advocacy Meeting Social Mobilization to Enable NTD Program ActivitiesDesign and distribution of the messages National MDA campaign launchNational MDA campaign launchRegional MDA launch ceremonyTrainingSupervisors training (Bamako)Training of Trainers (Regional level)Training of Trainers – Participation at the HD LevelTraining of Community Health Workers (CSCOM level)NTD Logistics TrainingFTS usage trainingMDAMDA drug package 1 (IVM and ALB) in 31 health districts: 31 for LF, 20 for OVMDA (PZQ or PZQ+ALB) for 36 health districtsMDA (ZITHRO and TEO) for 2 health districts MDA (ALB) for 10 health districtsDrug Supply Management and ProcurementDrug transport from national warehouse to regionsReverse Logistics from Region to National Warehouse

SupervisionSupervision of the National Level MDASupervision of the Regional Level MDASupervision of the District Level MDASupervision of the CSCOM LevelIndependent monitoring M&ELF Pre TAS Tombouctou (5 HDs)LF Pre TAS Gao (4 HDs)LF Pre TAS Kidal (4 HDs)LF Pre TAS Mopti (Youwarou, Tenenkou, Douentza)OV epidemiologic assessments (18 HDs)

Appendix 2. Table of USAID-supported Provinces/States and HDs

Region Health DistrictsLF

Pre-TAS

TAS1 TAS2 TAS3 TIS TSS OV Mapping OV Epi Surveys

SCH/STH Surveys

Gao

Ansongo x Bourem x Gao x Menaka x

Kayes Bafoulabe x Kayes x Kenieba x Kita x xSagabari xSefeto x

Kidal

Abeibara x Kidal x Tessalit x Tin-Essako x

Koulikoro Dioila x xFana x Kangaba x Kati x xKolokani x xKoulikoro x Ouelessebougou x

Mopti Bankass xDouentza x xKoro xTeninkou x Youwarou x x

Sikasso Bougouni x Kignan x Kolondieba x


Region Health DistrictsLF

Pre-TAS

TAS1 TAS2 TAS3 TIS TSS OV Mapping OV Epi Surveys

SCH/STH Surveys

Koutiala xNiena x Sélingué x Sikasso x Yanfolila x Yorosso x

Tombouctou

Diré x Goundam x Gourma-Rharous x Niafunké x Tombouctou x


· Web viewWuchereria bancrofti and transmitted by Anopheles mosquitoes in Africa, by the year...

Documents

Transcript of · Web viewWuchereria bancrofti and transmitted by Anopheles mosquitoes in Africa, by the year...