Technical Advisor for Guinea Worm Eradication Program–Ethiopia

Overview

TERMS OF REFERENCE – TECHNICAL ADVISOR

A.     Work with the Guinea worm eradication Program Manager (PM), Senior Technical Advisor (STA) if present, and with The Carter Center Senior Country Representative (SCR) to Ethiopia, as well as with Ministry of Health (MOH), and Gambella State Health authorities to perform, as appropriate, the duties listed below.

1.       Obtain geographic coordinates (using GPS units) of the location of the villages/localities reporting cases of GWD during. Report the geographic coordinates to the national EDEP secretariat for preparation of new or update of existing operational maps.

2.       Review the clustering of villages/localities reporting cases of GWD to determine the number of sub-districts defining clusters, following the norms established by these programs for number of villages and non-village areas to be supervised by a volunteer/focal person, and for a Field Officer (FO).

3.       Work with Senior Project Coordinator (SPC) to determine the number of FOs, Supervisors, and Village Volunteers (a male and a female volunteer, whenever possible) needed to cover each of the defined zones to implement interventions against GWD.

4.       Work in collaboration with the PM, relevant Officers, and SCR to develop training guidelines and schedules to improve the skills of field officers, supervisors and community leaders/village health committees. Train FOs and Supervisors on technical matters and norms of the integrated program, including definitions of Guinea worm rumors, suspects, and cases/infections and Guinea worm endemic villages, the interventions against GWD including health education, behavior change communication , social mobilization, surveillance (including use of case/animal infection registers, and monthly reporting) containment of transmission from cases and infections of GWD, distribution, use and care of cloth and pipe filters, ABATE Larvicide application, interventions related to domesticated animals, on the use of supervisory check lists, and on the use of forecasting line lists for endemic villages to help time the applications of ABATE Larvicide, the distribution of filters, etc.

5.       Where applicable, develop work plans with the FOs, FCs, BCC Officer, Program/Assistant Entomologist(s), and Program/Assistant Veterinarian to improve surveillance, consistent application and monitoring of interventions, community mobilization and behavior change communication/health education on consistent tethering of dogs/cats, and proper care, and regular treatment of unsafe water sources.

6.       Train Supervisors, FOs, and Village Volunteers/Focal Persons on how to establish an effective dialogue with GWD endemic communities to explain what GWD is, how it is transmitted, how it can be prevented, and to let the entire community know what the EDEP will do to empower them to take action to prevent transmission of GWD, while at the same time convincing residents that their active positive participation is needed to stop transmission, i.e., by preventing anyone with an emerging Guinea worm from entering sources of drinking water, and by always filtering all drinking water and caring for the filters provided.

7.       Supervise the training of Focal Persons/Volunteers by FOs to ensure the quality of the training and conveyance of the appropriate messages and techniques to the trainees.

8.       In coordination with the GWEP team develop an annual plan of action and budget for the needs of the endemic area of assignment and develop a plan for the use of resources in consonance with the seasonal needs of the EDEP. Submit and discuss this plan with PM and TCC CR for their recommendations and approval.

9.       Assess the sensitivity of the surveillance system for cases of GWD in endemic villages/localities. Determine whether the village-based surveillance is being conducted daily (active), and whether there are the required personnel and resources to detect 100% of all cases/infections of GWD within 24 hours of Guinea worm emergence. Check that all entries in the village case register are properly recorded. Where the surveillance system is not active and/or not completely sensitive, recommend immediate action steps the EDEP supervisor needs to take to correct flaws in the system, and help implement these.

10.   Ascertain whether there is compliance with the international definition of a case/infection of dracunculiasis and with the standards for containing transmission from each infected person/animal. Determine if a) endemic villages have the necessary resources (village volunteers, filters, medical kits, etc.) to contain every case/infection in the village and non- village areas, and b) transmission from infected persons/animal is indeed fully contained. In endemic villages where cases are not being detected and contained within 24 hours of worm emergence, recommend the implementation immediate action steps to correct these deficiencies, and help implement these.

11.   Assess the frequency and quality of supervisory visits to the village volunteers, including the use of a supervisory checklist and that the volunteers know what they need to do, are doing it, and are satisfied with the working relationship with their supervisor. Take immediate action steps to correct any deficiencies noted about the frequency and or quality of supervisory visits. Provide regular supervision, evaluation and on-the-job training to program assistants, field officers, supervisors and other actors in community-based health care as appropriate.

12.   Evaluate the frequency, quality, and penetration of BCC messages and social mobilization events about GWD and the prevention. Where inadequate, assist FOs, volunteers, and relevant stakeholders to improve the quality of participatory health education activities at the village level. Promote the need for political and community leaders and community members to take action to eradicate GWD.

13.   Become informed via civil authorities, partners, or other stakeholders implementing, monitoring and evaluating public health emergency management (PHEM) surveillance system in their respective locations.

14.   In areas where ABATE® Larvicide is being used: assess the frequency and quality of applications in sources of drinking water used by endemic villages, by checking the records, including the calculation of water volume, and whether ABATE® Larvicide crews are using “forecasting” to time the applications of ABATE®. Inquire as to the rationale for the particular selection of sources of drinking water being targeted for treatment with ABATE® Larvicide. Recommend immediate action steps to correct any deficiencies in the application or the strategy for use of ABATE® Larvicide and help implement these.

15.   Assess whether line-listings of GWD endemic villages (arranged in descending order of cases reported in the previous year and showing the number of cases reported, number of households, number of filters distributed, % coverage of households with filters, number of ponds, number of ponds treated, numbers of functioning boreholes/hand-pumps, etc.) are being used to monitor the status of interventions and as an advocacy tool for providing safe sources of water to these villages. If not, help supervisors prepare such listings and educate them about the advantages of using these to monitor interventions and of updating such line-listings monthly and posting them at the district and area level offices. Ascertain whether the data from the previous year showing cases reported by month is being used to forecast the timing of interventions in each of these villages, including health education, social mobilization, the distribution of filters and the treatment of ponds with ABATE® Larvicide. Check a sample of households to ensure that filters are available, being used, undamaged, and whether additional new filters need to be distributed. Assess whether supervisors are using a supervisory checklist during their visit to villages and that the outcomes of each visit are recorded in writing and acted upon by the senior field officers and or area staff.

16.   Where applicable, assist FOs to submit monthly reports on activities. Summarize these into one comprehensive report for the entire project area. Coordinate collection / compilation of monthly activities data from field to database.

17.   Ensure that FOs report monthly on the status of water hand pump construction/rehabilitation and/or other devices providing safe water in endemic villages, and whether these are functioning.

18.   Work with the SPC and local authorities/officials in establishing a system for secure storage and appropriate distribution and use of supplies for Guinea worm eradication activities.

19.   Work cooperatively and harmoniously with TCC and Woreda leaders/officials as an integral part to strengthen the programs in every way possible. Play active role to advocate and promote inter- sectoral collaborations with stakeholders and other actors in GWD eradication.

20.   Work daily with awareness that the EDEP is under the leadership of the EDEP Coordinator, and you are a guest of the Federal Democratic Republic of Ethiopia and work under the jurisdiction of the GWEP Director and the government of Ethiopia.

21.   Assist in improving the organization of program personnel so that all GWD cases are identified and contained and all GWD interventions are applied in all focal areas.

22.   Work with officials and persons at all levels in ways that build confidence and that promote a sense of hope and optimism that GWD can be eliminated in Ethiopia.

23.   Assist in improving every aspect of data collection and reporting, including accuracy, completeness, and timeliness.

24.   Ensure that data are internally consistent; analyzed on a monthly basis; used for decision-making at the district level; and reported in complete accordance with Region, Woreda, Kebele and national requirements and procedures.

25.   Work with the SPC and Woreda Coordinators/Supervisors and FOs  to organize and conduct monthly management/communication sharing meetings of State Coordinators, and Village Volunteers. These meetings should provide a forum for highlighting and resolving issues/problems faced by the coordinators, field officers and volunteers.

26.   Represent The Carter Center with pride, integrity, professionalism, humility, understanding and respect of persons, and sensitivity to local culture and traditions. Be constantly aware that you represent an organization founded by a former President of the United States who believes in working aggressively and harmoniously to assist and strengthen our host counterparts.

27.   Work with the SPC and identify all interventions supplies/materials that will be needed for the transmission season and regular programming. Review the list of needs and determine the items that the local authorities will provide and the items to be requested from the PM. Submit the list to the EDEP Secretariat by the end of the month for review by the PM and the SCR. Prepare other special or longer-term estimates as requested by the SCR.

28.   Work with the local authorities, EDEP staff and all associated with the program to ensure that the limited intervention supplies/materials (cloth and pipe filters, ABATE® Larvicide materials, medical kits and bandaging materials, flip charts and other health education materials, and other) are targeted on a priority basis to cover known endemic villages/localities where transmission of GWD is known to occur and in known endemic villages.

29.   Conduct monitoring and evaluation activities, in consultation with the PM, to improve the disease transmission interventions in endemic woredas.

30.   Write a monthly report to the PM and SCR, detailing activities, highlighting issues that need resolution, and making recommendations for actions to be taken. The tone of these reports should be objective and respectful and written in a way that enhances the probability of thoughtful consideration by the recipients. This monthly report is also shared with the GW Associate Director.

31.   Submit monthly calendar to PM/AD.

32.   Keep track of response to and actions taken on recommendations.

33.   Keep the PM and SCR apprised of the status of the programs, obstacles overcome, obstacles to progress that remain, and recommendations to overcome those obstacles. Actively seek their guidance, technical assistance, or direct involvement in issues as you consider would be helpful.

34.   Advocate at National, State, Woreda and Kebele levels for the need to halt all transmission of GWD immediately and encourage their support, particularly for the provision of safe sources of water to endemic villages. Promote the role that each level needs to play to help the EDEP achieve the objective, including the roles of all villagers, i.e., to always filter their drinking water, and to keep individuals with emerging worms from contaminating sources of drinking water.

B.      Provide a written report to The Carter Center Director, Dracunculiasis Eradication, for approval and distribution to The Carter Center’s Vice President (Health), SCR in Ethiopia, PM, Atlanta-GWEP AD and EDEP Coordinator within two weeks of the conclusion of your contract, detailing activities undertaken during the consultation and recommendations to The Carter Center for future action. This report also should be objective and respectful and written in a way that can be shared with all parties for consideration. This report should contain the following:

1.       Description of consultation (for example: problems solved, places visited, etc.). You have been sent to help solve problems, not just describe them or to only make recommendations to others.

2.       Recommendations. Put these in priority order. Be careful of making too many. Make sure you address the recommendations to those who need to take action.

3.       Information about your itinerary, terms of reference, persons met, etc., in an appendix.

 

This report should also include the following specifics about GWD:

1.       Describe the local epidemiology of, and status of surveillance for cases of GWD in formerly endemic districts (# of cases, changes in # of cases during a comparable period, etc.).

2.       Describe the current status of interventions with regards to formerly endemic districts:

a.       Discuss each intervention in turn: filter coverage, Abate, water supply, health education, case containment, etc.

b.       Include the updated line listing for villages in the area of your consultation.

 

C.      Before departing, debrief with PM and SCR and with the National, State, and Woreda EDEP team leaders as indicated. Detail your findings and provide recommendations for future action. This report also should be objective and respectful and presented in a way that is respectful to all partners.

D.     Specific assessments, data analysis, reports, presentations, and technical projects may be assigned to TAs in discussions with PM, AD, and SCR.

E.      Other duties as assigned.