BY REPORT ON THE FACILITATION OF TRAINING OF NOTF/TANZANIA ON PARTICIPATORY TNDEPENDENT MONITORING OF CDT! PROJECT DAR ES SATAAMIMOROGORO, TANZANIA, SEPTEMBER llfH _ OCTOBER 04 2OO2 Dr. Joseph Okeibunor Department of Sociology/Anth ropology University of Nigeria, Nsukka Enugu State, NIGERIA SUBMITTED TO TIIE. BFRECTfr,R AFEIC AFi Pfttrfi EL+-,}[SIE $trti. G}NC tlOC E ftCI&SES C S]\iTRfl L (.4FtrC) ffi'T(}B,SHZ{ffi For ActicnIo: For liiitrr,rrclilon To' I'li(t Llr ,\-\ t Facilitation of Truiningfor NOTF Tanzania on GDTI Monitoring TABLE OF CONTENTS T.ABI,E -AE C_ONTENTS- LIST OF ACRONYMS ..... ACKNOWLEDGEMENT . E)GCUTIVE SUMMARY LA -TNIR_O-.DUC-IION 2 0 OR.TE TIVF,S OF TI{E w KSHOP 3 O DESIGN AND METHODOLOGY 3.,1...C. oxru.ge-,. ............... 3.2 Design: 3.3 Methods: 4 O RESULTS/ACHIEVEMENTS DAY 1: l2/09,/02 Ifiroduction of the Esscnee of Monitorins TI 2 2 J 4 5 7 7 8 8 8 8 Proiects t2 1.1 1.2 s 3: l Eip-ldwork;DstsEnty;-Brielinsqtd-De-b-riefiusEprruqli.tip-;.; 1.4: Activities Dav 4 to Dav 18: 15/09/02 29109/02: Fieldwork, Entrv and 10 Management: 11 CS on Data Resull; tU); t2 20:01/1 and Results: (21 13 13 13 13 4.7: Activities 21: 02/10/02: Report bv Grouos. 4.8: Activities Dav 2 : 03/10/02: Debriefins and Elementarv on EPI Info ./J and NO 5._0_ ATI t4 t66.0 IX LIST OF PARTICIP NTS IN TFIE TRAINING OF NOTF T NZANIA ON. AND RfN, F REP_QBI_WN_.TING*TE__\P___L_AIE DEBRIEFING GUID FOR USE IN FIELD DATA MANAGEMENT TEMPLATES. PY4!U--ATIO-N.G-U--IDE USING EPI INFO VERSION 6 INT t6 19 49 50 51 52 Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring LIST OF ACRONYMS J APOC CDTI CSSC DOC DOT NGDO NIMR NOCP NOTF OCP ROC ROCT VETA wHo African Programme for Onchocerciasis Control Community Directed Treatment with Ivermectin Christian Social Services Commission District Onchocerciasis Coordinator District Onchocerciasis Team Non Governmental Development Organization National Institute for Medical Research National Onchocerciasis Control Programme National Onchocerciasis Task Force Onchocerciasis Control Programme Regional Onchocerciasis Coordinator Regional Onchocerciasis Control Team Vocational Education and Training Authority World Health Organization Facilitation of Training for NqTF Tanzania on cDTI Monitoring ACKNOWLEDGEMENT Dr A. S6k6t6li, the Director of APOC, with his team at the APOC management provided invaluable facilitating roles during the planning stage for this workshop. Dr. Amazigo, Agboton and Aholou also provided indispensable facilitation of my smooth and easy travel to Tanzania at atime when it was thought a Herculean task for Nigerians to step on the soils of Tanzania a revered tourist enclave in Africa. Drs Seketeli and Amazigo also lent valuable ears to the genuine concerns that were expressed during the actual workshop, with regards to the number of days earmarked for the training and fieldwork exercises. Mrs. Eva Muro, of WHO Tanzania was also a source of assurance, enriching my confidence that the assignment can be accomplished. She assured me of acceptance rnTanzania. The cooperation and enthusiasm of representatives of the NOTF Tanzania, Project Coordinators, DOTs, NGDOs and scientist from NIMR Dar es Salaam and Morogoro participating in the workshop and fieldwork exercises was very encouraging. They participated fully in all departments of the workshop activities, especially in the group- work sessions. The presence of Dr Simon Katenga, the National Coordinator of Tanzania CDTI project was a great morale booster. Finally, the support of APOC by providing the funds cannot be over emphasized. Without these funds and policy support to give technical assistance to Projects in need of such assistance the exercise would have remained a mirage as far as the NOTF Tanzania is concerned. The necessary catchments areas would also have remained ignorant of how to do their thing The management and staff of Vocational Education and Training Authority (VETA) Morogoro should also be thanked for their excellent services. 4 Facilitotion of Trainingfor N}TF Tqnzunin on cDTI Monitorin$ EXECUTIVE SUMMARY The training workshop on independent participatory monitoring of CDTI projects organized fol NOff Tanzania was held in two phases. The first phase, which pr.epa_r:g paiticipants for the collection of data in monitoring CDTI projects, was held from the 12' io 1+'r September 2002. This preceded the actual monitoring of four CD]I projecls in^ Ruvuma, Tukuyu, Tanga and kilosa CDTI project foci between the 15n and 29* of September 2002. The second phase took place between September 30'h and October 2nd ZOOZ. During this phase participants were taken through data analysis, after which they finalized their respective reports on the projects monitored. A total of twenty-five persons participated in the workshop. These were drawn from the National Onchocerciasis Control office, (NOCP), in Dar es Salaam, the five CDTI project foci, NGDOs in Onchocerciasis Control in Tanzania as well as the National Institute for Malaria Research Nn/R.) The general objectives of the workshop were to train the NOTF Tanzania and partners on the independent participatory monitoring of CDTI projects and also prepare them to monitor four CDTI projects in Kilosa, Ruvuma, Tanga and Tukuyu CDTI foci in four regions in Tanzania as well as debrief the Region and Districts where the monitoring took place. The activities/objectives of the workshop were addressed in three participatory work groups and in different plenary sessions. The key achievements/results of the workshop include the following: l. Brainstorming on the attributes of monitoring exercises for development projects in general and CDTI projects in particular 2. Identification ofthe objectives of monitoring CDTI projects 3. An overview of the methodology and instruments for monitoring CDTI projects 4. Role play trying to administer the monitoring tools 5. Overview of the process of developing sampling design for the monitoring exercises as well as a prototype sampling design as a guide for use in field exercises 6. An overview of report writing process as well as development of report writing template as guide for use in report writing. 7. An overview of data entry process as well as the development and installation of data entry template for use in the field 5 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 8. Overview of debriefing process and the development of a checklist for debriefing in field based on preliminary analysis of results. A more detailed debriefing of the NOTF followld after the second phase training on data analysis and final report writing. g. Overview on the use of EPI Info version 6 for the development of data entry templates and data entry and analysis of monitoring data. 10. Analysis and presentation of the monitoring data, using both quantitative and qualitative approaches 11. Final Reports on the monitoring of four CDTI projects and debriefing of NOTF including Coordinators and DOCs of projects monitored. Participants were happy to be part of the process and indicated assurance to be able to carry out the monitoring exercise in future. 6 Facilitation of Trainingfor NOTF Tanzania on CDTI Moniloring 1.0 INTRODUCTION The African Programme for Onchocerciasis Control (APOC) was created in 1995 to coordinate the extension of ivermectin (Mectizan@) delivery to over 50 million people at risk in 19 countries outside the areas covered by the Onchocerciasis Control Programme (OCP) in Africa. ApOC is a global health partnership involving affected communities, governments, Non- Governmental Development Organizations (NGDO), as well as multilateral and bilateral agencies, like the World Bank, WHO, UNICEF among others. The objective of APOC is to establish sustainable ivermectin delivery systems in endemic countries. Community Directed Treatment with Ivermectin is the main strategy adopted by APOC in enhancing treatment coverage while reducing the dependence of affected communities and governments on external financial support to ensure sustainable treatment for up to 15 years' this strategy requires a reorientation of the health system to accommodate partnership with the community and involvement of community in decision-making. There is a need to monitor the participation of the community and the health care services in the strategy. Procedures and instrument were developed in a series of efforts and meetings coordinated by APOC management to come up with process indicators for monitoring of process performance of APOC supported CDTI projects in Africa. APOC organized training of Project staff, NOTFs, and scientists from various institutions were trained on the use of the instruments and disseminated the instruments for independent participatory monitoring of CDTI projects. Projects and NOTFs with special technical/training assistance were nonetheless encouraged to request assistance from APOC management on the use of the developed procedures and instruments for monitoring CDTI projects. It was in this light that the NOTF Tanzania made its request for technical assistance in monitoring four CDTI projects in Tukuyu, Ru.vuma, Tanga and Kiiosa CDTI project foci in four regions of ianzania between the September 1l'h and 4m October 2002. APOC obliged the request of NOTF Tanzania by engaging Dr. Joseph Okeibunor as a temporary adviser to facilitate the training of NOTF Tanzania on the independent participatory monitoring of CDTI projects. The report that follows is on the process of the execution of this assignment and the results. 2.0 OBJECTIVES OF THE WORKSHOP: The general objective of the exercise was to facilitate the training of NOTF Tanzania on independent participatory monitoring of CDTI projects inTanzania. Following from these, the specific objectives were to 1. Train the NOTF Tanzania on the process of monitoring 2. Take the participants through the monitoring instruments and their use in collecting information for monitoring the process of CDTI implementation 3. Take them through the process of analyzing their results and using both the quantitative as well as the qualitative data in reporting the result of the exercise. 7 Facililation of Trainingfor NOTF Tanzania on CDTI Moniloring 3.0 DESIGN AND METHODOLOGY 3.1 Coverage: A total of twenty-five (25) participants were drawn from NOCP Tanzania, supporting NGDOs, DOTs, Regional Onchocerciasis Control Teams (ROCT), and research institute. The lists of people at the workshop are covered in the appendix. 3.2 Design: A two-phase six-day workshop was designed to cover the stated workshop objectives. The two phases include the first three-day session on preparing the participants for data collection and computer data entry. The second phase dealt with the analysis of data collected from field and report writing. The participatory tool of group discussions was adopted to ensure the full involvement of all the workshop participants and the practice of the use of lessons and tools. This was however used along with plenary presentations. 3.3 Methods: Four groups were formed using the team formation for the monitoring of Tukuyu, Ruvuma, Tanga and Kilosa CDTI project foci. In other words, the participants were grouped using the list provided by the National Coordinator. All the activities aimed at achieving the workshop objectives were carried out in these groups and in plenary. 8 4.1 I.O RESULTS/ACIIIEVEMENTS DAY 1: 12/09/02: Introduction of the Essence of Monitoring CDTI Proiects First, the National Coordinator did an introduction to the training workshop. He briefly highlighted the weak capacity for undertaking the monitoring exercise and the fact that a number of projects were due for process monitoring to ascertain their profile in terms of their compliance with APOC philosophy and ground rules in the implementation of the respective CDTI projects. He also mentioned request for technical assistance from APOC made by the NOTF and the response from APOC, which is the appointment of a Temporary Adviser for the purpose of facilitating a training and building the capacity of the NOTF in carrying out such participatory independent monitoring of CDTI projects. The facilitator now led the house to discuss the essence of participatory independent monitoring of any development effort and particularly CDTI projects. Two key concepts, namely, independent and participatory were also examined. The concept 'independent' implies that there is a level of outside presence in the monitoring exercise, the essence off which is to find out those things which the eyes of the insider is so used to and could not ordinarily identify when things go wrong. The concept 'participatory' implies that the exercise is a joint effort by both the insider and outsider to collectively evaluate the Facilitation of Trainingfor NOTF Tanzaniq on CDTI Moniloring 9 process of implementation and identify strengths, weakness, opportunities and threats to ihe implementation of the project along agreed and laid down procedures' After this introduction, the house was led to develop two lists of "what monitoring is" and what monitoring is not". According to them, "Monitoring is: o A tool for guiding the implementation of development efforts through the right process. A means of identifying wrong practices early in the life of a project and making necessary amendments. A means for identifying and encouraging best practices early in the life of a project. A means of identifying constraints to thee realization of project goals and seeking effective solutions early in the life of a project. A means of systematically following the trends and issues in the life of a project". On the other hand, the group indicated that "Monitoring is not: o Merely fault finding, seeking who to blame or crucify. o A means for destroying genuine efforts. o A time to protect interests to the detriment of the project" It followed therefore that key factors in good monitoring are honesty, painstaking, dedication and to be analytically in-depth as well as courageous. From this point the house went through the process of monitoring. These included 1. The identification and discussion of the objectives of monitoring CDTI projects as enunciated in the CDTI monitoring guide and instruments developed in Kabale, Uganda. 2. The methodology for monitoring, namely the study area and population; sample size and sampling procedure; instruments and methods of data collection. a a o o Fqcilitation of Trainingfor NqTF Tanzania on cDTI Monitoring 4.2 Activities Day 2: 13/09/02: Instruments and Methods for Data Collection: On this day and for this activity, volunteers led the participants through the different instrumenti fo, dutu collection. The volunteers took turns in lead the discussions on the instruments, under the guidance of the facilitator. The facilitator took questions and made clarifications where necessary. Next, the groups went into role-play trying to administer the instruments on hypothetical respondenis/community members. at the end of the role-play, those who did not participate in a particular group role-play session made comments. Participants narrated ih.ir .ip.riences in trying to use the instruments. They were also given advice on how best to do it next time.. After that, participants were taken through the process of developing a sample for the monitoring exercise. The house agreed to use the concepts - 'village' and 'sub-villages' instead olcommunity and villages. Using Ruvuma CDTI project focus, a typical study sample and sampling design was developed by the facilitator. The teams were encouraged to adapt this for use in their respective areas. At the end of the day, participants were advised to develop their sampling designs with information from the various project coordinators and DOCs present. Arising from observations and comments that came out of the role-play in using the FGD guide with community members, they were also encouraged to translate the FGD guide into Kiswahili since the village members do not understand English. It was noted that it would be more natural if the moderator leads the discussion in Kiswahili rather than try to translate during FGD sessions. These two assignments were to be carried out over the night and brought to plenary for review on the third day of the meeting/training. 1.3: Activities Day 3: 11t09/02: Review of Sampling Designs and Preparationsfor Fieldwork; Data Entry: Briefing and Debriefing Formalities: On the third day of the training workshop, the house started by looking at the sampling designs developed and presented by three groups constituted to monitor Kilosa, Tukuyu and Tanga foci. The groups made very good attempts but were constrained by the non- availability of lists of sub-villages in the villages and wards chosen through simple random sampling procedures. It was then agreed that each group fine-tunes and finalizes the sampling designs for use in the field. On the other hand, not much was realized in the area of translating the FGD guide into Kiswahili. The team left with a promise to ensure that the discussions are held in Swahili 10 Facititation of Trainingfor NOTF Tanzania on CDTI Moniloring 11 Next, on this day, the participants were taken through report writing process. The facilitator developed a template for report writing and gave to each team for use as a guide. This is attached in the appendix The teams were also taken through data entry templates developed and given to the teams by the facilitator. These are also included in electronic form in another file and programme. Together, the process of data entry was practised. The aim was to facilitate data entry while in the field and to save time for analysis and report writing. The training on data analysis was kept for the end of fieldwork, on request by the participants. They argued that it would make more meaning to practice data analysis with real data sets. The groups also went through briefing and debriefing formalities. In order to save time too, ind in view of the fact that teams may have to travel 10-12 hours back to the projects and many more hours to the Districts after report writing in Morogoro, the venue of the workshop, to debrief the Regional and District offrcials, a debriefing guide was developed by the facilitator to help the teams in debriefing these o{Iicials based on preliminary findings before leaving their respective areas of monitoring assignments. This guide is also attached in the appendk The teams will finally debrief the NOTF, including the Project Coordinators and DOCs of projects monitored, the National Coordinator with his team in the NOCP as well as the NGDO representatives, at the end of a detailed and in-depth analysis of the data report writing. 1.4: Activities Day 4 to Day 18: l5/09/02 - 29/09/02: Fieldwork, Data Entry and Management: The teams departed Morogoro for their respective project focus to be monitored. While in the field, the facilitator tried to keep in touch with the teams, using the cellular phone calls made by the members of the team working in Tanga region and the National Coordinator to monitor progress and problems as well as determining the possibility of reconvening early in Morogoro to finish the exercise on September 29, 2002, as earlier scheduled by APOC and the NOTF Tanzania. The result was that teams spent days traveling from one location to another. There was a four-day rain, which started two days before the commencement of the fieldwork. The rains made the roads difficult to drive on even with the 4WD vehicles. The mountains were slippery as the road became very muddy. These realities slowed down movements and a 54-kilometer distance from Soni to Mayo village in Lushoto district, for instance took over three hours of driving. The teams started returning to Morogoro by September 27,2002. Some were able to enter their data while in the field. Others suffered unforeseen set backs and could not enter their data in the field. The team that went to Tukuyu, for instance suffered a computer system crash while the Ruvuma monitors had power failure throughout their Facilitation of Trainingfor NOTF Tanzanin on CDTI Monitoring 12 stay in Ruvuma. These teams therefore used the weekend to clean and enter their data in EPI Info. The others engaged themselves in transcribing the FGD data. 4.5: Activities Day 19: 30/09/02: Training on Data Arrulysis and Presentation of Results (1): The teams reconvened at the training center, VETA Morogoro. Minor logistic issues and concerns in the field were discussed. These included the data collection, some 'mild' problems with data entry and difficulty in getting data in some cases. Other major debriefing was kept till the end of detailed data analysis and when the National Coordinator, who was away to Dar es Salaam to process the additional payment forr participants' in the extension approved by APOC management, is present. The house agreed on rules to guide the session. One of such agreements was on the work schedule and punctuality. The team agreed to skip lunch and work into the nights at the end of each formal session cover enough grounds and come up with site reports, which the facilitator will submit to WHO taizinia before departing for Nigeria on the 5ft of October 2002. The house however requested the facilitator to take the analysis in bits, break between the bits and allow participants to implement each bit under guidance from the facilitator before going into any other major bit. This is because most were not used to analyzing data themselves and/or use of EPI Info. Moreover, they were all very enthusiastic to learn. The Facilitator also assisted some teams in data cleaning before the commencement of the actual work for the day. Now, for the day, the house agreed to go through the first four Tables on results. The facilitator led the discussions through these Tables and left the participants to fill in the Tables and answer the relevant indicator questions using data collected from their monitoring exercise. The Facilitator was on hand to give assistance and clarification when called upon by any group. It was also agreed that each group goes back to discuss the Tables with supporting illustrative evidence and quotes from the FGDs, interviews and observations during the fieldwork and come back to the training venue the next day to filI in the remaining Tables. The groups worked tirelessly and by the end of the day all groups had completed the Tables on a hard copy of the templates distributed earlier by the facilitator. These were crosschecked and confirmed useful by the facilitator. The groups then went ahead to enter the same information on the electronic version of the same template given to them ealier by thee facilitator. Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 13 4.6: Activities Day 20: 01/10/02: Training on Data Analysis and Presentation of Results: (2) The day started with a review of what was done in the plenary, that is, the overview of thr p.oreri"r of completing Tables 1 to 4 for the results, yesterday. The various groups also presented what they did as take home assignment the previous. Next, the participants were taken through the process of completing the remaining Tables of results, after which they went into their usual groups and commenced work on completing the remaining Tables of results. Later in the day, the groups worked at discussing the findings using information from the Tables as well as FGDs and other verbal data collected from the field. 1.7: Activities Day 21: 02/10/02: Report Writing by Groups: On this day the groups worked on the respective report in preparation for debriefing of project team the next day. On this day participants at the workshop also evaluated the entire process starting from the pre-field work training, through the fieldwork exercise and later the training on data analysis. 4.8: Activities Day 22: 03/10/02: Debriefing and Elementary Training on EPI Info: On this day, the participants, as a whole team, debriefed the National Coordinator; some NGDOs present, namely, SSI and HKI as well as the Coordinators of projects monitored and their DOCs/DOTs. Later in the day, before the Principal Monitors departed for Dar es Salaam to Debrief the WR and the NOTF meeting on Friday 4ft October, 2002, the participants were taken through an over view of EPI Info. They were taught how to create data entry templates, develop questionnaire files; key in data and analyze. They were also given a short hand out to guide them in using EPI Info. 4.9: Activities Day 23: 04/10/02: Debriefing of the WR and NOTF Tanzania On this day, the Facilitator and the Principal Monitors for the other teams debriefed the WR and the NOTF Tanzania in two separate sessions. First was the debriefing of the WR Before debriefing the NOTF, however, the facilitator's report on the monitoring of Tanga CDTI project and facilitation of the training had been produced and submitted to the WR. Facilitation of Training for NOTF Tsnzania on CDTI Monitoring 5.0 EVALUATIONCONCLUSIONANDRECOMMENDATIONS The workshop was concluded with an evaluation of the entire exercise. In the evaluation process only thirteen of the fifteen persons who participated as monitors, including the b"puty National Coordinator, HKI and SSI representatives as well as the Regional Project Coordinators, DOCs and DOTs. The Regional Project Coordinators for Ruvuma and Kilosa were briefly absent during the evaluation for different reasons. The former lost his Computer which was being used in the analysis and report writing of the monitoring exercise the previous night to a burglar so had gone to the Police, while the latter went to his Project briefly to conduct a visiting UK SSI team to his project area. The result of the evaluation is contained in Table 1 below. Table 1: Evaluation of the Training and Monitoring Exercise t4 Issues Evaluators' Comments 1. Can you undertake a participatory independent monitoring of CDTlgqpgP a All the evaluators indicated "Yes" 2. What role can you play in such exercise? (Tick as m&ny as applicable) A monitor A pricinpal investigator Data manager Tr (84.s%) 8 (61.s%) 3 (23.1%) 3. Is there anything that needs to be done to make you function better in future participatory independent monitoring of CDTI proiects? o Yes oNo 12 (e2..3%) | (7 7%) 4. If yes, what needs to be done? o Further training on computer and data management with EPI 7 (s3.3%) More training needed on data collection 2 (16.7%) To gain more experience through more monitoring 2 (16.7%) More training on monitoring & EPI Info 1(8.3%) a a a 5. What is your general assessment of the training and monitoring exercise? o The training; o The data and report tumplates; o Debrieftng checklist; o Materials for the exercise; o Interpersonalrelationships; o Facilitation) The general comments include the following, which were unanimous. o Good o Good o Good and useful . Good o Good o Good and understood x But time was short for training 6. What are your recommendations for the future? o Increase time for future trainings o There should be annual internal monitoring for each project. This is Facilitation of Trainingfor NOTF Tanzania on CDTI Monitorin$ 15 After the evaluation exercise, the National Coordinator declared the exercise formerly closed. The facilitator and the Principal Monitors then traveled to Dar es Salaam where the further debriefing of the WR and full NOTF were to be debriefed. a crutial APOC should support rePort writing and EPI Info skill development Teaching aids like projectors should be used for future training Train project managers for project management related to CDTI process integrating in the PHC Design the indices of the instrument to suit country realities APOCA.{ational Coordinator should train DOTs and Project Coordinators on EPI6. a o a o Facilirafion of Trainingfor NOTF Tanzanin on CDTI Monitoring 16 6.0 APPENDIX LIST OF PARTICIPANTS IN THE TRAINING OF NOTF TANZANIA ON, AND MONITORING OF CDTI PROJECTS IN FOUR FOCI IN TANZANIA S/N o. Full Name Address in Full 01 Dr. Simon Katenga National Coordinator, NOCP T anzania Ministry of Health, P.O. Box 9083, Dar es Salaam, email : Katenea@,raha. com Tel: 255 222130025 Fax: 255 222130009 02 John Nganya Project Coordinator, Kilosa CDTI Project Focus P.O. Box 14, Kilosa Fax'.255 23 2623050 Tel 255 23 2623396 03 William Kisoka Social Scientist, National Institute for Medical Research, Nn/B, Box 9653, Dar es Salaam Tel: 255 222130770 Fax 255 222130660 Email. wkisoka@yahoo.com 04 Dr. Rehmah Maggid Project Coordinator, Tanga CDTI Project Focus Box 5547, Tanga Tel'.255 27 26447880 Fax' 255 27 2647943 Email. nuduga@yahoo. com 05 Sebastian Mhagama DOC, Ruvuma CDTI Project Focus Box 42, Mbinga Tel. 255 25 2640624 (Home) 06 Majuto Bakari Chambo DOT, Kilosa CDTI Project Focus Gairo Health Centre, Box 90, Morogoro Tel'.255 26 28087 2s5 23 2628048 07 Abdul A. Daffa DOC, Tanga CDTI Project Focus Lushoto District Hospital, Box 66, Lushoto Tel/Fax: 255 26 40098 08 Pius Mabuba Country Representative, Sight Savers International Box 2513, Dar es Salaam, e mai I : si gh1s..av ers.tz @,r.a.h.Ugam 09 George Mdusi Kassiga Project Coordinator, Mahenge CDTI Project Focus Box 337, Ifakara Tel 255 23 2625230 Em ai I : eka s.siea@.h.qt_qui l. sa.m Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring t7 10 Dr. Moshi Rohiso Project Coordinator, Tukuyu CDTI Box 38, Tukuyu TellFax: 255 25 2552293 Project Focus 11 Dr. W.A. Kabuka Project Coordinator, Ruvuma CDTI Project Focus Box 5, Songea Email : wakabuka@raha.com l2 George Pallangyo DOT, Ruvuma CDTI Project Focus Box 745, Songea w-akabuka@ra.ha,.-c..-o..m 13 Malley Karoli D Biostatistician, National Institute for Medical Research, NIMR, Box 538, Tukuyu Tel. 255 25 2552249 Fax'.255 25 2552293 Email : karolimd@vahoo. com t4 Harrieth Hamis Project Officer, Helen Keller International Tanga CDTI Project Focus Box 5547, Tanga Tel.255 27 2646217 Fax. 255 27 2647943 Email. lyimoharrieth@yahoo. com 15 Venance David DOT, Mahenge CDTI Project Focus Box 337, Ifakara, Mahenge Tel: 255 23 2620311 t6 Oscar C. Kaitaba Deputy National Coordinator, NOCP Tanzania Ministry of Health, P.O. Box 9083, Dar es Salaam, Tel'. 255 22 2130025 Fax. 255 22 2130009 email : katenga@raha. com 17 Abdallah Nuhu Driver, Ruwma CDTI Project Focus Box 5, Songea 18 Sebastian Ndole Driver, Interchurch Medical Assistance Dar es Salaam l9 George Makili I)river, Ministry of Health, Box 9083, Dar es Salaam 20 Shaibu Juma Driver, Kilosa CDTI Project Focus, Box 14, Kilosa 21 Ambrose Mamkwe Driver, Tukuyu CDTI Project Focus Box 38, Tukuyu 22 Kurwa Issa Driver, Tanga CDTI Project Focus Box 5547, Tanga 23 Filbert Lingopola Driver, Mahenge CDTI Project Focus Box 337, Ifakara 24 Mohammed Kibaya Driver, Sight Savers International Box 2513, Dar es Salaam Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 18 25 Jason Kyando Accountant, NOTF Christian Social Service Commission (CSSC) P.O Box 9433, Dar es Salaam Tel.255 22 112918 Fax',255 22118552 26 Dr. Joseph C. Okeibunor Facilitator, Department of S ociology/Anthropology University ofNigeria, Nsukka, Enugu State, NIGERIA. Tel. 234 42 771169 (Home) Email : jokeibunor@),ahoo. com epseelon@aol.com Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring REPORT WRITING TEMPLATE TANGA - WHO/APOC/CDTI PROJECT REPORT OF INDEPENDENT MONITORS OF CDTI ACTTVITIES IN TANGA, TANZANIA L5 .29 SEPTEMBER 2OO2 SUBMITTED TO THE DIRECTOR AFRICAN PROGRAMME ON ONCHOCERCIASIS CONTROL (APOC) t9 $ SEPTEMBER 2OO2 Facilitation of Trainingfor N0TF Tanzania on CDTI Moniloring TEAM OF MONITORS 20 Facilitation of Trainingfor NOTF Tanzanin on CDTI Moniloring TABLE OF CONTENT 2l Facilitalion of Trainingfor NOTF Tanzania on CDTI Monitoring LIST OF TABLES 22 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoilng LIST OF FIGURES 23 Facilitstion of Trainingfor NOTF Tanzania on CDTI Monitoring LIST OF ACRONYMS 24 Facilitation of Trainingfor NqTF Tanzania on CDTI Monilorin$ ACKNOWLEDGEMENT 25 I Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring EXECUTTVE SUMMARY 26 ii iii iv 1.3 Facilitation of Trainingfor NOTF Tanzania on CDTI Monilorin$ 27 INTRODUCTION 1.1 General Background 1.2 Tanga Project Background Write on the i Oncho status of the areu Geographical description of the area Population composition of the area APOC/CDTI activity in the project area Team Composition (Write project site specific) The independent monitoring team that was constituted by NOTF, Tarzania, on behalf of APOC to visit Tanga CDTI project, from 15'n-29'n September 2002, had Dr. Joseph Okeibunor, of the Department of Sociology/Anthropology, University of Nigeria, Nsukka as its Principal Monitor. The other monitors included Mr. John Nganya of Kilosa Project; Mr. Sebastian Mhagama, Mbinga District; Dr Simon Katenga, NOCP Tanzania; and Dr. Moshi Ruhiso, Tukuyu CDTI project. The team also had members of the DHMT and DOT in Muheza, Korogwe and Lushoto Districts as well as community members who acted as local guides. The team also had drivers. 1.4 Terms of Reference (Make it specific to Project e.g. Tukuyu, Kilosa Ruvuma) The team was constituted with the following terms of reference: 1 Succinctly document how ivermectin treatments were undertaken in a sample of Communities with approved CDTI project in Tanga focus, Nigeria. Assess community involvement in drug collection, decision making on the period and modes of distribution, the selection of distributors, and the willingness of the community to accept and bear these responsibilities designed in the CDTI process. Document community perceptions of CDTI processes especially the issue of ownership, and expectations for Onchocerciasis control, based on these perceptions and expectations determine the degree of satisfaction of the community with the different programme activities and outcomes. 2 J Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring 28 4 5 Assess the quality of training received by CDDs and health personnel involved in the project. Examine the record books of the CDDs and assess the quality of record keeping and their ability to keep accurate records. The same applies to the health services staffon the project. Determine the number of communities and eligible treated and compare findings with records of the CDDs and the records at the other levels (District, Division Ward - level records.) Determine whether the health personnel participated in ivermectin distribution and assess the degree and quality of supervision by health staff (and the quality and orientation of the health staffto the CDTI) Identify constraints in the distribution and recommend appropriate measures to APOC management to be taken before the next round of treatments. 9 Discuss the prospects of sustainability based on the findings above 6 7 8 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitorins 29 2. METHODOLOGY The methodology used for the selection of the villages and sub-villages was a modified form of the methodology that was developed during the meeting of the nine monitoring team members in Ouagadougou in 1998. In a review of the tools, in a tool development workshop in Kabale, this was further refined to include a few of the things that were not previously taken into account. The entire endemic villages were included in the sampling frame irrespective of levels of endemicity and closeness to the health facilities in the areas studied. This simplified approach merely selected villages by a simple random sampling approach. 2.1 Study Design (edit and make it project specific) For the monitoring conducted in Tanga Focus of Tanzania September 2002, a cross- sectional research design was adopted. This design was considered the most appropriate to generate the needed data and meet the study (monitoring) objectives. The data collection exercise consisted of a triangulation of qualitative and quantitative instruments designed to collect information from different segments of the target population 2.2 Population The target population for the monitoring exercise consisted of four broad groups. These include: 1) Health Personnel involved in the CDTI process at various levels; 2) Village leaders; 3) Community Directed Distributors (CDDs); 4) Household members in the hyper/meso endemic villages contained in the REMO result for Tanga region. In addition, policy makers in the areas where CDTI is implemented were interviewed to gauge their plans for sustainability of CDTI in the future as well as their policy direction with special reference to their current support for CDTI. 2.3 The Sample and Sampling Procedure A study sample of thirty villages was chosen using a simple random sampling procedure. However, the sampling process began with stratifying the divisions and wards in the District by levels of endemicity. Since treatment focus is prioritized based on hyper and meso, the hypo endemic divisions and wards were excluded from the sampling. Consequently, six hyper/meso endemic wards were chosen through a simple random sampling process (balloting), from three Divisions, one Division each from the three Districts under the Tanga project. The chosen wards included **** Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 30 The villagesr in the selected wards were listed on pieces of paper and six wards were randomly selected by balloting. The villages sampled through this process were **** fiom :l.'*:l'* wards respectively. Category A and B Villages: Having selected the six villages, one from each of the earlier sampled ward to be visited, the sub-villages in the chosen villages were listed. Thirty villages were randomly selected from this list. Another random sample of six villages out of these thirty sub- villages chosen earlier were taken as category "A" villages while the remaining twenty four villages became the category "B" sub-villages for the monitoring exercise. Table A1: Focus: DivisionsAilards/Villages and Sub-Villages Covered in Tanga Project Districts Division Wards ttA" Sub- Villages "8" Villages 1 I 1 I 1 2 J 4 2 2 5 6 7 8 2. ) 3 3 9 l0 ll t2 4 4 I 1 1 1 5 4 5 6 3. 2. 5 5 1 1 I 20 7 8 9 6 6 2t 22 23 24 TOTAL 3 6 6 24 I Here villages are the same with communities in Nigena and elsewhere while the sub-villages are equivalent to villages in communities as used in Nigeria and other places with similar usage for the concepts. I Facilitotion of Trainingfor NOTF Tanzania on CDTI Monitoring 31 Households: In each Category "A" sub-village sampled, fifteen households were chosen. To do this, the sub-village was carved into three clusters guided by the village head and local guides. The systematic sampling approach was then applied to select five dwelling units from each cluster. The sampling intervals were determined through a quick estimation of the number of dwelling units in each village-cluster. This differed from one sub- village-cluster to another. In each sampled dwelling unit one household was randomly chosen for the treatment coverage study. Furthermore, to check on the correctness of treatment, one household was randomly chosen, and the dosage for one household member, randomly selected and crosschecked. CDDs and Village Leaders In each Category "A" sub-village sampled, the sub-village leader was purposively selected and interviewed. The sub-village CDD was also purposively sampled and interviewed. In cases where there were two CDDs both of them were interviewed, but where there were more than two CDDs, only two were selected by balloting. Similarly, the sub-village leaders of the Category "B" villages were purposively chosen and interviewed. The sub-village CDDs were also purposively chosen and interviewed where the CDDs were two or less. In some sub-villages with more than two CDDs, two were randomly selected for the Category "B" sub-village CDD interview. Health Personnel and Policy Makers, Various cadres of health personnel involved in CDTI process were purposively selected and interviewed. These included Supervisors, District Onchocerciasis Team (DOT) members and Coordinators. The Coordinators of Primary Health Care and Health Officials at the District and Ward levels, involved in the CDTI process were also purposively selected and interviewed. The purpose of these interviews was to examine the orientation to CDTI process and provide information on the records and quality of training they receive and/or give on the CDTI process. Policy makers at these levels of the health systems' operations were also pulposively selected and interviewed to give idea of the support of the policy makers for CDTI implementation as well as their plans for the sustainability of the programme. Facilitation of Troiningfor NOTF Tanzanin on CDTI Monitoring 32 Instruments Eight instruments were used to gather information from both Categories "A" and "B" sub-villages as well as at the District and ward levels. Copies of these instruments are included as appendices to this report. Table 42: Summary of Instruments and Sampling Issues Instrument Category of Sub-villages and Unit Sample Sampling Procedure In-depth interview & Record review with CDD A&B l-2persub-village Purposive (Simple random, where there are more than2 CDDs) Household coverage survey A 15 households per sub- village Multi-stage (i.e. cluster, systematic and simple random Key informant interview of village leaders A&B I village leader per sub- village Purposive Group discussion A 3 groups per sub-village (i.e. I male and 1 female adult; and 1 female or male youth groups), 6-8 persons in each group Convenience Health personnel interview A I PHC coordinator I Oncho coordinator I DMO per District 1 LOCT member t health centre staff Purposive Programme manager/Policy maker interview Project, District & National levels I Director, Disease Control per District 1 NOCP Staff I Project Coordinator, I Supporting NGDO staff Purposive 0) -oCB t- o=l-Z oooca ci ca o\o \o c.) \o \o \O H() I €(.) '= ooH(6c F.Q or o -'=o0= tr(E+ C *R5-iF,9.Q C:a iJr (, C) L - 6.)P-V(€= o-v o O0 r-(sa) 0) oD 5,CB6 =E>tr osbD.= -:o -'! C)>z ch o o)o A r,E r}:EEA{AL-- Vs.Fr\u2.^.,)E\Jb rj€.EH E'g;E;FIE€ o'Io aE! U .E'E E S g = A s=o ., .Y'E a%Erti " 5€H3E;H ot-" 0O r- '!r X60;a e.= -. u t\U- nF># a(.)o o o e '-'E'Eo 5 2_da .r # ;i ; iU2 'l l- LJ3E.Zv9=E .Eits Ese€ HE L5,=58 ,tAa aaa ca co il ll - E(I)ll o trOEE6r-l (U iiGLLJ trc- CtoEo! e -Ot-9E-r6tr€o--E or98 -cE _q € --!ltr ii 'c)o-a 'I 6) ^-ai r .r^.(.)EE€ Ev_Ii €otrO.r A ;= c)E I: _a(D <h v)E0.)(l){jbO b0 or6(trr- ;H .- .Q u) u) v)q)oc) oooooo +r (H +<ooo l< lr l<o0)q) -o.o-o (s(sd oootrtrtroooo.aooooliHLAAA .r) U' €) (l) L cB Er \o c) q)I q) 00 a €) U) an c)I otrtr bo G I U) Iq) q) c(F U2t- ct? aF r.l a t-lfr tt, !o .rr F !\ S NI Ft R Eo .ls U t\ N I frl I tr] Facilitation of Trainingfor NOTF Tanzania on CDTI Monilorin$ 35 Do a prose giving a description of your jlnding on the Table above. Support your conclusions with evidence/statements from the FGD and in-depth interviews. You can also use graphs tofurther present yourftnding in picturtalformal ll Poq) EH(l) ll 0) Oo 'Err I tE o .jJ # -Errfrl> =o> ^sb6cd cd= F oc 9FI;6B; :FE >€-r5 qa,n -H- 96H .ta (r) ,Ti-o otr 'rg o.(H (ri +i l-r L Lrooc) -o -o ,o))) (sd(c ooo li Li lioooQ&O.oooHLI<OrqA 0) U)oL0.() L E(.) €(U oli € €o L € U) o4)(€ o t< (H o cn 0) b0 Cg (.) q) H(l) o. o F L 0) q) o ^'€Eo)gH(do o) r- t<P -bo Eq) --o lir€9-dtrooL ut) o Oli -c o:r lr!O5 .rt Q) 0)d -co (J! €o aD* .!2 o.r -!.la 0)e o: rn i:o €t- .,o r-o *or (l) AD HS <? :i = =a (-) a& yO o\ o z aF O'.oza €) r-r E0ils <'iFIA lf(, OI!& dGza ats O.oz, 6)HP <'tFli |,i Q E]& OroFz o\ U) +r o ..oFz o\ Q)HPl,/ =<'tit >a (-)I!il OroZC a OroZC 6)frl uo;i c!l/= <'tiL >ta (J tJl& Oro7o\ a dGza q) ,- 00 -6( lti-o tsca> O IJ.] dGz, a .o o\ o z * cll oti ar) cll U2 q) t,q) q) O U) anLq) o q) Gq) L o z (,) Q)fr t.l o, q) q) q) L Fr o\ ?h a G) q) L Ei N q) & cEF \o c.) !o .lr o F I S \l F ts 0o !t s' q! .ls a\ t-r Gl OOttt Facilitation of Trainingfor NOTF Tanzania on CDTI Moniloring Do a prose giving a description of your Jinding on the Table above. Support your conclusions with evidence/statements from the FGD and in-depth interviews. You can also use graphs to further present your Jinding in pictorial format Table 3 Proportion of Villages treated and in which CDDs were changed after the first treatment Wards Sub-villages (Both A and B) Treated CDD changed 5 5 5 5 5 5 O-3 Proportion and number of at-risk villages treated: O-5 Proportion and number of communities where CDDs were changed by the community after the first treatment: Do a prose giving a description of your Jinding on the Table above. Support your conclusions with evidencdstutements from the FGD and in-depth interviaos. You can also use graphs tofurther present yourftnding in pictorialformat Table 4 Proportion of villages which received health educationo and in which health care personnel supervised CDDs Wards Sub-villages (Both A and B) Received health education (YesAlo) CDD Supervised by health system 5 5 5 5 5 5 0-6 Proportion and number of communities in which the CDD is supervised by the health care (communities scoring 50oh and above) : 37 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 38 o-7 Proportion and number of target communities which received health education: Do a prose giving a description of your finding on the Table above. Support your conclusions with evidence/statements from the FGD and in-depth interviaos. You can also use graphs tofurther present yourJinding in pictorialformat o\ aa il li C)!t() o t .=d 0)t Lro Is '6 o. .9 €oo oll()() ol= r!-.1iloE ''La Err(! . T= .EEEE Eiu-6trtr vnug €4.1 - r.. '6 cB>li o,t -v€HO-rr O " FdXn@ rr =i #= thtE = !Y-^ L - ,, TEI gF ,RStt,,'50FH'ocE:, E E588Bgi= E o o o (l):-cdl.i.rtraF! =LL!vF.' .H B. B..E :o E =ts55i'El6 * e e C t:*i PPdduvf€t-E€€ B E ' E(hu)ar,'E<aHg g g hs E EEEEEiEE)))..)a Hr^rvE E E O/{ E ()!iHtr tr tr !r;-i E Ao o o YH o Sro () oEU o E(Hq<(H tr(*(r(roooJooo l<r<liEpp*O O O* O () O -o-o-o X-o-o-oiaa/trtrtr6trtrE )))CJJJtrtrtr6trtrtr E'lJE.EIgtddstFsaE E E 3E E EtrtrtroCCtrOOOl-OOO n, .r ti !i -!!!LLLt-l-l-ooo ooop.o.o. o.o.o.g I9+ I I Io.AAlJOi0io..r U) U)o o)tr c! \c 0) q) oU U, ,r cl9 ro o c{ ti ba .':! o + E S ll Sf, F k ,s !o B .:l \ to\Or-tttFrC-|tt q) h,9 T dEE=e atua 6)E7 .=E ctij L= €HESa g g< Ir Q) U) 00q)il Q) GIq) t- Fi 'i = c,) o(, S rE troOar ()a ooQ& (l,) UD c, ooE =oAA cE=)a 6) -|n CE^'l- l-'atiU . to€ -as<aE; A \r) U, fr c{ B Facilitation of Trainingfor NOTF Tanzqnia on CDTI Monttoring Do a prose giving a description of yourJinding on the Table above. Support your conclusions with evidence/statements from the FGD and in-depth intervietvs. You can also use graphs to further present your linding in pictorial format B Constraints Do a prose giving a description of your finding.. Support your conclusions with evidence/statementsfrom the FGD and in-depth intentiews i Management ii Techniccrl C Community Perception Do a prose giving a description of your ftnding.. Support your conclusions with evidencdstatements from the FGD and in-depth interviews 40 \ R. S ,o s o! o' = \ N s' S S H S o c Oo U o B9 o (D (! s, o o o lJ ,l o o\ U2 t' o (D B' o o (D t') (D Qt2 o o Fl It a a, !,na(4, s +P> n Fs cHg. F9 <ar#I F9j.9Dj = -04 Hg" FI o !o o FAFfDi!oE€ 8 IsEL ='0qrc D'H Eg ,:i to (\a \JtDrr, I q, o o o OFIFl rt!o(r- 0e o za') +sE.F+=. ,; OA OA aY v'trHo -5 o tt) 5A rjE re :ij laD( Joq D] o o Dr5'^ =oo =s.3ii== aB5!9 ii. r.9'.9 €or { ') { 'st hJ { F (,) 4 FU 5 4 FU UI { fr o\ Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring Do a prose given are description of yourJinding on the Tabte above Support your conclusions with evidence/statements from the FGD and in-depth interviews 42 s,l .=xa .SEB .1. 1 ..ti' .c -!i $[EE s{68 *l isssS !b i, .Iio EEE ..ti' 's .!i $E E H Sgs.X rl EIol B] 4IU Sr issB Eb i, .S!o .ss8 t .a .!i B$EEQ(OA IU Sr s.s.Ur:ri Rsss oi i, .!No *ES I .'ti' , E.? *$g gQ(OA rl .. IEr € 5r issss e ,i' .=xa 'SEC s .a .!i t*e gQEOO .'.1S r "lI 5t isss$ ui, .!No .sE8 .h' .a .!i $iE s3 3 B.eatsoo sb Sr isss oi i, .E*n TEE .s 'a .:l *$EEaqoa IU tts1. b.s.()r:!t isss ih,1 .=xa EEE .li' .Q .Lr *$g EQCOO FU Sr isss 00 .v cl 2 o O (Jq) o) OD q) Eo V E GI o frl E clq) tr 00 c)Io Fr €l c) (J E 0 (.) Xri 0! 2 o0 Iq) e q) o0 c) Eotrv GI o ri GI c) tr 00o(.) o Er o 0 G) BT ol a l/^)$ Oo .ri E F.iI S B bl N h R €, !o \., a 'st B .ti ri c! q) I Eo 0 Ixri Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects Table 8: Quality of CDD Training in Category "A" villages(% in Parenthesis) Ward No. of CDDs No. Trained Length of Training No. Trained in a session traintng sesslon. Give more details and evidence Do a prose given are description of yourJinding-on the Tables 6'8 above Support your conclusions with *ii"nraitotemii* frim the-FGD and in-depth intertiews +xfrilJtl.-, take a summary look at the quarity of the implementation of{DTI in the project focus. While Table 6 looks at the irpt...ntutiol 9f components of CDTI at the ward levels, Table 7 builds up information frfm FGDs with the different segments of the populations in the ;;;,1'A -sub-villagBs Tle.later gives qualitative and contextual flesh to the data p..r.ni.a so far in ,up"po.t of the arguments on the quality of GDTI i.pi...*ation inthe State, which currently rates very poor in all respects' Another issue that came up as an area of concern is the success and sustainability of the CDTI process. This is presented on-Table 8 above. The Table shows that the quality of training both in terms tf lengttr of training and the number of CDDs trained in each 46 Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 47 E UNIQUE FEATURES OF THE PROJECT AREA ' strengths are the attributes of the proiec! area or ,implementers you found to be beneficial to the success of the proiect? Discuss tnese' Weaknesses Wat are the attributes of the project area or implementers you found to'""Writy ilrtt the succeis of the project? Discuss these' a Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 48 4.0 DISCUSSION AND CONCLUSION what the good sides of the project implementers and proiect environment as well as the disposition of policy makers to the project? What are the bad sides? Balance both and attempt an assessment of the project in terms of the fulfillment of the requirements of CDTI principles and expectations' Facilitation of Training of NOTF Tanzania on Monitoring CDTI Projects 5.0 RECOMMENDATION WhatneedstobedonetoensurefullcompliancewiththerulesofCDTIwithinthe project area? Make your recommendations to these different levels/actors in the CDTI process 1 To the Project: (You may use the following sub-headings or some or others you find necessaly to make recommendations on) Training of Health Staff Training and SuPervision of CDDs Record KeePing and RePorting Approaching the Health Services and the Community Integration of CDTI into the PHC System To District: Owtership Mobi li zati on and sensi ti zati on Counterpart funding P r ovi si ott o/ I o gi sti c s P lans for sustainabi li tY Integration into the routine health system To National Onchocerciasis Taskforce Ownership Mobilizati on and sensitization 49 Facilitation of Training of I''IOTF Tanzania on Monitoring CDTI Projects Counterpart funding Provision of logistics P I ans for su stainab i li tY Integration into the routine health system To APOC Management Provision of logistics and capital equipments Provision of technical assistance 50 Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects DEBRIEFING GUIDE FOR USE IN FIELI) If No, to any of the questions above, o What are the reasons? o Who is responsible? o How can the situation be changediimproved upon? o What needs to be done ad bY who? For those that are Yes, are there things to be improved uporVmaintained? If yes o What should be improved upon/maintained? o what should be done to improve upon/maintain the system? o Who should be resPonsible? o How will the improvement/maintenance be ensured? o why is it necessary to improve uporvmaintain the system? When is it necessary to take action? 51 a NoYes Issues Are CDTI related activities the relevant structures?I within andnormal healththe systemCDTIIs2. integrated t?healthnormalas theemented funding for routine training, J authority activities artcounterpthees provideDo political curemMectizanas ent,suchCDTI pro sion etc? CDTI?4 sustalnlforlansthereAre undertaken?5. Are undertaken?6. Are neces 7 the District level staffto do this ? tolevelsnexttheem,ls higherleve bytheAre powereddifferent levelththeat healofficer facilitythee Sdoeroletheir s ( oplay tdoesornecfound requlreasCDD essarytheSEandtratn supervl les and responsibilities lementation?in the CDTI 8 Are communities well sensitized on their ro ve vl 9 ?their taking impldecision theandownershiofsenseshowi pcommunittesthe ngfue lnCDTIofonementatiensuretos propernecessary the authorities their ities?taketotizedwel sensl01 Are Others11 Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 52 DATA MANAGEMENT TEMPLATES Data Entry Templates included in electronic forms and in different programme are as follows t. ii. iii. iv. vi. vii. viii. ix. x. xi. xii. xiii. xiv. xv. xvi. xvii. xviii CDDVILA.REC CDDVILB.REC CDDVILA.QES CDDVILB.QES CDDVILA.CHK CDDVILB.CHK VILALDR.REC VILALDR.QES VILALDR.CHK VILBLDR.REC VILBLDR.QES VILBLDR.CHK HWORKER.REC HWORKER.QES HWORKER.CHK HHOLD.REC HHOLD.QES HHOLD.CHK Actual data entry file for village 'Al gPD Actual data entry file for village 'B' CDD Questionnaire file for village 'A. gPP Questionnaire file for village 'B' CDZ ittect programme file for village 'A^ gDD Check Progrurr. file for village 'B' CDD e.tuat Aati entry file for village 'A' leader Questionnaire file for village 'A' leader Cnect programme file for village 'A' leader a.ctual dati entry file for village 'B' leader Questionnaire file for village'B' leader itrect programme file for village 'B' leader Actual data entry file for health worker Questionnaire file for health worker itrect programme file for health worker Actual data entry file for household survey Questionnaire file for household survey inect programme file for household survey Facilitation of Training of NOTF Tanzania on Monitoring CDTI Projects 53 EVALUATION GUIDE 1 CanyounowundertakeaparticipatoryindependentmonitoringofCDTI Project? Yes tlNo tl Whatrolecanyouplayinsuchexercise?(Tickasmanyasapplicable)2 A monitor t l A pricinPal investigator Data manager Other (sPeci$') 6 What are your recommendations for the future? 5. What is your general assessment of the training and monitoring exercise? lZr*r, the'traiiing; the data and report-teylll'fs; lebrieJing checklist; 'iaterials for the ex\rcise; interp ertonil relationships ; facilitarton) tltl 3.Isthereanythingthatneedstobedonetomakeyoufunctionbetterin futur. partilipatJry independent monitoring of CDTI projects?Yes tlNo Il 54 Facilitation of Traming of NOTF Tanzania on Monitoring CDTI Proiects USING EPI INFO VERSION 6 Introduction: EPI Info version 6 is a dos program used in the organization' management and analysis of data. This version is an improvement on the earl"ier versions like version 5. The latest iorm of tnis version for Dos is the EPI Info 6'04' There is however a more recent version of EPI Info' This is the EPI 2000' It is the windows equivalent of the version 6.04. EPI 2000 is the most recent improvement made to run as Windows Program. Both the Dos and Windows version of EPI Info are very user-friendly software packages formanaging,orguniringandanalyzingdataformeaningfulinterpretation' To start using EpI Info you may open the PRoGRAM EpI6 from MSDos by typing in EpI6 at command ;r;.il una i..tt gNien on the keyboard' You may need to do this twice to get to the Lpr pnocnarvr menu. If you have the short cut to EPI icon on your Windows screen V* lrr, double click on it and that will take you to the EPI6 PROGRAM menu. In using or planning to use EPI6 like any other data analysis software' certain actions are taken in ordered d;;;. By this is meant that certain things must be done in their right sequence before u*i"ing at the point of doing analysis. The things that need to be done include the following: o Making a Questionnaire o Entering Data o Doing AnalYsis The tutorial program in EPI6 helps to teach one how to go about making questionnaire; entering data and doing analysis. Below are highlights of how to go about these activities. Making a Questionnaire: To make a questionnaire template you must take note of three things, namely' 1. Fields for entering data 2. Variable names 3. Saving with an extension <'QES> -AquestionnaireisthetemplatethatguidesEPllnfoinmakingadatafile.once you have created a questionnaire, makin g a data file is an automatic process' Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 55 AnEPllnfoquestionnairemayhaveupto500lines.Headingsandothertext may appear anywheie. Places where you will enter data are called "FIELDS" or ti"it " analysij phase), "y ARI ARLES" In Eped, holding down the control key and pressing-"Q'', twice (<ctrl + QQ>) will display a list "f fi;iJ ;vrnuot'' . bhootirrg " ry'!^,:'le from the list will automaticallyinsertthefieldafterthecurrentcursorposltlon. To start creating questionnaire, first set EPED for the questionnaire (QES) mode' This will turn off *ol.o *up and set the page size to 23 lines, the size of one screen in the ENTERProgram' To do this, press <F6> for setup and <spacebar> until mose is QES' Then <ESC> As you type your questionnaire, each question needs 113" by which it can be identified. The name is referred to a Variable name' EPI automatically takes the first ten letters or characters ofthe question phrase that precedes the field' that is small box or space where the data are entered' But you can give your own variable by placing curly brackets { } around the part of the question that contains the name' In creating data field, '#' gives you ? space for one character; '##' two characters; ,###, threecharacters whie '-----'gives space to write data in words' To save your questionnaire file, press <F9> this will give you a rectangular window. Type in the file name you want to give the questionnaire and end it with <'QES> und pt.tt Enter on the keYboard' ENTERING DATA: By now you have made a questionnaire file called "whatevername'QES" (e'g' CDTI.QES) Now we have to create a data base for entering data, using CDTI'QES as the template. TO dO thiS, SEIECT ENTER OTENTERX fTOM thE PROGRAMS MENU Of EPI. In ENTER or ENTERX you will see a screen that asks for the name of a data file' iyp. in CDTI. A;;iy, the data file will be called "CDTI'REC" but ENTER or ENTERX assumes the ".REC" if it is not supplied' Facilitation of Training of NOTF Tanzania on Monitoring CDTI Projects 56 After typing CDTI, press <Enter> on the keyboard and then choose menu item'2' -"making a n"* data file from a .QES file"' Now ENTER or ENTERX will ask for the name of the ".QES" file' Type CDTI or GDTI.QES, the name of the questionnaire you have made for organizing and analy zing the data- set. After you make these entries press <Enter> on the keyboard, ENTER or ENTERX will make a ".REC" file and give further instructions. FOR ANALYSIS: - Select ANALYSIS from the PROGRAMS menu list' - This will take you to an Analysis screen with two windows - The upper portion shows results and the lower window is for entering commands - The STATUS line at the top of the screen gives the name of the active data set and the amount of memory available - The pROMpT line at the bottom describes commonly used commands accessible through'function keYs'. - The ANALySIS program is command driven, that is, it requires commands for its operations. - The commands may be given from the keyboard or placed in a program file that is then RUN in ANALYSIS. The commands include READ LIST rREQ TABLES MEANS SELECT SORT ROUTE This specifies the data set to be analyzed. This command must precede all commands that use data files. This produces a line list Produces frequencY distribution Does cross tabulation of more than one variable Does means, ANOVA, Kruskal-Wallis tests Selects a subset of the data file Sorts the data for a line list Sends output to the printer, the screen or a file. To send output to a file and piint later from EPED Program, give the file name.out (e g CDTI.OUT) Gives you a pie chart for any variablePM 57 Facilitation of Training of l'tOTF Tanzania on Monitoring CDTI Proiects BAR IIISTOGRAM SET RECODE DEFINE Gives you bar charts Gives a histogram Give some conditions for analYsis Recodes the data Defines the variable fields To start analysis' when in the ANALYSIS PROGRAM - Type,,RFAr)" then the file name of the data set (e.g' CDTI'REC)' If the data set is in a floppy, type "Read A:" then "the file name'REC" - To do a frequency distribution, Type 'FREQ', or press F2 to select the command You want - Then press F3 to select the variable you want to analyze' - Then press <Enter) on the key board' - You can also make corrections to your data set by using the command UPDATE - If you type TABLES add two other variables to get a cross tabulation of the variables. g g, r"ur.s .treated, isex'. This will give the distribution of people 'treated' or 'iot' by their sex 'male' or'female'' -Ifyouwanttolookatonlymales,Type<SEIECTSex=lor}(whichiscode for males). This will pick out only those codes for sex that I or 2 as the case may be. OTHER TIPS: - add percents or lines to your analysis on Tables - Type sET PERCENTS = ON. With this each cell in the Table will now contatn percentages - sET LINES = ON. This will make lines to demarcate the cells in the Table.
BY REPORT ON THE FACILITATION OF TRAINING OF NOTF/TANZANIA ON PARTICIPATORY TNDEPENDENT MONITORING OF CDT! PROJECT DAR ES SATAAMIMOROGORO, TANZANIA, SEPTEMBER llfH _ OCTOBER 04 2OO2 Dr. Joseph Okeibunor Department of Sociology/Anth ropology University of Nigeria, Nsukka Enugu State, NIGERIA SUBMITTED TO TIIE. BFRECTfr,R AFEIC AFi Pfttrfi EL+-,}[SIE $trti. G}NC tlOC E ftCI&SES C S]\iTRfl L (.4FtrC) ffi'T(}B,SHZ{ffi For ActicnIo: For liiitrr,rrclilon To' I'li(t Llr ,\-\ t Facilitation of Truiningfor NOTF Tanzania on GDTI Monitoring TABLE OF CONTENTS T.ABI,E -AE C_ONTENTS- LIST OF ACRONYMS ..... ACKNOWLEDGEMENT . E)GCUTIVE SUMMARY LA -TNIR_O-.DUC-IION 2 0 OR.TE TIVF,S OF TI{E w KSHOP 3 O DESIGN AND METHODOLOGY 3.,1...C. oxru.ge-,. ............... 3.2 Design: 3.3 Methods: 4 O RESULTS/ACHIEVEMENTS DAY 1: l2/09,/02 Ifiroduction of the Esscnee of Monitorins TI 2 2 J 4 5 7 7 8 8 8 8 Proiects t2 1.1 1.2 s 3: l Eip-ldwork;DstsEnty;-Brielinsqtd-De-b-riefiusEprruqli.tip-;.; 1.4: Activities Dav 4 to Dav 18: 15/09/02 29109/02: Fieldwork, Entrv and 10 Management: 11 CS on Data Resull; tU); t2 20:01/1 and Results: (21 13 13 13 13 4.7: Activities 21: 02/10/02: Report bv Grouos. 4.8: Activities Dav 2 : 03/10/02: Debriefins and Elementarv on EPI Info ./J and NO 5._0_ ATI t4 t66.0 IX LIST OF PARTICIP NTS IN TFIE TRAINING OF NOTF T NZANIA ON. AND RfN, F REP_QBI_WN_.TING*TE__\P___L_AIE DEBRIEFING GUID FOR USE IN FIELD DATA MANAGEMENT TEMPLATES. PY4!U--ATIO-N.G-U--IDE USING EPI INFO VERSION 6 INT t6 19 49 50 51 52 Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring LIST OF ACRONYMS J APOC CDTI CSSC DOC DOT NGDO NIMR NOCP NOTF OCP ROC ROCT VETA wHo African Programme for Onchocerciasis Control Community Directed Treatment with Ivermectin Christian Social Services Commission District Onchocerciasis Coordinator District Onchocerciasis Team Non Governmental Development Organization National Institute for Medical Research National Onchocerciasis Control Programme National Onchocerciasis Task Force Onchocerciasis Control Programme Regional Onchocerciasis Coordinator Regional Onchocerciasis Control Team Vocational Education and Training Authority World Health Organization Facilitation of Training for NqTF Tanzania on cDTI Monitoring ACKNOWLEDGEMENT Dr A. S6k6t6li, the Director of APOC, with his team at the APOC management provided invaluable facilitating roles during the planning stage for this workshop. Dr. Amazigo, Agboton and Aholou also provided indispensable facilitation of my smooth and easy travel to Tanzania at atime when it was thought a Herculean task for Nigerians to step on the soils of Tanzania a revered tourist enclave in Africa. Drs Seketeli and Amazigo also lent valuable ears to the genuine concerns that were expressed during the actual workshop, with regards to the number of days earmarked for the training and fieldwork exercises. Mrs. Eva Muro, of WHO Tanzania was also a source of assurance, enriching my confidence that the assignment can be accomplished. She assured me of acceptance rnTanzania. The cooperation and enthusiasm of representatives of the NOTF Tanzania, Project Coordinators, DOTs, NGDOs and scientist from NIMR Dar es Salaam and Morogoro participating in the workshop and fieldwork exercises was very encouraging. They participated fully in all departments of the workshop activities, especially in the group- work sessions. The presence of Dr Simon Katenga, the National Coordinator of Tanzania CDTI project was a great morale booster. Finally, the support of APOC by providing the funds cannot be over emphasized. Without these funds and policy support to give technical assistance to Projects in need of such assistance the exercise would have remained a mirage as far as the NOTF Tanzania is concerned. The necessary catchments areas would also have remained ignorant of how to do their thing The management and staff of Vocational Education and Training Authority (VETA) Morogoro should also be thanked for their excellent services. 4 Facilitotion of Trainingfor N}TF Tqnzunin on cDTI Monitorin$ EXECUTIVE SUMMARY The training workshop on independent participatory monitoring of CDTI projects organized fol NOff Tanzania was held in two phases. The first phase, which pr.epa_r:g paiticipants for the collection of data in monitoring CDTI projects, was held from the 12' io 1+'r September 2002. This preceded the actual monitoring of four CD]I projecls in^ Ruvuma, Tukuyu, Tanga and kilosa CDTI project foci between the 15n and 29* of September 2002. The second phase took place between September 30'h and October 2nd ZOOZ. During this phase participants were taken through data analysis, after which they finalized their respective reports on the projects monitored. A total of twenty-five persons participated in the workshop. These were drawn from the National Onchocerciasis Control office, (NOCP), in Dar es Salaam, the five CDTI project foci, NGDOs in Onchocerciasis Control in Tanzania as well as the National Institute for Malaria Research Nn/R.) The general objectives of the workshop were to train the NOTF Tanzania and partners on the independent participatory monitoring of CDTI projects and also prepare them to monitor four CDTI projects in Kilosa, Ruvuma, Tanga and Tukuyu CDTI foci in four regions in Tanzania as well as debrief the Region and Districts where the monitoring took place. The activities/objectives of the workshop were addressed in three participatory work groups and in different plenary sessions. The key achievements/results of the workshop include the following: l. Brainstorming on the attributes of monitoring exercises for development projects in general and CDTI projects in particular 2. Identification ofthe objectives of monitoring CDTI projects 3. An overview of the methodology and instruments for monitoring CDTI projects 4. Role play trying to administer the monitoring tools 5. Overview of the process of developing sampling design for the monitoring exercises as well as a prototype sampling design as a guide for use in field exercises 6. An overview of report writing process as well as development of report writing template as guide for use in report writing. 7. An overview of data entry process as well as the development and installation of data entry template for use in the field 5 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 8. Overview of debriefing process and the development of a checklist for debriefing in field based on preliminary analysis of results. A more detailed debriefing of the NOTF followld after the second phase training on data analysis and final report writing. g. Overview on the use of EPI Info version 6 for the development of data entry templates and data entry and analysis of monitoring data. 10. Analysis and presentation of the monitoring data, using both quantitative and qualitative approaches 11. Final Reports on the monitoring of four CDTI projects and debriefing of NOTF including Coordinators and DOCs of projects monitored. Participants were happy to be part of the process and indicated assurance to be able to carry out the monitoring exercise in future. 6 Facilitation of Trainingfor NOTF Tanzania on CDTI Moniloring 1.0 INTRODUCTION The African Programme for Onchocerciasis Control (APOC) was created in 1995 to coordinate the extension of ivermectin (Mectizan@) delivery to over 50 million people at risk in 19 countries outside the areas covered by the Onchocerciasis Control Programme (OCP) in Africa. ApOC is a global health partnership involving affected communities, governments, Non- Governmental Development Organizations (NGDO), as well as multilateral and bilateral agencies, like the World Bank, WHO, UNICEF among others. The objective of APOC is to establish sustainable ivermectin delivery systems in endemic countries. Community Directed Treatment with Ivermectin is the main strategy adopted by APOC in enhancing treatment coverage while reducing the dependence of affected communities and governments on external financial support to ensure sustainable treatment for up to 15 years' this strategy requires a reorientation of the health system to accommodate partnership with the community and involvement of community in decision-making. There is a need to monitor the participation of the community and the health care services in the strategy. Procedures and instrument were developed in a series of efforts and meetings coordinated by APOC management to come up with process indicators for monitoring of process performance of APOC supported CDTI projects in Africa. APOC organized training of Project staff, NOTFs, and scientists from various institutions were trained on the use of the instruments and disseminated the instruments for independent participatory monitoring of CDTI projects. Projects and NOTFs with special technical/training assistance were nonetheless encouraged to request assistance from APOC management on the use of the developed procedures and instruments for monitoring CDTI projects. It was in this light that the NOTF Tanzania made its request for technical assistance in monitoring four CDTI projects in Tukuyu, Ru.vuma, Tanga and Kiiosa CDTI project foci in four regions of ianzania between the September 1l'h and 4m October 2002. APOC obliged the request of NOTF Tanzania by engaging Dr. Joseph Okeibunor as a temporary adviser to facilitate the training of NOTF Tanzania on the independent participatory monitoring of CDTI projects. The report that follows is on the process of the execution of this assignment and the results. 2.0 OBJECTIVES OF THE WORKSHOP: The general objective of the exercise was to facilitate the training of NOTF Tanzania on independent participatory monitoring of CDTI projects inTanzania. Following from these, the specific objectives were to 1. Train the NOTF Tanzania on the process of monitoring 2. Take the participants through the monitoring instruments and their use in collecting information for monitoring the process of CDTI implementation 3. Take them through the process of analyzing their results and using both the quantitative as well as the qualitative data in reporting the result of the exercise. 7 Facililation of Trainingfor NOTF Tanzania on CDTI Moniloring 3.0 DESIGN AND METHODOLOGY 3.1 Coverage: A total of twenty-five (25) participants were drawn from NOCP Tanzania, supporting NGDOs, DOTs, Regional Onchocerciasis Control Teams (ROCT), and research institute. The lists of people at the workshop are covered in the appendix. 3.2 Design: A two-phase six-day workshop was designed to cover the stated workshop objectives. The two phases include the first three-day session on preparing the participants for data collection and computer data entry. The second phase dealt with the analysis of data collected from field and report writing. The participatory tool of group discussions was adopted to ensure the full involvement of all the workshop participants and the practice of the use of lessons and tools. This was however used along with plenary presentations. 3.3 Methods: Four groups were formed using the team formation for the monitoring of Tukuyu, Ruvuma, Tanga and Kilosa CDTI project foci. In other words, the participants were grouped using the list provided by the National Coordinator. All the activities aimed at achieving the workshop objectives were carried out in these groups and in plenary. 8 4.1 I.O RESULTS/ACIIIEVEMENTS DAY 1: 12/09/02: Introduction of the Essence of Monitoring CDTI Proiects First, the National Coordinator did an introduction to the training workshop. He briefly highlighted the weak capacity for undertaking the monitoring exercise and the fact that a number of projects were due for process monitoring to ascertain their profile in terms of their compliance with APOC philosophy and ground rules in the implementation of the respective CDTI projects. He also mentioned request for technical assistance from APOC made by the NOTF and the response from APOC, which is the appointment of a Temporary Adviser for the purpose of facilitating a training and building the capacity of the NOTF in carrying out such participatory independent monitoring of CDTI projects. The facilitator now led the house to discuss the essence of participatory independent monitoring of any development effort and particularly CDTI projects. Two key concepts, namely, independent and participatory were also examined. The concept 'independent' implies that there is a level of outside presence in the monitoring exercise, the essence off which is to find out those things which the eyes of the insider is so used to and could not ordinarily identify when things go wrong. The concept 'participatory' implies that the exercise is a joint effort by both the insider and outsider to collectively evaluate the Facilitation of Trainingfor NOTF Tanzaniq on CDTI Moniloring 9 process of implementation and identify strengths, weakness, opportunities and threats to ihe implementation of the project along agreed and laid down procedures' After this introduction, the house was led to develop two lists of "what monitoring is" and what monitoring is not". According to them, "Monitoring is: o A tool for guiding the implementation of development efforts through the right process. A means of identifying wrong practices early in the life of a project and making necessary amendments. A means for identifying and encouraging best practices early in the life of a project. A means of identifying constraints to thee realization of project goals and seeking effective solutions early in the life of a project. A means of systematically following the trends and issues in the life of a project". On the other hand, the group indicated that "Monitoring is not: o Merely fault finding, seeking who to blame or crucify. o A means for destroying genuine efforts. o A time to protect interests to the detriment of the project" It followed therefore that key factors in good monitoring are honesty, painstaking, dedication and to be analytically in-depth as well as courageous. From this point the house went through the process of monitoring. These included 1. The identification and discussion of the objectives of monitoring CDTI projects as enunciated in the CDTI monitoring guide and instruments developed in Kabale, Uganda. 2. The methodology for monitoring, namely the study area and population; sample size and sampling procedure; instruments and methods of data collection. a a o o Fqcilitation of Trainingfor NqTF Tanzania on cDTI Monitoring 4.2 Activities Day 2: 13/09/02: Instruments and Methods for Data Collection: On this day and for this activity, volunteers led the participants through the different instrumenti fo, dutu collection. The volunteers took turns in lead the discussions on the instruments, under the guidance of the facilitator. The facilitator took questions and made clarifications where necessary. Next, the groups went into role-play trying to administer the instruments on hypothetical respondenis/community members. at the end of the role-play, those who did not participate in a particular group role-play session made comments. Participants narrated ih.ir .ip.riences in trying to use the instruments. They were also given advice on how best to do it next time.. After that, participants were taken through the process of developing a sample for the monitoring exercise. The house agreed to use the concepts - 'village' and 'sub-villages' instead olcommunity and villages. Using Ruvuma CDTI project focus, a typical study sample and sampling design was developed by the facilitator. The teams were encouraged to adapt this for use in their respective areas. At the end of the day, participants were advised to develop their sampling designs with information from the various project coordinators and DOCs present. Arising from observations and comments that came out of the role-play in using the FGD guide with community members, they were also encouraged to translate the FGD guide into Kiswahili since the village members do not understand English. It was noted that it would be more natural if the moderator leads the discussion in Kiswahili rather than try to translate during FGD sessions. These two assignments were to be carried out over the night and brought to plenary for review on the third day of the meeting/training. 1.3: Activities Day 3: 11t09/02: Review of Sampling Designs and Preparationsfor Fieldwork; Data Entry: Briefing and Debriefing Formalities: On the third day of the training workshop, the house started by looking at the sampling designs developed and presented by three groups constituted to monitor Kilosa, Tukuyu and Tanga foci. The groups made very good attempts but were constrained by the non- availability of lists of sub-villages in the villages and wards chosen through simple random sampling procedures. It was then agreed that each group fine-tunes and finalizes the sampling designs for use in the field. On the other hand, not much was realized in the area of translating the FGD guide into Kiswahili. The team left with a promise to ensure that the discussions are held in Swahili 10 Facititation of Trainingfor NOTF Tanzania on CDTI Moniloring 11 Next, on this day, the participants were taken through report writing process. The facilitator developed a template for report writing and gave to each team for use as a guide. This is attached in the appendix The teams were also taken through data entry templates developed and given to the teams by the facilitator. These are also included in electronic form in another file and programme. Together, the process of data entry was practised. The aim was to facilitate data entry while in the field and to save time for analysis and report writing. The training on data analysis was kept for the end of fieldwork, on request by the participants. They argued that it would make more meaning to practice data analysis with real data sets. The groups also went through briefing and debriefing formalities. In order to save time too, ind in view of the fact that teams may have to travel 10-12 hours back to the projects and many more hours to the Districts after report writing in Morogoro, the venue of the workshop, to debrief the Regional and District offrcials, a debriefing guide was developed by the facilitator to help the teams in debriefing these o{Iicials based on preliminary findings before leaving their respective areas of monitoring assignments. This guide is also attached in the appendk The teams will finally debrief the NOTF, including the Project Coordinators and DOCs of projects monitored, the National Coordinator with his team in the NOCP as well as the NGDO representatives, at the end of a detailed and in-depth analysis of the data report writing. 1.4: Activities Day 4 to Day 18: l5/09/02 - 29/09/02: Fieldwork, Data Entry and Management: The teams departed Morogoro for their respective project focus to be monitored. While in the field, the facilitator tried to keep in touch with the teams, using the cellular phone calls made by the members of the team working in Tanga region and the National Coordinator to monitor progress and problems as well as determining the possibility of reconvening early in Morogoro to finish the exercise on September 29, 2002, as earlier scheduled by APOC and the NOTF Tanzania. The result was that teams spent days traveling from one location to another. There was a four-day rain, which started two days before the commencement of the fieldwork. The rains made the roads difficult to drive on even with the 4WD vehicles. The mountains were slippery as the road became very muddy. These realities slowed down movements and a 54-kilometer distance from Soni to Mayo village in Lushoto district, for instance took over three hours of driving. The teams started returning to Morogoro by September 27,2002. Some were able to enter their data while in the field. Others suffered unforeseen set backs and could not enter their data in the field. The team that went to Tukuyu, for instance suffered a computer system crash while the Ruvuma monitors had power failure throughout their Facilitation of Trainingfor NOTF Tanzanin on CDTI Monitoring 12 stay in Ruvuma. These teams therefore used the weekend to clean and enter their data in EPI Info. The others engaged themselves in transcribing the FGD data. 4.5: Activities Day 19: 30/09/02: Training on Data Arrulysis and Presentation of Results (1): The teams reconvened at the training center, VETA Morogoro. Minor logistic issues and concerns in the field were discussed. These included the data collection, some 'mild' problems with data entry and difficulty in getting data in some cases. Other major debriefing was kept till the end of detailed data analysis and when the National Coordinator, who was away to Dar es Salaam to process the additional payment forr participants' in the extension approved by APOC management, is present. The house agreed on rules to guide the session. One of such agreements was on the work schedule and punctuality. The team agreed to skip lunch and work into the nights at the end of each formal session cover enough grounds and come up with site reports, which the facilitator will submit to WHO taizinia before departing for Nigeria on the 5ft of October 2002. The house however requested the facilitator to take the analysis in bits, break between the bits and allow participants to implement each bit under guidance from the facilitator before going into any other major bit. This is because most were not used to analyzing data themselves and/or use of EPI Info. Moreover, they were all very enthusiastic to learn. The Facilitator also assisted some teams in data cleaning before the commencement of the actual work for the day. Now, for the day, the house agreed to go through the first four Tables on results. The facilitator led the discussions through these Tables and left the participants to fill in the Tables and answer the relevant indicator questions using data collected from their monitoring exercise. The Facilitator was on hand to give assistance and clarification when called upon by any group. It was also agreed that each group goes back to discuss the Tables with supporting illustrative evidence and quotes from the FGDs, interviews and observations during the fieldwork and come back to the training venue the next day to filI in the remaining Tables. The groups worked tirelessly and by the end of the day all groups had completed the Tables on a hard copy of the templates distributed earlier by the facilitator. These were crosschecked and confirmed useful by the facilitator. The groups then went ahead to enter the same information on the electronic version of the same template given to them ealier by thee facilitator. Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 13 4.6: Activities Day 20: 01/10/02: Training on Data Analysis and Presentation of Results: (2) The day started with a review of what was done in the plenary, that is, the overview of thr p.oreri"r of completing Tables 1 to 4 for the results, yesterday. The various groups also presented what they did as take home assignment the previous. Next, the participants were taken through the process of completing the remaining Tables of results, after which they went into their usual groups and commenced work on completing the remaining Tables of results. Later in the day, the groups worked at discussing the findings using information from the Tables as well as FGDs and other verbal data collected from the field. 1.7: Activities Day 21: 02/10/02: Report Writing by Groups: On this day the groups worked on the respective report in preparation for debriefing of project team the next day. On this day participants at the workshop also evaluated the entire process starting from the pre-field work training, through the fieldwork exercise and later the training on data analysis. 4.8: Activities Day 22: 03/10/02: Debriefing and Elementary Training on EPI Info: On this day, the participants, as a whole team, debriefed the National Coordinator; some NGDOs present, namely, SSI and HKI as well as the Coordinators of projects monitored and their DOCs/DOTs. Later in the day, before the Principal Monitors departed for Dar es Salaam to Debrief the WR and the NOTF meeting on Friday 4ft October, 2002, the participants were taken through an over view of EPI Info. They were taught how to create data entry templates, develop questionnaire files; key in data and analyze. They were also given a short hand out to guide them in using EPI Info. 4.9: Activities Day 23: 04/10/02: Debriefing of the WR and NOTF Tanzania On this day, the Facilitator and the Principal Monitors for the other teams debriefed the WR and the NOTF Tanzania in two separate sessions. First was the debriefing of the WR Before debriefing the NOTF, however, the facilitator's report on the monitoring of Tanga CDTI project and facilitation of the training had been produced and submitted to the WR. Facilitation of Training for NOTF Tsnzania on CDTI Monitoring 5.0 EVALUATIONCONCLUSIONANDRECOMMENDATIONS The workshop was concluded with an evaluation of the entire exercise. In the evaluation process only thirteen of the fifteen persons who participated as monitors, including the b"puty National Coordinator, HKI and SSI representatives as well as the Regional Project Coordinators, DOCs and DOTs. The Regional Project Coordinators for Ruvuma and Kilosa were briefly absent during the evaluation for different reasons. The former lost his Computer which was being used in the analysis and report writing of the monitoring exercise the previous night to a burglar so had gone to the Police, while the latter went to his Project briefly to conduct a visiting UK SSI team to his project area. The result of the evaluation is contained in Table 1 below. Table 1: Evaluation of the Training and Monitoring Exercise t4 Issues Evaluators' Comments 1. Can you undertake a participatory independent monitoring of CDTlgqpgP a All the evaluators indicated "Yes" 2. What role can you play in such exercise? (Tick as m&ny as applicable) A monitor A pricinpal investigator Data manager Tr (84.s%) 8 (61.s%) 3 (23.1%) 3. Is there anything that needs to be done to make you function better in future participatory independent monitoring of CDTI proiects? o Yes oNo 12 (e2..3%) | (7 7%) 4. If yes, what needs to be done? o Further training on computer and data management with EPI 7 (s3.3%) More training needed on data collection 2 (16.7%) To gain more experience through more monitoring 2 (16.7%) More training on monitoring & EPI Info 1(8.3%) a a a 5. What is your general assessment of the training and monitoring exercise? o The training; o The data and report tumplates; o Debrieftng checklist; o Materials for the exercise; o Interpersonalrelationships; o Facilitation) The general comments include the following, which were unanimous. o Good o Good o Good and useful . Good o Good o Good and understood x But time was short for training 6. What are your recommendations for the future? o Increase time for future trainings o There should be annual internal monitoring for each project. This is Facilitation of Trainingfor NOTF Tanzania on CDTI Monitorin$ 15 After the evaluation exercise, the National Coordinator declared the exercise formerly closed. The facilitator and the Principal Monitors then traveled to Dar es Salaam where the further debriefing of the WR and full NOTF were to be debriefed. a crutial APOC should support rePort writing and EPI Info skill development Teaching aids like projectors should be used for future training Train project managers for project management related to CDTI process integrating in the PHC Design the indices of the instrument to suit country realities APOCA.{ational Coordinator should train DOTs and Project Coordinators on EPI6. a o a o Facilirafion of Trainingfor NOTF Tanzanin on CDTI Monitoring 16 6.0 APPENDIX LIST OF PARTICIPANTS IN THE TRAINING OF NOTF TANZANIA ON, AND MONITORING OF CDTI PROJECTS IN FOUR FOCI IN TANZANIA S/N o. Full Name Address in Full 01 Dr. Simon Katenga National Coordinator, NOCP T anzania Ministry of Health, P.O. Box 9083, Dar es Salaam, email : Katenea@,raha. com Tel: 255 222130025 Fax: 255 222130009 02 John Nganya Project Coordinator, Kilosa CDTI Project Focus P.O. Box 14, Kilosa Fax'.255 23 2623050 Tel 255 23 2623396 03 William Kisoka Social Scientist, National Institute for Medical Research, Nn/B, Box 9653, Dar es Salaam Tel: 255 222130770 Fax 255 222130660 Email. wkisoka@yahoo.com 04 Dr. Rehmah Maggid Project Coordinator, Tanga CDTI Project Focus Box 5547, Tanga Tel'.255 27 26447880 Fax' 255 27 2647943 Email. nuduga@yahoo. com 05 Sebastian Mhagama DOC, Ruvuma CDTI Project Focus Box 42, Mbinga Tel. 255 25 2640624 (Home) 06 Majuto Bakari Chambo DOT, Kilosa CDTI Project Focus Gairo Health Centre, Box 90, Morogoro Tel'.255 26 28087 2s5 23 2628048 07 Abdul A. Daffa DOC, Tanga CDTI Project Focus Lushoto District Hospital, Box 66, Lushoto Tel/Fax: 255 26 40098 08 Pius Mabuba Country Representative, Sight Savers International Box 2513, Dar es Salaam, e mai I : si gh1s..av ers.tz @,r.a.h.Ugam 09 George Mdusi Kassiga Project Coordinator, Mahenge CDTI Project Focus Box 337, Ifakara Tel 255 23 2625230 Em ai I : eka s.siea@.h.qt_qui l. sa.m Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring t7 10 Dr. Moshi Rohiso Project Coordinator, Tukuyu CDTI Box 38, Tukuyu TellFax: 255 25 2552293 Project Focus 11 Dr. W.A. Kabuka Project Coordinator, Ruvuma CDTI Project Focus Box 5, Songea Email : wakabuka@raha.com l2 George Pallangyo DOT, Ruvuma CDTI Project Focus Box 745, Songea w-akabuka@ra.ha,.-c..-o..m 13 Malley Karoli D Biostatistician, National Institute for Medical Research, NIMR, Box 538, Tukuyu Tel. 255 25 2552249 Fax'.255 25 2552293 Email : karolimd@vahoo. com t4 Harrieth Hamis Project Officer, Helen Keller International Tanga CDTI Project Focus Box 5547, Tanga Tel.255 27 2646217 Fax. 255 27 2647943 Email. lyimoharrieth@yahoo. com 15 Venance David DOT, Mahenge CDTI Project Focus Box 337, Ifakara, Mahenge Tel: 255 23 2620311 t6 Oscar C. Kaitaba Deputy National Coordinator, NOCP Tanzania Ministry of Health, P.O. Box 9083, Dar es Salaam, Tel'. 255 22 2130025 Fax. 255 22 2130009 email : katenga@raha. com 17 Abdallah Nuhu Driver, Ruwma CDTI Project Focus Box 5, Songea 18 Sebastian Ndole Driver, Interchurch Medical Assistance Dar es Salaam l9 George Makili I)river, Ministry of Health, Box 9083, Dar es Salaam 20 Shaibu Juma Driver, Kilosa CDTI Project Focus, Box 14, Kilosa 21 Ambrose Mamkwe Driver, Tukuyu CDTI Project Focus Box 38, Tukuyu 22 Kurwa Issa Driver, Tanga CDTI Project Focus Box 5547, Tanga 23 Filbert Lingopola Driver, Mahenge CDTI Project Focus Box 337, Ifakara 24 Mohammed Kibaya Driver, Sight Savers International Box 2513, Dar es Salaam Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 18 25 Jason Kyando Accountant, NOTF Christian Social Service Commission (CSSC) P.O Box 9433, Dar es Salaam Tel.255 22 112918 Fax',255 22118552 26 Dr. Joseph C. Okeibunor Facilitator, Department of S ociology/Anthropology University ofNigeria, Nsukka, Enugu State, NIGERIA. Tel. 234 42 771169 (Home) Email : jokeibunor@),ahoo. com epseelon@aol.com Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring REPORT WRITING TEMPLATE TANGA - WHO/APOC/CDTI PROJECT REPORT OF INDEPENDENT MONITORS OF CDTI ACTTVITIES IN TANGA, TANZANIA L5 .29 SEPTEMBER 2OO2 SUBMITTED TO THE DIRECTOR AFRICAN PROGRAMME ON ONCHOCERCIASIS CONTROL (APOC) t9 $ SEPTEMBER 2OO2 Facilitation of Trainingfor N0TF Tanzania on CDTI Moniloring TEAM OF MONITORS 20 Facilitation of Trainingfor NOTF Tanzanin on CDTI Moniloring TABLE OF CONTENT 2l Facilitalion of Trainingfor NOTF Tanzania on CDTI Monitoring LIST OF TABLES 22 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoilng LIST OF FIGURES 23 Facilitstion of Trainingfor NOTF Tanzania on CDTI Monitoring LIST OF ACRONYMS 24 Facilitation of Trainingfor NqTF Tanzania on CDTI Monilorin$ ACKNOWLEDGEMENT 25 I Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring EXECUTTVE SUMMARY 26 ii iii iv 1.3 Facilitation of Trainingfor NOTF Tanzania on CDTI Monilorin$ 27 INTRODUCTION 1.1 General Background 1.2 Tanga Project Background Write on the i Oncho status of the areu Geographical description of the area Population composition of the area APOC/CDTI activity in the project area Team Composition (Write project site specific) The independent monitoring team that was constituted by NOTF, Tarzania, on behalf of APOC to visit Tanga CDTI project, from 15'n-29'n September 2002, had Dr. Joseph Okeibunor, of the Department of Sociology/Anthropology, University of Nigeria, Nsukka as its Principal Monitor. The other monitors included Mr. John Nganya of Kilosa Project; Mr. Sebastian Mhagama, Mbinga District; Dr Simon Katenga, NOCP Tanzania; and Dr. Moshi Ruhiso, Tukuyu CDTI project. The team also had members of the DHMT and DOT in Muheza, Korogwe and Lushoto Districts as well as community members who acted as local guides. The team also had drivers. 1.4 Terms of Reference (Make it specific to Project e.g. Tukuyu, Kilosa Ruvuma) The team was constituted with the following terms of reference: 1 Succinctly document how ivermectin treatments were undertaken in a sample of Communities with approved CDTI project in Tanga focus, Nigeria. Assess community involvement in drug collection, decision making on the period and modes of distribution, the selection of distributors, and the willingness of the community to accept and bear these responsibilities designed in the CDTI process. Document community perceptions of CDTI processes especially the issue of ownership, and expectations for Onchocerciasis control, based on these perceptions and expectations determine the degree of satisfaction of the community with the different programme activities and outcomes. 2 J Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring 28 4 5 Assess the quality of training received by CDDs and health personnel involved in the project. Examine the record books of the CDDs and assess the quality of record keeping and their ability to keep accurate records. The same applies to the health services staffon the project. Determine the number of communities and eligible treated and compare findings with records of the CDDs and the records at the other levels (District, Division Ward - level records.) Determine whether the health personnel participated in ivermectin distribution and assess the degree and quality of supervision by health staff (and the quality and orientation of the health staffto the CDTI) Identify constraints in the distribution and recommend appropriate measures to APOC management to be taken before the next round of treatments. 9 Discuss the prospects of sustainability based on the findings above 6 7 8 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitorins 29 2. METHODOLOGY The methodology used for the selection of the villages and sub-villages was a modified form of the methodology that was developed during the meeting of the nine monitoring team members in Ouagadougou in 1998. In a review of the tools, in a tool development workshop in Kabale, this was further refined to include a few of the things that were not previously taken into account. The entire endemic villages were included in the sampling frame irrespective of levels of endemicity and closeness to the health facilities in the areas studied. This simplified approach merely selected villages by a simple random sampling approach. 2.1 Study Design (edit and make it project specific) For the monitoring conducted in Tanga Focus of Tanzania September 2002, a cross- sectional research design was adopted. This design was considered the most appropriate to generate the needed data and meet the study (monitoring) objectives. The data collection exercise consisted of a triangulation of qualitative and quantitative instruments designed to collect information from different segments of the target population 2.2 Population The target population for the monitoring exercise consisted of four broad groups. These include: 1) Health Personnel involved in the CDTI process at various levels; 2) Village leaders; 3) Community Directed Distributors (CDDs); 4) Household members in the hyper/meso endemic villages contained in the REMO result for Tanga region. In addition, policy makers in the areas where CDTI is implemented were interviewed to gauge their plans for sustainability of CDTI in the future as well as their policy direction with special reference to their current support for CDTI. 2.3 The Sample and Sampling Procedure A study sample of thirty villages was chosen using a simple random sampling procedure. However, the sampling process began with stratifying the divisions and wards in the District by levels of endemicity. Since treatment focus is prioritized based on hyper and meso, the hypo endemic divisions and wards were excluded from the sampling. Consequently, six hyper/meso endemic wards were chosen through a simple random sampling process (balloting), from three Divisions, one Division each from the three Districts under the Tanga project. The chosen wards included **** Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 30 The villagesr in the selected wards were listed on pieces of paper and six wards were randomly selected by balloting. The villages sampled through this process were **** fiom :l.'*:l'* wards respectively. Category A and B Villages: Having selected the six villages, one from each of the earlier sampled ward to be visited, the sub-villages in the chosen villages were listed. Thirty villages were randomly selected from this list. Another random sample of six villages out of these thirty sub- villages chosen earlier were taken as category "A" villages while the remaining twenty four villages became the category "B" sub-villages for the monitoring exercise. Table A1: Focus: DivisionsAilards/Villages and Sub-Villages Covered in Tanga Project Districts Division Wards ttA" Sub- Villages "8" Villages 1 I 1 I 1 2 J 4 2 2 5 6 7 8 2. ) 3 3 9 l0 ll t2 4 4 I 1 1 1 5 4 5 6 3. 2. 5 5 1 1 I 20 7 8 9 6 6 2t 22 23 24 TOTAL 3 6 6 24 I Here villages are the same with communities in Nigena and elsewhere while the sub-villages are equivalent to villages in communities as used in Nigeria and other places with similar usage for the concepts. I Facilitotion of Trainingfor NOTF Tanzania on CDTI Monitoring 31 Households: In each Category "A" sub-village sampled, fifteen households were chosen. To do this, the sub-village was carved into three clusters guided by the village head and local guides. The systematic sampling approach was then applied to select five dwelling units from each cluster. The sampling intervals were determined through a quick estimation of the number of dwelling units in each village-cluster. This differed from one sub- village-cluster to another. In each sampled dwelling unit one household was randomly chosen for the treatment coverage study. Furthermore, to check on the correctness of treatment, one household was randomly chosen, and the dosage for one household member, randomly selected and crosschecked. CDDs and Village Leaders In each Category "A" sub-village sampled, the sub-village leader was purposively selected and interviewed. The sub-village CDD was also purposively sampled and interviewed. In cases where there were two CDDs both of them were interviewed, but where there were more than two CDDs, only two were selected by balloting. Similarly, the sub-village leaders of the Category "B" villages were purposively chosen and interviewed. The sub-village CDDs were also purposively chosen and interviewed where the CDDs were two or less. In some sub-villages with more than two CDDs, two were randomly selected for the Category "B" sub-village CDD interview. Health Personnel and Policy Makers, Various cadres of health personnel involved in CDTI process were purposively selected and interviewed. These included Supervisors, District Onchocerciasis Team (DOT) members and Coordinators. The Coordinators of Primary Health Care and Health Officials at the District and Ward levels, involved in the CDTI process were also purposively selected and interviewed. The purpose of these interviews was to examine the orientation to CDTI process and provide information on the records and quality of training they receive and/or give on the CDTI process. Policy makers at these levels of the health systems' operations were also pulposively selected and interviewed to give idea of the support of the policy makers for CDTI implementation as well as their plans for the sustainability of the programme. Facilitation of Troiningfor NOTF Tanzanin on CDTI Monitoring 32 Instruments Eight instruments were used to gather information from both Categories "A" and "B" sub-villages as well as at the District and ward levels. Copies of these instruments are included as appendices to this report. Table 42: Summary of Instruments and Sampling Issues Instrument Category of Sub-villages and Unit Sample Sampling Procedure In-depth interview & Record review with CDD A&B l-2persub-village Purposive (Simple random, where there are more than2 CDDs) Household coverage survey A 15 households per sub- village Multi-stage (i.e. cluster, systematic and simple random Key informant interview of village leaders A&B I village leader per sub- village Purposive Group discussion A 3 groups per sub-village (i.e. I male and 1 female adult; and 1 female or male youth groups), 6-8 persons in each group Convenience Health personnel interview A I PHC coordinator I Oncho coordinator I DMO per District 1 LOCT member t health centre staff Purposive Programme manager/Policy maker interview Project, District & National levels I Director, Disease Control per District 1 NOCP Staff I Project Coordinator, I Supporting NGDO staff Purposive 0) -oCB t- o=l-Z oooca ci ca o\o \o c.) \o \o \O H() I €(.) '= ooH(6c F.Q or o -'=o0= tr(E+ C *R5-iF,9.Q C:a iJr (, C) L - 6.)P-V(€= o-v o O0 r-(sa) 0) oD 5,CB6 =E>tr osbD.= -:o -'! C)>z ch o o)o A r,E r}:EEA{AL-- Vs.Fr\u2.^.,)E\Jb rj€.EH E'g;E;FIE€ o'Io aE! U .E'E E S g = A s=o ., .Y'E a%Erti " 5€H3E;H ot-" 0O r- '!r X60;a e.= -. u t\U- nF># a(.)o o o e '-'E'Eo 5 2_da .r # ;i ; iU2 'l l- LJ3E.Zv9=E .Eits Ese€ HE L5,=58 ,tAa aaa ca co il ll - E(I)ll o trOEE6r-l (U iiGLLJ trc- CtoEo! e -Ot-9E-r6tr€o--E or98 -cE _q € --!ltr ii 'c)o-a 'I 6) ^-ai r .r^.(.)EE€ Ev_Ii €otrO.r A ;= c)E I: _a(D <h v)E0.)(l){jbO b0 or6(trr- ;H .- .Q u) u) v)q)oc) oooooo +r (H +<ooo l< lr l<o0)q) -o.o-o (s(sd oootrtrtroooo.aooooliHLAAA .r) U' €) (l) L cB Er \o c) q)I q) 00 a €) U) an c)I otrtr bo G I U) Iq) q) c(F U2t- ct? aF r.l a t-lfr tt, !o .rr F !\ S NI Ft R Eo .ls U t\ N I frl I tr] Facilitation of Trainingfor NOTF Tanzania on CDTI Monilorin$ 35 Do a prose giving a description of your jlnding on the Table above. Support your conclusions with evidence/statements from the FGD and in-depth interviews. You can also use graphs tofurther present yourftnding in picturtalformal ll Poq) EH(l) ll 0) Oo 'Err I tE o .jJ # -Errfrl> =o> ^sb6cd cd= F oc 9FI;6B; :FE >€-r5 qa,n -H- 96H .ta (r) ,Ti-o otr 'rg o.(H (ri +i l-r L Lrooc) -o -o ,o))) (sd(c ooo li Li lioooQ&O.oooHLI<OrqA 0) U)oL0.() L E(.) €(U oli € €o L € U) o4)(€ o t< (H o cn 0) b0 Cg (.) q) H(l) o. o F L 0) q) o ^'€Eo)gH(do o) r- t<P -bo Eq) --o lir€9-dtrooL ut) o Oli -c o:r lr!O5 .rt Q) 0)d -co (J! €o aD* .!2 o.r -!.la 0)e o: rn i:o €t- .,o r-o *or (l) AD HS <? :i = =a (-) a& yO o\ o z aF O'.oza €) r-r E0ils <'iFIA lf(, OI!& dGza ats O.oz, 6)HP <'tFli |,i Q E]& OroFz o\ U) +r o ..oFz o\ Q)HPl,/ =<'tit >a (-)I!il OroZC a OroZC 6)frl uo;i c!l/= <'tiL >ta (J tJl& Oro7o\ a dGza q) ,- 00 -6( lti-o tsca> O IJ.] dGz, a .o o\ o z * cll oti ar) cll U2 q) t,q) q) O U) anLq) o q) Gq) L o z (,) Q)fr t.l o, q) q) q) L Fr o\ ?h a G) q) L Ei N q) & cEF \o c.) !o .lr o F I S \l F ts 0o !t s' q! .ls a\ t-r Gl OOttt Facilitation of Trainingfor NOTF Tanzania on CDTI Moniloring Do a prose giving a description of your Jinding on the Table above. Support your conclusions with evidence/statements from the FGD and in-depth interviews. You can also use graphs to further present your Jinding in pictorial format Table 3 Proportion of Villages treated and in which CDDs were changed after the first treatment Wards Sub-villages (Both A and B) Treated CDD changed 5 5 5 5 5 5 O-3 Proportion and number of at-risk villages treated: O-5 Proportion and number of communities where CDDs were changed by the community after the first treatment: Do a prose giving a description of your Jinding on the Table above. Support your conclusions with evidencdstutements from the FGD and in-depth interviaos. You can also use graphs tofurther present yourftnding in pictorialformat Table 4 Proportion of villages which received health educationo and in which health care personnel supervised CDDs Wards Sub-villages (Both A and B) Received health education (YesAlo) CDD Supervised by health system 5 5 5 5 5 5 0-6 Proportion and number of communities in which the CDD is supervised by the health care (communities scoring 50oh and above) : 37 Facilitation of Trainingfor NOTF Tanzania on CDTI Monitoring 38 o-7 Proportion and number of target communities which received health education: Do a prose giving a description of your finding on the Table above. Support your conclusions with evidence/statements from the FGD and in-depth interviaos. You can also use graphs tofurther present yourJinding in pictorialformat o\ aa il li C)!t() o t .=d 0)t Lro Is '6 o. .9 €oo oll()() ol= r!-.1iloE ''La Err(! . T= .EEEE Eiu-6trtr vnug €4.1 - r.. 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Support your conclusions with evidence/statements from the FGD and in-depth intervietvs. You can also use graphs to further present your linding in pictorial format B Constraints Do a prose giving a description of your finding.. Support your conclusions with evidence/statementsfrom the FGD and in-depth intentiews i Management ii Techniccrl C Community Perception Do a prose giving a description of your ftnding.. Support your conclusions with evidencdstatements from the FGD and in-depth interviews 40 \ R. S ,o s o! o' = \ N s' S S H S o c Oo U o B9 o (D (! s, o o o lJ ,l o o\ U2 t' o (D B' o o (D t') (D Qt2 o o Fl It a a, !,na(4, s +P> n Fs cHg. F9 <ar#I F9j.9Dj = -04 Hg" FI o !o o FAFfDi!oE€ 8 IsEL ='0qrc D'H Eg ,:i to (\a \JtDrr, I q, o o o OFIFl rt!o(r- 0e o za') +sE.F+=. ,; OA OA aY v'trHo -5 o tt) 5A rjE re :ij laD( Joq D] o o Dr5'^ =oo =s.3ii== aB5!9 ii. r.9'.9 €or { ') { 'st hJ { F (,) 4 FU 5 4 FU UI { fr o\ Facililation of Trainingfor NOTF Tanzania on CDTI Monitoring Do a prose given are description of yourJinding on the Tabte above Support your conclusions with evidence/statements from the FGD and in-depth interviews 42 s,l .=xa .SEB .1. 1 ..ti' .c -!i $[EE s{68 *l isssS !b i, .Iio EEE ..ti' 's .!i $E E H Sgs.X rl EIol B] 4IU Sr issB Eb i, .S!o .ss8 t .a .!i B$EEQ(OA IU Sr s.s.Ur:ri Rsss oi i, .!No *ES I .'ti' , E.? *$g gQ(OA rl .. IEr € 5r issss e ,i' .=xa 'SEC s .a .!i t*e gQEOO .'.1S r "lI 5t isss$ ui, .!No .sE8 .h' .a .!i $iE s3 3 B.eatsoo sb Sr isss oi i, .E*n TEE .s 'a .:l *$EEaqoa IU tts1. b.s.()r:!t isss ih,1 .=xa EEE .li' .Q .Lr *$g EQCOO FU Sr isss 00 .v cl 2 o O (Jq) o) OD q) Eo V E GI o frl E clq) tr 00 c)Io Fr €l c) (J E 0 (.) Xri 0! 2 o0 Iq) e q) o0 c) Eotrv GI o ri GI c) tr 00o(.) o Er o 0 G) BT ol a l/^)$ Oo .ri E F.iI S B bl N h R €, !o \., a 'st B .ti ri c! q) I Eo 0 Ixri Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects Table 8: Quality of CDD Training in Category "A" villages(% in Parenthesis) Ward No. of CDDs No. Trained Length of Training No. Trained in a session traintng sesslon. Give more details and evidence Do a prose given are description of yourJinding-on the Tables 6'8 above Support your conclusions with *ii"nraitotemii* frim the-FGD and in-depth intertiews +xfrilJtl.-, take a summary look at the quarity of the implementation of{DTI in the project focus. While Table 6 looks at the irpt...ntutiol 9f components of CDTI at the ward levels, Table 7 builds up information frfm FGDs with the different segments of the populations in the ;;;,1'A -sub-villagBs Tle.later gives qualitative and contextual flesh to the data p..r.ni.a so far in ,up"po.t of the arguments on the quality of GDTI i.pi...*ation inthe State, which currently rates very poor in all respects' Another issue that came up as an area of concern is the success and sustainability of the CDTI process. This is presented on-Table 8 above. The Table shows that the quality of training both in terms tf lengttr of training and the number of CDDs trained in each 46 Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 47 E UNIQUE FEATURES OF THE PROJECT AREA ' strengths are the attributes of the proiec! area or ,implementers you found to be beneficial to the success of the proiect? Discuss tnese' Weaknesses Wat are the attributes of the project area or implementers you found to'""Writy ilrtt the succeis of the project? Discuss these' a Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 48 4.0 DISCUSSION AND CONCLUSION what the good sides of the project implementers and proiect environment as well as the disposition of policy makers to the project? What are the bad sides? Balance both and attempt an assessment of the project in terms of the fulfillment of the requirements of CDTI principles and expectations' Facilitation of Training of NOTF Tanzania on Monitoring CDTI Projects 5.0 RECOMMENDATION WhatneedstobedonetoensurefullcompliancewiththerulesofCDTIwithinthe project area? Make your recommendations to these different levels/actors in the CDTI process 1 To the Project: (You may use the following sub-headings or some or others you find necessaly to make recommendations on) Training of Health Staff Training and SuPervision of CDDs Record KeePing and RePorting Approaching the Health Services and the Community Integration of CDTI into the PHC System To District: Owtership Mobi li zati on and sensi ti zati on Counterpart funding P r ovi si ott o/ I o gi sti c s P lans for sustainabi li tY Integration into the routine health system To National Onchocerciasis Taskforce Ownership Mobilizati on and sensitization 49 Facilitation of Training of I''IOTF Tanzania on Monitoring CDTI Projects Counterpart funding Provision of logistics P I ans for su stainab i li tY Integration into the routine health system To APOC Management Provision of logistics and capital equipments Provision of technical assistance 50 Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects DEBRIEFING GUIDE FOR USE IN FIELI) If No, to any of the questions above, o What are the reasons? o Who is responsible? o How can the situation be changediimproved upon? o What needs to be done ad bY who? For those that are Yes, are there things to be improved uporVmaintained? If yes o What should be improved upon/maintained? o what should be done to improve upon/maintain the system? o Who should be resPonsible? o How will the improvement/maintenance be ensured? o why is it necessary to improve uporvmaintain the system? When is it necessary to take action? 51 a NoYes Issues Are CDTI related activities the relevant structures?I within andnormal healththe systemCDTIIs2. integrated t?healthnormalas theemented funding for routine training, J authority activities artcounterpthees provideDo political curemMectizanas ent,suchCDTI pro sion etc? CDTI?4 sustalnlforlansthereAre undertaken?5. Are undertaken?6. Are neces 7 the District level staffto do this ? tolevelsnexttheem,ls higherleve bytheAre powereddifferent levelththeat healofficer facilitythee Sdoeroletheir s ( oplay tdoesornecfound requlreasCDD essarytheSEandtratn supervl les and responsibilities lementation?in the CDTI 8 Are communities well sensitized on their ro ve vl 9 ?their taking impldecision theandownershiofsenseshowi pcommunittesthe ngfue lnCDTIofonementatiensuretos propernecessary the authorities their ities?taketotizedwel sensl01 Are Others11 Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 52 DATA MANAGEMENT TEMPLATES Data Entry Templates included in electronic forms and in different programme are as follows t. ii. iii. iv. vi. vii. viii. ix. x. xi. xii. xiii. xiv. xv. xvi. xvii. xviii CDDVILA.REC CDDVILB.REC CDDVILA.QES CDDVILB.QES CDDVILA.CHK CDDVILB.CHK VILALDR.REC VILALDR.QES VILALDR.CHK VILBLDR.REC VILBLDR.QES VILBLDR.CHK HWORKER.REC HWORKER.QES HWORKER.CHK HHOLD.REC HHOLD.QES HHOLD.CHK Actual data entry file for village 'Al gPD Actual data entry file for village 'B' CDD Questionnaire file for village 'A. gPP Questionnaire file for village 'B' CDZ ittect programme file for village 'A^ gDD Check Progrurr. file for village 'B' CDD e.tuat Aati entry file for village 'A' leader Questionnaire file for village 'A' leader Cnect programme file for village 'A' leader a.ctual dati entry file for village 'B' leader Questionnaire file for village'B' leader itrect programme file for village 'B' leader Actual data entry file for health worker Questionnaire file for health worker itrect programme file for health worker Actual data entry file for household survey Questionnaire file for household survey inect programme file for household survey Facilitation of Training of NOTF Tanzania on Monitoring CDTI Projects 53 EVALUATION GUIDE 1 CanyounowundertakeaparticipatoryindependentmonitoringofCDTI Project? Yes tlNo tl Whatrolecanyouplayinsuchexercise?(Tickasmanyasapplicable)2 A monitor t l A pricinPal investigator Data manager Other (sPeci$') 6 What are your recommendations for the future? 5. What is your general assessment of the training and monitoring exercise? lZr*r, the'traiiing; the data and report-teylll'fs; lebrieJing checklist; 'iaterials for the ex\rcise; interp ertonil relationships ; facilitarton) tltl 3.Isthereanythingthatneedstobedonetomakeyoufunctionbetterin futur. partilipatJry independent monitoring of CDTI projects?Yes tlNo Il 54 Facilitation of Traming of NOTF Tanzania on Monitoring CDTI Proiects USING EPI INFO VERSION 6 Introduction: EPI Info version 6 is a dos program used in the organization' management and analysis of data. This version is an improvement on the earl"ier versions like version 5. The latest iorm of tnis version for Dos is the EPI Info 6'04' There is however a more recent version of EPI Info' This is the EPI 2000' It is the windows equivalent of the version 6.04. EPI 2000 is the most recent improvement made to run as Windows Program. Both the Dos and Windows version of EPI Info are very user-friendly software packages formanaging,orguniringandanalyzingdataformeaningfulinterpretation' To start using EpI Info you may open the PRoGRAM EpI6 from MSDos by typing in EpI6 at command ;r;.il una i..tt gNien on the keyboard' You may need to do this twice to get to the Lpr pnocnarvr menu. If you have the short cut to EPI icon on your Windows screen V* lrr, double click on it and that will take you to the EPI6 PROGRAM menu. In using or planning to use EPI6 like any other data analysis software' certain actions are taken in ordered d;;;. By this is meant that certain things must be done in their right sequence before u*i"ing at the point of doing analysis. The things that need to be done include the following: o Making a Questionnaire o Entering Data o Doing AnalYsis The tutorial program in EPI6 helps to teach one how to go about making questionnaire; entering data and doing analysis. Below are highlights of how to go about these activities. Making a Questionnaire: To make a questionnaire template you must take note of three things, namely' 1. Fields for entering data 2. Variable names 3. Saving with an extension <'QES> -AquestionnaireisthetemplatethatguidesEPllnfoinmakingadatafile.once you have created a questionnaire, makin g a data file is an automatic process' Facilitation of Training of NOTF Tanzania on Monitoring CDTI Proiects 55 AnEPllnfoquestionnairemayhaveupto500lines.Headingsandothertext may appear anywheie. Places where you will enter data are called "FIELDS" or ti"it " analysij phase), "y ARI ARLES" In Eped, holding down the control key and pressing-"Q'', twice (<ctrl + QQ>) will display a list "f fi;iJ ;vrnuot'' . bhootirrg " ry'!^,:'le from the list will automaticallyinsertthefieldafterthecurrentcursorposltlon. To start creating questionnaire, first set EPED for the questionnaire (QES) mode' This will turn off *ol.o *up and set the page size to 23 lines, the size of one screen in the ENTERProgram' To do this, press <F6> for setup and <spacebar> until mose is QES' Then <ESC> As you type your questionnaire, each question needs 113" by which it can be identified. The name is referred to a Variable name' EPI automatically takes the first ten letters or characters ofthe question phrase that precedes the field' that is small box or space where the data are entered' But you can give your own variable by placing curly brackets { } around the part of the question that contains the name' In creating data field, '#' gives you ? space for one character; '##' two characters; ,###, threecharacters whie '-----'gives space to write data in words' To save your questionnaire file, press <F9> this will give you a rectangular window. Type in the file name you want to give the questionnaire and end it with <'QES> und pt.tt Enter on the keYboard' ENTERING DATA: By now you have made a questionnaire file called "whatevername'QES" (e'g' CDTI.QES) Now we have to create a data base for entering data, using CDTI'QES as the template. TO dO thiS, SEIECT ENTER OTENTERX fTOM thE PROGRAMS MENU Of EPI. In ENTER or ENTERX you will see a screen that asks for the name of a data file' iyp. in CDTI. A;;iy, the data file will be called "CDTI'REC" but ENTER or ENTERX assumes the ".REC" if it is not supplied' Facilitation of Training of NOTF Tanzania on Monitoring CDTI Projects 56 After typing CDTI, press <Enter> on the keyboard and then choose menu item'2' -"making a n"* data file from a .QES file"' Now ENTER or ENTERX will ask for the name of the ".QES" file' Type CDTI or GDTI.QES, the name of the questionnaire you have made for organizing and analy zing the data- set. After you make these entries press <Enter> on the keyboard, ENTER or ENTERX will make a ".REC" file and give further instructions. FOR ANALYSIS: - Select ANALYSIS from the PROGRAMS menu list' - This will take you to an Analysis screen with two windows - The upper portion shows results and the lower window is for entering commands - The STATUS line at the top of the screen gives the name of the active data set and the amount of memory available - The pROMpT line at the bottom describes commonly used commands accessible through'function keYs'. - The ANALySIS program is command driven, that is, it requires commands for its operations. - The commands may be given from the keyboard or placed in a program file that is then RUN in ANALYSIS. The commands include READ LIST rREQ TABLES MEANS SELECT SORT ROUTE This specifies the data set to be analyzed. This command must precede all commands that use data files. This produces a line list Produces frequencY distribution Does cross tabulation of more than one variable Does means, ANOVA, Kruskal-Wallis tests Selects a subset of the data file Sorts the data for a line list Sends output to the printer, the screen or a file. To send output to a file and piint later from EPED Program, give the file name.out (e g CDTI.OUT) Gives you a pie chart for any variablePM 57 Facilitation of Training of l'tOTF Tanzania on Monitoring CDTI Proiects BAR IIISTOGRAM SET RECODE DEFINE Gives you bar charts Gives a histogram Give some conditions for analYsis Recodes the data Defines the variable fields To start analysis' when in the ANALYSIS PROGRAM - Type,,RFAr)" then the file name of the data set (e.g' CDTI'REC)' If the data set is in a floppy, type "Read A:" then "the file name'REC" - To do a frequency distribution, Type 'FREQ', or press F2 to select the command You want - Then press F3 to select the variable you want to analyze' - Then press <Enter) on the key board' - You can also make corrections to your data set by using the command UPDATE - If you type TABLES add two other variables to get a cross tabulation of the variables. g g, r"ur.s .treated, isex'. This will give the distribution of people 'treated' or 'iot' by their sex 'male' or'female'' -Ifyouwanttolookatonlymales,Type<SEIECTSex=lor}(whichiscode for males). This will pick out only those codes for sex that I or 2 as the case may be. OTHER TIPS: - add percents or lines to your analysis on Tables - Type sET PERCENTS = ON. With this each cell in the Table will now contatn percentages - sET LINES = ON. This will make lines to demarcate the cells in the Table.