DRAFT – June 4, 2012
Report of the Western Pacific Region Technical Assistance Workshop
Manila, Philippines
27-28 May 2012
Introduction
On 27-28 May 2012, Children Without Worms (CWW) sponsored a Technical Assistance Workshop for countries in the Western Pacific Region implementing or planning to implement national Soil-Transmitted Helminthiasis (STH) Control Programs. Participants included representatives of ministries of health (MOH) and education (MOE), World Health Organization, and non-governmental organizations (NGOs). Other participants included representatives of the STH Advisory Committee and Johnson & Johnson. A list of meeting participants is provided as Annex A, and a final Workshop Agenda is provided as Annex B.
The objectives of the Workshop were to:
- Introduce the second edition of WHO’s “Helminth Control in School-Age Children” and the new monitoring and evaluation guidelines.
- Share best practices and establish processes for managing and coordinating mass drug administration (MDA) campaigns (i.e., utilizing benzimidazoles donated by different sources and targeted to different populations through different distribution channels).
- Share best practices for integrating deworming and WASH as part of school health programs to control STH.
Workshop presentations can be accessed at High-level conclusions and action-items resulting from the presentations and discussions are summarized below.
Workshop Summary
- The STH Technical Assistance Workshop is a milestone for the region because never before have so many partners sat around the table to discuss issues regarding control of STH.
- Neglected Tropical Diseases (NTDs) are often seen to be competing with large, well-established programs like Maternal & Child Health (MCH), HIV/AIDs, malaria, and tuberculosis.
Conclusions/Action Items
- Programs need to synergize to use resources efficiently.
- NTD programs need to ‘piggy-back’ on larger programs when opportunities present themselves.
- There is an enormous amount of resources for STH control as illustrated by the presentations from NGOs. The NGOs engage with the government ministries at various levels. All country programs represented at the Workshop have intersectoral coordination mechanisms, which take various forms (e.g., Steering Committees, Working Groups, Task Forces).
Conclusions/Action Items
- Country programs should utilize existing mechanisms to coordinate and promote activities related to STH control (i.e., put STH control on the agenda).
- These coordinating mechanisms should include representation from NGOs, the private sector and Ministries of Health, Education, Agriculture, Rural Development, Academe, etc.
- Treatment coverage rates are a very important process indicator. WHO has STH treatment data from 8 of 17 countries in the region. According to current treatment data, 12% of the at-risk SAC population in the region is being treated (the coverage rate increases to 25% if China’s data are not included). Existing treatment data are difficult to analyze because the countries have different definitions of school-age children and therefore, are using different denominators.
Conclusions/Action Items
- To find solutions issues related to treatment coverage rates:
-Need to look at the factors that contribute to low treatment coverage rates
-Need to look at the factors that limit reporting of data.
- Need to look at factors that contribute to long-term maintenance of high-coverage rates.
- Two reoccurring themes of CWW technical assistance workshops are collection of data and access to data. Utilizing SMS technology is one potential way to address these challenges.
Conclusions/Action Items
- Flexibility and cost of the system need to be considered.
- Incentives such as top-up cards should also be considered.
- Program sustainability is a concern, especially after international partners have withdrawn their support.
Conclusions/Action Items
- National Plans should include advocacy strategies. One recommended activity of an advocacy strategy was dissemination of information through the media to raise awareness (e.g., TV advertisements are popular in the Philippines)
- Strengthen collaboration with local partners, including rural health authorities, and parent teacher associations
- Presentations by NGOs that illustrated impact of efforts were appreciated evidence of impact is vital for advocacy as well as sustainability
- Integrate NTD Mapping with Resource Mapping. Resource Mapping should include availability of water and sanitation (WATSAN) facilities
- Treating hard-to-reach populations is a challenge. These populations are usually also high risk.
Conclusions/Action Items
- Utilize different distribution channels to reach all high-risk populations, including non-enrolled children (e.g., EPI, MCH clinics)
- The M&E Guidelines [VH1]for scaling down MDAs will be further developed as more data are collected in the field. Key components of the guidelines are the sentinel sites and collection of data on infection intensity.
Sentinel sites are used to monitor STH transmission because, unlike LF, there is no biological vector. According to WHO guidelines, sentinel sites should be selected to represent all agro-ecological zones in the country. Collect as much data as needed to inform site selection (e.g., access to WATSAN facilities, and history of treatment coverage).
Intensity is an important indicator because it is a more direct proxy of STH morbidity than is prevalence. Prevalence data are adequate for establishing treatment strategies. After 5 years of treatment, intensity data are important because they indicate level of transmission.
Conclusions/Action Items
- Guidelines should be modified as data become available from the countries.
- WASH indicators should be included in future decision trees.
- Need to find a sustainable approach to prevention of infection. Compared to construction of WATSAN facilities, hand washing is a low-cost intervention and therefore, should be promoted. However, for some countries, promotion of hand washing is not easy because of lack of access to water.
Conclusions/Action Items
- The new strategy for WASH is creating actual demand rather than construction of facilities (aka Community Led Total Sanitation). Programs should do more to work with Parent Teacher Associations or School Management Committees to create demand for access to WATSAN facilities
- There are three priority populations – Preschool-age children (PSAC), school-age children (SAC), and women of child-bearing age (WCBA). All countries present at the Workshop are identifying sources of benzimidazoles to treat PSAC. Coverage rates for this population are “high” in the region due to activities sponsored by UNICEF. Country programs have limited experience working with WCBA. Vietnam does have experience, and lessons learned have been published in PLOS NTD
Conclusions/Action Items
- WFP[VH2] experience working with WCBA can give country programs more information regarding best practices.
- Country programs should document and share experiences
- Different ministries and stakeholders target different populations utilizing different channels. Country programs should compare the various channels used to reach PSAC and WCBA and identify best practices
- Country programs are at various stages in development and implementation. Some have been deworming for several years and are therefore, making plans to scale down. Other programs are just starting.
Countries starting-up should take note of the best-practices of those countries with established programs such as the Memoranda of Understanding between the Ministries of Health and Ministries of Education. They should also utilize resources already developed such as school curriculums and information, education, and communication materials (IEC).
All stakeholders working to combat STH should take note of the countries working to establish STH control programs. We need to work together to be imaginative and industrious to find new solutions to solve challenges faced by all country programs.
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Annex A – Participant List
Australia:
Azadeh Baghaki
Senior Project Coordinator
Health, Nutrition & WASH
World Vision Australia
Cambodia:
Sinuon Muth
Program Manager of Helminthiasis
National Centre for Malaria Control,
Parasitology and Entomology
Ministry of Health
Chhavyroth So
Deputy Chief
Technical Bureau
School Health Department
Ministry of Education Youth and Sports
Zaman Talukder
Country Director and
Regional Food Security Advisor
Helen Keller International
China:
Chunmei (Mei) Li
Corporate Contributions
Johnson & Johnson
Lao PDR:
Chitsavang Chanthavisouk
NPO for Malaria, Vector-borne and Parasitic Disease Control
WHO Lao PDR
Soutsaychai Douangsavanh
Department of Pre-School and Primary Education
Ministry of Education and Sports
Khamkhanh Soulignadeth
Deputy Director
Department of Pre-School and Primary Education
Ministry of Education and Sports
Khamphoua Southisombath
Director
Ophthalmology Center
Ministry of Health
Malaysia:
Johari Awang Besar
Area Health Officer
Public Health Division
Kinabatangan Area Health Officer
Saban Health Department
Ministry of Health
Cyril Christopher
Senior Assistant Director
School Education Division
Ministry of Education
Papua New Guinea:
Leo Sora Makita
NTD Prgramme Manager
Ministry of Health
Walter Kazadi Mulombo
NTD focal point
PNG World Health Organization
Philippines:
Naomie Ababao
Technical Assistant - NTDs
WHO-Philippines
Rose Asis
National Officer
World Food Program - Philippines
Vicente Belizario,
Vice Chancellor for Research and
Executive Director, National Institutes of Health
University of the Philippines, Manila
Molly Brady
Technical Officer on NTDs
WPRO
Lourdes Desiree D.
Executive Director
GSK Foundation Inc.
Yolanda C. De Las
Senior Specialist, Educational Research & Innovation Office
SEAMEO INNOTECH, Philippines
Nino Dal M.
Special Fellow for NTD
WPRO
Maria Corazon Dumlao
Department of Education
Edgardo Erce
STH Technical Officer
Department of Health
Jun Figueroa
Program Coordinator Philippines
Fit for School
Timothy Grieve
Chief
Water, Sanitation and Hygiene Section
UNICEF – Philippines
Leda Hernandez
Division of NTDs
Department of Health
Alejandra (Sandra) Libunao
Consultant
Department of Health and FHI
Bella Monse
Principal Advisor
Fit for School Program, GIZ
Amado Parawan
Health Advisor
Save the Children International
Elmer
Assistant Secretary
Department of Health
Loida Ramos
Chief of the Health Division and Coordinator
of the Deworming Program
Department of Education
Rolando I. Santiago
Environmental and Sanitary Engineer
Environmental Health Office
Department of Health
Le Anh
Technical Officer on NTDs
WPRO
Denis Romerick G.
Project Officer
GSK Foundation, Inc.
Jon Michael Villasenor
WASH in Schools Programming
UNICEF – Philippines
Lasse Vestergaard
NTD Focal Point
WPRO, Philippines
South Pacific:
Kim Sung Hye
Pacific NTD Coordinator
WPRO, Philippines
Switzerland:
Antonio Montresor
PCT/NTD
World Health Organization
Thailand:
James Johnson
Project Director
FHI
USA:
David Addiss
Director
Children Without Worms
Kerry Gallo
Sr. Program Associate
Children Without Worms
Kim Koporc
Director of Program Implementation
Children Without Worms
Marci Van Dyke
Technical Advisor
USAID
Vietnam:
Tran Cong Dai
NTD focal point in Viet Nam
World Health Organization
Ha Thi Dung
Deputy-Head of Department of Student Affairs
Ministry of Education and Training
Trung Dung Do
Head of Parasitology Department
National Institute of Malariology
Parasitology and Entomology
Ministry of Health
Thu Huong
ViceHead of Parasitology Department
National Institute of Malariology, Parasitology
Entomology
Ministry of Health
Son Anh
School Health Expert
Department of Student Affairs
Ministry of Education and Training
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Annex B – Workshop Agenda
Sunday – May 27, 2012
Time / Session / Facilitator(s)8:00am–9:00am /
- Welcome
(b)Administrative Issues
(c)Review Workshop Objectives and Agenda
(d)Opening Remarks / Chair - Belizario
Assistant Secretary of Health Punzalan
9:00am–9:30am /
- CWW Updates
9:30am–10:00am /
- WPRO Updates
10:00am–10:30am / Tea/Coffee Break
10:30am–12:00pm /
- Country Program Updates:
(b)Lao PDR
(c)Vietnam / Sinuon
Chanthavisouk
Tran Cong
12:00pm–1:30pm /
Lunch Break
1:30pm–2:30pm /- M&E of STH Control Programs Targeting School-Age Children
2:30pm–3:00pm /
- Using SMS Technology for Collecting and Reporting Mass Drug Administration data
3:00pm–3:30pm / Tea/Coffee Break
3:30pm–5:30pm /
- Country Program Updates (continued)
(b)Malaysia
(c)PNG / Erce
Besar
Makita
6:30pm–9:30pm / Dinner Sponsored by CWW
Monday – May 28, 2012
Time / Session / Facilitator(s)8:00am–9:00am /
- NGO Partner Updates
(b)Save the Children
(c)UNICEF
(d)WFP
(e)World Vision
(f)GSK Foundation / Johnson
Parawan
Grieve
Asis
Baghaki
Tuazon
9:00am– 10:00am /
- Coordinating STH Control Among Different Sectors and Partners
(b)Challenges of Managing Different Sources of Benzimidazoles / Addiss
10:00am–10:30am / Tea/Coffee Break
10:30am–12:00pm /
- Integrating Deworming and WASH into School Health Programs
(b)Fit For School in the Philippines
(c)Partnerships for Sanitation and Water Supply in Lao PDR / Talukder
Figueroa
Chanthavisouk
12:00pm–12:30pm /
11.Discussion of Conclusions and Recommendations / Wrap-up of TA Workshop
/ Chair - Belizario12:00pm–1:30pm /
Lunch Break
1:30pm–3:30pm /- One-On-One Sessions with Country Representatives
3:30pm–4:00pm / Tea/Coffee Break
4:00pm–6:00pm /
- One-on-One Sessions with Country Representatives
Note: Regarding the one-on-one sessions, CWW will explore with country representatives additional time-slots, such as the day before or day after the workshop
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[VH1]?
[VH2]?