Kilosa focus CDTI project annual technical report submitted to Technical Consultative Committee (TCC): year 2002-2003

KILOSA FOCUS CDTI PROJECT I ff COUNTRY/NOTF : TANZANIA Proiect Name: KILOSA FOCUS CDTI PROJECT Approval year: 2000 Laun g Year: SEPTEMBER 2OO1 Reportinq Period (Monttr/Year): YEAR 2002-2003 Date submitted: JUNE 2004 NGDO partner: SIGHT SAVERS INTERNATIONAL, ROTARY INTERNATIONAL gtilrs,.nXo6 1 ccl ,oL0 o FA 5 \191 Ao AC 0 6 A0u1 2001 WHO/APOC, 26 September 2003 I I ! I I I I {I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ( AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t{ 1. t t * ll WHO/APOC, 26 September 2003 I ;I= ANNUAL PROJECT TBCHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: TANZANIA National Coordinator Name: Dr. G Saguti Signature Date Regional Delegate Name: Dr. M. Signature Date: .2-< This report has been prepared by Name:Mr . John Nganya Designation : pROJECT COORDINATOR Signature : .....#J.l:....... ti Date... ... !'.i. \.:^-.1 i.:.:.f . . . . . t iil, WI-IO/APOC, 26 September 2003 r,! i I,u4-{,....r.... I,F [' * I I il 1I Table of contents ACRONYMS v ......vI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY................ SECTION l: BACKGROUND INFORMATION......... I 4 5 l.l. GENEntI-rNFoRMATroN................... l.l.l. Description of the project (brieJly) l. l. 2. Partnership......... 1.2. Popur-RrroN aNo HBerrH sysrEM.. i;;;; i i; ; i; ;; ; ;;;; ;;i; ;;. u':?': u:::*?': ::: *l'":o; SECTION 2: IMPLEMENTATION OF CDTI........ ....................10 2.1. PBruoo oF ACTrvtrrES ............... ....................... l0 2.2. ORDERTNG, sroRAGE AND DELIVERy oF IVERMECTTN .........14 2.3. Aovocecy nNo SeNsnrzATroN ...................... 15 2.4. MoerI-rzerroN AND HEALTH EDUCATToN oF AT RrsK coMMUNrrrgS......................... l5 2.5. Couut-rNrrrEs TNVoLVEMENT rN DECrsroN-MAKTNG ........... 16 2.6. Cnpe.crry BUTLDTNG ..................... 17 2.6.1. Training..... ........ 17 2.6.2. Equipntent and hurnan resources ............ 19 CoNorrroN oF THE EeurpMENT * PLeasp srATE ......... 192.7. TnrervrrNrs................. ................20 2.7.1 . Treatnrcnt figures ........... ...... 20 2.7.3. Trend of treatment achievement from CDTI project inception to the current year 232.8. SuprRvrsroN................ .................24 SECTION 3: SUPPORT TO CDTI ,< 3,I. FINaNcIeL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES 3.2. OrssR FoRMS oF coMMUNrry suppoRT 3.3. ExpENorruRE PER AcTrvrry 25 25 26 SECTION 4: SUSTAINABILITY oF CDTI........ERROR! BOOKMARK NoT DEFINED. 4.1. INrrRNal; INDEIENDENT pARTICIpAToRy MoNrroRrNG; EvatuarroN...........Ennon! BooxrvrlRx Nor DEFINED. 4.2. CONIUUNnY SELF-MONITORING ENO STETPHOLDERS MrrrrNC .,..,....,.26 4.3. SustarNeeILITY oF PRoJECTS: PLAN AND sET TARGETS (MANDATORY Ar yR 3) .. ERRoR! Booxrr.rnRx Nor DEFINED. 4.4. INrncnerroN ................ ................27 4.5 openerroNAlRESEARCH.. ..Ennon! Boom,raRxNorDEFrNED. SECTION 5: STRENGTHS, WEAKNBSSES AND CHALLENGES ...........28 lv WHO/APOC, 26 September 2003 APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LTNICEF UTG wHo IEC CHMT DC DED SSI RHWs RI DMO DOT PC DOTM Acronyms African Programme for Onchocerciasis ControI Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization Information Education and Communication Council Health Management Team District Commissioner District Executive Director Sight Savers International Rural Health Workers Rotary International District Medical Offi cer District Onchocerciasis Team Project Coordinator District Onchocerciasis Team Members I WHO/APOC, 26 September 2003 t I i t t II ir r Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84oh 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 meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iu) 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 ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (ui) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). .i -t V1 WHO/APOC, 26 September 2003 Il * FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session I I Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY 1 Clarification on which zones are Urban and which are Rural and to give treatment and coverage figures Each zone has both communities, part of zone has rural communities and part ofzone has Urban communities URBAN Population treated is 49,6t6. Treatments Coverage is 12"/o of total coverage RURAL Pop treated 213,254. Treatments coverage is 53% oftotal coverage 2 Differences in Urban and Rural population that might explain the low coverage reported in urban area URBAN Population 83,71 I RURAL Population 320,690 J Strategies to reduce high number of refusal and absentees in urban Areas We plan to conduct More sensitization through social group, print and distribute IEC materials in urban areas such as Billboard, posters leaflets, use Radio spots and TV to sensitizations community to overcome the misconception masseges. 4 Health system in Tanzania at District level with cascade supervision reporting, Drug distribution, monitoring and evaluation For Kilosa District, usually CHMT and PC supervise cascade zone that based at Rural Health Centers in monthly bases then cascade (RHWs, DOTs) supervise there services areas that including All Dispensaries WHO/APOC, 26 September 2003 if within their catchments areas and give report to CHMT AIIFLHF staffs supervise CDDs at the community level 5 Integration within the PHC supervision and feedback system CDTI activities Supervision was already integrated into the CHMT checklist. 6. CDDs Distribution, male and Female ratio, training content The Distribution of CDDs from year one was based on gender for each hamlet. During sensitization meeting we were emphasizes gender issue for CDDs selection. 7 l. Content of Training provided at all level. 2. DOT and CHMT Management training content. For TOT (CHMT, DOTs) -Planning, - -Sensitisation and mobilization -Mectizan drug: Its benefit -Census taking -Record keeping and reporting system -Supervision and monitoring -Drug ordering and Storage. For RHWs -Planning, - -Mectizan drug Its benefit -Census taking -Sensitisation and mobilization -Record keeping and reporting system -Supervision and monitoring -Drug ordering and Storage -Management of cases of severe reaction and referral, if necessary ofthese cases to heath centres better able to handle them 2 I I h * WHO/APOC, 26 September 2003 For CDDs -Mectizan drug its benefit -Census taking -Record keeping and reporting system -Dose determination - Simple treatment of side effects -Drug ordering Storage. For management Training -Time management -Mectizan drug its benefit -Resource management -Finance management - Project ownership (Please add more rows if necessary) i d I il 3 WHO/APOC, 26 September 2003 t Executive Summary Kilosa Focus CDTI Project is the focus that base in Kilosa District one of the Districts among six Districts in Morogoro Regional. The Project was Officially Launching in September 2001. Year two started from l't September 2002lurp to August 2003,the plan for year two was focused on the creation of project sustainability and multisector collaboration within the District were by District leaders such as District Commissioner, District executive Director, Head of Departments and councilors participate fully on corrrmunity sensitization on mectizan swallowing. Most of the planed activities for year two were attended well. According to the 2002 National census, Kilosa District has a population of 489,5 l3 with 105, 513 households the average for households 4.6. The project has about 150 communities; among them all 150 communities were treated. According to census taken by CDDs and RHWs the project has a total population of 404,401 people, with the eligible population of 335845. About 262870 people treated equalto 65%. The Ultimate Treatment Goal of the Project for second year was aboutS2%o and the Annual Treatment Objective is 317,717 . The district has three type of population that is Rural Population, Mixed population and urban population. Twenty-three wards found in rural population, eight wards are mixed wards and six are Urban Wards. Agriculture is the most important activity in Kilosa, accounting for approximately 80% of household income. A total of 1952 CDD's were trained, of which 976 (50%) were females and 976 (5O%)were Male. A total 0f 65 First line Health Facility staff (RHWs) were trained for which 16 (25%) were females. About CDDS ratio one CDD treated a total of 202 people in average at the project level. Also one FLHW treat 6221people. CHALLENGES FOR NEXT TREATMENT CYCLE. l. To increase number of community mobilization and sensitization meetings. - To have more sensitization campaigns throughout distribution period. - To conduct sensitization and mobilization by using Video Shows, Radio spots, TV for areas with access to TV. - To conduct sensitizations and mobilization in rural areas by using piers groups - More involvement of Community Development Officers (CDOs) present in each Ward. - To produce adequate amount of different IEC materials. 2. To modify mode of sensitization based on groups, eg women, Youth and religious for community approach. - To produce and distribute posters which shows the burden of the Diseases 4 WHO/APOC, 26 September 2003 I I - For school we will use teachers those are responsible for health to mobilize pupils as well as their Parents. 3. For drug distribution - To encouraging CDD's / Village leadership to collect ivermectin from nearest Health Facility. - Provide proper information about the roles of communities about CDTI Programme. - Intensify health education of communities using appropriate IEC materials 4. Integration of CDTI activities with other activities. - To intensify integration of CDTI activities within the present Health system - To Integrate Mectizan delivery system into government drug delivery systems at all levels from the district level. - CDTI as na entry point to other Programme like Malaria Control by disributing ITN, Environmental Sanitation by construction of pit latrines. SECTION 1: Background information 1.1. General information 1.1.1. Description of the project (briefly) Kilosa Focus CDTI Project is situated in Kilosa District is one of the six Districts, which comprise Morogoro Region, which located in east Central 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%o of total surface area of Morogoro Region. Average length (North -South) 180 Km. Average width (East-West) 8Okm. 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 riches I 100m. The highest parts of the district are found in the Ukaguru, Rubeho and Vidunda mountains, which form almost continuous north-south mountains, range long the Western side of the District and reach an elevation of 2200m. Flood plains zone comprises both flat and undulating plains extending from the foothills in the west. Altitude is typically 550m. The plains are dissects 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. f l 5 WHO/APOC, 26 September 2003 t r 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 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 averages 800-l l00mm. However, the mountains forest areas can receive up to l600mm 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 typically 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 though it consists of Miyombo Woodland with grass and shrubs. There are 83,12ha. (Or l.lo/o of the total forested area) of catchments forest. Whilst these come under the jurisdiction of central Government, 24,65ha (0.3%) of productive, protected reserve are the responsibility of the district Council. A further l69ha of softwood plantations have been developed. Kilosa District is administratively divided into 9 divisions, which in turn are subdivided into 37 wards, and 16l registered villages. Kilosa town is the district headquarters and is located 96km West of Morogoro town. Other important settlements include Kimamba, Mikumi, Gairo, Ruaha and Dumila. There are five zone constituencies within the Project, namely Gairo zone, Kilosa zone, Mikumi zone, Magubike zone and Magole zone. According to the 2002 census, Kilosa District has a population of 489,513 withl05, 513 household the average for households 4.6. POPULATION DISTRIBUTION. Table I WARD TYPE NO.OF WARDS Rural 23 Mixed 8 Urban 6 6 It * WHO/APOC, 26 September 2003 fTOTAL 3l Agriculture is by far the most important activity in Kilosa, accounting for approximately 80% of household income. Cash crops including; Sisal (dormant), Cotton, Sugar cane, Coconuts, Onions, Coffee, Semsim, Castor seed and Tobacco Food crops including; Maize, Paddy, Beans, Cassava, Millet, Bananas. Kilosa District road network comprises 3565 Kilometers. DISTRIBUTION OF HEALTH FACILITIES BY TYPE AND OWNER Table 2 TYPE OF HEALTH FACILITY GOVERNMENT COMMI.INITY PRIVATE TOTAL Bedded Hospital I I 2 Health centres 5 2 7 Dispensaries 42 19 6t Village Health Post 90 90 I.I.2. PARTNERSHIP In Kilosa Focus CDTI Project we have two NDGO partners named as Sight Savers Internationai and Rotary International. ACTIVITIES CARRIED OUT FUNDED BY NGDOs SIGHT SAVER INTERNATIONAL FUNDBD THE FOLLOWING ACTIVITIES Publicity activities; Mectizan day; Fund the second year Launching week ceremony including football matches and drama groups' competitions focus on urban areas. Construction of office Also SSI funds the construction of a new Onchocerciasis and Eye care Office, the structure is in finishing process. Project management training for Staff September 2003 SSI was arranged a second phase for skill management course for Onchocerciasis team and CHMT was facilitated by Mzumbe University. 'iI + I * 7 WHO/APOC, 26 September 2003 I IROTARY INTERI\ATIONAL FUND THE FOLLOWING ACTIVITIES CAPITAL EQUIPMENT Provides two motorcycles. TRAINING AND SUPPLIES Also Supplies stationeries for Community registers, Health facility register, Village register, during training Advocacy. 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CAPACITY BUILDING 2.6.1. Training 3. TRAINTNG AND EDUCATION We start training CHMT and DOTs early in April followed by Training and retraining of RuralHealth Workers. The training and retraining of CDDs were conducted in all CDTI areas on May followed by Census up dating. The CHMT and DOTs and RHWs were fully participated in training of CDDs. FLHF staffs trainedlg52 CDDs on CDTI concept, Onchocerciasis as a disease, treatment, register filling and record keeping. Type of materials develops for use in Training health staff and CDDs During training we developed handouts on onchocerciasis disease and its cycle, the function of Mectizan and benefits. Also we develop Treatment forms that show, Name, Age, Sex, Year and number of tablets given. We also had Ledger book for mectizan Distribution of Drugs in the health Facilities and Control Inventory, Measuring sticks for measuring height of people to give them the right dose, Training manual for RHWs to train CDDs, Weekly CDTI progress report forms that used by Rural Health Workers and CDTI summary forms PERI'ORMANCE OF CDDs: In year two we have observed the dropout of CDDs in urban areas because they demanded payment, uniforms and transport (bicycles). During training season they have been educated on the concept of CDTI. The problem is more difficult in Ruaha, Kilosa, Gairo, Dumila, Mikumi and Kimamba, Chakwale and Iyogwe. Needs to be done to improve quality of training: During retraining we found that few CDDs had forgotten some topic this is because training is only two days per year. So there is need to conduct regular supervision & monitoring of the staff for the sustainability of the project because learning is the process. Also have to develop trair.ing materials in Swahili in addressing Health message and sensitize the community. Posters are the good tools for sending massage. Even this year we failed to get enough posters for community sen sitisa zation. I -tt r Jl5 WHO/APOC, 26 September 2003 66l o ,o 0) q 0)a c.l (J op.{ 'lr -0 : ib p a a\ s q a{ p V) a *( a qJ $ V2\q) F S(.)p B bO qJ{ p qJ' s\ € : A) R € -s U1 rrl * 60 B sq s) $'E \t \)? E .s q rrl -a\ Bq qi Uq) b U\ q)L o -N :$ s:r\a -()q q.) 6{ EfES E.3trqr .=\ . q.)trS Oqr oq) o*( '() .B>s G)\ 9\ E\ €$ c)% -c\ bostr9 d$ FB F.- U -a b.\ t f l I I t 1 () a U o 0) z F >r t = o.t o\ $ o\ c.l o\ $ \o q) q) o\ F GI o\ o.t o\ 0 c) .1 'o'dh CJ: o4) .o LGt o,lr- z d 'i' : z a.l 6l s q) c) c) a s F o 6tr !i: E8 =o-tr ---ZE q)() il F +. q z (\ 6l c) o c) LF c! o o Fl 9,ooq) ;'e () z C \'q z c- a- r- c- s qJ q) o o\ LF a- r- J U) o F.l V rl F t-{ Table 8: Type of training undertaken (Tick tlrc boxes u:here specific training was carried out during the reporting period) - Any other comments 2.6.2. Equipment and human resources Table 9: Status of equipme nt (Please add more rows if necessary) *Condition of the equipment (Functional, Currently non-functional but repairable, Written off). i { I 1 ti * Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifu) I Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state l. Vehicle I Currently non- functional but repairable l. Functional 2. Motor cycle 4 Functional 2 Functional 3. Computers I Functional 4. Printers I Functional 5. Fax Machines 1 Written off 6. Photocopy I Functional 4+ WHO/APOC, 26 September 2003 2.7. Treatments 2.7.1. Treatment figures Table l0 I S/NO. ZONE TARGET NO OF VILLAGE S TREATED NO OF PERSONS TREATED TOTAL POPULATI ON COVERAGE I KILOSA 38 55967 87378 65.5 2 MIKUMI 25 46874 75391 62.1 3 GAIRO 26 67480 102749 6s.6 4 MAGOLE 35 57535 86426 66.s 5 MAGUBIKE 26 35014 54457 64.2 6 TOTAL 150 262870 40440r 65 f t I { /\ WHO/APOC, 26 September 2003 I I c\ E(J .o o aoa \o 6l r) L' a) bhI a U lJ .c ^{B\ st) 00 \otF*)s I 9qiE: q8.S'trs \F9a/ -{:: *v5 trBo: _rl .:.=!t-> du(H ss o.1 I c.rSH.!S Er.S(')sr* L\()si X€l !-Lo:9 u .: '+iE E \E - 'i qr'5: t :\g N ss3 n 'E<!vP-%L €a5 E tr o i: :-!% .:.rg E ..Es+ h tF3 .s Et'O- = J\rG i Sso E *:b $s's € ! ittr :! *rr = {:' :XH s 'i5(€qr\s6 E !tF .S 9S oo cE '!.6\ € ss: rE[ *gil\I ttG tss s8 : =a\.%\ ESql 19E si : d\I ssq tiSSrt\ N='lt tt So stL &A \ v! (r) \ O x to c! a)! o o oo o. HO -otr zt d()p(! (-)(.) 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Ho F 1:. o 9( o= 6. oiJr-; o .1.r 9 e€6 c h*;9(E oa9 0. o o o o .o E z Jz J z E?\a2z Jz J z b9 -otrco =-ozd a.l o\ N N o\ \o o.l o,^ == - c ^- 6O ^ 9t - -o;E d trE:r,96ia <9) N @ a.l \o @ o d = o.,loA o 'Eo =ooO d^BUS oo .qoF o\ \o ? pooiio +f!rdE6g = o!z Ir- co6l\o c.l t-- @ o.l c-.1 _EedoZ d 9-o -t:O r- c-F- (-t c-F- ca 9 .,H::o:., trH45-?g o:ots = - 39 oF $ t :t * $ v ch o b0 an() tro O E .9o i: 9o\ooa- do FOO lr..l '7 t- a-lvo. AZtrl o/. l) E.o _- o c Mo! 5 d'=tr tr= A; fE>sZA o -cyd o.azEtjE E.CT 4 -i) 9' F(., F- t--t-. F- t--F- >9.,3q o= - o -.= c o.E+ c - >,-. -q ts -o^> tr € ES'q€ o ol a oIg Fl l'r F I t 2.7.2 Absenteeism Reasons a a Most of this happen in urban areas caused by lack of enough IEC materials for the community sensitization Fears of side effects, Some People were exaggerated side effects of drugs. Also most of urban people are not attend public meeting especial that arranged by sub villages' chairpersons.f f t f ..; I 1 $o WHO/APOC, l0 April2003 ral o. ti or o \ s\J ,s c! e) o) q)q) e6g O! oo' Eac) o.)()t- E5()c) '= -q o.- (E ,-lb3uiESI o:l .rr 6l =l 6),Esto() o(B E() cqo :o EE Ebetr o(! trFo .L\F r;s rj*6r b,: t o\ oFD o oo o () \o o\ F- o\ N o (J!E- F 6X -o o o\r- o\6l oEO =bnO 6^ E TEoosoF o\ o\ .o od r9o54- z?op. al$6l 6l F- ca c.l\o c\l _E.,G o.a3F- cd= < 9!'FU .f c.l c.l o. o H I GA .'d -oy -: o.ad.Y .. > -. A o; o r- r- .f v$ $ o ^d)L) ld- r Ua\ -o a. o0d- d,^ M)\ oo\ o - >voo 6\ o\ GOo:E 3*b E 9PUf E; Ei Et b >oa Eo 6 0.= c 6.9 < 9PF9 () bod o U bod -.rdq>Xoo> I6_:r o= x:: ::tr-oEa)-33e EO oo d gl o.t c-.1 a.t NOTF R.M.O (RHMT) Flow chart of supervision 2.8. Supervislon National level Regional level District level Health Facilities level Main issues identified during supervision. Some Community leaders were not participating well during distribution. Other Programme like trachoma (ITI) discourages CDDs because ITI provide bicycle and incentive to thier distributors during distribution. Some urban members are not respect CDDs work. Rural Health workers are not supervising well CDDs Lack of transport for RHWs (i.e. bicycle) Lacks of self committement to some of CDDs the during distribution period. Most of CDDs were not given Incentive by the community a j I fi 2.8.t 2.8.2. During supervision we use checklist developed by APOC 2.8.3. The outcomes at each level of CDTI implementation supervised was that, - Every community member promised to participate fully in the implementation of CDTI activities. DMO,PC (CHMT) J It I r DOT RHWs CDDs /COMMUNITIES 0q1-tlz WHO/APOC, l0 April2003 I t".1: II 2.8.4. The feedback of supervision Feedback meeting was held with Community leaders; RHWs and CDDs after conducting supervision. Community members were informed on their performance on drug distribution. Supervision help us to involve others extension works (i.e. Primary school Teachers, Community Development Officers) on communities mobilization and sensitization. SECTION 3: Support to GDTI 3.{. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years 3.2. OTHER FORMS OF COMMUNITY SUPPORT - General all CDDs selected from community members. - Some communities prepare Drama group to sensitize community members. E WHO/APOC, 26 September 2003 r I Contributor Year I ('provule the pernd') Year 2 ('provide the pertod') Year 3 ('provide the period') TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (US$) TOTAL Released rus$) TOTAL Budgeted (us$) TOTAL Released (us$) Ministry of Health (MOH) NGDO partner (l) $50,000 $50,000 $34,000 $34,000 NGDO partner (2) s4,000 $4,000 $11,222.6 $t t,222.6 DistricVLGA $2,1 l 8 $2,1 r 8 $7,736,s $7,736,s Others a) b) c) Communities APOC Trust Fund $ 109,805 $ 109,80s s 22,765 s 22,76s TOTAL $ 165,923 $ 16s,923 $75,724.1 $75,724.1 a, I I In some community the provide food for CDDs. 3.3. Expenditure per activiQl Table I4: Indicate how much the project spent for each activity listed below during the reporting period 4.2. GommuniQr self-monitoring and Stakeholders Meeting Table I5: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) a f I I -. f ,-i 1l! Activity Expenditure ($ US) Source(s) of fundins 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 alllevels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g. computers, printers etc) Others 6329 13318 3499 4324 5201.6 6230 172 13027 6021 17,602.5 RI/LGA zu RI RI/APOC SSYLGA RI RI APOC SSI APOC/LGA TOTAL 75724.1 Total number of persons treated 262870 DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) KILOSA 150 TOTAL 150 2u WHO/APOC, 26 September 2003 tDescribe how the results of the community self- monitoring and stakeholders meetings have affected project inrplementation or how they would be utilized during the next treatment cycle. 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1 Ivermectin delivery mechanisms The Mectizan Ordering and distribution method is in the existing Health Structure. 4.4.2 Training The CHMT member and FLHF staffs who normally conduct training are also member of PHC therefore it is in structure. 4.4.3 Joint supervision and monitoring with other programs The CDTI activities are included in CHMT existing supervision checklist. 4.4.4. Release of funds Since first year the District Council has planned and budgeted for some CDTI activities. 4.4.5 Is CDTI included in the PHC budget? Yes. Some of CDTI activities are included in PHC budget Comprehensive Council Health Plan (CCHP) v I t Ii L I .!E' 't t t ? /) WHO/APOC, 26 September 2003 f TSECTION 5: Strengths, weaknesses and challenges STRENGTH AND WEAKNESS Strengthen: l). We have increased the coverage from 63Yo year one to 650/o year two 2).We have succeeded to advocate and sensitized over 98% of the communities' leaders on CDTI concept. Also 98o/o of all councilors have been sensitized on CDTI activities. Almost 100% of CDDs selected, were trained on CDTI concept. 3). Good relationship with government and communities' leaders Weakness: l). Most of refusal and absentees are from urban areas 2)No action taken for refusal and absentees these demoralize other who took Mectizan. 3) Other Programme like trachoma (ITI) discourages CDDs because they do provide bicycle and incentive during distribution. 4) Immigration of temporary workers and businessman from sugar plantation estates during distribution. Major achievement of the Project during the Year. We had managed to provide Health education to the different community group's councilors, villages, wards and division leaders. Also we have conducted training session to 130 primary school teachers and l6-community development Officers on CDTI concepts. We managed to reach all targeted areas during this exercise. Most of Rural Health Workers (RHWs) performed their duty well. 100%o of community representative Ward development committee (WDC) was sensitized. We conducted CDTI activities as per our schedule commencing with trainings of different levels, data collection and report writing. TYPE OF ASSISTANCE REQUIRED l. Government: The District Council should continue support CDTI activities as have done in first and second year. For the sustainability of the project we suggest that during their normal supervision the CHMT should also supervise CDTI activities. t t I t I t I !t WHO/APOC, 26 September 2003 ,a As for the first and second year the Local government Authorities should increase amount for support and continue to support the project activities e.g. sensitization, training & supervision. 2. APOC Management: We suggest study tours to other projects outside Tanzania so as to learn more to the project that started early. Also APOC should supporl management training for DOT's and CHMT so as to build teamwork. APOC to support research on Onchocerciasis activities especial in sub urban areas. 3. Sight Savers International Fund for Managerial training for DoT,s and GHMT, fundraising and publicity Also we suggest having a Project annual meeting. 4. Rotary International: We plan to have retraining each year, so we are asking for RI to support IEC materials. As for IEC support we need fund for CDDs retraining, Support of fund for TV and radio spots for the community sensitization. Also we are asking Support of fund for Office supplies. f JI f l+ WHO/APOC, 26 September 2003