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

RESERVED FOR PROJECT LOGO/IIEADING (including e-mail address) t_ ? 1 ORIGINAL : Enelish i KILOMBERO CDTI ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO i TECHNICAL CONSULTATIVE COMMITTEE (TCC) t{z AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I tt)t ' - -l I 'r[..1 A +'F *, DEADLINE FOR SUBMISSION: rtt'Tti. i Q.l 1'o APOC Management by 3l Januarv for March TCC rneeting I| . _1 I ; \t,.8;i, ,,c To APOC Management by 3l July tbr September -fCC rneeting r.v I t y I COUNTRY/NOTF: TANZANIA Proiect Name: MAHENGE CDTI PROJECT Approval year: 1997 Launching yearz 1997 Reporting Period From: JANUARY 2010 To: DECEMBER 2010 onth/Y Month/Y APOCfundinsyear: (circleone) I 2 3 4 5 6 7 8 9 l0 (11) 12 13 tm entation rt circle one 1234567891011 I t3 Date submitted: llth February 20ll Partners: Ministry of Health and Social Welfare African Programme for Onchocerciasis Control (APOC) Mectizan Donation Prograrn (MDP) NGDO(s) supporting NONE 670 communities ,l ':l iUlL ?0ll APOCTDIR RECLI LE WHO/APOC, l.l September 2009 Ia tr AI\NUAL 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. Upendo Mwingira Signature: . Zonal Oncho Coordinator Name: Dr. Frida Mokiti Signature: .. Date: NGDO RePresentative Name: Signature: Date:... .. This report has been prepared by Name ' ili,*i";"e M' Kassiga and Alfred Designation : CDTIAITD Coordinators Signature d[a0.'^{. I I I I I I I I I I I I I I I I I I I I .)Date 11 February 2011 RECU LE t ? AillJl t0tl APOC/DIR Date: Table of contents ACRONYMS .................. DEFINITIONS.......... FOLLOW UP ON TCC RECOMMENDATIONS...... EXECUTIVE SUMMARY....... SECTION 1: BACKGROUND INFORMATION.... 1.1. GeNeRnl INFoRMATIoN............. 1.1 .1 Description of the proiect (brieJll') 1 1.2. Partnership 1.2. Popu14rtoN............... SECTION 2: IMPLEMENTATION OF CDTI 2.1. Tttrrpl-tNp oF ACTIVITIES ............ 2.2. Aovocacv 2.3 V VI I ......3 2 2 2 2 2 2 4. 5. 6. 2 2 2 2 2 7. 8. 9. 2 MOSILIZETION, SENSITIZATION AND HEAt,l'I.I EDUCATION OF AT RISK COIVIN'IUNITIES IO couNrwrrY INVOLVEMENT......... ..'.. 11 Cnpecrrv BUILDING.. -...-.l2 TReerrtENTS.............. .....14 6.1. Treatment.figures ..-....." "I1 6.2 l4/hat ure the cattses of absenteeisnt'? ... .... ...' 16 6.3 Whal are the reasons.for re.filsals?.. ..... .... ' "' """" 16 6.1 Brie.fll,describe all knov,n ctnclveri.fied serious adt'erse events (SAEs) that.... .. l6 6.5. Trenclo.f n'eutntent achiet,ementfront CD'll projecl inception lo lhe clil'renl yeur l8 OnDE,RING, sroRAcE AND DELIVERy oF IVERIvIECTIN . ...--... 19 CotrttrttrNtty sELl---NIoNlloRING eno S'IaTEIIoLDERS MEErlNc . ... l9 SupEnvtstoN............... . -....'........'..... 20 9 t. Prot'icle u.flotr c'hort o.f'strpert'i.rion hierurchl'. . . ' 20 Il'hat v'ere lhe ntuin l^rsrtes iclanlilied thring supert'ision? . .. . ... 21 trl'as o sttpert'i.siort chcc'kli.st tt.setl'.' .-. .. 21 Il'hctl were lha oticonta,s crl euch lcval o./'CDTI intplentenluliort.suparvision? 2l I[.tt't/-catlbuckgil,enlolhepe).So11ot.groupSstt1lcrl,isetl IIotr y'tts'the./'eeclbttc'k tts'etl ltt inltrore lhe orcrull perfbrnrunca of lhe pt'rtiect'? 21 2.9 2 293 29l 295 296 a SECTION 3: SUPPORT TO CDTI 3.1. EeurprteNr 3.2. FINaNClal CONTRIBUI'IONS OF lHE PARI'NERS AND CONIN'IUNIl'lES 3.3. Oruen FoRNIS oF coMMUNITY suPPoRT............... 3.4. ExpeNotruRE PER ACTIVITy SECTION 4: SUSTAINABILITY OF CDTI 4.1. INrenNal; INDEPENDENTPARTICIPAT9RYMoNIToRINc; EveluartoN 1.1.1 Has the project eyer been evaltruted/rnonitorecl'? (Tick any of the follov'ing which are appltcable) .. . . .... 27 4.1.2. lV'hatwere the recomrnendations? ...-...27 4.1.3. How have they been implemented? . ...........- - ..---...... 27 lll WHO/APOC, l4 September 2009 4 4 ...u*"".r t'r*'l ".o,n !**", ,.............8 10 8 22 22 Z) 27 27 27 27 4.2. SusrntNnerlrry oF IRoJECTS: ILAN AND sET TARGETs (vaNoeroRY AT...... ..........27 Yn 3) .......27 4.2.1. Plonning at all relevant levels... .. .... ...-- . 28 4.2.2. Funds.. - . ---........ 28 1.2.3 Transport (replacernent and maintenance) .....-.-....... 28 4.2.1. Other resources -...-.28 1.2.5. To what exlent has the plan been irnplemented................ .... ....... .. --.28 4.3. INrecRerroN ............... .....................28 4.3.1. lvermectin delivery mechanisms ............. '.-.- 28 1.3.2. Training.... . - --.... 28 4.3.3. Joint supervision and monitoringwith other programs........... .. --.28 1.3.1. Release of.funds for project actit'ities -.......28 1.3.5. ls C.DTI included in the PHC budget? .......... . -- - - .-... 28 4.3.6. Describe other heulth prograrnntes that are using the CDTI structure and hov' this v,cts achieved. Ll/hat hat'e been the achievements?...... . ... . . . . .29 1.3.7. Describe others issues considered in the integration ol CDTI .... 29 4.4. OpennTroNAL RESEARCH .....34 1.4. 1. Summarize in not ntore than one half of o page the operational research tmdertaken in the project area within the reporting periocl. .-...... 34 1.1.2. Hov,v'ere the results applied in the projecl?.... .---.-.......... 31 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.......... SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS..... 34 35 a I t lv WHO/APOC, l4 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse.event Stakeholders meeting Technical Consultative Committee (APOC scientifrc advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization a t WHO/APOC, l4 September 2009 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Obiective (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage. (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) lherapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF. screening for cataract, etc.) through CDTI (using the same systems, training. supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future. with high treatment coverage, integrated into the available healthcare.service, with strong comntttnity orvnership. using resources rnobilised by the community and the government. (ix) Communit), sell'-rnonitoring (CSM): The process by rvhich the community is empou,cred to oversee and monitor the perfbrmance of CDTI (or any communitv- based ltcalth intcrvention programme), rvith a vierv to ensuring that the programnle is being executed in the lvay intended. It encourages the community to take full responsibilitl, of-ivcrnrectin distribution and make appropriate modifications when necessary. a , a a VI WHO/APOC, l4 September 2009 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC 30 session a I Number of Recommendat ion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report related: a Correct the percentage of lrcaltlt workers trained to 47% and not 38.1% The correction done a Include lhe outcomes of odvocucl, The outcome included a Contplete the toble on SAEs Done. We have no SAEs in our Project $7,000 wus approved for purclruse of u nrotorcycle. By who? This requires follot- tup trction. APOC Approved that funds to purchase motorcycle for Kilombero District through WCO but the district never received it. Project related: a All FLHF staff should be troined in CDTI All Staffs rvill be trained as the old staffs got CDTI training. The neu.staffs u'ill receive this training in 20 I I a An allernutive NGDO purtner should be ident(ied a Proviile u molorcycle to ruldress the lronsport constraints of the project The NGDO partner for Mahenge Focus has not ,vet been rdentified. All NGDO should sign Memorandum of Understandrng at the NOTFNOCI) We do not have NGDO paftner to asslst on thts matter and the District Budget is limited fbr capital equipment replacement NOCP should cafi! esl internal monitoring at leost once 0 yeur a The NOCP conducted monitoring for Mahenge Focus trvo time in 2010 WHO/APOC, l4 September 2009 a a More sensitisation is required, especially on co- implementation Done and will continue to be done so as to achieve higher education coverage for Co implementation which started in2007 December. (Please add rnore rows if necessary) a , I 2 WHO/APOC, 14 September 2009 aExecutive Summary Mahenge Focus CDTI Project which is in the 12'h year of CDTI implementation, covering two districts namely Kilombero and Ulanga. The two districts are decentralized with separate government funding for CDTI, using its own Comprehensive Council Health Plan (CCHP). This led to separation of our common CDTI activities working group under one Project Coordinator in terms of Mectizan order, storage, Sensitization meetings, Advocacy, Training, Monitoring and supervision. Therefore, the activities of Mahenge Focus turned into a tbrmulating of Ulanga CDTI and Kilombero CDTI projects for easy funding through the District Councils. The project operates rn 670 communities. However, CDTI strategy has been introduced in None Oncho endemic areas for the implementation of NTDs elimination activities. In the year being reported, the project focused mainly on the following components:- training. monitoring, sensitization and mobilization. The project trained 2,052 CDDs and 202 FLHWs. 34 CHMT members and 77 ToTs. Sensitization and mobilization meetings conducted in all project area especially in places where there is a new leadership. The total population living in Oncho area, that is defined as hyper and meso- endemic is 498,248. Mass Drug Administrative (MDA) commenced in November 2010 and ended in December 2010 whereby 393,289 people were treated and this makes the coverage to be 79%o. The project has reached full geographic coverage (100%), its Ultimate lreatment Goal (UTG) rvas 453,828 and the Annual Treatment Objective (ATO) rvas 418,528. Challenges: ./ Out of order of project Vehicle and Motorbikes and lack of funder to replace these written off transport equipments. Sol. lYe are using the old butfunction vehicles. However, tlte timely implementations is impossible as sll l5 CHMT depend on few and old velticles to do also their project activities. We need the NGDO portnerfor NTD (MOH & Sry) so as to alleviate our problems. '/ Inadequate funds to ef'fcct trainings of CDDs and Teachers distributing cotnmodities to the communities Sol. LVe are plortrtirtg to ittclude Schistosomiusis control in scltools our Comprehensive Courtcil Healtlt Plan to relieve this problent. / CDTI activities using non employed personnel (CDDs) u,ho are volunteers and using School teacher rvho are er-nployees fbr schistosonriasis control. Sol. LVe are closely observing the respottse and soon we will be able to see vthtrt ure the genuine chollenge and the wty of dealing with them. Kilombero districl will distribute Praziquantel by 20ll March. r Llsing CDDs for Out of School pupils and School Teacher lbr those in school during Praziquantel distribution fbr Schistosomiasis control Sol: We hope to see tlte contribution of CDDs for out of school mobilization to take PraTiquantel and also school teocher's effortfor this as will be addressed soon. '/ Lack of incentive from the community to their own Community Directed Distributors Sol.: ll/e still encourage CDDs to continue as volunteer, troin yearly as motivatiort and encourage village community leaders to find in kind supports to their CDDs. '/ IEC material needs and or a kind of identity to the CDDs such as a CDD badge, T shirt or cap with any slogans concerning CDTI. Sol.: ll/e are waiting the MOH & SW, NOCP/NTD which is under preliminary stoges of the IEC/BCC material development. ! J WHO/APOC, 14 September 2009 il SECTION l: Background information 1.1. General information l.l.l. a ULANGA Ulanga District is located in southern part of Morogoro Region, 324Krfl from Morogoro town has a total population of 229,846. It has 7 divisions, 3l wards,92 villages and 396 communitier. Ulungu has an area of 24,560 sq. km. It has an area of embracing many climatic zones and geographical variations from low land swamps to mountain as high asll5 meter l080ms above sea level. It also comprises of 3 agro ecological zones; hot lowly flood plain, undulating Savannah miombo grassland and cool mountains with rain forests. The main ethnic groups in the project area are Pogoro, Ndamba and Ngindo and the newly migrating Sukuma from Lake Zone. The Pogoro tribe is still the major tribe in the district. Despite of tn. varied tribe languages, Kiswahili, which is a national language, is spoken by all ethnic groups. Ulanga CDTI project operates in all 7 divisions after integration with NTDs programmer, nu11.ly Vigoi, Mwaya, Ruaha Lupiro, Mtimbira, Malinyi and Ngoheranga having 92 villages 396 sub villageicommunities that are defined as hyper and meso endemic. Onchocerciasis is endemic in 53 villages with 163 community and hypo endemic in 39 villages with 233 communities. All sub village communities have received ivermectin since the commencement of CDTI project in 1997. 1.1.1. b KILOMBERO Kilombero district is among the six district fbrming Morogoro region. It covers an area of l4,9lgKm. is bounded by Morogoro district to the east, to the rvest there is Mufindi district, while to the south is Ulanga district and to the north the district bounded by Kilosa district. Most of the district lies along the Kilombero valley (part of Ruhli basin) rvhich extend belorv the Udzungwa mountains. The district has 38 permanent rivers which provide high potential lor hydroelectrically power plants and large irrigation scheme. Udzungrva national park and Selous game reservei are attractive area for tourist. 'fhe district divided in 5 division,23 u'ard. 8l villages and 365 sub villages rvith total population of about 426,195 (2010). The district has tu'o hospitals.6 Health Centers and 47 dispensaries. Out of them l4 are private and not participating on CD'fl. Climatic condition of the district is mild Temperature ranges fiorll 20 degree s centre grade as the lowest to 32-degree centigrade as the highest. Rains start in earll'November and end in May. It ranges from t300mm up to 1600mm. Forms of communication available include: landline and mobile telephones, fax. Internet / e-mail and post Ofl-rce. Horvever. difficulties in communication do arise due to tiequent power cuts. The main ethnic groups in the project area are Wapogoro, Wandamba, Wangindo' Wasukuma. Wabena and Wahehe, although they have their tribe languages all of them speak mainly Kiswahili, the Tanzanian National Language. Seasonally there is migration of cattle herders the Mang'ati and Masai from Northern and Central Tanzania. Most of the communities are involved in subsistence farming of rice, maize and beans but cash crops of sugar cane grown in some few areas. The cattle farming have emerged recently as one of the cash earning activity in these two districts. t I ! 4 WHO/APOC, l4 September 2009 aIn Tanzania we use Sub Village communities as our working units for CDTI implementations. Sub Villages are government created structures of which their community members do elect democratiially their leaders every, after five years. The latest was just this year2Ol0. This followed the traditional chiefdoms abolishment just after independence in the year 1961. The Sub Village leaders do function as the main supervisors of CDTI implementation at this lowest level. The Ward Executive Officer (WEO) is the government employee and do function as a Ward Development Secretary within the ward, which is the next largest administrative unit compriiing a number of villages. Moreover, is that each Village subdivided by small community units known as Sub Villages, that differ in number from one village to another' This level has now been fully involved as an influential level, using its Ward Development Committee to assist in health education, mobilization, monitoring and supervising of CDTI activities. The next lower level to the Ward which is a Village do have. the Village Govemment. Throughout Tanzania there are Village Health Workers (VHWs), trained in a number of simple health disciplines by the Tanzania Ministry of Health and Social Welfare. These Community Orvned Resource Persons are included in CDTI implementation rvhich inch-rdes distribution activities. This is also a fact that, these also volunteers and chosen by their communities and do to join CDD in their sub villages during CDTI implementation. In addition. the CDDs rvho are under the Sub village leadership distribute Mectizan and Albendazole that cover Onchocerciasis, Lymphatic Elimination and Soil Transmitted Infection treatment. Moreover, do act as health educators and mobilizalion activities for NTDs in general. Table l: Number of health staff involved in CDTI (Please udd more rows if necessory) District/LGA Number of health staff invohed in CDTI activities. Total Number of health staff in the entire project arEa Number of health Percentage staff involved in CDTI B B2 B::B:/ Br *100 Kilombero -'\'l 156 38 Ulanga .+03 271 67 Total 730 430 59 1.1.2. Partnership APOC funded the project for advocacy, Sensitization and resource mobilization activities. Flowever, it should be acknowledged here that it funded the capital equipments especially transport equipments in 1998 and 2000 which are now grounded and non functioning. The rest of activities were funded by the District Councils (KDC and UDC) using the funds from Comprehensive Council Health Plan. a 5 WHO/APOC, l4 September 2009 The project merged CDTI with Lymphatic Filariasis Elimination Program (LFEP) activities since December 4th 2OO7 . These programs are now using CDTI strategy, CDTI trained staffs, infrastructure, CDDs and other community volunteers for the current Mass Drug Administration of Mectizan and Albendazole to even hypo endemic area of the district. I. DISTRICT COUNCILS 2. APOCTWHO 'r Sensitization, mobilization and advocacy. '/ Capital equipments '/ Supplies of Mectizan (lvermectin) and Albendazole 3. COMMUNITY. / Selection of CDDs 'r Distribution of Mectizan and Albendazole. '. Data collection and reporting t I I 6 WHOiAPOC, l4 September 2009 N L 0) E() o- 0)a $ O U o 4 o\) U\ q) )\q) u q) \) ^o a '5 0) o.a (.) a k c.) o c (, C)(-) .. LL ^0)ar' -.(.) -o 0) c) 'o 0) (H 0)oL o U) 0) lr) (0 o z(H Ch a) 'o o ! 0) o- co ! () ! 0) CO lr -o q) o -d o 0.) al< a- C) t< .o a a () o cr) o \) Fi5 ULh\ 9-: .Y q_ L'\t s0) -s >, -\U ?l O' U: Bq, 'is -sB $r- ,s.ila$c, ?U}F l-.* Cis:9 SS :-aB\ -oP{ :+>i\qlbi l\' Et :bo E} -U 3$\a- Bar\bo -Y= v\Y-s'll g()-tIt\ Bl\$ q q) \ q)q !q) U li C) o. oo L 0)k (.) oo L ! o ! o Eo Cd() () $<(g >' 0) ti C) C) q) I c) i) 4) :l a ! o o. 'o (d th 0) UO oi1 0)l -ol FI c o +a G J Et or N F a a ae)Uq) (-- caO c.I N$N ra)N\o N 00N € ?.) rat (, F a;k o-EE3 = 3u)b 6tf, el €a$ + a il r.ts _oo .= o-N d-C.= LqaL o-t,trc NOs od\o N \ot@ oi o] C'.t r- o\ r-N CDecc) ^O O.rr\|^ +'=oEd' ^E D (d -r o-c -oe o.r tr- $ * \o\r oo^ t--N ra?'I \oNN (+< clot cdl o.iol o. o E9B0)t ! Yoo oi= aa aa $ C.l O C..lO $r- on r-\o O -1-(-'l \c) o\ ca \o aa(..l .a t) I-- ra ro dl .=l 6 0) oo(! o-) E (_) t* L() -o E z o .9() -'=UX -o*- =o:YoJ.c Y OL >\o -r- 6N U co!i Yoo ?aY. a o9. ON 3.9 -o cCO oF \c)$ oo oil c.l ao .d'6I ao o\v 0) -L5 or{ de: ;=do)ij o- -- 'F -v9-LL^-A c\Os od\o c! ol<() .o EI u bo d D -] F F ErE o.q 0-) E E E.E ^AtiI-.1 -i C.) (s r-\J=hr bO l+ SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. , i 8 WHO/APOC, l4 September 2009 o\ a.l 0) -o o o-oa $ U o o = o. at) > 0) a o.5Etr U C) C) o(.) t-.t r() -o E() o z 6D -E a- o) -o () o z r 0.) 0) z U) ox sE U H a.) -o 0.) o z L c.) -o E 0) o z ET L 0) -oo oc C) -o E() o z q) F U) A) q) U q.)e EO Q 0) -o q.) oZ a bo b.0 a- o -oo oc b oo bo F EOEtr Q Lo -o 0) o z c) o o bn 'l- c a- L 0.) -oo oc 0) -oo oc Na z ()! he (, o (! z. 9 a do E0 a- b(n L -o() 9a bo -] e) u) o c) -o E o g (d DO cd D '.] F t-,t a t 0) *7 q) () U 4 -\)Ui) h i) o \ q) V) tJ a_ L (J c)!l< o 0) -o(J () ! a () !(s 0) L .o a 0.) o 0) 0.) F ..ir (Jl -ol(st FI 2.2. Advocacy All District head of department, Ward Executive Officers, Village Executive Officers, Village Chairpersons and Sub Village Leader at their level were mobilized this followed the National election that led to choosing of many new leaders and change of leaderships at all levels mentioned above. This was mandatory for the 2010 CDTI activities planned so as to maintain the established chain of command in CDTI and empowerment of CDTI in all Meso and Hyper endemic communities in our districts. Front Line Health Workers led this activity, by sensitizing also communities served by the health facility. The Council Health Management Team members (CHMT) responsibility was at the district level, educating government leaders, Politicians, other influential persons and local partners the Co-implementation approach, its benefits while emphasizing cost effectiveness of the CDI strategy. Whereas; Frontline Health Workers did their part at community level; encouraging community meetings, CDTI sustainability. community self monitoring and project ownership. There was no difficulties or constraints laced during advocacy as the new leaders were mixed with the experienced leaders who also assisted in giving live examples of horv successful they were in instituting CDTI in their area and the practical integration mechanism to other diseases was simple using this system. 2.3. Mobilization, sensitization and health education of at risk communities The media used to disseminate information were two local Radio stations - Pambazuko FM in Ifakara *Since January 2009) and soon we will start using a newly created Ulanga FM in Mahenge town both transmit their program across the Mahenge Focus communities, Parents meetings in Primary schools, village public meetings, church, mosques and through Community Own Resource Persons (CORPs). Mobilization and health education of rvomen and minorities are as to the above as their participation is active. Holever, this includes the special Reproductive Maternal Neonatal Child Health (RMNCH) clinics. Out Patient Clinics. and Outreach RCFI clinic. I'hrough these opportunities women are encolrraged to educate others in their special women groups r.vhich are some social or income generatirtg ones. Response following these approaches have been very good hence the maintaining high coverage on the presence of several changes of community' leaderships after the National Election. Wea kness/Constrain ts : Lack of funds to procure more Infbrmation Education and Communication (lEC) materials and increase local Radio programs and Radio spots fbr CDTI Suggestion for ways to improve mobilization and sensitization of the target communities are:- . To increase local Radio programs, Radio spots and special CDTI talks in our local radios for more understanding. o To involve more youth who are the majority in our communities, existing cultural groups, schools and religious sectors in implementing CDTI. . To produce local and cheap IEC materials and disseminate in all endemic areas. t ? l0 WHO/APOC, l4 September 2009 a2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more row's if necessary) Attendance and participation of female members of the community at health education meetings have been excellent since the inception of CDTI project in 1997 .ln meetings fcmales are frce even if you mix thcm rvith men. In somc cases arc even more active than men especially in volunteering during mobilization. distribution and health'education. All communities do give moral support and leaders do exclude them to community contributions and other works during months of distribution activities. In general there is no significant CDD attrition as more CDDs were chosen and trained to lessen the workload for CDDs. a I istrict/LGA Number of communities/villages wrth communlt) members as supervisors Number of CDDs and the communittes rnvolved Male CDDs Female CDDs Total ts B Bq- Number of communtties /vrllages with female CDDs Total no communities rn the entire project area Number rvrth communlt) members as supervisors B1 B5 Percentage Bo= Bs/ B{ * 100 Number of communltres w'ith female CDDs B'o Percentage Brr: B,,/84* 100 Kilombero 274 274 r00 628 494 1,122 274 r00 Ulanga 396 396 100 485 445 930 222 56 Total 670 670 100 I,113 939 2,052 496 74 1l WHO/APOC, l-l September 2009 2.5. Capacity building Almost all Health staffs are aware and knowledgeable about CDTI activities and we have never experienced transfers within the project area. This was found to be a positive step to sustainability as all health facilities did have one ormore health staff trained for CDTI. There was recruitment of new staffs to fill some gaps in our health facilities and hoping to open more than four dispensaries while upgrading some to became Health Centers. All new staffs will get an opportunity to be trained for CDTI and NTD in the year 2017. Even with the availability of experienced health staffs in our district, no health staffs transfers this year, election of leaders at all levels the government leaders at Ward levels and Villages remained at their post and assisted much in keeping our track of CDTI coverage in term of therapeutic and geographic sustainability in order. I e t2 WHO/APOC, l4 September 2009 oS,!qv d ll \,, --(J- a.) o\ (..l t--\o r- ?a) {.l rn al N 00q 0) U) U c) z oLJ, NN $N r-OO o\ al(.l e) q) c) o ca ca O r-r- r-r- t--$ (-.l .i- (\ <- O a{6 () q) c) o\ t) c) .a q' cn tr cr' oc) .6J L. cc()L z U \ ULF =?ilU o.. +LI,: .(J -s rl -_ q) U- E3 tr--- ZE q) <) U L - E,, dE.1 + s&'u (-l (-l (-l (\ o\ I O O O al 6l .I al Nr- ar () () 4) a ^\ A O q a l] (.)0) a!s z r UI ULF iilvX,- + O o\ -rO = -] L oL 0) E M b0 (c D '] F F () q) c) q) o\O N C) -o {) o.oa$ O - o- o ca h{ o ea a c a b1 a- o * o a. 4 - Uq) ? a) t a)q q) a* o C) o. L t-!U t* a 0) O O! ,0) 'o o (B bo d!F .iir o-,l -t -ol(gl FI I o E Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management V V Horv to conduct Health education V V Management of SAEs V CSM V SHM V Data collection V V Data analysis V Reporl rvriting V V Others ( spec ify) Table 6: Type of training undertaken Qick the boxes where specific training was carried out during the reporting period) fhe firll council rvhich is a powerful Political body in the district will be inaugurated in 2011 hence the training will be done. This followed the 2010 National Multiparty' election which observed several changes in leaderships of which ',vill need CDTI training. The Ward Councilors are members of the District Irull Council, and by, their virtual of status they take up the Chairpersons position in their Ward Development Committees rvhich is a very important body for all CDTI activities. 2,6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65o/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. t4 WHO/APOC, l4 September 2009 I I o\O N 0) -o () o. 0)a$ Q o o > OO\ U a-\ Ea U 60 \OE ! -)tv3e CJ3 G 9! .0) 'o -'.\r:4.O-:a) oiS !:= -.4 I '=ooi +trx F!3'=* a.:!H:!UYL LFU <di.a 6ESul: o== .rp= C)+sr >r-i rC\QA=>;}Y cJ = '=\:<. c '-- ic - g a..l .E $ i! L\\X\ri) .Y \ '=SG l\ =-!,\JAG' .= u l:CJ I iY!\Yl il = ;:"I = 'iir - ! !:, c .: ;: , = != u = ilr;t = ssx i s-Lbr = s l\i '-v cdt!6 i *s:-r- - J= M uiI- -C\ '- + E-3s c! .i &{ ,q q-5 i id: a!: si \-% -t \\3 =Yr i.\ =PL = da-3 i: u U\{Srt'- t\ ='ll llEa 9!SES -\t\ Y! ta) OO I q) 0) o o a) o ! C) -.o = Z (.) o CJ5' =o OJ,F = O =I C) C) c o C)o o L 0) -o =Z 0)L o 0) 'e La() ; z, r! r', >' -o OJ |+= () =a a .9 .= =E Eoo .9 E .J 'o o I L (J o- c a() E c LO -o = C = o|- ()L O() 'd Lo o '= .: 6 0) E E oo (.) tr 0io ut .r! ^-o Y,(Ju.( -G a0 '!, ,E; ALo-() -=2 FZ O =I () o L 0.) o a o c u -D = Z r5 0) (.) C) F D -o o\ 0) L 0-) oo L9/^6s>:- o(.) F CJ c-) iO , c) a(.) o-l -.c o\ cdL ao ooc (.) L 0) 5I) L CJ o (,) ^ !o. 0) o- L 0) -cF ql orldl c6l vl -l 'l rel(Jl €i c:l!lIivlDIil -arl -l 3l )l .JI ol LI d)l -clel od a EI ol ot -l €l ql ft EIul ol r&l a:o! (i€ svaa.7,a- Abtras!a' -o.Y 1, -E <d 95H€EH:; -7 oqY Oi9 o O Du 6tr o fr.,l = -< -7 ach O ='J^-')- --^':,,_--^=-', ea -L y G ..=6: =;-.) 'za=E'' LOoo EOV"' =oAd \o co ('-s rA\o a.) 6 o\ O a-o I+r ll -: AJ =oocoO- d^ C'-;:- FO u1 00 o\ trr o\ tr- ! o -- o=o trlo z c-)O(-l ol (\ oo o\a al rA o\ ?o E 6.>- ::o .l .Q -a oo q C\ c'.1 OF-O € ol ra ao t 7 Yo -q-7 a ? 4E -; =-= a'!;; au! C\ q CO\o N \o$ oo c.l cl 6tN € t a a) bo a 0) E oO ll * = L ?c' cb= - il')(, O = tqE?.- y c 9!v =Ft-Z6 .:t t--(-l .o r- --b do= 4 9-a -io -$ t-- a.l \c r- .De - a b,,C=ao= * C ilu xE o :E;.=3d.duut-oi c 'OL $ Ir-(\ o\ t--\o ;q oH 0) -o o V (o o0 d D J F 3 -:\ - q V) a)U a) \ ? ;\ a) \ \)a U a_ :l 6 L a c.)L = J o ! a -o a El a r3 o 6 0) t<F r.-r o',l -ol(dl FI I 2.6.2 What are the causes of absenteeism? The changes of treatment months have caused the number of absenteeism to be high. The drug was distributed between October and November instead of July through September the time suggested by community themselves. 2.6.3 What are the reasons for refusals? No refusals are experienced these years compared to previous more than five years, whereby, the doubts were still in some people's mind. Mectizan have won people's mind hence approval, due to the existing knowledge of disease, drug it self and presence of people r,vho improved their health and relieved of their existed intensive itching that was to the majority of persons in, especially rural communities. 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 experienced since the project commencement in our focus. . Parasitologist traincd? YIS . ' Existence of nricroscope'/ YHS 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 a V ? l6 WHO/APOC, l4 September 2009 oi C) -o 0) o.(.) a s () o o. o I t-- qJ a_ a) ! Lq) 'a q)4 JE ,)q q) U !J a o\ q) L o !a q) a_ o () o. bo L U or 0) L 0-) co L -o C)!i (.) a tr.l a C) o o(n Lio CA ! a.)(n (H o a C)adO ddr o,l -ol(Bl FI I C)tr- Ao9 5yo <.E E L ;toB L'- E ';Eq cEoo a;) XAL rll 5'5 O* ;o a3^ JO:Y(uEF /,3 A A.2E C o) q tr= d@ooo€ee o ot .2 C^OEooD a? '= o - .6 -E.2 H (6,cq: a -c .^ o on.N E a,o.= 9ii;_3E> -E =oN* 9?- a>; o o- E cn a 6 ! tr o o- E -o o L .3 0) o- xo a C) oo * (h o oooc d.- =do?o 1It Fi z Av z L )o c! 0) -o 0) o-(J cn .f, O(J o. a) co () 50 YL^F- o\ /O C) a\ o\ $oo \C.oo oo \q oo o\ oo o\ t--oo o o. ll + ,'; (, ti o ^ooF 6"< -o o r-$ \oaa N\o o\\o F- 00 $oo co oo $co s C' s Ll lol ti I '.= o ,hoO ci^ :fuo\i: >v oo -coF o\ aa O CN co ca\o co\o Ot-- vl r- (-.l F- sr- aaco (\co o\r- G] -o ,o od .o -o .^ FE 72,D o- CI .f, r- o\ O r- O\o "1 \o (r- .o- t--$C\ tr- ca ooN t-- c! c\(\ ca co ral oo ca co t-- (..l C' ca aa q oor- c-l aa$ N o\ oo c\ ca o\ a-) =aEZ= cd:- .? p-a ca v s\c) N (\ r-(-l OF- c\ r- oo c.l \o r- .o^ O$(\ o\\o O c-l an \o \o^ \o C. a.) \o q O ca ca r- ol ca O q \o t-- s \ o\ ao C\ oo $ c..l oo c.I O c.l oo(-l co $ aq -:OL^= !1 i o io . .o s€= EEr O- u; o r- caO co N .1 c.l co oo o\ .f, o\ \o oo c.l co C. o\ ca C. t-- s o\ c.l Ir- $ c'.1 c'I oo o.l$ ca-t cor-o $$ $ .o^ o\$$ \o c't$^ aa $ r-N\\o(\ co$C\ oo o\$ o bo ='J- .9 E E oU ll *(,l! E) ^ b{,(rs-F U"\ -o I OO OO OO OO O OO o O q !_-i\:i- 93 d 3 "-j r.r L: Dai OO OO OO OO O OO OO O OO O !t c, = =e - e-:: 7ar' o o tr-N t--c.l r-(..l r- c.l aa .i- r- c\ r-\o =u-ei'. 4 A9' F9 o\ o. t.-(-.l t--C..l tr-c\ r-N $Ir-N O tr-\o bO cd =qq> h;iO}-E EE+ u! ^-- o=q1 aa F tr U 9.O E,D oo o\ o\ c- c\ r-c.l t--c\ r-c{ $F-(..l or-\o q.l r- o\ coo\ o\ o\ o\ o\ N oot c.l c.l O a.l $O(\ oN \o N F-o c.t oo ON o\ c.l O (\ th a, (J q) oo o (J E-r q) q) U) q) bo U) q) U) € .I ao cr) rn = q) (.) q) c) Fp c) q) () q) U) q) -e' +.q) !rt 9.: o\a -qv\l 0) \.) q! o(.)90) o CJ f r L L0)(r >l u -ol i arlY=l uol a, -Olir 0Jfbo 2b Cq (J 6.) tr()O, C,!-LiE .9)lr-) ,a .r- (ri o\l(Jl -l -ol .dl -t I I I 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) wHo tr UNICEF tr Mectizan@ delivered by - Qtlease tick the appropriate answer) wHotr UNICEF tr MOH Other MOH Other specify) specify) NGDO tr NGDO tr a The projection of the Mectizan order from the communities through CDDs and Sub village Chairpersons following the community census is the key to Mectizan order estimations. The Frontline Health Worker complies and send to the district where the data are complied. Therefore, the projects request Mectizan at the MOH &SW by filling the Re- Application forms. From there, the NOFT send the form to MDP who supply the drug to Projects through Medical Store Department (MSD). The clearance and forwarding is the duty of the Tanzania MOH & SW. When the drugs arrives the MSD notify NOTF who inform RMOs/DMOs and Coordinators before MSD transfer to respective districts. The District Government Health stores do temporarily store and forward to the FLHFs using special issue ,n,oucher and {edger book. FLHF staffs inform their Sub village leaders and request them to collect Mectizan ready for distribution to community members. Table 10: Mectizan@ In (Please add more rott's ne Drug inventory and store remained drugs at central level ri'hich is the district Ordering of Mectizan@ drug. ternporally store. distribute to FLHFs Training and re-training of CDDs for Census and distribution activities Conducting monitoring and super",ision to CDDs during census update and drug distribution Data collection. analysis and report rvriting Conduct feedback meetings to atfected community PIan fbr next year. tlnancial, educational. Internal Monitoring and E,valuation I I Number of Mectizan%"bl.tt Expire d RemainingState /District /LGA Ilr stock I'ronrprcr iorrs vca r Requested Received Used Lost Wasted 0 0 0Kilombero 343,118 5 14,000 5 14,000 857.7 r 8 0 97,500Ulanga 450,000 450.000 3 52,s 00 0 0 0 964,000 1,210,218 0 0 0 97,500TOTAL 343,718 964,000 19 WHO/APOC, l4 September 2009 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSND No of Communities that conducted stakeholders meeting (SHIvt) Kilombero Ulanga 214 396 214 154 160 t6 TOTAL 670 428 176 2.8. Gommunity self-monitoring and Stakeholders Meeting Table I l: Community self-monitoring and Stakeholders Meeting (Add rov,s if needed) StakeHolders Meetings and Community Self Monitoring was conducted between October and November 2010 that helped to bring again the project in track after it was affected by the National Election at all levels from the community to the district level and sustain our CDTI activities. This will be repeated in the year 2011 so as have been found very useful and easy to do using the existing goverrunent structures for the success during the next treatment cycle. 2.9. Superuision 2.9.1. Provide a florv chart of supervision hierarchy. District Frontline Health Facility 0 w Sub V I C lage ommunitl' I 20 WHO/APOC, l4 September 2009 il 2.9.2. What were the main issues identified during supervision? The activities were running smoothly at all levels however only worries of the Praziquantel Tablets for Schistosomiasis control was of concem to Ward and community leaders. Mectizan tablets in not any more an issue of concern as it is almost there are no even minor side effects being experienced. This is likewise the Albendazole for Lymphatic Filariasis and Soil Transmitted Helminthiasis. Praziquantel will be distributed by early 201I and the medicines were distributed to all health facilities waiting its distribution all primary schools. 2.9.3. Was a supervision checklist used? CDTI checklist from APOC was used as is comprehensive and has proved helpful lbr checking implementation activities and monitor CDTI as the whole. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? All levels were cooperative showing the sense of strong ownership which was our target I'or a long time. 2.9.5. Was feedback given to the person or groups supervised? Both individual and group feedback was given. To the Ward level and health facilities with few staffs the individual one was used with the promise of the one receiving the feedback also do the same to his or her CDTI trained and non trained staff. The community level the group t'eedback was preferred so as to easy disseminate the message to those absent and to higher coverage. 2.9.6. How was the feedback used to improve the overall performance of the project? -l'he overall performance following feedback have proved valuable as yearly the CDTI improves and rumors decreases. more volunteers emerges to replace those shifted, died or those rvho rvill be absent tbr longer time. 2l WHO/APOC, l4 September 2009 SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equiprnent (F:Functional, CNFR:Currently non-functionalbut repairable, WO:Written ofl). The replacement of the vehicle in Kilombero district CDTI of Mahenge Focus, Motorbikes and computer have proved difflcult. Hence we use the existing very old vehicles of the Health Depaftment, which are costly to maintain during the activities, and lead to disruption of planned CDTI implementation schedule, as all are in a pool to be used by l5 CHMT mernbers each implementing her or his own project. This also cause delay in data collection and report rvriting. we please, ask APOC/USAID to give our project a special priority and consitleration as an old project that have no NGDO partner to assist with capital equipment issue rvhile actively we are rvorking hard to eliminate NTDs through CDTI rvhich need close supervision. 3 Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtron No Condrtron No Condrtron No Condrtron No Condrtlon l. Vehicle 2 wo 1 wo 2. Motor cycle(s) J WO 3. Computer(s) J lwo IF I CNFR 4. Printer(s) I F I F 5. Photocopier (s) I wo 6. Fax Machine(s) I CNFR 7. others a) Bicycles 44 28WO 16F b) c) 22 WHO/APOC, l4 September 2009 t a3.2. Financial contributions of the partners and communities There is no problem in the release of CDTI AITD funds from the Comprehensive Council Health Funds. This is due they have gone many processes of counterchecking during pre planning, planning and approved at central. \problems do happen only due to late release to the district from the central Govemment and once in the district no problems are encountered. Mahenge Focus have no NGDO partner to assist filling the gaps such as this transport problem at our project. 23 WHO/APOC, 14 September 2009 to\ O o.l (l) -o o) o- c)a t U o o. o $N 0) 0.)9r a () L a li 0.) L Cd a U -o li o (B o d ? cgt) q) F I Eco, o rr- o- '!i<3 F oco o gCO(O - (O- N = @ co 3.oPf'-- ro (\l :NP $ O, c.)co@(o(o- (f)_ -tr)I\ oOO t-o F- $s'-rt tctro)- lr)6l o L o -c o '= :,CO =0)E€ oo ! DEc cc .! !-= ECC Dc -E c EE cc .?= EC EEcc XY cc oE Y c oc v cz oz =z ofoq3 'z c o E o oL o .9! 'o o, Lt o CL G, UJIF o o oo oz E' oo .cl o}eE s ssoooooo ssooOO ssoooo OOO ssoooo q $ r() c\t F-(o$ ooooo_Ns- NCO @- ro CDO('$o$O)_ @ t--lr)(o toolo 50t\@ -J o)6@o6 N c.i $ FEI "o3UIt oooo o-N$- N(O (o ,rt coo(ososO) cO F- u^, d u)oro N9E -- =ItocOOco N o'l P 3EsF- S PE t rr) c\l t-(Ot o E g PE;e o =o o ! e(J(E'tr E.e9o ot .9cl, .9oc,)qo =.to- < iuEzc o o(\t E ot o o- oL ct)c '6 lt t UI o!,c O) oo co :l -ct L c oo Fz IU =zt lJJ oo o) c) o tI) OOooO. N S- NCO (O^ lr, CDO('$o$ o)_ co F-^ lr)(o u)o(, iO co -- o)o@oco c! c'l (o 93 VN I co3v{ $lo o{ F-(o rf ltJz J uJ oof, dt 0) s o o t4 so t4 So GOCoo>EH5 E E qSEE E ilE E; = E E i ;\o(JoE,o,* .gE! - N cr, \r a isr q 6F oO -vtbs 5\ .G o=tu3f $ oob otor! LL cco ro'd tr -5 5,(D(D.r EE .9 cc,-loP:E.-E=.F :E; S E € RS;.,ii; .i c.i crii r, -: =r (a'= oorc o.c.9 -z.EE=+ EEI - o.i c.jd c.i d r"t .f, (,, E o !t)trce.eH', a)tr(DGgatr ;ii;Btr(5Go) be b IEtr E 6):J0, ) a{t> ='f o E b '!X o .9. z .=Ut E LEX - I Ei. E E,9o E HSI g S>o .i . -:, c!Ib .''s (E o afq 0)ch-> +stlJ O Na rri5q 14 Q)t, 0) a_xo (E:( o; EaE.{r -J,(.) J F oF oz tr o o,o cl Lq) -o 0) o- 0)a s (J o- L' > ra)N 0) o c) th t< Cd ()(J r< a C) I ,o a a o _o L oo o (d tr. t) 0) ( F otlO o- N o o oo o@ rJ)(o Fj @ u.(o_ N ooEcoforr+iq.f L l- $ O)(f) t t O)(, $ ooo oo ooo o o o o) -c o oo o oo o o o o o.E 3co:o E€ oo o o oo oo o60q8 -z ooo o o oo o c o E o oL fo ,9!, 'o L oc ts G CLt IUrFo o oo oz o o o oo o o ooooo)oo- o\ Il 0) oo Oo)o)OF@Ncc- \(o; !-N (,l o(, ol rr,(/)(, oo oo ooo) o, c,i o) O) co oo)o)o@ l.- c'.r- \C')})ld (, @(Y) o{ lr)(,(, O o oO) O) co o o o_;strO 'tF o 65o o'tr Ei5 Eo-or! .d.eU,o,r&. o io tro (! z oo)o)o@ l'- (t- \C');U(, @(?) c\l lJ) (9)(t o o or'ooN -E o) L o CL o L cn .g o) -o t tu (! ! -goo o of o 't o o (! 0) o) o o , .o L c o o Fz UJ =zt lrJ o o ! o o o) E' dI o) o- Cr) o) Or-(, J FoF oz t o !rcdo :G\{5\ -G aft ur3fl PEb 5o)ore .=.!ccco6'6 tr (D(I)..' trtsi .9 .c .E' s .t' F F.g 6l:;oa '" !i,5 -'e.i -a U)6i6ifi U'= OItr, tr' Gti 5 -.'6 .= .9'Fb6= ;i.=fs +EEEa'>u,o IE Nc")a c,i c") c', ; IC 0) 0) o)a 0) 13 o 0,) !o)!2> =o)6a EOoeOC _o)LC o0)OC,r>tr(!EEE Na$s.; O) o Br Gs(! b G teEq5!,Q> 'F o) .EsE5 s> .5E O(!9o sbo>>o :b t, o t4 o a_x-ocE 3E\\ - d )s * eEE'/)UJO!? s u,td UJz J F lrJ oofo c o (5 ol >' iO Odr(tr-9E :EE (f)$a (r, o q o G v, so tt, So G o o Hs F Ei'r '. 6 .93 N N:N€ € ? =q, e c)E<i > a 9\E3 _: o\OO a.l r o) -o 0) o-oa =U o o- o > \c) N () oo () c.)lr a o L .o a !(.) a o -o L o (d t I c.) C) F t o oo (.) c)(,) oi o oo o oo of FEClr olrL (Y) (Y) c) ni (o (f) c.) N lI)q(t $o o oo los co $ l(}$(t $ o o o ! o o ott lr, o o ot$ lr)o o o ooo Ec) E E o o o o) os s- ro o sf$ tr) oo ooooooO o o oEOq3 -2. oooooo oooo c o E o ? llt .!2E 'o L o,trE .l, CL u uJIF o I ooo oz o o ooooooooo o oO oo o T' o) oL flt oSE oo o o @\t- o) oo)o)@co\to)- c, (o- 3@3 r ot o{ N otN c.i lr)lr)(o@ c9(')o(O(\l(D t (o N O)_ t o@ F-_ F. o) rO(o(r) ro(o(') O^iCD(oY\t o)- a d)-(o-o@(oo) r o$N. N ot c\l(\I (O(\l o) t (oN O)- s ,l o.r I > _lo (Ul ED oleFl3l o oo5.=P6 =i5(EEoooc:oJ.-II EDooEt o =(trE5 z o @t-- t- o) rr,(I)(.) rO oo)o)(o@$ o)cDo^ UU3 o$ol c\l osN- N o l .cl c o o Fz tu =ztr ul o o ! 0) o)g, E o (O N O)_ $ (o N o)-$ aoo a: O)L o, '6 -o t lu (! ! cI(! o o o .9 0,L o BF CL t, O)lt, o a.XP(DE 0)(! (,trtrox> .8E = Gttxuro -vJ9.<-,ry €5,ri u, d J F oF oz t o EeEqH,;co)oPtro);itroGql be b EEtr= q)5(l): aSlt =fvvuEg€ EEhc PeY: tr .=< iJ o EIE glHIs sl:E.. "!lJ!$ s G o a5q coo)c '6 .= .9 Po(E=;i-=f\ +EEE -o.iddc.i c'i ."i ,; a o -v o B oE oiiOI oo o) o, -E '6 'to oo) o, o)CCOl='=s F-=.= .=(U(trO .:':EoGttr"i { SNNd o o5 Elrltuz J F uJ oof,o Io)lslott(E N ti o t4 io oocoo>'E -(trEF = E 9SEEEilE '- U vt t ,\ -Sf -o ? 9 rt ;S0, o d) E o i: liP = : : : ; 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) In kind contribution in Kilombero district CDTI is through collection of drugs, storage, distribution, census, data compilation, reporting and venues to some areas with village halls. The transport to the trainings and seniitization meeting are community costs also. This is also to the CSM activities and Follow up treatment to temporary absentees. 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. Indictate exchange rate used here US $1,465. Any comments or explanations? NONE SECTION 4: Sustainability of CDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 IIas thc pro.icct er cr been cr aluatctl/nronitorctl I ('l'ick anv ttf thc lolkxr ilrg u lrich arc :rpplicablc) V Year I Participatory Independent monitoring V Mid Term Sustainabilitl' Evaluation V 5 1'ear Sustainability I:r'aluation Intcmal N'lonitoring b1' NOTFV t V Other EvalLration bv othcr partltcrs 1.t.2. What w,ere the recommendations? The projcct is on the otr patlt fbr strstainabilitl" {.1.3. Horv have they been implemented? Sustainabilitl'plan rvas doue and implemented accordingly 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? N/A N/AWas a sustainability plan written? 27 WHO/APOC. l4 September 2009 I When was the sustainability plan submitted? N/A What arrangements have been made to sustain CDTI after APOC funding ceases in terms ofl 4.2.1. Planning at all relevant levels: It is integrated with Council yearly Health Plan 4.2.2. Funds: Through CCHP and local stakeholders which we are trying to mobilize we will be able to distribute the Mass Medicine Distribution. 1.2.3 Transport(replacementandmaintenance): The Project request APOC management to replace the worn-out capital equipment The Government will do maintenance. 4.2.4. Other resources: Communities are our main reliable source of success that makes us sustainable. with APOC/USAID and CCHP funds. 4.2.5. To what extent has the plan been implemented: The yearly plan completed to nearll' 90Yo as CCHP Plan b1' 1009/o andT0oA of APOC funding for year 2010 4.3. lntegration 4.3.1. Ivermectindelivery mechanisms: The Mectizan delivery is within the Health systerns, through the Medical Store Department (MSD) after MoHSW authorization and payments. 4.3.2. Training: The training were mandatorl, to be done at all levels of implementatiotts as we had integrated implementation of NTDs activities. {.3.3. Joint superl'ision and monitoring w'ith other programs: The Council I leatth Management Team (CFIMT) do have a timetable lbr Joint supervision with a regional checklist olsupen,ision that incltrde NTI) zrctivities rvhich are irnplenrented using CDTI strategy. 4.3.,r. Release of funds for project actil'ities: The release of funds tbllorvs the Government procedures and rvas disbursed on the right time according to the plan. .1.3.5. Is CDTI included in the PHC budgetz CDTI have been included in the PHC budget since 2003 and do increase as needed as we now deal with multiple diseases in CDI strategy. a f 28 WHO/APOC, l4 September 2009 t4.3.6. 4.3.7. Describe others issues considered in the integration of CDTI Other NTD will also be considered Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o Filltables 14 and 15 and provrde describe other programmes that are using the CDTI structure and how this was achieved. What have been the achtevements? o For each intervention listed in table 15, explarn what were the roles played by the CDDs (census, mobilrzatron, distribution, data collection, storage, collectton of drtrgs, referral of SAEs, etc ...)? o Explain what are the combrnatrons of tnterventions co-trnplemented? r How were the rnterventions implernented? (at the same time?) a 29 WLIO/APOC, l4 September 2009 o\OON r o) -o () o. d)a s () o o a O ca ! c) (J(! c) c) o z oF @N ca o\ co o\ € c\ ca o, a-l aa r-- o\ c.I o\ oo c\ ca o\ co OO od$(..l q o G C)fr co \o $ o\ ca ,o^ $ o, I aa ,o^ $ o\ sN q) (! z \o tr-\o od o\ \or- .o^ co o\ \o tr-\o^ oo o\ $(\ o q) bo 6 () Lq) z oF C' $- N\o$ q N\o$ c-t o\r- $$ c.i q(\\o$ co <-(.1 () c)fi oo o\(") $ caN co c.I $ caN oo o\ ,'l $ aa c'.1 OOO $N o a oo(\(\ coc.l(\ O" co onC\ OOO =fa\ U! E> L9 z F c\ c...f N O.(.l (..l (..l O oi (-..l ..l oqr-A ca $co o\ co o, $ 6 2 ca oo oo c'l Z6 q) () cg c) O\o t-- O\o r- 00 O\or- \oao () q) o! (!F O\o t-- O\o t-- c\ O\or- oq aa z q) I c) c.l c.l (-l q) b! F (-.l c.l ..l -? A.: >,R o.Q ^{;s. 0) .=(-) = 4t - =cc-X ^^UJ.-! ='-'6 : - - = .r !V U ,^'= ) " N = - ;\ ! =-er!(u UUO:E>N U .= tJ- .U.YL OeO -ft-^ ^.,O).-t -]Jvt4 vN- u)-d_.J= ovL:^d L-.^(J O.= q):6UUC:E>O -c3 c:=\ .C=;, ='A =-6:b():s;E2. o .= .)= oo _=UO() ^nUJ.-! ,^'E - or ii ; - o:-== G o q) !='= n o) O.= 0j:(Buucr>o (J alr-Cir = ? (6---:':.!'; i, y - 3 i !E;=:-=:€ =,r a..j-o:.t - ---A;uo!.Y(oE\ .=9=Es{,.93 PTE€ !"E Sac=i-c=l\o o 5.= (oEi-{ S(r-.c (dE-c d.rE Q a) :'i >.Lfr q) C .Eo P- ., Pdc'E 0Jo >! a o c0J .9o PNf,(E C-O '-C P(U .2 -aOro a o_ coJ .eE =ro €6i'n6(, Oo- a o0) co .eH =o) 6O)i5> a o c .9 f ! '=4 eZ i5i a C OJ -fOC.- sEOJ rS rOECCXo- -Eo a oo Pq .ai oFe a '5 L d)-oo ()- -XO- o 2a EaQ-(d EL Jrt q E oa a oa Fa LU .<oZ.o d!- dE<oZ<) ? q) q) I U t c) F.', o.O N o -o E 0) o- 0)a $ (-) - o- c.l a a) t C,J :- ,U '\ 6 1) - q) q) a) 4 h \-q) q) eo r!J p q J Fc z 'u (o C <o)CE '= a) Lo_(I]a P=-;d6 a a a a a a a a a o (d 2, (! E o o cd F CA o(c d (n Q -aEil u9 I I o\o(\ q) -o () o-() a s (J o o- o B o I c\ ca x<u :1 ra(J^ EH\H<<oE X<c-, ^VJV^?PEE ts39^H\\H<<OIE I c\t€ X<c-'Y ql) ^Hi-\\H<<o!E UE ^ == a -:-\L\J tr >,a) .Lc'= 6 'o = = O -Eau E >.5€ i 6 *E = =9 --:i\L(J E >,0) o o q) g) q) eE = =g --:i-\LU E >,or I c.;n(d - - L Ai- c "=o\F'! 8 E E ?27; ! a)tE Ytt u-EJ - 9 L' (J >-q. <€ L,, L u0 () .=9 =,i^(s ^ = ! ai- E 5 E € ?ZE;^ I otE !H9-J-9UU >. Ir EQ - .=9 c,i^cd -=b<IE X E:7 Z'? '/1 I C)FlE !?H9-J-VUU >.E EU - U ,;Acd , a- C()\F.- E>'zT o;.FF !35E EFr:- EU * 0.)Eboc .scnG?- -o-oX1(El-l ,n9Q z c)Eboc6dtre-2 o)A -o!X6 a,a bD 'E= oa .e- u) EQ z ()!boc ?e- -oEX< 6t-l ,5 ae ;= a ;Eh EbAHET .>l) C,Y cdU LI:()o ,;= a /LF Ib.XEE >(J tr j (gL/ ,;= a ;LF !EbAEE:E >U.E () H(J -Fllii'!* 2 *q.n- J\e-- l-L h dU a LJ(-) a t-l nO -0) lv6Oo a a l-.1Q o a n (d tri J q)O Nt qREo o. @-o- o_ 6-C,- f-.] cd f! H() 9O(Ed(>oi I L (.) e (-)dd(>oi q n n L) I* 9 -u o =.9Oo()c) h l-.1 HU a IJ oU vu o c:)AE t? =6 -c) q) q) 'Ecq c)q) OFqE 'Z- jatr-o o(.)Q= C? =U oc) 0) o L0) -cZ L DO 0) :ol boo^ -'- >, -6-)-e " L() -o !bo() 5o) 6 o z Ool bo() E o o z C)-o () q) q) q) c) bn FZ- da o L(] q) I L 50 0) -i aJ 0) ^Ll: olZS -). o coJ .9o!Nf(I,o-o !d .:1 -oOE a o_ cG) .eE =ro €+!'n6(I, Oo- a o0J co oN ';(o --O €b .= -oqQ) i5E a o o o F .s3P_'i o: E-= A,q >'15 a t a Fa a q E oa (r) oU) a a (d o a- E J cd o (') o_O^ ots (Jo c) F a) \)\ \ A' \) q \) ^vU (.) ;r C) ,r a (J U oo a =a 0) dtr b0 o L< o. t<() :)c rr) e) F o. c.l a) -o 0) o- 0)a O o o. o ca ca aU \ IlJ :- iJ a ! i) *a ! 1) a) a 4 o I q) q) s o o) a aLo o o(!Ld CN O E o F o L (! z o oo 2 or oo (n L Q-otrf>o Vra I v\L! _.=! A =:6.:F\Ll,/ = >\o aL(De u1 e lI. o !- = O d,- cd Co y'I=gEES8UEX Lr (EdZr.tuaJ: rr - 0J a -rGtr(.)^) V-UH^o a,(! =(J ,va^ -gtr = =^)UH5aif H9^U'E O & a 6-Ya )qotE iCO -U(l-LU_U O >cB:I > r, ra'0J \ 0)v.---- =E o>, .: =?ja oq)UE -o = =oL-()c: () rt =a\t; -z d.g Vo .vL C a.l o o U :o o- z =J o c .9 _o .:2o a c qJ E GJ oo(o c 69.(D cLL(o OJEEE os -o a c .9 ro C <o) cE '= o) of >'0 a o a a a a a a a rt I 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 within the reporting period. NO operational research done in 2010. We hope to do impact assessment in the year 20llll2 that will be reported 4.4.2. How were the results applied in the project? NOT APPLICABLE SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and rveaknesses of CDTI implementation process. - List of-strengths of CDTI implementation process: -/ Council Health Management Team (CHMT) and health facilities rvorkers are fully aware of CDTI project in the district to the communities 'r Communities have collected the ivermectin and Albendazole themselves from central collection points throughout the district '/ Community members do not lear anymore the previous seen Mectizan side effects rvhich are no'uv extremely rare r Steadf increase in therapeutic coverage in the communities annualll'. Weakness: '/ Sltortage of staffs existed at the FLHF ler,'els that restrict the CD'|I health staffs working u,ith CDI'I and uork overload to the existing ones. -/ Inadequate firnds to eff'ect trainings of teachers distributing Praziquantel fbr Schistosomiasis control '/ l-ack of NGDO partner to tlll the existing financial gap in our project. / Inadequate incentive from the community to their own Community Directed Distributors. Worn out Vehicle (1), Motorbikes (3) and worn out bicycles(18) as transportation equipments for sustaining CDTI and co implementation with other Mass Drug Administration activities such as Lymphatic Filariasis and Soil Transmitted Infection treatment I a t Threat: 34 WHO/APOC, l4 September 2009 t a device at any time using a e modem. This delays communication and timely reports and information for implementation of CDTI as needed. other education campaigns. Variation of incentives from diff-erent program List of challenges and how were addressed during training and stakeholders meetings other NTD education campaigns. NTD registers. -/ Transport problem fbr CDTI activities existing in our district '/ The project plan to use Local Private Radio FMs in Kilombero fbr more health to all NTDs SECTION 6: Unique features of the project/other matters NONE a I 35 WHO/APOC, l4 September 2009