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Trachoma Action Plans

In this step we explore how Trachoma Action Plans create a meaningful intervention with a purposeful national goal – to eliminate trachoma.
Trachoma Action Plans
By the end of this presentation you should be able to explain: The key elements of Trachoma Action Plans (TAPs). And how TAPs guide trachoma interventions at the national, district and community level A trachoma action plan (TAP)
is a tool that a country can use to: - Meet its specific need to eliminate trachoma, and - align this with strategic plans for health, water, sanitation, education and community development. Large countries may produce sub national TAPs. A TAP is a realistic, strategic plan for eliminating trachoma as a public health problem.
A TAP is: - Evidence based - It uses current scientific knowledge to develop local approaches for SAFE interventions. - Data-driven - Decisions on where and how to intervene are based on data from the most recent local prevalence surveys. - Locally owned - The plan is developed through discussion and agreement between local stakeholders. For example on how to carry out mass drug administration. - Practical - A TAP takes a step-by-step approach, starting at the district level. It is is used to set targets and plan appropriate activities to achieve them. - And lastly, a TAP is periodically updated - to take account of new developments. When to do a TAP.
A TAP often begins after baseline mapping of suspected trachoma-endemic areas reveals information which was previously unknown to a country’s health system. A TAP is needed if one or more of the mapped evaluation units
has: - A prevalence of TT (trachomatous trichiasis) of greater than 0.2% of all adults aged 15 years and above. - Or, a prevalence of TF (trachomatous inflammation–follicular) of 5% or greater in children aged 1 to 9 years. Who is involved in a TAP?
A typical TAP meeting will involve : - Trachoma leaders from the Ministry of Health. - Trachoma programme district managers. - Stakeholders from non-governmental sectors which are working to support specific elements of the SAFE strategy. - External facilitators to guide the participatory process. Ideally, the number of participants should be less than 30. A TAP has four key purposes
One, to calculate, district by district: - The number of people who need trachomatous trichiasis surgery in order to reach the trachoma elimination goal. - The number of people who need interventions for antibiotics, facial cleanliness, and environmental improvement, and for how long. - Two, to establish a programme of specific activities at national, regional and district level, to reach the people identified. - Three, to assess the programme’s resource needs and gaps. - Four, to determine when impact surveys and surveillance surveys will be required. Ideally, a TAP workshop is undertaken over five days. - The first two days are for planning surgery interventions for
trachomatous trichiasis: the S component of the SAFE strategy. - The last three days are for planning interventions to eliminate
active trachoma: the A, F, E components of the SAFE strategy. TAP workshop participants for the first two days will not necessarily all be the same as those needed for the last three days. - Planning interventions against trachomatous trichiasis requires ophthalmic personnel. - Planning interventions against active trachoma requires those engaged in mass drug administration, together with individuals from the water, sanitation and hygiene, and education sectors. Trachoma programme managers should attend the whole week. All the workshop participants need to actively engage in developing a strong Trachoma Action Plan. The workshop relies heavily on group work to solve problems and make recommendations for the actions to be taken to move the country toward its trachoma elimination goal.
The resulting TAP should clearly set out what needs to be done, by whom, and by when. Let’s look at an example of a Trachoma Action Plan. Kenya was one of the first countries to do a TAP in 2011.
They created a strategic document which identified: the magnitude and locations of active trachoma and trachomatous trichiasis, known resource gaps, opportunities and partners, realistic targets. This information was used to develop a detailed district-by-district roadmap for SAFE interventions. Trichiasis surgery was provided at community level and mass distribution of antibiotics was undertaken. F and E interventions were implemented through collaboration with the water and irrigation ministry to provide boreholes. And progress was made towards community led total sanitation.
Two years later, in the Narok district it was found that: - Active trachoma prevalence had decreased from 30.5 to 11%. - Trachomatous trichiasis prevalence had decreased from 2.3 to 0.9%. It’s important to remember that any Trachoma Action Plan is a living document. It needs to be updated periodically, as new data become available, as situations change and new opportunities and threats present themselves. For more information, please see the ‘Trachoma Action Planning’ guide, which is available to download from the internet.
In conclusion, a Trachoma Action Plan: - Is developed at national level by local stakeholders who determine the need for public health level interventions based on the most recent data. - Is based on agreements and partnerships to deliver specific targets for specific interventions, district by district. And it is a ‘living document’ that is updated periodically, based on achievements and opportunities.

Mapping provides authorities with the evidence of where public health-level interventions are needed to eliminate trachoma. It also triggers the recognition that effective and efficient planning must be initiated at the national level. This is a critical step, creating a meaningful intervention with a purposeful national goal – to eliminate trachoma, district by district.

A national Trachoma Action Plan (TAP) is usually developed during a 5-day workshop. The workshop is participatory, which means everyone who has a stake in an intervention is given a voice to decide together and act together.

National planning is guided by local data

A Trachoma Action Plan will accomplish the following:

Outline the path to trachoma elimination (with a nationally-appropriate target date)

  • Use mapping data to generate annual milestones for implementation.
  • Highlight gaps between current service delivery data and annual targets needed to reach elimination.

Develop the messages necessary for advocacy

  • Provide metrics to generate compelling statements regarding needs and benefits.
  • Clearly articulate actions and resources needed to reach elimination.

Drive stakeholder alignment

  • Bring together interested parties in a collaborative planning process.
  • Guide country leadership in critical evaluation of existing partner support and stakeholder activities.

As you watch this video ask yourself: What documents and data need to be compiled by the national trachoma coordinator (MoH level) before the TAP workshop to ensure that the workshop would be successful?

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Eliminating Trachoma

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