Monitoring of the implementation of Tanga CDTI project sustainability plan

fri 3 MONITORING OF THE IMPLEMENTATION OF TANGA CDTI PROJECT SUSTAINABILITY PLAN AFRICAN PROGEAMME FOR Ol\lcrcCERCIASIs CONTROL June 2OO5 DRA.FT REPORT i,i ! 2 0 JUtr{ 2005 f*? I t ,) ACRONYi'S .{POC Afiican Programme tbr Onchocerciasis control CDD Communitl Drrected Distributor CDTI Communin Directed Treatment with Ivermectin CO Clinical otl-rcers DED District Executive Director DOC District Onchocerciasis Coordinator CHF Communitl Health Fund CHMT Council Health Management Team DMO District Medrcal Otficer DPS Director of Pre,u'entive Sen'ice. MoH FLHF Frontline Health Faciliry' HSAM Health Education. Sensitization. Advocacy and Mobilization IEC Infbrmation. Education and Communication MoH Ministrl of Health NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force RHMT Regional Health Management Team RMO Regional Medical Otficer 'v\TlO World Health Or-eanization WR WHO Representative l IEXECTTTIVE STTMMART Background and Introduction: ln November 1003. APOC evlauated the sustainabilitl of the Tanga CDTI project berond APOC support period. The project was adjudged to be making progress towards sustainabilin. The Tanga CDTI project subsequentll made a sustainabilitl plan tr) co\er all the three Districts of Korogwe. Lushoto and Muheza which are sen'ed br the project. One -v-ear later. in Ma1 2005. APOC management sent a team of t-tve monitors to assess the progress of implementation of the plan and provide technical support to the project during the mission. Methodologr': The team comprising external and internal monitors brief'ed officials of the Ministrl' of Health (MoHt and the WHO representatir,.e ro Tanzania (WR) about the mission befbre tleld i, isits to Tanga region. In Tanga regional and officials of: the three selected districts (Korogwe. Lushoto and Muheza) w'ere brietbd and discussions held with both administratir,e and medical otllcials about the implementation of the sustainability plans. Two randomll selected Frontline Health Facilities (FLHF) and two communities were selected fiom each district and visited. An interactive session was held with the Clinical otficer in charge (CO) about the implementation of the sustainabiliry plan using the pre-designed tools. The issues raised in the sustainability' el'aluation reports were discussed at each ler,'el and opportunities. strenglhs and w'eaknesses that were recorded. Findings: .{t both regional. district and FLHF levels the CDTI has been well integrated into the health svstem as to mal,ie it sustainabte. The coordinators are either members of the RHMT or the CHMT Actir,'ities are integrated and jointly carried out b) a multi- disciplinar-r team. which constitutes the regional health management team and innovations are made at the peripheral health facilities ro ensure sustainabilitl. LF. evecare are implemented along with onchocerciasis control in an integrated manner. The programme is accommodated in the regional and distnct budgets and tunds are released tbr actirities as budgeted without hassles. The communities and their CDDs are well arw-are of the advantages of the interventions. Coverage has increased by' more than 5ozo betu'een l00i and 100-+. .A.n annual report is w.ritten b1 the district but documentation of events and acti,u'ities. especialll records at the FLHF are w-eak. The communities have well-kept and correctlr documented integrated records of treatment including LF. The major problem is the manpower at the FLHF and the lack of transporr tacilitl fbr outreach to thc communiLies. Opportunities. The Tanga CDTI is adjudged to be well integrated and highly susrarnable within the health svstem. The implementers are committed and innovative. Funds are made available and there is a multidisciplinary team of implementers at even' level. Challenges: the main challenge is the inadequate manpower at the FLHF level and the lack of transport requrred tbr outreach during monitoring and supervision. Another challenge is the integration ol other programmes to an alreadt overstretched schedule of the CO at the periphen of the health svsrem. Recommendations. It rs recommended that the FLHF level should be strengthened to enable it plal its role ln communin directed intervention programmes: Districts should encourage good pertbrmance and initiati,u'e to harmonize difl'erent recording requirements onchocerciasis. LF and evecare as well as their difl-erential endemicities in the r,arious districts within Tanga CDTI area. Projects should develop communitl level treatment registers whrch tncorpr)rates the required intbrmation tbr er.en intervention in an ,) integrated tbrmat \^lthin the same document: CHMT data management should be computerized tt) enable data entn. storase. anahsis and retrieval. The skills tbr computer-aided data mana-qement should be inbuilt into the CHMT. periodic replenishment of traintng materials should be taken seriousll' by' the region or district. but simplitied to suit the needs of FLHFs. HSAM should correcr wrong impressions and address rumours that mar likell harm project activities befbre it becomes ioo late to do so. The sug-qestion to put lar-ue counterbooks in each clinic tbr use as diarl tbr recording events and actil'ities was taken at the regional level and the districts and it *-u, ug...d that this would be done immediateh. Harmonisation of registers at the countn level would be pursued to tnclttde columns tbr albendazole and evecare in CDD treatment register + \ ACKNO!\'LEDGEMENTS The team rs grateflil to all those who have made the mission possible and fulfllling of its objectives: the W'HO countn'representative. Dr. Maganu made time available to the team on arrival and at the end while Dr Mohammed Amri and Ms Eva Muro facilitated the logistic aspects of the missron tiom the \f,'HO office: Dr Grace Saguti. the National Coordinator and other members of the national otfice w'ere ven' helpful with airport pick- ups and planning. Dr Ali Mzige the Director of Preventive Services made time available tbr the mission team betirre and after and made useful suggestions. Dr Rehma Magid. the coordinator tbr the region and Mrs Harrieth Hamisi provided secretarial and logistics assistance and ensured that the team was able to meet as man\-people as were necessan.. There r*ere numerous other people that pror,'ided some fbrm of assistance orthe otherthat we are unable to list in this report but we cannot but mention Venance Ndolo and Svh'ester Msamila who chaufl-eured the team around the region and back to Dar es salaam with prot-essional ease. t(\ TABLE OF CONTENTS EXECLITIVE SL'MN,I.{RY ACKNOWLEDGEMENTS I INTRODLICTION I. I Background 1.3 Objectir.'es I i Focus t'rf rmplementatrttn ].0 MONITORING PROCESS l.l Team Composrtront.l Meetrnes l.-l Team Orientatir'rn l.-l Site Selectron and sampling 1.5 Field work 2.6 Anallsis and Report writinc J O FINDINGS. DISCLISSION AND RECOMMENDATIONS l. I Situation at each lerel includine 3.3 Strengrhs. weaknesses and opportunrties ]. CONCLLISION .AND RECOMMENDATIONS -l.l Conclusrons -{.1 Recommendations Appendir 1 _) 5 7 7 7 7 l 8 8 l0 l0 l0 ll t3 ti r5 t7 t7 t7 r8 6 I.O NTTRODLICTION l.l Background Tansa CDTI prolect cornmenced distribLrtron rrf ivermectin to endemic communrtles rn 1000 and tts sustainabilin uas eraluated rrr l()0i when it attained its ird r.ear. The project was adjudged to be makrns progress tt'rwards sustarnabrlitr and suegestlons \\ere towards strenglhenrng it On the basts of e,r'aluators' repc)rt and drscussrons during the f-eedback rleetings. rmplementers developed sustarnabilin plans to address rssues that posed challenges to sustalnabtlit). ln order tLl assess how the sustainabilit_r plans are berng implemented APOC sent a mrssion to Tanga CDTI project. The repon presented here descrrbes the process. tindings and recommendatrons of the assessors of the rmplementatron of the plan 1.2 Objectives The specitic ob.jectir,es olthe missron are to a) Determine the extent to which program partners. particularh ar the district- FLHF and communitl levels are implementing the proposed activities in their sustainabilitl'plans. b) Provrde technrcal support tbr achierrng the objectives of the sustainabilitl plans and the rmplementation of the CDTI 1.3 Focus of implementation The Tanga CDTI covers three districts. Koroswe. Lushonto and Muheza. The distances varied tiom i4 kilometres to 100 kilometres tiom Tanga cin Lushonto. the tlrthest distnct rs up on rh mountatns and the communitres wrthin it are situated along the escarpments and vallels of several undulattns hills whrch reach Il00 m rn altrtude. Duringthe rainsthel are ratherdifficultto reach. Although all le,uels within the rmplementatron chain were v'rsited- fiom the national and the resional. the matn fr-rcus t'rf the assessors' acti!irr was the "level where plannrng and tunds allocatton dectstot.rs are made tbr health ser\rce delivery Regton and where actual CDTI lmplementation rs done- the drstnct. FHLF and communlf\ (as appropriate)". Using pre-designed tools tbr collectrnc tt.tttrrmatrc'rn at each lelel. the team assessed the tbllowrne rndicators of sustalnabllit\ Plannrng. Health educatron, SensrtizatroniAdvocacl/ Mobilization (HSAM). Trainrns. Finance. Transport. Mectizan Procurement. Deliven and Drstribution. Monitoring and supen tsion. Human Resc'rurce and coverage. Record keepin-u had been identif red as an lmportant but rnadequatelr addressed pornt rn CDTI proJects and was theretbre rncluded among those items to be assessed dunng the v rsrt 2.0 MONITORING PROCESS The monrtonn-g process was rn three stases. Frrst a meeting was held with some members of the NOTF in Dar es Salaam to broadlr plan the exercise The dates and logrstrcs of movement were made at thrs stage consrdering the meetrnss with offrcials at the WHO and MoH office rn order to ensure harmonr in schedules The team drscussed the previous reports on the Tanga CDTI project especialh the elaluatrr)n reports and the sLrstainabilin plans that were drawn. The team rel,iewed the plans made tn Dar es Salaam on the basrs trf rntormation and resources at the re_eional ler,'el. on meetinq utth the regtrrnal cr'rordinatttr. and rn order tc'r ensure harmonr within the local realrtres at that lerel 7 2.1 Team Composition The team corrsrsted r'rf rndependent monrtors (tiom outsrde the prolect)one \^hom was the team leader and rnternal monltors. tncludtno an NGDO representatt've and a member of the proJect manasement team tTable I t Table l. Team members and their contact Details Address Phone/Fax Prof Oladele Akosun T Names Parasrte and Troprcal Health. Federal L nrversrtr rrf fechnologr. \'ola. Nigena Health Specralist. Policl. Strateslc. Planning and Technrcal Serv rces. Atiica Branch. CIDA. 100 Promenade du Portege. Gatineau. Quebec. CANAD.A KI.A OG+ Mr \['illiam Joseph Research Scientist. NIMR. i Kisoka P O Bor 965i. Dar es salaam. Tanzanra Dr. Bertha Maega NIMR-Tukur Statrorr. PO Bor 5i8. TLrkuru. Tanzan ra C el *134-80i 72)0,160 ell+13-1 8051516611 olaakosLrrr v ahttc-r.cOtTt Pierre breirr manarci.acrda- c ida. gc.ca vr kisoka,4 ) ahoo.com maeggabta t! afiicaon I ine.co. t Dr. Pierre-C laver Bi-sirimana Tel+l 819 99426i-l Tel -l-5-5lll ll ll00 ttl I t]8_i Fax .15-i-ll2 tl ll60 Cell -15-s 746i 10504 7-14648640 Tel -155 (15) 155551-+ Cell: 07-186i0.191. 074486i4.11 4 Email Mr Prus MabLrba Cr.rtrntrr Representatl,v e- Tanzanra S rghtSav ers Internatronal. PO Bc'rr. l-i li. Dar es salaam. Tanzanra Fax 155 t5) t55l0l6 Tel +l-55 lll70l098 t Fax +155 212701091 pma bu lar iz) s i qhtsavers.or.tz Dr Rehma Magrd the Rectonal Onchocercrasrs Control Coordrnator served as the -uuide to theteam. On arrtval rrr the reslon the team studred the irurdelrnes and tools tbr assessrng the tmplementattotr of sustatnabrlin plans and the reports of the evaluatron teams and recommendatrons of .APOC to tfig 1un*a CDTI proJect. Tasks were allocated to team members according to pre\ trlus e\penences. skrlls and interests. 2.2 Meetings 2.2.1 The with the NOCP Coordinator and other Ministrv of H Officials The team members reported i Coc'rrdrnator. the A,ssrstant \at at the Minrstn of Health and had a meeting with the Narronal ronal cr)()rdrnator and other members of the NoCp. The National Coordtnator made a brtef rrrtrtrductron of tlre statf of the LInit. rts tlnctrons (el,e care. hmphatrc tllariasrs and onchttcercrasrs control) and prolided back-sround documents on Tanga CDTI proJect. tt I ke-l sok,t:i htrtm a i l. ct':m The team therr met the Drrectt'rr trf Preventrve Serr,rces in the lVlinrstrl of Health in companr of the National Coordrnator and memLrers were introduced. The team leader explarned the team's mlsslon and the duralron as well as described the process The team had an audience with the WR and the process of explaining the mrssion and the actil'itres \\as repeated. Feedback appolntments were negotiated at thrs point. When all the key otflcials had been met the team left tbr Tanga reglon. [t should be mentioned that the team had telephone con!versatrr)n ahead of departure ,urith the Regional Coordinator of the Tanga CDTI project 2.2.2 Nleeting with the NOCP Resion Coordinator ln Tanga the Resronal Coordinator received and rntroduced the team to the Regional Medical Otficer. The scope and areas that uill be visited were explained to the RMO befbre departure to each of the three districts. The time schedule. which had been developed with the NOTF was reviewed to ensure it tltted rn with local realitl . Appointments that had been made were cont-irmed and rntbrmatron vvas sent to the distrrcts on the dates of visrts to the selected FLHF and communities Table 2. Schedule for the Monitoring of the Implementation of Tanga CDTI Sustainabilie'Plan :30'h May'2fi)5 to 07th June 2005 l Sun t9-5-0-i Ivlon l0-_i-0-i Erternal team members and team leader arrrved Dar es salaam NOTF mernbers. MoH. WR brret'ed Tentatrl e :chedule of actrv rtres prepared Drstrrcts. FLHFs and !'illages selected Relevant documents and rntbrmatron obtarned Other team members arrrved l Actrv rtresDateDar -) Tue i t-_i-05 tbr T ron Resronal otllcrals rn Tanga met and bnet'ed ' Team members orientated on the tool and process Schedule of actrvrtres cont'irmed at the reglonal level Logrstrcs planned (transport. photocopvtns. asstgn role to team members. etc) -+ 6 Wed 0 r-6-05 llluheza'ursrted I FLHF and I vrll Muheza drstrrct I FLHF. I vrllase Feedback ro Muheza Drstrrct Muheza tbr Koro e I FLHF and I Vil Thu 0l-6-0_i Koroswe drstnct I FLHF. I Village Feedback to Korogwe drstnct Koro e tbr Lushoto Frr 0l-6-05 Sat Lushoto Drstrrct I FLHF. I vrllages Feedback to Dtstrrct ,{nalrsts and Report wrltlng 0.1-06-05 8 Sun 0_;-06-0_i Analysrs and repon wntlng q Mon 06-06-05 Feedback to regronal otfice De tbr Dar es Salaam Tue 07-05-0-i Feedback ro MoH and WR Dratt repon t0 9 a 2.2.3 Mee tins the District. FLHF and Com officials At the district. the DOC w'as the tlrst to be contacted then the DMO who negoriated a meeting with the Distnct Erecutrle Direcror (DED). The meetings otl-ered opportunin to explain the team's mtssion and to make an appointment tbr t'eedback at the completion of the district level assessmenr. 2.3 Team Orientation The monitors met tbr one day to study' the tools and guidelines. Relevant documents w-ere also studied and notes made of the issues of interest. Emphasis was made during the orientation that the approach was important to the outcome-to avoid intimidating posture or countenance of anr tbrm but tc'r be inquisrtir,'e and probing without over-awing the respondent. It u'as also agreed that the team meet ro rer,'iew work done on a daill- basis. Eren team member was enjoined to make notes olall observations and relevant comments and to include those made during f-eedback as part of the intbrmation received, The team worked as a single group since this has advantage of collating more infbrmation tiom diff-erent perspecti\ es. which could be svnthesised into one single tool of obsen'ation at that level. However it r.r.as agreed that onll one person would speak to the respondent at anv particular period and that no respondent would be subjected to a barrage of questions and or requests. While the respondent speaks the other team members made notes. The permission to make notes \4as received betbre the commencement tlf the interriew and when pictures were required- permission was also received betbre doing so ['here the team had a large number of people such as CDDs or village members. the lbcus sroup discussion was adopted rather than group inten iew-s. The experience of the team members came into good use at such occasions. In one instance the team had tt'r sptit up into two to make up tbr time ind ensure that an earlier agreed schedule was Lept. 2.{ Site Selection and sampling Infbrmation w'as collected fiom the Region. the Districts. FLHF and communrties. There are three endemtc areas rn Tanga and all the three were theretbre included in the sample. For each district. a list of the FLHFs was made. and two FLHFs were randomll selected tiom the list usin-c ballots. Altogether six FLHFs were selecred tiom the project area. A list of the subvillages ser\ed br, the FLHF was made and one of the subr,illages selected by balloting. Sir r,illases were selected in the project area Table I Lrst of Drstricts. FLHF and Vrllases vrsited Districts FL HF I Muheza I I Misozwe l.l.l Misonve I.l Nkumba Mn LIZI l.l.lMK2 eg\{Llro Sub-Vill I.l.l Nkumba-Kisiwani l.l Lewa l.l.l Welei -l Lushottr -l Son i I l.Lwandar i.l Mlaltr I l.l.Kwezindo Total l0 66 l.l 2.5 Information Collection and Feedback Process 2.5.1 Interviews and information collection The team w'as small in each case and non-intimidating. Everl interaction tbr intbrmation collection colrunenced vrrth small infbrmal chats about the otflcials'work and other tamiliar things betbre ret'erence to the CDTI project in the area and the work plan that was made. The conrersation was natural and allowed to mature through probing until the desired issues of sustainabilitl are addressed within the requirements of the tools. At the FLHF ler,'el. the clinics were often crowded at the time of visit. It w'as ensured that the patients \,\iere not inconrenienced by the'"isrt- the clinician w-as allowed to see patients tirst or to delegate another member of statf who could attend to the team. The DOCs at the distnct were rnterviewed. With the DOC serving as guide the selected FLHF was visited as we[[ as one of the communities that the FLHF serves. In each case the FLHF health personnel responsible tbr irermectin deliven activities was interviewed while another team member interacts with the communitl' leaders and the CDDs. At each ler,'el. documents and evidence of claims were requested and intbrmation fbund useful that corroborates statements w'as noted in the tbrms as required by' the tool. The intbrmation that was received was used to brietly' inten'iew the DMO and some other of}-rcials of the DHMT. The approach descnbed in the Mahenge sustainabilitf implementarion monitoring reporr (1004tof which the team leader was a member w'as used: Conversution.s were ulltnretl ro clet'elop uncl gtriclecl to the toptc ot'rssue of mteresr The prohmg upprttuc'h u'ct.t tr.setl to leuse ttut tnformution on uctivine:; thefi y'ere listecl m the plon but vrfuch the responclent cliel rutt mentrcn, uchievement.s thcrt were mocle. expertenL'e.s guinecl. the upplrcution ol the nevr experiences to other uc'tivitrc.s or sen,ice.s The c'onstrtunt.\ ot' problerus thett u ere encountered eluring the periocl ol implementation untl hotr thet hercl heen resttlt'etl or thet rntencl to re.solye them The team erlso compurecl the trc'tit'rtre.s plunnetl trrrh rhtt.se thot \4'ere implemented. the achievements reported in the previoLt.s eruluLtfton rep()rt trrfh oh.sert'et{ uc'lit,fite.:.sinc'e fhe L'()mmenc'ement ol the plan In each case and at each lei,'el the experiences of other projects were shared with the implementers. Lessons learned tiom them were recognised and commended. opportunities were identifled and the strengths and weaknesses discussed. Considerable ef-forts w.ere made in each case to encourage the implementer to identi! how the weaknesses could be addressed and in almost all cases the approach worked well. Room w'as siven tbr intbrmal chat when the monitor shared experiences of other projects with the implementer. E'"en interr.iew or interaction ended with an opportunit\ fbr the implementer to make inquiries. share concerns or ralse issues that mav affect sustainabilitr, of CDTI 2.5.2 Feedback Meetines Feedback was sl\en at e\er\ stase At the FLHF rt was done on the spclt srnce the intbrmatron cclllectttln process was made thrrlr rntbrmal to allor.r a natural t-low of con\ersation. The pattern lt I aof t-eedrne back to the respclndent \{as the same at even level. The respondent l!as encouraged to rdentrfi what would be done to lmprove the situatron. The decrsions made were noted. In closin-s the t'eedback sesslolt- the team leader repeated the entrre arm of the missron and the importance t-rf sustainabiltN to the orerall L)utcL)me But tbr slight moditicatrr)n ttr tl1 'nao protocols- the f-eedback ar rhe regional. MoH He. and to the WR took the same pattern. Tlre conversatrons and opinrons during the t-eedback were noted as part of the report. 2.6 Data Analvsis and Report writing The team made daih summaries of the received intbrmation received. Observ'ations made and their implication tbr project sustainabilitl. All the data collecred at each level were pooled into a single lnstrument as representing observations at that level. The or,,erall project sustainabilin at each level was then discussed with ret-erence to the pooled data and the oLltcome of the discussions constituted the report that addressed the project opportunities. w'eaknesses and the strengths. Suggestions and recommendations w'ere made on ho'* the project implementation could be further strengthened. l 3.0 FINDINGS AND THEIR TMPLICATION FOR STISTAINABILITY 3.1 Situation at each level including 3.l l on The Regronal Coordinator rs a member of the RHMT. which is responsible tbr health manaqement in the region and chaired br the RMO. The programme is therefbre well integrated into the regional health care s\stem which supen'ises the district health system. Members of the RHMT share resources with respect to supervision. training and t-acilitic's. The LF and et'e care programmes are integrated and the sarne officer coordinates them wrth CDTI This has enabled a similar action to be taken at the district level. It was theretbre not deemed necessan but in actual f'act counter productive to set up an onchocerciasis control task tbrce at this le,''el. The functions of such a task tbrce are alreadr being carried r)ut b\ the RHMT. This explanation b1 the region rs well taken. The reco-qnition that the existing structures could be modif-red to take on additional tasks is indicatir,e of ownership. The need tbr additional statf tbr onchocerciasis controI activities is also not tenable as tasks are shared among the RHMT members. CDTI acrivities are limited to about three months in a vear w-hen training fbr data collection and it will be unw-ise to recruit more staff tbr the programme at the region when activities could be shared. All activities tiom planning to monitoring and superv'ision are integrared into LF and Ele care and are -jotntlr carried out br members of the RHMT hence if APOC withdraws support the RHNIT ser\es as the support pillar tbr manpower. resource. t-tnance and policr. 3.l.l D lstrlct CDTI is ven much part of the District administrative machinen since it has been integrated into the health s\stem at that level. The head of the implemenration team is the District Medical Otlcer (DMO) who is the Chair of the CHMT. the team charged w'ith tmplementation. The inclusion of the District Onchocerciasis Coordinaror (DOC) in the CHMT has made rt possible for the entire process to be within the district health s]-stem. In Korogwe and perhaps a t-eu, other places the DOC is yet to be included in the CHMT and it is advised that this be pursued as a policv especialh. 'w'ith the integration of LF and eYecare sen'ices to CDTI tbr vrhich the same DOC is responsible. We understand that the ROC has alreadl' submitted a proposal to rhis effect. The example of Lushoto distnct is worth mentioning. Lushoto has reached a lel,el of integration and implementatlon that can almost be described as selt'-sufficient but tbr turther strengthentng of the FLHF to enable it carn out outreach that is necessarl fbr efl-ectrr,'e supen'rsion and monrtonng. In all the districts. trainrnc of the COs in charge of the FLHF was done b1 the CHMT wrth the DOC at the Drstrict hospital. The main training objective was ro orientate rhe FLHF on the additional programmes of LF and el'e-care. Training addressed gaps in inte-uration especiallr, hor.,, the problems of the new interventions are recognized. treatment and dosage admrnistration as well as recordkeeping. The ini,'olvement of the CHMT ensures the etllcient use ol resources. The main challenge to training rs the erclusion of COs that are posted to endemrc areas. CHMT planned and included CDTI -l in the District budgets and the council approved. allocated and released tunds fbr all planned acti'"-ities. There were no IEC matenals in anr of the levels despite the tact that ther had been prorided earlier on. Perhaps integrating rhe HSAM into some other programmes such as malaria could be considered. Besides Lushoto. monitoring and superl'lslon activities were not documented nor w'ere checklists used. But there is an annual report. which rs ar.ailable at the district health office -uiving details of theactivities. Ivermectin quantln was sutficient. timeh delivered by' the coordinator and kept in the hospital store at the district. It is integrated to the other drugs within the district. All the DOCs are emploved b1 the public sen'ice and are permanent. Budgets are allocated tbr each of evecare and LF prosrammes hence bringing some tunds to the basket it as well. .{ll budseted and approred funds were released l00ozo depending on the requests tiom the prosramme tbr actir,'rties. Tw.o motorcl'cles are ar,,ailable at each district and used by the DOCs. Thel were tunctional. adequate and used tbr programme activities. Geo-uraphical corerage is l00ozo in all the districts and therapeutic coverage ranged betw'een 7i-8-io'o in 1003 and 78-8lozo in 1004 The projects pertbrmed tar above the minimum lel'el and has etl'ected all the recommendations made in the evaluation report except the issue of motivation tbr FLHF facilities and reward svstem tbr the COs that perfbrm creditabh well. 'fhe other w'eakness that needs ro be addressed is documentation of activities. There are t'e'r.r records on activities at this level besides the annual report- which in anr case summarises the entire vear s pertbrmances. 3.I.J FLHF Despite progress in some areas such as training. Mectizan procurement and distribution. as well as health education and sensitization. some of the recommendations of the evaluators are still to be addressed. These include absence of written plans. w.hrch has made it ditlcult tt.r obtain er,'rdence of actir.'ities at this lel'el. All though oral er,'idence and outcome indicate that processes were tbllowed but not documented. A similar obsenation w'as made tn the caSe t)f monitoring and supervision that were carried out most often when the CDDs visit the health tacilitl since their abilitl to reach our to the villages is limited b1 the lack of transportation. An explanation is that monitoring and supenision is done as soon as the distribution was over within three months. The entire exercise was often orer within three months and was never rerisited until the next round of distribution. There are t\ o CDTI implementation durations in Lushoto district since additional endemic areas w.ere later included. Of the ten wards under the CDTI prosramme. -i rillages w'ere enrolled at the beginning of the programme and the other 5 rillages vvere enrolled tnto the programme in 100-l tbllowing a REA exercise rhat indicated that ther were endemic. Motir,'ation of this level is poor and ther, seem overworked. One health tacrlitr was sir,'en an award as the best health tacilin. i.l.-{ Communin As usual the communin pertbrmed extremeh'well in all the indicators used. CDD5 w-ere selected. mott'u'ated in some communitres and the service delivered in all the communities and their cLrnstttuent parts In Lushoto CDTI was said to be a perrnanent agenda in the r.illage committee meetrngs. r.rhrch rs attended br,'r'illage health committee Commr-rnities are highlr educated and sensttized. Thrs rs demonstrated by communitr acceptance to panicipate in treatment and the commitment bl CDDs to serve t-ellow communitl l+ members despite lack ot'cash rncentir,'es. Recognition by the t'ellow communitl' members is seen as motir,'ation to continue working. CDDs w-ere !'err' innovatir,-e and were able to keep records tbr other drugs includin-s albendazole. which w-as not in the treatment records. Thel were alsr.t able to handle other health related activities e.g h,mphatic tilariasis. eve care and registration of nevr births. deaths and other marernal records. CommuniN moti\ation of CDDs br means other than mone\ was seen in some communittes-- exemptit'rn tiom communal work and also allowed to skip the line when going to seek treatmenr at health tacilities. CDD attntlon rate was almost zero. and marnly due to death or moving awal of a CDD. The balance betw-een male and tbmale CDDs at the communitl level is ver-!- commendable. How'erer. communities are unaware of the decision-making powers in selecting as man\ CDDs as they see necessarl. CDDs whose sub-villages have more households complain of the workload and there was no svstem in place to deal with refusals. those who absent themselves during treatment and those who use taking alcohol as an excLISe fbr not taking drugs. Some communit-v members and leaders still think onll' CDDs and onchocerctasis cr)ntrol staff are responsible tbr programme activities e.g. maliing measuring sticks and some communities do not have incentive schemes fbr CDDs. 3.2 Strengths, Weaknesses and Opportunities 3.1.1 Strengths -All the issues raised in the er,aluation tindings have been properlv addressed. Budgets made were realistic and the tirnds released. The stren-uths of the District level lies strictly in the abilitl ro integrare CDTI into the health svstem and to include the DOC in the CHMT which enables the sharing of resources at this Ievel. The project in Tanga is self--sustainable once Mectizan is available to the project. Communication is ven good in the area and most people could be reached at the distnct level br phone. This mav not be the case with the FLHF level where the roads are poor. The health personnel at the FLHF are rrained in CDTI activities are integrated even at the FLHF level where training in LF. onchocerciasis control and evecare are done at thc same time using the same resources. Therapeutic coverage obtained tiom the Distnct records ranges between 7?oro and 83% but most FLHFs do not have summan sheets to calculate their therapeutic cor,'erage tiom. Coverage is good so tar. but care should be taken to ar,'oid complaisant innor,'ation and motivation to reinlbrce the current positive trend should be intensified. 3.1.t weakness The main problem here is the weakness of the FLHF level. w'hich is understafl-ed and ignored but which remalns crucial tbr all cr)mmunlt\ particlpatorr inrenentions. The main sore-polnt at this ler.'el rs documentation of actir,'ities and events. especialh at the FLHF lerel. Documentation of plans and activities are important since they sen.e as ref-erence. Monitonng and super','ision of activities vrithm the village \4,as not t-easible tbr t\ro reasons: most dispensaries had three personnel and were too busr, to go on outreach I'rsits and sublrllages were tar apart and were so situated as to make reaching them diflicult r.rithout transport r ehicle. {lthough this ler,eI has mandate fbr outreach 1_i actirities. the resources and skills are not ar,-ailable fbrthem to can]'it out. There were no IEC materials at the FLHF and communitl levels. posters were not seen. It is advised that IEC materials be integrated rntt-r other pre!'enti\e senices. People tend to pret-er tace-to- l-ace communication. 3.1.i Threats There is an obr.ious threat to the project. posed b1' the addition of new programmes without rer,'isiting takrng rnto consideration the carn'ing burden of the FLHF which is short-stafl-ed and has limrted capabiliry fbr outreach lmonitoring. supervision. social communication and negotiation). There is need to strengthen the FLHF to enable it take on these additional responsibilities of health education. advocacl'. sensitization. mobilisatron. supen isron and monitoring. It will be noted that at the implementation level. add-on programmes tr) cL)mmunity'-directed interu'ention is much more complex and raises additional demand at the district. FLHF and communit-l' level. These demands are hardll noticed at the national or regional ler,'els. The adds-on could be a threat fbr CDTI activities if this level is not strenglhened. If APOC w.ere to cut its contribution. CDTI activities could continue if Mectizan w.as made available. i.2.+ tles The presence of CDDs is an opportunlt) to achreve numerous health objectir,es. e.g malaria prer,'ention- hlgrene water and sanitation. enr.'ironmental protection. micronutrient initiatir,es. child protection. health and demographic surveys. and health education. The integration of LF has had a positil'e influence on CDTI as those who were initialll' reluctant to take Mectizan were happl to take it when Albendazote was added. For the FLHF to address a wider range of communitl health interventions. training in sensitization. communitl participation. and negotiation skills should be parr of the content of training fbr FLHF stafl'. There is opportunin to integrate a social worker in the staff at the FLHF tacilrtr The cender balance in implementation at the communitl level is an opportunin tbr sereral additronal interventions. The attitude of all partners at both the communitl and health service is ven positive. A f-e'* cases are worth being cited. In Soni. Lushoto District health talks are -eiven everlTuesdal and Fridal betbre consultation and treatment. The CO and his stafTchose a topic to discuss. such as LF. Ei'e care CDTI etc. as some of the topics. He reported that people. especialh women camc \ery earh not to miss these talks. This will be excellent fbr others to emulate Hovrerer. not written records were al'ailable. so. it is not documented as well. .\ tbrmer rillage leader rn Lushoto district continued to supervise the CDDs and to ensure proper records were kept er,'en w-hen a new village leader was elected. Another case is the selection of a student CDD tbr a boarding school in Lushoro district. [n some tacilities. CDDs are gir,'en pret-erential treatment to show them recognition ar the FLHF. This is an innor,'attve l!'a\ of motivating them. In another the DOC ofters a handshake to those who do well. -l .{ctions that were ln order to har,e eas\ access to documentation at the FLHF le'"el. we sug-sest that a "Counter book" be pror rded tlrr each FLHF tc'r enable them document acti\-ities lincluding but not exclusrr,e to CDTI) tbr easl ret-erence. ') t6 l. The FLHF lere[ should be strengthened to enable it withstand and plal its role in communitr drrected inten ention. l. Distncts should encr)urage the FLHF personnel and district staff br,' rewarding -uood pertbnnance and initiative such as the CDDs who introduced a column on the regtster to accommodate new inten,ention programmes. i. There is the need to harmonize difl-erent requirements of onchocerciasis. LF and evecare as well as their dif}-erential endemicities in the various districts within Tanga CDTI area. l. Prolects should der.elop communin level registers. which incorporates the requtred intbrmation tbr eren inten'ention in an inte-urated tbrmat within the same document. -i. The CHMT data management could be turther simplified when computerized ro enable data entn. stora-se. analysis and retrieval. The skills fbr computer-aided data management should be inbuilt into the CHMT. 6. Periodic replenishment of training materials should be taken seriously b1 the region or distnct. hut srmplified to suit the needs of FLHFs. Translation to Kisr,rahili. harmontze the three or more conditions that will be addressed at the communih lerel. Some of the health personnel reported that a couple of village leaders would not caIT\ out health education tbr their communities because it was --the health personnel had been paid" to do so. HSAM should correct these impressions and also address rumours that may likely' harm project actil.ities befbre it becomes too late to do so. For example a f-ew who refused the drug because of alctthol or in the belief that it induces impotence should not be ignored because these are rst'rl21gc[ or exceptional cases. ll t5. CONCLTISIONS AND RECOMMENDATIONS 5.I CONCLTTSION Three districts were monrtored rn Tanga CDTI proJect tbr their abilitl to implement post- APOC sustainabilitr plans and to address issues raised in the evaluation reports. Tanga CDTI has within tr,r'eh e months of implementation of their sustainabilitv plans being able to address mo.st ol the issues raised by the evaluators and har,.e put in place a highll sustainable project in all the three districts with each level of the implementation chain play'ing its role. The Tanga CDTI project is well integrated into the health svstem and sustainable at all le'"'els. The main weakness is the rnadequate documentation that was obsened at the FLHF lerel. The addition of LF and evecare programmes ma\ pose a threat to CDTI implementation at the FLHF unless adequate measures are taken to strengthen thrs lerel to take on the burden. 5.2 RECOMMENDATIONS It is recommended that l. The national Health Infbrmation Management System (HIMS) tbrm should be expanded to include CDTI. We understand that this is being fbllowed up at the national level but we are not sure if this can be etl'ected atthe distnct levell. Motil'ation of the FLHF personnel is important and should be encouraged as parr of the programme 3. Programme implementers should be note that add-on is not the sarne as integration and that the latter is more demanding and at the communitl ler,,el could be demandin-u and compler. requiring data compilation using the same resister tbr difl-erent inten'entions. +. Top lerel programme planners should recognize the pivotal role of the FLHF in CDTI and empower it rn order tr'r maintarn current strength 5. ^{POC should check ltem -{ 9 in the tool fbr monitoring which seems out of place and inappropnate tbr this ler,'el. Similarll ltem 4.1 I on coverage should be re- eramine fbr appropnateness at the communi& [er,.el. 6. APOC should commend the Tanga CDTI project tbr its achievemenrs within one rear in implementing the sustainabilitv plans. r8 APPENDIX 1 TOOL FOR MONITORING OF CDTI SUSTAINABILITY PLANS MONITORING IMPLEMENTATION OF CDTTI STTSTAINABILITY PLANS INSTRTJMENT I ( State/Region/Prov ince ) COTJNTRY PROJECT NAME NAME OF THE STATE REGION PROVTNCE r \\,/ \\l-\ i\\trrrl-t ,;Rt)ll (-i I \\(r \ DATE OF COMMENCEMENT OF CDTI DATE OF EVALLiATIOIT- D\TE ()F C(]IVIIVIE\CEVIE\T ()F SI ST\IN\BILIT\ PL \N IVIPLEVIENT\TI()\ DATE OF ASSESSMENT OF SLISTAINABILITY lt;()() i t;i.7 : t\l i lr)ir< PLAN IMPLEMENTATION NAME OF MONITOR Instruction Chcr'k rmplementLttt()n ()/ \u,\tLttnLthrlrn plttn LrnLl verth vrhether L.()nstrLynrs eorlrer rtlentrlietl ure hetng ret'rtliecl 1l.st,,het'k tt ket CDTt dcttt.rttes tTrLuntns. ,\lonttttrrng antl Supen.rsrtl,tt HS.1l'l uncl llec'tt:ttt1 pr()L'urement LtnLl Llt.\trthutro,l) Ltre hetng tntpletnented us planned STATE/ REGION/PROVINCE 1.I PLANNING I { )()"1 Characteristics of the indicator - ls CDTI rntesrated lnro the overall health servrce plan" \ i . I f, Does a detarled lrst of CDTI acrlvlttes exlst lncludrng the dares when thel wrll be carrred oLlt'r - \i. Sources of information . Intervrews with polrcr makers and managers at thts level . Inspectron of CDTI plans. l9 Findin"s. Descnbe the situatron (+comment on leadership at thrs level) llll I \,)i.RS;1 lP \l)Pi \R\ ,-,'\i* -.\lil .\,,rir\.,, \\,) )ri;r, \iil|,{)\\\;i,lr,,lt \l(.(irrr)l ,i-} PRrtt,R\\,1\,11 -li! \'lrk:r, ,\\ \ \ll,i\tr.) t,l r{) r,},llr)\')Pll\ *rllt'l l\ \(}\\ -l l\r'r '1.,\\\r '. J,.. .., 1.\r \r ir,\r\ \i l-l\t \itt Il:\P[_r-{\:L\\l llillttr,lt)\t- \\ I I i1( ), : \Pr,1;i; r, i \lFi \i{xr\i; r)\ >lrr){ll Ii R\l fJl \i:r li\ f r)r1 \t I i r ,l\\r (-)[ [\i, ., \. 'i.l.r r \{it \\}Lt lL \\\, [) Irr(.,[ [tll it \\llil r):-lii R ill \r ili \l\'--'ti: \ri\.r \, \\\r ;'lVI r)r i\l(ll'l()\ \\irl. I)l \\\i i)\('.:\:i'it \?\RIl\ tl \:lri) i liilt rJri,.' \.;'R \. rro\' a( r,Il:l'R\B\ I;1. itF(;it)\ If plannrng was not done grve reasons wh\ Suggest steps to be taken to lmprove srtuation 1.2 HSAM (Advocacv) \( ] -' \irPl .(. \Bi * Characteristics of the indicator What was the objectrve' r' \'r r\ i i\; l)r-(.( )(.\ \\l\ I \t ,)r-r ,t..' \ L.\1 r \, , \ ,1 \t \-i Rl \, , \ Who was targeted tbr thrs advocacr Rt .. & Rlr\l' \\ f,l \! \ \ r.i 1 1r .! I)( )l i( \ \l \1.,1 rl\ What approach \!as used' \\ \i | \ )'\ fr{ :1 r,i;,1 \ F ^, r.rl \.i \\\; \. \1 I \. r r:r)[ .11, , \ t\ilirrl), r l\r '1,,1,11\\l\ll lirii ll liii:l ir\lr What was the outcome') '<l i' I Ii {r ' i.i . 1\\. Sources of information o lntervrews wtth officials responslble tbr onchocerctasls at thls level lmanagers etc ) . lnspectron of the technlcal acrivit\ reports l0 Findrn"S DescnbeSttuatton \ r\,|( \! \ \' lill\ l i \i l \\ \rr.)l til :llitI rrit. i\ Il\ir\r, \\l) '\ i\t\rRlr(iN\ \,( ,. \l'-)\ ,)l . \\li \t: .)tP\R1\ll \l\. I{i fl): Ii{l l\irtR\,I \.J{)\ PttLsi.\1,['r \\ r. < \\ r, []\ \lns \\:),xl\ lr_r ilil t,{ 1{ :t)l (ilVi (()\s,riIl i\cil \ \> 'l:{ \, \[ir ''i?i :' j) r.,)t Il\ -.rir Iiri \l i() iR \\\\.1 l1 \l ('ll \,1 t.\\\Ct]> \\D \L\r) \i r.)()lii ri.r ,r<Lrt;t<\r'\,lt \l \ l\\! p,{r rl){ r il) \. D()\{1{\i \:;-,lt)l I()li lT: \\, ,. I' \\, l. , ,.:i rl<\,ll [) \r {\ \\h.1. \\ i. il(\\\, \ll:) j1)lr)\\ r [)[) r., -R,'-ir)\ t-ir,ir 'ilr R \ '' I '" .'." rr \r,[ \\l) I ,)\\ iiFL! \\l \ l-rI r',)\li'|rl]lr,\ (it.l(;\\. \]R(,\\r 1.\ii(jl [l;)f ()R \t')\()( \( \ \\ \\li)i.11 f r)R. iFiL ;. \r iri;\ \\[ \, lj\,(-tl ;\:l \ \[:]\[[';) I(j i.\\i FjF;]\ ,i ]if( I'lVL l\ t_\li\\( :\(r ' \\(; \ r. )ir [)ri.()(rk \\l\1, If advocacy w'as not done grve reasons wh\ \(lI ti)[)l I( \Bl Suggest steps to be taken ro tmprove sltuation I.3 MECTIZAN Characteristics of the indicator Is ivermectrn suppN sutlicrent (adequac\')o r I .. Is the delrven of lvermectrn trmelr (tbr drstnbutron)'r \ r s ls rt rntesrated tnto drug delrven s\stcm') , \ , , \ \ Intervrews wrth otficials responsible tbr onchocercrasls at this level (manaqers etc ) lnspectron o t' techn tcal repons records a t',,ir r Frndrngs Descrrbe rhe \lijt\ir\^/rr I I [(l\,i()\ \\l,t Ii. R', \ L r Vr \ t\ r\\i\t\Ru\\ .'r,i ii,\ :r :\:il \l sltuatton- \:. \' \ii \ll( Il,/ \\ \l 'rPt \ \\ \( l\ l'(rR \ ti ) \\:l'i{ ^ ,ir,t ii\\l\!r !\.illr l,i l; \l(i '; \\) It{\\\\11-"il) I ii; 1 11i,1 '\^\\,''[\(ll\\\*. r") Ir,]-ll t)l\l-illrl'\\i)it\l \l i\ \.1 F( ,/\\l\ . ,t \ r:li?1.-r, r,\1\i; ,{, rr1{ r\ \, \l \.{l lr()i \i \ i.i<i }\.1 \\ljt-R: '.,'\{rri }ri (ir.)lir l, r)l\'iilr l\ ,lii:l)-r,\i ).-:l\l-il\ ) ' .ti li\lr\r r), I l)Rt)t,ii\\l\l[ \1\li. li\tr[()R Il.i i r:R_\, 1l\,lf \\ r \\ \,\iir i\ \ r(rli\l,i) i\rr,'ill \\il()\\i i)Rltr,)rrl\ii.\ Sources of information If rvermectrn ts nor avatlable tsutllcrent. trmelr rntegrated)gr!e reasons wh_r \rr' \;)l)' ,r \li; I l I o i Suggest steps to be taken ro lmprove srtuation I.{ INTEGRATION Characteristics of the indicator I Resources Mentron the resources (e g transpon statfl that are shared between CDTI and other healrh prosramme actlvltres (e.9. EPl. malana- HIV AIDS) Activities Lrst the actlvtttes (e g. Mectrzan procurement and suppN. supervlston and monrtonng and trarnrng of lower level staffl carrred ouI ln an rntegrated manner wlth cDTI Findings: Describe situation:{i' -.. PPI li. 31 \ \, \\l( r\( ,i Iil,\1 \l; \ll(;i r|\\, -{ rrrll;),\ \i: )l( Sources of information J Intervrew of staff at thrs level i al Inspectron ofreports. plans. budsets etc RESOTRCES :)11 l\ l\l I ]\ll(,ii\lLl) \\t{ti I " ,'i ,,ir rr,li \\1\1, . \i {-, I'l()\ liL \\:pr)r{- j\ \r-t 'i.,,)ri.. i,,ri\.:i(}\,)l \ \lilr )l \ \( l\ ;i\ (l) \\ ,-, \ \ :i \li \l13. R't[" li] R]l\l- \ Jii \\\,-/(lli I \: t\:1,\{ti_r) .r lli,'\lr \Rr_ \('il\ ITtt..\ \ , \ { }{ )Piri\ \ i lr ,\ \. :t r ir \k i { lr) \ '' 'rillr(,ii\\,\l \.r "\ :-t l. '. r,rrl{\t\l\)\ ll<\\i\t, tl:,,rrlii) r,}l rrl-r()\ '' )[li\l\,i\ , I I \iti .r:\."r1 ,i.irrlrr\\. (()()ili)i\\it)R \\i1()ii,{.1i, i ,Rr)(,1{l\,\1,s:.r,i \.:il llr. il,. ,r\r.l itil : tt\11)l . . l, ' rti ili \ i :r 1r,1 r1r. ril lf there rs no ev rdence of integratron gtve reasons Suggest steps to be taken to tmprove \t t f 1111;1-l(' \llt t -) -) I.5 FINANCE Characteristics of the indicator f, Are resources allocated at this level tbr the contrnuatron of CDTI" \ i . - ,A.re resources released tbr CDTI acttVttles'\, - \\ ,l \l \\llt l, f What proponlon of allocated funds , was released' \\ti\ \\ ] \;'i\r;;r .i \, i\ll( i I , \alii,l I , )r r{,\,\ ',i, ,,1 ;{rri . .\.1 \\t, \\ l)l \"i \\r){ Frndrngs. Descnbe the srtuatron l:ir Ri : \ .lr ')(.,i o Interviews wlth officrals at thrs level . Inspectlon of the plans. budeets. documents showtng drsbursement. tbr year of ret-erence l(lR\:) \r \'.'iS\lRl t:l()\\..l\F il'l lr\'): \Ri \ir(\';1..1 ril .r\:ti) \\ \( r'i\il'il\ \r{l r \itRil.l) r)r i \\r) \(), l\ \r)\.\\i.: ,Ji l\, :,rii\ ),l. Iit\\l i-()R \.\\ i)l \\\l J) \(- :\, \ t)f l)i\Jl\()\ i\itt\, .:r\;, I ,,r:.,)qrl\1 .);\l\\_i llr ll\l-r:.1a.)\Rr r,\t\\.li_ll\rrt.r ',., \11' | \1i '. r'\ \ i , rN \\lr i)l Il i)lr \l I (rli :{ [,1 ]l\. t:ir )\ lf t'inances are budseted but nor released glve \t,, \Pp,,1 111, reasons whr Sugsest steps to be take n to lmprove srtuatlon I.6 RECORD KEEPING Sources of information Characteristics of the indicator 1 Sources o[ information r ls data on CDTI avarlable', \ o Are ther properlr recorded and stored') \ r . Are ther analrsed and urrlrzed tbr plannrns CDTI actrvrtles,',r o {re ther relrable'' r )r r \ i \ Are ther tntegrated rnro the normal health record Svstematthrslevel" \ \ \,ii \i.\,(ri, I.\ iirr\ri .\ r\, ,., ..,. ii- ,1 \. . Intervlews wrth officrals at thrs level . lnspectton ofrecords and records s\stem l _l \'1. i"i i \lr r;i , rt rt'. \ri\ i \, l r il Frndrngs: Describe sltuatlon i, I')\l\ i\lii: \.\:l I\ PRilr,{\\l lr\\ ili l\. \ \. ll( )\ \\. l).' :l \\ii; :fr)lt._ (ir\.{r)i '{lii\} i) \\., ',,\iii,\_[i1 \tt)\ I i r)\l ! r\ ,.ir. \r \ t<r,\_l \\[) l)l\i;<,r. \.r.,i\l\ \,.,\ I r:rq, \ {rli\lr:)l\1,, 'k, I ,'rii \i 1 r [) \\ ' i),\']\l \l{\ I \ ,. \lil \: i\ fi r Suggest steps to be taken ro tmpro!e sltuatton I.7 COVERAGE \\ \ll \ili i l()R \l : rli r yR\ . \\\ I( ) ,<l I lill \ ' ,{l ( ()t{l)\ \tt, I'lii iil l)r-;R i \.ll r ' ,\i;: ll: \\t)\it-)\tlrl ii\lt\ r{ 'r.i lf record keeprng is poor gtve reasons wh\ \tt- 11'rP1 ( \tJi I Characteristics of the indicator I Sources of information o What rs the ueocraphrc coverage , ,rr', . Intervtews wtth officrals responsible fbr e what ls the therapeutrc coverage tbr the onchocercrasrs at thrs level last treatment c!cle') \ I , I lnrpa.rron of records tbr prevrous vear Findrngs Describe srruarlon \ r,\, rlt) i \l)l \li( \'ll l \(ri r l\ \i , r :)l\ RIr i: , rl (i)R(}tl\\ { [ :1ir; r r \ri :r . ,i., .]i i\ (,,,,rilil) i)t iti\( \\. 'iil \,\,li \l ,\r..r ii\r-i '\.tR\il. li\')l\'i li ,,. r,irl{r;ir,,1r1 [i-\lLi_\r.,: 'l \l\li\l .)\rn\r i ri\.t]l \ l<l ),)l{'lr:. \ .i,, \ r\l \\,ir}. 'N\\"\{ \ \ ri | \r{i ,. l,lirl: i}il ,i. llrj ' II( . , 'r i r( \r.i lfueographrcal coverage rares are below l00oo and therapeutrc co!erage rates less than 65oo. glvB reasons whr \t)' 1Pl)l it tLlr i Suggest steps ro be taken to rmpro!e sltuatlon l+ t- MONITORING TMPLEMENTATION OF CDTI SUSTAINABILITY PLANS INSTRUMENT ] (District/LCA) COUNTR} PROJECT NAME NAME OF THE DISTRICT/LGA DATE OF COMMENCEMENT OF CDTI DATE OF EVALUATION DATE OF COIIIVIENCEIVIENT O SI,IST {INABILIT\ PLA\ IIVIPLEVIENTATION DATE OF ASSESSMENT OF SUSTAINABILITY PLAN IMPLEMENTATION NAME OF MONITOR Fi l_i TOOL FOR MONITORING OF CDTI SUSTAINABILITY PLANS (Distrrct LGA I Instruction: Check implementution o.f sustoinabilitt' plan und verifl, whether construints earlier identified ure being rectified. llso check il key CDT| uctivities (Troining, Monitoring ond Supervision, HSAM ond llectizun procurement und dbtibution) are being implemented as planned 2.I PLANNING Characteristics of the indicator Sources of information o Is CDTI lntegrared lnro the overall health servrce plan o Is there a detarled lrst of the ker CDTI actlvtttes (monttonng. tralnlng. etc. ) rncludins their ttmtng l Frndrngs Describe sttuatlon o lntervrews wrth policr makers and managers at thrs level o Inspectron of the wntten plans If there rs no plan grve reasons whr NA Suggest steps to be taken to lmprove sltuatton 2.2 TRAINING r Characteristics of the indicator Sources of information o o What \.!as the ob.;ecttve of the trarnrng'' What was the content of the trarnrng', How \.!as the need tbr trarnrng i determrned'' Who conducted the rrarnrng'- \! here was the tratnrng done', W ere trarntng resources etllcrentlr used'' . Intervrews wlth polrc\ makers and managers . lnspectlon oitrarnrng programme a a a a a l6 Findrngs Descnbe srtuatlon [f trarnrng ls not done grve reasons whr Suggest steps to be taken to tmprove sltuatlon 2.J HSAM (Sensitisation and Advocacy) Characteristics of the indicator o Was there sensitrzatton of officrals. oprnton leaders about Onchocerctasts at thrs levelo o How was tt done {approach )', o What \.!as the result" . How manr people were sensrtrzed') Sources of information r Interviews with officials responsible for onchocerciasis at this level o Inspection ofactivitv/technical reports Frndrngs Descnbe sltuatton If sensrtrzatton \{as not done ,rtve reasons wh\ ') Suggest steps to be taken ro lnprLrve sttuatlon )7 2.-I MONITORING AND SUPERVISION Characteristics of the indicator Sources of information o Was there supervrston and monrtonng', r When \{ere CDTt super! lslons and monrtonng actrvttres carrred out, o How trequentlr'' (at least once a r,ear) . Is there a checklrst on oncho actrvitres, . Is rt rntegrated lnto other health care supervlsorr tbrms' checklrst" o Were strengths and weaknesses rdentrtled" o Iil ere weaknesses redressed'' o Were there reward svstems, o Was there t'eedback to those supervrsed? Findings Describe struatlon o Intervrews wrth otllcrals responsible tbr onchocercrasls at thls level . Inspectton of activrn and technical reports as well as monttonng and supervrsron reports If supervtslon and monrtonng were not done glve reasons whr Suggest steps ro be taken to rmprove sltuatton l8 2.5 MECTIZAN SUPPL} Characteristics of the indicator o Was rverrnecrtn suficrent tbr last a rn a trmelr the Drstrrct LGA" o Is rvermectrn supplr rntegrated lnto the normal drug manaeement component of the health svsrem'' Frndinss Descnbe the sttuatron- lf rvermectrn was not sutllcrent. trmeh. and lts i deliven not rntegrated grve reasons wh'u Suegest steps to be taken to tmpro've sttuatlon Sources of information . Intervlews with oflficrals responsible tbr onchocercrasrs and drug supplres at thts level . lnspectlon of actrvrtv,'technrcal reports . Inspectron ofdrug deliven tnventon records drstrrbutron crcle'' Was rvermectin delrvered manner hom the state to 2.6 HUMAN RESOURCE Characteristics of the indicator o ls there an otficer responsrble tbr onc hocerc ras rs . Is s he trarned knowledseable tn a CDTI" Is s, he responsrble proJects or actrv rtres'' lntervrews wrth otficrals responsrble tbr onchocercrasls at thts lcvel lnspectron of actrvrtr records a a tbr other health Sources of information Frndrngs Describe the sttuarron l9 Sug_eest steps to be taken to tmprove sttuatron lf responsrble otficer ls nor available knowledgeable. grve reasons whr or 2.7 INTEGRATION r Which activities (e.g. tratnlng. monitonng) are carrred out .lotntl\ wrth other health programme actrv rtres' . W'hich resources (e g statl. transport) are shared between CDTI and orher health EPl. rnalarra etc. ) Frnding: Dcscnbed thc situatton lntervreu ofstaff lnspectron of reports. log-books etc a a (e If CDTI rntesrated reasons \r actlvittes and resources are not well wlth other health programmes slve Suggest steps to be raken to rmprove the sltuatton Characteristics of the indicator Sources of information 2.8 FINANCE Characteristics of the indicator Sources of information . Are resources allocated at thrs level tbr rhe contlnuatlon of CDTI'- . Are resources released tbr CDTI acrrvitres rn tlme'' o What proportion oi allocated resources rs re leased o lntervrews wrth officrals at thrs level o lnspectlon of the plans. budsets. documents showrng disbursement. tbr year of ret-erence Frndrngs Descrrbe the srtuatron i0 If proponron of resources budgeted. allocated and released ls lnadequate grve reasons wh'u Suggest steps to be taken ro lmprove sltuatton 2.9 RECORD KEEPING Characteristics of the indicator o Are data on CDTI avarlable" r ,Are the) properll recorded. stored and r eas\ to retneve'' I . Are they analysed and used tbr plannrne." e Are they reliable'' . Are the) tntegrated rnto record s.vstem at thrs level') Frndrngs. Descnbe sttuarlotl If record keeprng rs poor gl!e reasons whl Suggesr steps to be taken to lmprov e S ltuatlon Sources of information . Inspectron records. records s\stem . lntervtews wrth otficrals at thrs level 2.IO TRANSPORT ' Characteristics of the indica tor Sources of information o [s rranspon avarlable tbr CDTI acrrvrrres', o [s rt functronal. adequate. and used rn an Integrated wa) \,vlth other health care actrv rttes'- . lntervlews wrth otficrals responsible tbr onchocercrasis transport at thrs level . Inspectlon olrecords. reporrs. vehrcles log-books Frndrngs Descrrbe \ltuatlon JI lf transpon rs nor avarlable tas stated above) grve reasons whr Suggest steps to be taken ro tmprove sttuatton 2.I ICOVERAGE Characteristics of the indicator r What rs the Geographrc coverage tbr past rwo \ears') What rs the therapeutlc coverase t'or last fWO ., eaf S') Frndings Describe srtuarton Sources of information . Intervtews wrth otficrals responsrble for onchocerc ras is ar th ts leve I . lnspectlon of summar-l records tbr rverrnectln treatment and reports If coveragc rates are below expected (-l00oo geoeraphrcal and 6-io o therapeuttc- ) gtve reasons whr Sugsest steps to be taken tr) lmprove srtuatton t_ I MONITORING IMPLEMENTATION OF CDTI STISTAINABILITY PLANS (FLHF) INSTRLMENT 3 Instruction: Check implementation of sustainabili4' plan and verifi, whether constraints earlier identified are being rectified. llso chech il key CDTI activities (Training, Monitoring and Supervision, HSAM and illecti;an procurement and distribution) are being implemenred as planned. 3.I PLANNING Characteristics of the indicator o [s there a lrst of the ker CDTI actrvrtres (monttonng. tratntng. etc) tncludlng datest r Where and when were the\ conductede Frndings Describe situatron Sources of information o [ntervrews with oftrcrals responsrble tbr onchocercrasts at thls level r Inspectron of charts on walls- work plan. list of thrngs to do. \r .iri ' I i--, -- \\ t. ,, r' ri. ,\('1,' I ri','a-' -,)" r.rj ,\!'1., ,''i-Jr."'3.i h.t. .l-a.( ,\.1\ .!.rlr.)C._ll.t!t.1-ri,r)i- ,)l ,l! It,ilk. it,,l(l \r, L'l!. ,,) - .l "'r l-: ,\ ,.\ .i i l\' If plann lng was not done grve reasons whr Suguest steps to be taken to lmprove situation \ ll()l (1i.1 i.\LrJ .rTliJ'1c-"\\'- r. :l(' ru.lllI .,.1.'I .i''u\: I ll ,', to\i \\t-'tr-':l rl.ll-. It'.tr i_li trrl-J rr)()k. !tr)r-Li!'(' r!)r ...1\\ I Jlat-J'tLi \\ Ci -' J.2 TRAINING Characteristics of the indicator Sources of information f, What were the obJectlves .;ustrticatron tbr the trarnrng', f, What \nas the content of the tralnlng J How manr CDDs were trarned', I W ere tratn tng resourccs etllcrentlr used. . Intervrew wrth offlcrals rn charge. of onchocerctasls at thrs Ievel . lnspectton of trarnrng manuals. tralnlng repons. notes etc Findrngs' Describe sltuarton .rll-il-:- '(,L,1..i. |.i'l ' rr' r l!' ,,1'Ir\,!Ji,i.rsr. .rc!.1.t\.- L)l rl'- 'tlJul:rlrtrt' rrl ll-t'c pirr,{lriit.tr)c. i ,-.,,t i ' \r.r'-\-ii.l:--. .,-.. .1.:ll.a,l -.r.r,l- l- rr..1 rr.ihln I ' l',' )r). : .- l.r..r- t ri. lrrL ...1 r,lr, 'lt .'rrl')ll'i|l 1 .ilil' If tralnrng was not done grve reasons whr -l ,l 'l','a Ll-.' i.'l',,i Sugeest steps to be taken to rmpro!e sltuatton I. ..1_gg;." -.-'.,,1,, ] l'li'-'r'l"r ,.ir ,,,' rl Inr,..,lrlu 'L- a'l \'l''ljl'i .' lr ,t'L"\jrlr()t'\ ;'.1'l r* ,-l,rtar-l:tl .i'.].- i' ,rric -'\ r-lJLl- -1\ 3.3 HSAM (Sensitizarion) Characteristics of the indicator r Was there sensrtrzatton of communtr\ and optnton leaders about oncho. at thrs levelD r What was the obJecrtve ot the HSAM" . How was tt done (approach ) o What was the result'r . How man\ people \.!ere sensltlzed? o Who were sensttlzedo Frndings Descnbe slruatlon ; Sources of information . Inter! lews w.lth officrals responstble onchocercrasrs at thrs level . lnspectlon ofactrvrt'"',,technrcal reports tbr If sensltlzatton was not done gtve reasons wht Suqge'st steps to be taken to tmprove srtuatton "', a U'l.,i ,;t'1.-'l'. ,\'( )l \!.e\iii1-. :,tC !\iI\l !{)trll.nlltiu i,5 \\l .1.,,., i :trr. ,l.t r {)[). 11ii11 1li r! -lr r itl'-re!rrL- .( 11'r.r lur l.i,.t :l .,.l,rL."rt.()t- l(, iilt \ Ii.rt. e,tJar\ -\nuC.t {r .1g11 .11ir-r tl,.t*l ce,li*. ir :Jr,*tt rrt'1{: \tt .rt()Ulrl .iCrlt-c)\ \l)i( iii..,rtqr,-t.,rt ll,.c lr:rr .\ l(r 'llltl^ irl.il \lcCt,,,.if; ..irl-1C., -: lart, ,i. , \.tr^\J\ "i:')riiil,lC! .ll..l Il.r\-, \\,1{) Jdl.lti.i :lrtl-..l.rItr. l!.rr.r)1,(, 3.{ MONITORING AND SUPERVISION C haracteristics of the indicator Sources of information r Was monrtonns and super!rslon (M,S) carrled out tbr CDTI reeularlr (ftsp p3n, tlmes ln a \ear)'r o Is there a M S checklrst', o \&ere lVl&S actrvrrres lntegrared wrth M&S acttvttles of orher health programmes.) o What were the strengths and weaknesses rdentr fled '' o Was there t'eedback to rhose super!lsed,) al lnte rvlews wlth persons rn charge at thls level J Inspectron of documented reports and superv rson checklrst etc, ,t+ Findrngs Descrrbe the srtuatron \i,',1,.,rt,'tl . .lq) tr 't-\)r.- t,)r ,-.-t\lL, -.,,'t'li ClCfle\\ .l.ij r\rt-)'-.Ci,te\- \,11..: .t i,.t( i t )\ .,.. 111'1irr6 J,r \ 1\ii aL),1't,,,.1',i: .l-r- ,, 1.. -rrr .r. li-(.jt.\ri()r-:Ll,lt)rl .llrtl \tl()..,-.i!(. .,.':tafi \\) .,lCa\ I\f !\A: 1(li:tiJ .il "ic |' f, ,irt 'l'- i.' . r,'r .iu.,..1-,.1 ".,'t.t\- .,\,r'. \,lft,-\ \ \\1. ,.t(,\\l-lll.-,1 J\ (it-ntC \\<l: Iil1111., Il monitorrng or superrv lsron l!as not done as i planned give reasons whr Sugsest steps ro be raken to lmprove the sltuatron il'. .rl'\'\ \'(,1' )' (iilfa:()ft'h:t' .-.ltl_\f,\('ft.il (ll. t\r)i, 1.] !'nilrle i-t rll -r) .l(, (rl,[l .lic't .]ali\ ll'a\ itL.rruilt: '- :) T I I i'ul'lr'r .r()()(\ \'t()trli lrr .11.., !t,)\,()L'i1 3.5 MECTIZAN C huruc' re r ts t t L'.\ ol I he t nLl t L. Lt t ot. Sourc' e s o/ t nlor nt Lt t t ot1 W'ith reeard to the supplr of tvermecrln f, Are the suppltes adequateo r f, [s rt ordered and dtstribured to the FLHF and the communrtles wlthln the regular i health care sr srem'' Frndrngs Descrrbe the srtuatton f, Records of tvermectrn ordenns and stock I control f Is it delrvered on trme tbr dates of planned ] r lntervrew wrth nurse or health statF ln distributron'' | .narg. \1.'.'iz.r'. r\d: r!1c.i-rrf , ,r-t: ,ir ';t-.-1 .rlid ''.r:u.1 .) I a !tl\,r\ If rvermectrn suppl) and delilerr was inadequate or untimel\. glve reasons wh\ Suegest steps to be taken to tmprove the situatron J.6 HUMAN RESOURCE Characteristics of the indicator Sources of information o Is there a desrgnated person tbr onchocerclasrs controlt . Intervlew with the Head of the Health Department o [s the desrgnated person trarned and . lnspectron ofdocuments knowledseable rn CDTI'' . Is the person able to et'tectrveN combrne CDTI wrth hrs orher communlr\-based health responsrbr I rtres'- Frndrngs Descrrbe the srtuatron irr r l{ lt ,'-. r ,r\,..r' rl .l :''- -.'ti,i.' ! ^r r.\,rit! '(r)' , i ri'J -\'r'tr'l.ll'iI l5 il-:\aC'-,\i'(tl'- l' rll'a- i t"'tf\\..;1r)\l",u l ' .i\ \ a"l'LL ll-| '.--t- lr)' I'.llltr,, I '-L (:lill al,lr()I , ]'llr- lf the use of human resources rs rnappropriate or unsatistacton. tdentlt\ the weak potnts and _slve reasons Susgest steps to be taken to lmprove the sttuatron J.7 INTEGRATION a Whrch acttvttle5 ( e.g tTalntng. monltonng) are carrted out Jolntl\ \elth other health programme acttvltleS') . Whrch resources (e g staff. ransport. space. time etc ) are shared between CDTI and other health programme actlvtttes (e g. EPl. malana etc ) Findings Describe the srruarron i,a rt,lt: lt'\l rl()l'1, -._ l - -.r,. -\_ ,.,1 \.ri-.i. \ .l ilL,:i ,' I J..._ J\ _ ,1 - - --t-.I , .J r..,,l.tilJr.J,) iii .iJ\." \i r---lLlL(',r' .: - ti-_ -:l-'- r ! r[irLri ll'-itllJ. \1.:" .i',tL. ;'r! -..1-i lt-,lt^.i^()r-' ,t. .']Jl-ail'.cl!\,'JI r. ill i r,t.-' -, r., :,'. If ion rs not etlecttve reasons wh 3.E COVERAGE Characteristics of the indicator o What,,!as the Geographrc coverage tbr past lwo \ears'r . What was thc therapeutrc co\,erage tbr the last treatment c.ucle'' Findings Descnbe sttuarron \ r I'!)\\ \ r). - lr:.1 I'r\ .lt-C.j. .i'r)tr,a rj i,':t,liU.l lr. !1t1.' 'l'.- .i b\c!l,lcni r'l) J i .ict:r.r. . Intervte'"\ of proiect staff . Inspectton ofreports. log-books etc r Sources of information Intervrews wrth officrals responsible tbr onchocercrasrs confrol at thrs level lnspectron of summan records tbr rvermectrn treatment and reports fbr prevrous vears a a L lr),li 'ilrl'rr - l_ il "il I -it.l,1 L 1)1" 'll{rt-l'l,il \\t t\.l, .l,rl! ll.-...i1)U,lii. -,)\ -.r.1il-. ..i,ld:\ - " .l\ .rj,:t'u ,,'')(,\. r)r t'rt I r li Characteristics of the indicator Sources of information to be taken to I the srtuatronS If coverase rates are below expected (-l00on eeoeraphrcal and 6-io o therapeuttc- ) gt!e reasons whr Suegest steps to be taken to rmprove sltuatton Ir i , ' i r\).r ,1 ,'.a1)''J i,t,1'.11Jr\\ ,rf\)t'.lJl!r)i- ,rr- ..-il' l!l \ l-'\ i',. lta.::l|a " '-t \i,r 36 DTI DA C MONITORING IMPLEMENT.{TION OF CDTI SUSTAINABILITY PLANS TNSTRLTMENT + (Communitl ) COTTNTRY PROJECT NAME NAME OF DISTRICT/LGA NAME OF STTPERVISOR}- FLHF TE OF COMMENCEMENT OF DATE OF EVALI-IATION DATE OF COMMENCEMENT OF 100,1 I susramABrl,rrl PLAN IMPLEMENTATION DATE OF ASSESSMENT OF il 5-i.60_5 STTSTAINABILIT}' i IMPLEMENTATION PLAN NAME OF MONITOR MABLTBA. ETC NAME OF THE COMMI-TNITI' MONITORING IMPLEMENTATION OF ST-TSTAINABILITY PLANS (Communitv) INSTRTIMENT { Instruction: Check implementation of sustoinabilitl' plan and venfi, whether constraints earlier identified are being rectified. .4lso chech tf key CDTI activities (Training, Monitoring and Supervision, HSAM and Mectizan procurement ond distribution) are being implemented as plonned. {.I PLANNING NOT CRTICIAL AT THIS LEVEL {.2 TRAINING NOT CRTICIAL AT THIS LEVEL {.3 HSAM (Health Education and Mobilisation) Characteristics of the indicator Sources of information o \fr'as there health education and mobilisatiorr of the communitr,'l o How was it done lapproach)'l . What was the result'l o Hovr man) petlple recerled health educatron'l o Interviews with CDDs and communitl leaders and members. . Inspectionofvillage-kept records l8 Findings: Describe situation ih.':e ,i,:. '!'"1 il^ :,:. r.rl r' 111. :i,'r,l -,ii:,r[ rri .1. !,rl]'.rlU.r'i'1. i-,'riI :.r.iiSti-,h"tt;otr Il-i. !\ir\ J-i.r-j,:.\r_f i' l'. .,.i" ''lL.:-'t,j\ Il r.1:..1\\lle tll:-rlLl{i: c.rt.ltttil,llit\ tltcct.l Jl!, \rr:lJl.il./cLl dt iitr-' .itf-r jS. rr"';. \. -t lj<til: ,rl ',1 -. 'rg1rl)li .lCCcli..rj i(, [).ir1 iCl]r.ltg ln ( l) j I^ ,i: rtrntr i rll.igc.. lj'l1!l'tll'i -r'lri-ri1J :It't-- .1|:1 ' l'u'r-l Ltirlctl Iir oc 1t'il.ltctl \1p.1 i1,,1111-lLrlll\ ntc6tne r\ 1\r)ilirl l.l ', - "-Lu -,1 l-':r,1'- -'Jr,i;i:1,'t, l:1 .. ji. !(llrlll'-il.r, r..- ( l)i)r '.r) u.ir" \. - :, lt.:r If sensitization was reasons wh\ Sug-uest steps to be takc.n to improve situation {.{.MONITORING .{ND STIPERVISION NOT CRI-ICIAL AT THIS LEVEL {.5 MECTIZAN STIPPL}- ,--:-- \\il'o .rrSS-.1 \lu\ ,il3[ tha -'ltt.t( ilLifllctl ,,1'(-l) I I rr.t: ^cli trr 1r1g il:- tr I'lCCt 'itu ur':, rri illC ilicit:L,i-lI,' <tltir not done give N/a Characteristics of the indicator Sources of information o \\'as ir.ermectin supph sutl-rcient tbr last distribution crclc.') o W-as lverrnectln made available at the FLHF when needed'l o \\'as ir ermectin collected in a timelr manfler tiom the FLHF'I o Inten'iew's with CDDs and communitl members. I o Inspection of d.rg delivery lnventon' records t9 Findings: Descnbe the situation: l'- .1. ihc -,rnt:trri t l,i. 'L,i':le rini !l ri.inlil\ ,)f .ii.ll'rhi:ic.i !r, -rrn,t'.,1j' : ttL:ll]l1C1.\ lt tit:tt If irermectin was not surtlcient. timelr and its mode ol distribution not determined bl communlt\ glve reasons wh) Suggest steps to be taken to improve situation {.6 HTTMAN RESOT-IRCES nt.'uti,z.I-r \\.1\ i()llccir(l titrl]- I i i if .tnJ Characteristics of the indicator Sources of information :r How manr trained CDDs are there in the communitr '' f, Is there a tair mix of bolh sexes among the CDDs'l J [s the workload tbr each CDD cr)mpatible'.' vr rth eflicient distribution ol rr.ermectin 'l f, Are the CDDs well motilated'.) J What is the anntion rate amonr CDDs ''] Inten'ieu with CDDs and members communtt\ +0 Findings: Describe the situation \i lc.isl I t'[)[)r J]'r' r'irrltcLl rn eJCh :Ll'r-,.,iiage - {}ne n.iilie- thc,r:ircr lcrlllc litu riork- oaii l'cr- ( I)ll \ -ll"c\- .r. 'i-. 'rillltl.Cr' .,1' .1,)rl:.'.t,rlil pcr' :u0-r illl,:r r;rtcr rirrn-. iu--: in ;irc utlillllltlllrLle. ll,itll'.','-,''l ..ll-tPC3a- Tll,:i J\)l1l:tlLiil:t:c\ \\il-c Ir),.1\\llrt Ili.-il lhcr c,_-ttlcl I'ui'-..r:u' 'il- r',tt'i'.1 il )r :'c' \[,'-\.,r.rge Jcl-rtt'.in:S,,t' tlte riirt'1.-ir).iJ ( i)t)..lt.c itrghlr l'1rr1.r..iicti^ u ! il'irlt : ,-lt-;-r1,,,'1 fi'trtli .rrn"llLtit:l-\ \\r)1.l\. ir].r'lcfc'tt,J' lfc.itlltCnt iti I I il1.-)_ :ifC l'ce \lgllit jr-rl'" thc l'',iii-.rit:- :i.It'\ r't'ui.\ i. Jntl ll'rlnt rhc ilrct titirt illcl \jr-\ L- :ltclr- lcllovi r(rnllllLlllli_\ :lliillt)ui . \ i.,.: ( .)l): e rpi'.:5 \\ tiiingpe S* t{) l3hu (,11 l-t-,)rC hC,rltl: lr-(}gillp-,-tC r!'sllriliirhlltllc-. .:tl.] \,)r']lu -t- ' i-rcin! se lcctcrl tirr th.':c \1:-ittrtn t. lt..l:1 1;Jl - nt11iitlr Jur.' :ir ._lr,.illt_ ;ll.g-l-t(:_e \\r- -r, .. l: .:,.r-j\ If CDDs are not arailable or are not trained. give reasons'whl Suggest steps to be taken ro improve \dcii:t,tnll ( I)l)\ i'rc s.'1.'cicrj iiir irrrpltLrlllc-\ sltuatlon rr ti,-r ::lh-\. rLitige- l1lrr.ng -i ittr::i 'trtnthc'. ,)l 'tr)-r:-lttri.l: Ig nt'tn! tl-re tirrr:Ci-.\,id t'f )l) r.:1t,, .., ' .rL. .)lrtilhle ,J\ ci 1.7 INTEGRATION NOT CRUCIAL AT THIS LEVEL {.8 FINANCE NOT CRUCIAL AT THIS LEVEL .I.9 RECORD KEEPING Characteristics of the indicator Sources of information a Are data on CDTI arailabrle'l Are thel properlr recorded. properlr, stored and eas!'to access') l Are ther anah sed and used tbr planning.') .{re ther reliable'' . Inspection records- records s)'stem o Interviews with otficials at rhis levela a a +1 . Are ther. integrated into record s-v--stem at this ler,el'l Findings: Describe situation: i ):il.' ,-t-, ( 1l i - .,\ .i.,.r '',. :..I ll-1. ,c\ e I .lt-tl '. 'r11 rpg;11- r'cL\)r-L:e11. 'r' ille tfc.ltlllCtlL i'jgt\tcl'j , hc 1'-',r''..t"tri ii:r\ler . rr-ir.etci,i \\r-r-,r' ,\r'll-tr.r"ttcn ,iitrt rrcll-i...'l-rt \ crrtnn:Luu:tc- ltat\ j r-t:t.i thcr:' rlt!il:lil\ ! l\, r'-e(rr.i t'tttni.,cr- .rl i-rcrrnic fcCc'r\ ltlS albctiti.rzt.llc l:t lhc \xlitc ''iglitel-\ If record keeprn-u is poor si\,'e reasons wh) Suggest steps to be taken to improve sltuatron {.10 TRANSPORT NOT CRTICIAL AT THIS LEVEL {.II COVERAGE Characteristics of the indicator o Were all households treated rn the last distributron cl cle'l o Were all eligible persons treated in the last distribution crcle? Sources of information o Interv'iews with CDD and communin' members. o Inspection of summan records tbr ivermectin treatment and reports. u,)illllli"ll-11\ Findings: Descrihe srtuation \u,rrfrl't1: ir. .:1u ,.:a' !,\- .\rlt' t i)[)r .i j. lt(]Lt\eholtl: uu't'. lt'C.ltdtl. I-tll t:l:' !\(l\ n()l 3:ai]'tln'crl ll r ,n' :'t( ''-.ri:'-r':-]r tiJl-\le 1'\ IJ,llj*:.'ri,i ill.'. \\.'l-.i -\\ ..1\! ',1 ".ilt:.t1. JIlrl .:lr:j:ltCj- a.! \!\ r- ' ri)il\ il^.CIl.r..r .li_l. 1,, ll'lli j,^ .lr ?l If household cor.'erage and therapeutic cr)\erage rates are belo$ expected g[ue reasons w-hr Suggest steps to be taken to improve sltuatlon +_l