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Haiti Work PlanFY 2017Project Year 6

October 2016-September 2017

ENVISION FY17 PY6 Haiti Work Plan1

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 Haiti, ENVISION project activities are implemented by IMA World Health.


TABLE OF CONTENTSPage

ACRONYMS LIST...........................................................................................................................................5

COUNTRY OVERVIEW..................................................................................................................................7

1) General Country Background..........................................................................................................7

Administrative Structure.....................................................................................................................7

NTD Program Partners.........................................................................................................................7

2) National NTD Program Overview..................................................................................................11

Lymphatic Filariasis............................................................................................................................11

Soil transmitted Helminths................................................................................................................15

3) Snapshot of NTD status in Haiti....................................................................................................17

PLANNED ACTIVITIES.................................................................................................................................18

1) NTD Program Capacity Strengthening..........................................................................................18

Strategic Capacity Strengthening Approach......................................................................................18

Capacity Strengthening Interventions...............................................................................................18

Monitoring Capacity Strengthening...................................................................................................19

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

Strategic Planning..............................................................................................................................20

Advocacy for Building a Sustainable National NTD Program.............................................................20

Social Mobilization to Enable NTD Program Activities.......................................................................21

Training..............................................................................................................................................24

Mapping............................................................................................................................................25

MDA Coverage and Challenges..........................................................................................................25

Drug and Commodity Supply Management and Procurement..........................................................27

Supervision........................................................................................................................................28

M&E...................................................................................................................................................29

3) Maps.............................................................................................................................................31

Appendix 1. Work plan Timeline...............................................................................................................37

Appendix 2. Table of USAID-supported Provinces/States and Districts.....................................................39

Appendix 2.1 Table of Provinces/States and Districts not supported by USAID........................................41

Chapter 1 TABLE OF TABLES

Table 1: NTD partners working in Haiti, donor support and summarized activities...................................10

Table 2: Snapshot of the expected status of the NTD program in Haiti as of September 30, 2016...........17


Table 3: Project Assistance for Capacity Strengthening.............................................................................19

Table 4: Social mobilization/communication activities and materials checklist for NTD work planning....23

Table 5: Planned disease-specific assessments for FY17 by disease..........................................................30


ACRONYMS LIST

ALB AlbendazoleASTMH American Society of Tropical Medicine and HygieneCDC United States Centers for Disease Control and PreventionCDD Community Drug DistributorCIFF Children’s Investment Fund FoundationCL Community LeaderCOR-NTD Coalition for Operational Research on NTDsCP Community PromoterDEC Diethylcarbamazine CitrateDQA Data Quality AssessmentDSA Disease-Specific AssessmentsDSF Direction de Santé de la Famille (Directorate of Family Health)DSS Direction de la Santé Scolaire (Directorate of School Health)EAG Easy Access GroupsEU Evaluation UnitFTS Filariasis Test StripsGIS Geographic Information SystemGPELF Global Program to Eliminate Lymphatic FilariasisHNTDCP Haiti NTD Control ProgramHSC Hôpital Sainte CroixICT Immunochromatographic Card TestIDB Inter-American Development BankIEC Information, Education, and CommunicationIVM IvermectinJRSM Joint Request for Selected MedicinesKAP Knowledge, Attitudes, and PracticesLF Lymphatic FilariasisM&E Monitoring and EvaluationMDA Mass Drug AdministrationMENFP Ministère de l’Education Nationale et de la Formation Professionnelle (Ministry of

Education)MMDP Morbidity Management and Disability Prevention MOH Ministry of HealthMSPP Ministère de la Santé Publique et de la Population (Ministry of Public Health and

Population)NTD Neglected Tropical DiseasePAHO Pan-American Health OrganizationRDT Rapid Diagnostic TestRPRG Regional Program Review GroupSAC School-Aged ChildrenSAE Serious Adverse EventSCH SchistosomiasisSTH Soil-Transmitted HelminthsTA Technical Assistance


TAS Transmission Assessment SurveyTCC The Carter CenterTIPAC Tool for Integrated Planning and CostingUCS Unité Communale de Santé (Communal Health Unit)UND University of Notre DameUSAID United States Agency for International DevelopmentWHO World Health Organization


COUNTRY OVERVIEW

1) General Country Background

Administrative Structure

Haiti is divided into 10 departments: Artibonite, Center, Grand’Anse, Nippes, North, Northeast, Northwest, South, Southeast, and West. These departments are divided into 140 communes and sub-divided into 570 communal sections (village level).

The Ministry of Public Health and Population (MSPP) guides policy, planning, and monitoring and evaluation (M&E) efforts for health programs in Haiti. Within the MSPP, the Director General is the lead for all health sector work and reports to the Minister of Health. The Director General oversees the directors of several health priority areas at the central level and all department-level health directors. At the commune level, the unités communales de santé (communal health units [UCSs]) take the lead in all health efforts. The UCSs are decentralized administrative units responsible for carrying out a series of health activities with the participation of the community, and often a UCS will oversee multiple communes. The number and location of UCSs are determined by the size of the population covered, the UCS’s jurisdiction, and geographical location.

The Ministry of Education (MENFP) has a similar structure to the MSPP, with a Director General who oversees all education-related work in Haiti. The Director General oversees several priority area central-level directors as well as education directors for each department. Within each department, there are principal and zone inspectors who work with the facility-level school directors.

In Haiti, neglected tropical disease (NTD) control program efforts require close coordination between the MSPP and MENFP. These two ministries work together to coordinate, plan, and supervise many health activities throughout the country because schools are often used as a platform for service delivery and, in particular, for mass drug administration (MDA). Efforts for the Haiti NTD Control Program (HNTDCP) are led at the central level by the lymphatic filariasis (LF)/malaria coordinator and the technical advisor for soil-transmitted helminths (STH). These two key personnel also work closely with the central-level director within MENFP for school-based, MDA-related work. Supporting the LF/malaria coordinator are a team of M&E staff, two entomologists, two nurses, two advisors, two communication agents, a management and disability prevention (MMDP) and Pharmaco-vigilance Focal Point, and a secretary. The M&E staff includes a geographic information system (GIS) analyst, two data assistants, and an M&E manager. These staff mainly support the malaria program although they also work on the LF program.

NTD Program Partners

The HNTDCP is supported with financial and technical assistance from partners in addition to the U.S. Agency for International Development (USAID)-funded ENVISION project (Table 1). The University of Notre Dame (UND), with financial support from the Bill and Melinda Gates Foundation (BMGF) from 2001 to 2013 and through other funders in 2014-2016, funded MDA in the communes of Gonaives and Arcahaie and M&E activities including pre-Transmission Assessment Surveys (TAS) in the communes of Gonaives, Maïssade, Mirebalais, Leogane and Gressier, and community TAS in Saut d’Eau in FY16. Due to


funding constraints, UND was not able to identify funding for MDA in Gonaives and Arcahaie, which failed pre-TAS in FY16; therefore ENVISION will cover MDA for these communes in FY17. However, aAt the July 2016 partners’ meeting, UND confirmed they have funds from a private donor to treat Leogane and Gressier, , which also failed pre-TAS, in the fall of 2016 and to carry out 12 sentinel sites and spot checks (SS/SC) in the six Port-au-Prince communes in November 2016, and using funds from The Carter Center (TCC). UND also has funds to carry out TAS1 in the Center department in September 2016. ENVISION will cover MDA for Gonaives and Arcahaie in FY17.

In FY16, as in previous years, the U.S. Centers for Disease Control and Prevention (CDC) partially financed MDA in the Port-au-Prince metropolitan area and provided technical assistance, including training on the LF diagnostic, filariasis test strips (FTS). CDC has informed the MSPP that they will have limited funding available for the 2017 MDA in the Port-au-Prince metropolitan area.

Through financial support from the Inter-American Development Bank (IDB), MSPP has carried out albendazole (ALB)-only school- and community-based MDAs in each of the 10 departments, targeting children ages 2 to 14 in 2,000 schools (200 schools in each department), complementing LF/STH MDAs carried out by ENVISION. Starting in calendar year 2015, the IDB provided funding for STH MDAs to the Direction de Santé de la Famille (DSF) for a period of three years, through December 2017 (the project was originally two years and was extended by one year). The IDB fiscal year runs from January to December. Thus funding started in January 2015, funding for year two is from January to December 2016, and funding for year three is from January-December 2017. Twice-annual ALB-only MDAs have so far been conducted in all 10 departments except where ENVISION is treating for LF-STH; in ENVISION-supported areas, IDB provided one additional round of treatment. A third round of MDA each year was planned for Grand’Anse, given the continued high STH prevalence in that department; however, the DSF has only been able to conduct two rounds there to date. The MDA in each department is being supplemented with STH prevention training for nurses, teachers, and directors.

Hôpital Sainte Croix (HSC) serves as a morbidity clinic in Haiti carrying out hydrocelectomy services and provides laboratory personnel to implement sentinel and spot check sites as well as TAS in UND-supported areas only. CBM International provided some support for morbidity management services in Léogâne, though funding ended in 2015. Partners in Health supports several hospitals to perform hydrocelectomies including Mirebalais, Hôpital St. Nicolas (St. Marc), and Hôpital St. Therese (Hinche). Further, IMA, through a global cooperative agreement with CDC, has funds to carry out a morbidity MMDP situation analysis and direct inspection protocol evaluation for health facilities, using WHO LF MMDP toolkit tools, to be carried out in the last quarter of FY16.

Other partners include the World Health Organization’s Pan-American Health Organization (WHO/PAHO), which facilitates the delivery of donated ALB. Through a partnership with TOMS (a private sector company with an extensive corporate social responsibility agenda), IMA works with local NTD volunteers, the MSPP, and MENFP to distribute donated shoes to school children. The donated shoes leverage efforts of the school-based MDAs that are supported by ENVISION and serve as a secondary prevention method against STH. IMA has distributed shoes in the Port-de-Paix commune (Northwest Department) and the Grand’Anse and North departments in FY16 and plans to distribute in the Grand’Anse department as well as selected communes in the North and Northwest departments in FY17.

Haiti has also been selected as one of five countries to participate in a high-profile clinical safety and efficacy trial and acceptability study that will be instrumental in moving forward the LF elimination global effort and shaping WHO LF treatment guidance, the “Community Based Safety Study of 2-drug versus 3-drug Therapy for Lymphatic Filariasis.” The results of a pilot survey carried out by the Death to


Onchocerciasis and Lymphatic Filariasis project in Papua New Guinea, with funding from the Bill and Melinda Gates Foundation, suggested that a combination of three drugs (ivermectin [IVM], diethylcarbamazine [DEC] and albendazole) was superior to the dual therapies currently recommended for the treatment of lymphatic filariasis. The dramatic and sustained reduction of microfilariae and the safety profile observed in the Papua New Guinea study suggest that triple therapy could be an effective tool for the elimination of LF as a public health problem by 2020. However, more data on the safety and efficacy of this drug regimen is necessary before it can be widely used in mass drug distribution in LF endemic countries.

The primary objective of the Safety Study, which has been approved by the Haitian Ethics Committee, is to determine the frequency, type and severity of adverse events following administration of therapy to three drugs (IVM, ALB, DEC) compared to standard treatment with two drugs (DEC and ALB), in infected and non-infected individuals in a community. Following the safety study, a study to assess treatment acceptability in the community is planned; this protocol is currently under review by the Haitian Ethics Committee. The principal MSPP investigator is Dr. Jean-Frantz Lemoine, and the principal investigator from the CDC is Dr. Christine Dubray. RTI International’s Dr. Abdel Direny is one of the co-investigators and IMA World Health is the implementing partner. Other partners/co-investigators include CDC and the University of Florida. IMA has hired additional research staff to ensure that this study does not affect ENVISION-related activities. The survey will be conducted in the commune of Quartier Morin, currently supported by ENVISION. 3,000 people will be included in the survey, and the rest of the population in the commune will be treated by ENVISION once the study has been completed.

The Ministries of Health in Haiti and the Dominican Republic have developed and costed a plan for malaria and LF elimination from the island of Hispaniola. In early 2015, the Gates Foundation began funding the Haiti Malaria Elimination Consortium, now called the Malaria Zero project. To assist Haiti and the Dominican Republic in achieving malaria elimination by the 2020 target, Malaria Zero is currently carrying out operational research to identify geographic areas of high transmission and risk and piloting new approaches to elimination. In addition, the TAS carried out in Haiti by ENVISION and UND have been integrated with malaria (with CDC funding for the rapid diagnostic tests and additional personnel), and these results have been shared with Malaria Zero partners in support of their efforts to map areas of malaria transmission in the country.

In support of Malaria Zero’s aim of developing novel approaches to mapping areas of high transmission, IMA World Health, with funding from Malaria Zero, is serving as the implementing partner on the Easy Access Groups study. The overall aim of this study is to generate evidence which will allow development of a standardized protocol for a rapid sampling method targeting easy access groups (EAG) with sufficient sensitivity to identify areas with evidence of malaria transmission requiring targeted parasite elimination interventions. The study will begin in September 2016 in 4 communes of the Grand’Anse department (Moron, Chambellan, Dame Marie, Anse d’Hainault) and finish in October 2016.

The Task Force for Global Health (with USAID funding), CDC, RTI, the University of Florida, and IMA World Health are carrying out TAS Strengthening in Limbe, North department starting in the last quarter of FY16 in order to test the sensitivity of the TAS for detecting evidence of recent transmission in an evaluation unit. The results of this study are expected to inform WHO recommendations regarding the TAS protocol by either confirming the rigor of the current TAS design for making programmatic decisions or suggesting modifications to the current TAS design (e.g., changing the target population or indicators measured) so that it becomes a more rigorous tool for identifying areas with evidence of recent transmission.


Table 1: NTD partners working in Haiti, donor support and summarized activities

Partner Location Activities

Is USAID providing

NTD financial

support to this partner?

Other donors supporting

these partners/ activities?

CDC Port-au-Prince; National level

Fund part of MDA in the Port-au-Prince metropolitan area Technical assistance in M&E (TAS training, TAS follow-up/analysis) and MMDPIntergrated PC-NTD/malaria surveillance performance evaluations

No

Yes

No

PAHO Entire countryProvides ALB donated by GlaxoSmithKline (GSK), Inc. and 100mg of DEC produced by Eisai.

No GSK; Eisai

TFGH Limbe Strengthening the TAS operational research project Yes CDC

UND West, Artibonite, Central Plateau

Until July 2016, implemented MDA in Arcahaie (West), Gonaives (Artibonite), Port-au-Prince (6 communes); pre-TAS surveys in Leogane, Gressier, Arcahaie, Mirebalais, Maissade and community TAS for Saut-d’Eau. In FY17, MDA in Leogane and Gressier

No CDC and UND private funding

IDB All 10 departments

Provides funding through the MSPP for three rounds of ALB-only MDA for the school age children (SAC) and Pre-SAC population (ages 2-14) in Grand’Anse and two rounds in all the other departments (1 round where ENVISION is treating)

No IDB

HSC Léogâne LF morbidity management No UND Partners in Health

Mirlebalais, St. Marc, Hinche Hydrocelectomies No Partners in

Health

RTI International Quartier Morin

Co-investigator for Community Based Safety Study of 2-drug versus 3-drug Therapy for Lymphatic Filariasis and Treatment Acceptability study

No

BMGF through Washington University of St. Louis

IMA* Moron, Chambellan, Dame-Marie and Anse-d’Hainault,

Research coordination and field implementation for the EAG study for the Malaria Zero Project in Haiti

No Tulane University/Gates Foundation


Partner Location Activities

Is USAID providing

NTD financial

support to this partner?

Other donors supporting

these partners/ activities?

Grand’Anse department

All 10 departmentsPilot MMDP situational analysis and direct inspection protocol at department level in FY16 (with MSPP and CDC)

No CDC

Quartier Morin, North department

Research coordination and field implementation for Community Based Safety Study of 2-drug versus 3-drug Therapy for Lymphatic Filariasis and Treatment Acceptability study

No

Gates Foundation through Washington University of St. Louis

Limbe, North department

Coordination and field implementation of TAS strengthening activity Yes

Task Force for Global Health/USAID

Malaria Zero** Haiti and Dominican Republic

Malaria and LF elimination strategic planning and malaria elimination programming No

Bill & Melinda Gates Foundation

TCCSix Port-au-Prince/Metropolitan area communes

Support to UND/HSC for 12 SS/SC in the six Metropolitan communes No No

*Other partners on the study include CDC, RTI, and University of Florida.**Formerly known as the Haiti Malaria Elimination Consortium; partners include the MSPP, the Ministry of Public Health and Social Assistance of the Dominican Republic, the CDC, the CDC Foundation, PAHO, The Carter Center, the Clinton Health Access Initiative, the London School of Hygiene & Tropical Medicine, and Tulane University School of Public Health and Tropical Medicine.

2) National NTD Program Overview

In its national NTD strategic plan and in line with the global LF elimination goals defined by WHO, the HNTDCP has a goal to eliminate LF by 2020 and continue control activities for STH throughout the country. Haiti follows the LF strategy for elimination through consecutive MDA rounds with DEC and ALB for at least five to six years to interrupt transmission. In 2012, the HNTDCP achieved 100% geographic coverage. Because of a gap in funding, national coverage did not continue in 2013, when 13 communes were untreated. In 2014-2015, the HNTDCP was once again able to reach 100% geographic coverage with funding and technical support from its partners USAID (through the ENVISION project), UND, and CDC. However, in 2016, due to funding constraints, UND was not able to treat Leogane and Gressier were not treated after they failed pre-TAS, leading to a coverage of 93% (28 communes treated out of 30 planned for the country). However, UND has funding to treat Leogane and Gressier in fall 2016.

As noted in the Partners section above, UND has confirmed that it does not have sufficient funding for the fiscal year 2017 MDA cycle to cover the six Metropolitan communes, Gonaives, or Arcahaie. Funding is available, however, to support MDA in Leogane and Gressier. TCC has approximately will support the sentinel sites/spot checks for the six communes in the Port-au-Prince/Metropolitan area. Starting in


FY17, ENVISION will provide funds and carry out MDA in Gonaives and Arcahaie, TAS in the six communes of the Port au Prince metropolitan area, and MDA in the Port-au-Prince metropolitan area if these communes do not pass pre-TAS.

Haiti has made incredible strides in reaching its program goals. 101 communes successfully have completed transmission assessment surveys and have been able to stop MDA.

Lymphatic Filariasis

In 2001, under the leadership of the MSPP, with support from donors and partners, the National Lymphatic Filariasis Elimination Program was launched. In its national NTD strategic plan and in line with strategies outlined by WHO’s Global Program to Eliminate Lymphatic Filariasis (GPELF), the HNTDCP has a goal to eliminate LF by 2020 and continue control activities for STH throughout the country. The objectives of Haiti’s national LF elimination program, in line with the GPELF are to:

Reduce the rate of antigenemia at levels not causing more risk of transmission to the population;

Alleviate the suffering of people with clinical manifestations of the disease; and Improve understanding of the relationship between good hygiene and disease.

Key strategies include mass drug administration; support for morbidity management and disability prevention; social mobilization and community participation; M&E; surveillance; public-private partnerships; institutional strengthening and training; and resource mobilization.

LF, caused by Wuchereria bancrofti and transmitted by Culex mosquitoes, is endemic throughout Haiti, as indicated by mapping completed by MSPP and partners in 2000. Based on prevalence at mapping, the MSPP designated communes as zones rouges (10%–45% initial prevalence); zones bleues (blue zones; 5%–9.9%), zones vertes (green zones; 0.1%–4.9%), and zones blanches (white zones; 0%) (Please see the map in Appendix A). Approximately 15% of the country is designated as red zones; red zones and blue zones were initially prioritized for MDA by the MSPP because the funds were not sufficient for full geographic coverage. MDA began in Léogâne in 2000 with funds from CDC and the Gates Foundation. In 2005, due to funding constraints, MDA was stopped, and 24 communes went untreated until 2008 (treatment had been started in these 24 communes before 2008). Later studies demonstrated that this gap in treatment led infection levels to rebound—both antigen and microfilaremia levels had increased to 2003 levels.1 Based on this research, the HNTDCP works under the principle that a single year of missed treatment in Haiti equals the loss of two years of gains achieved by previous MDAs.

MDA

In Haiti, integrated LF-STH MDAs have been conducted by distributing a combination of ALB and DEC to target populations through distribution posts in a joint community- and school-based distribution. In FY16, 24 communes were treated in the North (6), Northwest (1), West (11), and Port-au-Prince/Metropolitan area (6). These include 15 communes not yet eligible for TAS, 3 communes which did not pass TAS in FY15 in the North (Limonade, Plaine du Nord, and Cap Haitien), and 8 communes for which pre-TAS indicated another two rounds of MDA were required (3 communes in the North, Acul du Nord, Milot, and Quartier Morin; 3 in the West, Arcahaie, Cabaret, and Croix des Bouquets; 1 in Northwest, Port de Paix; and 1 in Artibonite, Gonaives). Of these 24 communes, 1820

1 Won, K.Y., Beau de Rochars, M., Kyelem, D., Streit, T.G., and Lammie, P.J. (2009). Assessing the Impact of a Missed Mass Drug Administration in Haiti. PLoS Negl Trop Dis 3(8): e443. doi:10.1371/journal.pntd.0000443


reached at least 65% epidemiological coverage and 6 (Fonds-Verrettes, Thomazeau, Grand Goave, Petionville, Carrefour, and Port-au-Prince) did not. The potential reasons for low coverage and possible solutions are discussed in the MDA coverage section of the work plan.

In FY17, the HNTDCP with partners will treat a maximum of 18 communes located in Artibonite (1), North (6), Northwest (1), West (10). Note that this includes 9 communes (Acul du Nord, Milot, Quartier Morin, and the six Port au Prince/Metropolitan communes) where pre-TAS is planned in FY17; if these communes pass pre-TAS they will not be treated.

Pre-TAS

Haiti’s TAS strategy, developed in June 2013 with technical assistance from CDC, treats each red zone implementation unit as a separate evaluation unit (EU); to date, RPRG has accepted this approach. Additional EUs were developed by grouping communes together based on initial prevalence and geographic contiguity. In order to determine eligibility for TAS, the program conducts pre-TAS surveys in at least one sentinel and one spot check sites within an EU. However, in each zone rouge, only one sentinel or spot check site takes place since it is a smaller geographical area (one commune per EU). Within larger EUs, where multiple communes are grouped together, one or two sentinel and/or spot check site surveys take place. For example, the Southeast Department formed one large EU made up of green and white zones; in this EU, one sentinel and one spot-check site pre-TAS were carried out.

By the end of FY16, the HNDTCP will have carried out 20 pre-TAS to determine eligibility for TAS (ENVISION: Artibonite (2), Grand’Anse (2), Northwest (1), North (6), South (3), and West (2); UND: West (3) and Artibonite (1)). In addition, one mid-term evaluation in Fonds-Verrettes, West department was carried out with ENVISION funds. Of note, the HNTDCP successfully transitioned from using ICT cards as the diagnostic tool for pre-TAS and TAS to FTS in FY16, without any major implementation issues, despite some delays in the arrival of the FTS from the WHO donation program. ENVISION had aimed to start using FTS by February 2016, whereas the donated FTS were available to ENVISION by early April 2016. Before making this transition, the ENVISION project used all remaining immunochromatographic card test (ICT) in its possession. WHO provided a shipment of 28,000 FTS to the country in March 2016 to be used only for TAS.

In FY17, pre-TAS SS/SC are planned covering a total of 13 communes, including 3 in the North (Acul du Nord, Milot, and Quartier Morin) and 10 in West (Anse-à-Galet, Petit-Goave, Kenscoff, Ganthier, and SS/SC in Carrefour, Cite Soleil, Tabarre, Petion-ville, Port au Prince, and Delmas).

TAS

In FY16, the HNTDCP carried out LF TAS in 57 of Haiti’s 140 communes, with data cleaning and analysis pending (note that this included community TAS in Saut d’Eau, which already had TAS1 in FY15 and La Tortue which passed TAS1 in 2006). This is in addition to the 55 communes that passed TAS1 in FY17 to the 45 communes that passed TAS in FY15 and La Tortue in 2006; bringing the total to 101 out of 140 communes (72%, or 20 EUs out of 23 total EUs that passed TAS) that will have passed TAS by the end of FY16—a significant achievement for the country and a testament to the excellent population coverage the HNTDCP, with ENVISION’s support, has been able to attain. According to preliminary results from FY16, no communes failed TAS. One high-prevalence commune, Borgne, (known as a zone rouge [red zone]) passed the TAS, which is remarkable given its high baseline prevalence (28%). This is an addition to the 5 zones rouges communes which passed TAS in FY15.


The 57 communes where TAS1 and TAS2 were carried out were grouped into 10 evaluation units (EUs) including 1 EU in Center (Saut d’Eau), 2 EUs in South, 2 EUs in Artibonite, 3 EUs in the North, and one EU in Grand’Anse department, and 1 EU in Northwest (La Tortue). Each of the 10 TAS carried out in FY16 were integrated LF TAS/malaria surveys, allowing the national program to assess its progress toward malaria elimination, which is another priority for the country. A total of six TAS, in Northwest (1 EU), Artibonite (2 EUs), Grand’Anse, and South (2 EUs), also integrated STH assessments. The data from the TAS completed in FY16 are currently being cleaned by IMA/ENVISION and CDC. IMA, RTI International, and CDC will review the data with MSPP to finalize the results. (See map LF current status)

In FY17, the HNTDCP anticipates conducting TAS in 24 EUs covering 72 additional communes. These communes include ENVISION-supported TAS1 in 13 EUs (17 communes), ENVISION-supported TAS2 in 10 EUs (44 communes), and TAS1 in 1 EUs (11 communes in Center) to be supported by UND. Note that because Saut d’Eau had school-based TAS in 2015 and community TAS in 2016, the decision was taken at the July 2016 partners’ meeting to postpone TAS2 in Saut d’Eau until late 2017 (FY18).

Pending successful pre-TAS results, in FY17, the HNTDCP plans to conduct TAS1 in a total of 28 communes. ENVISION plans to fund 17 communes, including: 3 communes in the North departments (Acul du Nord, Milot, and Quartier Morin), 6 communes in the Port-au-Prince/Metropolitan area (6 EU: Delmas, Carrefour, Cite Soleil, Port au Prince, Petion-ville, and Tabarre) and 8 communes in the West department (Cornillon, Ganthier, Grand Goave, Anse-à-Galet, Petit-Goave, Pointe a Raquette, Kenscoff and Thomazeau). UND/HSC has funding to carry out TAS in the 11 communes of Center department in late FY16 or early FY17, pending Regional Program Review Group (RPRG) approval. Given the high coverage and consistent MDA treatments, it is anticipated that each of the ENVISION-funded EUs will pass the TAS1. However, the Port-au-Prince/ metropolitan area is less certain given higher initial baseline prevalence in some of these communes and inconsistent coverage.

The HNTDCP plans to complete TAS 2 in 44 communes that passed TAS in FY15. ENVISION funding is planned for all 44 communes, including Nippes (1 EU with 10 communes), 3 EUs in the North (Dondon, Plaisance, and Limbe), Northeast (3 EUs representing 13 communes), Northwest (2 EUs representing 8 communes), and the Southeast (1 EU with 10 communes). Because Saut d’Eau had school-based TAS in 2015 and community TAS in 2016, the decision was made during the July 2016 partners’ meeting to postpone TAS2 until 2017 (FY18).

The HNTDCP also works with partners to implement LF morbidity management activities, which are carried out to date only in Léogâne. This activity includes hydrocele surgery (supported by HSC/UND). Through a cooperative agreement with CDC, IMA worked with the HNTDCP and UND to develop a morbidity management and disability prevention (MMDP) national strategic plan for 2016-2020. The plan was submitted to Haiti’s National LF/Malaria Coordinator, Dr. Lemoine, in January 2016, and presented at the bi-annual NTDs partners meeting in January for feedback. The plan included a tentative timeline of activities for the 2016-2020 period. The plan is an important component of Haiti’s national LF program and meeting the WHO’s elimination dossier requirements, and will also be a valuable advocacy tool for the program. Among other key activities, an MMDP situation analysis is scheduled for quarter 4 of FY16, with the aim of assessing in each of the ten departments and at the national level the MMDP services, infrastructure, materials, and supplies available for MMDP. The situation analysis, a WHO developed tool, will be adapted and submitted to the Haitian ethics committee before the HNTDCP, CDC, IMA, and partners carry out this activity, planned for August-October 2016, using funding from IMA’s CDC cooperative agreement. The situation analysis tool is used to describe available information and capacity to measure the number of patients with lymphedema or hydrocele and geographic distribution (also referred to as burden assessment or patient estimation); to identify the relevant policy frameworks necessary for effective and efficient MMDP services; and to determine the place, structure


and platforms of current and future MMDP activities. As part of the situation analysis, the WHO direct inspection protocol tool will be piloted at 14 health facilities to assess lymphedema services and 5 health facilities to assess hydrocele services. The purpose of the direct inspection protocol tool is to supplement the situation analysis with relevant health care facility data; establish baseline for quality of services (general and MMDP-specific); and identify areas in particular need of strengthening as part of the implementation of MMDP services (e.g. supplies, training, etc.)

IMA also worked with the CDC and HNTDCP to revised its MDA tools and registers for its 2016 MDA in order to integrate indicators on lymphedema and hydrocele, including the age and sex of MDA participants reporting either of these conditions. This enabled the HNTDCP to integrate an MMDP burden assessment (which is an ongoing part of the situation analysis) into the 22 communes where ENVISION carried out MDA from March-May 2016, and for two additional communes in September 2016, at no additional cost to ENVISION. The two UND-supported communes, Gonaives and Arcahaie, also integrated MMDP burden assessment into MDA. See the section below on MDA for additional information about how MMDP burden assessments were integrated into routine MDA. Since the WHO LF elimination dossier requires an assessment of the number of patients with lymphedema and hydrocele in each implementation unit, the HNTDCP hopes to identify additional opportunities with NTDs and malaria partners to carry out burden assessment in the remaining implementation units, with the aim of completing these in all 140 communes of Haiti.

In partnership with MSPP and CDC, IMA has been working to develop an MMDP situational analysis roadmap and schedule for the summer/fall of 2016. IMA and CDC met with the MSPP LF/malaria coordinator and MMDP focal point in May 2016 to further discuss these plans and next steps. In August 2016, CDC and IMA carried out a situation analysis and direct inspection protocol training workshop for MSPP and IMA staff with CDC funding, with plans to initiate the situation analysis in September.

USAID support to the HNTDCP began in late 2007 under the NTD Control Program, managed by RTI and implemented by IMA. Activities have continued with the ENVISION project from 2011 to date. USAID support for the HNTDCP started in 26 communes in FY08, and over the years, support was scaled up to 106 communes in FY13. Since then, USAID has supported the program to begin scaling down as communes reached stop-MDA status, and supported treatment of 24 communes in FY16. Of note, after the devastating earthquake in January 2010, the HNTDCP was fortunately able to continue with scheduled April/May MDAs as planned. In addition, due to the large number of internally displaced persons in several locations seeking refuge from Port-au-Prince, the HNTDCP had to treat even more individuals during MDAs. Fortunately, with financial support from USAID, HNTDCP and NTD Control Program/IMA purchased the MDA supplies and drugs necessary to accommodate the increased population.

Since 2011, IMA has led the implementation of the USAID-funded, RTI-managed ENVISION project. Main activities include integrated MDA, advocacy, training, supervision, M&E, and social mobilization. Through 2013, USAID-funded MDAs were carried out in the North, Northwest, Northeast, Artibonite, South, Southeast, Nippes, and Grand’Anse departments. In 2013, the HNTDCP experienced a gap in funding and 13 communes in areas funded by UND were untreated. In 2014, the funding gap remained, and at the request of the HNTDCP, ENVISION expanded its support to implement MDAs in 11 additional communes within the West Department. In FY16, due to reduced levels of UND and CDC funding, USAID approved funding and implementation support for the six Port au Prince/Metropolitan area communes, filling a key funding gap for the program.


In FY16, HNTDCP carried out TAS in 57 communes in the Artibonite, Center, Grand’Anse, North, Northwest, and South departments, a tremendous accomplishment for the country. ENVISION supported TAS in 56 of these communes.

Soil transmitted Helminths

STH is endemic throughout Haiti (information based on mapping conducted by MSPP and partners in 2002). The HNTDCP aims to control STH in school-aged children (SAC) through annual treatment with ALB to reduce the intensity of infections and protect infected individuals from morbidity due to STH. SAC are targeted for treatment through the DEC+ALB MDAs conducted in schools by community drug distributors (CDDs).

The biggest de-worming (STH) campaign was conducted during the LF MDA while distributing one dose of DEC and Albendazole to the eligible population yearly. The integrated approach (LF and STH) was strongly supported by partners and donors. USAID plays a key role by supporting STH and LF MDA in a large part of the country since 2007. As LF MDA is scaling down, the MSPP and HNTDCP partners are continuing to discuss the best strategy to continue de-worming efforts after interruption of LF transmission has been confirmed in program areas; see additional details in the STH transition plan supplement to this work plan.

A nationwide STH survey was funded by IDB and implemented by the MSPP, October–December 2013. The results show a prevalence of infection at the national and departmental levels. The survey revealed that STH prevalence had decreased overall within the country, and in 9 of 10 communes, the prevalence is at or below 25%. In the Grand’Anse Department, which had an initial prevalence of 74% when surveyed in 2001, the decline was not as significant, and the prevalence of infection remained at 55%. Further analysis of the data is still taking place to better identify causes. The MSPP has identified poor sanitation as a serious issue in Grand’Anse.

Following the national prevalence survey in 2013, ENVISION successfully carried out STH-TAS surveys in FY16 in six EUs including two in Artibonite, one in Grand’Anse, one in Northwest, and two in South. Preliminary results give a mixed picture. STH prevalence in Grand’Anse remains high, with 51% of children testing positive. STH prevalence rates in the other EUs were the following: in La Tortue, 13%; in South1, 8%; in Camp Perrin, 8%; in Artibonite 1, 3.3%; and in Artibonite 2.6%. This is in addition to the integrated STH-TAS carried out in Nippes in FY15, during which 19% of children tested positive. Information on prevalence by species and intensity is currently being analyzed and will be shared once finalized.

MDA

Starting January 2015, the DSF, an arm of the MSPP, has carried two yearly rounds of ALB-only school- and community-based MDA, targeting children ages 2–14 in 2,000 schools in the ten departments (200 schools in each department) with support from the IDB. The IDB funding is available through December 2017. While the DSF had planned to use IDB funding to complete a third round of ALB distribution each year in Grand’Anse, given the continued high STH prevalence in that department, so far DSF has only been able to complete two rounds due to delays stemming from political uncertainties in the past year. Where ENVISION or other partners have conducted LF-STH MDA, only one additional round of MDA was carried out by DSF using IDB funds. The MDA is supplemented by training that focuses on STH prevention, which has already been rolled out for nurses, teachers, and students.

Note that in FY15, ENVISION supported ALB-only MDA in addition to one round of LF/STH MDA in Grand-Anse.


3) Snapshot of NTD status in Haiti

Table 2: Snapshot of the expected status of the NTD program in Haiti 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 ACHIEVEME

NTDSA NEEDS

A B C D E F G H I

DiseaseTotal No.

of Districts in Haiti

No. of districts

classified as

endemic

No. of districts

classified as non-

endemic

No. of districts in need of initial mapping

No. of districts receiving MDAas of 09/30/16

No. of districts expected to be

in need of MDA at any

level: MDA not yet started, or

has prematurely stopped as of

09/30/16

Expected No. of districts

where criteria for stopping

district-level MDA have

been met as of 09/30/16

No. of districts requiring DSA

as of 09/30/16****USAID-

Funded Others

Lymphatic filariasis

140

140 0 0 24* 15** 0 101***Pre-TAS: 13

TAS1: 28TAS2: 44

Onchocerciasis

– – – – – – – –

Schistosomiasis

– – – – – – – –

Soil-transmitted helminthes

140 0 0 24* 116# 0 ––

Trachoma – – – – – – – –

*In FY16, ENVISION provided MDA in 24 communes, which already includes the 6 Port-au-Prince/Metropolitan communes along with other ENVISION-supported communes in the North (6), Northwest (1), West (11). TAS1 was planned in the remaining 56 communes and TAS2 in one commune. By the end of FY16, ENVISION supported TAS1 in 56 communes and TAS2 in one commune. Two communes (Cabaret and Croix-des-Bouquets in the West) did not pass pre-TAS and so did not have TAS as planned.** These 15 communes represent the 11 Center communes that did not have MDA in FY16, passed pre-TAS, and have TAS planned in late FY16 or early FY17 (funded by UND); Gressier; Leogane (both UND-funded in FY17); Gonaives and Arcahaie (both planned ENVISION funded in FY17).***Preliminary results indicate that 55 of 55 communes passed the TAS1 in FY16 in addition to the 45 that had passed TAS1 as of the end of FY15 plus La Tortue in 2006. Note that UND carried out a school-based TAS in FY15 and a community TAS in FY16 in Saut d’Eau, so only 55 new communes had TAS1 in FY16.****Pre-TAS sentinel sites: pre-TAS covering 13 communes, including 3 in North (Acul du Nord, Milot, and Quartier Morin) and 10 in West (Cite Soleil, Delmas, Tabarre, Petionville, Port de Prince, Carrefour, Anse-à-Galet/Pointe a Raquette, Grand Goave/ Petit-Goave, Kenscoff/Cornillon, and Ganthier/Thomazeau). Note that each of the 6 communes in the Port-au-Prince Metropolitan area (Cite Soleil, Delmas, Tabarre, Petionville, Port de Prince, Carrefour) will have 2 SS/SC.TAS1: 3 EUs in North (3 communes), 10 EUs in West (14 communes), and 1 EU in Center (11 communes). TAS2: 1 EU in Nippes (10 communes), 1 EU in Southeast (10 communes), 3 EUs in Northeast (13 communes), 2 EUs in Northwest (8 communes), 3 EUs in North (3 communes).# IDB is providing funding for school-based STH only MDA in 200 schools in each of the 10 departments. Funding for twice annual MDA (and thrice-annual in Grand Anse department) started in January 2015 and ends in December 2017. Where


ENVISION is still funding LF-STH treatment, IDB is treating with one additional round of ALB (in Grand Anse, two additional rounds).

PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

Strategic Capacity Strengthening Approach

ENVISION and MSPP have identified the following priorities for capacity strengthening to ensure the continued success of efforts to address NTDs in Haiti:

Identify and apply for new funding sources for sustained STH control, and LF morbidity Strengthen data management and use by the STH program Increase the number of trained laboratory staff Increased number of NTD staff at national level to manage M&E and surveillance activities Strengthen supply chain

To strengthen the national NTD program capacity, ENVISION will support MSPP to work on three major objectives this year, responding to those areas above where ENVISION will have the most influence and therefore impact. These priorities are:

(1) Strengthen M&E capacity to meet the need of planned TAS over the next few years;

(2) Strengthen use of integrated NTD database across MSPP divisions;

(3) Strengthen HNTDCP capacity to identify funding gaps and priorities; (4)

While ENVISION recognizes that other needs, including access to new funding sources and increased number of staff, are critical to the future of NTD control in Haiti, these objectives have been selected based on being the best fit to ENVISION’s current scope and strengths.

Capacity Strengthening Interventions

Objective 1: Strengthen M&E capacity to meet the need of planned TAS over the next few years. ENVISION has trained 20 departmental-level MSPP laboratory technicians to carry out pre-TAS and TAS. Given the increasing number of surveys as the program moves through remaining pre-TAS and then TAS1, 2, and 3 surveys, more staff are needed. ENVISION plans to train 24 additional laboratory technicians, both MSPP and outside MSPP staff. These trainings will mitigate the issue of insufficient personnel to conduct M&E activities. This will further strengthen the capacity of the HNTDCP to carry out critical DSA as need is scaling up in both ENVISION and non-ENVISION-supported EUs. The budget for this objective is included in the Training section.

Objective 2: Strengthen use of integrated NTD database across MSPP divisions. As noted above, there has been strong interest in the national integrated database, and the bulk of historical data has been entered. However, some historical data from non-USAID partners is still missing and the MSPP is not yet actively using the database since it is incomplete. A meeting is planned in the fourth quarter of FY16 to make the necessary updates to the database and plan for its continued maintenance and usage. Following on from this meeting, ENVISION will continue to provide support to the MSPP 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 DSS and DSF to first help them understand the utility of the integrated NTD database as a tool to support program planning and then to support data entry.

Objective 3: Strengthen HNTDCP capacity to identify funding gaps and priorities. Following the August 2016 training on the TIPAC, in FY17, ENVISION will support the HNTDCP to complete the TIPAC for Haiti and start to regularly use the tool for program planning and forecasting. One anticipated challenge is that the HNTDCP and/or other NTDs partners in Haiti may not have detailed financial information to input into the tool. If these data are lacking, ENVISION will work with the HNTDCP to generate accurate financial estimates for program needs. This tool will enable the HNTDCP to more accurately estimate the costs and funding gaps for the national NTDs program. The only cost for this activity is ENVISION staff time, no additional costs are anticipated. ENVISION will encourage the HNTDCP to share the TIPAC estimates with current partners at the biannual Haiti Partners Meeting.

Capacity strengthening efforts will be led by the ENVISION Haiti team - a small but dynamic team with very strong technical and operations skills under the leadership of IMA’s Country Director and NTD Program Manager. The staff are competent in the use of the integrated NTD database, DQA, TAS, STH-malaria-TAS, and coverage surveys.

Table 3: Project Assistance for Capacity Strengthening

Project assistance area Capacity strengthening interventions/activities

How these activities will help to correct needs identified in

situation above

a. Strategic planning Assist the HNTDCP to continue entering costing data into the TIPAC

Help identify program costs and funding gaps; to be used by HNTDCP and partners to advocate for increased financial support with other donors

b. Training Train 24 additional laboratory staff to conduct TAS and pre-TAS surveys

As the LF elimination program reaches its end stage, there will be a significant scale-up in TAS surveys and a need for trained staff to be able to perform them.

k. M&E Assist the HNTDCP 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 transition.

Monitoring Capacity Strengthening

Both routine informal meetings as well as regularly scheduled quarterly review meetings with the HNTDCP will be used to review progress made towards achieving the desired capacity strengthening outcomes, using the following strategy to measure success.

Objective 1: Strengthen M&E capacity to meet the need of planned TAS over the next few years. ENVISION will meet with the LF/Malaria Coordinator and together review progress towards building human capacity needed to implement future TAS activities. The number of projected staff required will be compared to current numbers of trained staff and the quality of recent TAS surveys will be discussed. A revised plan of action will be developed if needed.

Objective 2: Strengthen use of integrated NTD database across MSPP divisions


ENVISION will convene the various stakeholders including the different MSPP divisions, WHO, CDC 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 provided to WHO and to the ENVISION HQ M&E team.

Objective 3: Strengthen HNTDCP capacity to identify funding gaps and priorities.

ENVISION will continue to engage the both the LF/Malaria Coordinator and the DSF Coordinator and their staff 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.

2) Project Assistance

Strategic Planning

On a regular basis, ENVISION staff work closely with the MSPP, MENFP, and other partners and donors to plan HNTDCP activities. This includes identification and confirmation of geographic target regions for MDA and DSAs; review and regular use of data analysis for activity planning (e.g., using coverage to identify communes needing additional support, using pre-TAS data to plan for TAS, etc.); as well as ongoing planning, coordination, and implementation of all activities. These discussions take place through formal and informal meetings at the MSPP and MENFP, and through phone calls and emails. In FY17, the HNTDCP will work with ENVISION to carry out MDA, and DSAs according to the schedule of LF MDA scale-down (as noted in the LF Section), as well as other NTD activities.

As noted in the Capacity Strengthening section, ENVISION will have trained key HNTDCP staff on the TIPAC tool by September 2016. In FY17, ENVISION will support the HNTDCP to complete the TIPAC for Haiti and start to regularly use the tool for program planning, forecasting, advocacy, and resource mobilization with the proposals consultant. One anticipated challenge is that the HNTDCP and/or other NTDs partners in Haiti may not have detailed financial information to input into the tool. If these data are lacking, ENVISION will work with the HNTDCP to generate accurate financial estimates for program needs. No additional budgetary costs are anticipated for this activity.

HNTDCP biannual partner meetings: In FY17, ENVISION will provide funds and assist the HNTDCP in organizing two partner meetings in Haiti for local and international stakeholders to ensure strong coordination among MSPP, MENFP, and local and international NTD partners (including CDC, TCC, University of Florida, and others). These meeting will be led by the MSPP and are critical for the HNTDCP to establish how best to implement activities, assess overall progress toward achieving Haiti’s NTDs elimination and control goals and areas requiring additional focus, identifying programmatic and funding gaps, and discussing the potential for integration with other diseases, e.g. integrating LF surveillance with malaria surveillance.

Advocacy for Building a Sustainable National NTD Program


The key players for conducting advocacy to ensure the sustainability of the Haiti NTDs program and increasing government commitment include the national LF/Malaria Coordinator, the DSF, the DSS, the General Directorate of the MSPP, and the NTDs implementing partners including ENVISION/IMA World Health and UND/HSC.

There are several potential political, financial, and social barriers to raising additional resources and deepening national commitment to the NTDs program. Further, the Haitian government allocates only 5-8% of the national budget for health, increasing competition for these limited resources. Following the hierarchical structure of the MSPP, the LF/Malaria coordinator, DSF, and DSS, with the support of implementing partners, can submit NTDs-related programmatic and funding requests to the General Directorate of MSPP. Once approved, the head of the General Directorate can advocate for the NTDs program and for additional funding with the Health Committee of the national Haitian Parliament and donors. The HNTDCP will also look beyond the Haitian government for additional donor funding, with the help of a proposals consultant, as discussed in the Capacity Strengthening section. Beyond USG funding (which has been the key funder to date), potential donors include the Children’s Investment Fund Foundation (CIFF), the END Fund, Inter-American Development Bank, World Bank, the European Union, the Japanese International Cooperation Agency, and other NTD donors.

The overall goal of these advocacy efforts is to ensure the sustainability of the NTD program in Haiti as current donors phase out funding. The specific objectives of these advocacy efforts are to find additional funds to support the implementation of Haiti’s MMDP plan; fill MDA, pre-TAS, and TAS funding gaps in the areas formerly supported by UND (Center department); and to mobilize additional funds for surveillance.

TAS planning meetings. In FY17, ENVISION will support TAS planning meetings in each evaluation unit where TAS1 and TAS2 are planned. The purpose of these meetings are to inform and sensitize the community leaders, MSPP departmental and communal health officials, and MENFP school inspectors about the objective of TAS, to enlist their consent and support for carrying out TAS, to plan the survey dates, and to collect school population data. During these meetings, ENVISION requests that the departmental school inspectors write a letter addressed to individual school directors explaining the purpose of TAS and asking for their consent for their students to participate in TAS. Once the letter from the departmental school director is available, ENVISION makes copies for community leaders (CLs) to distribute to the school directors of selected schools.

In the EUs where TAS1 are planned, these meetings are also an important opportunity to discuss MDA transition. The TAS planning meetings will start with one day for the departmental and communal health and education officials, and then cascade down for a second day with CLs. In total, 463 individuals from the department, commune, and community levels will participate in these meetings.

The indicators for monitoring the success of the TAS planning meetings include the availability of complete school population data, consent from school directors to participate in TAS, and eventually, successful execution of each of the TAS.

Social Mobilization to Enable NTD Program Activities

Social mobilization activities will be targeted toward the departments where ENVISION will be funding MDA implementation (West and parts of the North and Northwest departments).

Development and production of health messages. ENVISION will fund the development and production of health messages in Creole for television and radio, similar to those that were produced in previous years, but updated with entertaining and fresh messaging and the FY17 MDA dates and times. These


spots will be developed in coordination with and approved by the MSPP and MENFP. After the health messages have been recorded, they will be copied onto CDs and DVDs distributed to community leaders, radio, and TV stations to carry out social mobilization.

Disseminating health messages via TV, radio, press conference, sound trucks, megaphones, letters and brochures: The budget for disseminating health messages includes airing the TV and radio spots, organizing a press conference to launch MDA, renting sound trucks, renting megaphones, purchasing batteries, and printing letters and brochures.

To further increase MDA coverage and facilitate the leadership and engagement of MSPP officials in MDA, ENVISION will advocate with the LF/malaria coordinator to request that the General Directorate of MSPP have a press conference. The purpose of the press conference will be to launch MDA at a highly visible event. The Director General will provide an overview of the state of LF in Haiti and encourage the participation of department and communal health officials in promoting and carrying out MDA. This press conference will be picked up by local radio stations across the country.

The sound trucks and megaphones rented are used before and during MDAs to rally communities by disseminating health messages on relevant MDA topics. These sensitization and social mobilization activities will target the entire population and can be helpful for illiterate individuals. Additional sensitization and social mobilization information, education, and communication (IEC) materials are discussed in the MDA section of this work plan. Given the evidence on the effectiveness of megaphones for mobilizing the population above, as well as feedback from CLs and health officials that more megaphones would improve social mobilization and distribution efforts, additional megaphones will be rented and distributed to CLs, CPs, and CDDs in order to increase awareness of the campaigns, emphasize the safety of the drugs, and address concerns about side effects.

ENVISION also fund the printing of official government letters and brochures sent to communities ahead of MDA as part of sensitization and mobilization efforts. The aim of the brochures is to increase and raise awareness about LF and MDA among the general population. The brochures describe LF causes, symptoms, and treatment and the purpose of MDA using clear, simple language and include images to enhance comprehension, particularly for individuals who might have lower levels literacy levels. The brochures are professionally printed and primarily distributed in the West Department communes, which require more information because they are newer to working under the ENVISION model for MDA. The brochures will be tailored to address the needs of urban areas in particular, including information about the high prevalence in these areas, the effectiveness of the medications in preventing disability associated with LF, and the ease of taking the medications. The letters are specifically directed at CLs such as church leaders and school directors who are typically better-educated and highly literate, in order to inform them about the purpose of MDA, to ask for permission to carry out MDA in the schools on the proposed dates, to ensure their engagement in MDA, and to encourage them to mobilize their communities for MDA.

IEC Materials for MDA. ENVISION will fund the production of IEC materials for planned FY17 MDA. These will include posters, banners, flags, flyers, and T-shirts for CDDs. The number of posters produced have been decreased slightly to reflect the results of the KAP/coverage survey and feedback from USAID. Banners are used to advertise the dates and location of MDA across road intersections. Flags are used at the posts to identify the posts; ENVISION has reduced the quantity to be purchased by half. T-shirts are produced and given each year as a form of motivation to the CDDs, CPs, and CLs. Further, the T-shirts from the previous years’ MDA might not be kept in perfect condition over the course of one whole year since ENVISION does not recuperate T-shirts after MDA each year. ENVISION will continue to fund printing of posters, brochures and flyers but has reduced these quantities by half and increased


quantities of megaphones and radio spots. ENVISION will continue to print a reduced quantity of posters, brochures, and flyers because CLs and CPs use the information on these items during their megaphone advertising. These items (posters, brochures, and flyers) also are important IEC methods for targeting officials and the literature population. As noted above, in the 2015 coverage survey, respondents were limited to choosing one IEC and most chose megaphones. However, the 2014 survey does show that other communication tools are useful and ENVISION thinks it is important to give CLs and CPs a variety of communication tools.

Delivery of IEC materials and radio and television spots. ENVISION will then fund the delivery of IEC materials to communes and radio and television spots to stations in the departments by supporting fuel and per diem for ENVISION staff. Messages will begin airing approximately one month before the MDA and continue through the last day of an MDA in a given area.

ENVISION will also brainstorm with the MSPP and other partners about how to improve MDA coverage in the Port-au-Prince/Metropolitan area specifically, where coverage has been consistently low and could impact the ability of the program to carry out pre-TAS.


Table 4: 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?

MDA Participation

Inform the community about the MDA dates and locations in the commune.

School children and the entire population in the community(except pregnant women and children under 2)

Banners, posters, flags, megaphones, sound trucks, radio and TV spots

Banners hung in main crossroads 4 weeks before MDAPosters used during community sensitization meetings starting from 8 weeks before MDA.Flags hung to clearly identify distribution posts during MDA.Megaphones distributed to CLs, CPs, and CDDs and used 2 weeks-one month in advance of MDA. Sound trucks one week in advance and during MDARadio and TV spots aired starting from one month before MDA expect in the West, where spots are aired 3 months in advance of MDA

Radio and TV spots: aired 4-6 times per dayBanners posted for duration of MDAPosters used throughout mobilization and during MDA

Social mobilization evaluation: Short questionnaire distributed to community members by CLs, CPs, or CDDs to evaluate social mobilization activities in Fonds Verrettes

Drug Safety DEC + ALB are free and safe drugs; they come from the best laboratories overseas.

School children and the entire population in the community (except pregnant women and children under 2)

Radio and TV spots

Radio and TV spots aired starting from one month before MDA expect in the West, where spots are aired 3 months in advance of MDA

Radio and TV spots: aired 4-6 times per day


Side effects If sometimes you experience side effects, this is a sign that the medicine is working and we have drugs to handle these

School children and the entire population in the community (except pregnant

Megaphones, sound truck, radio and TV spots

Megaphones distributed to CLs, CPs, and CDDs and used 2 weeks-one month in advance of MDA. Sound trucks one week in advance and during MDA


Social mobilization evaluation: Short questionnaire distributed to community members by CLs, CPs, or CDDs to evaluate social mobilization activities


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?

side effects women and children under 2)

Radio and TV spots aired starting from one month before MDA expect in the West, where spots are aired 3 months in advance of MDA

in Fonds Verrettes

Disease Prevention

The drugs are preventative and curative for LF and STH; the earlier you take the medications the better


Megaphones, sound trucks, radio and TV spots, community sensitization meetings

Megaphones distributed to CLs, CPs, and CDDs and used 2 weeks-one month in advance of MDA. Sound trucks one week in advance and during MDARadio and TV spots aired starting from one month before MDA expect in the West, where spots are aired 3 months in advance of MDACommunity meetings start from 3 months in advance for CLs and 2 months in advance for CPs of MDA


Community meetings held on average 5x/week


Disease transmission and clinical manifestations

LF is transmitted by mosquitoes. Just one bite can lead to big foot and hydrocele.


Megaphones, sound trucks, radio and TV spots, community sensitization meetings

Same as above Radio and TV spots: aired 4-6 times per day

Community meetings held on average 5x/week

Social mobilization evaluation: Short questionnaire distributed to community members by CLs, CPs, or CDDs to evaluate social mobilization activities in Fonds Verettes

Training

The ENVISION program anticipates refresher training needs for CLs, CPs, and CDDs in the communes where MDA will take place in FY17. In addition, ENVISION will send two of its country staff to the ASTMH and COR-NTD meeting in FY17 to present the program’s successes (pending acceptance of the two abstracts submitted for Haiti) and to stay abreast of the latest scientific and programmatic developments in the field of NTDs.


Printing of training materials. In departments and communes where MDA activities will continue in FY17, ENVISION will fund printing of training materials including posters (job aids), registers, and DVDs (including the WHO LF documentary) to use during MDA and social mobilization. The registers are used during the training to clarify the definitions of the indicators and how to fill the forms. The DVDs (including the WHO LF documentary) are given during the trainings since the community leaders are all present. The posters are used as a job aid to help CLs and CPs explain LF and MDA and for social mobilization in the community.

Conduct refresher training for community leaders, community promoters, and CDDs. ENVISION will organize one-day refresher trainings for CLs and CPs and half day trainings for CDDs conducted by the MSPP central, departmental, and communal representatives with support from the ENVISION team. The refresher trainings are necessary because it is typically 10 to 12 months between MDA rounds, and in that time, volunteers carry out various other health-related work in their communities and can forget critical information about MDAs if they are not retrained. These trainings happen in a department-by-department cascade fashion based on the MDA schedule, with the community leaders training the community promoters, and the community promoters training the CDDs. These trainings are also necessary for educating new volunteers who replace those who may be lost to attrition; however, it is important to note that almost 95% of volunteers continue to work with the HNTDCP.

These trainings will focus on a review of LF and STH fundamentals, as well as disease transmission, clinical manifestations, and prevention using PowerPoint presentations and job aids/posters. They also highlight key steps of the MDA rollout, tasks of MDA implementation, and data review, reporting, and data quality. Although these refresher trainings revisit NTD and MDA overview information, they also serve as an opportunity to discuss the previous MDA results, provide a platform for discussions of lessons learned, and focus on any challenge areas (such as low coverage). In addition, these trainings are another opportunity to provide motivating messages to community volunteers. A particular focus of these refresher trainings will be to emphasize directly observed therapy.

In order to carry out post-training follow-up/monitoring to ensure skills retention and application, ENVISION will conduct regular supportive supervision throughout MDA activities. In addition, ENVISION staff will cross-check MDA reports received from communal and departmental health officials with a significant sample of MDA reports submitted by CLs not only in order to ensure that the figures are consistent and reliable, but also to look for issues of completeness and accuracy. Where there are issues, ENVISION staff will take corrective action and provide additional coaching and feedback for these leaders and their CPs and CDDs.

Training of 24 additional laboratory technicians: ENVISION will train 24 additional new lab technicians (MSPP and outside MSPP staff) to mitigate the issue of insufficient personnel to conduct M&E activities including pre-TAS and TAS, in particular TAS1 in the six Port-au-Prince/Metropolitan EUs. The 24 technicians represent two teams of 7 for TAS-STH and two teams of 5 for TAS without STH. This will further strengthen the capacity of the HNTDCP to carry out DSA in both ENVISION and non-ENVISION-supported EUs.

Mapping

Haiti is considered to be fully mapped. No mapping will be supported by ENVISION in FY17.

MDA Coverage and Challenges


As noted in the Country Overview section, Haiti is quickly reaching its LF elimination goals. In FY17, Haiti marks a huge achievement: a continued decrease in the number of communes requiring treatment for LF for the second year in a row. Only 10 ENVISION-supported communes will be treated in FY17, including three in the West department (Cabaret, Croix-des-Bouquets, and Fonds-Verrettes), one in the Northwest department (Port de Paix), and six in the North department (Acul du Nord, Milot, Quartier Morin, Cap Haitien, Limonade, and Plaine du Nord). This includes one commune in the Northwest (Port de Paix) where pre-TAS is planned in September 2016 and three communes in the North (Acul du Nord, Milot, and Quartier Morin) where pre-TAS is planned in FY17. If these communes (all of which are zones rouges) pass pre-TAS, they will not need to be treated.

The 10 communes where ENVISION-supported MDA is planned for FY17 represents a decrease from the 24 communes ENVISION treated in FY16. In the originally approved FY16 workplan, MDA was planned for a total of 19 districts. However, one of these districts, Borgne (a zone rouge) passed pre-TAS in FY16, and so no longer needed treatment. In addition, USAID approved funding to support MDA (with UND and CDC support) in the six Port-au-Prince Metropolitan area communes, bringing the total number of communes treated by ENVISION to 24 in FY16. The reason for the decrease from 24 communes to only 10 communes in FY17 is because 8 communes out of the 11 ENVISION-supported communes in the West department received their fifth round of MDA in FY16 (Grand Goave, Petit Goave, Anse a Galets, Pointe a Raquette, Thomazeau, Cornillon, Ganthier, and Kenscoff). In addition, the six Port-au-Prince/Metropolitan area communes also received their fifth round of MDA in FY16. Pre-TAS and TAS are planned for these communes in FY17. However, due to persistent low coverage, MDA may need to be continued for additional years in some of the Port-au-Prince/Metropolitan area communes if they do not pass pre-TAS.

The HNTDCP conducts LF/STH MDA through schools and distribution posts. Although the central- and department-level representatives from MSPP and MENFP assist in planning, training, and supervision, the critical MDA implementers are the community volunteers.

In FY17, following the strategy introduced in FY16, in order to maximize coverage rates, an additional two days will be budgeted for MDA (compared with the number of budgeted days in previous years) in order to improve coverage rates, for a total of six days per MDA. These two additional days will enable CDDs to carry out more door-to-door distribution at households to reach those who do not come to the distribution points. During these additional days, CDDs will be stationed at distribution points and, if attendance is low at fixed distribution points, the CDDs will make household follow-up visits. Additional days will be particularly important for those communes in the North that did not pass pre-TAS in FY14 (Quartier Morin, Milot, and Acul du Nord) or TAS in FY15 (Cap Haitien, Limonade, and Plaine du Nord) and the communes in the West that did not pass pre-TAS in FY16 (Cabaret and Croix des Bouquets). Both the MSPP and UND, as key partners in the HNTDCP, approved ENVISION/IMA’s plans to extend MDA by additional days.

There are only two communes, Fonds-Verrettes and Croix-des-Bouquets, which had low coverage for their last MDA and that will continue to receive MDA in FY17. In Croix-des-Bouquets, there is significant population movement/migration to the Port au Prince Metropolitan area for work. In addition, there has not been a national census in Haiti since 2003; population estimates are derived by projecting a 2.2% population growth rate each year. This means that population denominator figures may be inaccurate, and overestimated in Fonds-Verrettes and Croix-des-Bouquets. In addition, CLs and communal health officials indicated that additional megaphones were needed to carry out direct, person-to-person social mobilization with community members. The KAP/coverage survey supported by ENVISION in September 2015 in Thomazeau and Croix-des-Bouquets confirmed that megaphones were the best way to reach community members with information about MDA. Thus, in FY17, ENVISION has budgeted for additional


megaphones for MDA in all ENVISION-supported communes. ENVISION will also continue to ensure that during social mobilization, volunteers emphasize the safety and effectiveness of the medications in order to reduce the number of individuals that refuse to participate. Last, ENVISION plans to redouble its efforts to have the full participation and leadership of central and department level MSPP officials to increase the visibility of MDA in these communes and encourage participation. For example, ENVISION will encourage the MSPP to hold a press conference prior to the launch of MDA in the West department.


Drug and Commodity Supply Management and Procurement

In FY17, Haiti will start to use the 100mg DEC tablets provided by Eisai DEC donation program for MDA in both ENVISION and non-ENVISION supported communes. In addition, ENVISION and the HNTDCP will use the remaining supplies of partner-procured 50-mg tablets; post-FY16 MDA inventory is currently underway to identify the quantity of tablets remaining. ENVISION anticipates having enough 50mg DEC to cover MDA in Quartier Morin, Croix-des-Bouquets, and Cabaret in September 2016. The MSPP submitted a Joint Request for Selected Medicines in August 2015 for 100mg DEC tablets, which were delivered to PROMESS (the Program for Essential Medicines in Haiti) and are already available for MDA in FY17. This supply will be sufficient to cover the FY17 MDA. In order to avoid confusion among the 100mg and 50mg, ENVISION will not use the two different formulations in a single MDA. For example, ENVISION will use the remaining 50mg DEC in its stock for MDA in Cabaret and Croix-des-Bouquets in September 2016.

ALB is donated by GSK through WHO/PAHO. After completing a report form for the ALB used in the previous year, the MSPP will submit the JRSM form in August 2016 to request ALB for the communes where MDA is planned. ENVISION assists the MSPP in completing the JRSM for the ENVISION-funded areas through collaborative working meeting with the MSPP and other implementing partners. ENVISION has 6 million tablets of ALB in its stock in its own warehouse (separate from MSPP’s warehouse), which will be sufficient to cover the MDA planned in ENVISION-supported communes for FY17.

To quantify the amount of DEC and ALB needed for the country, the HNTDCP formally requests a meeting of the implementing partners, ENVISION and UND. During this meeting, population figures for the communes where MDA are planned are compiled and used to forecast the quantities of drugs needed, including a 10% buffer to account for wastage and population fluctuations.

To date, no significant supply chain issues for DEC or ALB have been identified.

Both DEC and ALB are managed and stored at PROMESS. After the ALB is in the country, IMA has three days to pick it up from PROMESS to avoid paying a daily fee for the storage. Since the DEC tablets for FY17 are already in country, ENVISION will request the necessary quantities of 100mg DEC tablets from MSPP needed and once approved, ENVISION will collect the drugs from PROMESS.

Drug and diagnostic clearance and storage. In FY17, ENVISION will continue to provide funds to cover the costs of clearance, storage and transportation of drugs and diagnostics (FTS). ENVISION covers packing costs for TAS materials (e.g. lancets, etc.) purchase in the US, shipping costs for TAS materials purchased in the US, and MDA drug clearance costs and transportation to the warehouse in Port au Prince. ENVISION also funds the costs for storage at the warehouse and then transportation from the warehouse to the communes two weeks before MDA. As mentioned in the MDA section of the work plan, MDA kits consist of various supplies in addition to the ALB and DEC.

Drug repackaging into kits and delivery of MDA supplies. ENVISION funding supports the packaging of the MDA kits. The costs for this includes warehouse loading/unloading fees. Once the kits are prepared, ENVISION prepares delivery notes and receipts for the communes concerned, and contacts community leaders and commune and department officials to discuss the delivery schedule. ENVISION uses a transportation service to deliver the kits for security reasons. When the kits are delivered, a commune official or community leader signs a bill of receipt and delivery in duplicate which includes the department name, description and quantity of the items found in each kit, date of delivery, number of posts, and number of leaders. Community leaders and commune officials then deliver the kits to


individual distribution posts. One copy of the receipt is kept at the commune and the other is returned to ENVISION. Delivery of the kits is completed no later than one day before the start of MDA to ensure that the kits are available before MDA starts.

National policies for waste management of drugs/other commodities exist in Haiti. After the MDAs, CLs bring all unused supplies and drugs to health facilities, and IMA collects the unused supplies, conducts inventory, and rearranges them into new MDA kits that are used in the upcoming MDAs and stored at the IMA warehouse. ENVISION informs the MSPP about the quantities of any remaining MDA drugs, and follows any instructions given about how to manage them. However typically, MSPP allows ENVISION to keep the drugs in the ENVISION (IMA) warehouse until the next MDA. Any expired drugs are emptied from their bottles and stored securely and separately at the IMA warehouse until they are incinerated. Empty pill bottles are also incinerated by ENVISION/IMA.

ENVISION follows the national laboratory/pharmaceutical directives for the storage of all drugs/commodities used for MDA and M&E activities. When ENVISION was still using ICT cards in the first half of FY16, the ICT cards were stored at cool temperature at the IMA World Health office.

All CLs, CPs, and CDDs are trained by ENVISION during refresher trainings to watch for adverse events and serious adverse events (SAEs), although there has not been an SAE in Haiti since the start of the program. Side effects, such as headaches, nausea, abdominal pain, fever, and nodules, are recorded. These medications are included in MDA kits. In the rare cases that more serious complications occur, patients are transferred to hospitals for a follow-up, accompanied by CLs. If an SAE occurs, it will be reported to the HNTDCP LF/malaria coordinator, Dr. Lemoine, who will then report it to PAHO and the drug donation program. RTI will be notified by IMA within 24 hours if any SAEs occur. IMA/ENVISION has shared the French version of the SAE handbook with the MSPP and partners. In addition, during FY16 ENVISION worked with the MSPP to identify a SAE Focal Point at the HNTCDP, Murielle Gilbert and shared with her and the national LF/malaria coordinator ENVISION resources and webinars on SAE.

ENVISION has not identified any new procurement or supply chain activities for FY17 that are not already being supported by the program.

IMA is requesting from ENVISION a total of 3,675 FTS to carry out pre-TAS in FY17. This represents a sample size of 500 per planned pre-TAS plus a 10% buffer. FTS will be purchased by RTI and shipped to Haiti for use in sentinel site surveys. As with DEC, the U.S. Embassy will be the consignee and clear the FTS through customs. After they are cleared, the FTS will be stored in the IMA office prior to use. For TAS, ENVISION will use FTS donated by WHO to the HNTDCP, and assist the HNTCDP in quantifying FTS needs for the country and submitting the request to WHO for FY17.

Additionally, IMA is requesting from ENVISION a total of 10 Kato Katz kits for use in integrated STH TAS1 (in Quartier Morin, Milot, Acul du Nord in the North), West (6 EU in Metropolitan), and TAS2 (in Southeast and the 3 EUs in North that have TAS2). This represents a total 3 EUs for TAS1 and 4 EUs for TAS2 with STH integration. The kits will also be purchased by RTI and shipped to Haiti, with the U.S. Embassy as the consignee to clear the kits through customs. After being cleared, the kits will be stored at the IMA warehouse. These departments were chosen based on the results of the national STH prevalence survey carried out by the DSF in 2013, which showed that of the departments where ENVISION has plans to carry out TAS1 in FY17, the North and Northwest departments had the highest prevalence. In addition, although TAS1 carried out in FY15 in Southeast, was not integrated with STH, because the STH prevalence according to the 2013 survey was high, ENVISION has decided to integrate STH in this evaluation unit for TAS2. These data will help inform the DSF of their ALB-only distribution plans, provide updated STH prevalence information from the 2013 national survey, and will be an important component for informing the national STH transition plan.


Supervision

Supervision of LF/STH MDA activities: The MSPP, the MENFP, and IMA staff will supervise LF/STH MDA activities. The MSPP will actively participate in training the MDA volunteers, and all volunteers must follow the training/refresher training directives prior to MDA. If a volunteer was absent during the scheduled training/refresher training, then he/she must meet with the communal head of MSPP to receive a follow-up on the missed information. If the follow-up meeting is not held, that particular volunteer will be replaced. However, the retention rate of CLs, CPs, and CDDs is very high, with most returning year after year, meaning that they have a very solid level of experience and understanding of their responsibilities.

During MDAs, the MSPP central-level representative accompanies IMA staff to supervise the distribution posts and the school-based MDAs and brings additional MDA supplies during supervision visits to replenish volunteers’ supplies if needed. Central-level staff will provide recommendations to the volunteers if necessary. At the departmental level, ENVISION covers transportation costs for the LF/STH departmental personnel to supervise the MDAs. At the communal level, the MSPP representatives supervise the distribution posts and the schools. Note that when different teams are in the same communes for supervision, they supervise different areas to avoid duplication.

Supervision by the MENFP is less active than that of the MSPP. However, an MENFP representative from the central level accompanies CLs in some communes for supervision in schools. At the departmental level, the principal school inspector also participates in the supervision in some schools, but at the communal level this participation is very low.

Within areas that failed pre-TAS or TAS, supervision efforts will be intensified, particularly in areas that are hotspots for LF transmission based on ENVISION’s data from previous DSA. In order to improve/intensify supervision, ENVISION will use a supervision checklist to better standardize supervision efforts and mentor commune and department officials on how to incorporate the supervision checklist in their work. Supervisors will be encouraged to carry out more spot checks of the social mobilization being carried out by CLs and CPs in advance of MDA as well.

Supervision of M&E activities. ENVISION also supports the national program to conduct supervision for M&E activities, including sentinel site surveys and TAS. HNTDCP staff are invited to the TAS refresher trainings organized by ENVISION, and ENVISION covers the transportation, lodging, and per diem costs for one national-level MSPP staff and one or two departmental or communal level officials to jointly supervise pre-TAS and TAS with ENVISION. To further strengthen M&E supervision, ENVISION and HNTDCP will start to systematically use the TAS Outcomes Checklists to prepare for TAS implementation and investigate any TAS failure in FY17.

In order to ensure that WHO and MSPP regulations are adhered to, ENVISION will continue to closely supervise MDA and ensure that clear reporting mechanisms are in place for CDDs, CPs, CLs, and communal health officials report any issues that arise during the execution of MDA. Any instances of regulations not being followed will be documented, followed up on, and shared with the HNTDCP.

In order to identify and address any potential issues that arise during the course of MDA, ENVISION will maintain close communication with MDA volunteers and MSPP and MENFP officials. For example, in the past, some school directors have refused to allow volunteers to carry out MDA in their schools. In this case, ENVISION would call and/or meet with departmental school directors, and encourage them to liaise with the school directors to explain the purpose of MDA, its importance for the health of their students and families, the safety and effectiveness of the drugs, and address any other concerns.


Author, 01/03/-1,

Would this be sensitive?

M&E

WHO Joint Application Package: ENVISION will work with the HNTDCP and other implementing partners to ensure that the application package is completed in a timely manner and that the package is complete and accurate. This will involve in-person meetings scheduled well ahead of the final deadline. More details are provided in Drug and Commodity Supply Management and Procurement section on the process for completing the WHO Joint Application Package in Haiti.

Improving TAS Outcomes Checklists for Program Managers: ENVISION and HNTDCP will start to systematically use the TAS Outcomes Checklists to prepare for TAS implementation and investigate any TAS failure in FY17.

WHO Integrated NTD Database: In FY17, ENVISION will continue to work with the HNTDCP and other implementing partners to ensure complete historical data entry into the database. This will enable to HNTDCP, with ENVISION support, to complete the WHO JRF and EPIRF using the database, and eventually, to prepare the LF elimination dossier. Historical data from 2008 to 2015 have already been entered in the database for all USAID supported communes and for some non USAID-supported communes where information was available. However, some historical data from non-USAID partners is still missing. ENVISION and MSPP have requested these data from other implementing partners on several occasions and is still hoping to receive these. The MSPP has not yet actively used the database since it is incomplete. A meeting is planned in the fourth quarter of FY16 to make the necessary updates to the database and plan for its continued maintenance and usage.

The main change in the M&E strategy from previous work plans is that the country has transitioned from using ICT cards as the LF diagnostic tool to FTS. No coverage surveys are planned for FY17.

Pre-TAS. In FY17, ENVISION plans to support 7 pre-TAS covering 7 communes including 3 in the North (3 communes) and 4 in the West (4 communes representing 4 EU).. ENVISION will ensure that these pre-TAS are carried out at least six months after the last MDA and that the pre-TAS follow all WHO and national guidelines.

TAS 1 and 2. ENVISION also plans to carry out TAS1 in 13 EUs covering 17 communes (3 in North, and 14 in West). Each of these will be integrated with malaria, with additional costs for rapid diagnostic tests (RDT) and personnel covered by CDC. ENVISION will support TAS planning meetings in each evaluation unit where TAS1 and TAS2 are planned (see Advocacy section for additional details). In addition, TAS1 in the North and West will be integrated with STH (see explanation above for why the TAS will be integrated with STH in these EUs in section h, Drug and Supply Chain Management and Procurement).

ENVISION also plans to carry out TAS2 in 10 EUs in a total of 44 communes (10 in Southeast, 10 in Nippes, 8 in Northwest, 3 in North, and 13 in the Northeast). Of these, TAS2 in Southeast and the 3 EUs in the North will be integrated with STH.

Saut d’Eau is ready for TAS2 in FY17; however, given that TAS2 can be carried out up to three years after TAS1, the decision at the partners’ meeting in July 2016 was to postpone TAS2 to the following year.

Some of the EU in the West department, including the six Port-au-Prince/Metropolitan area communes and Grand Goave and Thomazeau did reach 65% minimum coverage consistently and over five consecutive rounds. However, IMA discussed this with RTI and MSPP, and came to the conclusion that since some of communes had low baseline prevalence and the RPRG had approved TAS in other EUs that did not have 5 rounds of 65% coverage such as La Tortue, the HNTDCP plans to carry out pre-TAS and, if these communes pass, submit the results to RPRG for approval. If they do not pass, these communes


will require 2 more rounds of MDA. For the six Metropolitan communes, each commune will have a pre-TAS sentinel and spot check site in order to provide more evidence to RPRG for TAS approval.

Table 5: Planned disease-specific assessments for FY17 by disease

Disease No. of endemic districts

No. of districts planned for

DSA

Type of assessment

Diagnostic method (Indicator: Mf, FTS,

hematuria, etc)

LF 41 7 Pre-TAS FTS

LF 41 17 TAS1 FTS

LF 41 44 TAS2 FTSSTH* 140 29 STH Kato-Katz

*The STH evaluation is integrated with LF TAS

The results of the DQA carried out in FY15 will be used to strengthen national reporting, feedback, and data management systems. The primary result of the DQA showed that:

The departmental level does not submit reports directly to the national level; it submits reports to partners only. So there was no data from departments at the national level

At all levels the number of DEC distributed was a reporting challenge; this indicator is not regularly evaluated at any level.

Lack of staff specifically designated to verify data quality

ENVISION will use MDA refresher trainings to emphasize data collection, data quality, and data management among CLs, CPs, and CDDs, explaining the importance of all the MDA data collection tools as a whole and each tool individually. ENVISION will also write a short data management protocol to share with each level of data aggregation (CL, communal level, departmental level, partner level, and national level). The ENVISION staff will also carry out data feedback for each aggregation level to increase staff motivation.

One anticipated challenge is that school directors sometimes provide inaccurate school population data to ENVISION ahead of TAS, which makes reaching the targeted sample sizes more difficult. This is because school directors either do not have well-maintained records, or, they may believe that some benefit will come to the school if they inflate their enrollment figures. In order to address this challenge, during TAS planning meetings, ENVISION will emphasize with CLs, MSPP, and MENFP officials the importance of gathering accurate school data, and encourage CLs to visit each school to verify enrolment figures in the school registers ahead of TAS.


3) Maps


Source CDC

Note: FY16 MDA data for Port-au-Prince/Metropolitan area were not available when the MDA coverage map was drawn.


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

Project AssistanceStrategic PlanningNational NTDs Roadmap updateBi-annual NTDs partners’ meetings NTD SecretariatOngoing support of operational costsLetters to school children parents and churches in North and Port de PaixBrochures (Letters to school children parents) in Metropolitan areaBuilding Advocacy for Sustainable National NTD ProgramTAS planning meeting in Southeast for TAS 2TAS planning meeting in Nippes for TAS 2TAS planning meeting in North for TAS 1TAS planning meeting in North for TAS 2TAS planning meeting in Northwest for TAS 2TAS planning meetings in West for TAS 1TAS planning meetings in Northeast for TAS2Social Mobilization to Enable NTD Program ActivitiesDevelopment and production of health messages (Radio and TV spots)Dissemination of health messagesIEC Materials for LF MDADelivery of IEC materials and radio and TV spotsSocial Mobilization Evaluation in West (Fonds-Verrettes)TrainingRefresher Training of Community LeadersRefresher Training of Community PromotersRefresher Training of Community Drugs Distributors (CDDs)Refresher training for TechniciansTraining of 24 new lab techniciansMDAMDA in 6 communes in North Department (Cap-Haitien, Limonade, Plaine-du-Nord, Quartier-Morin, Milot, Acul-du Nord) MDA in Port-de-Paix ( Northwest Department)MDA in 4 communes in West Department (Arcahaie, Fonds-Verrettes, Cabaret, Croix-des-Bouquets)MDA in 6 Port au Prince communesMDA in GonaivesDrug Supply Management and ProcurementDrug clearance, transportation to the warehouse, and transportation from warehouse to communesDrug StorageDrug packaging into kitsDrug packaging into kitsSupervisionSupervision of LF/STH MDA North, Northwest, and WestRecuperation of materials and receipts following LF/STH MDA, Allowances distribution Supervision during pre-TAS and TAS activities.M&ELF Pre-TAS: North Department :(Milot, Quartier Morin, Acul du Nord), West (Petit-Goave/Grand-Goave, Thomazeau/Cornillon, Anse-a-Galet/Pointe-a-Raquette, Ganthier/Kenscoff)

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

Department Commune LF Pre-TAS TAS1 TAS2 TAS3Nippes Anse A Veau X

Arnaud XFonds Des Negres XGrand Boucan XL'Asile XMiragoane XPaillant XPetit Trou De Nippes XPetite Riviere Nippe XPlaisance De Sud X

North Acul-du-Nord X XDondon XLimbe XMilot X XPlaisance XQuartier Morin X X

Northeast Capotille XCaracol XCarice XFerrier XFort Liberte XLes Perches XMonbin Crochu XMont Organise XOuanaminthe XSainte Suzanne XTerrier Rouge X


Department Commune LF Pre-TAS TAS1 TAS2 TAS3Trou Du Nord XVallieres X

Northwest Anse A Foleur XBaie De Henne XBassin Bleu XBombardopolis XChansolme XJean Rabel XMole Saint Nicolas XSaint Louis Du Nord X

Sud-Est Anse A Pitre XBainet XBelle Anse XCayes Jacmel XCote De Fer XGrand Gosier XJacmel XLa Vallee XMarigot XThiotte X

West Anse-a-Galet X XCornillon X XGanthier X XGrand-Goave X XKenscoff X XPetit-Goave X XPointe-a-Raquette X XThomazeau X XCite Soleil XCarrefour XDelmas X


Department Commune LF Pre-TAS TAS1 TAS2 TAS3Petionville XPort-au-Prince XTabarre X

Appendix 2.1 Table of Provinces/States and Districts not supported by USAID


Department Commune LF Pre-TAS TAS1 TAS2 TAS3Centre Belladeres X

Boucan Carre XCerca Cavajal XCerca La Source XHinche XLascahobas XMaissade XMirebalais XSaut D'Eau XSavannette XThomassique XThomonde X

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