Exactly 1 month left here in Togo as a Peace Corps volunteer…pretty weird. I can’t believe it. Surprisingly I’m not sad about leaving I’m ready to go because I feel accomplished. Sure I haven’t done everything I wanted to do, but I’ve done enough. There are still a couple of additional projects that I hope I can accomplish before I leave, but if not I think I’ll be satisfied. A big reason I feel this way, though, is because of a big project that I’ve been working on, the official name is:
After I came back from the malaria conference in Senegal, Stomp Out Malaria, I created a malaria committee here with the PCVs here in Togo. I first called it the Malaria Coordinating Committee, but I didn’t think it was catchy enough so I changed it to the Malaria Action Committee or MAC. Volunteers applied to become part of MAC and my plan was to have 2 volunteers per region to provide on the ground support to the PCVs doing malaria activities.
Side note: There now are “6” regions here in Togo because they recently split up Maritime into Lomé Commune and Maritime. To break it down for you, in order from South to North, we have Lomé Commune, Maritime, Plateaux, Centrale, Kara and Savanes. I still, however, refer to Togo as only having only 5 regions because other Togolese refer to Togo as only have 5 regions...sorry, it's a little confusing, changes take awhile to take affect here.
"Rapid Household Evaluation of the 2011 Integrated Campaign LLIN Distribution Component in Togo", which means that it is a national survey of the last mosquito net distribution in 2011 by the non-governmental organization, Plan Togo. The project mobilized 201 Togolese and Peace Corps volunteers to survey 197 villages and 6,015 households all throughout the country from Maritime to Savanes. With this survey we ended up counting 35,215 Togolese and 18,805 mosquito nets and finding a wealth of information about mosquito net use. Here is a little of the history of how I became Project Manager of this national project.
After I came back from the malaria conference in Senegal, Stomp Out Malaria, I created a malaria committee here with the PCVs here in Togo. I first called it the Malaria Coordinating Committee, but I didn’t think it was catchy enough so I changed it to the Malaria Action Committee or MAC. Volunteers applied to become part of MAC and my plan was to have 2 volunteers per region to provide on the ground support to the PCVs doing malaria activities.
Side note: There now are “6” regions here in Togo because they recently split up Maritime into Lomé Commune and Maritime. To break it down for you, in order from South to North, we have Lomé Commune, Maritime, Plateaux, Centrale, Kara and Savanes. I still, however, refer to Togo as only having only 5 regions because other Togolese refer to Togo as only have 5 regions...sorry, it's a little confusing, changes take awhile to take affect here.
I felt that the first thing we should do is get an understanding of the malaria status here in Togo. The data that is available on malaria is meager at best and the data that is available I find very untrustworthy knowing how Togolese health workers do surveys here. In addition to announcing that we would be accepting applications for MAC, at Mid-Service Conference (MSC is 4 days of technical and administrative training, just to keep PCVs who have been in Togo for 1 year up-to-date with policies and have PCVs come back and discuss within their sector of how projects went), at the same time I also asked people to complete a survey I had designed. I later presented about malaria, MAC and the survey to the new PCVs who had just gotten into the country at their Pre-Service Training (PST).
The survey was twofold, 1. Figure out what really is the malaria situation in Togo. 2. Create a baseline survey of bed net use and malaria knowledge so that volunteers know what they can focus on when they do trainings and activities in regard to malaria. I’ll admit that it pretty much failed. 1. The timing was terrible. It was during the holidays (American holidays) and a lot of volunteers were travelling. 2. The survey questions were not specific enough. 3. There was no survey training. I just stood up in front of everyone and said this is how it should be done, but no practice. This problem could have been mitigated somewhat, though, if there was a survey kit with very clear instructions and all the materials for the survey. I did send an email with directions but nothing was printed out. 4. Saying that the survey was mandatory I think backfired somewhat as well. Some volunteers didn’t like hearing that and didn't do it. However, on the plus side, the people who who were new PCVs found the survey invaluable because it forced them to meet members of their village. It provided PCVs with a clear and concrete activity that they could easily complete in their first month or so at post. For this and the fact that I learned how to create an effective survey and provided me with invaluable experience in motivating people. Yes, it could have been better but I see it as at least I tried something and if anything it got volunteers thinking about malaria and malaria control.
The survey was twofold, 1. Figure out what really is the malaria situation in Togo. 2. Create a baseline survey of bed net use and malaria knowledge so that volunteers know what they can focus on when they do trainings and activities in regard to malaria. I’ll admit that it pretty much failed. 1. The timing was terrible. It was during the holidays (American holidays) and a lot of volunteers were travelling. 2. The survey questions were not specific enough. 3. There was no survey training. I just stood up in front of everyone and said this is how it should be done, but no practice. This problem could have been mitigated somewhat, though, if there was a survey kit with very clear instructions and all the materials for the survey. I did send an email with directions but nothing was printed out. 4. Saying that the survey was mandatory I think backfired somewhat as well. Some volunteers didn’t like hearing that and didn't do it. However, on the plus side, the people who who were new PCVs found the survey invaluable because it forced them to meet members of their village. It provided PCVs with a clear and concrete activity that they could easily complete in their first month or so at post. For this and the fact that I learned how to create an effective survey and provided me with invaluable experience in motivating people. Yes, it could have been better but I see it as at least I tried something and if anything it got volunteers thinking about malaria and malaria control.
This set the groundwork for the next survey. So around the time that I was receiving the baseline malaria surveys, Ismael (the APCD of CHAP: the Associate Peace Corps Director of Community Health Aids Prevention…in other words the boss of the health program for Peace Corps Togo. He went with me to the Senegal malaria conference) and I chose members of MAC and nearly achieved the 2 volunteers per region that I wanted. MAC had its first meeting and we spent all day from 7:30am to 8 or 9pm at night taking only brief breaks for lunch and dinner and then again in the morning we spent 3 hours finalizing everything. We came up with our mission, goals and objectives of the committee and everyone's roles and responsibilities in MAC. It was going great and we were revising the botched survey as well, writing up a budget and creating a survey kit. We were going to apply for a grant to create a survey kit and send it to each volunteer and that’s when a couple things happened at once.
First, around February 2012, Peace Corps Togo was called in to a meeting with all the top humanitarian aid organizations here in Togo, World Health Organization, PLAN, Red Cross, UNICEF, National Malaria Control Program (in French PNLP), and the Ministry of Health of Togo (PNLP is kind of under the Ministry of Health as well). They announced that they would like us, Peace Corps Togo, to do a nationwide evaluation of the outcome of the last mosquito net distribution that PLAN had executed using Global Fund money. The distribution was to achieve the goal universal coverage of mosquitoes with the ratio of 1 net per 1.8 people and it cost millions and millions of dollars. They needed an independent evaluator and would fund the entire survey. All we had to do is come up with a budget, Terms of Reference and present it to them. I was excited. If we executed the survey well and showed that we could be depended upon for such a large scale project who knows what kinds of doors this could open for Peace Corps Togo. It was the first time that this had ever happened for Peace Corps Togo, that these aid organizations enlisted our help for evaluating a project and such a large project at that. Immediately I started designing a survey with input from the other members of MAC and Stomp Out Malaria admin people. Then, I got into a moto accident that had me recuperating for a couple weeks so that slowed down progress. In addition, there was no update from the aid organizations. They didn't give us any indicators to look for or even questions to ask on the survey, we were left in the dark and it was pretty frustrating. So after I got a little better we sent in an example survey. That started the ball rolling a little a faster and they sent back the start of a Terms of Reference listing their desired indicators.
It was around this time that I moved down to Lomé and started working in Plan as Project Manager of this bed net evaluation project. It turned out that Plan Togo was the recipient of the Global Fund money and they were the ones who actually executed the mosquito net distribution. This I didn't know for an embarrassingly long period of time. I thought it was WHO because they were the organization during the preliminary meeting that did most of the talking and asked us to do the evaluation. Plan, WHO and UNICEF were the ones who funded the evaluation. In addition, Plan set me up with an office and a work laptop to use at their Lome office. It is a really nice place with air conditioning and an awesome bathroom…you really come to appreciate these things in Togo. Also everyone loves their work here, that's the best part. You don't really see that very often in Togo, except in Peace Corps. It’s awesome. I’ve also become good friends with the director. He is actually a previous Peace Corps volunteer who served in the Dominican Republic during the 70s so it has been really fun getting to know him. I hope that Peace Corps volunteers can continue to work for Plan in some capacity as I think it is a great working environment.
So over the course of a few months, myself and with two other PCVs, Liz and Abby, we revised and presented then revised and presented again the Terms of Reference, survey and budget. I have to admit it was pretty frustrating because we had very little guidance. Earlier on we should have been more demanding about what indicators they wanted and the structure of the survey, but we waited for them to tell us what they wanted. However, everything turned out ok in the end although it did feel pretty rushed. We were also very conscious of the budget and in retrospect spent a lot more time than we should have. We are in the Peace Corps mindset and Peace Corps doesn’t nearly have the budget that these aid organizations have. It was an interesting insight into the world of large scale development projects in Togo. I really appreciated the opportunity that was afforded to us.
It was also awesome to have Liz and Abby on my team. Abby gave me her expert French abilities and Liz her health statistic abilities. Both have a background in health and are currently going for a MPH through a program called Master International where they get some of their university requirements filled by doing Peace Corps. Pretty cool. I literally wouldn't have been able to do it without them. It has been a lot of work and is still continuing. It was really essential working for Plan while doing this project as it made just logistics so much easier. They have done these kinds of huge, nationwide projects before and have supply chains already in place such as t-shirt makers, printers, etc. Also when I needed information about the distribution I was already there and could ask them about. It was an independent evaluation so they couldn't help me do the actual work, however it is a shame it took me awhile to get down to Lomé because I started working for Plan after we already wrote our Terms of Reference and did our budget and their advice on prices would have made things go a little smoother I think. Still, it all went really well.
First, around February 2012, Peace Corps Togo was called in to a meeting with all the top humanitarian aid organizations here in Togo, World Health Organization, PLAN, Red Cross, UNICEF, National Malaria Control Program (in French PNLP), and the Ministry of Health of Togo (PNLP is kind of under the Ministry of Health as well). They announced that they would like us, Peace Corps Togo, to do a nationwide evaluation of the outcome of the last mosquito net distribution that PLAN had executed using Global Fund money. The distribution was to achieve the goal universal coverage of mosquitoes with the ratio of 1 net per 1.8 people and it cost millions and millions of dollars. They needed an independent evaluator and would fund the entire survey. All we had to do is come up with a budget, Terms of Reference and present it to them. I was excited. If we executed the survey well and showed that we could be depended upon for such a large scale project who knows what kinds of doors this could open for Peace Corps Togo. It was the first time that this had ever happened for Peace Corps Togo, that these aid organizations enlisted our help for evaluating a project and such a large project at that. Immediately I started designing a survey with input from the other members of MAC and Stomp Out Malaria admin people. Then, I got into a moto accident that had me recuperating for a couple weeks so that slowed down progress. In addition, there was no update from the aid organizations. They didn't give us any indicators to look for or even questions to ask on the survey, we were left in the dark and it was pretty frustrating. So after I got a little better we sent in an example survey. That started the ball rolling a little a faster and they sent back the start of a Terms of Reference listing their desired indicators.
It was around this time that I moved down to Lomé and started working in Plan as Project Manager of this bed net evaluation project. It turned out that Plan Togo was the recipient of the Global Fund money and they were the ones who actually executed the mosquito net distribution. This I didn't know for an embarrassingly long period of time. I thought it was WHO because they were the organization during the preliminary meeting that did most of the talking and asked us to do the evaluation. Plan, WHO and UNICEF were the ones who funded the evaluation. In addition, Plan set me up with an office and a work laptop to use at their Lome office. It is a really nice place with air conditioning and an awesome bathroom…you really come to appreciate these things in Togo. Also everyone loves their work here, that's the best part. You don't really see that very often in Togo, except in Peace Corps. It’s awesome. I’ve also become good friends with the director. He is actually a previous Peace Corps volunteer who served in the Dominican Republic during the 70s so it has been really fun getting to know him. I hope that Peace Corps volunteers can continue to work for Plan in some capacity as I think it is a great working environment.
So over the course of a few months, myself and with two other PCVs, Liz and Abby, we revised and presented then revised and presented again the Terms of Reference, survey and budget. I have to admit it was pretty frustrating because we had very little guidance. Earlier on we should have been more demanding about what indicators they wanted and the structure of the survey, but we waited for them to tell us what they wanted. However, everything turned out ok in the end although it did feel pretty rushed. We were also very conscious of the budget and in retrospect spent a lot more time than we should have. We are in the Peace Corps mindset and Peace Corps doesn’t nearly have the budget that these aid organizations have. It was an interesting insight into the world of large scale development projects in Togo. I really appreciated the opportunity that was afforded to us.
It was also awesome to have Liz and Abby on my team. Abby gave me her expert French abilities and Liz her health statistic abilities. Both have a background in health and are currently going for a MPH through a program called Master International where they get some of their university requirements filled by doing Peace Corps. Pretty cool. I literally wouldn't have been able to do it without them. It has been a lot of work and is still continuing. It was really essential working for Plan while doing this project as it made just logistics so much easier. They have done these kinds of huge, nationwide projects before and have supply chains already in place such as t-shirt makers, printers, etc. Also when I needed information about the distribution I was already there and could ask them about. It was an independent evaluation so they couldn't help me do the actual work, however it is a shame it took me awhile to get down to Lomé because I started working for Plan after we already wrote our Terms of Reference and did our budget and their advice on prices would have made things go a little smoother I think. Still, it all went really well.
So in a nutshell this is what the project entailed. As I mentioned before, the main objective of this project is to find the effectiveness of the last bed net distribution which was executed in 2011. We developed a rapid household survey in order to keep project expenses down and quickly get the results of the survey. We asked for around $23,000. With that money we chose Peace Corps volunteers in each region to attend a 1 day training in their region along with 2 or 3 host country nationals who would help in this survey. The training consisted of learning about the importance of a survey, the importance of correct results and how to do our survey correctly. We also gave everyone a survey kit contained in an 80 page manual that had instructions, explanations, visual aids and the survey already printed out for each household. In addition we gave each person a colored shirt and vest to distinguish themselves from everyone else and professionalize the surveying. The Peace Corps volunteer was the one in charge of submitting the results of the survey electronically using a data input program that I wrote in Microsoft Excel that made it easy to input the the survey data. The program opened up a userform where people would input the survey data of one household after another. Abby, Liz and I unfortunately did have to do a number of them ourselves because it wouldn't run on macs or even certain windows computers, but only 20% of surveys.
Each person who attended the training was in charge of surveying one village, this included the PCV. We required that for the first village everyone would go together and the volunteer would be the one to do the survey. Then two HCNs would go to the next village and then after that two people would go to the next and so on. Each team of 3 (including a PCV) would be responsible for surveying 3 villages, teams of 4 would survey 4 villages and so on. The reason for the different size of teams was based on the amount of volunteers in that region and the population of that region. Abby and Liz chose the villages that were surveyed. They made the survey sites as random as they could including small to large villages in the sites. Each survey consisted of 30 households and took on average 7 to 10 hours to complete.
Each person who attended the training was in charge of surveying one village, this included the PCV. We required that for the first village everyone would go together and the volunteer would be the one to do the survey. Then two HCNs would go to the next village and then after that two people would go to the next and so on. Each team of 3 (including a PCV) would be responsible for surveying 3 villages, teams of 4 would survey 4 villages and so on. The reason for the different size of teams was based on the amount of volunteers in that region and the population of that region. Abby and Liz chose the villages that were surveyed. They made the survey sites as random as they could including small to large villages in the sites. Each survey consisted of 30 households and took on average 7 to 10 hours to complete.
All the trainings went along without a hitch which we were thankful for, but there were always things to improve upon and I believe primarily because we had less than a month to execute a national project. We didn’t get the funding till a month before all these training were supposed to happen and literally 3 days before our first training which trained the Togolese in each region who were doing the training. This coupled with transportation and just organizing things quickly in Togo while culturally it is so laid back here being and French not being our first language and it not the first language of the majority of Togolese it was pretty amazing that we were able to pull this off. We weren’t able to push back the project till later because not only would it be when volunteers were COSing and new volunteers were coming in, it also would put the surveying to be executed during the heart of rainy season, making it difficult to travel and do the work.
Overall, everything turned out great. We had a 100% of volunteers who we asked to particpate in the survey completed the survey which was pretty awesome. We have compiled the results now and while Plan did not achieve the 1 net to 1.8 people ratio then needed to accomplish the goal of universal coverage they did do an amazing distribution and the knowledge of what bed nets are used for and the importance of bed nets is 90.9%. I will try to add a link later to the stats and the paper if I can.
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