Tunduru CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2009

T]NITED REPUBLIC OF TANZAI\IA MINISTRY OF HEALTH AND SOCIAL WELFARE ORIGINAL : Enelish I t Proiect Name: TUNDURU CDTI Approval vear:2004 Launch Year:2005 Reportine Period From: JAI{UARY 2009 To: DECEMBER 2009 ( Month/Year) APOC fundine year: (circleone) I 2 3 4 (5) 6 7 8 9 10 lt t2 t3 (circteone) I 2 3 4 (5) 6 7 8 g r0 ll tz 13 Date submitted: MAY 2010 Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sight sayers International - 536 communities I I id CsN CoP TD36 ro Pq ?or Hz b Honrbn To,-D.1n H,g.Ko.e RECU LE APOC/Dt,( WHO/APOC, 14 September 2009 at ./_tl COUNTRY/NOTF : TANZANIA (Month/Year) I TUNDURU CDTI 2009 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 oNcHocERcIASIS CONTROL (APOC) a I t aIt ! ll WHO/APOC, 14 September 2009 ANNUA.L PROJECT TECHNICAL REPORT TO ]ECHNTCAL CONSULTATTVE COI\d\,IITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFX'ICERS to siqn the rePort: Country: TANZANIA National Coordinator Name: Dr. Mwakyusa Signature: .... e3 .t{ 'ZotODate: Znnal Qncho Coordinator Name: Dr. Signature: . NGDO Representative Name: Dr.Ibrahim Date: This report has been prepared by Name : Mr. Nurdin Malloya Signature : Date .Ot J"T:lUht'EDJe$LPFF[Bot']:*n' "'-,oto TCO a a ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: TANZANIA National Coordinator Name: Dr. Nkundwe Mwakyusa Signature Date Zonal Oncho Coordinator Name: Dr. Daniel Malekela Signature Date NGDO Representative Name: Dr. Ibrahim Kabole Signature Date This report has been prepared by Name : Mr. Nurdin Malloya Designation : Project Coordinator Signature: Date 1ll WHO/APOC, 14 September 2009 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. Planning at qll relevant levels.. Funds....... Transport (replacement and maintenance) .. ..... Other resources To what extent has the plon been implemented.4.3. INrecRerloN .................... Ivermectin delivery me chanisms ............... Training.... Joint supervision and monitoring with other programs Release offunds for project activities Is CDTI included in the PHC budget? ............ 4.3-6. Describe other health progrommes that are using the CDTI structure and how this was achieved. Iilhat have been the achievements?............. .................... 294.3.7. Describe others issues considered in the integration of CDTI. 4.4. OppnerroNAl RESEARCH 29 4.4-1. Summarize in not more than one half of o page the operational research undertaken in the project orea within the reporting period. ........ 344.4.2. How were the results applied in the project?............. .................... 34 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AI\D OPPORTUNITIES 34 SECTION 6: UNIQUE FEATURES oF THE PROJECT/OTHER MATTERS...........34 34 v WHO/APOC, 14 September 2009 .....28 .,'.,28 ,'.,.28 ..... 28 ..... 28 .,,..29 ',.., 29 ,.,,.29 .,,.29 ,.., 29 ......29 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.INICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Or ganization 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 vl WHO/APOC, 14 September 2009 Definitions (D Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). (iD Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatrnent 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/tryper 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 j'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geogaphical coverage: number of communities heated 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 corlmunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) $ustainabili8: 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. community self-monitoring (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 p.ogr"... is being executed in the way intended. It encourages the community io tut . t tt responsibility of Ivermectin distribution and make appropriate modifications when necessary. (ix) vll WHOiAPOC, 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 session2gth I NUMBER OF RECOMME NDATION IN THE REPORT TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FORTCOAPOCMGT ASE ONLY 176 Report related O The project should explain the reasons why activities were not implemented according to the scheduled timeline We delayed to implement activities according to scheduled timeline due to delay of disbursement of funds from APOC and NGDO-SSI. (ii) The project should use the update reporting formatforfuture reports. The project did not receive the new reporting format but this report is in new reporting format. (iii)The name of other partners involved in the project should be provided, and their role should be highlighted. Partners - Tunduru District Council (Financial support and human resource during mass distribution of Mectizan and Albendazole, also infrastructure -health facilities for storage of drugs) - SSI (Financial and technical support) - Community (Willingness to take the drugs and implement CDTI philosophy) Project related (i) The project should carefully elaborate the timeline and ensure thot octivities are implemented in logical order We intend to implement CDTI activities in the timeline, and in logical order but due to delay of funds disbursement from APOC, NGDO-SSI and District Council these lead to delay in implementation WHO/APOC, 14 September 2009 (i, The involvement of health staff in CDTI activity should be further increased The involvement of health staff has increased from the previous 40 up to 58 Rural Health Workers and 22 CHMT and Co-opted members. (iit) The project should complete the operation research proposal and submit it to APOC We are in the final touch to frnalize operational re s earch proposal, after completion it will be sent to MoHSW and eventually to APOC management for approval. 2 WHO/APOC, 14 September 2009 EXECUTI\TE SUMMARY The report covers a period of 12 months starting from I't January, 2009 to 31't December, 2009. Year 5 of the project was faced with many activities and these were being implemented by integrating with other Programme such as Trachoma, Lymphatic Filariasis, Soil Transmitted Helminthes (STH) and Schistosomiasis since the courtry has embarked towards NTDs control. These activities were implemented by using funds from APOCruSAID, Council and Sight Saver's International. The activities were directed at creating sustainability of the progirm by involving leaders at district level. The treatment cycle of this reporting period started in December 2009 and lasted in January 2010. A total of 102,554 people from 536 communities in Oncho endemic areas were treated. The total population in Hyper and Meso endemic in those communities are 125,449 people. The geographical coverage for the reporting year is 100% whereby the therapeutic coverage is 82Yo. The ATO is 105,480 and UTG is 107,392. In this period 1,080 CDDs, 54 RHWs and22 CHMT & HMT members were trained and re-trained on the implementation of CDTI together with NTDs activities and how to administer medicine by intervals. The training was done in October and November 2009. Also the project conducted sensitization meetings at various levels; district -70 people were sensitized, Ward level - 48 people and at community level - 668 leaders were sensitized. The CDD to community member ratio is l:116. Mectizan@ tablets arrived in the country early enough and the project office in Tunduru received the medicine in June 2009. The project received 677,500 tablets (3mg) Mectizan@ for all NTDs and we had a total number of 313,038 Mectizan@ tablets from our old stock at the beginning of treatment. Distribution of medicine in Oncho endemic communities and non Oncho endemic communities in the district was done by using existing health system through Front Line Health Facility. 890,103 Mectizan@ tablets were used to treat people in those areas whereby 900 tablets were lost. The district had remained with a balance of 100,225 tablets which will expire in February 2011. We received a sum of Tshs.l4, 300,3291: from APOC for implementing various CDTI activities including NTD activities. The district council released Tshs. 14,000,000/: for trachoma control activities, while SSI released Tshs. 14,300,0001: for CDTI activities. The whole project serves 536 communities (Oncho endemic area) but in this year we worked in the whole District which has 1124 sub villages (118 villages) for the implementation of NTD activities. The major Challenges and how they were overcome: o NTD activities are not featured in the CCHP templates Ensure that all CDTI and NTDs activities are featured in the Comprehensive Council Health Plans, funded and timely release of funds. The influx of people from outside the district prospecting for gemstone. Proper planning and approximation of the anticipated influx based on previous census and treatment report. J a WHO/APOC, 14 September 2009 a Writing more than one report while reporting on the same thing implemented at the same time, it gives us more confusions. There is a need to harmonize reporting format to include all NTDs 4 WHO/APOC, 14 September 2009 SEGTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Tunduru district is located far south of Tanzania between 10"15 and 11o45 south of equator and longitudes 36"30 and 38o East of Greenwich. It borders with Namtumbo district to west - in Ruvuma Region, Liwale and Nachingwea to the north in Lindi Region, Masasi district (Nanyumbu district) in Mtwara Region to East. In south there is the Ruvuma River which forms a physical International boundary with peoples of Mozambique. Tunduru district covers a total land area of 18,778 Sq km out of which 413 square kilometers (2.2%) are covers by water bodies leaving the area of 18,365 Sq krn the land. The district is situated between 200 and 500 meters above sea level. There are three ecological zones namely:- l. MATEMANGA ZONE: This covers the north - west part of Tunduru and includes almost all of Matemanga division. This part falls under Selous Game reserve, it's a zone where by big rivers such as Muhuwesi, Nampungu and Mbarang'andu "Luwegu river" starts at the rolling hills. 2. SOUTHERN TUNDURU ZONE: This zone covers the whole of the Southem part of Tunduru District including the divisions of Lukumbule, Nalasi, Namasakata, Nampungu and West Mlingoti ward. It is a zone characteized by rolling hills, dominated by miombo woodland. 3. NAKAPAI\IYA ZONE: This small zone located eastern part of Tunduru district bordering to Masasi district (Nanyumbu district). It covers Nakapanya division and East Mlingoti ward. It has Rock Mountains and miombo woodland. CLIMATE: The temperature ranges between 20'C up to 30oC Dry season: June - November Rain season: December - May Farming season: o Preparation: August - October o Planting and weeding: November - April o Harvest: May to July (Food crops) o Harvest Cashew nuts November to December (Cash crop) Tunduru District has been distributing Mectizan for several years since 1994 using bridge funds donated by River blindness Foundation IMA, CSSC and Sight Savers International. The main task was to train 2 CDDs in each village, sensitize the local village leaders who will facilitate the Mectizan distribution to villages concemed. The project commenced with 17 villages increasing yearly to 34 villages in 2001. - In 2002 REA study were conducted to the remaining 3 divisions of Namasakata, Nampungu and Lukumbule. A total number of 32 new villages were found to be meso and hyper endemic thus making a total number of 66 villages in the Project. 5 WHO/APOC, 14 September 2009 On 26h January 2005 - Launching of the Tunduru CDTI Project was carried out. The NOTF member (MoH), NGDO - SSI representative, Regional Team and other CDTI project staffs participated in the event. District Govemment leaders - District Commissioner, District Administrative secretary, DED and other departmental Heads - CMT members, urban residents and drummer groups participated in the launching. The CDTI project now has 66 villages with 536 sub villages/communities. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA 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 B2 Percentage BFBzlBl *100 Tunduru 323 65 20% 1.1.2. Partnership The project has completed 5s year Mectizan distribution. The project is implementing its 5n year of APOC support with SSI as an NGDO partner. There is good relationship between the partners. The district council supports the implementation of activities. The community in general, is willing to take Mectizan and in some communities the CDD's are well motivated both in kind and by exempting them from communal work. 6 WHO/APOC, 14 September 2009 o\oo c.l ko -o 0)g c;) v) <f, o oA E (ll o () o cl q oq o tr u) o o (g ti GI CC (r))(n () o() -oGI CA =o cn (B(.) cn O C)oliqr o o li rh € Jli = =t-t € c)9Ead oaLEtrE .r -(J oo0()tr A ctx @o tro .F! o)EP.()h OX o=tr(+i d:, =o5 c)L c) q) I tr o th +. GIq) ,r c! CJq) oliq q) tr tr 6l a q q)E o G en o)Lq) tr o E cl E L € E li Q) o E c{ q) Lq) U2 9d r-r po .69 €) q)ijE EHe -gaA ca.! 6)'rga4 ;=o'rj .t cd t<,9 -dE EEY, HS:aVL- -L"rvE A' ._6 ;. g7^ c) iJ=E oi:r? c)E EN .2 8eE trOF. 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(BlFFI SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in curuent year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHOiAPOC, 14 Septemb er 2009 o\oo c.l L c) -o q.) q(.)a $ Q A o tJr oi ON to -otr o)oo o g ! q) cd B c) g E 3|r = 8E .5r =o -orEC'#s o\ E8a ESv (D Etii =sP or oo2 = o trdH " B>E Iq Io 6:2 5E.9 '= -b.E?E 8 B' .E IZFIE#Ag LQ> B-AI E€E= = z a€EtfiH lEIa*sEs!iE;8EHE f IEE,HiE + E= $; fis s*r F! '5 O. ojl oo o ''d '-H?Ertrerg55i:frgt *: :N#E$TEEE €;Htct E AE ti =fr#.E_! E;59 OFOI /^/^,^6-C-l .n .+r, ttt E v) 0) tr oO -\i U2qq)() q) S U)5 L q)\ t v a) V) Bq) U L(d(D >r (l) L.h o o) tr €() 6 0) *< cnd!) H(l) lr € v,() o GIq{ o o)c 0.) E F .rir ol -oldtFI o\ tro(, Lq) a o c)e a6EE I xL cl d Y-c !.9 d= kO3 q) o z E ! L 02 EN fr n o o= oo EE xL ct) (dh En= Ltr 6: kop E o)()q) q) GI ar) an c) U o eE o(J k o)so o EO -E ?tr d: a- li C) -o E 0) a o)a bT tr clL t'r o -9:qE EE oI t) , bI)) >r h hDEsl tiE c: fE v .tD -c)o.ts .EE s= .oEooE92 o 0)! a6EE I o))>- Er+ 1iE d: xd (, FI I L o, =L E tr t'r FI 3 otr 2,2. Advocacy We conducted advocacy meetings with Council Management Team members in order to sensitize them on CDTI philosophy. This advocacy was conducted in October 2009; Council provided funds for the activity from the Basket fund. The outcome of the meeting was an increase in funds allocation for the implementation of CDTI activities in the districts. The reason for mobilization and sensitization: Most of the departrnent heads in the district are newly appointed CMT members. Divisional Secretaries, Ward Executive Offrcer and Village Executive Offrcer have been transferred to non endemic areas. In this set up there was a need to conduct Mobilization & Health education to the new offtcials so that CDTI activities can be supported by the council. Problems encountered We had no problem in the district when conducting these meetings. Participants requested for similar meetings to be held annually especially for the sake of newly elected council members. Suggestion to improve advocacy All policy makers should be invited to attend advocacy meetings at all level and there is a need to request the Tunduru District Executive Director to facilitate these meetings. The following table shows the number of policy/decision makers advocated at different level per each district. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other local systems to dkseminate information t Leaflets and T-Shirts carrying various CDTI massages were used to mobilize and sensitize communities in our district. a We involved leaders at all levels in the district in conducting mobilization to targeted communities. - Mobilization and health education of communities including women and minorities a Health education was provided to women, teachers, school children and female CDD's to assist in mobilizing the community prior to Mectizan distribution. DISTRICT DISTRICT LEVEL WARD LEVEL COMMUNITY LEVEL Tunduru 70 48 668 Total 70 48 668 l0 WHO/APOC, 14 September 2009 Respons e of target communities/villages a The response of target population was good as evidenced by high treatrnent coverage rate of 8l % for 2009. Accomplishments o The project managed to conduct CDTI activities depending on funds provided by Councils, APOC and NGDO partner (SSD. a Community ownership of the Programme is still maintained amongst community members but we have to conduct HSAM following transfers of various community leaders. a CDDs are willingly to continue to distribute Mectizan@ voluntarily; few of them demand paid incentives. - Suggest ways to improve mobilization and sensitization of target communities - a Mobilization and sensitization meetings should be conducted every year prior to Mectizan@ distribution cycle. a Health education should be done continuous to remind the community their responsibilities. I Primary school teachers can be included in mobilization for the CDTI activities. a To strengthen Community self Monitoring and Stakeholders meetings in all affected communities. a Provision of T-shirts to CDDs and community leaders would motivate them to be more corrmitted to their roles in the community. 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: o Attendance offemale members of the community at health education meetings -Female members at community health education meetings attendance were good. o In general, how do you rate the participation offemale members in the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). -Attendance and participation in the discussions is bigger than male a Incentives provided by communitiesfor the CDDs -Exemption of communal work and recognition. . Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? Perccntege Brr= 100 Number of communities/villages with community members rs supervisors Number of CDDs rnd thc communities involved Number of communities /villeges with femelc CDDs Total no. communities in the entirc projcct rrer B. Number with community membcrs es supervisors B{ Percentage B; BJ B. *100 Male CDDs B: Femele CDDs Br Total Bq= Br+Br Number of communities with femele CDDs Btn Tundunr 536 668 100% 541 539 1080 536 l00yo Totel 536 668 1000h 541 s39 1080 536 lO0Yo 11 WHO/APOC, 14 September 2009 ln Tunduru, CDD is a privileged post in the community therefore there is low or no attrition in the whole project. o Other issues 2.5. Gapacityr building - Describe the adequacy of availability of knowledgeable manpower at all leveh. So far the staff at all levels are stable and competent in executing CDTI activities. There is no shortage of staffin all health facilities where CDTI is implemented. ' ll/here frequent transfers of trained staff occur, state whal the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meosures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffs are frequently transferred during the course of the campaign). We have extended training of FLHF staff to include other competent staff at this level in order to decrease the work load of the FLHF in charge or when is transferred. l2 WHO/APOC, 14 Septemb er 2009 S.i&v rll \./ o -n +Fr\J:.U l.i =v o oo Or- a r- q) 6lL ?h A nU o Lq) z ?eFU oo € o {) c) c) o \oo\ S$ = 6 -n +Fe_? E6 rr) $ ro t o anlr Q) .=cGlr<L'a r. f-{o: vra o4)r.. 9 L6l(I)l z UF ra) ia oo o c) o () \c oo r o ral oo 6in ola 6 Q+.q U.* E.l?F-(jq) atrl =c(ctl!8E Eg EEE> zE Q)q) QF €lat 6iA () o o (J \c lt I n oF Ua( o (J + Q = rtla) (., F- r- inia la 6l ah Q () Fl$e9(D E!r Ae o L o)E z I o F r- t- e €)F Fl t- o Er oo q) q) q) I \c () Fl .9 U2 e o\Oo a.l (.) -o C)q o)a tf, O o E o B i cn bO I oo o R \I I t o\ s ,o s ct B Bt\ ,r 9( =t -:.i' q v2q) uq) S q > oL q)\o t q)q q) Q1 tro d (,) Eo A E F aO(rr o cn o o tr o)tr _(D!:(ta o& (tt bo trq clliF .iir ol -ol(Bl FI Table 6: Type of training undertaken (Tick the boxes where specific training was caruied out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. N/A Trainees Type of naining CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management ./ ./ { ./ How to conduct Health education { { { { Management ofSAEs { ./ .i CSM { ./ { { { SHM { { li { ^/Data collection ./ ./ { Data analysis ./ ./ { Report writing ./ ./ { Others (specifr) {Primary school teachers 14 WHO/APOC, 14 September 2009 o\ o ct Lo -o o a.(I) a rt d o O. o Flr > la) a!a!tLqr E\I E$\ s Y. \oI FS qJ tJ!tvs63fo3L(€ 'E()U o '=r'gs EOSq)s 3:tr'i{E is .rr S $Rdss$H iIolS '=\1 €EB oEtt:J.PEoto-oct .ei s aeBg .s 's.ttrEn.U : $ *[X \ sa, E F tB+r \J LS -8 : ti,es:L s 3 'E-PF s t*X qr u-. ,i'E sxo * $;bs{'s € { $E = $ ssE E 'tsc,E H SSF .! SE Oa$qrE Q\:: ss :" $\S EE$ r Baf E!i sfrE .i.P 'B rl\B Seo $Es Srlr rt=' il ilEP HS\ Dg olol -lxl t C) d(l) liI 0) a ooo(t o Lo!t z t(.) () o cl oF D s (o oLrd Io C) 'a LRl^ OJH0)Gld P€OFo.= 'A -rL () rY l dE& '= -o .i9 - 6.;o! L .=otr! FAtr(! F66.9o.t .9s )E ot tr() ol =-o -l ts6 xl 8 * El.e o- dlE5 sl bs et E afi 4E st*l E -:l o al e *l c 'il X Il.EEt'; Bt< Et BHl.E 'El H *1.5-Et t '=t o trt nel .a =l c €l v ol - =l H o)l llBE EIts EEBIE 8IE BIEtxl -j qrl * trl grol o- ol tr ol-ul o ul 5 r-l 'ol o- ol tr ol= .ot ,ot - -ot H58 El8 5lEzl? zl? zl< o dH o ho!0^0s o o oF o ctL o bI) 63lro oo cdoa _c o\ Q.-((t L b0 oo o C) L obo c0k C) oo O,^ Eo\ 0)a(B Lo F v)l(j)l b0(dllrl ol >t ol ol ctlol -qlol(Bl Lrl s ol b4 EI EI ol 9l ,tol ol(dl Lrl(Dl -el!l bd ct €l ,t ol EI ol :l €l ol 5l EI ol rI.I ! r;i € .SI e gd a='a E E€?iEsZ HE E o E:#Zoui ca)+ rOi ;€tt p E Ei gSz E'i€' c- t'- EI* * t-- in \ ! oe Ea'EE \o\o \o\o rA o cd ao O{ c ll rAd6\ o5q) ,o0o(B 5o ooEOF N € s ctl € b 9o5, x 0) EETE z Qs <t at ! ra ra al do EE-6i.e trHU € o\ r- oao\ r.- ts *B - E EES'E o io6 d.t <'= ' a 39o Exa "6 o\tq 6l o\++ rA GI u)l(Dl b0dl a u, c) c =E E oO ll r a'a' n 6\ E .9o *PFbbD{ ov o oo =o 3 E SHtr tr= o =c>rz6o \o \o rOtr) A :oE 6.2 !Eot eFFU \o \o(n rA >9.,3(r o= }l o = E gEg" \o \o(.) ra .9< Hqn\ a E F r.l tr otr -\i' B U2 Vaq) uq) S U2: o\ q) t B q) U) \3 a) U )4 U) h Gt U'd c) H cd o .I o t< a) € >i -o t, EI a €d(tt c C) (rt okF r-t orl -oldtFI 2.6.2 What are the causes of absenteeism? Distribution was done during the rainy season whereby many community members were engaged in productive work such as farming, hunting, fishing and mining. 2.6.3 What are the reasons for refusals? Some of community member have negative perception on the effect medicines. 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. o Parasitologist trained? N/A o Existence of microscope? N/A 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 ^/ t6 WHO/APOC, 14 September 2009 o\ oN Lq) -o 6) Q)a $ O o Oi o tf{ B q) B\q) \q) "a s s Lq) r.i * U^1qq) Uq) \- 4: :\ a)T\ N B q) 4 vq) e1 o t{q)a bI) tr Eoa(!)lr C) ht) H) € o)tiL (.) o (d U)t! a U) 0) o) 0)(r) '-io) Cd u) o Lr() C')qi o U) C) U) GIO #r()l -ol CBIFI c-- =Ee -EE b<.E E H- 6 i'E .LIE HP6J(ll (J ia == d c Hi lIJoo (H o o.9 E89C EB'o5. 9o ts-E o!^E ru'L'AE Eo-< tr&ed **E-o.3 -q a6) C c=(!4oq n E,E,E r{ .. .9.E3=b o'= li =cl-:l:Y (JO H.E.E z (6 €-g9pE? P o.5 ()gEEIg o q H o 0.tr u) z €(I) c, 0)o o. o o.r I dF 11 0 tA s-g 9Q-A: i (H o ob0c6.1 = O{) ?o X()a (l) h0 * C,) () bll P $s Yo O 00 o\ @ .! * o\ F- o\ o\ o ct a 9.roA oo rr i HI H C)pS- tl Oo\ <1 >v o tt € t@ c.,! +o\ t- o\ o\ ll * r{ t! ri \o 5\ () 'E c)J bI)o(lg9 ooF()t- o\ r- .o 6\ t,- o\ t'-. t-- ^\ @ 5\ e.l € ri E ,,o OGi u9 oll2-Etr50 L\ 'o a =to\o- sr- +r- € o\ €cl oo + ofO ri E c.r? 6.2 aEo <.s*' FV oNq € @ \o\o oi o\ 6l c! o\ o\ F- o\ €o\ t-. ! rB *6 .S'.i qr ho . o c€€<'=El ' a E9E EE F- € € $ t-- a.l \o s a.l o\ <t -l: el oq) ood eq G.) trJ A oU o ll r lI1ri rd () 9Sata Oa\d >v o \oo\o 6\o 6\ o\ ^\ EoQ $e $s,i i Oerrl \o oo 6\ o \oo\Oo o\ -oo\ f.l aoo.E g* E 5 SE I tr= i5 = E.a rz8' N o \o \o rd :()d o,= =Eo ;/ o3' Fv N o ro \o \o a06l =qtse " u u rt fi5 HI =.E c €.: r.ir: tr'- o E € e I pEtro o C) al o \o \o F- o\ o\ € o\ o\ o\ o\ o\ N a.l c.looN cooo c.l I ol ro al \ooo c.l r- o c.l ooooN o\ o c.l oc-l o\ao c.l E(.) -o E c) q oa I Qo o.{ o *r B oo -an E o ._t s - - .9 6l e) o AD 6lsb €B\eU rhLV'sq B.)$Lt !$61!)s.Eg.s !FN EF\E = $"=3sE -\tsi&q) -9 .:ru 6t!E HEBEeC)o= a.E- .=oaD rltE !? Ijr E, .:9'a t-Y.-9 eH9F;Entglu.batr-t-e H=::r;iEEI HE-Ul E (l)()I .EE*li 'Dho=EgiJ -(lJL 3AE$io -vr.CF !d=vA €irqtroelrtrclLH5 -Eiac!r .2gnE ci o\l ';(Dl E) =l GtHPFI er 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - @lease tick the appropriate answer) ,/ MOH WHO N UNICEF I NGDO Other (please specifu) Mectizan@ delivered by - Qtlease tick the appropriate answer)r' MOH fl WHO tr U]\{ICEX'fI NGDO tr Other (please specifu) NIMR Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan is requested by filling in the ordering forms and sending them to the National Onchocerciasis Control Task Force in the Ministry of Health. o The NOTF Secretariat goes through the Re - Application Forms, approves them and then send it to Mectizan@ Donation Programme (MDP) o The MDP aralyze the Form and send the drug to the Ministry of Health through the Government Clearing and Forwarding Agent in Tanzania. (Medical Store Department- MSD) . The MSD notifu the NOFT Secretariat on arrival of Mectizan@ who then informs the Project Coordinator. . The Project Coordinator collects the drug from the zonal Medical Stores Department and enters the received drug to the District Pharmacy. o The Coordinator sends Mectizan to the nearest health facility for distribution to the community through normal drug distribution channel. o FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan@ . They come for collection from FLHF and distribute them to the community member in the entire area Table 10: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining lvermectin tablets collected and where are they kept? The remaining tablets were collected from the communities and returned back to FLHF by CDD's and then the DOT'S or CHMT members collected them and bring back to the district pharmacy whereby they were reallocated to other FLHFs for NTD implementation. Reallocated to other FLHFsfor NTD implementation in the whole districtNlL State /District ILGA Number of Mectizant tablets In stock from previous year Requested Received Used Lost Waste d Expi red Remaining TLINDURU 39,123 3 r 3,038 3 13,038 251,461 465 Nil Nil 100,235 TOTAL l9 WHO/APOC, 14 Septemb er 2009 - List and briefly describe the activities under Ivermectin delivery that are being canied out by health care personnel in the project area Activities performed by Health personnel in handling Mectizan@ o Supervise census update in his/trer catchment areas. o Mectizan ordering by filling in the forms and sending them to the District Onchocerciasis Coordinator. o Make follow up to the District Office. o FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan. o Organize and attend mobilization and sensitization meeting to the community members o Conduct supportive supervision during Mectizan@ drug distribution to CDD's. o Data collection and report writing and send it to District Oncho Coordinator o Conduct feedback meeting with community members. Any other comments NONE 2.8. GommuniQr self-monitoring and Stakeholders Meeting Hos any training (of trainers) for community self-monitoring been done in the project area? YES If so,lYhen? January 2008 Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meefings have alfected project implementation or how they would be utilized during the next treatment cycle. The result of community self-monitoring is higher therapeutic coverage of 8lo/o for 2009. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF I DISTRICT EXECUTTVE DIRECTOR t DITRICT MEDICAL OFFICER J PC J DOTS DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meeting (SIIM) Tunduru 536 350 2 TOTAL 536 350 2 20 WHOiAPOC, 14 September2009 t FLHW'S I CDD'S t Community I House hold 2.9.2. \Uhat were the main issues identilied during supervision? o In adequate CDD motivation. o Inadequate IEC material o Improper recording in treatment registers in villages where the CDD were new . Staff transfer at some FLHF 2.9.3. Was a superuision checklist used? o Yes. APOC-developed check list and integrated supervision check list at the DMOs office were used. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Levels concerned gave a positive answer to improve their performance during the next distribution. 2.9.5. Was feedback given to the person or groups superrised? Yes. 2.9.6. How was the feedback used to improve the overall performance of the project? The majority of community leaders provide incentives to CDD's Community members were encouraged to provide incentives during distribution. The District replaced registers in communities that were in need. 2l WHO/APOC, 14 September 2009 SEGTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR:Cunently non-functional but repairable, WGWritten off). How does the project intend to maintain and replace existing equipment and other materials? The existing equipment is maintained through the normal system in the district through Cental Procurement Unit. Repairs and services are carried out using funds from the Council and sometimes from the NGDO partner- Sight Saver's Intemational. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle I F 0 0 0 2. Motor cycle(s) 1 F 0 2 F 0 3. Computer(s) 0 I F 0 4. Printer(s) I F 0 0 0 5. Photocopier (s) I F 0 0 0 6. Far Machine(s) I F 0 0 0 7. Others 0 a) I CNFR 0 b) I F c) 0 22 WHO/APOC, 14 September 2009 3.2. Financial contributions of the partners and communities - Fill tables l3a, l3b and 13c If there are problems with release of counterpart funds, how were they addressed? Delay in release of funds, we utilized some funds that were released from the council basket funds. We are thankful to the APOC Management, SSI for their financial and other resource support Additional comments 23 WHO/APOC, l4 September 2009 o\oo c{ Lo! 0) ao U) $ O oA o > $(\t €!) tr o() U)L C(I(l) h o)(l) L. CA CB (l) k .o ofio tr GIq (\t >rp u) o p lr o() (€ oc(B ? 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N .s o IaI an (t) o =c o ..i(o c7)cr) G o IaI(r, so o tr, o G t a aco o 'Ir o o to J o o o ao o c o :,TI '= a .rrl cl ol ol EILIol >l .t FI .rl o c o o ooL o E o oL c) oa Io 2 L olct oldi(El cl(Ul >l Nl +l >l gl olttalsl atrl oo 2 o al xt ol GI sl ot EI!t <t rl at 0)l LI(El (6l a.l FI 'ol E o E o,l '=l cn 1t c!l -l .E o aa5(t, o oz ol(, o o o\ ct Lo -otr c)q oa s Li o o< o rat c.l aooNtGo\ o .b(, o a.{L EoE o CL E ED oll t IIJ .UEtr -9oo o oJ o o CL (Il o oc o E o Eo g, ftt .9,It 6 otE G CL d UJ - o t trO=orr tE ro(') o(\t e, o o o o o o o o o o o o o o o o o o o o o o .9 .=cf E E oo o o o o o o o o o o o o (o(',lo o @G' ro o o o o E8qE -z o o o oo l-l.i.lttrttitl ,i ooo ooo o l!iitrtttlololrlllli t, o ooo oz oo o- N oo o_ oo o_ oo o- oo o- rl) oo o-$ oo o- N oood oo o-(\I oo o_ o oo o-(., oo o_ o oo o- oo o- 6l q t @ (o t to- N (D + (o ti tr o Il tr oo z, IIJ =zt ul o(, T' o e =It .2t s o o o o o u? c!(o oo c, oo oo o oo oo o oo oo oo oo +(n -go ss EDOCF '= o =soate.= P6 =i5(!t-oll,oc :.eIlC,looEtr 6 =.!xo <i!z o o o o o ooo lo oo o- N oo o- oo o- c\l oo o- o oo o- G' oo rO- c! o oo rD- N oo o-|o(o oo ro oo ro rt aO ooq. ot o o o o o oo o- rr) oo o- N oo o- oo o- c.l oo o- oo _o- f., oo rO_ N o ooto- N o oo l() oolO ooo ..t o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o ooq rO(r) o oo o- lo(t oood a, It o o(,)tt3 @ o o o o o oo o- @ oo o_ N oo _o- o oo o_ N oo o- o ooo F) oo lf)_ N o oo rO N oo o- l()(f) oo rO oo r(' rt cl, oo o- ro utz J o s ot GN 0coi\(tto o t- .b SEEPsf =oES =8 c o o .N 5 o i C o o .N .=oc oa ..i o(E o o !, "i t G o IaT ao otr tr Gi u,ooo o o .c .E(E o oc c '6 LF -oj o o) .Y o =! =tUo - o G o IaS v, tr o GI g ut d 't o o Ei o ]D .E o aI U, C .9 1r, .E o)o aa -t"i oc o .=c o ..i(o tr o o E tU ci ci = s o IaI aa s otr ooGc! EsG EeFtrSO{r> 'tro .E8 :TEEO(!Po sbo>>o II c .9 f .ct .2! c o o Eg o -2 -+ o c o) o o)o o oo oLo oo o cq) Eoooc o = ..i t G o IaSq ln o .a tro a 5 {! tr o EE J o o -g(E a -d c o E .sfo tr.J ..i ro lE o IaI .4 o oz t o 2s6t tr.socos =cL.!fl-EFTE EEg o- o o\ o C\l o -o o & c)a$ oA{ o \oN (D c o(.) q)(I) l-< (n(lt () l.r .os{ t-E oioc-tr '=c6YNF trF Eo>oo:i ==,i€oc5 cl (, tro .o L d oo (t oc c,trt I(a q) E cl H ofFE(Jr olL o. C'oq oC' o-(o!t ? o .t o o o o o o o o o o o o o o o o o o o o ao EcJ E E oo o o o o C' ooo o 3 o ctoq ott ro o o o C' o o o o o o ooo- ot E8q8 -z o o o o o o o o o o o tt .l-1. tl o o c, o lclo IElo le I!g E t,ocE oe trlrlEFo ooo(9 = oo o- oo o-(\ o ooo ooo- N o oo o- ooC' + ooo- oo 1r,(o ooodo ro- ooodoq oo ooo- oo o_ (r' ooo oo o- o oo o_ oC' o-t ooo- oo(o_ o oC'q. oo 6rr- GI ooo- ooo\(t oo o- oo\N ooq CIoq .\a t o ef .Ct .9t s o o o o o ro o o o o C' o o o oo oo oo o o o o o ooo- oo o- o C'oC' c;o -c!- o o o o o o o ooo osl @_ @N oo o_ oo o- ooC'd!i aO oi(\t o ct o- o!l @dG' o o o o o oo o- oo o- o C' CI o- oo o- o o o o o o o o o o ooq ooq o o o o o o o o o o o o o o o o ooo- oo o_ C'o o- oo o_ oo o- oo o- ! o o- 6: i'9-6.9 o6to C EE26 igE !-to5trooTI o o o o o o o CI o o o Ct o o o ooo ot(o @N o oood!t aO_ 6 6a c,oq ot(o dAl E, ul c!c o a!(, o o S oi l.lo lflIl tr o(, F -IU .l =ttrl url >t ot ol Ito o EDtfo o o o o o oo o_ (o l'-(o ooo|r, tr)- N C'oq rot\6t o) o o o o ooo. oo o_(, o oC' o- oo o- F' ooo- o\t @-q, C\I oo o- ooo- oo o- ot@ otN oo o-(o or- !t IJJ = F lU oo =o !s a! o GN art tro tD\(t Go o E-obir EE s€\oEs =8 tr o o .N II o i c o o .N .=oE 0)o ..i oI o E' 1(o1 .l tro (E o)!o =GoI a G o IaSto E,I .sl trl q oooo o et cl (El ol \l(,, cl _cl EIFI .t FI oil o o)JL o =.c. =(E 0) -+ ol E'IEi .El olLI ot LI OIEI .tr1 EIiql Nl G o aaS U, o GI (E ur ds 'tr o '= o E c o o EoaI aa L .9 .D 'E o o.f(n (r) o,C o =c o (\l crj c o (El E uJ r'id g o aaI .a o g o to o so E o U,Gc a E tr a oEIa .T a^ E ai so o c o'- =ll .E 6 z, cl ot cl EI o)t >l:l -l+l o c o o) q) o o) Eo o o oa o =Lol tr1(l)l d!(El cl ol >I c!l!rl >l GI OI 6ltlql tt, oto o "q]ol Gi ol EIrt <l sl o o G oa -d E o E Cll)dl tu .l c!l tol lE o aaS at, o oz d o a3.3. Other forms of communiQl support Describe (indicateforms of in-kind contributions of communities rf any) The CDDs are exempted from the public works especially during distribution. CDDs are given priority for other works available in the village especially if there will be monetary incentives. Community members produce Mectizan measuring sticks without costs. a a 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 local currency. Indicate exchange rate used here USD$ 1 : Tshs. 1.300/: Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnterna!; independent participatory monitoring; Evaluation 4.1.1 4.1.2. Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) r' Year I Participatory Independent monitoring r' Mid Term Sustainability Evaluation 5 year Sustainability Evaluation r' Internal Monitoring by NOTF Other Evaluation by other partners What were the recommendations? o The project was advised to carry out operational research on the Why CDD attrition rate in Tunduru is low compared to other Oncho endemic areas o District Council have to make sure that CDTI activities are incorporated into CCHP and funds for implementing those activities are timely released How have they been implemented? . The project is working on the proposal when ready, it will be sent to MoHWS and then to APOC for approval and funds requests. o The budgetary allocation in the CCHP for implementation of the NTD's activities in this reporting year has increased compared with previous years. 4.1.3. 27 WHO/APOC, 14 September 2009 4.2. Sustainability of projects: 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 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 community level they plan on how to collect Mectizan@ from the nearest health facility and distribute to the community members. o 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. o 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 CHMT and attend Project annual review meetings. o The Project Coordinator compile report form district, prepares Technical APOC annual report, Mectizan@ retirement and Re-application, supportive supervision to district and attend various CDTI meetings. 4.2.2. Funds As in the previous year the district council allocated funds for implementing CDTI activities. It is encouraging to note that money allocated for CDTI activities is increasing. a 4.2.3 Transport (replacement and maintenance) o APOC management will replace all capital equipment in the six year of the implementation of CDTI activities. Maintenance of these equipments will be done by Council in collaboration with partners. 4.2.3. Other resources o NONE 4.2.5. To what extent has the plan been implemented CDTI activities have been incorporated into CCHP and most planned activities were implemented but sometimes it was difficult to implement other activities due to differences of financial year between APOC and Government. a 28 WHO/APOC, 14 September 2009 4,3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms . The Mectizan@ drug is transported through the existing PHC systems. o a 4.3.2. Training CDTI structure is being applied in many projects in our District Trachoma Control Programme is using the same structure in Tunduru 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Fill tables 14 and 15 and provide describe other prograrnmes that are using the CDTI structure and how this was achieved. What have been the achievements? For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? . Explain what are the combinations of interventions co-implemented? . How were the interventions implemented? (at the same time?) Yes 4.3.7. t 4.3.3. Joint supervision and monitoring with other programs o The District Onchocerciasis Coordinator is a co-opted member of this team at district level and always they conduct routine supervision as a team. 4.3.4. Release of funds for project activities o In this reporting year the council has contributed Tshs. 14,000,000/: for the implementation of NTDs activities. 4.3.5. Is CDTI included in the PHC budget? CDTI activities and NTD activities are executed under the directive of DMO who is in charge of all matters pertaining to Health in the district, therefore all plans including CDTI goes through his/trer office then are tabled in CHMT. 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