Ruvuma CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2010 to December 2010

RESERVED FOR PROTECT LOGO/IIEADIIYG (including e-mail address) I : t_ ORIGINAL : Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO CHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 3l January for March TCC rneeting To APOC Managernent by 3l July for September TCC rneeting AFRICAN PROGRAMME, FOR ONCHOCERCIASIS CONTROL (APOC) For'l .r.-":i:,,.-,', TE'iz'i D7R. i ITci I t I ", I I t I t a I q AninrL l ! I ., -,f y COUNTRYTNOTF: TANZANIA Proiect Name: RUVUMA CDTI Approval Year: 1997 Launch Year: 1998 Reportins Period: From: JANUARY 20l0To: DECBMBER 2010 (Month/Year) ( Month/Year) APOC fundins vear: (circle one) I 2 3 4 s 6 7 8 9 l0 11 (12)13 APOC Pro iect imnlementation renort (circleone) I 2 3 4 5 6 7 8 9 10 11 (12) 13 Date submitted: 25th July 2oll Partners: Ministry of Health and Social Welfare (MoHSW) African Programme for Onchocerciasis Control (APOC) Nlectizan Donation Program (llIDP) Sightsavers Tanzania 1,138 communities ---fteutE--- ? 3 JUIL 2011 APOC / DIR WHO/APOC, l4 September 2009 iIi I t t t KAIINUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by appropriate space. OFFICERS to sign the report: I Country: National Coordinator Name: Dr. Upendo Mwingira Signature: Date 3r o6 Zonal Oncho Coordinator Name: Dr. Daniel Date: fl> qrGroilAL NGDO Representative Name: ... Signature Date This report has been prepared by Name : Dr. Ida M. Ngowi Designation : Project Coordinator signature: ...&t*. Date .?]\.qee.\ ?ot s S >DQ .-. r,.rmlt, I I I 'iililf ?1c11i, " APCC /DtR RECTJ LE ll WHO/APOC, 1.1 September 2009 Jb a 0 20 /.mtt Table of contents ACRONYMS DEFINITIONS.............. FOLLOW UP ON TCC RECOMMENDATIONS...... EXECUTIVE SUMMARY ....... SECTION 1: BACKGROUND INFORMATION........ 1.1. GeNeRRLINFoRMATloN..................... t . t . 1 Description of the project (brie.fly) 1.1.2. Partnership 1.2. Popu14.1oN............... 2.6. 1. Treatrnent /igltres . ....... 2.6.2 lI/hat are the cattses of abs'enteeisnt'/. ....... 2.6.3 ll/hat are the reasons.for re.fusals?.... .. .. 2.6.4 Briefly describe all known ancl verifietl set'iotts adverse evenls (SAEs) that 2.6.5. Trend of treatment achieventent from CDTI project inceptiott to the cm'rent 2.7. OnpERtNc, sroRAGE AND DELIVERy oF IVERMECTIN ............ v VI 1 .......3 ............4 .4 Ij .7 .8 .8 l0 SECTION 2: IMPLEMENTATION OF CDTI 2.1. TtueltNe oF AcrlvlrlEs ............ 2.2. Aovocecv 2.3. MOEILIZNTION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMI\"IUNITIES ERRBUR ! SIcxor NoN DEFINI. 2.4. Cout',tuNtrY INVoLVEMENT......... ""' 11 2.5. Cepnctry BUILDING.. """ 12 2.6. TRpnrttpNrs.............. ""' 14 .....14 ...16 ... 16 . ... 16 )'ear I8 ...19 2.8. CotrllaUNtrY SELF-I\,IONITORING nNo S1eTEHOLDERS MEerlNc ......- ....20 2.9. SupeRvtstoN............... "' "" """"""20 2.g. 1 Prot,ide u.flotv chctrl o.l'supert'is'ion hiercu'ch1'. . ...... Erreur ! Signet non ddfini- 2.g.2. lf'hut trere the ntctin l^s.vre.s iclenti/ied tltrring strytan'ision'? .- 21 2.9.3. l'l'cts a sttpert'isicttt c'hecklisl ttscd'? ' " 2 I 2.g.1 ll,hctt wcre lhe gutcontes crl ecrch levcl of C'D7'l intpletnenlcttirttt suparvision'? 2l 2.9.5 lN/us.feejbac'k git'en lo lhc par.\'on ot srotq)5 .stqtart'i'tacl? ' ' 21 2 g.6. Hrnr tt,cts thc feeclbttck usetl to intltrot't' lhc ot'erull pcrfornturtt'e of tlrc pro.iecl'? 21 SECTION 3: SUPPORT TO CDTI ....21 3.1. Eeutptr,teN.r................ 3.2. FINANCLcL CONTRIBU'f IONS OIr TFIE PARTNFIRS .\ND CONIN[LTNIl'ltrs 3.3. OrHen FoRlvts oF coNll\luNITy suPPoR'l-.....'........' 3.4. ExpeNotruRE PER Acrlvlry SECTION 4: SUSTAINABILITY OF CDTI ............26 4.1. INreRNel: INDEPENDENT PAR'flclPAl'oRY l\,{oNIToRINcl EvnLuR'rtoN..'......' ..--.""'26 1. t.1 Has the project et,er been et,aluated/ntonitored'? (Tick an',' o./ the /bllov'ing v'hich are applicable) . .. . "' 26 1.1.2. Whar were the recommendations'? . . ... " ' 26 4.1.3. How have they been implemented?... .. " 26 4.2. SusterNnsrl-rTy oF PROJECTS: PLAN AND SET TARGETS (N{ANDATORY AT...... ..........27 Yn 3) """'27 2l 22 26 26 lll WHO/APOC, l4 September 2009 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER NIATTERS 4.2.1. Planning at all relevant levels... .......---.--..27 4.2.2. Funds....... ....-........... 27 4.2.3 Transport (replacement and maintenance) ----.-.. 27 1.2.4. Other resources . . -.-...... - 27 1.2.5. To v'hat extent has the plan been implemented.. ...-.... -.'...--......." 27 4.3. INrecRertoN............... .-......-.-...-.....'27 1.3.1. Ivermectin delivery mechanism.i .......... --..-......-.. 28 1.3.2. Training.... "" 28 1.3.3. Joint supervision and monitoring v'ith other programs......... ......."' 28 1.3.4. Release of Junt)s.for project activities . .-.-......'.." 28 1.3.5. Is CDTI included in the PHC budget? .--.-.... ""' 28 1.3.6. Describe other health programmes that are using the CDTI structttre und hotv this tyus achieved. ll'hat hat'e been the achievements?... . " " ' 28 1.3.7. Describe others ls.rles consideretl in lhe integration of CDTI. ...28 4.4. OppnnTIoNAL RESEARCH .'.'. 31 1.1.1. Summarize in not more than one half of a page the operational research ttnrlerlaken in the proi ect cu'ea v'ithin the reporting period. " " " " ' 3 1 1.4.2. Hov,v,ere the results applied in the project?...' ...'.""" 31 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES ...........31 ...........32 IV WHO/APOC, l4 September 2009 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CCHP Comprehensive Council Health Plan CDD Community-Directed Distributor CDI Community Directed Intervention CDTI Community-DirectedTreatmentwithlvermectin CHMT Council Health Management Team CSM Community Selt-Monitoring DC District Commissioner DED District Executive Director DHRP District Human Resource Person DMO District Medical Officer DPLO District Planning Officer FLI IF Front Line I-lealth Facility HUC Hang Up CamPaign KDC Kilosa District Council LGA Local Government Area LLIN Long Lasting Insecticide Net MCH Mother and Child Health MDP Mectizan Donation Programme MOHSW Ministry of Health and Social Welfare MSD Medical Store DePartment MTEF Mid Term Expenditure Framervork NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Governtlental Organization NOTF National Onchocerciasis fask Force Nl'D Neglected TroPical Diseascs PC Project Coordinator PllC Primary Health Care REA Rapid Epidemiological Assessment REMO Rapid Epidenriological Nlapping of Onchocerciasis Rlvlo Regional Medical Olllcer SAE Severe Adr,'erse E,r'ent SIJM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WEO Ward Executive Officer WHO World Health Organization VEO Village Executive Officer WHO/APOC, l4 September 2009 Definitions (i) Total lation: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking) (ii) Elieible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) al Tre ectl (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project inten ds to treat with Ivermectine in a grven year (iv) Ultimate Treatment Go (UTG): calculated as the max imum number of peoPle to within the project area,be treated annually in meso/hyper endemic areas (v) (vi) (vii) (viii) ultimately to be reached when the project has reached full geographic cov.erage (normally the project should be expected to reach the UTG at the end of the 3'" year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage)' Geographical coverage: number of communities treated in a given year over the total nurnbe. of m.so/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)' lntegration: delivering additional health interventions (i.e. vitamin A supplements, Rlbendazole for I-F, screening for cataract, etc.) through cDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and er.,-,power communities to solve more of their health problems' This does not incIude activities or interventions carried out by community distributors outside of CDTI. Sustainabitit),: CDTI activities in an area are sustainable when they continue to function eflectively fbr the fbreseeable fttture. with high treatment coverage' integrated into the available lrealthcare service. with strong communily ownership' using res61rrces rnobilised by,the commttnitv and the government. (ix) Cornmut-t itv sel l--tt-ton itori rt s (CSM): The process b1' rvhich the community ts nce ol CDTI (or any communitY- w to ensurittg that the Programme rages the community to take ftrll make appropriate modifications cmpo*,ered to oversee and monitor the pcrfbrrna based health intervention programme). lvith a vie is being executed in the rv'av intended. lt encolt responsibility of Ir'crnlcctine distribution and rvhen necessary vl WHO/APOC, l4 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 sessio n 27'h Number of Recommend ation in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 199 TCC accepled the rePorl with the above (following) recommendalions(i) Frequent trunsfer of trained personnel lo non-CDTI areos should be adressed by lraining all health staff irt tlrc endemic ureos ; (ii) Record-keepittg, especially where lltere tre untrained heulth workers, should be ved; (i) The country has lnoved to the integration for the implementation of NTDs activities therefbre all Health staff in the region are being training on how to execute NTD by usine CDTI strategy (ii) Same as above (iii) Project lo intprove the c u rrenl C D D/poPu lul ion ralio of 1:221; (iii) The project is trying to irnprove the CDD/PoPulation ratio but the cotnrnunitY members are satisfied bY the services provided by the present CDDs. Itt some areas in the project the houses are verl close u'hich rnake CDD not to rvalk a long distance. (iv) Etrsure good record- keeping in ull contmutrilias und districls. (ii) Allconurrurities have been pror ided u'ith tteu' registers therefbre data are u'ell WHO/APOC, l4 September 2009 Number of Recommenda lion in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report Relalal O Address past TCC recommendations (note lhere were none), Past recommendations are well elaborated on the above table. (ii) The Project should investigate and exPlain conflicting population figures, The conflicting population figures rvere attributed by the fact that the administrative population census differed from the census taken bY CDD's. We have norv agreed to rely on the annual CDD's census. Another is seasonal migration in and out of mining areas (iii) Provide information on the oulcome of advocacY and communitl sensitization. More demand of Mectizan drugs and increased therapeutic coverage Proiect Relaled (i) The Project should be ntonitored and evolualed, There has not been a Project evaluation after 72 years of treatment (ii) Upscale CSM and SHM to cover oll Comruunities, The Community is now enlbracing the project and actively involved in CSM as shown by increase tn number of CSM in each district (iii) Train nnre CDDS, There was a limitation of training more CDD's due to inadequate funds. The District councils have been directed to have Nl'D activities included in their health lans fbr their btrd to be sed. Advocacy' and CommLrnitY sensitizatiott barriers e,{isted. J'here was no advocacy and involvement of political leaders on CD-fl and NTD at hi levels TCC session 31't r65 (iv) Investigote w'ht' t h e rute of refusols trnd ubsentees is ve4' high in Ludex,u District. (l'leuva utltl ntore rows' if ttcL'e,\sut'r') 2 WHO/APOC, 14 SePtember 2009 Executive Summary The Ruvuma CDTI Project was launched in 1999 and operates in fbur oncho endemic districts, which are Songea Rural, Mbinga and Namtumbo in Ruvuma region and Ludewa district which is found ii Iringu region. Ruru*u region which exclude Ludewa district has a rotal population of I ,303,963 l.opi.. The project is in l2b year of MDA for Mectizan drug, treating Onchocerciasis, and this report.or"., the activities implemented in the year 2010' 'fhe project started the implementation of CDTIATITDs activities from January 2010 to June 2011. This was caused Uy tate arrival of drugs in the project area' The project managed to conducted the following activities in this..po.ting year; Advocacy meeting with the Regional pHC. Districts PHCs,-Political leaders at all levels, Sensitization of RHMT and CHMTs, Ward and Village leaders, training of FLHF Staff, CDD's and mobilization to community members. The project had been integrating drug administration for Onchocerciasis Control and Filariasis Elimination since 2OOg. The project also managed to do maintenance to the capital equipment such as motor vehicles/cycles, as well as the computers and photocopiers' Mass treatment in hyper and meso endemic areas for Onchocerciasis started in October 2010 and lasted in June Zbf f in some project areas due to insufficient drug supplies (Ludewa district). Total population living in hyper and meso endemic areas is 469,390 people who reside in 1,138 communities. A total of 384,123 people were treated which makes the regional therapeutic coverage of 81?1,. Geographical covcrage'uvas maintained at 100% whereby the UTG is 398,982' -fhe ATO was 394,288' The project received a total of 3,099,931 Mectizan@ tablets which were also used for NTD p.ogiu* areas in the whole region of which 3,097,892 Mectizan@ tablets were used' 1,621 iablets were lost and 7l 8 Mectizan@ tablets remained' The Region received amoLlnt of Tsh. 147,259,563.25 from difference sources for the impleme--ntation of cDTIal'l Ds activities. From APoc/usAID the Region received a total of rsn. t13,g59.563.25 and Tsh 33.300,000.00 was a contribution {iom Local Governments at rcgional and districts levels. However Sightsavers Tanzania supported the region by provision ot'sen.ices to the vehicles. motorbike and office equipments. Major Challenges and holv thel' rverc overcome' . Ludewa district is situated in Iringa region rvhich is located in a different adn-rinistratir.e region b1' regular coordination to district coordinator. o Sgpportirl ,,,pc.r.isi,,,r is donc by' Iringa Regional NTDs Coordinator of rvho ,"..ir,", tlnalcial support lbr super.,'ising Ludcri'a district frorrl APOC/Lf SAID' . r\ll districts ancl particularlv Lude u,a clistrict did not reccive Mectizatl -f ablets allocation in titnc. o MDA wzrs done latc ald have ttt be prolongecl. In tttost areas IvIDA done during the rainr season. J WHO/APOC, 14 September 2009 SEGTION 1: Background information 1.1. General information l.l.l Description of the Project Geographical location, topography, climate The Ruvuma Focus CDTI Project is situated on the southwest part of Tanzania, and lies between latitudes 10 degrees south and 11.5 degrees south and longitudes 33 degrees east and 38 degrees east. It shares borders with The Republic of Malawi and Mozambique to the west and so=uth respectively. It borders Mtwara and Lindi Regions to the east, lringa and Morogoro Regions to thl north and northeast. It covers approximately an area of 64,333 sq. km of which t,0-06 sq. km are inland water bodies from Lake Nyasa. With the exception of a small area along Lake Nyasa (altitude approximately 100 m above sea level) most of the project area lies between 500 and 1.600 m above sea level. The project area has a tropical climate characterized by two distinct seasons, the wet and dry seasons. Temperatu.", o." also modified by the seasonal variations during the dry season it is hot. average temperature is 27 degrees Celsius and cold during the rvet season average temperature is 14 degrees Celsius. The dry season is from June to December and the wet January to April/Nlay. The raily seasop peaks fropr N{arch to N{a1'. 'fhe drainage pattern of the area is mainly two fbld. Permanent rivers of Hanga, Lutukira (these two rivlrs join to fbrm river Ruhuhu) and Rwekeye drains into Lake Nyasa. River Ruvuma. Luegu and Ruhudji drain into the Indian Ocean. In betrveen we hat'e many seasonal rivers draining into these two drainage patterns. Population: activities, cultures, language: - Major food crops grown in this area are maize, rice and potatoes. Legumes such as blans and soya are also cultivated in large quantity. Cash crops cgitiuated include tobacco and coffee. Economically the area is quite well-of although the wealth so generated is not equally distributed among the people, giving a rvide range betrveen the poor. rvho tbrms the majority. zrnd the few effluent group. Communication systems (roads):- The road network in the project area varies considerably' Seasonal roads that is onll' passable during'the dry season-an important factor during Mectizan @ distribution. Feeder roads going to meso and hyper endemic comrnunities in all clistricts are only passable during the dry season. Songea district is sen'ed b1' a tarmac road, u{rich passes in the Onchocerciasis area and therefbre offers easy trallsporlation to those comrnunities situated along this road. Songea torvn, situated 1.000knt southu'est of Dar- Es- Salaam port. sen,ed by ail n'eather tarmac road. is thc administrative hcadquarters of the Ruvurna CD-fl Irocus Project. Administration structure;- Each district is divided into Division then Wards headed Ward Executive Offlcer (WEO) employed by The District Council, villages and sub villages. The size of each village varies; *ith population of up to 5,000 people or small rvith population of about 500 or less' The government system at village level is well organized with established village government offi".r, which are easily accissible, giving easy entry point into the community- A sub village is the smallest administrative structure. However in the towns and Municipal we have Divisions, Wards and streets which are in clusters which could possibly be referred to a village. 4 WHO/APOC, l4 September 2009 Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). it .i. are l0 Hospitals of which 3 are government and 7 to religious organizations in the region while theie are 26 Health Centers of which 19 are Govemment owned;211 Dlpensaries of which 166 Dispensaries belong to the government. The region therefore has a total of 247 health facilities. Number of health staff in project area and number of health staff involved in CDTI activities. Number of Health staff and their regional distribution is shown in the table below. Table l: Number of health staff involved in CDTI (Please add more rou's if necessary) DistrictiLGA Number of health staff involved in CDTI activities Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B? Percentage Br=Bzl Br *100 Songea DC 157 138 88 Namtumbo 209 105 50 Mbinga 102 128 18 Luderva 255 56 22 Total 1,323 427 4t 1.1.2. Partnership l. Ministry' of Health antl Social Welfare: Provides strategies and guidelines in approaching any planned activity. The Ministry also provides financial and technical sLrpport through supervision and internql monitoring during implementation of program activities. 2. Sights:rvers: Sightsavers is supporling thc program through tlnancial and technical supporl. In previous year funds received lrorn Sightsavers u'ere used in adyocacy' ancl comrnunitl, sensitization, pro-iect oll-rce sllpport and servicing capital equipmcnts. 3. District Councils: 'l'he district councils are providing funds. human resources and technical support to the project. The districts also support monitoring and supervision wherebl, Oncho activities are incorporated in health systems. The project activities are 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. 5 WHO/APOC, l4 September 2009 Working Relationship There is good cooperation between district councils, Sightsavers 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 select Cbns whose duties is to collect Mectizan tiom the nearest FLHF and distributes them to the people in the community, also they discuss problem facing during MDA (CSM) 6 WHO/APOC, l4 September 2009 o\ O(\ () -o () o- C) CN =Q o o. o -r > q) 0) q) s U) q) o U) F q) EO c) q) aq) U) I q) q) q) bo I 0) c,) oo (r) 0) e( '5 o a-a oio! a lro C I --7 l-1 C-) I I I I I I I I I ch U) 0)-o= Hol o cO 7. ;. 0) oLL3d;- 6) a/ q) 0) q) q) q) C) o U) 0) A) z I IoZ I --7 Ia 0) -o U 'i() a. co E L o o. L c) 50 .E -o o o 'd o 0) 'd tr a.() L .o c/) a 0)o d 3 sU 1) l.\ \ T q) o'\ a) q) U F-) q) U \ q) U\x't X) -a\ U o' L\ i) -+ L oS \) hn\ EJ oo U \ L bo q) bO q) u \)\ U) Iq) \ q) > q) o q)\ $ -olot\ 1 \) Bq)\ oq) o' L\ \) t\ : a L o \ q) l-IU\ \ u1q) :^ B C) q) L q) -o o ! 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OF- n^ o\\o car- (a) oo c.t \o <f, CO cn r$ t-.N c? ca t-- t--N oo" oo N .o -e)o .= o.N ri\ E F A{ o :''l . qtE E (,Etr-Q.q)'- </ ? >,E o e, - *F-.- -ooY Na + il rn ro ra r-O.a aa N o, oo c.i o\ c\c\ tr) $ <r G t.e E :-6 iclq) 33x z oo 6 rnr-$$ caca t-- @ oo aa co r- € ln$ \o(-- C\ Ir- CI o. = \o Ir- U) G) (,) q) Z o9o C^'L: i--cq)tr >, q)+C *o N I lt i ILq) oN 3.e -o 6c) o 'Ec3 ?0.,U B3x N ?a ln ra o\ N\o oo^ N ca r-- N oo$ O c\ -q t-- OO .'I ca o\ .;U LH o9c! ! i!- -i q ECE.i e.+X ?a.) PVUFXF q= a. 7 0) -o J rl F E-( L & (,) oo CN o -o d z oo -o z e q) c-) .9 E o,) IcEc .= .- - 6")c: i,-h A-] F ri e SECTION 2: ImPlementation of GDTI 2.1. Timeline of activities Fill in table 3. timeline of activities for areas treated in currenl year, indicating when the key activities were implemented by the month they began and the month they ended' 8 WHO/APOC, l4 SePtember 2009 o\O(\ L C) -o o o. 0)a $ () o. o >.! oo EE: oo=," 'Eoo 'A==LO0)()tr>oI) ua0.) - o-o a' .h -.r=9) '= cJ (d *9o ul 6'E(lJ-(g zeO -,I tr<o= ^- tr zbE!85ana aYo-r (CLO-PC) Eo(J()'d C triloa=a c 2-, '" 0-) -l-t E(.rg.rE9 fi o<9o-6-; raOa =(J:f.a)(.)=-o : !? o.) ._ubO FLbE o1-'59 ' v ^ Ol) P "-.1 L-O 5 u'- E(JA'aa - .a'a =! g -a0)u v !-()P^ >4tv '-QA v d t .r ! * (J .::La(S .*)P4',.>9-o-r .:1, ?! ! L (-).JA - -n)u'"J +i- ccl e -:>ov2.- 9ot; ^P._o aF =C o.rL^toriJ trcr) oLv6 cdOao.q ,5 9 66(,0)O) .H V.- -+Pi! 6.FFc>cL.r^ .;iEV 9 .l (9 LuF'i o, I9-Etrt=>'? F LUi.i5 t.q Eu * s9 , d6 <di ?) v) q) uq) ?s L q) L o ! a q) a_ L c3 o utrL t) AJ O 0)L a cd 0.)! () I € a 0.) o(0 o() 0) E F ..it orl -lAlGIFI =lal >lLl c) a,l a c)e o.5 trE U c.l o z oN O 0) iJ r..l o 0) t-.1 O(..l C) UD a- o.l o(, O O(\ oc o.l o() IJ c\ o - o q) ox o9 U C\ Z ON o C) IJ O (\ o z ON (.) bo a' O N oc o'l oZ O (-.l oZ o.l a, I a A) o) U o.5 (J O O c'l oZ O C\ o z O N o o o] OZ b.D a- O O c.l o- 0.)a ON a-oa N o o (-.l o z ao F trE o U a.l o z O(\ o O C\ o- oa O O c\ o z OD a- O O c..l o o O O c.l oc O (.1 o-() a O(.I oC Oq z ro U O c'.1 oZ 5(-l oZ O ON o 0) A) =O(-l oc bD a- O O C.l o- 0)a O C.l oC O O c.l oo O c'.1 (,) c J o L U) O l-.1 C)bo oa o -o E (n z c! bo 5 2. c! 0)! 2.2. Advocacy - Srarc the number of poticy/decision makers rnobilized at escl, relevanl level during the currenl year; tlte reason(s) for underriting ihe advocacy and the outcome. Describe tlifJiculties/conslraints being faced and suggestions on how to improve advocacy. Advocacy of Region Health Management Team and District Political / Govemment leaders were done together, in cascade wayfollowed by Ward development committee members then sub-village leaders. Advocacy meetings were undertaken before distribution cycle aiming at creation of more awareness for those who are familiar with CDTI and for others few which is the first time to attend these meeting. Advocacy also aimed to build and maintain the sense of ownership to the community leaderi and members. The outcome of this advocacy meeting is that Regiin and Districts has included CDTI activities in their Comprehensive council Health plans. The outcome at community level is that community members are fully participating in taking drugs from the nearest FLHF and support of the CDDs hence stable high therapeutic coverage. No constraint in advocating were faced since the majority of leaders/policy makers were the same people since we started the implementation of CDTI activities so they are well advocated. Suggestion on improving advocacy is to involve staff of other sectors in the Region and districts such as Culture olfi""., and Social workers rvho are expert in advocacy cornpare with technical people This is the second year CDTI activities are being integrate with elimination of all NTDs' School teachers was full involved in advocacy and mobilization, hence increase awareness' Table 4a:- The following table shows the number of policy/decision makers arlvocated at different level per each district DISTRICT DISTRICT LEVEL WARD LEVEL Songea Rural JI 102 Namtumbo 18 74 12 40 Ludewa l8 22 Total 85 238 2.3. Mobilization, sensitization and health education of at risk communities Inlbrntation on: The use of medio and/or other locol s1'stenrs to tlissentinate informiliotr .The methods used by the project is through political and government leaders rvho assisted 1o disseminate infbrmation to the community members during community meetings this is the commonest way of information dissemination' .Using the school children through their teachers is another method used. rPosters are also used for information dissemination' Mobitization and health education of communities including women and minorities oAll village leaders including sub- village leaders rvere sensitized in the current year; this was done aftei sensitization at thi district level. The FLHFs together with community leaders are responsible for mobilize and to provide health education to community members' l0 WHO/APOC, l4 SePtember 2009 .school children, teachers and their fellow woman CDDs are the ones who mobilize and provide health education to the woman and minorities, with good response' Response of target communities/villages - The response was good Accomplishments .lncrease of community participation in CDTIA{TDs activities. .Able to maintain high therapeutic coverage oMost of the communities know the important of taking drugs regularly. .There is willingness of a majority of CDDs to take responsibilities in the MDA implementation of Nfp activities. (Onchocerciasis, Lymphatic Filariasis &. Soil Transmitted Helminths and Trachoma). .lncrease of Mectizan acceptance by community and when the drugs late, community members start to complain. -Even though the drugs arrive late the people were willing to swallow the drugs. Suggest ways ro improve mobilization and sensitization of the target communities- .Mobilization and health education of at risk communities should be done continuously so as to improve community health and reduce disease burden' .To continue to use policy maker and influential people to sensitize the communities .To adhere with time frame on MDA implementation suggested by the community 2.4. GommunitY involvement Table 4b: Communities participation in the CDTI (Please add ntore rov's if necc.ssary) 1 Comment on: - Alendance of fenrule nrcmbers of the contmunity at health educaliort nteetings . In Ruvuma CDTI the ratio of females attending public meetings is higher than men. In general, low tlo 1,ou rate the parlicipation of fenmte menthers of the communitl' nrcetings when CDTI issues are being discusses (attendance, participation in lhe discussion elc). . There is a considerable involvement of women in CDTI activities as evidenced by a good proportion of selected female CDD's. District/LGA Number of communities/villages with community members as suPervisors Pcrcentage Brr= * 100 Total no. com m unities in the cntire project area Number with community members as su pervisors Pe rce tage Bo= Bs/ B{ * 100B{ Bs 360 131 ,147 r00Songea D C 11'7 11'.7 I00 ) 14 .13 5 670 -.]35 100Namtutnhcr i35 335 100 ji5 NI b rngrr 185 r85 l(x) r83 lt{7 -.170 t7l ll2 I ti-i I0() l,ttcleu a t7l t7l t00 t7 I tlt l(x) Total r.138 1.138 I00 t.063 1.05i l. l l() 1.05 I I00 11 WHO/APOC, l4 September 2009 t Incentives provided by communities for the CDDs . There is communities who provide incentives to CDDs by exempt them from voluntarily work and some helping them to harvest crop from there farms during the distribution period. In Mbinga Council the CDDs get some cash provided by Council. Anrition of CDDs. Is ufirition a problemfor the proiect? If yes, how is it addressed? o Attrition is not a problem in the project; most of the CDDs are still the same since the project started the implementation of CDTI activities. CDDs attrition occurs in rare tccasions, like death or marriage for a female CDD. This was seen and evidenced by previous Madam APOC Director, who pay a visit in Ruvuma CDTI and met with long time rvorkers as CDDs and decided to give each a bicycle' Other issues NONE 2.5. GapacitY building - Describe the adequacy of avaitable knowletlgeable nrunpower ul oll levels. . This is a big p.tbl.* in Ruvuma CDTI as there is a change of project staff in the recent y.u.r. bnly Mbinga district have stable staff but fiom Region office there change of staff w'hich has made it difficult to maintain'good trainings to FLHF rvorkers. - Where frequent transfers of trained staff occur, state rvhat the project is doing, or intends to do, to remedy the situatio n. (The most importunt issue to describe is wheil nreasures were taken to nnru* adequate CDTI implementation where nol enough knowletlgeable nuutpower w'us ovailable or if staff is trtnsferretl tlurittg lhe course of the campaign)' . There is immediate replacement of the region, district or FLHF worker rvhen the previous one is retired or transf-erred to another area. The replaced staff are trained immediately on CDTI and is tbllowed up frequently in order to assess their performance. 12 WHO/APOC. 14 SePtember 2009 ! OOr- $ O t-' r- t\o(.l rn V](.l \oin N al o\ 00- (J q) q) c) t € co r- N$ a.l(a c\ N q) 0 U tr() Z 3n U U LF U NI 3 r oN \o \o 6r- co (-.J al{ € \o& c) () o\ r- -f U) c) .ao cn f-r tFq) ,0) LCBq, l- Z U *. q i *a 3il Fe LF O () o c) I o\ a.l -s \, \o \o cl t rr) \r1 r- al d 0 a d 0) () Z q,) c) U t. ..)LF Q o 'iFV alj cl alf \o .t ol 00$LF r r r c O 6l at -l F q a -] () 0,1 a} q) z U dbIl 5 o-o J -] F F c) q) q) o\ U .i (! o oo a o -o E Ed z I a o\ c..l o -o O o-oa : U o o. o V)q a) uU a: L a)L o \\ qJ a a) o_ '-= cd co E 0) o. E l--.1 O ,* a o 0.) 0) li .0)!H () Cd 50 (dkF ,;1 ol -l -oldlFI 50 o s € c C </ C U- ! > a{ C c_ ea c o =t\ t\ l\) e $ N -t al alf (-I Table 6: Type of training undertaken (fick the boxei where speci.fic training was carried out during the reporting period in Ruvuma CDTI Project area) Trainees T)'pe of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifo) Program ntan { FIow to conduct Health education Management of SAEs d CSM SHM Data collection ./ I Data analysis ./ Repoft rvrrtt Others (Supportive supervision M&E) 2.6. - Any other comtnents We have created zonal FLH\rL' rvho assist DNTD Co during MDA activities and data collectiol. Zonal cogrdinators are FLFHW rvho directly assist Districts coordinators drug clistribution during MDA as r,r'ell as collect data and return renlaining drugs to the Disirict. Thel' and are present cluring training of CDD's' Treatments 2.6.1.'f reatment figures I/-the project is nrtt uchiet'irtg 100'% geographicctl t'ot'erage und u rninimum d 65% therctpeulic coyer{Ige or the corerage rrite is.flttclttttlirtg, stale lhe reosons und lhe plans being made to remedlt this. Therapeutic coverage in all sub r,'illages are above 70o/o in Ruvuma region and average in each district ranges at about 8070 t4 WHO/APOC, l4 SePtember 2009 o'O o.l o .o c) a.q) a s O o o. o (r) t:0a >- s.Y Q ^\!:ts\ 00 oo, .sL EUua. \i sc, \UU U 1, U \: 1 3-= c- U (\ o* : =< L - s-= t- S=\= s< e- o' s- i\ .:! HS[=()t LO\t { 0o \ u t U \\ ts U I\ a4 a a- \ F\ II F-\ () F D (n C) o 0) 'e a-() .= E a 0-) .9 =0) -ot{.) I! 0) o- oq 0) = .= () o 0) -o o CJ oa c- c Lq, -c = = = = c :- -o c) 0) (-)(! F o\ O I -o c L a) -o !() -o =I oL O C) 'e ! o. 0) c r! -o -o (.) o .; a o) :E tr E E a(,) (.) E 6-) -o c() I L o o6 u C a L C) a = = al- O ; -o() C) a o o a oL () 'e L o- 0) = 6 o ,: tr 6 O o E() 0) I L() o- .E o a() = .= :o r c .9 = = o - OI -l'/t =lorl d u .=() a o ! u -D a Z al .J b( L{) o ,) k!I o c) .I d 0.) o()E =A) c.) Lt- = = = = C) G L 0) CIJ iJ^ o^\ o(.) (- 0) L (.) oO u 0) o =O^ E- bo o() () L() 50 L C) o() <) ': =Y-()o C) L- a a) -c Z ,J 0)o 0) bI o E o ! €l ol tr h o a:o .v!. E dr!9<oE6-i:e4-yL49 -! 6 :/ a I OF : E F.tr Bod o>o o-OL o o o -o z 9uq =.1z au) O ._ 0)L=v=bOE* =f s E-Ets o E >O cd >=F'6\oz 53 :oO-eO co F- ol €$ r- 6o\ LO o0 EOU"' A6 o al \o c1 F- r- c\ o) o\$ r- !U EC_OO - e'6 c -o -r,E u L eL>6= =cL 9ts o. -1- € co^ N \o a- co F- o,\o F- .i^ H o ;D f CII o d^ N !' o' oo -co! a -Tn=u F 4d =-b9z oe sE * caia.) co-F4., x :'3 " ?.o EZui'o ,ui:=> tr e t;. ^-1x=t D o trr € (..l oo co @ 6 & a1 = \o c.l =J c- ,n r-s oo ro^ aO(.r t6t) o\ v) = dl ol$ r- $ rd € € al $ o. rO a=N ca = O tr-i r- a.l -f, F- o\ r.) o\\ot ll * aG,=.t d ,- o=:: o a E -(u+-rlr __=,aE.Y; d = o .\ d!6 E PE b , L_ vE o>-o ? - c[) ^ d^ ii 9c- ai a =.^ ,J=a)J ; t= u)r2-Z6 -dY2 9s' --o a = a 0) E E oU rj a = r cc rat co r- €t) j co r- 6 ea .9< HV Uo oo o6 -o CC z oo .o C) -] F 3 !q a\)U ? =\ t)L s a) a t) e_ ! J tn a OL d 'l O ! 6 >' -o a Lrf a -d cd 0) E () l.F r-.1 c)t -oldtFI I 2.6.2 What are the causes of absenteeism? Absenteeism was mainly caused by the migration of peasants during the farming seasons, as well as petty businesspeople moving about some to hard to reach areas due to impassable roads; MDA in most districts was conducted during the rainy seasons. 2.6.3 What are the reasons for refusals? people had misconception of the drugs functions (family planning) and that they can not consume alcoholic drinks during the day of MDA' 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. No serious adverse Reaction has been observed and reported in the Region during MDA this year 2010. Few people had minor side effects e.g. swelling of limbs which subsided after treatment at the FLHF. o '.. .: '(..'.' : i " No parasitologist specifically trained for CDTI project activities however rvorkers employed by the MOHSW are used when investigations are required.' I .,1, i,,. ,l l,ll\ r\ ,' l'. NONE for the project. but those located in HF are used' I{as the project reported all SAE's to Mectizan Donation Program (MDP)? Please tick one. a I No Yes In case thc project did not have any cases of serious adverse events (sAE,) during this reporling period. please tick in the box. No SAE case to rcport l6 WHO/APOC, l4 September 2009 al o.O (..t () -oF 0) o- C)a$ C) o o. o B r-- q) a_ a) I\ U -a \q) V) l( :\a q U) A)(.)\) V) + ;\ q)\ o 1) a q) a_ 'o o L(.) oo L ()! (J bo L -o -o 0)L! oO a !r-.1 CN a o u (,) cr) L 0) -o a ! 0.)a (H o a 0)a(t O ddl 0)l -tol cdl FI (.) Ao9 5Yo <.= E O- +.Q aD ^J-U 91 aEF&3d c;o- u F F= d@ooA = .r,o!u9.* o ^a^ " aE.= L-.1 6 -c q: cd -C .^ C, on.N 6 --,9.; :i;EE> =o aqG o a I n)a c.) bo o oo (6 0) xq.) 0) oo o bo (J a E o bO o o. 0) o E o o o o =iN* vEAo>, o o oOc d.; =.P>5 r-l f-l z - r z Z z I i * a I ao\ O a.l 0) -o C) o-q) a $ O o + o oo v) () 6(.) c) bo q) () F 0) c) v) oo (r) c,)a c.ll col o'l .dl ^t .al C) q) F;)() o) 6 o c,) a G o) !.) q) q)t 9;= ;v1 oq) A!q)<) a) q) c., c.) l-() LC) .t 1, -ol -l:DlY=l/ Leluut I -tr4<) -ol !l 0ie oll orl U o)L'oeC -9a 9Ltr0)c)F l- :; 'a;{E\o6i o\() -o F co \o o\ s \ r- oo Ir- @ oo vl € \o $o, Ir- @o\ () bora (€ ^F bs -o O r-n \ a- co@ tl oo s r- co co|l*,,i kl ii o r', So ^F oo' -o co 09 car- r- ..l F- vl \o - a- c.ir-\o FT r-C' t-- I! il (l] oEo =boo d^ il )-oo -coF r- 6 c\v) $ 6 (a al s oo CQ o. r- C.l o\s N $r- od c.l c.l co <- oo oi o\ oo N F- \o <- O co r- c\ $ a- -i(\ al .o od .o 2a =6z-i o- $ @dI r- oo oo ..l$ o, - -s o\ (.l r- ca \o N r- 3$N \c) d al O oo(.1 O c.l $ $ oo N o. (-l c.l oor- oo^ (\ Z -a .>- /Ea t9-O -Fo oo co\dtt o\ o,\o$ co r- 6l $ ca F- oo a\ \o @ ro^ c- o.N oo r- oo N r-N co .d a.) cor- c.l oo \O^ \o r- a.l tr- \o. .f o :'dv!:o 6.Y r, a,, - o -€= Er '?'aus o-O C; D co O O = O = I kl ! F 6:i -a @ Oo O?OC = O = g crrii 93 Jir.l a- a.l @ _ r- -1 o--t: -j-\o -: -l € ,:! -f\acl :\=!,J'= l- - )'. z-.-' @tr-(-l-j. .3co aa F-O .1-]-9 -t : n 2al du'- aC,) 4 P-o cor- r-(\ 1$\o 'f .i- caf$a.l oO =aqJ ::;; ^\, Y L- tt - a4$ o; >.-. ,c=il32 trq o o 50 a3 6.) .: E E (-) N r- N & N o\ ONcl \o N a\ ol a.l $ N o\ o\ N N d, Il.] 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/aPPlied for by - Qtlease tick the appropriate answer)WHOtr UNICEF UMOH Other (please specifY) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH wHo D UNICEF NGDO tr NGDO tr V Other (please specifY) Please describe how Mectizan@ is ordered and how it gets to the comntunities Table 10: Mectizan@ Inventory (Please add more rows i-f necessary) - How ttre the rentuining lvermectine tablels collecled ond v'here ore the)' kepl? Mectizan@ and distribution data are returned back to the Health facility by CDD's once the distribution is over. From here Mectizan@) is either re-allocated to other villages or sent back to the district pharmacl' fbr re-allocation 1o other Ilealth Facilitl' or kept u'aiting another distribution c1'cle. - Lisl ond hrieJll'describe rhe uclit,ities under iv'erntectitr delit'ery'thrtt ure heing carried oul bl' heulth core persottnel in lhe projecl areu' Actir ities performed by' Health personnel in handling Nlectizan I .SuperviSeCenSLlSupdateinlris/hercatchtnenlsirrca. . Mectizan ordering by filling in the tbrms and sending them to thc Dlstrict Onchocerciasis Coordinator. . Makes a follow up and receive drugs fiom District NTD coordinator' . FLIIW infbrm the sub-village leaders and CDD's about the arrival of Mectizan' . Organize and attend mobilization and sensitization rneeting to the community members . Community FLHW's collect and distribute to the CDD's in their catchment area. . Conduct supportive supervision during Mectizan@ drug distribution to CDD's' o Data collection and summary report writing and send it to District Oncho Coordinator . Conduct feedback meeting with community members' Number of Mectizan tablets Remaini ng ExpiredLost WastedUsed inReceivedRequestedIn stock from previous year State /District /LGA 4920501 0308,8 r 366,5003 70,000300,521Songea DC 1410 _:)308,701182,500210.000193.600Namtumbo 000606407,000 109,356407,000t,l35.l l0Mbinga 22t,2800 14,238 Exp Feb 2010 BN 130I l8,l l2320.0003l2,ll314,238 Ludewa 221,91914,238I,{66 0844,982976,0001,299,1l31,613,169TOTAL Any other comments NONE l9 WHO/APOC, l4 SePtember 2009 2.8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the proiect area? If so, lvhen? Training has not done for cSM and SHM in year 2010 to the communtttes' Community self-monitoring and Stakeholders Meeting (Add rov's if needed)Table I DistricV 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 (SHNI) Songea DC Namtumbo Mbinga 441 335 r85 447 335 185 447 335 185 Ludewa tll t7l tll TOTAL 1,138 1,138 1,138 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. 2,9. Supervision 2.g.1. Provide a florv chart of supcrvision hierarchy NOTF + I CHMT/DMO --) I RHMT/ RMO RNTD/ PC DNTD/ DOT FLHW COMMUNITYCDD 20 WHO/APOC, l4 SePtember 2009 (2.9.6. How was the feedback uscd to improve the overall performance of the project? Feedback at all levels fiom Regional Consultative Committee, RHMT, CHMT, pHC in the community is used to advocate leaders on benefits of Mectizan treatment and the neei of including MDA in our budgets at all levels. The f-eedback is also used to sensitize the community on the benefits of MDA with Mectizan to eradicate Onchocerciasis' SEGTION 3: SuPPort to GDTI 3.1. Equipment 2.9.2. 2.9.3. 2.9.1. 2.9.5. ) what were the main issues identified during supervision? Drugs remain in FLHF and some retumed to District Pharmacy Was a supervision checklist used? YES what were the outcomes at each level of CDTI implementation supervision? Ai District level CHMT team are too busy to fully participate on CDTI implementation in all activities. tnihe Wards the Administrative Officers are sometimes transf-erred to nerv areas or are elected and therelore political leaders need to be sensitized every year. it.o--unity level. some people create barriers due to misconception of the drugs or for political interesls. This was overcome by working closely with accJpted leaiers in the communities eg Religious, Teachers and respected elderly people within the communities. Was feedback given to the person or groups supervised? The FLHW and the CDDS give f-eedback to respective communities on the success of MDA success storl' of people benefiting from aliments after treatment wifh Mectizan. ul nI (l'le a.sa udd ntore rotts if necc.s's-f able Status o1- e Sourcc -1'y pe of equipntenl APOC ivlol I DISl-RICl-/ LGA NGDO Otliers No ('ontl t tt trtt Ntr Condtttolt No C'ondrtton No (-()nd r t I()n No Condrtlon 1. Vehicle J Ir J F 2. Motor cycle(s) .+ F 3. Computer(s) 2 F 4. Printer(s) 2 F 5. Photocopier (s) 2 1 F CNFR 6. Fax Machine(s) 1 F 7. Others a)Bicycles 136 F b) c) 2l WHO/APOC, l4 September 2009 *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO:Written ofO How rloes the project intend to maintain and replace existing equipment and other materials? By doing regular services and repair to our equipments whenever required' Rlquesting and reminding our administrato.i to include CDTI (NTD) activities in the Health budgets. 3.2. Financial contributions of the partners and Gommunities Fill tables 13a, 13b and l3c If there are problems with release of counterpart funds, how were they addressed? Additional comments 22 WHO/APOC, 14 SePtember 2009 o, O C.l L 0) -o C) 0)a t (-) o o ca(-n ra tt r- al \o € \o €r- 6 \o \o at o6t.oO\O\ ont.t <to,s^ \o. o- oSri|t666 o Eo^ 5E 5 *cE) E.; EiE oFEE o€ fOoi(Loi <F* -z E3"eE"eR83Rt$- O^ .o" @. €- :6r-o\3 oL 0) -c o co:o E9o'Fo3 oEOq3 -z g o) E o oL) .cl .9 E' ^o L oct(! CLt IrJIF o 28, J l) air-V)€ = 1' o) oL -oost t r - o\€r- ct rn co O O + N(\ Ialcl OO O O o\ + + €c.6 6al 4=$@@\oN6No.a.@ , rf) al\' YY OrnV) clc{t €ao OO <-6l cl .t 6l N clnt N =f+€6lo -tO' .C rn F- , + O.-al O' -tt oq oo rJ)^ Fta oo oo n- F.-rt I 0) I ct)c 't o 6 c) ! 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(o : ?a q) F Lo\O a.l L 6) .o () o- 0)a $ O(J a- o $N U() o a Fr o 0) a 0) H ,o a , 0) 6 o -o L oo 6 o CO ;i ca c) F r) ol + ".i ral clvl Ci tlt CI o\r-o\r- \.o ol 6l ttO.l ca oooo c-t-O66oO,ON <t c.l o) FE C'forr(L o o o fCOs0) EE 6'tr oEOq3 L o E o oL = .cl .2!, 'o L oct(E CL G uJIFo o oo oz x :ool CDr r + I ^l :;; o,€r- clroc6 oO 'a \o oi rft4 or ol o\ atd rft r- al cnlr) 6lali@co6i V' N d N 6 - cl , , o,o , o) I E,,c 't 96 o,E at !, o, oL a -oo E o o E ar o a r V, al r at , -t ! o Vt tr- ar dln r/l) dt c o flt L c o o Fz ul Ezt tu o(, I E 6 C o (o z .E oF o L .9o t o Ct. \OrnN(\rnot- r-'!,o oL ao o ;eE \D€T cl nf-60\ a1 -J -f\D@ CI '6 (--rn O. a] Ofiloo\rt -, ,n - €r cc CO c. al O C& alCI \o a. ar ? al c.l <)J € \al ! o)E o CL o o,oo(\ o c '6 -o v l,.rj (! !,c 0)to o o o (, CL L o o J FoF oz & o tt o U' coa 0)L =o9E g e>Od= :Jfr .E(6di:!(!r)uJ9E rjddS IC 0) (D 0)a (D o(g 0) sE9q=o)oia o:o o9=gto^L :66HPE oic\dt(s Eio! s$tf o o o tr) G tr o E G o 5a .4 E J G o aIq cOorc6.=.9 zo(l=;= o-XG(!a=,nE -Gic'iidc"jc.j; o c)lz o B .^f LJ(sOo)OI oo o) o, -e 6'6 o0) o) o)CCch='= ':orus .\i;oF'. ?E.:c!€ sN',; i tr o o:(! ru c o 'z -(5cch9A^YJ .=.Y=>.oE6NPO)o.N'rU-c f=6d=E-oc>oo)o(DEq) !E *. c! q nO-r i(.) Go o E$ i o GN Ea o E q) c o oN v, 0)t, o o a q uz J F UJ oo :fo .rl eJl .ot t'r ri6l 6?o al at $i Vt o\F- r- \o co t o\ 6 €oo r-r-O6noO\ O c.l +al oL o ! o o oo(9 z c O) E o) o 'o L o, t(! CLt ul IF o o ,FE oforr .L oEOq3 'z lEE E:Po'Eo ON6OOOr-.ltO\ \onclEo o f -oost arrnorr- t\ -l 0\6r (\'n6 O 'q 6l tt N AI ;^ : al ol 6i tf)t; C rnr rn o\ a.l -f+'n\o6r c.l d = c- alr ,4 OhVt ajN!f6€ O \o ..i rn N el oiN at oo, 'i' € & d VI rnrrn O, CI 6i+=J\o€ CJ - ^t!? :? :<t uel C\oN OI -l , r O F. o o o) o,c 't o o o (! E ooL -o .2E o o E E o (! z E oF o L o i5 t C .9 - ,a e^o,&Fr .l v, ac .a CI CI , al ccl -f E'n n a. O1E O) 0) o)E o d\'r al '^CCr,.,- t.\ \D \at Go\ o oooN o oE o o. o '6 -o t ul (! E'c 0) oo o of o 't 0) o. o (! c) GI o BF o l -o c o o Fz lU EzE uJ o(, tuz J Fl! oofo J F oF oz t o vt olt, co a_ oicE3H\\'-o-) .9oi: .: o 6aiE.(, trJ Ot: Ju,u,d IC o) q) 0) 9. 0) o(E 0) E9q3,9 o-=o>(,O;C oI9Vr'Ecb8g *EqEbEE,=,9-c.io$s lrt o o 5a to E oo o J o q) Eo B) os G lElu o o aIq Coo)c '-o .E .9 >oo=;i==- +5EE -c.ic.id(?) c"i c"i ,; a o)fz =,^E o6Oo)OI oo o) o) ==oo o0) o) o) Bt= .\6'6(! .:E;of!'. ?l: .. c! € SNNd o G:(! UI o c o o,O N 0) -o q) o()q) $ O a) o. o rr) (.'.1 c - -G -!(-):9 Y9 oiiHo)N:)\r:.-Y=EsH:-sE 9;6id+iB- --d s Go o o (! t4 tro v, so G o o E G o o a o E () oO a! o 0)L a C) i ,a a , =L _.c T. o _o L oO d Ir- U t) q) F al ml 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure Per activity IF.C rnaterials del'cloPment. 1.1.3. Horv have they becn implemented? . -largeted training to cDD's and Health personnel has.been increased and the training period alsoincreasedto3daysforCDDand4daysforHealthpersonnel. .CommunitySelf-Monitoringhasbegunin2villagesinMbinga. . Updating of census is being caniei out before each distribution and the data obtained is us"d fo. o.dering Mectizan@ for next distribution cycle' . ApoC ,ou.rug"n1"nt has extending period of project funding to enable project sustainability' much emphaiis being on health education and IEC materials development' - Any comments or explanations? None SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are aPPlicable) ./ Year I Participatory Independent monitoring ^/ Mid Term Sustainability Evaluation !-.-- 5 year Sustainability Evaluation !_-- Internal Monitoring bY NOTF { Other Evaluation by other partners 1.1.2. What rvere thc recommendations? - Indicate in table 13, the amount expended during the reporting peri-od for each activity listed' Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here US$ 1 : Tshs. 1530 . Training sessions fbr CDDs and Ilealth personnel should be increased and periods should be longer. . Comnutrity education on key issues like programme o\\'nership, communit-v responsibility' reporting of side effects and census should be stressecl during CDD training' . An update o1'comrnunity census before the next routld oltreatment should be carried out' o AI,OC should consicler possibility of extending perio<l of project lunding tbr zrt least tBr.r rnore ),ears to enablc project sustainability. n*rcti empSasis being on health edr-rcation and 26 WHO/APOC, 14 SePtember 2009 4.2. sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NIA Was a sustainabilitY Plan written? N/A 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 o At co-m.,nity level they plan on how to receive Mectizan@ and distribute to the community members FLHF order Mectizan@ from the District Oncho Coordinator and inform community members on arrival of the drug, also conduct HSAM and perform supervision, monitoring, data collection and report writing' The DOC performs spot check supervision, monitoring, data collection and report writing. Also participate in planning of CDTI activities at district level as a co-opted member of GHMT and attend Project annual review meetings. -fhe Project Coordinator compile report form districts, prepares Technical APOC annual report. Mectizan@ retirement and Re-application, supportir"e supervision to district and attend various CDTI meetings' a a a 4.2.2. Funds 4.2.3 1.2.1. {.2.5. . All district councils are allocating funds for implementing CDTIA{TDs activities' Horvever the allocation varies from one council to another. Mbinga District is Ieading in the current Years. Transport (replacement and maintenance) . Maintenance of motorcycles is being done using funds tiom district council and other tiom partner (Sigirtsavers) u'ho also support the project to maintain. off-rce equipmcnt. We thank epOC management lbr replacement of capital equipment ancl provision of new vehicle to Mbinga district' Othcr resources None To rvhat cxtent has the plan been implcmented . I{uvunra cDTI developed Suslainability Plans in 2003 ancl subrnitted it to APOC and to the Councils which fbrrned the tbcus. Since 1hen. CD-l-l activities are t-eaturing in the ccHP and rve are no\\'receir,'ing lunds liorn APOCruSAID for the implementation of CDTLNTDs. 4.3. lntegration Outline the extent of integration of CDTI integration: into the PHC structure and the plans tbr complete 27 WHO/APOC, 14 SePtember 2009 4.3.1 1.3.2. .r.3.3 1.3.4. 4.3.5 4.3.6 Ivermectin delivery mechanisms o Ivermectin delivery is done through Medical Stores Department (MSD) up to the District pn*u"y] ero- the dis-trict pharmacy the drug is transported to the FLHF through the existing PHC structure where the cDD or any selected community members collecis the drugs to the community ready for distribution' Training r rr rrr^ ^+^+T ^l^^ tra. . The project conducted refresher training to CDDs and FLHFs statf' also tralnlng to the new CDDs and FLHFs stafiin in"ho endemic areas and in none oncho areas where the project has started implementation of NTDs activities in the integration *unn",." School Teachers were trained on how to administer Praziquantel to the school and none school children' Joint supervision and monitoring with other programs o CHMT members usually conduct s,p".,ision-and.monitoring in district to all health pertaining matters. The District NTDs coordinator is a co-opted member of this team ari always goes for supervision wit!.thg team in the same routes' CDTI activities a.e intluled in the bcnp in all districts council and they have budget for suPervision' Release of funds for project activities o Funds are released through Government procedures and it fbllows the budget line item and timeline for the i-pt.,r.niution of NTDs activities horvever release of fundssometimesittakesalongtime.Theprojectismainlydependingon APOCruSAID and Council' Is CDTI included in the PHC budget? Yes DescribeotherhealthprogrammesthatarcusingtheCDTIstructureandhorv this rvas achievetl. Wtrat have been the achievements? . Fill tables 14 ancl 15 and provide clescrrbe other programnres that are using the CDTI StruCt[lreandhor,vthiswasachrevecl.Whatharrebeetltheacltrevements) .Foreachtnterverttionlrstedintablel5,explarnwhatweretherolesplayedbytheCDDS (censtrs, rrrobrlizatiort, distr tbttttotr, clata collectlolt' storaSe' collectron of drugs' referral of SAEs, etc - .)? 'EXplc]lllwhatarethecorrlbttlatrorlsoflrltelVelltlollscotnl;llerllerlted? .Howwetetheiritervt.ntiotlsrrrl;llerllertt..ll(;1[iresulllletirtle)) 1.3.7 Describe others issues consiclered in the intcgration of CDTI' 28 WHO/APOC, l4 SePtember 2009 o\ ON L q.) -o E C) a() a $ U o o- o I > 6l o €q) c) o q) q) lz Z co o. ro- r- t-. u'l t-. ooz zz an o\t^ t\o co o\ ro^ r- co c!{ co E oF I( N (-) t< a 0) '1 { o L a c oo -o Z. I\ o -o E tr Z I (, o () oo oa I ,q :r >.() V a\) xi) :- ,qJ U) P a) -a q) L!t- \ a) a q q) q) q) t\ ea = \o O zzz $ o)$O 7 N co oo t o.q$ c) 6l c)& s co\o N C\ sl € zZzz $ \\o\o a] o\ r- $ r- N c) 6 a o\ oo =1: a\ = r- oioN ZZzz \oq \o a.l\o c.l t-- @^ \o n\o ..l F oo co a\ v o\ ca cl zzz z -$\o c.i r- o\ $\oq Nr- c\ q) () lL O(\ ..l \o ZZz Z t-- q o\(..l $ ro t-- $- o\ c.l tr- t-- c.t r- oo 4) o) BD 6 4) L() z I c! 2 C\ zz ZZ @$r-N @$ fiF N r- ZZz O\o z(.l\o () (g c)A zco-tz zz co$$ N @$ 3() u9 L9 !-= z c.l oo zZzzf-t--r-Nr-r- () q) @ (..l co o, Zzz z t--r- t--Nr-r- co uo oi a= EE Z6 a)b!L zc'lzZ Z$ -1-tt q) (,) z(-IZZ z$.3=f-:i aq Z q)b! F =o o :(J tn 3<: -^i:'...i- H d ,Lzt) aao '.= o2o) a 3<: -A.::r2n aaa o og 9?;<: - -:-: -6tsrl)zn aaa C o O2c) atro3<: -nij,J--d ,J.ZA aaa o c-) =oJa 8<: -ni:J;n (dJS^IA;) aaa -6 A.:U( -eS o.Q =- E> C( qj aa o cOx '.=(o =5 .4;oi< a C C) -6 s6(U(o(, FcF IEO O 'u(! C <C) cE '= O) CO rOa >6o a o .9 = -o P1 .= a e (L)O= coHoo(o = N! -(ICXo o-r =c-a,! qr or '6!Si5a< a 6 oE(J a (I, E o- o_ co .eE .O'*" '-.=(utE3Oo-O aa +Eoc ccc'o.c oEEE = oJ-o ;;3i5 >a a .9or€o): E'=(u6>t a x9 >.Ltr o) =C) C) o. a ar)L 0.) o o o l<F U) C)(d l-<(o dO ! (B z o li oo (c Lrd (s z ol< o t< cd d z Tr Fa a tn o ch c/) oa o Ea Ea o.Cg LL -H a c/)d o t< 0.)o*O- o: lJo o: Pq -rOF() e) () I U $ 0) F 5 o\ a.l 0) -o q) o() a =O oA o ca a AJ r_ k !,) :- .! 7 XJ l.l -a t) t) 4 a o q) L a) q) :{ rl,] z o zz z rl] zo z rr.l zo z z rl]Zo z (! () 6l tr.l z z --7 Z Zz-7--7 =(J oo il Z --7z z--7 -7--7 --7 bo c) Z -7z Zi7--,7 b! o22A 2 z Z-a. z-7 -a'-7() 4 Z --7Z z--7 -7--7 --7 zz z-,7 -7-7 --7SE a zz Z-7 --r. o! v+ Y a!{oEq9-.- oooa) --7 Z z-7 z-..--7 c) c) ocD ooiiEBg o q a o (J C oOCZ z Z Z Z Z Z Z z Z o C..) o :E 0-) =o o oocz 6) a oE a 6) a :E o oZoC oZ Z /,q d9 o- (n () o oZ OJq 0)= o- bn '=z 6A c) ql o o ';1 c) o 0) 0) aa O a aa a c .F (o (U E c) o = o COx '.=(o =o -q;oii a z =) o C .9 _o '- .9o a c OJ E G) oo roC r!-(! L(E or6EEO+ IO a o cE .eE =(o €aino(o Oo- a OoJ co .eH =0Jti ori5> a o c(Uoo .;N -- (6 tcr '6 -Oi5a a cC^ P'=UiPEtrc o)6>E a cl () q) F o (d O (,) 0) o-a a () o (E E o o(!!F oL o o L d z. o o L(n o H z, i. Fa aq tr= o a- E J q a cd oq o a oa a a or 0)o_Oo o= (Jo o q) F a) t\ \\,L\$l\' q t\ *\c U C) - o Li rJ(r) (, c0 a a c.)(- L< bo o!O. tr C) fi a) F \ a 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area wilhin the reporting period. None 4.4.2. How were the results applied in the projecf? N/A SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of GDTI implementation process. Strengths . CDTI activities are conducted by health workers employed by the Government' . CDTI approach is now used in the implementation of integrated NTDs activities' . GHMT members are knowledgeable on implementation of MDA of Mectizan and aware of CDTI benefits . presence of political stability in the project areas therefore possibility of ownership and long- term sustainability of the project is increasing' Weaknesses . Some councils are willing to provide funds however funds are inadequate tbr the implementation of CDTIAJTDs activities, . Diibursement of funds from councils does not match with MDA timeframe . Change or transfer ofstafffrom and to the project area' Opportunities . Availability of local Radios, and TV helped to disseminate information to the communtty' . Council Health Management Team (CHMT) and FLHF stafTs are lully arvare of the implementation of CDTINTDs activities in their rcspectiVe areas' . Contribution from the councils is increasing each 1'ear . policy -rnakers are aware and willing to participate during sensitization and MDA irnplementation. Lisr fie cltollenges and indictrte how lhel,were uddressed. . Luderva district is situated in lringa region rr,'hich is located in a ditl-erent adnrinistratir"e region by regular coordination to district coordinator' o Supportive supervision is done by Iringa Rcgional N'l'Ds Coordinator ol rvhcr receiyes frnancial support fbr supervising Ludewa district lrorn APOC/USz\lD' o Data collection from Ludewa done through phone calls because we are not ttrnded to travel to Luderva. . Ludewa district did not receive Mectizan Tablets allocation in time ' o MDA was done late and have to be prolonged. In most areas MDA done during the rainy season. o Delayed finances led to MDA to conducted during the farming season' I 3l WHO/APOC, l4 SePtember 2009 SEGTION 6: matters NoNE Unique features of the proiect/other .n \ t 32 WHO/APOC, l4 SePtember 2009