1. SMC in GHANA: current status & lessons learnt
JAMES FRIMPONG, PROGRAMME OFFICER
NMCP, GHANA

2. GHANA: operational map
2015 Implementation
Upper West Region (11 Districts)
Operational funds provided by the Global Fund
Medicines provided by DFID
Door-to-Door Approach
Trained Community Volunteers
4 Rounds of dosing

3. GHANA: operational map
2016 Implementation
Upper West and Upper East Regions (11+13 Districts)
Operational funds provided by the Global Fund
Medicines provided by DFID
Door-to-Door Approach
Trained Community Volunteers
2 Rounds of dosing

4. Ghana: Funding map Partner/Districts covered 2016 2017 2018 Comments
Number Eligible Districts* 24
All the districts in UE&UW
The Global Fund -
GF provided operational funds and medicines
DFID 11
Procured the medicines for 2015 and 2016
Govt
Total funded
Unfunded
* By WHO criteria

5. Ghana: Targets & coverage
Target number of children
Administrative coverage results
Severe Adverse Events reported
2015
2016
3-11 months
24,685
61,128
23,253
45,010
12-59 months
123,423
305,639
116,264
258,009
Total
148,107
366,767
139,517
303,019
152
313
Other comments: Specifically, this represents 70% of targeted children in 2016 as against 94.2 % in 2015

6. GHANA: Lessons learnt Training - I Numbers Trained 2015 2016 Comments
Trainers 30 64
These include National, Regional and District level staff and it is cumulative for the two years. Training cascades
Supervisors
280
652
Health Facility Workers
325
780
Community Health Workers
2500
5300
Public announcers and other mobilisation actors 14
Total trained
3,149
6,826

7. GHANA: Lessons learnt
Training – II (max 1 page + 1 page with sample pictures if appropriate)
Training was done in a cascading mode, national-regional-district-sub- district/community
This helps to train more people in a shorter time
However, the quality of training reduces down the line
Impact of the training reflects in the volunteer performance
Solution
Supervision by national trainers helps to improve performance of trainers
Use of pictorial job aides helps improve understanding
Involvement of regional and district staff creates a sense of ownership staff
Potential issues may include:
- Minimum standards, coordination and harmonization
- Key training levels / tools
- Capacity gaps
- Review and evaluation processes

9. GHANA: Lessons learnt
Door-to-Door approach was used in all instances, fixed approach gives impression of the usual facility based services, care givers choose to go at will and may prolong dosing schedule-
This helped to ensure maximum coverage in the given period
It helps improve on other disease surveilance
Community members did not have to travel, no excuses of raining, etc
Volunteers chose flexible times to ensure they reach households
For a fixed position, volunteers/health workers will have to wait without knowing if caregivers are coming or not
Door to Door also helps to identify kids who are in the community and those who had travelled out
Door-to-Door also helps to validate community population

10. GHANA: Lessons learnt Delivery approaches – II
Protective clothing for the Volunteers-eg rain coats, wellington boots
Torch lights, plastic bags, zip-locked plastic envelopes to hold medication etc
These should be factored into the resource mobilization
Need to be budgeted for
Could be considered as part of volunteer motivation
Potential issues for consideration may include:
- Explanation about the choice for specific approach choices
- Key constraints / challenges
- Integration within existing networks / systems (CHWs / health workers)
- Motivation issues
- Review and evaluation processes (monitoring, supervision, daily coverage analysis)

11. GHANA: Lessons learnt Eligibility and referrals
Age determination must be cross-checked with the child’s health record books (Road to Growth)
There is the need to thoroughly question the child’s health status and medication history
Complete explanation of the exercise and its benefits is very important
The risk of taking the doses without considering existing medication should be well explained to caregivers
Supervisors can play a leading role by reviewing the child health records if available
Ineligible children due to ill health should be referred to identified facilities with relevant diagnostic tools and personnel to manage
All health facilities were told to manage ADRs free of charge
Potential issues for consideration may include:
- How it worked in country
- Issues with age-setting
- Role of health facilities
- Availability of RDT and treatment
- How many children were ineligible (% of target) / Common reasons

12. PV and safety monitoring
GHANA: Lessons learnt
PV and safety monitoring
Pharmacovigilance was implemented together with the FDA
Teams were formed around FDA trained Institutional Contact Persons
Volunteers were given instructions to report any ADR to their supervisors (HWs) who helped complete the ADR forms
All ADR forms were sent to the Regional FDA office for transmission to Accra
A major challenge is differentiating regular occurrences such as vomiting or spitting from real ADR
Misunderstanding ADR to be only life threatening conditions
These result in under-reporting of ADRs

13. GHANA: Lessons learnt Monitoring, supervision & evaluation of reach
Tools provided in the WHO Field Guide were adopted, modified and used
Periodic review was necessary to achieve final tools
Daily meeting with volunteers was helpful in identifying difficult issues for addressing
To ensure that each child receives the 4 cycle dose, the same register is used during a round
To verify parents administer the dose, volunteers inspect the blister and conduct key informant interviews with neighbours
District Malaria Focal Persons transmitted daily coverage to the Regional office, this helped identify areas in need of attention and additional support
Potential issues for consideration may include:
- Appropriateness of tools (provide summary of key monitoring and supervision minimum tools)
- Fitness-for-purpose, challenges and constraints
- In-process monitoring and how data are used / not used to inform implementation
- Supervision processes and gaps
Quality assurance:
How do you make sure children are reached 4 times?
How do you assess adherence to home doses?
Cross-checking age targets
- Existence and reliability of coverage surveys or other surveys
- Impact assessment (is there any?) and evaluation gaps

14. Country XX: Lessons learnt
Key messages / recommendations / conclusions
(max. 2 pages)
Social/community mobilization is essential for acceptance and success
Early identification of key stakeholders is very important-partners go beyond actors in the health service;
Procurement of SPAQ must be initiated early-8mths to 1 year ahead!
Supervisors must be well trained and committed
Volunteers should be sufficiently motivated-financially and morally
The challenges of SMC implementation are enormous but the benefits make it worth the efforts
Please consider:
- Proxy measures of success (evidence of reduction of cases, feedback from health workers, etc.)
- Beneficiary perceptions (positive, neutral, negative) (Quote from the end of cycle rapid surveys where available)
- What key message from country on the future of SMC implementation? How to sustain financial investment?
- Expected short-term and mid-term challenges
- Other points to be raised / open questions / recommendations / points of advocacy

15. ACKNOWLEDGEMENT GFATM DFID GOG The WHO-Country Office
Sub-Regional Partners-WAHO, W/CARN
The Regional Health Directorates-UWR &UER
FDA National and Regional Offices

16. THANK YOU