Morogoro CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2010

I( THE UNITED REPUBLIC OF TANZANIA (including e-mail address) ORIGINAL: Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC)N L q 6F EIf EI-Lg t COUNTRY/NOTF: TANZANIA Proiect Name: MOROGORO CDTI Approval year: 2002 Lalr.rlch inJI yqar : 2003 Reportiutt Period: From: JANUARY 2010 To: DECEMBER 2010(Month/Year) ( Month/Year) APOCfundinsyear: (circleone) | 2 3 4 5 (6) 7 8 9 10 11 12 13 APOC Proiect imrrlementation year report (circleone) I 2 3 4 5 (6) 7 I 9 10 11 12 13 Date submitted: Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sightsavers (SS) - 893 Communities 0 7 FE\,. 20ll RECU LC RDcoPA IE WHO/APOC, 14 September 2009 I I I ! I I i I i I I I I I \ANNUAL PROJECT IECIINICAL REPORT {o TECHNICAL CONSULTATIVE COMMITTEE (TCC) i ENDORIS i Please confirm you have read appropriztte space. EMENT this report by signing in the OFFICERS to s;ign the rePort: Country: TANZANIA National Coordinator lr{ame: Dr. Nkund Mwakyusa Siignature Date: !9.t* [" Zonal Oncho Coordi Name: Dr. Frida T. Mokiti Signature: fl- Date: q".\.r* I ( NGDO Representative Name: I)r m Kabole Signatur:e t( IDate This report has been prepared by Name : Dr. Deborah Kabudi Designation : Project Coordinator Signature Gt"J^' +sl rlMr I SIGHTSAVERS TNTERNATIONAL . TCO P. o. Box 2513 i .DAR8S SALAAM TANZANIA : Country Director, I)ate WHO/APOC, 14 SePtember 2009 I Table of contents ACRONYMS .v VIDEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION........ l.l. GpNeRnl INFoRMATIoN............. 1.1.1 Description of the project (briefly)..... 1.1.2. Parlnership 1.2. PopuLnrroN............... SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. Trver-rNB oF ACTrvrrrES ............ ......... 8 2.2. Aovocecv ..................... 10 2.3. MoerI-rzRrroN, sENSrrrzATroN AND HEALTH EDUCATIoN oF AT RISK coMMuNrrres 10 2.4. CovvuNrry rNVoLVEMENT......... .....12 2.5. Ca,pRcrrv BUTLDTNG.. ...... 13 2.6. TRpRrveNrs.............. ..... 15 2.6.1. Treatment figures .......... ........... 15 2.6.2 l{/hat are the causes of absenteeism? .......... ..................... 17 2.6.3 What are the reasons for refusals?................ ................... 17 2.6.4 BrieJly describe all known andverified serious adverse events (SAEs) that....... l7 2.6.5. Trend of treatment achievement from CDTI project inception to the curuent year l92.7. ORopRtNc, sroRAGE AND DELIvERy oF IVERMECTIN ...........20 2.8. Cotr,rvurxtry sELF-MoNIToRING eNn SrareHoLDERS Meetmc ............21 2.9. SupeRvrsroN............... ......................21 2.9.1. Provide aJlow chart of supervision hierarchy. ............ 21 2.9.2. What were the main issues identified during supervision? . Erreur ! Signet non ddfini. 2.9.3. Was o supervision checklist used? .........Erreur ! Signet non ddJini. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Erreur ! Signet non ddJinl 2.9.5. Was feedback given to the person or groups supervised?... Erreur ! Signet non ddfini. 2.9.6. How was the feedback used to improve the overall performance of the project? Erreur ! Signet non ddJini. SECTION 3: SUPPORT TO CDTI I 3 4 4 4 6 7 8 3.1 3.2 J.J 3.4 EqureuENr FnseNcrRr- coNTRTBUTToNS oF THE pARTNERS AND coMMLn!rrrEs OrueR FoRMS oF coMMUNrry suppoRT............... ExpeNorruRE PER ACTrvtrY SECTION 4: SUSTAINABILITY OF CDTI........ 4.1. INrenNnl-; TNDEIENDENTpARTICIpAToRyMoNTToRTNc; EveLuRrroN lll WHO/APOC, l4 September 2009 23 23 24 28 28 28 .....28 4. 1.1 Has the project ever been evaluated/monitored? (fick any of the following which are applicabte) ........... ............ 28 4.1.2. [4/hat were the recommendattons? ..........--. 28 4.1.i. How have they been implemented? ............. -. . ............ 28 4.2. SusrelNnerLrry oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT................28 Yn 3) .......28 4.2.1. Planning at all relevant levels... ..........-...... 29 4.2.2. Funds....... ..-....--..-... 29 4.2.3 Transport (replacement and maintenance) -....... 29 4.2.4. Other resources ...-.. 29 4.2.5. To what extent has the plan been implemented................ .............. 29 4.3. INtecRRrtoN............ -.....29 4.3.1. Ivermectin delivery mechanisms................ .. ....... -.- ...29 4.3.2. Training.... ....29 4.3.3. Jotnt supervision and monitoring with other progran7s........... ...... 30 4.3.4. Release offunds for project activities .....-.. 30 4 3.5. Is CDTI included in the PHC budget? ............ .......-..... 30 4.3.6. Describe other health programmes that are using the CDTI struclure and how this was qchieved. What have been the achievements?............. .................... 30 4.3.7. Describe others issues considered in the integration of CDTI. .-... 30 4.4. OpenarroNAl RESEARCH .....34 4.4. I. Summarize in not more than one half of (t page the operational research undertaken in the project area within the reporting period. ........ 34 4.4.2. How v,ere the results applied in the project?.... ........... 34 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTUNITIES.... SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS .....34 34 1V WHO/APOC, 14 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment wi th Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization WHO/APOC, 14 September 2009 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). ( ii) Elieible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic cevqrage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by cornmunity distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage. integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitv self- nitorins (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 14 September 2009 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 30th I Number of Recommendalion in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report related a Address past TCC recommendations exltoustively In this report past TCC recommendations was addressed exhaustively a Culculale tlte cosl per trealment, CDD population ralio and mal: female CDD ralio Cost per treatment : 1:US$ 4 CDDs per pop: l:100 Male:Female ratio :1:1 a Use tlte new reporting format This report is written in the format . Provide informaliott on:- evaluqtiort The project have been evaluated but not on the sustainability. This year we expect that Sustainability evaluation will be conducted. support Community members collect drugs from the FLHF or provide bicycle to CDDs to go to the FLFIF to collect drugs outcome of advocacy Creation of more awareness, to build and maintain the sense of ownership to the community Ieaders and members. As a result Region and Districts has included NTDs activities in their CCHP. At WHO/APOC, 14 September 2009 community level there is fully participation of community member in the implementation of CDTI activities. Few communities exempt CDDs to participate in development work during drug distribution period Attrition occurs in rare occasions, like death or marriage for a female CDD supervisiott Problems and Successes was identified Proiect related a Iniliale in-country inter-sectorsl collaboralion lo enltonce resource mobilization, integration and The project has integrated with other NDTs Programme hence we collaborate in resource mobilization. a Train ull healtlt stalf on CDTI All 152 FLHW in Oncho endemic area were training in this reporting period a Truin nrcre CDDs 2434 CDDs was trained a Retrain all involved in CDTI on record keeping Training emphasized mainly on sensitization of Community members, drug distribution, monitoring and supervision, data collection and 2 (Please add more rows if necessary) WHO/APOC, 14 September 2009 Executive Summary Morogoro CDTI Project operates in two districts namely Morogoro Rural and Mvomero out of six districts in Morogoro region. The project is now in the sixth year of implementation of CDTI activities and second year for the implementation of integrated NTDs activities in Oncho and non Oncho endemic areas. Onchocerciasis is found in 893 communities which are Hyper and Meso endemic and the total population is 356,469. Drug administration extended from May to December 2010 whereby total of 286,032 people were treated using Mectizan drug and Therapeutic coverage is 80.2%o. The geographical coverage was 100% whereby UTG is 299,789 and ATO is299,434. In this reporting year, the project managed to accomplish the following activities; training of 152 FLHW, training of 2434 CDDs, sensitization of Community members, drug distribution, monitoring and supervision, collection and compilation of treatment data and report writing. The CDD per population ratio ranged between l:100 and l: 120. The project received a total of 1,116,260 Mectizan tablets for treatment of Onchocerciasis and Lymphatic Filariasis in oncho and non oncho endemic areas and 765,875 Mectizan tablets were used to treat people living in oncho endemic areas. Challenges and how they were overcome: - CDDs demanding to be paid during training and not motivated to work on voluntary basis. o To encourage community and district councils to provide incentive the CDDs - FLHF staff are overloaded with work due to shortage of healttr staffs making them less efficient in CDTI activities. . The Government to look a means of employing more Health staff and to post them in the FLHF - Other programmes who comes with different approach by providing payment to Village Health Workers and CDDs to implement their activities. . To emphasize CDTI Philosophy during training of CDDs and to conduct sensitization meeting with community members. - Submitting implementation reports in different format as required by partners ( APOC, SSI and NTD). This increases the workload to project coordinators and other staff. o Waiting for a consolidate format which will cater for all paftners 3 WHO/APOC, 14 September 2009 SEGTION {: Background information 1.1, General information 1.1.1 Geographical Location Morogoro Rural and Mvomero districts where CDTI activities are being implemented are found in Morogoro Region which is one of the 2l regions in Tanzania Mainland. It is an inland area lying towards the East and Southern boarder of Tanzania Mainland. The region lies between latitudes 5o 58" and l0"0"southoftheEquatorandbetweenlongitudes35"25" and38o30"eastofGreenwich. Ithas atotalareaof 73,039 sqkmwhich is8.2%oof Tanzania.Accordingtothe2002 populationandhuman settlement census, the region had an estimated population of about 1,759,805 people with a growth rate of 2.6%o annually. The two districts lie between latitude 8o and l0o south of Equator and between longitude 37o and 38o East of Greenwich. The region is inhabited by Luguru, Kaguru, Kwere and Masai tribes. These communities consist of indigenous and nomadic population; the mountainous areas being much more densely populated than the low land. The young people keep on migrating to look for employment in towns and to areas or neighboring regions where there are newly discovered mines. The main occupation of the community is fanning of foods and cash crops, cattle herding, small scale fishing and timbering. Several rivers and tributaries originating from the mountains cut across Morogoro region. Major rivers include Kilombero, Ruaha, Luwengu, Ruvu, Wami, Ngerengere, Mkondoa and Mkindo. There are about 143 rivers, rvhich form very large plains in the lowlands consisting of fertile alluvial soils. Due to the climatic influence of the Indian Ocean, the Eastern Arch Mountans have unique plant and animal life. Although environmental degradation has affected the area for many years, there are still different species of fauna and flora. This is particularly true in the case of the Udzungwa and Uluguru Mountains. Topography The two districts are divided into three geographical zones:- (a) Mountainous or Highland Zone (25%) This zone covers the Uluguru Mountains located at an altitude of 1200 - 2000 m, above sea level with the clay type of soils. The zone is suitable for the production of maize, beans and horticultural particularly Mediterranean types of fruits. (b) Semi-Mountainous/Low Land Zone (20%o) This zone covers most of the Southern part of Morogoro/Mvomero districts, at an altitude of 800 - 1200 m above sea levelwith sandy clay loam type of soils. The zone is suitable for the production ofmaize, cassava and sorghum as staple food crops. (c) SavannahZone (55%) This zone is located at the altitude of 600 - 800 meters above sea level; with same clay loamy type of soils. The zone is suitable for paddy, maize and cassava, for both food and cash crops; and also suitable for sugarcane, cotton and sisal as cash crops. Part of South East of the zone falls under Selous National Park, further the district has big valleys and numerous fast running rivers such as Mgeta, Ruvu and Wami-Luhindo. 4 WHO/APOC, 14 September 2009 Climate The region enjoys two rain seasons - the short rains, which normally starts in October and ends in January and the long rains which commence in Mid-February and end in May. The annual rainfall ranges befween 600 mm in the Savannah areas up to 1600 mm in the mountainous areas. . The temperature ranges between 20oc up to 28oc. Population According to the 2002 national population census, Morogoro Rural district has a population of 263,970 with an average household size of 4.7 where as Mvomero district has a total population of 260,525 with an average household size of 4.5. Major tribes are Luguru, Kutu, Zigua and Kwere; minor ones are Kaguru, Sukuma and Masai. Their main activities are:- - Subsistence farming - Business - Livestock keeping Cultures Main cultures are:- - Traditional ngomas, (dances), - Use of traditionalmedicine, - Conduction of church sessions over the hills Languages Main languages include:- - Kiswahili as a National Language - Local languages ie. Luguru, Kwere, Kikutu and Masai Communication The total road network in the district is l168 km categories:- The roads are divided into the following - National truck roads - Regional roads - District roads - Village feeder roads 188 km (tarrnac) 343 km 295 km 342 km (40oh are passable throughout the year and 60%o seasonal). Most of the road nefwork is passable during the dry season, but some feeder-roads to the villages are impassable during the rainy season. Administrative Structure Administratively the two districts are divided into l0 (ten) divisions, 42 wards and 233 registered villages. They also constitute 3 parliamentary electoral constituencies. Health System The Morogoro Focus CDTI Project area is constituted by 3 hospitals. One owned by the Governrnent, one (1) by Parastatal organization and the I (one) by Voluntary Agency. There are ten (10) Rural Health Centers; nine(9) being Government owned and one (l) belonging to Parastatal organization and 105 dispensaries of which 72 are owned by the Government, l6 by Religious agency, l3 by Parastatal organizations and four (4) by individual/private organizations. 5 WHO/APOC, l4 September 2009 Table l: Number of health staff involved in CDTI (Pleose add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Bl Number of health staffinvolved in CDTI B2 Percentage g.=gr7 g, *100 MVOMERO 195 70 3 5.8 MOROGORO RURAL 196 79 40.0 Total 391 149 38 1.1.2. Partnership l. Ministry of Health and Social Welfare: Provides strategies and guidelines in approaching any planned activity. The Ministry also provide financial and technical support through supervision and internal monitoring during implementation of program activities. 2. Sightsavers: Sightsavers is supporting the program through financial and technical support. The funding received from Sightsavers International are used in advocacy and community sensitization, project office renovation and equipments; whereas in terms of technical support Sightsavers International is supporting capacity building and project monitoring. 3. District Councils: Both Morogoro and Mvomero district councils are providing human resources and technical support to the project. The districts provide support through supporting supervision and monitoring. The project is also being integrated into district plans to ensure sustainability. 4. Community: The communities in the project areas are the critical supporters of the project implementation. They are supporting in providing human resources such as CDDs, collection of drugs from FLHF, support supervision to CDDs and self M&E. The community also has the crucial role of motivating CDDs through provision of incentives. Working Relationship There is good cooperation between district councils, SSI and communities in implementation of CDTI activities. District council's plays a big role in paying salaries, allowances, supporting Supervision and Monitoring and also pays other in-kind costs. Communities r"i."t CDDs whose duties is to collect Mectizan from the nearest FLHF and distributes them to the people in the community, also they discuss problem facing during MDA (CSM) 6 WHO/APOC, 14 September 2009 o. 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';Ntr e= do'= (hu) -^ t^,(,H L E I-.,IC) f ) >lv ad!0-)d!e 5uzt 8r*6cs[j= =L,G)'5 pI , E.H €rEv)0)- bOY Ctr:'id fi-a i 5' c.r .r=H s"EP 0)E-:" 6X9d)-5o -dv6().= '= !sltEiu_cn =ooQ>E o *P44 a F; 8oE.cO o\ N () -o 0) o.oa$ O o q o N a/)o aPX ItraO =oo{)E!(n'e'ac Fa.) =L:3 EP .9E EE I = .^ IJi c) eio.= Ev€v .P tsE :o*ad'=G A NT C ii'i !vOSX.= '.5 c .= oo =d)-t € E-o 'i; *E € s9Avts6 oo '=; !tr or I f-.1 .- r\ =P!4 !-3 qvp(€Y; Eo cYRrL > ji= 6r '.= uD v r+r trvU)(H3 83 ? .= op bL H ch6(de: tr &r *d, .'59 6, 9'E: snH^F .; t_.1 t- P = 0(tl) ! (/) cdYarOdrE HI€:: = ; Cq. C O(.).a"- PcgOC H.;L A._:.HUY.ii.V!.t(E U)* E: _..1 6j0)ttrr/)EE e Sg 3t---tl!ud > w) ,P>A'AA Ud.rH -oEd H oritd'-tHLvtr =LJ - o.l OI E g:€ 8.otr=l?a >' X qi cd .:l '- -o U o9.: grXsE;EE F"8 Ei H s(J ,^ .^ -^ ar EeA-EsE€r !-r H O"6 o.r a) O .iu h tr >'E'6tp*O(")tSga3 Be 3= x e,E8;H:F$ 0).. _ L^\r.= =EHcior6iIE E?E E** x 5 P O.93 9 =8HE= =:E'E ! =: H i.cd i o c.Y l* 9EEH.eEtf":w:.HP.--v H H [.E i E:E E.its:'E=.ErE tsfl 3{UilE 3 ()trdo bo JZ eU o C)H o E € 0) (Btr 0) o oo() l< () (s E e o a (d oo .o o E oH o. o U)lr) o a bo () o E o o (n c) a Ho -o C) 0) e(H oo 0) (d() FC) oU qO E- trc ot r!o.- -o [itroo!c ZF ll * tr o b0 C! e Er oo o\ o\ o\o\ ca Eg* :.E EX .5 =eX E E!6z a'i c.l s C{ s =€€ q E o -o A.= Q o L oE E z ta + I la (q F a{ al a.l N .c F)tcl EA 9-(!a o r\ { N ta A a U 3(! z o,6l cral a'= Fb )oOG .-L EO EO otr -E o= ze ll * EA EA EA o o06 tro o ca Sakri'=, r 2b = I't EEE+2vEa r + c- d \o o\6 ?oc :.:-! 9;.E;; !qtroEE E€'a \o o\6 I e L A o& P o o d)a= z& G F -\ q V) q) q) a) 4 + \ q) L >:I \)q \) a* F oO() +r* -o.=EEO '.= o'5 trE *r() J-1Ei trE O (",o:. $l . arl t -ol . CtrINFI 2.5, Gapacity building Adequacy of available knowledgeable manpower at all levels. The project has greatly benefited from the trainings conducted for different cadres at all levels of project implementation as these have been the key persons in advocacy and community mobilization and sensitization. We went further by also including in our work plan for the next year to conduct training for primary school health teachers and community development officers residing or working within the project area to make it more objective. lYhere frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. Normally training is done to the in charge of FLHF on how to carry CDTI activities. He/she trains his/her colleagues and delegate power to them so that, in case of transfer CDTI activities will continue as normal. 13 WHO/APOC, l4 September 2009 .+ aet6l ia = o\ al S.itv ! ! 9r L9 : ' (-) Sul $co N c.) c.l oo o\\o olO c.l t-- t-- o\$ ?:FU (\c.l c{N :f,.otol q) 4) () a) s q) d ah aU o z = ! I s,i o.i +L\, = :s zv c\ ol cn c\ = o q) o -o o\ an () .1 'ot'FF r- [-rq,) oq) ,-9 r- c{ 6)L z U LF ol N c- \o o\ t-- N t--\o alia al cl II U 6 F U. (.) + : Q e c.l r-. o\r- al rn o () o o\ () dl- !s E3 tr--- ZE q) (,, (JoF (-l <f, $ o\ F-\o .o N (j+. a< l) g rlv ori + s w o\ 0 a) (J Fl 90) aw o) z U () (,) c) c,) o\ o& rrl z o 2 o& o d)A= z& -] 3 F J .2 q n o\ a.l o -o C) o-q) U)$ Q U o. o ,J. > $ ba o { € o p B B o bo .E o * o t o\ o .: st\ .a .. z - -:\i !4q q) Uq) 4i \ q) s- U \ q)q U 5 o d o c) a. ts F aO(H o (h o 0) 0)t< +.i ! c) 9- bo (d l.<F ..iil ,l -oldlFI Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifu) Table 6: Type of training undertaken (lick the boxes where speci,fic training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatmentfigures In this year treatment, was done in 893 endemic communities and the project managed to treat a total of 286,032 people and attained the therapeutic coverage of 80.2'h. The geographical coverage was 100%. There is people who still refusing to take the drug and some were absent during drug distribution. We are planning to intensify, sensitization and mobilization in area where number of refusal and absentees is found to be high. l5 WHO/APOC, l4 September 2009 o,O c'.1 ! 0) -o 0) p. c)(n $ (-) o o. o ,Ji 00\! \ 00 c) Oo \rts\JH (/ tr!U 6\0.)= (!\5E .gI '+ Ltss\o-i! 6a=:ts -.i.i .=oo}' -C(ir -!>.=.r 6 .: .lJHts! q)$-.!s: rr u o aF-6=: !i= 6)E=J.t: +si -a€ bZ}YE .s 'stL C a..! .= s rg \r\H a. ru .Y \ ':< cd t- =-ot g s 'ii'Ol - !r qI;13 : I\;l s S :L9l c-r ! 'iu(El : : :q et 3 s !i -l o .: t!()l o- .: i\ ^l a S r:5To t *;glH S S'S EIE ! !,: Et d € .isEIE $ t-r =l al E =!zln I Itbq b^!\)E- 'Q\ .1 :; -.til + t-I!* oyi. *&+ :. :'; \ !H! srE \: r-%U \ SPr, s .s'5 .= s x\ - t da.E T E:(g u qrt rA'tSr\-/ t- t\ ='FrrttS ') S 9:- .o t\ S: o\ \ ag \c) (.) L6 9oo 'a L3o-L0)(B-c Oto.= .F LAr< z.() rrl id =-o.:!>()a Ia .eE .= (.)CU =dAtr(0 l-a6.eo.:(-) ( L OI tro ol =E -l EE xl 8i 3l .,o Yl .=O- cdl t-b 9l 6 + Pl !A alC st r qt -lE :levl .-t p;l.s -.1 h9l oo 3l= :Yl -H el oEl.z 'El g o.rl - =l L -t I Fta!+6 EIo EIq UIP <*l = q-l ?olo- oltrulo rlf0.)lo- ()ltr -ol _ -ol -trl d trl cd :l!-lP =l -o =l Ozlt- zl? () .z o()Fo C) E (n 0) F (n ol -txl !l 0.) d 0.)L 0) oo 0)o(H o L C) -o z () () bo !w?^ v^\></ o oF () dr 0) bo(n L() o (! o- ao\E-(! b0 o 0.) o q) L() bo L() o o o-. P^\ C) c0I C) F -() APg( qs 6.b9;a3 > a o iiEEEFE;gqY o>ooOL o o o .o E z O -oL otr bral5 *(7 oa O '+ .t ? t) -.=a''-y ; cs 6,.r -o=,,+iltr:--lE> -i,DJ2;'--c,o+z'.P co4 t-- c\ V) EoqS2b4" c.l C.l\o a.l @ N ?al F-t qo !c LC^-O 5;E d qri>6=Eozi:'l Ue N c.l ?.) \o ra a dk b 2E4-69ts^od =-b9 =9 .i ;EE-E.Ocoj-, =\ F L.,) : .,p -; E.H €Eg€E 6 A'O- o;oc: o. o 200od oo -coF o d oo € al € N\o c'](\ NF- ro^ al c.) \o6 or @ ooc\ o\ \o$ !f, t an -=^ o\ a\ at @(\ \o^ o\ € t oo^ \o o\\oi \o 1A ?.1 a-E:i'I 3-g t ESciE qu -n F= ; tr'"t:E> oo o- ll * o\ L.= U!o tr ool4 .o5didI d= u =t>-z6o ?oEEZ -d:2 .o -a'F L,) (! .9o dilE- td !wo oo< ;o (/) o E E oQ OO r- $ \o s ?o o\ co r- $ s t) o\6 c- .t \o c.l$ ?n € .9< Hq H o& 14 o z &olo<o&&>odEo Fl t.i o t-r trr -:\ q 4q) u\) q > \ a)L U ! q)q !q) o* ! J4 ar) ti cd a(d oLr -l o tr a € >. .o a E] a C) E 0)l<F r-f ol _ol(dl FI ll 2.6.2 What are the causes of absenteeism? Implementation of drug distribution was done during rain session and people were aklady engaged in the farming activities and therefore fear for side effect of drugs Movement of people especially young ones who are businessman. o a o 2.6.3 What are the reasons for refusals? Ignorance for some of the community members who have no sign and symptoms think that they are healthily therefore there is no need to swallow drugs 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. . Parasitologisttrained? o Existence of rnicroscope? . In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report l7 WHO/APOC, l4 September 2009 ol 6) -o E() o. 0) a $ O o r - oo \) a* o'\q) .a !\ q.)4 -:. a 44 a)Uq) 4 + s- q) s- S q) 4 q) EL\, € li C) o. oo li 0.(.)$r 0.) bo lr () ti L<)oo o d a E] a Ch 0) 0) C) u)!(.) (s th lroa(* o cr)oa Q oo (.)5(!F _E=e9E EE a <.E E L - ao()o0- Ic'= tr e (!iiGO4 E E.=x 6.=I!oo o.9 E^oE!2 00 (J O. O'r .*Q o.o ^ d.9 uo-c trd3d ri a€q;(J-O.2EC o tr c= !FH'-dooooE&e o ^aivq-E, utsr'id=:''l e L-.1 (B -c q: z d € - E 9P'EEE*i.E +PXG> *at-? o o. a o () L q) o. a.(d o9 d5 l)a =() .N -E(.)o-- =a2o> = z o C)ooc d.i -ho ao xo U) () o0 * a o\o(\ () -o () o.q) U)$ O o -) o\ o oo9 EaF 9a\/o (J !'l t--\o 9 @+ o, r) o\ n o. trlo (B o. o or I o ll r .-i ri ti o ^oO!, EG.F Oo\ < >v -o o ...| o co \ o\ @ o\ oa cl t o\ s € vl o\ ll * '.i d ri \o o !o =bo!) (€ =o oo<oF t--\o c1 r- r-. co @ oo cl 00 r{ ,o O.€ ,o oE .D_ aFE 7.? 'o o- \ot\ r- cnNn oo N a.l oo^ \o w(-.l <f, o\ t-- c{ ca\o o) @r- a.t s ca \o € N rd ?o? 6.> c d.:j9.a' FL' \o N a.l \o r-- oo- \o N s C\ \o c- o1 o\ 00q$ ooN o\c\ o\N son o\ o\N Lqo *3 -- X o-al:=o:'ooo 6t< =El '?aa q Oi o O\oq \o c.l O v1 \o $ oo^ oo o] v\o d} tr- m c- c-\\o .f, ca \o$ \o 6) oo(! o o() ll * fr.l lr] ti o ^60() 6 ^F Oo\ o o, o-bo=s= EGtt-l- *U 99r.ltt OoEl cl co o\ OO t! qo -.= o-b = 99u tr E= ij = E-t b206 \o ca oo c.l @ tr- @ r-6 r-oo ca o\ @ ri :od o.= c 6 .:a-)o3' Fv \o <- € an oo Ir- oo r- co r- oo o\a bo =hq> ii;o>: Lh +u-h-. E tr._ o L ^ a A 6 at; E o 9t tro o \os @c!@ c-oo r-oo r-co o\oo r! r- o\ o\ co o\ o\ o\ o\ (\ ON c.l c.t cnOO c.l t ot ol \o O c.l r-o c..l oo c.l o\O c.l cl -ar) - U .- ! CE - a (') e) c) o! -FLio) €E \<.lqJ ril-v 'iF !r)p\ \!:-\isr- H\99;:c(n\tr - vd63Eod: \r 5€3c) dd HC)! 9L5c{ft o,!33Ed.+) .=ouD €=li !? L.r a I .-- -v! *no v= 39vRia\J=r-Etai v\Y:Yr{lF >' € .l Cqtr El 9.'orl =6sl E c)(Jl IA .trHtr?'ol p.:8,P Hlvg9bL !-(ic!5EEYirtr= lF(9, 96 !itrQ)!otrq)LH-t) 'ti 6iI;;CJ .Yra-EG '.. tr ..i orl ';0)l .n -l €l _uFl 0r 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH{tr WHOtr UNICEFtr NGDO tr Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH { f] WHO tr UNICEF E NGDO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project. We calculate the number of tablets require by multiplying the ATO times 2.2 then we get total number of required tablets. The Regional office request Mectizan and Albendazole to NTDs Secretariat. The request is sent to Mectizan@ Expert Commiffee for approval. Mectizan@ arrives in country through the same channel and is cleared by Medical Store Department (MSD) which handles over to the NTDs Secretariat. The NTDs Secretariat within the Ministry of Health and social Welfare are responsible for delivering of drugs up to the District level . The District authority distributes drugs to the FLHF by following request sent to them by FLHF staff. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Mectizan thereafter the CDD or any selected community member comes to the FLHF to collect Mectizan@ ready for distribution to other Community members. Mectizan ordered/received for this reporting year has change compared to the previous three years because of integration between Onchocerciasis and Lymphatic Filariasis and decentralization were by district(Councils have given full mandate-where by drugs are sent straight to districts)Region remain with supervisory role) - How are the remaining ivermectin tablets collected and where are they kept? The remaining lvermectin tablets are collected into bottles and taken back to the nearest health facilities and then they transported to the district pharmacy waiting for next distribution or distruction if they are expired. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Advocacy and sensitization to community members and political leaders in the area of jurisdictions. ' Training to CDD's State /District tLGA Number of Mectizat o tabl"tt ln stocl< frorn previous vear Requested Received Used Lost Waste d Expired Remai ning MVOMERO 36,760 750,000 555,500 398,455 Used LF area MOROGORO RURAL 38,000 710,000 546,000 367420 Used LF area TOTAL 7 4,760 1,460,000 l,lol,50o 765,875 20 WHO/APOC, 14 September 2009 . Supervision during drugs distribution. . Data collection and report writing Any other comments ' None 2.8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, When? In each distribution cycle ToT training had been conducted Table I l: Community self-monitoring and Stakeholders Meeting (Add rou,s if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. . Increases community ownership hence sustainability can be achieved in the project . Solving the problems in the next treatment cycle if identified and maintain successes 2.9. Superuision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF + I CHMT/DMO --------> I District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) MVOMERO TTAOnOCORO RURAL 457 436 l0l 101 98 87 TOTAL 893 202 r85 RTIMT/ RMO RNTD/ PC DNTD/ DOT FLIIW 2l WHO/APOC, 14 September 2009 Level 2.9.2 NIain issues identified 2.9.3 Supervision check list used Yes/l',lo 2.9.4What were the outcome of CDTI implementation supervise 2.9.5 Was feedback given to the supervise d YesA[o 2.9.6 How was feedback used in improving the overall performance of the project DISTRICT a) Incorporate of CDTIAITD activities in CCHP b)Committed DOTs c)Some District budget small amount of funds Yes Problems and Successes Identified Yes FLHF a)Maintained High therapeutic coverage b)Due to shortage of staff supervision of CDDs are mainly done in nearby communities Yes Problems and Successes Identified Yes COMMUNITY a)Distribution period was carried out during rainy season when most of the community members are at farming hence many absent seem b)Full involvement of community leaders Yes Problems and Successes Identified Yes CDD COMMTINITY -Council continue to Put CDTI/NTDs activities in CCHP -More commitment of DOTs -Maintain high geographical and Therapeutic coverage -lmprove performance of the implementation. Maintained high theraPeutic coverage -FLHFs supervise CDDs& to involve pr. School teachers to do supervision to CDDs - Distribution to be done Pu^- community Need hence high theraPeutic coverage c)Increase ownership and sustainability of the project. d)lmprovement of filling of treatment registers 22 WHO/APOC, l4 SePtember 2009 SECTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR: Currently non-functional but repairable, WO:Written offl). How does the project intend to maintain and replace existing equipment and other materials? - Maintenance of motorcycles are being done using funds from council (CCHP) and paftner (Sightsaver) suppofts the project to maintain office equipment - The project has requested placement of existing equipment from APOC Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtron No Condrtron No Conditron No Condrtton No Condrtton 1. Vehicle I CNFR 2. Motor cycle(s) 5 F 1 CNFR 3. Computer(s) I F 4. Printer(s) I F 1 CNFR 5. Photocopier (s) I CNFR 6. Fax Machine(s) I F 7. Others a)Laptop I wo b)Biycles 77 F c) 23 WHO/APOC, l4 September 2009 3,2. Financial contributions of the partners and communities - Fill tables l3a, 13b and 13c - If there are problems with release of counterpart funds, how were they addressed? - Additional comments 24 WHO/APOC, 14 September 2009 o\ al o -o E 0) o.oa$ O o * (J > (r) N tt(, od @t-- o,(r, olo o- @ (o_ o, ro, o- @ (o- o' .t. .tlO, @;G(II@ o'@' 6i '- ril(f), o)' ol , orot -Oc.i - -, Crl oo o- ot @- o o.o:o' o$'(o-' o, !c():l olr(L; <5 LF ol oloi o oololo'o,o$- o- o- @_' $I\t, O' (O tr). (o@r NOoro$! 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H.s 3 t4 o tnq o o_x*ocE3E\L '- A J 9d'= :JA .ts (6 di:!4tr)uoE: J,d d; J F oF oz t o coo)c '.r, .c .9 ;i.=f- +E E E r, a -No.^Qc.j, e'j' c, ; Eetrc$HE3E9 EEtrGG6.l E.s b IEtr = A)5(u I aQ> ='tro E o *e: b €fi E E, = s$ E 5If fl - c.i oIb o 't fi s o GI G lu d o o s o tn to a.S U) o (DY o B oE !Gu(DOI oo o, o)cc :E' :SG(Il (l)o o) o! o'E = =F.=.= .=(s(trG FL .=r-r-O G',1it-o.id c.i 6i' ! =(4 llJz J F uJ oofg! oq o oN .: to tro .4 so oocoo>.=Es E 5 q SE E E T EXs ='; X = *E E E i $ sg= - c.i c'i .t', o '6'-.--r'li€, ut 0,) o)Lr U)(B (.) ! _o (n L{ (d t) o -o L oo d o (d f! c.) tf) q) E 6l t-, 3.3, Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) o Collect Mectizan from the nearest FLHF o CDDs are being excepted from community development work in the drug distribution period . Make a follow up to other community members to encouraging them to swallow Mectizan 3.4. Expenditure per activity - Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to Iocal currency. Indicate exchange rate used here USS1450 Any comments or exPlanations? SEGTION 4: Sustainability of CDTI 4,1. tnternall independent participatory monitoring; Evaluation 4.1.1 Has thc project evcr bccn o'aluatcd/monitorcd? (Tick an1'of thc following rvlrich arc aPPlicablc) ./ Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation _{- 5 year Sustainability Evaluation ^/ Internal Monitoring by NOTF 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. Sustainabitity of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? N/A- Was a sustainability Plan written? N/A 28 WHO/APOC, 14 September 2009 When was the sustainability plan submitted? N/A What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels CDTI activities are already incorporated into CCHP, and the plan is bottom up plan which is based on the priority of the community themselves. 4.2.2 Funds The district council has already started releasing funds for implementation of NTDs activities. In this reporting year most the activities were conducted using LGA funds. 4.2.3 Transport (replacement and maintenance) Maintenance of motorcycles are being done using funds from council (CCHP) and partner (Sightsaver) supports the project to maintain office equipment. Tlie project has requested placement of existing equipment from APOC 4.2.4. Other resources The project mainly depends on the support from APOCruSAID, Sightsavers, Council and Communities to Implement NTDs activities. 4.2.5. To what extent has the plan been implemented The Project had been evaluated in year three of implementing CDTI activities, since then Action PIan was developed and have been incorporated into CCHP and planned activities are funded. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. Ivermectin delivery mechanisms Ivermectin delivery is within Government system using the existence structure. Mectizan drugs are being delivered to FLHF in Oncho endemic areas through normal channel together with other essential drugs/drug kit and vaccines. The FLHF in charge and his/her subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect Mectizan ready to distribute to the community members. The same CDD are also responsible on distribute Mectizan and Albendazole for Lymphatic Filariasis Elimination Training The project conducted refresher training to CDDs and FLHFs staff as there were no new staff in oncho endemic areas. Training was also conducted in none oncho areas where the project is implementing integrated NTDs activities. 29 WHO/APOC, l4 September 2009 4.3.3. 4.3.4. 4.3.6 Joint supervision and monitoring with other programs Supervision and Monitoring of CDTI activities are integrated within PHC system' Thlrefore at Region and District level supervision is done jointly by a team using the developed checklist. Release of funds for project activities Funds are released through normal channel according to budget line item even though disbursement of funds sometimes it takes a long time. The project is mainly depending on APOC and Council. 4.3.5. Is CDTI included in the PHC budget? YES lT IS Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? r Filltables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? r For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilizatron, clistribution, data collection, storage, collectton of drtrgs, referral of SAEs, etc ...)? a a Explain what are the combinations of interventions co-implenlented? How were the interventions implemented? (at the same time?) 4.3.7. 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