Kilosa focus CDTI project annual technical report submitted to Technical Consultative Committee (TCC): January 2007 to December 2007

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE COUNTRY/I.{OTF : TANZANIA Proiect Name: KILOSA FOCUS CDTI PROJECT Approval vear: 2000 Launchins year: SEPTEMBER 2001 Reporting Peried: JANUARY 2007 To DECEMBER 2007 (Month/Year) (Month/Year) Proiectveqrofthisreport: (circleone)1 2 3 45(6)7 8 9 10 Date submitted: JANUARY 2008 NGDO partner: SIGHT SAVERS INTERNATIONAL \\L 0 q A0tlr 2003 OzuGINAL: English For To: v 8i rl c5b CeP 6tlu Bfic cc fl4 rl For l;';lcn:clicn T",\iR AO, L 4t1i"tg {,tsob6nJ WHO/APOC, 24 November 2003I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I 2 WHO/APOC, 24 November 2003 ANNUAL PROJBCT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: I I I Country: Tanzania National Coordinator Name: Dr. Grace Saguti Signature hlo+ loq Date: /Y Date: Zonal Oncho Coordinator Name: Dr. M .M. Z. Massi.. Signature: r NGDO Representative Name: Dr. Ibrahim Kabole... Signature: gF* Date: *r/a{(og This report has been prepared by Name : Ms Rosemary Nguruwe Designation : Project Coordinator Signature: ... Date 08 JANUARY 2008 I 3 Table of contents DEFINITIONS .......... 7 FOLLOW UP ON TCC RECOMMENDATIONS...... 8 1.1. GENsnerrNFoRMATroN................ I .1 .1 Description of the project (briefly) .... 1.2. PopurerroN SECTION 2: IMPLEMENTATION OF CDTI .................16 2.1 TturrrNB oF ACTTvITIES ....13 .... I3 .... l5 ....... l6 ....... l6Tael-e 3 2.2 .J. 2.4 2.5 Aovocecy Mostt,tzerloN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES... CotuuuNrry INVoLVEMENT ............ Capaclry BUILDING 2.6. TnseruBNTs .. l6 ..17 .. l8 .. l9 ..22 34 34 2.6.1. Treatmentfigures............ .............. 22 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year........ 252.7. ORoETNG, sroRAGE AND DELTvERv oF IvsRrrasclrN 2.8. CourrrLrNrry sELF-MoNrroRrNG aNo SrerrHoLDERS MprrrNc 2.9.1. A flow chart of supervision hierarchy... SECTION 3: SUPPORT TO CDTI........ ...........28 No............ CouonroN No............ CoNorrroN...... No ................... CoNorrroN...... No............. CoNortroN 3.3. OrsBn FoRMS oF coMMUNrry suppoRT 3.4. ExpsNortuRE pERAcTrvrry........... 4.1. IuteRNer-; INDEIENDENTpARTTcTpAToRyMoNTTozuNG; EvRruarroN..... 4.2. SusteNRsrt-rry oF IRoJECTS: ILAN AND sET TARGETs (ueNonroRy AT Yn3)......... WRs rup pRoJECT EVALUATED DURTNG THE REpoRTrNc ppruoo? No .................. 4.2.1. Planning at all relevant levels 4.2.2. Funds......... The District council will be encouraged to release funds budgeted for carrying out CDTI activities as outlined in the CCHP. Moreover the NDGO partners have been requested to conttnue to support the project. 4.2.3 Transport (replacement and maintenance)...... 26 27 27 28 29 29 29 29 29 29 29 29 29 29 29 29 29 29 3l 32 33 34 34 34 34 34 4 WHO/APOC, 24 November 2003 4.2.5. To what extent has the plan been implemented .......... ........ 34 4.4. OpenarroNAl RESEARCH.. ....... 35 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES... 35 5 WHO/APOC, 24 November 2003 Acronyms APOC ATO CCHP CDD CDTI CHMT CSM DC DED DMO FLHF IEC KDC LF LGA MOHSW NGDO NOTF PC OPD RCH RCHC RHWs RI RMO SAE SHM SSI TCC ToT UTG WDCs wHo African Programme for Onchocerciasis Control Annual Treatment Objective Comprehensive Council Health Plan Community-Directed Distributor Community-Directed Treatment with Ivermectin Council Health Management Team Community Self-Monitoring District Commissioner District Executive Director District Medical Officer Front Line Health Facility Information, Education and Communication Kilosa District Council Lymphatic Filariasis Local Government Area Ministry of Health and Social Welfare Non-Governmental Development Organization National Onchocerciasis Task Force Project Coordinator Out Patient Department Reproductive and Child Health Reproductive and Child Health Clinic Rural Health Workers Rotary Intemational Regional Medical Officer Severe adverse event Stakeholders meeting Sightsavers Intemational Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Ultimate Treatment Goal Ward Development Committees World Health Organization 6 WHO/APOC, 24 November 2003 Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible pooulation: calculated as 84%o of the total population in meso/hyper-endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesofttyper-endemic areas that a CDTI project intends to treat with Ivermectin in a given year. (i") Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). ("i) Geosraphical coverage: number of communities treated in a given year over the total number of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment. (ix) Communitv self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. (D 7 WHO/APOC, 24 November 2003 FOLLOW UP ON TGG REGOMMENDATIONS The recommendations of the last TCC on the project and how they have been addressed 8 RECOMMENDA TION NO: in the report TCC RECOMMENDATION ACTION TAKEN BY THE PROJECT FOR TCC/APOC MANAGENT USE ONLY 325 TCC notes with concern that therapeutic coverage which should be at least 80% for a 5'h year project is still below 75%. The project is facing a problem of distributing Mectizan in Urban areas where migration of people is very high. People living in the Urban areas most of them are businessmen they tend to move from one place to another and sometime they are absent during drug distribution or refuse to take Mectizan fearing side effect. This is the reason why the Project didn't reaches 80%. The project has planned to conduct more sensitization and mobilization in those urban areas prior to drug distribution every year. 326 TCC accepted the report with the provision that coruections of the tables 5 and 14 be sent to reviewers via APOC. Corrections were done in tables 5 and 14. But unfortunately was not to reviewers via APOC 327 TCC request that future reports include a a more comprehensive executive sun mary wltich covers all activities In this report executive summary is more comprehensive and it covers all activities implemented. a a list of abbreviations used and updated List of abbreviations is inserted and updated. WHO/APOC, 24 November 2003 328 TCC recommends fo, project improvement: o Continue advocate to government authorities about the importance of timely release of funds for CDTI activities The project has taken a step to make sure that CDTI activities are incorporated into the CCHP and funds are allocated to those activities. Moreover PC is now a co-opted member of Council Health Management Team (CHMT), this gives the project assurance of their activities to be funded. a Try to moximize the number of health workers and CDDs trained to reduce work load on individuals The Government has employed new FLHF staff in the district. This will reduce work load to the previous one. Also the project is planning to conduct more sensitization meetings to encourage community members to select more CDDs a Ensure that community has required training and supplies Before the commencement of drug distribution communities are sensitized and trained on the side effects of Mectizan also the project make sure that all requirement are available. Distribute lvermectin during the period selected by communities in order to reduce the number of absentees The project is very keen to observe peoples' suggestion except that last yeff the project received drugs late due to on going process of integrating Lymphatic filariasis and Oncho control activities. a fncrease sensitization and information to reduce the number of refusals The project is encouraging community members to conduct CSM and SHM whereby all issues concerning Mectizan drug will be discussed. Moreover CDTI issues have been made permanent agenda in the community meetings. 9 WHO/APOC, 24 November 2003 3 a Encourage, train and facilitate CSM andSHM For this reporting period, the project has conducted CSM and SHM in 10 villages of Kimamba, Zombo and Ulaya Wards. This will be a continuing exercise in remained Wards in the next financial year. a Increase/improve IEC materials The project is planning to solicit funds from Govemment and different donors that will enable it to conduct a workshop to review available IEC materials and produce new ones which contain massage relevant to Kilosa community members. l0 WHO/APOC, 24 November 2003 Executive Summary CDTI activities in Kilosa district is being implemented in five zones, namely Gairo, Kilosa, Mikumi, Magubike and Magole. The implementation is now entering in the seven year whereby year six activities which are reported started in January 2007 and ended in December 2007 . Plan for cycle six focused on improving treatment coverage and promotion of sustainability of the project and therefore the project managed to accomplish the following activities; Census updating, retraining of CDDs, Health education to community, advocacy, sensitization and mobilization to Policy makers, Vehicle repair and maintenance and Community self Monitoring training. We managed to distribute Mectizan drugs to all health facilities through health delivery system. Also we conducted supervision and monitoring of Mectizan swallowing in some communities, data collection, analysis and report writing. During reporting a total of 70 FLHF workers,34 CHMTs, and 2,138 CDDs of which 1,069 (50%) are females and 1,069 (50%) are Males were trained and re-trained on how to conduct Health education to community members, advocacy, sensitization and mobilization meetings also FLHF staff were tough how to conduct Community self Monitoring. The ratio for CDD is l: 2ll people while that of FLHF workers is l:5,342 people. Project has 970 affected communities with a total population of 468,434 people living in the Meso and Hyper endemic areas. In this treatment cycle 3531707 people were treated and attained a therapeutic coverage of 75.5o/o. All communities were treated that means l00o geographical coverage. Eligible people were 393,485, Ultimate Treatment Goal (UTG) was 393,485 and Annual Treatment Objective (ATO) was 373,493. The Project received 850,000 Mectizan tablets from Meck & Co. which will expire in December 2009. 778,156 tablets were used, 3,224 tablets lost/wasted and 68,620 tablets remained. Major Challenges and how they were overcome A. To attain a therapeutic coverage of 80% and 100% geographical coverage as recortmended by TCC - Mass treatment of District officials and health staff with public swallowing of mectizan on launching day - To identify refusals and give them adequate knowledge to enable them change positively towards CDTI activities - To conduct launching of Mectizan swallowing at all levels (from grassroots to district) in order to increase awareness and improve coverage - To use modern sensitization methods like, Video Shows, Radio broadcasting, TV for areas with access to TV. - To use IEC materials that focuses on the importance of swallowing of Mectizan drug once a year for consecutive l5 years or more. - To make sure that Onchocerciasis prograrnme Continue to be one of the agenda in meetings at all levels (Village, Ward, Division and District). B. To integrate CDTI activities with other Programmes. To maintain integrated implementation of CDTI activities and other health care systems /programmes so as to minimize costs. To keep on using developed integrated supervision checklist C. To ensure communities are well aware of their roles and responsibilities in the implementation of CDTI activities hence sustainability of the Project. . Provide proper information on the roles of communities about CDTI Programme to all newly erected leaders at all levels ll WHO/APOC, 24 November 2003 . To encourage communities to discuss on how they can create ways of motivating CDDs. D. To continue with Community Self-Monitoring (CSM) training to the remaining Front Line Health Facility Workers and communities t2 WHO/APOC, 24 November 2003 SEGTION {: Background information 1.1. General information 1.1.f Description of the project (briefly) Kilosa Focus CDTI Project is situated in Kilosa District. The district is one of the six Districts in Morogoro Region, which is located in east Central of Tanzania. It is 300km West of Dar-es-salaam, and is bounded by latitudes 5'55' and 7.53 South and longitude 36'31' and 37'30 east. The total surface area of Kilosa district is 14,245 sq km, which is 20% of total surface area of Morogoro Region. It has an average length of (North -South) 180 Km. and width (East West) 80km. The topography varies significantly within the District. The Central and Southern flood plains of Wami, Mkata and Ruaha rivers stand at 400m above sea level, while the cultivation steppe in the north around Gairo reaches I 100m. The highest parts of the district are found in the Ukaguru, Rubeho and Vidunda mountains, which form almost continuous north-south mountain ranges with an elevation of 2200m. Flood plains zone comprises both flat and undulating plains extending from the foothills in the west with an altitude of 550m. The plains are dissected by many rivers, principally the Wami and Ruaha systems. The central plains are subject to seasonal flooding. The mountain ranges running North-South are part of Eastern Arc system and comprise pre- Cambrian metamorphic rock covered by coarse soil with altitudes up to 2200m. Drainage of the District's main rivers is to the east. The area provides most of the headwaters of the Wami river of National significance. The southern part of the District drains into the Great Ruaha River. Kilosa District's rainfall is fairly similar to that of tropical region and is largely bi- modal with 'short rains' in November/ January and 'long rains' in March/May with a peak in April. The average annual rainfall varies from year to year and between ecological zones.l000m - l400mm is common in the southern flood plains whilst Gairo in the north the average is 800-l l00mm. However, the mountain forest areas can receive up to l,600mm annually. The lO-year mean for Kilosa (1982-91) is 1040.3mm, with 82 rainy days per year. All over the district, the dry period extends from June to October. The average annual temperature is 25'C in Kilosa town with extremes in March (30'C) and July (19'C). The vegetation is characterized by both tropical and Mediterranean type, depending largely on altitude. Typically it consists of Miyombo Woodland with grass and shrubs. There are 83,12ha. (Or l.l% of the total forested area) of catchments forest whilst these come under the jurisdiction of central Govemment,24,65ha (0.3%) of productive, protected reserve are the responsibility of the district Council. Furthermore l69ha of softwood plantations have been developed. Kilosa District is administratively divided into 9 divisions, which in tum are subdivided into 37 wards, and 161 registered villages. Kilosa town is the district headquarters and is located 96km West of Morogoro town. Agriculture is by far the most important activity in Kilosa, accounting for approximately 80% of household income. Cash crops include: Sisal (dormant), Cotton, Sugar cane, Coconuts, Onions, Coffee, Simsim, Castor seed and Tobacco l3 WHO/APOC, 24 November 2003 Food crops including; Maize, Paddy, Beans, Cassava, Millet, Bananas Kilosa District road network comprises 3565 Kilometers. Table l.Number of health staff involved in CDTI District Number of health staff involved in CDTI activities Total Number of health staff in the entire project area B1 Number of health staff involved in CDTI B2 Percentage Br:BzlBt*100 KILOSA 3s0 87 24% Total 350 87 2AYo 1.1.2 Partnership Kilosa CDTI Project implements CDTI activities under the support of District Council, Ministry of health, APOC, and Sight Savers International (SSD. For the past five year the project has been benefited from the support of Rotary International (RI). The contract between RI and district council ended in December 2006. The District council provides salary to Oncho staff who are DOTs and FLHF staff. Also supports the project to conduct HSAM, Supervision and planning. The Ministry of health provides Manpower for the implementation of several activities, provide funds for some activities, and conduct supervision and monitoring of CDTI activities implemented in the project. The SSI as NGDO partner provide funds for training of new FLHF staff, production of IEC material, Support advocacy meeting to District management team, some times advocacy meeting to ward development committees, launching of Mectizan distribution and provide office furniture and supplies. Community members are encouraged to collect Mectizan from the nearest Health PosUfacility and distribute to other members. 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E E $ ffit"E6A tO= -= 5tsE: tr u)'s: E9-o !,f 'o o'-?.H 8:r--= a b.0 -.Y -E tr .9.9 ha'6 !.2 €;2 XA-qGl ar E.F F;-EE E€gE-8 ET BE o-- - n-a1\ F V 6.- I 6) rv !! ii v (-)Sr= c'l?tE Et >, E E 3" nX -Y=EA = o 4 0! .Y! - o (o o'- d > .-LH:99o)anrreSt E-etA.; EF .-q -ZAeE =E e.:: '!.: HF;5 .NE€i.t.E EuI =; H E =X.ei Egu$;i EE* Fo(,8 oEEEo?tr q,r€tEtrflEEOHE6 EAE HI r- Lc.I :Ei E .!OaNo ..E -E iOE TIL 5 ":EIIIJEHO cif;E o U) L 0) (n q) :.E oOOE & q o z E)r-AO zx 0a t-trc!O(hE & IJ.] a 2g.l -:.r Er5(, 6l o ! rr U' E ot rr o q) 7.e oO\Jtr &ql EA oLTi,o (,N bo GIO(hE dg.) o t!Lll.- IJr5 C/) ar o ah O o) U q) ^t ooIJtr I rI1 H oF< r-i,o OX 00 6tO(hE & s) a 2 rr.l L!r sc)(rd ot clLF o () =-e oO \Jtr & IJ.] o 2 g.)4 qo(,N 0! 6ro U)E F cn =\JT <x E? ii= otrtroaa) o q)7E oOOE Fa DO r-- <x UD cE U) r- N F]3 C) v) a o rl v j 3 o3 The following table shows the number of policy/decision makers advocated at different level at project DISTRICT DISTRICT LEVEL WARD LEVEL COMMUNITY LEVEL KILOSA 34 37 970 ' The reason for sensitization: To create awareness among the communities and educate them, also to remind communities their roles and responsibilities in the coming cycle . The outcome: To raise in therapeutic coverage and reduce refusal rate ' Advocacy to be done by any influential people (eg. Religious leaders,) or decision makers plus technical people) ' The project faced problems of fund constraints for sensitization and advocacy .3. Mobilizatlon, sensitization and health education of at risk communities Information Provide are: Information on the use of media to disseminate information: The approach used to disseminate information was community dialogue and health education session. Several meetings were conducted in Villages and Wards regarding implementation of CDTI activities to combat Onchocerciasis and other health related matters. We addressed people coming to seek medical treatment at the District Hospital, Health Center, Dispensary (OPD) and Reproductive and Child Health Clinic (RCHC). We emphasized them on the need of any eligible person to swallow Mectizan@ once a year for not less than 15 years. We also aired jingles (Radio spots) with Onchocerciasis message through Local Radio. On Mectizan day, (i.e. Launching of treatment), we distributed Mectizan to all members available on that day including District Commissioner, District Executive Director and heads of department. Also, we supplied posters to CDDs that carried the massages of community mobilization and sensitization on Oncho Results of mobilization efforts: More people participated in CDTI activities in this year than last year. Furthermore those who were not given Mectizanin time struggled to get the drug from CDDs Response of target communities: As a result of sufficient health education provided, many communities accepted CDTI as the most suitable approach to control Onchocerciasis and other health problems in their areas. Suggestion for improving mobilization of target communities: Suggestions given were as follows: To increase the number of community sensitization meetings prior to Mectizan distribution, to have Mectizan day at each level and to produce and distribute IEC materials with a massage aimed at improving community participation in CDTI activities. To convene more meetings to Government leaders, Councilors and other stakeholders who get transferred to our District. Involving District top leaders in supervision of Mectizan distribution has been found to be another key method of advocating CDTI activities l7 WHO/APOC, 24 November 2003 2.4. GommuniQl lnvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Number of communities/Sub villages with community members as supervisors Number of CDDs and the communities involved Number of communities /Sub villages with female CDDs Total no. communities in the entire project area Br Number with community members as supervisors Bs Percentege Bo= By' 84 *100 Male CDDs B7 Female CDDs Bn Total Bo= Br*Br Number of communities with female CDDs Bro Percentage Brr= B,o/8.*100 KILOSA DISTRICT 970 970 10001o r069 1069 2138 970 t00yo Total 970 970 1000h 1069 1069 2138 970 1000h Comment on: Attendance offemale members of the communiq) il health education meetings Many u)omen h'ho b'ere given health education during their visils to RCH responded positively. Those teho b'ere near to anticipated delivery promised to swallow Mectizan as soon as the contraindicated period lasts. A few who were not met at RCH visits got this education in public meetings. Association of Mectizan with infertility is no longer an issue as mony women are nohtfully educated in this. In general, how do you rate the participation offemale members of the community meetings when CDTI isszes are being discusses (attendance, participation in the discussion etc). We rate the participation of female members in the community meetings when CDTI issues are being discusses by the number of women attended and how many of them actively participated in the discussion. Also they are given more chances to contribute something by picking them more than men The participation of female members is increasing year by year as evidenced by the number of females who participated well in the implementation of CDTI activities than in previous years. Incentives provided by communities for the CDDs o Exempting CDDs from participation in voluntary community works for the whole month of Mectizan distribution. o Some villages provided cash to CDDs in the month of distribution o CDDs are being involved in other Programme activities which provide different incentive like Trachoma, Lymphatic Filariasis and Malaria tr If the distribution is done during farming season some community members do help CDDs in their farm. Other issues l8 WHO/APOC, 24 November 2003 District 2.5. GapaciQr building Training and Education The project re-trained all2,138 CDDs in the CDTI area. Thereafter followed distribution of Mectizan and Census up dating. CHMT, DOTs and RHWs fully participated in training of CDDs. The training emphasized on Onchocerciasis as a disease, CDTI concept, Mectizan drug, filling of new registers and record kipping Type of materials developed for use in Training health staff and CDDs During training handouts and training manuals were developed explaining Onchocerciasis as a disease, life cycle and it's prevention and treatment by using Mectizan. We also developed Treatment forms that show, Name, Age, Sex, Year and number of tablets given. Other things that were available during training are Ledger books for Mectizan distribution and for health Facilities Control Inventory, Measuring sticks, Training manual for RHWs that are used to train CDDs, Weekly CDTI progress report forms for Rural Health Workers and CDTI summary forms l9 WHO/APOC, 24 November 2003 ON ko3 c) o z$N do o. o B O C..l b0 oo C) -o o o U) 0.)tr 0) ()L (A o .\Z a >. o c,k q o U) C) Lr ooo li (.) li bo (\, li L(.) ah(l) ,a: C) CB o z d C)L cn E] * a;qi Qq) q p \)L o B F t-.1Uqi o U) o 0) q) .o(i.j c) (! 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'F>,.s s E Htbo ,JL' oq) sE a( = @ co : oo co : oo .^ @ : q) 6l O U o 0)E z e €c.) c{ oo c.l s : q) I q) n c si I a o O q) G EO :H iiF 9c,Eo) =Gzf, oI r* a- q) Q) {) v C oF i. : * t't o Fr o o : r- cg9t G O 0 o< -OL Ea)Z- a) ? r- Fr s : q) q) (u !-' o< = .- il o-- c.l v N a.t c.l $ c.l N ct atl 0 0 (J :] 0 O o 9G'EO, lcqzb ? .fc.) $aO ()j .9 o a a.\ r.l v j t'r o t'r 1Co\ : q) q) () I Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments NIL Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (specifu) Program management How conduct Health education to Management ofSAEs CSM Ward development committees members SHM Data collection Data analysis Village and subvillage leaders Report writing Project coordinator Others (specify) Supervision on Mectizan swallowing a Council Health management Team District officials (DED & DC) a 2t WHO/APOC, 10 April2003 c.) a.t A (-) o. 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Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH ({) wHo ( ) uNrcEF ( ) Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH ({) wHo ( ) uxldnr ( ) NGDo o NGDO ( ) Please describe how Mectizan@ is ordered and how it gets to the communities Yearly Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project. We calculate the number of tablets require by multiplying the ATO times 2.2 then we get total number of required tablets. The Project Coordinator fills the Re - Application request of Mectizan for oncho endemic areas. The request is sent to Mectizan@ Expert Committee for approval by National office - Ministry of Health. Mectizan@ arrives in country through the same channel and is cleared by Medical Store Department which is the Govemment Clearing and Forwarding Agent. When drugs arrive the Ministry informs the concerned part that is District Medical Officer who sends any CHMT member or District Pharmacist to collect the drugs. The District authority distributes drugs to the FLHF in respect to the requested amount of Mectizan in a particular year.. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Mectizan. Thereafter the CDD or any selected community member from the sub village come up to the FLHF to collect Mectizan@ ready for distribution to other Community members in the sub village. Mectizan@ In add more rows Activities under lvermectin delivery that are being carried out by health personnel in the project area are: - To inform the community that Mectizan is already in the nearby Health facility ready for them to collect - Collection of the remaining Ivermectin tablets and brings them to store in the district Pharmacy waiting for next treatment cycle - Issuing Mectizan to community according to their needs - FLHF staffs are involved in monitoring and supervision during Mectizan distribution period. When they are attending Patients in the OPD, they provide them with health Education on the importance of taking Mectizan. Number of Mectizan@ tabletsState/District/LGA Requested Received Used Lost/waste Balance Expired KILOSA PHARMACY 0 0 FROM MECK 850,000 850,000 778,t56 3,224 68,620 Dec 2009 TOTAL 850,000 850,000 778,156 3,224 68,620 Dec 2009 26 WHO/APOC,24 November 2003 2.8. GommuniQr self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, lYhen? The training for Community Self- Monitoring was done in November 2007.The training involved community leaders, CDDs, Influential people, Representative from religious leaders and some members from ward development committees. If the project will solicit funds from various sources the training will continue in other wards of the CDTI area. Table I l: Community self-monitoring and Stakeholders Meeting (Please add more rows d necessary) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle: It is too early to assess the impact of CSM as it was done during last Mectizan swallowing. Hopefully next cycle will be the best time to evaluate the impact of CSM in the already implemented wards. 2.9. Supervision 2.9.1. A flow chart of supervision hierarchy NOTF National level Regional level District level Health Facilities level DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) KILOSA 970 58 970 TOTAL 970 58 970 RM.O DMO, PG DOT RHUYs MMUNITIESGDDs WHO/APOC, 24 November 2003 The table below shows how supervision is done at each level of CDTI implementation SECTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) 28 WHO/APOC, 24 November 2003 Level 2.9.2 Main issues identified 2.9.3 Supervision check list used Yes/[r{o 2.9.4 What were the outcome of CDTI implementation supervised 2.9.5 Was feedback given to the supervised Yes/1.{o 2.9.6 How was feedback used in improving the overall performance of the project DISTRICT Shortage of funds for supervision. The checklist used to some how was very complicated (with too many things) Yes -Improved performance in CDTI implementation -Create commitment among CDDs, village leaders, -Problems identified and solved early (during period of Mectizan distribution) -CDTI activities are in cooperated in the health care system Yes Feedback wasgiven to the community members on their performance on CDTI by convening meeting, which involves all CDTI implementers in the area visited. FLHF Lack of transport for supporting supervision. Yes CDTI activities are integrated with other programs like malaria control Trachoma and sanitation improvement. Increase moral of work to implementers Yes Feedback was given to the people supervised and community by using normal public meetings of the Villages and other community gathering. When conducting supervision you also include extension workers. COMMUNITY Some community leaders are not committed. Some communities does not respect their CDDs, therefore no incentive is given. Yes Community to know their responsibility and own the project Yes Public with leaders meetings community Source Type of Equipment APOC MOH District NGDO Others No Condition No Condition No Condition No Condition No Condition l. Vehicle 1 F 2. cycle Motor 4 3F, lCNFR 2 F 3. Computers a) desk top I F b) Lap top 2 IF, ICNFR 4. Printers I F 5 Fax Machines I F 6. Others a) Photocopy machine I F b) Air conditioner I F c) Office Furniture 8 F *Condition of the equipment (F=Functional, CNFR:currently non-functional but repairable, WO=Written offl. How does the project intend to maintain and replace existing equipment and other materials? In this year the project expect APOC management to provide new capital equipment as stated in year one that after 5 years the project should be replaced with the equipment, but so long as CDTI activities are already integrated into the health system, the project now use available capital equipment at the DMO office as short/immediate measure. KDC supports the project in capital equipment maintenance. 29 WHO/APOC, 24 November 2003 a.l o -o o o zs c.l() o oir ca =_ .) r- o\ \o N ! ll \o Nt \o N \o! ra o\d \o Co F}E< e.t .1 a € @ s v_) r.- -v \oN$ \o €\o ia o0 -cn0 O€,EEra?-&) -t I o .t\ .t o\\o" a rc ! lt f! o Qn n a.l t o\a al\o ia 6lo !g C)E goe,sZ 3aFc0D 1 J oq .n. clF- F- oq € o\ \o n a.lN ! .5Z r.- r- !r: a!\o € F (.)0 !q o€356rnE-il) Ncl I o\\o- r I { \ N o\ N 9 e{@\{ \oo\ € CEe)rv ro o c) E Sooe -o iaFc0D I € 9 t \ atq N \o\o o" N c ! €d N € F.] (D4 9^F U9? LJ O-\t-&Y o 6 N t- c\ r- r\o € c.lN va ra \o6 6 e .o .r 0) J C)^i-s3(-, = -fFCOS @N r e.l t- t-\o 6 e.ld r) \oe L L o U >a L L C) ti o o()^ Av tr C) trdr r O.l o L an .oLo I o ct)o oO trr U) t-F O o Fl F t'r o 0)Lr (h C) Lr _o cO U) o .o li oo (! o Cg fri .hq) oo cB (h Lro ! p. 0) qr o U) o) -o .E oo (! o cB r! ".ic-) Comments: We urge all partners to fulfill their commitment according to the agreement and release funds in time so as to enable the project to conduct all its activities as scheduled. 3.3. Other forms of community support - Provision of transport to CDDs or community members during collection of drugs from the FLHF. Some communities prepare drama group to mobilize and sensitize community members prior to drug distribution and during distribution. Provision of incentives to CDDs and exempting them from voluntary community works during Mectizan distribution. 3l WHO/APOC,24 November 2003 3.4. Expenditure per activiQr Indicated in table 14, the amount expended during the reporting period for each activity listed. Current United Nations exchange rate to local currency was l$ US: 1,300 TSHS. Table 14: Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Suplrvising CDDs and distribution Internal monitoring of CDTI activitie:q Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcyclesi bicycles maintenance Office Equipment (e.g. computers Lap top, printers etc) Others F27:31 Nil 7,738.50 0 873.08 l0 lo 0 0 3,200.01 769.23 KDC Nil SSI & APOC Nil KDC Nil Nil Nil Nil APOC SSI TOTAL 13,407.62 Total number of persons treated 353,707 32 WHO/APOC,24November 2003 SECTION 4: SUSTAINABILITY OF CDTI 4.',. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick where applicable) _Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation {_ InternalMonitoring by NOTF Other Evaluation by other partners What were the recommendations? - Community leaders should participate fully in the implementation of CDTI activities - Policy makers and Government Departmental Officers were requested to be in the front line during drug administering. - Communities should be encouraged to participate in the implementation of CDTI activities and urge them to attend sensitization and mobilization meetings 4.1.2 How have they been implemented? - Before the start of year six distribution cycle, the Project conducted sensitization /mobilization meetings to leaders at all levels focusing on the importance of participating in the implementation of CDTI activities. - Sensitization and mobilization meetings to community members were conducted prior to drug distribution where by community responsibility and ownership of the project was the major topics discussed in those meetings. 33 WHO/APOC, 24 November 2003 4.2. Sustalnabllity of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No lYhat arrangements have been made to sustain CDTI after APOC funding ceases in terms ofr 4.2.1. Planning at all relevant levels CDTI activities are incorporated in the CCHP. Moreover from this year the planning process will be from the bottom, meaning that the community will empowered to make their plans according to their priority. 4.2.2. Funds The District council will be encouraged to release funds budgeted for carrying out CDTI activities as outlined in the CCHP. Moreover the NDGO partners have been requested to continue to support the project. 4.2.3 Transport (replacement and maintenance) In the sixth year of CDTI implementation APOC will provide new capital equipment. The District council will be responsible for services and repair of the vehicle. 4.2.4. Other resources The Project has a reliable NGDO which is expected to support the project in crucial issues 4.2.5. To what extent has the plan been implemented In this year the implementation of CDTI activities has followed the Sustainability Plan developed after the mid- evaluation of project. 4.3. Integration: 4.4. Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.3.1 .Ivermectin delivery mechanisms Ivermectin is delivered through the existing Health system. 4.3.2. Training In this year six, trainings were integrated with Trachoma. We trained CDDs and FLHF staff on both Oncho and Trachoma. Next year we are planning to integrate LFEP in our CDTI training. 4.3.3 .Joint supervision and monitoring with other programs CDTI activities are incorporated in the district supervision matrix using the existing Onchocerciasis checklist. 4.3.4. Release of funds Funds are released together with other funds as planned in the CCHP 4.3.5. Is CDTI included in the CCHP budget? Yes, and some of CDTI activities are being financed by CCHP 34 WHO/APOC, 24 November 2003 4.3.6. Describe other health programs that are using the CDTI structure and how this was achieved. What have been the achievements? We use CDTI structure in Malaria Control (distributing Insecticide Treated Nets), Vit. A supplementation, distribution of Zithromax tabs for Trachoma control and improvement of sanitation through slabs distribution. This was well achieved and proved great success. 4.3.7. Describe others issues considered in the integration of CDTI. We are planning to integrate lymphatic Filariasis Elimination Programme with CDTI structure 4.4. Operational research No any operation research done SEGTION 5: Strengths, weaknesses, challengcsr and opportunities STRENGTH AND WEAKNESS Strength: - Committed leaders at some levels. - CDTI activities are incorporated in the CCHP - Knowledgeable CDTI staff at all level - Availability of Mectizan - CHMTs are willing to work close with Onchocerciasis team. - Integration of Oncho activities with other programme using CDTI approach. Weakness: - Lack of transport to FLHF staff - Late reimbursement of funds from donors. - Some communities do not respect CDDs and thus do not give incentives as we always advocate - Small number of people do not know well about CDTI activities CHALLENGES: - To maintain and increase the therapeutic coverage attained this year. - To ensure that CDTI activities continued to appear in the CCHP and funds are allocated and released - To convince other community health based programmed to use CDTI approach - To empower communities to own the program - To hold on our donors. Major achievement of the Project during the Year - The project managed to raise chemotherapeutic coverage from 71.4% achieved last year to 75.5%o this year. - All Policy makers at all level participated well in the implementation of CDTI activities. - Conducted Project's Annual Review Meeting where all major actors were invited to participate. 35 WHO/APOC, 24 November 2003 \: TYPE OF ASSISTANCE REQUIRED 1. Government: A timely release of funds that has been budgeted in the Council Plan to continue supporting CDTI activities as it has been done before. 2. APOC Management: APOC management is requested to replace the old capital equipment as per memorandum of understanding 3. Sight Savers International Continue with their moral support and extend their support to other health related problems. SECTION 6: Unique features of the profecUother mattenB - Integration with other Health Based Programme in the implementation of CDTI activities. Moreover the Project is intending to continue with this integration with LF 36 WHO/APOC, 24 November 2003