Senegal Work Plan - ENVISION · IEF Inspection de Formation et de l’Education ... PGIRE Projet de Gestion Intégrée des Ressources en Eau et de Développement des Usages Multiples

Senegal Work Plan FY 2018 Project Year 7 October 2017–September 2018

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 U.S. Agency for International Development or the U.S. Government.

ENVISION FY18 PY7 Senegal Work Plan ii

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, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at global and country levels, and support ministries of health (MOHs) to achieve their NTD control and elimination goals.

At the global level, ENVISION—in close coordination and collaboration with WHO, USAID, and other stakeholders—supports NTD control and elimination goals through several technical contributions:

• 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

• NTD monitoring and evaluation (M&E) At the country level, ENVISION supports national NTD programs through 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 (DSAs) and surveillance

In Senegal, ENVISION project activities are implemented by RTI International.

ENVISION FY18 PY7 Senegal Work Plan iii

TABLE OF CONTENTS

ENVISION Project Overview .......................................................................................................................... ii

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

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

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

b) Support for Neglected Tropical Disease (NTD) Control from the US Government ...................... 1

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

a) Lymphatic Filariasis ....................................................................................................................... 2

b) Trachoma ...................................................................................................................................... 3

c) Onchocerciasis .............................................................................................................................. 4

d) Schistosomiasis ............................................................................................................................. 6

e) Soil-Transmitted Helminths .......................................................................................................... 6

3) Snapshot of NTD Status in Senegal ................................................................................................... 8

PLANNED ACTIVITIES ..................................................................................................................................... 9

1) NTD Program Capacity Strengthening .............................................................................................. 9

a) Strategic Capacity Strengthening Approach ................................................................................. 9

b) Capacity Strengthening Objectives and Interventions ............................................................... 10

c) Monitoring Capacity Strengthening ............................................................................................ 11

2) Project Assistance ........................................................................................................................... 13

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

b) Advocacy for Sustainability of the National PC-NTD Program .................................................... 13

c) MDA Coverage ............................................................................................................................ 14

d) Social Mobilization in Support of MDA ....................................................................................... 16

e) Training ....................................................................................................................................... 22

f) Drug and Commodity Supply Management and Procurement .................................................. 22

g) Supervision for MDA ................................................................................................................... 23

h) M&E ............................................................................................................................................ 23

i) Supervision for M&E and DSAs ................................................................................................... 26

j) Dossier Development .................................................................................................................. 26

3) Maps................................................................................................................................................ 27

APPENDIX 1: Work Plan Timeline................................................................................................................ 31

APPENDIX 2. Table of USAID-supported Regions and Districts in FY18 ...................................................... 34

ENVISION FY18 PY7 Senegal Work Plan iv

TABLE OF TABLES

Table 1: Snapshot of the expected status of the Senegal NTD program as of Sept. 30, 2017 ..................... 8

Table 2: Project assistance for capacity strengthening ........................................................................ 12

Table 3: USAID-supported districts and estimated target populations for MDA in FY18 .................... 15

Table 4: Social mobilization/communication activities and materials ................................................. 19

Table 5: Planned disease-specific assessments for FY18 by disease .................................................... 25

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ACRONYMS LIST

AE Adverse Event AFRO Africa Regional Office (WHO) ALB Albendazole BCC Behavior Change Communication BREIPS Bureaux Régionaux de l’Éducation et de l’Information pour la Santé (Regional Offices for

Health Education and Information) CAEL Cellule d’Appui aux Elus Locaux (Support Unit for Local Elected Officials) CBO Community-Based Organization CDD Community Drug Distributor CDTI Community-Directed Treatment with Ivermectin CM Case Management CODEC Collectifs des Directeurs d’École (School Principals’ Group) DBS Dried Blood Spot DCMS Division du Contrôle Médical Scolaire (School Health Control Division) (MEN) DLM Direction de la Lutte contre la Maladie (Disease Control Directorate) (MSAS) DQA Data Quality Assessment DSA Disease-Specific Assessment DSRSE Direction de la Santé de la Reproduction et de la Survie de l’Enfant (Reproductive Health

and Child Survival Directorate) (MSAS) ECD Équipe Cadre de District (Health District Management Team) ECR Équipe Cadre de Région (Health Region Management Team) ELISA Enzyme-Linked Immunosorbent Assay EPIRF Epidemiological Data Reporting Form (WHO) EU Evaluation Unit FTS Filariasis Test Strip FY Fiscal Year GTMP Global Trachoma Mapping Project HQ Headquarters IA Inspection d’Académie (Schools Inspectorate) ICP Infirmier Chef de Poste (Health Post Head Nurse) ICT Card Immunochromatographic Test Card IE Inspection de l’Éducation (Education Inspectorate) IEC Information, Education, and Communication IEF Inspection de Formation et de l’Education (Training and Education Inspectorate) IME Inspection Médicale des Étudiants (Medical Inspectorate of Students) IR Intermediate Result ITI International Trachoma Initiative IVM Ivermectin JAP Joint Application Package (WHO) JRF Joint Reporting Form (WHO) JRSM Joint Request for Selected PC Medicines (WHO) LF Lymphatic Filariasis LLIN Long-Lasting Insecticide-Treated Bed Net M&E Monitoring and Evaluation MCD Médecin-Chef de District (Health District Head Doctor)

ENVISION FY18 PY7 Senegal Work Plan vi

MCR Médecin-Chef de Région (Health Region Head Doctor) MDA Mass Drug Administration MEB Mebendazole MEN Ministère de l’Education National (Ministry of National Education) Mf Microfilaremia MSAS Ministère de la Santè et de l’Action Sociale (Ministry of Health and Social Work) NGO Nongovernmental Organization NTD Neglected Tropical Disease OCP Onchocerciasis Control Program (WHO) OMVS Organisation pour la Mise en Valeur du Fleuve Sénégal (Senegal River Development

Organization) OV Onchocerciasis PC Preventive Chemotherapy PCV U.S. Peace Corps Volunteer PGIRE Projet de Gestion Intégrée des Ressources en Eau et de Développement des Usages

Multiples du Bassin du Fleuve Sénégal (Integrated Water Resource Management Project) (OMVS)

PLMTN Programme de Lutte contre les Maladies Tropicales Négligées (Neglected Tropical Disease Control Program)

PNA Pharmacie Nationale d’Approvisionnement (National Supply Pharmacy) PNEFL Programme National d’Élimination de la Filariose Lymphatique (National Lymphatic

Filariasis Elimination Program) PNLBG Programme National de Lutte contre la Bilharziose et les Géohelminthiases (National

Bilharzia and Soil-Transmitted Helminths Control Program) PNLO Programme National de Lutte contre l’Onchocercose (National Onchocerciasis Control

Program) PNLP Programme National de Lutte contre le Paludisme (National Malaria Control Program) PNPSO Programme National de Promotion de la Santé Oculaire (National Eye Health Promotion

Program) PNT Programme National de Lutte contre la Tuberculose (National Tuberculosis Control

Program) PPS Probability Proportional to Size (sampling) PRA Pharmacie Régionale d’Approvisionnement (Regional Supply Pharmacy) PSSC II Programme Santé–Santé Communautaire II (Health Program-Community Health

component II) (USAID) PTA Plan de Travail Annuel (Annual Work Plan) (MSAS) PZQ Praziquantel Q Quarter RM Région Médicale (Medical Region) RPA Resident Program Advisor (RTI) RPRG Regional Program Review Group (WHO/AFRO) SAC School-Aged Children SAE Serious Adverse Event SAFE Surgery-Antibiotics-Facial Cleanliness-Environmental Improvement SCH Schistosomiasis SMART Specific-Measurable-Achievable-Relevant-Time-Bound SNEIPS Service National de l’Education et de l’Information pour la Santé (National Health

Education and Information Service) (MSAS)

ENVISION FY18 PY7 Senegal Work Plan vii

STAG Strategic and Technical Advisory Group STH Soil-Transmitted Helminths TA Technical Assistance TAS Transmission Assessment Survey TEMF Trachoma Elimination Monitoring Form (WHO) TEO Tetracycline Eye Ointment TF Trachomatous Inflammation—Follicular TIPAC Tool for Integrated Planning and Costing TIS Trachoma Impact Survey TSS Trachoma Surveillance Survey TT Trachomatous Trichiasis USAID U.S. Agency for International Development VAD Visite à Domicile (Home Visit) WHO World Health Organization ZTH Zithromax®

ENVISION FY18 PY7 Senegal Work Plan 1

COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Senegal has parallel structures for its administration and local communities (collectivités locales). The administrative structure includes 14 regions, 45 departments (départements), and 123 municipal districts (arrondissements). The local community structure includes the same 14 regions, with 114 municipalities (communes), 46 joint municipalities (communes d’arrondissements), and 370 rural communities. The presiding authority at each level of the administrative structure (governor, prefect, and sub-prefect) is appointed by the President of the Republic, whereas the presiding authority at each level of the local community structure (president of the regional council, mayor, and rural president) is an elected official.

The structure of Senegal’s health sector consists of 14 medical regions (régions médicales [RMs]), which are the same as the administrative and local community regions; 76 health districts; 40 hospitals; and approximately 1,257 health posts. These levels are presided over by the health region head doctor (Médecin-Chef de Région [MCR]), health district head doctor (Médecin-Chef de District [MCD]), and health post head nurse (Infirmier Chef de Poste [ICP]).

The school system includes approximately 8,198 primary schools. Senegal’s school health policy is the responsibility of the Ministry of National Education (Ministère de l’Education National [MEN])’s School Health Control Division (Division du Contrôle Médical Scolaire [DCMS]), whose overall objective is to monitor the health of the school community. The DCMS’s key activities include preventive health; regular visits to schools; immunization campaigns; medical monitoring of sports, sporting, and physical education (education physique et sportive); and transfers to hospitals and specialized services. The DCMS is represented in each region by a Medical Inspectorate of Students (Inspection Médicale des Étudiants [IME]), which conducts health inspections in schools. The DCMS manages relations between the MEN central administration and the IMEs, including coordinating activities and providing resources.

b) Support for Neglected Tropical Disease (NTD) Control from the US Government

In fiscal year 2018 (FY18), the U.S. Agency for International Development (USAID) will support the Ministry of Health and Social Work (Ministère de la Santè et de l’Action Sociale [MSAS])’s national NTD program through the ENVISION project, led by RTI International.

ENVISION supports disease mapping and surveys, mass drug administration (MDA) for all preventive chemotherapy (PC) NTDs, social mobilization, technical training, advocacy, and monitoring and evaluation (M&E) and procures required drugs (including tetracycline eye ointment [TEO] for trachoma MDA, mapping, and surveys) and diagnostic tools. Support for surveys, training, and trachoma MDA may be provided anywhere in the country. In FY16 and FY17, support for MDA for lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), and/or soil-transmitted helminths (STH) was limited to nine regions (Dakar, Diourbel, Fatick, Kaffrine, Kaolack, Kolda, Sédhiou, Thiès, and Ziguinchor) plus three districts of Louga Region (Coki, Darou Mousty, and Kébémer), amounting to 52 districts in all. In FY18, 42 of these districts will require MDA; ENVISION plans to support MDA in 30 of these (those where LF MDA is required). It is expected that the other 12 districts will constitute a gap in coverage.

U.S. Peace Corps volunteers (PCVs) collaborated with RTI in FY16 and FY17 on social mobilization for and supervision of the integrated MDA campaign in four ENVISION-supported regions (Fatick, Kaffrine,


Kolda, and Thiès) where PCVs are also located, in close coordination with RTI’s Dakar-based staff and Regional Focal Points. Before the campaign, the ICPs oriented the PCVs on PC-NTDs and MDA. In FY18, RTI will strive to involve the PCVs earlier in preparations for the campaign—potentially including the district- and regional-level planning meetings, as feasible and appropriate. RTI’s Regional Focal Points will be in more frequent contact with the PCVs, potentially coordinating with the MSAS RMs in assigning greater responsibility to the PCVs, which could include reviewing the MDA coverage compilation forms and participating in activities such as data quality assessment (DQA) (also as feasible and appropriate).

2) National NTD Program Overview

The MSAS DLM oversees most NTD activities in Senegal. The DLM supervises the Communicable Diseases Division, which includes the national PC-NTD programs—the National Lymphatic Filariasis Elimination Program (Programme National d’Élimination de la Filariose Lymphatique [PNEFL]); the National Onchocerciasis Control Program (Programme National de Lutte contre l’Onchocercose [PNLO]); the National Bilharzia and Soil-Transmitted Helminths Control Program (Programme National de Lutte contre la Bilharziose et les Géohelminthiases [PNLBG]); and the PNPSO, which is responsible for trachoma—along with the Case Management (CM)-NTD programs.

The Reproductive Health and Child Survival Directorate (Direction de la Santé de la Reproduction et de la Survie de l’Enfant [DSRSE]) oversees the treatment of pre-school-age children (defined as 1 to 4-year olds) for STH (deworming), which is conducted using albendazole (ALB).

The MSAS has a Master Plan for Integrated NTD Control, 2016-2020 (launched in September 2016), which establishes the national strategy for control and elimination of PC- and CM-NTDs for that period.

The MSAS first integrated its MDA for LF, OV, SCH, and STH in 2012 in Tambacounda Region, following the World Health Organization’s (WHO’s) recommendation and with funding through USAID’s Health Program-Community Health Project (Programme Santé–Santé Communautaire II [PSSC II]). In the other OV-endemic regions—Kédougou and Kolda—OV treatment was first integrated with MDA for the other NTDs (including LF) in 2013. The integration of LF MDA with SCH and STH MDA reached national scale in 2015 with the launch of LF MDA in the other nine LF-endemic regions (Diourbel, Fatick, Kaffrine, Kaolack, Kédougou, Louga, Saint Louis, Thiès, and Ziguinchor). The MSAS conducts its MDA for trachoma using Zithromax® (ZTH) and TEO a minimum of one week after MDA with praziquantel (PZQ).

a) Lymphatic Filariasis

Senegal’s goal is to eliminate LF as a public health problem by 2020. PNEFL goals include implementing MDA in all endemic districts with ≥65% epidemiological coverage, surgical CM of ≥25% of identified hydrocele cases in endemic zones each year, community CM of ≥75% of identified lymphedema cases with the support of health services, and monitoring the impact of MDA via sentinel sites.

PNEFL strategies reflect the WHO Global Program to Eliminate Lymphatic Filariasis, and incorporate periodic WHO recommendations, such as those of the NTD Strategic and Technical Advisory Group (STAG) M&E Subgroup on Disease-Specific Indicators (August 2014) and the NTD-STAG Global Working Group Meeting on M&E of PC (February 2015). Senegal’s strategies include annual MDA using ivermectin (IVM) and ALB in endemic districts, collecting data on morbidity cases (including hydrocele and lymphedema) during MDA campaigns, community CM of lymphedema, and vector control in cooperation with the National Malaria Control Program (Programme National de Lutte contre le Paludisme [PNLP]) through the distribution of LLINs and other means (indoor residual spraying and


control of peri-domestic larval nests). Conducting hydrocele surgery campaigns is also part of the strategy.

LF has been fully mapped in Senegal using immunochromatographic test cards (ICT cards). Mapping was conducted as funding became available: 14 districts were mapped in 2003, 6 districts in 2007, 27 districts in 2010, and the final 6 districts in 2012. A total of 50 districts are LF-endemic across 12 of the country’s 14 regions (all regions except for Dakar and Matam).

The MSAS collected baseline data (microfilaremia [Mf]) at sentinel sites before initiating LF MDA. These included sites in each of the seven districts of Tambacounda Region in 2007, where baseline data were collected; sites in two districts of Kolda Region and one district of Sédhiou Region in 2012; and sites in one district each in Diourbel, Fatick (also considered to represent Kaolack), Kaffrine, Kédougou, Louga (also considered to represent Saint Louis), Thiès, and Ziguinchor Regions in 2014.

LF MDA began in the seven districts of Tambacounda Region in 2007, and was extended to Kolda and Sédhiou Regions (three districts each) in 2013. In 2015, all 50 LF-endemic districts were treated, with 37 receiving treatment for the first time. As of August 2017, no support is available for LF MDA in Kédougou and Tambacounda Regions (in 2017) or for Kédougou, Louga, Saint Louis, and Tambacounda Regions (in 2018).

Three districts of Sédhiou Region will conduct a pre-transmission assessment survey (TAS) in FY18 Quarter (Q)1, followed by a TAS1 if the findings are favorable and if the TAS is approved by the WHO Africa Regional Office (AFRO) Regional Program Review Group (RPRG).

The second prong required for disease elimination—managing morbidity and preventing disability—has received little attention. WHO recommends access to basic care for every person with acute dermatolymphangioadenitis, lymphedema, and hydrocele in all LF-endemic areas. With RTI’s encouragement, over the course of USAID-supported integrated MDA in LF-endemic districts in FY15 (all 50 endemic districts) and FY16 and FY17 (the 33 endemic districts supported by ENVISION in these two years), the DLM developed a list of persons with LF morbidity by appending to the MDA tally sheets a table containing a line-listing of hydrocele and lymphedema cases. In addition, the DLM (via the health districts) has asked drug distributors to refer persons with LF morbidity to the closest health post, where they are then referred to the health district and then on to the RM, which is responsible for organizing CM services (at present, CM consists of hydrocele surgery).

b) Trachoma

Senegal’s goal is to eliminate blinding trachoma by 2020. The MSAS subscribes to the SAFE strategy. During MDA, ZTH is distributed; TEO is provided to pregnant women and children under six months, as per the national strategy. Survey participants who are found to have active trachoma (trachomatous inflammation—follicular [TF]) receive TEO for curative treatment. Since 2015, the PNPSO has followed the recommendations of the WHO NTD-STAG for an additional round of MDA, followed by a second impact survey in districts that register 5%‒9.9% in impact surveys. Since the April 2015 release of the International Trachoma Initiative (ITI) Diagram on Decision Making for Antibiotic Treatment of Trachoma, version 9, the PNPSO has based its decisions on whether and when to conduct trachoma MDA and surveys on a combination of that diagram and local knowledge of each district’s characteristics.

Trachoma mapping has been performed through clinical grading using the WHO simplified grading system and standard protocol. Mapping started in 2000, and the last 17 suspected-endemic districts were mapped in 2014 following the Global Trachoma Mapping Project (GTMP) protocol. Trachoma


impact surveys (TISs) in 2014 and 2015 also followed the GTMP protocol. Since the beginning of 2016, all surveys (including trachoma surveillance surveys [TSSs] and remapping) are being conducted using the Tropical Data system. As of June 2017, a total of eight districts remain endemic, defined as ≥5% TF.

As of the same date, TISs conducted with support from ENVISION using the GTMP or Tropical Data systems have confirmed that a total of 20 districts that formerly had ≥5% TF now have <5% TF. This includes 15 districts that have conducted MDA and were able to stop MDA, and five districts that registered 5%–9.9% TF at baseline in 2013 or earlier and never conducted MDA. Among these, one district has conducted TSS following the same approach, showing that TF remained <5% two years after the TIS.

From July–September 2017 two districts—Saint Louis in Saint Louis Region and Touba in Diourbel Region—are targeted for MDA with ENVISION support, each for a single round only. Additionally, five districts (all of which registered 5%–9.9% TF at baseline in 2013 or earlier and have never conducted MDA or a follow-up survey) will conduct their first TIS. A sixth district, with the same profile, will be programmed for FY18.

Reducing the prevalence of trachomatous trichiasis (TT) to less than 1 per 1,000 among the total population (below 0.2% among persons aged 15 years and older) is the other key criterion for elimination. As of June 2017, a total of 45 districts (many of which did not require MDA) had trichiasis prevalence of ≥0.2% among adults, meaning that surgical interventions are required. Of these districts, 33 are located within the six regions that have been supported by Sightsavers for trichiasis surgery in the past; the other 12 districts (across four regions) have not been supported.

In FY17, RTI has assisted the PNPSO to begin collecting and compiling information and data required for validation of the elimination of trachoma as a public health problem. This will help to ensure that the MSAS is ready by the time it reaches the point of stopping MDA, and then confirming that TF remains below 5% and that surgery targets are met in all targeted districts.

c) Onchocerciasis

Senegal’s goal is to eliminate OV in all endemic communities. The specific objectives of the PNLO include implementing annual MDA with IVM with programmatic coverage of ≥80% in all OV-endemic villages, monitoring MDA impact via annual epidemiological evaluations in the network of village sentinel sites, and achieving early detection of transmission risk via annual entomological evaluation at capture points.

OV was mapped in the southeast and south of Senegal in 1987 as part of the western extension of the Onchocerciasis Control Program (OCP) to Guinea, Guinea-Bissau, the western part of Mali, Senegal, and Sierra Leone. The severity of disease, as determined by the estimated prevalence of OV, in the three Senegal-related zones was as follows:

1. Falémé and Gambie River Basins: the northern part had low or no risk, and the southern part had medium risk. This zone includes the eight current districts that are considered endemic for the disease.

2. Tomine and Geba River Basins: low or no risk.

3. Fouta Djalon: the west subzone (westerly bound rivers) had low or no risk of onchocercal blindness, while the others had medium risk.

The PNLO control strategy is annual MDA with IVM in endemic zones, which exist in three districts of Kédougou Region, one district of Kolda Region, and four districts of Tambacounda Region. The Falémé River Basin runs through the OV-endemic districts of Kédougou and Tambacounda Regions, and the


Gambie River Basin runs through the OV-endemic districts of Kédougou, Kolda, and Tambacounda Regions; these two river basins are considered the OV foci (or transmission zones).

The PNLO conducted IVM treatment via health worker-led community-based treatment with IVM (1988–1996) or the more-grassroots community-directed treatment with IVM (CDTI, 1996–2005) in all known endemic foci. CDTI was conducted using MSAS and local communities’ own resources to motivate CDDs. Beginning in 2012 in Tambacounda Region and in 2013 in Kédougou and Kolda Regions, the MSAS shifted to an MDA model, integrating the treatment for OV with MDA for LF, which is also endemic. Thus, IVM (along with ALB) is administered in the entire district rather than in OV-endemic foci alone, and over a time period set by the national NTD program rather than individually by local communities.

The MSAS conducted epidemiological assessments of the impact of IVM treatment on OV in 1996, 1999, 2000, 2001, 2002, 2003, 2006, and 2007. These assessments covered approximately 620 villages across eight districts, three regions, and two river basins (Falémé and Gambie); 73 sentinel villages were established, and a selection of these was visited during each assessment. During these visits, the entire population aged more than one year were assessed using the skin snip method with microscopy. The assessments found that the OV prevalence remained low, with most infections identified among people aged ≥15 years and beginning several years prior. The researchers did, however, conclude that the continued presence of OV-infected persons constituted a possible avenue for OV resurgence.

During 2006‒2011, Senegal’s MSAS and Mali’s Ministry of Health and Public Hygiene conducted a longitudinal study to determine whether OV could be eliminated in the African context through IVM treatment alone. This study focused on three OV-hyperendemic foci—along the Gambia River in Senegal, the Falémé River on the border of Senegal and Mali, and the Bakoyé River in Mali—in which 15 to 17 years of annual or six-monthly treatments with IVM had been conducted. The study combined epidemiological methods and entomological methods. Treatment was stopped in the test areas of five to eight villages in each focus area and, subsequently, in the entire study area. Five years after the last treatment, all infection and transmission indicators were below the postulated thresholds for elimination. As the treatment stoppage was experimental, in Senegal, treatment was resumed in 2013.

In 2014–2015, the PNLO conducted a comprehensive OV impact survey involving both epidemiological (in 2014) and entomological (in 2014 and 2015) components in these three regions. In all three regions, the epidemiological component consisted of OV skin snips (ages ≥five years) analyzed by microscope and paired with dried blood spot (DBS)-based OV antibody tests using Ov16 antigens (ages ≥five years in Kédougou Region and ≥one year in Kolda and Tambacounda Regions), which were subjected to enzyme-linked immunosorbent assay (ELISA).

The entomological assessments identified no blackflies positive for the O. volvulus parasite by testing with O-150 polymerase chain reaction (Poolscreen); these entomological findings suggest no ongoing transmission.

Senegal’s OV elimination expert committee held its first meeting in February 2017. Key outcomes include the recommendation that a national OV expert committee be established officially and that the country’s OV transmission zones be identified. The committee recommended that the eight OV-endemic districts, all of which are co-endemic for LF, continue MDA for both diseases through 2019 or later, depending on the district.


d) Schistosomiasis

Senegal’s goal is to treat at least 80% of school-aged children (SAC) and groups at risk for SCH by 2020. Specific objectives of the PNLBG include implementing MDA with ≥80% program coverage in all SCH-endemic districts and determining the impact of interventions via regular evaluations of sentinel sites. The last districts were mapped for SCH in 2013.

Strategies include ensuring the availability of PZQ in all health facilities in high- and moderate-risk areas for both routine treatment (for which patients are charged) and MDA, conducting MDA with PZQ for SAC and at-risk groups in high- and moderate-risk communities, performing case-by-case PZQ treatment of patients at the health facility level in low-risk zones, and promoting hygiene and sanitation in cooperation with other sectors.

MSAS baseline data showed that 60 districts are endemic for SCH (defined as prevalence ≥1%, determined by parasitological means), including 18 high-risk districts (≥50%), 29 moderate-risk districts (≥10% to <50%), and 12 low-risk districts (≥1% to <10%). Prevalence evaluation surveys conducted in later years have shown that certain districts have since changed their risk category or are no longer endemic.

In FY12‒FY15, USAID/Senegal supported all national integrated MDA, including PZQ for SCH, through the PSSC II project. In FY16 and FY17, USAID supported integrated MDA, including PZQ, through ENVISION in eight regions.

ENVISION supported SCH-STH prevalence evaluation surveys in 11 districts (representing a total of 24 districts, via ecological zones) in FY16 and eight districts in FY17 that had completed at least five rounds of SCH MDA. The sites were selected from among the sites that were previously surveyed in 2008, 2009, or 2010 (for FY16) or 1996, 2003, or 2012 (for FY17), choosing those with the highest prevalence of SCH (either Schistosoma mansoni or S. haematobium).

e) Soil-Transmitted Helminths

Senegal’s goal is to treat at least 80% of SAC (aged 5–14 years) for STH by 2020. Specific objectives of the PNLBG include implementing MDA with ≥80% program coverage in all endemic districts and determining the interventions’ impact via regular evaluations of sentinel sites. The last districts were mapped for STH in 2013.

Strategies include ensuring the permanent availability of mebendazole (MEB) or ALB in all of the country’s health facilities, performing MDA using MEB or ALB in schools and the community, providing case-by-case treatment of patients using MEB or ALB in health facilities, and promoting hygiene and sanitation in cooperation with other sectors. In practice, MDA for STH has been conducted using ALB since 2010.

MSAS baseline data showed that 4 districts were high risk (≥50%), that 7 districts were moderate risk (≥20% and <50%), and that 39 districts were low risk (<20%); among the low-risk districts, 23 had prevalences of 0%. For 26 districts, no baseline data are available. Per WHO guidance, high-risk areas should conduct MDA per year, moderate-risk areas should conduct MDA once per year, and low-risk areas should conduct case-by-case treatment only (no MDA). As noted below, prevalence evaluation surveys conducted in later years have shown that selected districts have since changed their risk category or are no longer endemic.


During FY12‒FY15, USAID/Senegal supported all of the country’s integrated MDA, including ALB for SCH, through the PSSC II project. In FY16 and FY17, USAID supported integrated MDA, including ALB, through ENVISION in nine regions plus three districts of Louga Region.

As noted above, ENVISION supported SCH-STH prevalence evaluation surveys in 11 districts in FY16 and in 8 districts in FY17 that had completed at least five rounds of SCH MDA.


3) Snapshot of NTD Status in Senegal

Table 1: Snapshot of the expected status of the Senegal NTD program as of Sept. 30, 2017

Columns C+D+E=B for each disease* Columns F+G+H=C for each disease*

MAPPING GAP DETERMINATION MDA GAP DETERMINATION1 MDA

ACHIEVEMENT MAPPING GAP

DETERMINATION

A B C D E F G H I

Disease Total No.

of Districts in Senegal

No. of districts classified as

endemic (initial

mapping)

No. of districts classified as

non-endemic (initial

mapping)

No. of districts in

need of

initial mapping

No. of districts receiving MDA as of 09/30/17

No. of districts expected to be in

need of MDA at any level: MDA not yet

started, or has prematurely stopped

as of 09/30/17

Expected No. of districts where

criteria for stopping district-level MDA have been met as of

09/30/17

No. of districts requiring DSA as of 09/30/17 USAID-

Funded Others

Lymphatic Filariasis

76

50 26 0 33 0 17 0 Pre-TAS: 3 TAS1: 32

Onchocerciasis

8 68 0 1 0 7 0 0

Schistosomiasis

563 20 0 264 0 285 2 SCH prevalence evaluation survey:

3

Soil-transmitted helminths

116 39 07 118 0 199 12 STH prevalence evaluation survey:

6

Trachoma 2710 68 0 0 0 0 19 TIS: 3

TSS: 12

1 This MDA gap determination applies to the FY17 period, ending September 30, 2017. It is anticipated that districts targeted for MDA and partners’ geographic support for MDA will both be changing as of October 1, 2017, so in many cases the numbers of districts listed in Columns F and G will no longer apply. 2 These numbers refer to the same three districts; TAS1 will be contingent on the results of the pre-TAS and review by WHO AFRO’s RPRG. 3 Endemicity defined as prevalence ≥1% determined by parasitological means. 4 This total includes 12 districts that conducted SCH MDA in FY17 but are expected to be without support starting in October 2017. SCH MDA is not necessarily required every year. 5 Includes 24 districts formerly-supported by Senegal River Development Organization (OMVS)-Integrated Water Resource Management Project (PGIRE), plus four districts that conducted MDA with ENVISION support in FY16 and/or FY17, but will no longer be supported starting in FY18. 6 Endemicity defined as prevalence ≥20% determined by parasitological means. 7 Baseline mapping results are not available for 26 districts. This does not constitute a gap, however, given that baseline mapping is no longer possible in those districts as all of them have since conducted MDA. 8 The number of districts on a treatment cycle as of FY17. STH MDA is not necessarily required every year. 9 Includes 14 districts formerly-supported by OMVS-PGIRE, plus districts that conducted MDA with ENVISION support in FY16 and/or FY17, but will no longer be supported starting in FY18. 10 Endemicity defined as prevalence ≥5% TF among one–nine year olds.


PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

Capacity goals

ENVISION’s high-level goals in support of the PLMTN’s capacity are represented by selected intermediate results (IRs) drawn from the project’s results framework,11 namely:

1. The country has a plan of action that outlines surveillance strategies for LF, OV, and trachoma and appropriate, evidence-based strategies for SCH and STH control (IR 3).

2. The MSAS reports on MDA results (through data validation meetings and/or a written report), identifying districts with low coverage and analyzing the cause(s) (IR 2).

3. The country utilizes the integrated NTD database to generate the Joint Reporting Form (JRF) and/or Trachoma Elimination Monitoring Form (TEMF) and submits the Joint Application Package (JAP) or TEMF on time (IR 2).

4. The country has information readily available on funding resources and gaps (IR 3).

Capacity strengthening strategy

RTI will contribute to building the operating capacity and skills of DLM NTD staff by continuing to participate in the DLM’s NTD meetings, as invited and appropriate. RTI’s participation in these meetings constitutes an opportunity to communicate regularly with the DLM’s NTD personnel.

RTI works closely with central-level MSAS NTD personnel to help them to develop the PLMTN’s long-term strategies and shorter-term activities. ENVISION also serves as a technical resource for a range of WHO and WHO-recommended tools used by the MSAS (e.g., the Integrated NTD Database, the Tool for Integrated Planning and Costing [TIPAC], and DQA).

RTI’s Regional Focal Points are embedded in the offices of the RMs outside of Dakar that ENVISION fully supports for integrated MDA; they have effectively become integral parts of their respective RM’s Health Region Management Team (Équipe Cadre de Région [ECR]). This provides a local source of NTD technical expertise, advocacy, and encouragement.

Strengthening of capacities for planning, monitoring, and evaluation: RTI staff will assist the PLMTN/DLM staff as invited and appropriate, in cleaning and finalizing the DLM’s annual NTD work plan (PTA) for CY18, establishing an action plan with a timeline and a checklist.

In each of the PLMTN’s annual phases (planning, coordination, protocol development, implementation, and M&E), RTI will:

• Assign an RTI staff person to support and accompany the designated DLM staff person in identifying relevant documents (WHO guidelines, protocols, and forms), synthesizing technical guidance for colleagues and developing a plan and timeline for specific technical activities. RTI will help to ensure that the PLMTN/DLM team receives copies of all key WHO guidelines, protocols, and recommendations;


• Collaborate with the PLMTN/DLM team to help ensure the aforementioned documents are understood by providing individual or group orientations on particular topics within those documents for members of this team.

In the supported RMs and health districts, the ENVISION Regional Focal Points will use the quarterly meetings of the ECRs and the monthly meetings of each Health District Management Team (Équipe Cadre de District [ECD]) to raise issues related to PC-NTDs, ensuring that the MSAS teams and partners at these levels receive the latest technical information and guidance from the PLMTN. Before, during, and after the MDA campaigns, the ENVISION Regional Focal Points provide organizational and technical support to the RMs and health districts. Strengthening knowledge of WHO guidance and protocols: Through close contact with the PLMTN/DLM via regular communication and meetings, RTI and the PLMTN/DLM will jointly identify the PLMTN’s technical orientation needs (if any). RTI and the PLMTN/DLM will then jointly address these needs through one-on-one or group orientations. These sessions could potentially be incorporated into RTI’s regular one-on-one and group contacts with the PLMTN/DLM team. The PLMTN/DLM and RTI will jointly select the topics for orientation, and they will alternate in researching the topics and presenting to the group during the regularly scheduled plenary meetings.

Strengthening coordination with PC-NTD partners: As requested and appropriate, RTI will support the PLMTN in developing a list of all NTD partners and their areas of intervention to create a partner map and enable better coordination of NTD control activities. RTI will also provide organizational support to help the PLMTN/DLM hold a quarterly meeting with its NTD partners to ensure the coordination of activities and avoid duplication.

b) Capacity Strengthening Objectives and Interventions

Objective 1: Strengthen capacities for planning, monitoring, and evaluation

1. Accompany PLMTN/DLM staff in activity planning, protocol development, implementation, and M&E: As invited and appropriate, central-level RTI staff will closely accompany the PLMTN/DLM staff in:

a) Jointly cleaning and finalizing the DLM NTD PTA for CY18 and establishing an action plan with a timeline and a checklist.

b) In each of the PLMTN annual program phases (planning, coordination, protocol development, implementation, and M&E), RTI will:

i) Assign a staff person to support and accompany the PLMTN/DLM in identifying relevant documents (WHO guidelines, protocols, and forms), synthesizing this technical guidance for colleagues, and developing a plan and timeline for the activity;

ii) Help to ensure that the PLMTN/DLM team receives copies of all key WHO guidelines, protocols, and recommendations (see intervention 3, below); and

iii) To make sure that the aforementioned documents are understood, collaborate with the PLMTN/DLM team to provide individual or group orientations on particular topics within those documents for members of that team.

2. Accompany the MSAS’s RM and health district staff in activity planning, implementation, and M&E: As invited and appropriate, in the 7 RMs and 30 health districts supported by ENVISION for MDA, RTI’s Regional Focal Points will:


a) Use the quarterly meetings of the ECRs and the monthly meetings of the ECDs to raise issues related to PC-NTDs, ensuring that the MSAS teams and partners at these levels receive the latest technical information and guidance from the PLMTN/DLM; and

b) Provide organizational and technical support to the RMs and health districts before, during, and after the MDA campaigns.

3. Provide copies of WHO reference documents related to PC-NTD control: RTI ENVISION will financially support the ordering, printing, and/or photocopying of key WHO (and other) PC-NTD reference documents and will share these with the PLMTN/DLM team during each knowledge-strengthening session.

Objective 2: Support the PLMTN/DLM’s coordination with PC-NTD partners

1. Support the PLMTN/DLM in developing a list of all PC-NTD partners and their areas of intervention to create a partner map and enable better coordination of PC-NTD control activities.

2. Provide technical and financial support to support the PLMTN/DLM to hold its regular quarterly NTD coordination meetings with its partners. Activity listed under Strategic Planning.

c) Monitoring Capacity Strengthening

Assessing progress

RTI will monitor capacity strengthening during meetings with the PLMTN/DLM. RTI will assist the PLMTN/DLM in developing a timeline listing all PC-NTD-related coordination meetings. RTI will financially and technically support the PLMTN/DLM to hold these meetings as scheduled and will help the PLMTN/DLM track the participation of PC-NTD partners in these meetings. RTI will also assist the PLMTN/DLM to develop specific-measurable-achievable-relevant-time-bound (SMART)-type recommendations at the end of each coordination meeting. .

Objective 1: Strengthen capacities for planning, monitoring, and evaluation

Indicators:

• Number of MSAS M&E tools finalized, including the NTD Master Plan and NTD M&E Plan

Objective 2: Strengthen coordination with PC-NTD partners

Indicators:

• Number of quarterly meetings organized by the PLMTN/DLM with its NTD partners to ensure the coordination of activities

• PLMTN/DLM has an up-to-date list of of all NTD partners and their areas of intervention, with which it can create a partner map and better coordinate NTD control activities


Table 2: Project assistance for capacity strengthening

Project assistance area

Capacity strengthening interventions/activities (as invited and appropriate)

a. Strategic Planning

• Jointly clean and finalize the DLM NTD PTA for 2018 and establish an action plan with a timeline and a checklist

• Assign RTI staff to assist the PLMTN/DLM in synthesizing technical guidance and developing a plan and timeline for each technical activity

• Use the MSAS quarterly NTD coordination meetings to share information, guidance, and tools related to PC-NTDs

• Use the quarterly ECR meetings and monthly ECD meetings to raise issues related to PC-NTDs

c. Building Advocacy for a Sustainable National NTD Program

Strengthen coordination with PC-NTD partners Ensure involvement in and/or support for PC-NTD control activities of:

• Local elected officials

• Solidarity or corporate social responsibility arms of major companies

d. MDA Coverage

The coverage monitoring template enables the central-, regional-, and district-level MSAS to know the daily status of coverage during the MDA campaign in ENVISION-supported areas. RTI has helped the MSAS to finalize this template by correcting formulae and population data and building the capacity of the central, regional, and district levels to fill in the template

e. Social Mobilization to Enable NTD Program Activities

Organize an orientation/refresher session on NTDs for BREIPS personnel and MSAS NTD Focal Points

f. Training (See Training section)

g. Drug Supply and Commodity Management and Procurement

Joint, quarterly updates of the TIPAC involving the DLM’s pharmacist

h. Supervision for MDA

Review the approach to MDA supervision, stressing the need for data quality control

i. Dossier Development

Review the LF and trachoma elimination dossier templates with the PLMTN/DLM and assert the importance of having quality data as the timeline for elimination approaches


2) Project Assistance

a) Strategic Planning

RTI aims to support the MSAS in incorporating available data from USAID’s M&E Workbooks, the Integrated NTD Database, the TIPAC, and supported surveys into the activities described below to inform programmatic decisions and planning.

Funding of and participation in the MSAS quarterly NTD coordination meetings: RTI will fund and participate in this quarterly meeting run by the PLMTN/DLM. This meeting is held to monitor the progress of planned activities, discuss challenges, share information related to NTDs, and avoid duplication between partners.

Participation by RTI and PLMTN/DLM staff in the quarterly coordination meetings of eight RMs: The RMs conduct general quarterly coordination meetings, covering all health topics under their purview. ENVISION will fund the participation of one PLMTN/DLM staff member and one RTI/Dakar staff member in one quarterly coordination meeting in each of the seven RMs supported by ENVISION for integrated MDA. (RTI’s Regional Focal Points, who are present full-time, will participate in such meetings every quarter.) In Sédhiou Region, where no MDA is scheduled but several surveys will be supported (i.e., pre-TAS, TAS1, and STH prevalence evaluation survey), one PLMTN/DLM staff member and one RTI/Dakar staff member will participate in two of the RM’s quarterly coordination meetings.

Participation in the monthly coordination meetings of 30 health districts: Within each of the 30 health districts supported by ENVISION for MDA, RTI’s local Regional Focal Point will attend at least two of the monthly health district meetings organized by the health district ECDs over the course of the 12-month FY. These health district meetings cover all health topics under the district’s purview and constitute an opportunity to keep NTDs on the radar year-round.

Participation in NTD partner coordination meetings: RTI will continue to advocate for and schedule these meetings, which constitute an opportunity to discuss the activities implemented by each partner, identify opportunities for collaboration, and avoid duplication. As previously, the venue will continue to rotate, with a different partner hosting each month.

Updating and use of the TIPAC: The PLMTN/DLM will update the data in this tool on a monthly basis in 2018 through one-day work sessions with RTI. Highlights from the updated version will be shared in the DLM’s quarterly NTD coordination meetings.

Funding of and participation in workshop to develop the MSAS annual NTD work plan (2019): ENVISION will fund the DLM’s two-day annual workshop to develop a national PTA for NTDs in collaboration with its governmental and nongovernmental partners. Typically, participants separate into working groups, then present their work to the plenary. Partners commit to supporting specific activities within the overall PTA as they are able. The compiled document is then finalized, validated, and shared with all participants.

b) Advocacy for Sustainability of the National PC-NTD Program

Support development and distribution of MSAS’s semi-annual NTD newsletter: Printed materials are an effective way of reaching government personnel, and increasing the profile of the PLMTN within the MSAS and other ministries is critical to the program’s long-term success. In FY18, this activity will continue to be strongly supported by RTI, working closely with central-level MSAS personnel on a semi-annual basis.


Raise awareness of PC-NTDs among local elected officials: in their respective RMs, RTI’s Regional Focal Points together with the ECRs will schedule meetings with the Support Unit for Local Elected Officials (Cellule d’Appui aux Elus Locaux [CAEL]), which has influence with and access to elected officials (such as mayors and sub-prefects) who can be advocated to for public support and, potentially, resources. The CAELs write reports on activities and living conditions within their zones.

c) MDA Coverage

RTI ENVISION will technically and financially support the PLMTN/DLM, which will collaborate with the National Health Education and Information Service (SNEIPS) and DCMS, in organizing MDA in 30 districts across seven regions (Table 3). As in prior years, MDA for other diseases requiring treatment (OV, SCH, and STH) will be integrated with LF MDA. As of June 2017, it is anticipated that no trachoma MDA will be required in FY18 as Senegal will have reached the elimination targets for active trachoma (TF).

In the ENVISION-supported regions and districts, MDA is slated for March-May 2018 in Diourbel, Fatick, Kaffrine, Kaolack, Kolda, Thiès, and Ziguinichor Regions (30 districts targeted altogether) in March–May 2018, including the following:

MDA with IVM and ALB for LF and OV in 1 district;12

MDA with IVM, ALB, and PZQ for LF, SCH, and STH in 2 districts;13

MDA with IVM, ALB, and PZQ for LF and SCH in 10 districts;14

MDA with IVM and ALB for LF and STH in 4 districts;15 and

MDA with IVM and ALB for LF only in 13 districts.16

12 LF and OV (1): Vélingara District (Kolda Region). 13 LF, SCH, and STH (2): Dioffor (Fatick Region) and Joal-Fadhiouth (Thiès Region) Districts. 14 LF and SCH (10): Mbacké and Touba (Diourbel Region); Sokone (Fatick Region); Birkelane (Kaffrine Region); Guinguinéo and Kaolack (Kaolack Region); Popenguine and Tivaouane (Thiès Region); and Diouloulou and Ziguinchor (Ziguinchor Region) Districts. 15 LF and STH (4): Mbour, Pout, Thiadiaye, and Thiès Districts (Thiès Region). 16 LF only (13): Bambéye (Diourbel Region); Fatick, Gossas, and Niakhar (Fatick Region); Kaffrine, Koungheul, and Malem Hodar (Kaffrine Region); Kolda and Médina Yoro Foulah (Kolda Region); Khombole (Thiès Region); and Bignona, Oussouye, and Thionk Esyl (Ziguinchor Region) Districts.


Table 3: USAID-supported districts and estimated target populations for MDA in FY18

NTD Age groups

targeted

Number of rounds of distribution

annually

Distribution platform(s)

Number of districts to be treated

in FY18

Total # of eligible

people to be targeted in FY18

Lymphatic filariasis

Entire population aged ≥5 years

1

Door-to-door Fixed-point Schools and daaras (Koranic schools)

3017 5,266,324

Onchocerciasis Entire population aged ≥5 years in endemic villages

1

Door-to-door Fixed-point Schools and daaras

1 103,753

Schistosomiasis SAC 1 Schools and daaras

12 830,864


SAC 1 Schools and daaras

6 396,967

Trachoma Entire population 1

Door-to-door Fixed-point Treatment in schools and daaras

018 0

Produce MDA M&E tools for 30 districts: MDA data collection and compilation tools (tally sheets and synthesis sheets) will be printed and provided to the health districts, which will in turn distribute them to community distributors.

Fund and participate in orientation and MDA micro-planning workshops at the regional, district, health post, and community levels in seven RMs and 30 districts: In ENVISION-supported regions and districts, planning at the central level begins at least four months before the MDA campaign; at the regional level at least one month before the campaign; at the district level no later than two weeks before the campaign; at the health post level two–three days before the campaign; and at the community level one–two days before the campaign. Typically, the planning at each level takes place as part of a two-day workshop, consisting of a one-day orientation and refresher training on NTDs and the MDA campaign, and a one-day planning session.

These sessions will take place at each of the following levels:

• Region: orientation of the ECRs (30) and IAs (7);

• District: orientation of the ECDs (90) and IEFs’ (30) NTD Focal Points;

• Periphery: orientation of the ICPs and the school principals’ group (Collectifs des Directeurs d’École [CODEC]); and

17 The three districts of Sédhiou Region will conduct pre-TAS (and potentially TAS1) and are not scheduled to conduct LF MDA. 18 Treatment would be required in any districts that register TF of ≥5% in one to nine-year-olds in the TIS scheduled for the latter part of FY17 and the TIS and TSS planned for FY18.


• (refresher) Training of teachers from public schools and daaras and CDDs.

The PLMTN/DLM team will conduct orientations for each of the seven supported regions’ ECR, ECD, IA, and IEF personnel in their respective regional capitals. The regional-level personnel will constitute the pool of trainers for their region and will be responsible for orienting the ICPs and CODECs. Once the ICPs and CODECs are trained, they will, in turn, orient the teachers and CDDs (who are also responsible for raising awareness in the community).

The education sector plays a key role in MDA for the target population in the schools. The public school and daara teachers teach life-skills lessons on NTDs and MDA to strengthen their students’ knowledge, and in turn, the students serve as relays in their communities.

Support for implementation of MDA in 30 districts.

d) Social Mobilization in Support of MDA

ENVISION will continue its support for social mobilization in FY18 to encourage public adherence to the MDA campaign. The following activities, conducted by the NTD communication committee in 2017 with strong technical and organizational support from RTI will be carried forward into FY18:

• Involvement of the country’s senior-most public health authorities (e.g., the MSAS General Director of Health, the WHO/Senegal Representative, and university professors) in the launch of the MDA campaign;

• Informational visits to administrative authorities (e.g., regional governors, departmental prefects, and sub-prefects) and local elected officials (e.g., mayors and départment-level counsellors);

• Development and broadcasting of radio and TV news commercials related to PC-NTDs and the MDA campaign;

• Production of communications materials (shirts and hats) for those involved in field implementation;

• Production of posters on each of the five PC-NTDs and a cross-cutting poster on the complications of these NTDs;

• Development of banners;

• Taping and broadcasting of several advertorials (publireportages) on TV shows and stations with large viewership; and

• Taping and broadcasting of radio and TV shows on NTDs in the capital and supported regions and, in certain regions, in local languages (e.g., Peulh and Mandigue).

Participate in NTD communications committee: RTI will collaborate with other members of the NTD communications committee (the DLM and SNEIPS) in charge of information, education, and communication (IEC)/behavior change communication (BCC) for PC-NTDs in FY18. This committee will also collaborate with the Regional Offices for Health Education and Information (BREIPSs), which are extensions of the SNEIPS in the RMs. The committee will be responsible for the following:

• Developing an NTD communications plan for 2018 focused on MDA and other NTD control activities;


• Organizing an NTD information day for the SNEIPS’s “numéro vert” free public-health information phone line staff and BREIPS staff;

• Developing NTD-related event trailers for radio and TV regarding the MDA launch day and the dates of the MDA campaign;

• Developing and organizing the broadcasting of NTD-related commercials for radio and TV;

• Posting ads on Senegal’s most-visited website, Seneweb, each day during the month of the MDA campaign; and

• Producing and distributing IEC materials.

Production and delivery of IEC materials for 30 districts: These materials will include posters, banners, t-shirts, baseball-type caps, and collared t-shirts for the supervisors. These materials will be provided to the central level (MSAS, SNEIPS, and MEN) and the seven RMs that will be supported by ENVISION for integrated MDA. The materials will be transported to and distributed in those seven regions one month before the start of the MDA campaign.

Design and broadcasting of commercials and shows on radio and TV: RTI will sign contracts with national TV and radio stations that stipulate the number of commercials and shows to be broadcasted over a specific time-period. The RMs will sign contracts with local radio stations for the same purpose, with close supervision by RTI’s Regional Focal Points to ensure that the broadcasts take place as stipulated.

The commercials developed and broadcasted in 2017 will again be used in 2018, with minor revisions to incorporate feedback. Awareness-raising audio segments will be developed for use in health-focused radio shows. With support from RTI, the NTD communications committee will ensure the technical accuracy, appropriateness, and clarity of messages for the general population. Broadcasts will be aired at appropriate times to reach the target populations and via broadcasters with national coverage and high viewer- or listenership. The PLMTN/DLM and SNEIPS will moderate health-focused radio and TV shows to raise the public’s awareness of NTD control and inform them of the strategies used by the MSAS. TV broadcasts on the national stations are available to anyone who has access to TV anywhere in the country. The same is the case for the national radio stations.

The national broadcasts have wide reach but are not as linguistically diversified as more local broadcasts, which have their own viewer- and listenership. In the regions and districts where MDA will be conducted, there are community radio and TV stations that broadcast in local languages. The NTD communications committee will provide the finished communications products (e.g., radio and TV commercials and trailers) to the RM teams, which consist of the RM NTD Focal Points, BREIPSs, and RTI’s Regional Focal Points. These teams will be responsible for working with the local media to translate the commercials into local languages and collaborating with the health districts to sign contracts for broadcasting the commercials on community radio.

At all levels, airing of messages should begin well before the MDA campaigns start (at least one month before the national-level campaign, and at least 15 days before the regional and district campaigns).

Internet advertisements during the MDA campaign: RTI will sign a contract with Seneweb.com, Senegal’s most-visited website, to post ads about the MDA campaign each day during the month that the MDA campaign is supported by ENVISION (in CY18 only), in close coordination with the NTD Communication Committee. This will increase the visibility of the MDA campaign.

Organization of a national MDA launch day: RTI ENVISION will financially and organizationally support the PLMTN/DLM in organizing this activity two days before the start of the CY18 integrated MDA


campaign, with the participation of senior health and education authorities. In FY18, this activity will be organized outside of Dakar Region to better involve the public in rural areas, who are more exposed to NTDs (including LF, which is not endemic in Dakar Region).

The launch day strengthens the ownership of and commitment to the MDA campaign specifically and PC-NTD control more broadly by health personnel and partners. As in 2016 and 2017, the launch will be broadcasted on national TV to raise awareness and gain the adherence of the general public. The NTD Communication Committee will strive to recruit a senior MSAS representative to preside over the launch day.

Community mobilization strategy in 30 districts: This will consist of systematically involving influential community groups in the organization of PC-NTD control activities. The strategy will be focused on informing the public about MDA via the appropriate communications channels, messages, and use of IEC materials. The intent is to secure the targeted populations’ acceptance of and adherence to the MDA. This community mobilization will be conducted in the RMs and health districts and will be organized by the BREIPS supported by the RM NTD Focal Point and RTI’s Regional Focal Point. The following activities to mobilize influential groups will be organized starting between one month and 15 days before the start of the MDA:

• Community advocacy: This targets local and administrative authorities and community leaders, encouraging them to share information on the strategy and negotiating their active participation in the different phases of activity implementation. Advocacy will be led by the ECRs, ECDs, and ICPs.

• Information caravans: These will be organized within each zone of responsibility of the RM for more active, personal communication and to mobilize the public. The community relays supported by the ICPs will post posters in public meeting places and will conduct home visits (Visite à Domicile [VAD]) to inform community leaders and their families. Discussion topics will include the magnitude of NTDs in Senegal, preventive behaviors (face washing, draining of ponds, avoiding consumption of soil/dirt, using impregnated bed nets, and wearing shoes), diagnostics (what are the telltale symptoms), and the benefits of MDA against PC-NTDs.

• Partnership with schools and daaras: This will consist of using the teachers/Koranic teachers and students/talibés as potential relays to inform other students/talibés and community members about the MDA campaign. Educational and recreational activities will be organized as life lessons and/or skits.

• Partnership with sporting and cultural associations (association sportive et culturelle) and community-based organizations (CBOs): The actors will be integrated into the information caravans.


Table 4: Social mobilization/communication activities and materials

Key Message Target Population

IEC Activity Where/when will they be distributed

Frequency

La lutte contre les MTN une affaire de Tous (The fight against NTDs is everyone’s business).

General public

• T-shirts

• Collared t-shirts

• Banners

• Radio and TV commercials

• Awareness-raising caravan

• In districts supported by ENVISION for MDA

• Starting one month to 15 days before the start of MDA

Continuously throughout the MDA campaign period

Profitons du traitement de masse une opportunité de prévention et de traitement contre les MTN (Mass treatment is an opportunity for the prevention and treatment of NTDs).

General public

• T-shirts


• Awareness-raising caravan




La campagne de masse une opportunité de prévention et de traitement (The mass campaign is an opportunity for the prevention and treatment of NTDs). Above the message, there is the following phrase: Lutte contre les Schistosomiases (Fight against SCH).

General public


• VADs

• SCH poster




Profitons de cette campagne de masse pour prévenir la filariose lymphatique et ses complications (Let’s benefit

General public


• VADs

• LF poster







Frequency

from the mass campaign to avoid LF and its complications).

La campagne de masse offre une opportunité pour se déparasiter et rester en bonne santé (The mass campaign is an opportunity to deworm and stay in good health).

General public


• VADs

• STH poster




Le trachome est une maladie qui peut faire perdre la vue. Profitons de cette campagne de masse pour lutter contre cette maladie (Trachoma is a disease that can cause loss of sight; let’s benefit from this mass campaign to fight this disease).

General public


• VADs

• Trachoma poster




L’onchocercose est une maladie qui peut faire perdre la vue. La campagne de masse prévient cette complication (OV is a disease that can cause loss of sight. The mass campaign prevents this complication).

General public


• VADs

• OV poster







Frequency

La campagne de DMM contre les MTN permet d’éviter la survenue d’hydrocéle, de lymphoedéme, d’ascite, d’hématurie et de cécité (The MDA campaign against NTDs makes it possible to avoid the occurrence of hydrocele, lymphodema, ascites, hematuria, and blindness).

General public


• VADs

• PC-NTD complications poster




Les médicaments contre les MTN à CTP existent et sont distribués gratuitement lors des DMM (Drugs against PC-NTDs exist and are distributed free of charge during MDA).

General public

Radio and TV • By all contracted stations and networks

• Starting one month to 15 days before start of MDA

Three‒four airings or broadcasts per week until the end of the MDA campaign

Les MTN limitent le développement socio-économique du pays (NTDs limit the country’s socioeconomic development).

General public

Radio and TV • By all contracted stations and networks


Three‒four airings or broadcasts per week until the end of the MDA campaign


e) Training

NTD training/refresher-training for the SNEIPS’s “numéro vert” staff and BREIPS staff in seven RMs: RTI ENVISION will technically and financially support the PLMTN/DLM’s one-day orientation on NTDs and the MDA campaign for staff members of the SNEIPS “numéro vert” free public health information phone line and staff members from the BREIPS of regions supported by ENVISION for MDA (Diourbel, Fatick, Kaffrine, Kaolack, Kolda, Thiès, and Ziguinchor), one month before the start of the MDA campaign. The PLMTN will give up-to-date presentations, answer questions, and provide informational documents. This activity will help to ensure that these MSAS departments provide correct information to the public at their respective levels of the health system and will increase the visibility of the PLMTN and MDA campaign through improved understanding of and increased interest in these topics among the trainees. Involving the BREIPSs will enable them to provide accurate information about NTDs to the public within their respective RMs.

f) Drug and Commodity Supply Management and Procurement

Procure TEO for TISs and TSSs: During surveys, individuals diagnosed with active trachoma are provided with two tubes of TEO.

Procure filariasis test strips (FTSs) for pre-TAS and TAS1: This will be the lone diagnostic tool used in the pre-TAS and TAS1, if the latter is approved by WHO AFRO’s RPRG.

Procure Kato-Katz kits for SCH and STH prevalence evaluation surveys: This will be the lone diagnostic tool used in the STH prevalence evaluation surveys and SCH-STH prevalence evaluation surveys.

Pay transit fees for donated MDA drugs: These are charged by Senegal’s customs service for the importation of ZTH and TEO; in FY18, only TEO will be imported. As the MSAS does not cover this cost, ENVISION will pay the fee.

Transport of MDA drugs from PNA to PRAs in seven RMs: As in prior years, there is a chance that funding for this may be required, from the National Supply Pharmacy (PNA) to the Regional Supply Pharmacies (PRAs).

Transport of MDA drugs from PRAs to health posts in 30 districts: The MDA drugs must be transported from the PRAs to the health districts and on to their component health posts before MDA, as needed.

Return of unused MDA drugs to PRAs in seven RMs after the MDA campaign: After the MDA campaign, the RMs collaborate remotely with the DLM Pharmacist to confirm the supply of unused drugs that remain. RTI’s Regional Focal Points support the RMs in counting the quantity remaining. All drugs remaining at the health posts and health districts are to be returned to the parent region’s PRA. Funds are provided if needed.

Technical assistance for monitoring and management of AEs and SAEs: RTI will encourage: 1) the DLM and the ECRs and ECDs of the RMs supported by ENVISION for MDA to actively refer to the copies of the Handbook for Managing Adverse Events following Mass Drug Administration and Serious Adverse Events that they have on hand; and 2) the ECRs and ECDs of the RMs supported by ENVISION for MDA to actively refer to AEs, informing the central-level MSAS (anti-poison center, with a copy to the DLM) quickly. RTI will also ensure greater focus on the AE/SAE component in the cascade trainings for ECRs, ECDs, ICPs, and drug distributors before the MDA campaign.


In the case of any SAEs in districts supported for MDA by ENVISION, RTI Senegal will inform its home office within 24 hours and will encourage the DLM to inform the MSAS’s anti-poison center, drug donation programs, and WHO within the same period.

g) Supervision for MDA

RTI ENVISION’s personnel will support the MSAS with MDA supervision.

A supervisory timeline, plan, and supervisory checklists will be reviewed and updated by the PLMTN/DLM and RTI for each activity. The supervisory checklist used by the DLM allows for assessment of the quality of data, archiving, health personnel’s knowledge levels, and the availability and use of data collection and management tools.

Before the start of each activity, the PLMTN/DLM personnel participating in the activity will, as a team and together with RTI, review the expectations for the supervisory mission and the contents and use of the supervisory checklist.

Supervision of regional-level MDA orientation and micro-planning workshops in seven RMs: The PLMTN/DLM and RTI will jointly supervise these two-day workshops in the regions supported by ENVISION for MDA.

Supervision of district-level MDA orientation and micro-planning workshops in 30 districts: ECR personnel and RTI’s Regional Focal Points will jointly supervise these two-day workshops in each of the districts supported by ENVISION for MDA.

Supervision of the integrated MDA campaign in 30 districts: RTI will join the central-level teams in supervising the MDA campaign in 30 districts across seven RMs. Each RM will be supervised by central-level personnel (two PLMTN/DLM personnel, either one DCMS personnel or one SNEIPS personnel, and one RTI personnel, either Dakar-based or a Regional Focal Point) for five days during the ENVISION-supported MDA campaign. Each supervisory team will ensure the quality of drug distribution and assist in awareness-raising, data quality control, and data compilation. RTI’s Regional Focal Points will also be involved in those regions where they are present, together with regional-level personnel.

h) M&E

Support for the preparation of the WHO JAP (JRSM, JRF, and EPIRF): RTI will assist the PLMTN/MSAS in completing and submitting these documents if the MSAS is willing to accept this support. This would facilitate ensuring that the JAP is high quality and submitted on time and would also enable easier follow-up with WHO HQ and WHO AFRO to ensure timely approval and shipment of the requested drugs.

Updating the Integrated NTD Database: RTI will assist the DLM in updating demographic, disease distribution, and intervention data; survey results; and/or process indicators, as justified by any changes to these data (the historical data have already been incorporated). RTI and the DLM’s Data Manager will meet monthly to update the Database with data on interventions and surveys. The PLMTN/DLM will generate reports (JRF and EPIRF) using the database and share these with WHO.

Funding and participation in MDA data validation workshop in seven RMs: Each of the seven RMs conducting MDA with support from ENVISION will be supported to hold a one-day workshop to review and validate the data from their region’s CY18 MDA campaign, formulating recommendations for subsequent campaigns as appropriate. They will also review remaining MDA drugs and supplies.


PLMTN/DLM and RTI/Dakar personnel will participate in these workshops, along with the local RTI Regional Focal Point.

Funding of and participation in national MDA data validation workshop: The PLMTN/DLM will hold a one-day workshop to review and validate the data from the CY18 national MDA campaign, formulating recommendations for subsequent campaigns as appropriate. They will also review remaining MDA drugs and supplies. RM and RTI/Dakar personnel will participate in this workshop.

LF pre-TAS in three districts: The three districts (Bounkiling, Goudomp, and Sédhiou [Sédhiou Region]) that have completed five rounds of LF MDA with constant ≥65% epidemiological coverage will each conduct pre-TAS in early FY18 (Table 5), in line with WHO guidance, with technical and financial support from RTI ENVISION. FTSs will be used as the diagnostic test; if results are <1% in all three districts, then the MSAS will propose the three districts as an EU to the RPRG.

LF TAS1 in three districts: If the three districts mentioned above register satisfactory results in their pre-TAS and the RPRG approves TAS1, the districts will proceed with that activity. As the total population of the three districts is approximately 530,000 (2018 estimate), it is likely that they would constitute a single EU. FTSs will be used as the diagnostic test.

TISs in three districts: RTI will technically and financially support the PNPSO in conducting TISs in two districts, with implementation by PNPSO personnel under the supervision of the PNPSO and RTI. This activity will include Touba District (Diourbel Region) and Saint Louis District (Saint Louis Region), each of which are conducting a single round of MDA in FY17 based on a survey result of 5%‒9.9% TF prior to any MDA, and Mbour District (Thiès Region) which registered 5%–9.9% TF at baseline in 2005 and never conducted MDA. As previously, the TISs will follow the standard WHO protocol and use Android smartphones and WHO’s Tropical Data system for data collection. The teams will 1) survey the prevalence of TF among children aged one‒nine years, 2) survey the prevalence of TT among men and women aged ≥15 years (including the presence or absence of corneal opacities among all persons examined for TT), and 3) measure links between trachoma and environmental and behavioral factors (e.g., the availability and use of latrines, facial cleanliness, household cleanliness, and access to water).

TSSs in 12 districts: RTI will technically and financially support the PNPSO in conducting TSSs in 12 districts (Bambéye and Mbacké [Diourbel Region]; Birkelane, Kaffrine, Koungheul, amd Malem Hodar [Kaffrine Region]; Ndoffane and Nioro [Kaolack Region]; Darou Mousty [Louga Region]; and Khombole, Mékhé, and Tivaouane [Thiès Region]), with implementation by PNPSO personnel under the supervision of the PNPSO Coordinator and RTI. The 12 districts will conduct their TSSs a minimum of 24 months after their prior TIS that showed that TF was <5%.19 The methodology will be the same as for the TISs described above.

SCH-STH prevalence evaluation surveys in three districts: The three districts (Kaffrine and Koungheul [Kaffrine Region] and Médina Yoro Foulah [Kolda Region]) that have conducted five‒six rounds of SCH MDA with PZQ with ≥75% program coverage among SAC and have not yet performed prevalence evaluation surveys for SCH and STH will do so in FY18, in line with WHO guidance, with technical and financial support from RTI ENVISION. The results will enable the MSAS to decide whether to maintain or adjust the treatment schedule for these districts, in line with WHO guidance based on prevalence.

The following techniques will be used to examine stool and urine samples: 1) macroscopic examination of urine; 2) reagent strips for urine; 3) microscopic examination of urine filter for S. haematobium eggs;

19 ITI. (2017). Diagram on Decision Making for Antibiotic Treatment of Trachoma, version 10.


and 4) Kato-Katz with microscopic examination of fecal material for S. mansoni and STH eggs in stool samples.

STH prevalence evaluation surveys in three districts: The three districts (Bounkiling, Goudomp, and Sédhiou [Sédhiou Region]) that have conducted five‒six rounds of STH MDA with ALB with ≥75% program coverage among SAC and have not yet performed prevalence evaluation surveys for STH will do so in FY18, in line with WHO guidance, with technical and financial support from RTI ENVISION The results will enable the MSAS to decide whether to maintain or adjust the treatment schedule for these districts, in line with WHO guidance based on prevalence. The methodology will be the same as noted above, with the exception that only Kato-Katz tests will be used (for STH) as mapping of these districts in 2013 detected no SCH, and therefore, no PZQ MDA has been conducted.

Table 5: Planned disease-specific assessments for FY18 by disease

Disease

Number of remaining endemic

districts (as of June 30,

2017)

No. of districts planned for

DSA

No. of EUs planned for

DSA (if known)

Type of assessment

Diagnostic method

Lymphatic filariasis 50

3

3 (each district)

Pre-TAS FTS

3

1 (probable) TAS1 FTS

Schistosomiasis 57

320 3 (each district)

Prevalence evaluation survey

Dipsticks Filtration Kato-Katz


17

6 (of which 3 are the same as described

for SCH)

6 (each district) (3 of these will be the same as

for described SCH; the

survey will be

integrated in those

districts)

Prevalence evaluation survey

Kato-Katz

Trachoma21 8

TIS: 322

TSS: 1223

TIS: 4 for Touba

District, 2 for

Impact survey

Clinical grading

20 The three districts of Sédhiou Region that will be conducting prevalence evaluation surveys for STH are not included for SCH prevalence evaluation surveys as they registered <1% (though >0%) at baseline. 21 TIS are planned for an additional five districts in late FY17; the results are not available at the time of writing. 22 Touba (Diourbel Region), Saint Louis (Saint Louis Region), and Mbour (Thiès Region) Districts. 23 Bambéye and Mbacké (Diourbel Region); Birkelane, Kaffrine, Koungheul, and Malem Hodar (Kaffrine Region); Ndoffane and Nioro (Kaolack Region); Darou Mousty (Louga Region) and Khombole, Mékhé, and Tivaouane (Thiès Region) Districts all registered <5% TF in TISs in CY16.


Disease

Number of remaining endemic

districts (as of June 30,

2017)

No. of districts planned for

DSA

No. of EUs planned for

DSA (if known)

Type of assessment

Diagnostic method

Saint Louis District, 2 for

Mbour District

TSS: 1 per

district

Surveillance survey

i) Supervision for M&E and DSAs

Supervision of LF pre-TAS in three districts: Two PLMTN/DLM personnel and one RTI/Dakar personnel will jointly supervise this activity.

Supervision of LF TAS1 in three districts: Two PLMTN/DLM personnel and one RTI/Dakar personnel will jointly supervise this activity (if the activity is approved by the RPRG).

Supervision of TIS in three districts: The PLMTN/DLM and RTI will jointly supervise this activity.

Supervision of TSS in 12 districts: The PLMTN/DLM and RTI will jointly supervise this activity.

Supervision of SCH-STH prevalence evaluation surveys in three districts: The PLMTN/DLM and RTI will jointly supervise this activity.

Supervision of STH prevalence evaluation surveys in three districts: The PLMTN/DLM and RTI will jointly supervise this activity.

j) Dossier Development

Initiate LF elimination dossier development: RTI ENVISION will technically support the PNEFL, other members of the PLMTN/DLM, and partners supporting LF elimination in Senegal to review the information and documents needed for the dossier and compile those that are available at the time of the meeting.

Ongoing trachoma elimination dossier development: RTI has assisted the PNPSO in filling in a good portion of the Excel template that is required as part of the dossier package. RTI ENVISION will technically and financially support quarterly sessions bringing together the PNPSO, other members of the PLMTN/DLM, and partners (Sightsavers) supporting trachoma elimination in Senegal to review the various information and documents needed for the dossier and compile those that are available at the time of the meeting.


3) Maps





APPENDIX 1: Work Plan Timeline

FY18 Activities

NTD Program Capacity Strengthening

Closely accompany PLMTN/DLM staff in activity planning, protocol development, implementation, and M&E

Accompany the MSAS’s RM and health district staff in activity planning, implementation, and M&E

Provide copies of WHO reference documents related to PC-NTD control

Strengthen the PLMTN/DLM’s coordination with PC-NTD partners

Project Assistance

Strategic Planning

Funding of and participation in the MSAS’s quarterly NTD coordination meetings

Participation by RTI and DLM staff in the quarterly coordination meetings of eight RMs

Participation in the monthly coordination meetings of 30 health districts

Participation in NTD partner coordination meetings

Updating and use of the TIPAC

Funding of and participation in workshop to develop the MSAS’s annual NTD work plan (2019)

Advocacy for Sustainability of the National PC-NTD Program

Support development and distribution of MSAS’s semi-annual NTD newsletter

Raise awareness of PC-NTDs among local elected officials

MDA Coverage

Produce MDA M&E tools for 30 districts

Fund and participate in orientation and MDA micro-planning workshops at regional, district, health post, and community levels in seven RMs and 30 districts

Support for implementation of MDA in 30 districts

Social Mobilization in support of MDA

Participate in NTD communications committee

Production and delivery of IEC materials for 30 districts

Design and broadcasting of commercials and shows on radio and TV

Internet advertisements during the MDA campaign

Organization of a national MDA launch day

Community mobilization strategy in 30 districts

Training


FY18 Activities

NTD training/refresher-training for journalists, the SNEIPS’s “numéro vert” staff, and BREIPS staff in seven RMs

Drug Supply Management and Procurement

Procure TEO for trachoma impact and surveillance surveys

Procure FTS for pre-TAS and TAS1

Procure Kato-Katz kits for SCH and STH prevalence evaluation surveys

Pay transit fees for donated MDA drugs

Transport of MDA drugs from PNA to PRAs in seven RMs

Transport of MDA drugs from PRAs to health posts in 30 districts

Return of unused MDA drugs to PRAs in seven RMs after the MDA campaign

TA for monitoring and management of AEs and SAEs

Supervision for MDA

Supervision of regional-level MDA orientation and micro-planning workshops in seven RMs

Supervision of district-level MDA orientation and micro-planning workshops in 30 districts

Supervision of the integrated MDA campaign in 30 districts

M&E

Support for the preparation of the WHO JAP (JRSM, JRF, and EPIRF)

Updating the Integrated NTD Database

Funding and participation in MDA data validation workshop in seven RMs

Funding of and participation in national MDA data validation workshop

LF pre-TAS in three districts

LF TAS1 in three districts

TISs in three districts

TSSs in 12 districts

SCH-STH prevalence evaluation surveys in three districts

STH prevalence evaluation surveys in three districts


FY18 Activities

Supervision for M&E

Supervision of LF pre-TAS in three districts

Supervision of LF TAS1 in three districts

Supervision of TIS in three districts

Supervision of TSS in 12 districts

Supervision of SCH-STH prevalence evaluation surveys in three districts

Supervision of STH prevalence evaluation surveys in three districts

Dossier Development

Initiate LF elimination dossier development

Ongoing trachoma elimination dossier development


APPENDIX 2. Table of USAID-supported Regions and Districts in FY18

Region Health

Districts

MDA DSA

LF OV SCH STH TRA

24 LF OV SCH STH TRA

1

Diourbel

Bambéye X TSS

2 Mbacké X X TSS

3 Touba X X TIS

4

Fatick

Dioffior X X X

5 Fatick X

6 Gossas X

7 Niakhar X

8 Sokone X X

9

Kaffrine

Birkelane X X TSS

10 Kaffrine

X

Prev eval

survey

Prev eval survey

TSS

11 Koungheul

X

Prev eval

survey

Prev eval survey

TSS

12 Malem Hodar X TSS

13

Kaolack

Guinguinéo X x

14 Kaolack X x

15 Ndoffane TSS

16

Kolda

Kolda X

17 Médina Yoro Foulah

X

Prev eval

survey

Prev eval survey

18 Vélingara X X

19 Saint Louis Saint Louis TIS

20

Sédhiou

Bounkiling

Pre-TAS, TAS1

Prev eval survey

21 Goudomp

Pre-TAS, TAS1

Prev eval survey

22 Sédhiou

Pre-TAS, TAS1

Prev eval survey

23

Thiès

Joal-Fadhiouth X

x X

24 Khombole X TSS

25 Mbour X X TIS

24 To be supported only if results of TIS or TSS require it.


Region Health

Districts

MDA DSA

LF OV SCH STH TRA

24 LF OV SCH STH TRA

26 Mékhé TSS

27 Popenguine X X

28 Pout X X

29 Thiadiaye X X

30 Thiès X X

31 Tivaouane X X TSS

32

Ziguinchor

Bignona X

33 Diouloulou X X

34 Oussouye X

35 Thionk Esyl X

36 Ziguinchor X X

Documents

Senegal Work Plan - ENVISION · IEF Inspection de Formation et de l’Education ... PGIRE Projet de Gestion Intégrée des Ressources en Eau et de Développement des Usages Multiples