PROGRAM YEAR 1 First and Second Quarterly Performance Monitoring Report October 1 st, 2010 March 31 st, 2011

Transcription

1 PROGRAM YEAR 1 First and Second Quarterly Performance Monitoring Report October 1 st, 2010 March 31 st, 2011 May 16, 2011

2 TB CARE I Partners American Thoracic Society (ATS) FHI Japan Anti-Tuberculosis Association (JATA) KNCV Tuberculosis Foundation (KNCV) Management Sciences for Health (MSH) International Union Against Tuberculosis and Lung Disease (The Union) World Health Organization (WHO) 2

3 Table of Contents 1. Introduction Knowledge Exchange Project Management Unit (PMU) Core projects Country projects Afghanistan Botswana Cambodia Djibouti Dominican Republic Ethiopia Ghana Indonesia Kenya Mozambique Namibia Nigeria Pakistan Southern Sudan Vietnam Zambia Zimbabwe Central Asian Republics (CAR) Regional Projects Center of Excellence (CoE) for PMDT East Africa Supranational Reference Laboratory (SNRL) ECSA (East, Central and Southern Africa) List of Tables and Figures Table 1: Overview of Year 1 Core Projects, October 2010-March Table 2: Geographical distribution of TB CARE I partner countries

4 List of Abbreviations ACSM AFB CAR CDC CoE CDR CSO DOT DOTS DR DRS DST ECSA EQA ERR FIND GDF GFATM GLC GLI HRD HSS IC JATA KIT KNCV MDR MDR TB M&E MOA MOH MOST MSH NGO NTP NRL OR PMDT PMU PPM PPP RIF QMR SLD SNRL SOP SS+ SS- TA TB TB CAP TBCTA USAID WHO Advocacy Communication Social Mobilization Acid Fast Bacilli Central Asian Republics Center for Disease Control and Prevention Center of Excellence Case Detection Rate Civil Society Organization Directly Observed Treatment Directly Observed Treatment Short Course Drug Resistance Drug Resistance Survey Drug Susceptibility Testing East, Central and Southern Africa External Quality Assurance Electronic Recording & Reporting Foundation for Innovative New Diagnostics Global Drug Facility Global Fund for Aids, Tuberculosis and Malaria Green Light Committee Global Laboratory Initiative Human Resource Development Health System Strengthening Infection Control Japan Anti Tuberculosis Association Royal Tropical Institute KNCV Tuberculosis Foundation Multi Drug Resistance Multi Drug Resistant Tuberculosis Monitoring and Evaluation Memorandum of Agreement Ministry of Health Management & Organizational Sustainability Tool Management Sciences for Health Non Governmental Organization National TB Program National Reference Laboratory Operational Research Programmatic Management of Drug-resistant Tuberculosis Program Management Unit Private Public Mix Public Private Partnership Rifampacin Quarterly Monitoring Report Second Line Drug Supra National Reference Laboratory Standard Operating Procedures Sputum Smear positive Sputum Smear negative Technical Assistance Tuberculosis Tuberculosis Control Assistance Program Tuberculosis Coalition for Technical Assistance United States Agency for International Development World Health Organization 4

5 1. Introduction The Tuberculosis Coalition for Technical Assistance (TBCTA) is pleased to present USAID with the first report of the TB CARE I project. Due to the time required to start up project activities and to set up the reporting system this report will cover the first two quarters of the project, from October 1, 2010 up to and including March 31, Since this is the first report, special attention will be devoted to the process of work plan development, staff recruitment and setting up of monitoring and evaluation systems. The main technical areas that TB CARE I will focus on are as follows; 1. Universal and early access 2. Laboratories 3. Infection Control (IC) 4. Programmatic Management of Drug Resistant TB (PMDT) 5. TB/HIV 6. Health Systems Strengthening (HSS) 7. M&E, Operations Research (OR) and surveillance 8. Drug supply and management Within the first six months of the project, the main priority for the coalition partners was to develop work plans and budgets for core, country and regional projects. In order to facilitate this process the PMU developed a special work plan template that ensures close links between the monitoring and evaluation plan, the plan of activities and the budgets. As of March 31 st, 26 core projects, nine country programs and two regional programs have been approved by USAID. Implementation of these projects has started and those activities that have already been undertaken are reported on below. In line with the cooperative agreement, TB CARE quarterly reports will focus mostly on progress towards planned outputs and main activities, while the annual report will provide more qualitative data and reflection on progress towards achieving project targets and objectives. Both reports will aim to identify and outline particular successes that have been achieved or challenges that were encountered during the reporting period. This report will contain both technical and financial information and for the first time will report financial expenditure down to the activity level of country programs. 2. Knowledge Exchange A new brochure highlighting the goals and unique qualities of the TB CARE I project has been designed and submitted for approval before printing. The first edition of the TB CARE I newsletter was produced and distributed electronically. Future versions of this will still be distributed electronically, but will move from a webpage/html format into a downloadable PDF which can also be printed if necessary. The next version will be released in September. Regarding knowledge management under the TB CARE project, we intend to explore several methods of communicating our impact and work. There will be a strong focus on communicating our successes, and countries will tell those stories directly. Every country QMR will contain stories of projects and programs which TB CARE I has undertaken and how those have impacted countries, communities and individuals. They will be asked to provide other types of documentation including photos and even videos. The first set of stories will be published in October 2011 and each QMR thereafter will also contain further stories or updates to running stories. The TB CARE I website will be a central point of communication and information, kept up to date with current situational information, reports, stories, events and tools. TB CARE I also will assist country projects to supply current information regarding their projects and perhaps ultimately develop their own satellite websites. It is also proposed to purchase the TB CARE I domain name. The first phase of this will be implemented this year, with the purchase of the domain name and the updating of the TBCTA site. In year 2 countries who wish to set up satellite sites, will be aided and encouraged in this process. 5

6 Finally, TB CARE I also intends to embrace wider forms of social media in order to bring both our work successes to an even larger audience. Tools such as Facebook and Twitter are simple and easy to maintain whilst tapping into a large number of people. These portals allow TB information and TB CARE as an organization/project to be brought to a wider audience and can be used: as a networking tool to aid communication to enhance TB CARE I's reputation online. TBCTA's reputation is built on its achievements. Social media provides us with channels / tools to make these achievements known. It is a form of empowerment that offers significant potential for enhancing TBCTA/TB CARE's worldwide reputation. The expansion/testing of social media will be gradual throughout the next two years. 3. Project Management Unit (PMU) In the first six months of the TB CARE I project, the PMU prioritized the recruitment of additional team members and the development of templates for work plans and technical and financial reporting, in order to ensure a fully functional implementation and reporting system. In addition, the PMU continued to work on the finalization of the TB CAP project, which will be reported on in a separate quarterly and final report. This section will focus only on TB CARE I related activities. In order to successfully implement the TB CARE I project and to better support the partners of the coalition, the PMU has decided to expand the staffing with one additional Project Officer, one new M&E Officer and two Financial Officers. The recruitments will be completed in the course of A key milestone within the reporting period was the March 2001 Joint Strategic Meeting together with USAID and TB CARE II implementing partners held in Washington DC. The meeting served as a very useful platform to discuss a number of key issues, including expected outcomes and performance measures. In the course of February and March 2011 the PMU developed several reporting templates, including for country reporting to USAID field missions and for reporting on core projects. These templates were discussed with USAID during the meeting in Washington, revised and disseminated to all partners. Trainings on quarterly reporting and on the use of the eroom have been held for all TB CARE I country directors, M&E officers and project officers at partner HQs through an online meeting platform, GoToMeeting. All reporting templates are available in the TB CARE I eroom. 4. Core projects Based on the suggestions of the advisory groups, TB CARE I partners developed and received approval for 26 core projects. Most approvals were received in the period between February 1 st and March 31 st so actual implementation to date has been fairly limited. The following table provides detailed information on the progress of each core project. 6

7 Table 1: Overview of Year 1 Core Projects, October 2010-March 2011 Technical Areas Code Lead and collaborating partners Title Expected Outcome(s) Progress to date Status 1 Universal and Early Access C1.1.1 ATS, MSH, JATA Tool to identify TB most at risk and vulnerable populations Framework format developed Vision statement drafted, literature review on-going, 4 teleconferences were held, Writing workshop May 17-18th planned. Based on the outcomes of the workshop, the project might need revision into the direction of the development of a multifunctional interactive-web-based tool. C1.1.5 ATS, FHI, WHO Adapt and pilot patient centered package Methodology developed Two kick-off workshops conducted First teleconference is planned for May to agree on draft methodology and workshop framework to be finalized by June 30. Delayed 2 PMDT C2.1.1 PMU, The Union Strengthening of regional and local technical collaboration centers (TCC) for PMDT Assessment of technical collaboration center in India Functioning exchange between TCCs The project had to be revised, focusing only on an assessment visit to India. It has been approved in May 2011, no activities started yet Delayed 3 Infection Control C3.1.1 FHI, MSH, The Union Develop a tool to measure TB incidence in health care workers Draft guide and protocol agreed on by writing committee and experts Agreement on the project development plan achieved; ongoing collection of tools; ongoing preparation of LoPs to the expert meeting planned for July. C3.2.1 PMU, MSH, FHI Core Package of IC Interventions Core TB IC package developed The joint Core project, led by PIH, has started to gather opinions from IC experts on the formulation of the Campaign message for a TB IC Core package through , which will be further discussed and agreed upon during the expert meeting planned for 11/12 July at The Hague

8 Code Partners Title Expected Outcome(s) C3.3.2 MSH 4 TB/HIV C4.1.1 FHI, MSH, JATA, PMU Training and mentoring on TB IC TB Infection Control at Community Level 9 IC consultants trained and underwent one mentored field visit TOT Curriculum developed How-to manual developed Progress to date Too little time was left to organize training according to planned date. Progress: trainee selection criteria identified, data bases of potential trainees searched, preparation of course curriculum started. MSH: curriculum developed and given in Addis. 12 international consultants trained. 9 will be mentored during field visits by the end of Sept. TOT Curriculum: The Learning Needs and Resource Assessment (LNRA) was developed and administered in Kenya. The outline of the TB IC community curriculum has been developed and about 60% of the modules drafted a first full draft should be ready by June 1. Status Dates for the TOTs in Zambia and Kenya have been confirmed (August 2011) and key stakeholders have been informed of the project in both countries. How-to manual: the content of the howto manual will be finalized after the TOTs have been conducted, as the feedback from the curriculum, training design and materials will inform revisions that will need to be made to the manual. C4.2.2 ATS, FHI Guidelines for evaluations of contacts to infectious cases of tuberculosis WHO-approved set of guidelines developed The project has just started. No progress has been reported so far. Delayed C4.3.1 MSH Assessment of TB/HIV mortality data Five high-burden countries assessed Strategy to improve M&E systems developed Draft protocol written, countries selected, missions planned, roles established. 8

9 Technical Areas Code Partners Title Expected Outcome(s) 5 M&E, OR and surveillance C5.1.1 C5.1.2 MSH, KNCV JATA Guide on electronic recording and reporting for TB care and control Guide on inventory studies to assess the level of TB underreporting Guide on ERR developed Guide on inventory studies developed Progress to date Electronic Recording & Reporting (ERR) meeting took place on April to review draft chapters and share country experiences to be reflected in the guide. Participation from KNCV and MSH as well as country representatives from China, Georgia, Romania, Brazil, Pakistan, Kenya, Netherlands, UK and Eastern Mediterranean. It was agreed that the guide will include the following four chapters with practical examples: 1. Rationale for ERR; 2. Adoption and design; 3. How to prepare a RFP; and, 4. Implementation of ERR. Second draft of the chapters are due by end May. WHO will share meeting summary and list of participants. The guide on inventory studies will be published in the form of an electronic document by September Work is ongoing to that extent. The printed version is expected to be available by the end of the year. Status C5.2.1 MSH, PMU Develop M&E COP for NTPs Increased use of data for decisionmaking in TB CARE countries A needs assessment has been drafted. It will be finalized and disseminated to NTP and TB CARE I/II M&E officers by June September training dates have been selected and participants will be informed of the dates when the assessment is disseminated. 9

10 Technical Areas Code Partners Title Expected Outcome(s) 6 Laboratories C6.1.1 The Union, MSH Practical handbook for the development of a national laboratory strategy Practical handbook developed Progress to date A teleconference was held at the end of April with stakeholders of the project. Country lab experts have been engaged, as well as an external expert May a consensus meeting will take place in The Hague. A questionnaire is developed for 17 USAID/PEPFAR priority countries in sub- Saharan Africa to ascertain the perceived need for a guide for lab strategic plans from NRLs/NTPs. Status C6.1.2 Union, MSH Tool for lab network assessment Consensus tool developed and tested Start-up workshop planning has started. Since mostly the same participants are involved as those needed at the similar workshop for the project, it was decided to organize them in the same geographic area (The Hague and Antwerp) and also connected in time. Further arrangements are underway to hold the workshop on May C6.2.1 MSH, The Union Lab accreditation tools and roadmap Lab accreditation toolbox and templates drafted In March a consensus meeting was held at KIT which has been sub-contracted to prepare a national accreditation framework. A draft has been developed and will be presented at the GLI meeting in Geneva in July. The project will support participation of 15 stakeholders in this meeting. CDC will also co-fund this meeting. C6.3.1 MSH Guiding and coordinating Xpert MTB/RIF implementation Guidance made available on scaling up and implementing new testing algorithms incorporating Xpert MTB/RIF The implementation document has been developed. It is published on the GLI website. Completed 10

11 Code Partners Title Expected Outcome(s) C6.4.1 MSH, The Union Assess quality of WHO-GLI SRLN and individual SRLs using GLI assessment tool Draft of GLI assessment tool revised Progress to date A field evaluation of the revised tool was conducted at the NRL in Uganda from 4-9 May KIT will assist the partners in refining the tool based on the outcome of this assessment. Status 7 Health Systems Strengthening C6.4.2 C6.4.3 C7.1.1 The Union, MSH, WHO MSH, The Union ATS, FHI Develop Benin NRL in Africa to join SRLN Meeting of the SRLN Increased and sustained political and financial commitment to TB prevention, care and control Benin NRL is staffed with trained and competent personnel; quality management system in place and adherence to procedures ensured Meeting of SRLN convened and consensus workplan and strategy developed Improved TB plans, indicators and budget embedded within national health plans and/or strategies. The project had to be revised, focusing only on the development of the Benin lab. It has been approved in May 2011; no activities started yet. The SRLN meeting is planned to take place on 5 October 2011 as part of the GLI Partnership meeting from 3-5 October WHO has begun collecting national health plans and TB strategies & structuring mapping. Planning with FHI and ATS for field visits to begin. Workshop may be postponed due to late start of the project. Delayed C7.1.2 ATS, MSH Create political commitment and financing database Political commitment (measured by domestic financing for TB) increased The project has just started. No progress has been reported so far. Delayed C7.1.3 WHO Enhancement of the planning and budgeting tool Planning and budgeting tool enhanced 15 participants trained on its use Internal feedback on the use of the tool has been obtained. Results will be presented next week to WHO-HQ colleagues, later to all the participants. Since the proposal TB CARE II - activity (lead by Global TB Institute) was not approved, WHO took over the planned activities, therefore the implementation of will take longer. Delayed 11

12 Code Partners Title Expected Outcome(s) C7.4.1 C7.5.1 MSH, The Union FHI, ATS Training national leaders on HRD Tools Build capacity of civil society in TB Control Action Plan on HRD in place in NTPs A methodology to build capacity of civil society organizations in TB control developed and pilot tested 6 civil society organizations in 2 countries have a TB activity plan and started implementation Progress to date Invitation/application for Virtual Leadership Development Program (VLDP) on HRD sent out in April; applications due mid-may; program scheduled to launch mid-june. Selection of countries (Nigeria and Indonesia), CSO's and mentoring organizations being selected; Learning Needs assessment developed. Draft training curricula developed, Planned next steps; Development of M&E approach + tools, training in Nigeria (June) and Indonesia (July) Status 6 civil society organizations in 2 countries have partnered with national and/or local stakeholders in TB control 0 Overarching elements C0.0.1 The Union Support to the Sub Working Groups of the Stop TB Partnership Strategic areas of work discussed and agreed in seven groups Reports from all meetings available The Sub Working Groups of the Stop TB Partnerships will come together in the fourth quarter of APA1. No activities took place in Quarter 1 & 2 C0.0.2 KNCV Support to CSHGP and CORE Group CORE PVOs improved competence in providing TB services A mid-term evaluation of the CARE project in India has been supported by TB CARE I through this project. It was carried out by a KNCV consultant and awaiting the report. Another mid-term evaluation can still be supported. 12

13 5. Country projects Following the announcements of the USAID Mission buy-ins, the TB CARE partner countries have devoted the first three months of the project to the development of their work plans and their budgets. As of 31 March a total of nine country work plans have been approved by both the USAID missions and USAID Washington. Project work plans are under development in another nine countries, bringing the total number of expected partner countries within APA1 of TB CARE to 20. Please note that for this total, each of the Central Asian Republics (CAR) has been counted as a separate country, although the region is treated as a single (regional) program for financing reasons. See Table 2 for a list of all TB CARE I partner countries by region. Table 2: Geographical distribution of TB CARE I partner countries Africa (11) Asia (8) Latin America (1) Botswana Djibouti Ethiopia Ghana Kenya Mozambique Namibia Nigeria South Sudan Zambia Zimbabwe Afghanistan Cambodia Indonesia Pakistan Vietnam Kazakhstan* Kyrgyzstan * Uzbekistan* Dominican Republic * Note: the three Central Asian Republics are joined in a single regional program. All nine country offices with approved work plans submitted a semi-annual technical and financial report to the USAID mission by April 30 th, in accordance with the deadline set in the cooperative agreement. These reports can be found on the TB CARE eroom. Due to the rolling nature of approvals not all countries could start at the same time. Each country will now be briefly discussed in turn. 5.1 Afghanistan MSH, the lead partner in Afghanistan, has not submitted the work plan during the reporting period, as the country is still implementing the fifth year of TB CAP. The Afghanistan country team is expected to submit a work plan for TB CARE I in the course of June. 5.2 Botswana the lead partner in Botswana, was one of the first to get approval for its work plan. Activities have started on February 23, During this period Botswana project has developed the first draft of TB prevalence protocol as well as first drafts of actions plans for PMDT, TB/HIV, community DOTS and infection control. Following the development of SOPs and protocol for validation of MGIT960 SLD DST, 30 lab technicians were trained on AFB microscopy (see photo to the right). MGIT960 DST validation of first line and second line drugs has been delayed due to an interruption of supplies, shortage and transfer of trained staff and ongoing renovation of the NTRL building. 5.3 Cambodia JATA, the lead partner in Cambodia, received approval of the APA 1 work plan by USAID Washington on the 19 th of April. 5.4 Djibouti the lead partner in Djibouti, already received approval of its work plan on February 18 th and started its first activities. As part of the process of renovating the National Reference Laboratory, the NTP was supported in the process of establishing the bio-safety level 3. Procurement of equipment and reagents necessary to the introduction of new and rapid diagnostic tools, namely liquid culture, Line Probe Assay, and strip speciation are directly supported by the Foundation for

14 Innovative New Diagnostics (FIND). After the successful submission of the Global Fund Round 10 TB proposal, rated category 2, TB CAP technical assistance was provided for the answers to the clarification questions raised by the TRP. Technical support was provided to the process of restructuring the institutional framework of the management of the Global Fund related matters, including CCM reform, proper drug management, discussions on PR alternatives and on the role of WHO. In order to mitigate the effects of long lasting drought in the country, technical assistance was provided in the development of the CERF project whose aim is among others to strengthen mobile teams in charge of providing basic health care in remote areas, including TB detection. 5.5 Dominican Republic the lead partner in Dominican Republic, submitted a work plan to the USAID mission which is still under consideration for approval. 5.6 Ethiopia the lead partner in Ethiopia, received approval of the work plan in March. Project implementation has started. Most significant achievements of this quarter are as follows; World TB Day: On the move against tuberculosis; innovate to accelerate action was the theme of World TB Day for this year. The Ethiopian Federal Ministry of Health commemorated WTBD on March 24 th in Bora Woreda (District), East Shoa, one of the TB CARE supported Zones in Oromia Region. The Woreda was selected for its high performance in community based TB care services. The event was a good opportunity to share experience with other zones in the country. For this event TB CARE I staff were actively involved in steering committee and also supported printing of 6,000 T- shirts in three local languages of the country (see photo to the right). External Quality Assurance: Supportive supervision has been conducted between March 14-30, 2011 for 170 (99%) TB Diagnostic Facilities and EQA was implemented in 169 (99%) health facilities. Blind rechecking being done at regional Laboratories and the result of the finding will be communicated with the Health Facilities shortly. SOP to improve TB Case Detection: A one-day sensitization workshop was conduct in West Arsi zone, Shashemene town. Objective of the workshop was to sensitize and familiarize Zonal and Woreda TB/HIV experts, health facility heads, TB focal persons and laboratory heads about the case detection SOPs. A total of 98 (81 M + 17 F) health professionals from 30 health facilities participated. Before concluding the workshop the following action points were noted: The TB focal person should ensure that TB case detection materials are available and used in every department/unit of the health facility; Health facility heads will chair Multi Disciplinary Teams & the Woreda TB/HIV experts will supervise the case detection activities and SOP Implementation. Facility level SOP implementation will be conducted in the next quarter. 5.7 Ghana MSH, the lead partner in Ghana, submitted the work plan and received approval on March 8, 2011 and has started project implementation. During this quarter the new contracts for the TB CARE I Country Manager, Project Officer and Project Driver were successfully signed. The new M&E Officer was successfully recruited and is starting on April 18, The first short term technical assistance to discuss the strategic approach for TB CARE I in Ghana with the USAID Mission, NTP and key partners was successfully completed. The date for the Regional Review meeting in the Eastern Region was agreed to by both the NTP central Unit and Eastern Region Director of Health Services. This meeting will take place on April 19, Support for the first monitoring and technical supervision visits in Eastern Region were agreed to take place in April The TB CARE I Country Manager participated in the National Launch of the World TB Day. One local popular musician was crowned as TB Ambassador and he launched a TB song in local language encouraging the community to visit for health facilities for TB diagnosis and TB Treatment when they have signs and symptoms suggestive of tuberculosis. 14

15 5.8 Indonesia the lead partner in Indonesia, submitted a quick start work plan which was approved by USAID in the last week of March. The full annual work plan will be prepared and submitted to USAID in June A major highlight in this reporting period was the approval of the Round 10 proposal for Global Fund (157.5 Million US$) titled Accelerating Progress towards Universal Access to Quality DOTS. TB CARE I has provided the technical lead to the proposal writing team and sub-contracted UGM to develop and finalize the National Strategic Plan , the Global fund Round 10 proposal and a series of action plans including the PPM TB action plan, the laboratory network development plan and the PMDT expansion plan. In addition, TB CARE I provided technical support to develop and finalize the other components of National TB Action Plan such as Drug Management, ACSM, HRD, Commodity Management and Strategic Information Plans. A TB CARE I consensus meeting was conducted in Jakarta with the participation of all TB CARE I partners and stakeholders (see photo to the right). The service delivery areas and activities to be implemented by different partners were agreed upon. There was consensus on a work plan based on the NTP's 5 year strategic plan and 5 years plan of the USAID support to TB control. TB CARE I partners participated in the TB Joint External Monitoring Mission in mid February and visited 5 provinces (DKI Jakarta, North Sumatera, South Sulawesi, Papua, and East Java). TB CARE I provided technical assistance and financial support to finalize the revised training module of smear microscopy. TB CARE I also supported the second National TB Congress held March 24th -25th. There were several symposiums providing updates on TB program activities, and exhibitions with participation from partners. Five PMDT sites (East Jakarta, Surabaya, Malang, Solo and Makassar) are now operational. As of the end of March 2011, 940 MDR-TB suspects were tested, DST results were available for 668 patients, 277 confirmed MDR-TB cases were identified and 202 of them were put on treatment with SLDs. The 6-month interim results showed that among 102 MDR-TB cases on treatment 72 have converted. MDR-TB counseling and case management were strengthened to reduce treatment refusal and lost to follow up. 5.9 Kenya the lead partner for Kenya, received official approval of its work plan from USAID Washington on March 21 st. The implementation has already started. Most significant achievements of this quarter are as follows: TB Poverty and gender guidelines: Following piloting of the TB CAP tool to estimate patients' costs in Kitui district in 2008, there was an identified need to mainstream gender and poverty issues in relation to TB care services. Under TB CARE I, technical assistance was provided by a consultant from KNCV to support the development of TB poverty & gender guidelines. A field visit was made to two districts (Kitui & Mutomo) which are implementing activities to address gender and poverty. After the field visit, the Poverty & Gender technical working group worked with the consultant to come up with the guidelines. A first draft was developed, which shall be shared with stakeholders for further inputs before finalization. Quarterly Review Meetings, February 2011: Quarterly Review Meetings for Quarter 4 of 2010 were held for each of the 12 regions. During these meetings the regional teams were provided with an overview of TB CARE I project and operational issues. This provided a good background of the project to the regional teams. TB quarterly data for each district was presented and validated by the regional teams and the Central Unit staff participating in the meeting. MDR TB Surveillance: In order to enhance surveillance for MDR-TB, support for the TB Central Reference Laboratory (CRL) was provided to transport specimens from peripheral sites to the CRL. 15

16 A mechanism has been put in place to transport MDR TB specimens from peripheral facilities to the nearest courier point and then transported to the Central Reference Laboratory via courier. During the reporting period, a total of 3,079 specimens were received by the CRL Mozambique FHI, the lead partner for Mozambique, has submitted two separate work plans to USAID: one for its malaria activities, and one for its TB activities. Both work plans are currently awaiting approval by the USAID mission. No activities have been undertaken in Mozambique within the current reporting period Namibia the lead partner for Namibia, received approval on March 8th. Project implementation has only started very recently. TB CARE I-Namibia has provided technical and financial support to the National TB and Leprosy Program (NTLP) in much the same way that TB CAP has been doing over the past five years. Most significant achievements of this quarter are as follows: TB CARE I has recruited a Country Representative Officer as well as a Senior Finance and Administration Manager. TB CARE I provided technical assistance to the NTLP at national level in the development of the TB and Leprosy M&E plan, MDR TB pocket handbook, Annual report 2010/2011 and the National Guidelines for the Management of TB and Leprosy in Namibia, 3rd edition. The World TB day commemorations were successfully held with support from TB CARE I (see photo to the right). TB CARE I supported the planned District TB and Leprosy Coordinators (DTLCs) annual forum in January 2011 in Otjiwarongo, Waterberg Plateau. This forum brought together all 34 District TB and Leprosy Coordinators of the country to one venue, where a combination of routine work and team building was done. The district and zonal TB and Leprosy Review Meetings at which TB data is verified were conducted as planned through TB CARE I financial and technical support. TB CARE 1 supported MDR-TB management sites with the provision of rehabilitation equipment (see photo to the right). As a component of this activity, a total of 34 Rehabilitation Technicians (12 males and 22 females) were trained on MDR-TB. TB CARE I continued to support the NTLP in the various clarifications sought by the Technical Review Panel TRP for the Global Fund Round 10 application which has been approved by the Global Fund subject to a few clarifications. TB CARE I supported the NTLP in conducting training of doctors, pharmacists and rehabilitation technicians on the revised TB guidelines and training of focal persons on TB Infection control Nigeria the lead partner for Nigeria, has prepared and received approval for two work plans; one for TB and the other for TB/HIV funded through PEPFAR. Most significant achievements of this quarter are as follows: TB (OP) work plan: TB CARE I organized a series of start-up meetings to introduce the work plan to all NTBLCP Focal Persons as well as ILEP Partners. Part of the support to the NTBLCP through the work plan was the involvement in The Union Conference in Abuja. FHI, KNCV and WHO were part of the Local Organizing Committee. Through support of USAID, KNCV consultants were invited to give presentations. Susanne Verver and Victor Ombeka from KNCV came to Abuja to give presentations on the following subjects: Writing Scientific Papers, Program M&E and TB in Hard to 16

17 Reach Populations. Grace Kitonga (Director of KAPTLD, Kenya) came to share her experiences in PPM. As part of efforts towards expansion of MDR-TB diagnosis and treatment a meeting was organized to assess IDH-Ward Kano for renovation and upgrade into an MDR-TB treatment center. At the end of the meeting, the stakeholders had a clear understanding on the renovation requirements of the MDR-TB ward at IDH, Kano. A concept paper was also shared on the roles and responsibilities of the FHI partnership with the Kano State Government towards effective management of MDR-TB. COP (PEPFAR) work plan: The activities were broken down into COP10 ($600,000) and COP 11 ($1,500,000). Overall it was agreed with the ILEP partners to start implementation of full activities in 40% of the planned clinics and laboratories based on the released $600,000. The MDR-TB activities supported by TB CAP continued at UCH Ibadan. Fifteen patients (from the initial batch of 23) were discharged for their continuation phase. Follow up visits to the discharged patients were undertaken during the quarter Pakistan the lead partner for Pakistan, is still in the process of developing a work plan for APA1, most notably for completing the TB prevalence study started during TB CAP Southern Sudan MSH, the lead partner for Southern Sudan, received official approval of their workplan by USAID Washington on the 5 th of May Vietnam the lead partner for Vietnam, received approval for the work plan on March 30, During this period the following activities have been conducted: the proposal for technical support for renovation of five laboratories and MDR-TB treatment wards in five MDR-TB treatment centers was prepared with technical partners (DNV, NIHE, WHO and NTP). The TORs for technical support for implementation of TB control in children and TORs for technical support for overall human resource development activities under the project were discussed and prepared with consultants. The detailed work plan for TB infection control strengthening was prepared with consultants and technical partners ( NIHE and NTP). The suppliers of Hain test system and GenExpert system were contacted and quotations were requested Zambia FHI, the lead partner for Zambia, submitted a work plan on March 3, 2011 and is currently addressing USAIDs comments. No project activities have been undertaken yet Zimbabwe The Union, the lead partner for Zimbabwe, developed a work plan, which is still under consideration and the country program has not yet started Central Asian Republics (CAR) the lead partner for CAR, has submitted one narrative proposal and three separate budgets for Kazakhstan, Kyrgyzstan and Uzbekistan. The position of Central Asian Republics within TB CARE is slightly complex and warrants an additional explanation. These countries will receive both financing from the respective USAID country missions and from a regional fund, and they will therefore be reported as individual countries. 17

18 6. Regional Projects In addition to the abovementioned country and core programs, TB CARE I also manages three regional projects which are all follow-on projects from TB CAP. 6.1 Center of Excellence (CoE) for PMDT the lead partner for regional CoE for PMDT, has submitted and received approval for their work plan on April 8 th. The TB CAP follow-on program has just started. 6.2 East Africa Supranational Reference Laboratory (SNRL) The Union, the lead partner for regional East Africa SNRL, has submitted a work plan and is waiting for approval. 6.3 ECSA (East, Central and Southern Africa) the lead partner for regional ECSA project, received approval for the work plan on April 8 th. East, Central and Southern Africa Health community (ECSA HC) is a regional inter-governmental organization established to promote and encourage efficiency and relevance in the provision of health services in the region. Currently, ECSA is made up of 10 active Member States namely Kenya, Lesotho, Malawi, Mauritius, Seychelles, Swaziland, United Republic of Tanzania, Uganda, Zambia and Zimbabwe. 18