5.5

London School of Hygiene & Tropical Medicine

Skip to 0 minutes and 13 secondsBy the end of this presentation you should: - Understand the principles of decision making for trachoma interventions and monitoring of progress - Appreciate the importance of the data flow from the district to the national trachoma task force Virtually all the decisions made during implementation and monitoring of trachoma control activities are based upon data. The data comes from surveys and programmes and is used to decide on interventions. Trachoma control activities in an endemic district

Skip to 0 minutes and 42 secondsaim to achieve two elimination targets by the year 2020: - First, managing trachomatous trichiasis (TT). How many trichiasis surgeries do we need to do to get rid of the TT backlog and how long will it take to achieve the elimination target of less than 1 trichiasis case per 1000 population - Second, reducing active trachoma. How many mass drug administration (MDA) cycles are required? How many antibiotics? And how long will it take to achieve a prevalence of TF less than 5% in children aged 1 to 9 years old? Activities for F&E - facial cleanliness and environmental improvements - vary from place to place, and have locally agreed targets and indicators for monitoring.

Skip to 1 minute and 26 secondsThese are not bound to the trachoma elimination timeline of 2020. Let's start with the management of trichiasis. The target number of trichiasis surgeries that each district needs to do is established in the national trachoma action plan. This target is called the Ultimate Intervention Goal (or UIG). The UIG equals the TT backlog minus the allowable number of people with TT to achieve the elimination target. That is less than 1 case per 1000 people. Let's look at an example. District X has a population of 510 000 over the age of 15. We know - from mapping - that the estimated TT backlog is 1600.

Skip to 2 minutes and 9 secondsWe calculate the allowable number of people with TT by multiplying the population aged over 15 by the elimination target for TT prevalence - 1 in a thousand or 0.001. In district X this equals 510. So we can calculate that the UIG for district X is 1600 minus 510. This equals 1090. This is the minimum number of surgeries that must be done in the district by 2020. Annual targets for trichiasis surgery, also known as annual intervention objectives - AIOs - are calculated based on the UIG. The global minimum TT surgery target for outreach is 15 people per surgeon per surgical day. The annual number of surgical outreach days must be considered when calculating the AIO. It is important to be practical!

Skip to 3 minutes and 3 secondsThe district trachoma manager is responsible for the UIG district target and reports back annually to the national coordinator on achievement. In our District X for a UIG of 1090, the calculation is 1090/15. This equals 73 surgical days required. In District X it is only possible currently to do between 20 and 30 surgical days each year.

Skip to 3 minutes and 29 secondsThe district manager therefore sets the targets as follows: - In 2017, 300 surgeries with 1 team - In 2018, 600 surgeries with 2 teams - In 2019, 200 plus surgeries. Using this plan, the district will exceed their UIG by the end of 2019. It is important to monitor progress each year against the established annual target. Data can be used to motivate and encourage the team's progress as well give feedback and support. Managers should not wait till the end of the year to provide feedback. Each team should be aware of how they are progressing each quarter. Managers can use a range of process indicators

Skip to 4 minutes and 12 secondsto help monitor progress towards achieving targets: - Number of surgeries per outreach, per surgeon - Quality of surgeries provided per surgeon - Acceptance rate for surgeries at outreach campaigns. At the national level, the annual reports on the UIG per district are discussed. If a district is on track then the team is congratulated. If the district is not on track, the district manager is asked to provide the key reasons and to give the team more support. The national task force should always ensure that district teams are provided with the appropriate resources, training and surgeon accreditation.

Skip to 4 minutes and 49 secondsManagement of active trachoma requires data on: - Antibiotic coverage of the population. Ideally everyone in the population is treated, but a minimum coverage of 80% is acceptable - Number of antibiotic doses dispensed. This figure is reported back to ensure further requests to Pfizer - the drug donor - are appropriate. District managers work closely with the MDA teams. They use microplanning to ensure that each MDA will reach 80% or more of the target population. When coverage is less than 80%, it is important to identify and take practical decisions in the field to address the problem. At national level the data is closely followed each year.

Skip to 5 minutes and 30 secondsAfter the planned A, F and E activities for the required number of years have been completed, an impact survey should be undertaken to determine if TF has dropped below 5%. If not, then the A, F and E activities are continued. If TF is found to be less than 5% MDA is stopped but F&E activities are continued for a 2 year period which will, ideally, continue to see TF fall. After this, a surveillance survey should be undertaken to confirm that active trachoma has not re-emerged. The use of data is like regularly measuring progress

Skip to 6 minutes and 5 secondson a journey: - How much petrol have we used so far? - How far have we gone? How far do we have to go? - Finally, did we get to the right destination on time as we planned, or not?

Skip to 6 minutes and 17 secondsIn trachoma elimination, national coordinators must: - Implement a clear process for collecting and sharing data, either on paper or electronic format - Provide training and guidance for district managers on the data required, and on how to collect and report on it - Include feedback mechanisms from the same level at which the data is collected - Use data to measure progress and to motivate, support and encourage the teams - Use data to secure resources and finances for the districts.

Skip to 6 minutes and 46 secondsIn summary: - Data is used to guide planning, implementation and management decisions for the district level trachoma team - Data must be shared by the district team with the national coordinator for provision of support, resources and guidance - Targets for TT surgeries and antibiotic distribution are agreed in planning meetings for the national Trachoma Action Plan - The national Trachoma Action Plan is a living document. It tracks and adjusts for annual data, identifies gaps and updates progress towards elimination.

Using data to make decisions at the local level

The strategic drivers to eliminate trachoma at the local level are based on data.

Data is used to:

• Know where, and how big, the problem is
• Develop an appropriate Trachoma Action Plan at a national level
• Advocate with local stakeholders
• Ensure resources (both human and infrastructure) and finances are appropriately allocated at district level
• Track and monitor SAFE implementation against a timeline for elimination by 2020
• Assess the outputs and achievement of elimination targets through further surveys

As you watch the video consider how data can be used to motivate a district team to maintain implementation of SAFE and scale up services.