ASCEND LEARNING BRIEF Applying Risk Assessment And .

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ASCEND LEARNING BRIEFApplying Risk Assessment and MitigationAction tool to safely restart NTD activitiesAscend is managed geographically in two lots. Lot 1 focuses on 11 countries in East and SouthernAfrica and South Asia. Lot 2 focuses on 13 countries in West and Central Africa. Both Lots gratefullyacknowledge the financial support provided by the UK Foreign Commonwealth and DevelopmentOffice (FCDO) to fund the Ascend programme.Lot 1:Lot 2:

ContentsAcronyms . 11.Background . 22.Introduction to RAMA . 23.Taking a deep dive to learn and adapt . 44.Lessons from the field . 55.Opportunities and recommendations . 8Concluding remarks . 0Acknowledgements . 0AcronymsBCCBehaviour change communicationCDDCommunity drug distributorsIECInformation, education and communicationM&EMonitoring and evaluationMDAMass drug administrationMMDPMorbidity management and disability preventionMoHMinistry of HealthNGONon-Government OrganisationNTDsNeglected tropical diseasesPPEPersonal protective equipmentSOPsStandard operating proceduresRAMARisk Assessment and Mitigation ActionVLVisceral leishmaniasisWHOWorld Health OrganisationLearning Brief - RAMA March, 2021 1

1. BackgroundSince 27th July 2020 with the release of interim guidance from WHO, countries have been working towardssafely resuming neglected tropical disease (NTD) activities following an almost four month recommendedpostponement of community-based surveys, active case-finding activities, and mass treatment campaigns forNTDs. The guidance proposed a two-part decision-making framework: part 1 was a risk-benefit assessmentcarried out by the governments to decide if the planned activity should proceed; and part 2 was anexamination of a list of measures that should be applied with the aim of decreasing the risk of transmission ofCOVID-19 associated with the activity. Working with various non-government organisations (NGO) andgovernment partners, the Ascend programme quickly adapted to navigate this uncertainty. This meant thatcountries wishing to restart NTD activities could be accommodated by creating a process that gave them thebest chance of doing so successfully. By adapting an existing WHO risk assessment tool for mass gatherings,the Ascend Lot 2 programme was able to specifically address key considerations for NTDs.The Risk Assessment and Mitigation Action (RAMA) tool was developed by Sightsavers in collaboration withpartners working in NTDs who identified the need for a systematic assessment of the risk posed by the COVID19 pandemic against the country specific context. The tool has been through several iterations and pilots.This learning brief shares the experiences of applying the RAMA process across different countries.Similarities and differences offer key learnings for current and future risk management in national NTDprogrammes. Suggestions provide potential for further adaptation and application in countries where NTDactivities are implemented.2. Introduction to RAMAA comprehensive risk management process was developed to ensure compliance with the WHO guidance,including close monitoring of COVID-19 trends, independen

indicates desire to resume NTD activities. MoH representatives have fed into all iterations of the RAMA tool and are encouraged to lead in completing and reviewing RAMA documentation at each stage, with technical support from Ascend. The RAMA process involves completion of a tool (excelbased

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