Tanga focus CDTI annual project technical report submitted to Technical Consultative Committee (TCC): 1st January 2006 to 31st December 2006

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE ffi ORIGINAL : English ! COUNTRY{NOTF: TANZANIA Proiect Name: TANGA FOCUS CDTI PROJECT Aqproval ve?rz 1999 Launchins vear: 2000 n.rr.tirr f..lm: From: I't JANUARY 2006 ro: sf'uTCEMBER 2006 ear) ( Month/Year) Proiect vear of this report: (circle one) I 2 3 4 5 ( 6) 7 8910 Date subr4itted: NGDO partner:HELEN KELLER INTERNATIONAL n,fCU : IAPOCFor To: cL95 for hfonnotton T",.biR, ffi,,a Y|,Lr,!,l 2 0 Jtjlll 2007 r,.r'.JC/D!L eiH rsI @? h[e % i -=-'THo/APoc, 24 November 2()04 I I t I I t ! i i .L ? i , I I rt ,I H ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAI\ PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I ll WHO/APOC, 24 November 2004 t a ! ! I ! : ? L ? - 1 I T T H ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: l I z ? i Country TANZANIA National Coordinator Name: Dr.Grace Saguti Signature Date B[ae lBt : Regional Medical Officer Name: Dr.B.Ngoli Signature: ......1 Date tzl elr:+ NGDO Representative Name: ...ManishaTheraney Signature t4 This report has been prepared by Name: Dr. R.B Maggid Designation : Proj ect Coordinator. Signature Date 2 ,20oJ, Se*: lll WHO/APOC, 24 November 2004 I ! ; ! l Ei ?iI H t !Table of contents ACRONYMS YI FOLLOW Up ON TCC RECOMMENDATIONS .........................1 SECTION 1: BACKGROUND INFORMATION........ ...................4 1.1. GnNBnar TNFoRMATToN ! t L 1.1.1 1.1.2. Description of the project (brieJly)..... Partnership 4 4 7 8 9 ! 1.2. Popu1euoN......................... 2.1. Trrr{rtnrp oF ACTryITIES ...... 2.2. Aovocecy l0 Aovocncv or Rrctouer eNo Drsrruc-r Pouucal/ GovTnNMENT LEADERS wERE DoNE ToGETHER, IN CASCADE wAY FoLLowED BY Wano DEvELoPMENT CoMMITTEE MEMBERS THEN SUB.VILLAGE LEADERS.............. l0 2.3. Mos[EeuoN, SENSITIzATIoN ANDHEALTH EDUCATIoN oFATRISKcorrauuxnrcs l0 2.4. CoupruNrrv rNvoLvEMENT................. ............l2 2.5. 2.6. Capncrv BUILDING ... TnnerutpNrs............... .......... l3 .......... l5 2.6.1 Treatment Jigures ...... I5 2.6.2 What are the causes of absenteeism?... l7 2.6.3 What are the reasons for refusals?...... l72.6.4 Briefly describe all known and verified serious adverse events (SAE) that ... l7 2.6.5. Trend of teatment achievementfrom CDTI project inception to the current year l9 2.7. ORoennrc, sroRAGE AND DELTvERv oF TvERMECTIN .........20 2.8. CorwuuNtry sELF-MoNIToRTNG eup SrexeHoLDERs MerrrNc ...........21 2.9. SupBnvrsroN ..............21 2.9.1 . Provide a flow chart of supervision hierarchy... ........ 2l NATIONAL LEVEL- NOTF., 2I SECTION 3: SUPPORT TO CDTI ....,.....23 Eeutptrteur ................23 FnqaNcnt coNTRTBUTToNS oF THE pARTNERS AND coMMUNrrrEs............... ............24 Yren 3, US$12,668 nrrerNep By WHO-FoR CAprrAL EeurpMENT (rnou APOC rRUSr ruNo.) ...,,24 . Yren 4, US$4,690 RETATNED sv WHO-roR THE rURCHASE oF THE Brcyct,es. (Fnou APOC TRUSTFTJND.)................ .................24 . YEAR 5 US$ 13,8& RETAINED sv WHO-roR THE eURCHASE MoroRCycLES. (Fnorra APOC rRusrruNo.).... ........24 3.3 OrgER ronus oF coMMUNITy strppoRT......... 24 3.4, ExpBTvoIruRE PER ACTTVITY ..........25 SECTION 4: SUSTAINABILITY OF CDTI- ............25 4.1. IurrnNer; TNDEIENDENTpARTTcTpAToRy MoNrronrNc; EveruATroN.. 25 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable) NONE. 4.1.2. ltrhat were the recommendations? NA .......... 4.1.3. How have they been implemented? NA......... 25 3.1. 3.2. I ,..,........,,.. 26 ......26 lv WHO/APOC, 24 November 2004 i ? * ilI I E H ]l i ! 4.2. SusrerNesILITy oF PRoJEcrs: PLAN AND sET TARGETS (uexoeroRY AT ..26 Yn3) 4.2.1. Planning at all relevant levels...... 26 4.2.2 Funds ................ .....,..,26 .,.,,...,26 4.2.3 Transport (replacement and maintenance) .........r.....r............ 26 4.2.4. Otherresources.... ,.,26 ...26 27 27 27 27 27 Authority has supported CDTI activities. .......... 4.2.5. To what extent has the plan been implemented....... 4.3. INrrcnettoN 4.3. l. Ivermectin delivery mechanisms 4.3.2. Training..... 4.3.3. Joint supervision and monitoringwith other programs..... 4.i.4. Release offunds for project activities Funds are released through normal channel according to budget line ilem and every responsible part plays its role. The responsible part in our budget is APOC, Council, Government and NDGO.... ,,.,,........ 27 4.3.5. Is CDTI included in the PHC budget? .......................27 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achteved. What have been the achievements?.............. .................. 27 4.3.7. Others issues considered in the integration of CDTI. ...................27 4.4. OpeneuoNAl RESEARCH 28 4.4.1. Summarize in not more than one half of a page the operational research undertal<en in the project area within the reporting period. ...... 28 4.4.2. How were the results applied in the project?.............. .................. 28 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES..... STRENGHS....... WEAKNESS...... SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS 28 28 28 29 v WHO/APOC, 24 November 2004 ? ! ? Ir6 i i& * * tri+ l,- Acronyrms I t I , ! APOC ATO ATrO CBO CDD CDTI CSM LGA FLHF MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.INICEF UTG wHo African Programme for Onchocerciasis Conhol Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distibutor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Frontline Health Facility Ministry of Health Non-Governmental Development Organization Non-Govemmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization ! vl WHO/APOC, 24 November 20(X + -i ? .* E :-t $ IT IDefinltions (i) Total population: the total population living in meso/ttyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper-endemic communities in the project area. (iii) Annupl Treatment Objective: (ATO): the estimated number of persons living in meso/tryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ulti{.natg Treatment Goal (UTG): calculated as the maximum number of people to be feated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally thg project ihould be expected to reich the UTG at the end of the 3'd year of the project). (v) Therapeutic gover?ge: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geqgraphical covefage: number of communities treated in a given year over the total number of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an atea are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Cor-nnlunity Self-monitoring, (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), I ! ? vll WHO/APOC, 24 November 2()04 I LI? .t" a 1 with a view to ensuring that the progralnme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. I I t I I ! ; a : !I ie ?i TI I T tl: a I T ! I I I I vlll WHO/APOC, 24 November 20M IFOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session22"d Number of Recommendation in the Reoort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FORTCC/APOC MGT ASE ONLY 135 (i) Provide the information on what actually happened to the remgining 69,002 tablets i) Normally remain tablets are stored at the Regional Pharmacy waiting for the next distribution cycle, hence 69,002 Mectizan tablets remains were handled in the same way. 135 (ii) Document the support glven by communltles The project has started to document support provided by communities especially those given to CDDs i) In some communities CDDs are exempted from Community development works. ii) Communities provide venues during rainings iii) Communities are proving/replacing worn-out treatment registers and measuring sticks. 135 (iii) Provide lnformation on monitoring Monitoring of CDTI activities are integrated in the Health System where by the Regional Oncho coordinator is a member of RHMT therefore she do monitoring using developed integrated checklist. This implies also to DoCs who members of CHMTs. But occasionally the PC and DOCs may conduct spot check supervision. r35 (lv) Provide more information on integration of LF and eye care In this report more information has been provided on integration ofLF and eye care. The lacking information in the last report are as follows i) The coordination System from Regional up to FLHF is the same. Person who coordinates Oncho is the same coordinate LF. ii) CDDs are distributing Mectizan and Albendazol at the same time. Also they are using one register to conduct this exercise. CDDs have trained to identiff early stage of eye problems in the community and later advice them to attend clinic at FLHF. WHO/APOC, 24 November 2004 H I l 2: j : : ? ,i ? .t ?I I t*t I I T I t I I 135 (v) Erplain why the percetrtage of communities with female CDDs was 48o/o in Lushoto and 100% in Muhezs and Korogwe In Lushoto most of the women are very much involved in family caring therefore they are much involved in cultivating and sell of vegetables in the market so they don't have time to participate in CDTI activities. Also in some areas in Lushoto district women have no decision in deciding anything, it is only men who decide everything and many village/sub-village leaders are men therefore in community meetings where CCDs are being selected only men who have the mandate to talk, therefore they tend to select their fellow men to be the CDDs WHO/APOC, 24 November 20O4 I !Executive Summary Implementation of CDTI activities enters its six year in Tanga CDTI where by Muheza, Korogwe and Lushoto are three districts among seven in the region were the implementation is taking place. From the time when CDTI activities implementation started in Tanga Focus in 2000, the main objective was to establish an effective and self-sustainable community based ivermectin treatment for Onchocercasis disease in endemic communities by involving community members in decision making. Up to now the objective is well achieved as the project is implementing CDTI activities through the sustainability plan. In 2004, Tanga CDTI Project integrated its activities with the Lymphatic Filariasis Elimination Programme, which adopt the same method of involving community members in decision making on how run the project especially drug distribution. Parallel to CDTI and LF the community members also take charge in primary eye care activities and many other community prograrnmes. There are 1309 communities in Hyper and Mesoendemic and all were treated. The population in this area is 313,242 people; where by ATO was263,124 people. Out of this 251,144 people were treated makes the therapeutic coverage to be 80%o, which is almost the same compare to the last year. The project attained 100% geographical coverage. Project UTG is 263,124. The Region receives 4,040,000 Mectizan@ tablets for both onchocercasis endemic communities in Three Districts (Muheza, Korogwe and Lushoto) and Lymphatic Filariasis Elimination in other four Districts within the Region. Total of 660, 085 tabs were sent to Oncho endemic areas and out of this 603,145 tabs were used, 56,932 tabs remained and 8 tablets were wasted. The project has remained with the stock of drugs amounting to987,312 which will expire in July 2008 but will be used in the coming heatment cycle. In this reporting period, total of 2624 CDDs and 55 FLHF staff were trained /retrained, more emphasis were on proper data recording and keeping, how to update census by registering permanent resident only and the need of filling summary treatment report form on appropriate time. The CDD/Population ratio is I CDD per I 17 people were by there is increased of 5 people compare with the last year, Major Challenges and how they were overcome o Introduction of new community programme with different approach by giving incentive to VHw (CDDs). To overcome this problem is to ensure that other Community Based Health Programmes are adopting CDTI method, and use the available resources to motivate CDDs and will make them to be recognized within the community o Shortage of staff in most FLHFs in endemic areas hence unable to perform CDTI responsibilities as planned. This will be overcome by involve school teachers to perform those simple activities o To ensure that therapeutic coverage above 65%ois sustained r I ! I Eo ? fr il tIt t 3 T I I I I I t WHO/APOC, 24 November 2004 SEGTION {: Background information '1.{. General lnformatlon 1.1.1 Description of the project (briefly) Muheza, Korogwe and Lushoto are three endemic districts were CDTI is implemented among seven districts in Tanga region. The Tanga region is located is in the extended north - east Corner of Tanzania between 40 and 60 and below the equator and 370 - 390 East of the Greenwich Median. The region occupies an area of 27,348 Sq. Kms, being 3 per cent of the total area of the entire Counfy. Tanga shares borders with Kenya to the North, Morogoro Region and Coat Region to the South, Kilimanjaro and Arusha region to the west. Indian Ocean borders it on the East. Tanga region have seven districts that are Lushoto, Korogwe Muheza, Handeni, Pangani, Kilindi and Tanga City. There are 37 Divisions, 155 Wards, 701 Villages and many sub- villages. The population of Tanga region is 1,728,988 The number of inhabitants in most of the villages varies between 1500 to 3000 people per village. Their main activities are peasant farmers, as well as few traders. The farming activities are more active during the long rain from April, May to June with the harvest soon afterwards in the months of July up to august. The major ethnic groups are Sambaa, Zigra, Bondei, with few Digo and Segeju and are almost similar to all 3 districts, Sambaa, Zigua, Bondei, with few Digo and Segeju and are almost similar to all3 districts. Also are other many small ethnic groups These ethnic groups speak, their mother tongue, but most of the younger people speak Kiswahili, which is the national language, and has become the most important language in the country, spoken nearly by 100% of the Tanga Population and the Tanzanian as a whole. Few of the population in oncho endemic area are also able to communicate in English. The major religions remain Moslems and Christians. Access to the endemic districts (Lushoto, Korogwe and Muheza) from Tanga and Dar es Salaam is via a good quality maintained tarmac road although the final 32 km winding road to Lushoto District is through mountains. Most of the roads from district headquarter to the peripheral are muddy, rough and mountainous roads which are risky and not easily passable especially during rain season. Other means of commutation are telephone radio call and Mobile phones, which are working effectively from regional to the district level and even to the FLHF /Community in some villages MUHEZA DISTRICT: Is situated in the Northeast corner of Tanga Region, is about 39 km from Tanga town and 310 km from Dar es Salaam. It is the second largest district in the Region next to Handeni. The distict is bounded in the North by Republic of Kenya, East with Indian Ocean, South with Pangani district and West with Korogwe district It covers an area of 4,922 sq.km. resulting in a population density of 55 persons per sq.km. The district altitude is between 0-2000 meters above the sea level, the temperature ranging from 30 - 32 degrees however the climate varies mainly with altitude with Usambara 4 t I a ! WHO/APOC, 24 Novcmber 2004 ? t ?I Ii E D FI ! I ! Pangani district and West with Korogwe district It covers an area of 4,922 sq.km. resulting in a population density of 55 persons per sq.km. The district altitude is between 0-2000 meters above the sea level, the temperature ranging from 30 - 32 degrees however the climate varies mainly with altitude with Usambara Mountains (forest) posing a grcat deal of influence. The district can be divided into three climatic belts as follow; - Coastal belt - Mountains - Low plains There is a series of major and minor rivers Pangani, Zigi and Umba are few of the major rivers, which pour their contents into the Indian Ocean. Mkurumuzi is one of the minor rivers in the District. The district generally gets three rainy seasons in the year, long rains between March and June (Masika) scattered showers (Mchoo) in August and September and short rains between October and December (Vuli) average annual rainfall is between 1000-1500mm. 90% of the population live in rural areas abott20%o of them live in a radius of l2-l4km from the nearest health facility while 80% have to walk a distance of 5-l0km to the nearest health post, and most of them are peasants in which they grow Maize, Cassava, Rice, Bananas, Beans as a food crops. Black peppers, Iliki, Vegetables are the cash crops. However there are big tea and sisal estates, which are owned by foreigners. Administratively Muheza district is comprised of 6 divisions, 24 wards and 174 villages with the total population of 291,324 people according to projection of 2002 national census. Onchocerciasis is found in 328 communities. KOROGWE DISTRICT: Is located in the center of Tanga region, is 87 km from Tanga town and 290 km from Dar es Salaam. It's bounded with Muheza district to the Eastern side, Lushoto district to the Northern and Western Southern part is bounded by Handeni District. The district covers an area of 3,756sq. Km resulting in a population density of 69 persons per sq. km. The district forms a narrow lining to the whole Southern half of the Usambara Mountains. The district is divided into three zones, which have different physical features and weather as follows; - Arid lowlands on the western part rainfall is below 800 mm - Wet lowlands on the south and eastern part average annual rainfall 800mm-1000mm 5 WHO/APOC, 24 Novembcr 2004 l a il i E E FI TI E II I ! Mountainous on northern part with cool weather and more rainfall ranging from 1000- 2000 per year, so the average rainfall of the district ranges between 800-2000 per year, with heavy rains on April to July and October to December within the year. Most of the population live in the rural area and are depending in agriculture small scale farming grow Maize, Cassava, Rice, Bananas, and Beans as food Crops, while Coffee, Cardamom and vegetables are grown as cash Crops. Like other Districts in the Region there are big Sisal and Tea Estates, which are owned by foreigners. Adminishatively the district is comprised of 4 divisions,20 wards andl33 villages with the total population of 273,770 people according to projection of 2002 national census. Onchocerciasis is found in 441 communities. LUSHOTO prSTBrCT. Is situated in the Northern part of Tanga Region, is about 187 km from the regional headquarter where Tanga CDTI office situated, and 350 km from capital city Dar es salaam. Its bounded with Republic of Kenya on the Northem part. Korogwe district on the South and Kilimanjaro Region in the Northwest. The district covers an area of about 3500sq km. Resulting in a population density of 127 people per sq. km. Much of the district lies in the midst of the Usambara Mountains where altitude range is 4500 meters above the sea level. The District divided in two physical features the highland, which cover almost 75Yo of the land, and is characterizedby cold weather and the low of 25Yo, which is having a hot weather. An average amount of rainfall is I l00mm with heavy rains mainly in the months of March and May which is the wet season, from June to September is cold season with the temperature dipping as low as freezing. The dry season is from October to March. More than 80% of populations live in rural area and are peasants engaged in small-scale farming and petty Business. Main food crops are Potatoes, Bananas. Rice, Maize, Beans and Cassava. Cash crops are Vegetables, Fruits, Tea and ginger. Administratively the district is divided into 8 division,32 wards and 163 villages and have the total population of 432,568 People according to projection of 2002 national census whereby Onchocerciasis is endemic in 540 communities. Korogwe and Lushoto district hospitals owned by government, while Muheza District hospital owned by the church as a District Designated Hospital (DDH) perform district hospital services under special agreement with the govemment. DMOs in collaboration with CHMT members are in charge of all health facilities, both under the government, private and Faith based organization. Disbict hospital is responsible to deliver drugs to health centers and dispensaries that are under govemment. One of the Health Sector Reform policy is to strengthening Public Private Partnership (PPP), in the places were there is no government health facility the drugs like vaccinations and Mectizan which are only 6 WHO/APOC, 24 November 2004 t ? i t x E t6oN !) -o Eo oz$(\l do Or o > o nO8sEE.I -- 'ritE9^; EE(l)- ll 'trdL s+\() q)sE: $().=,o SE E.Oa ti EHT'- \./ !.EoS2E,$ s -.i H\ c) H* $ A EEil ! .E o\ o E:E EI 9os Bs*s€(l)>^:d ..i4 s 3iI a: e.r E fETE €tE{ H frxbE u EQSCE $fiHAgEU;66E 'g_aERs8 srriE$ S5 HE B i s:gi E E *&':SEE SiEB c E $ifr H si BEE€Ni u GIo -7 oc.O 9(Jos(o q) -o(! 9 Qo cd(a 'u8(l)- €E!.9 s2 oIA I ca !l .rY -Ed>a d zE* Bs () P'\q) .,t \) di\q)t s 3 o sq) B !SG.rE ri '6,$\\\Ig $B\ba9 .{A s:^ SaJ:x IEr Ii.s Its IcH o'bb zSq)s.sE-sg$ E' *lt A.t$ uES .9s$ E!s illix trTE E3d esd gqr.9 o\x tJ *$H L{I JEJE EEN EEE .9sv Eg. I'8S 'a 9-HE9 o.qrl oTE €ss .Es$ f,,ts. e *= Ed5 0ld clPE .F5P U V)}I q)\ o Et B E, o oA a0trto o.q)lr G) bI) ti a € o Ho!o o cl C)L olr RI x C) o o 'cc)L al Iq) oLq €)L tq) o Ji cA L GI o at aoo € GI ar,o H oa oit aJ .ol cll F.l E o -Itr - =c oA INIF ! T € E E E E I E I T t t t T I I 'r ; I (J H sEs o\\o co ino €\o(fI o\ r r-\o c'I € o\ $N (a\o N t I b .c)i. EI rQ)O .= E!N = -h:g\ E € aE o\(a$ rn N \or-\0 o c- r- c\t r- NtN(t) (?l r.:81 HE'i r ; .6 E.g ca 6l o rr) \o rr)6l Nra o\r- n^6 c.) 6!t o\ ot t: o o 6l ct o Fr sr g F:Eo E!'=gsI 2 \o6tN rnr- oN$ 6 oo$\o- @r- t+ o\N 6lt- g o)ct -,>.: ON 8.c,EI E -Eoao o ti + I 00N cO \f,!f, o$rn o\ (a €.EE9o!E ?Cil.E g[!totr >olrl EEo N cO rn o!n cA cOr- \ot\\a .aq) otq, tO C) o e) o LroEE z 'Egt €:;fltEo El'=$sr ia r- o\ r\\o cO (a(a\0 E clE9 .=tr6J.r -- aEEEE 3g 9'HEl.t:EL o\ co$ \N \0r-\o ot\ r-(\l r- olvcl ra ra !,1 o c) .:, E q);;'g* 3r igFi956t a GIN!) o B bI)o o v o o vt Fl F1 tr o t'r Table l: Number of health staff involved in CDTI (Please add more rows if necessary) Distrlct/LGA Number of heelth staff involved ln CDTI rctivitics. Totrl Numbcr of hcrlth strltln thc entlrc proJcct rrer Br Number of herlth strlflnvolvcd ln CDTI & Percentege B.=Br/ B' *100 Muhcza 45 27 60% Korogwe 36 l8 50% Lushoto 54 l7 31.50/o Totel 135 62 47Y. 1.1.2. Partnership Ministry of Health and Social Welfare(MOH&SW), Regional Authority, District Councils and Helen Keller International (HKI) in collaboration with APOC, support CDTI activities in Tanga Focus by provision of Manpower, funds (of some activities), conducts Supervision whereby the MOH& SW supports monitoring and supervision in CDTI activities implemented. The region conducts supervision and fueling of vehicles during advocacy and mobilization activities. Tanga Focus CDTI Project has currently implementing CDTI activities for th.e six year, despite the fact that the support from APOC tust fund is in the 5* year. In 3'd year the project did not receive funds from APOC, the CDTI activities were supported by region, district councils and HKI who is NGDO partner. HKI contributes funds for the training of CDDs, other logistics (transport, office support) and technical advice on integration of CDTI activities with other progralnme. Project staffare being paid by District councils, also support the project to conduct HSAM, Supervision, planning and training of CDDs. Community members are willing to collect Mectizan from the nearest Health Post and encourage other members to take Mectizan drug every year for not less than 15 years. Some communities provides incentive to CDDs by exempt them in voluntarily work done by community members in their areas. Before the start of Mectizan@ drug distribution, Policy makers at different levels are mobilized to assist implementation of CDTI activities. 7 WHO/APOC, 24 Novcmber 20M I ; 't ,j t iI Ef II tl E0 EE EEI o 'tra qo(t L o) EI a H.c:E 6r=6a E c, oz oz o E0 oq t oI C)(t oH Eo ct o E L t, E ET Lr a Enr 9E Gt= -oC)rr .o c)h .o a)lri E o :E gE I () d !l)lL, o d (l) 6t €o .D ta q) U H--e YE d= p o E o C) tr{ I c)t\ tgE ELOEEoU 'ot)IL trc, EI(t EI clLH Enr .F' E ca= aE !() lL d cl E e o tEEEcQ Ed d ()()o r: Qqt s.9 €.E s= .clEoo!a (Ja H=ftr d= aE tr cl oz oz () FI .9li .A A GIN a)E a z o) o0 eov o o 6) Fl Fl F{ oH I +oo(\t c) -o E G) ozt c{ do ? o B cic Gt bI)o 0{ tro cl tr E 14 o ad RI tI. o cl q Fl > C) C) oo o C)tro C)k C) B rt)o o GI .D tr C) oO I a\ Bla V)q)() q) S } o q)\ o \ B a Vz q) s_ cd Q) >\ =oLLr o o €o ((! G)Lv v, CI 0)E(! C) k € tnq) o cl o o) {) F crit o.)l .ol cll F.l € GI GI b0 C)s o tro o ,.o o tr o) tr!) o. o 0) IAo o GI x(l) J1 C) o) B b0 GIa ! L Bq)\ q) () \ a) cl a)L v,\lq)L B .o aaq) q) B o'$ ti .s6 c.i9 o+a5s'ct Eex .rE 3c> tri u o o -IE Efl(, 6 t- o o E - -o E5F Ir!N Fr a(J o o GI q) (l) r N z o -tr(J rd(A i i I ! r o\ i ? i I It I E E T I I I I I I t I L ! i 2.2. Advocacy Advocacy of Regional and District Political / Government leaders were done together, in cascade way followed by Ward development committee members then sub-village leaders. No constraint were faced as majority of leaders/policy makers were the same people since we started the implementation of CDTI activities five years back so they are well advocated. Advocacy meetings were undertaken before distribution cycle aiming at creation of more awareness for those who are familiar with CDTI and for others few which is the first time to attend these meeting. Advocacy also aimed to build and maintain the sense of ownership to the community leaders and members. The outcome of this advocacy meeting is that Region and Districts has included CDTI activities in their Comprehensive Council Health Plans. The outcome at community level is that community members are fully participating in taking drugs from the nearest FLHF and support of the CDDs hence stable high therapeutic coverage. Suggestion on improving advocacy is to involve staff of other sectors in the Region and districts such as Culture officers, Social workers and Primary School teachers who are expert in advocacy compare with technical people The following table shows the number of policy/decision makers advocated at different level per each district DISTRICT DISTRICT LEVEL WARD LEVEL Muheza 42 274 Korogwe l0 100 Lushoto l8 7t Total 70 445 2.9. Moblllzatlon, sensltlzatlon and health educatlon of at rlsk communltles Information on The use of media and/or other local systems to disseminate information oThe way used by the project is through political and gbvernment leaders then the leaders disseminate information to the community members during community meetings this is the commonest way of information dissemination. oUsing the school children through their teachers is another method used. oPosters are also used for information dissemination. Mobilization and health education of communities includingwomen and minorities oAll village leaders including sub- village leaders were sensitized in the current year; this was done after sensitization at the district level. The FLHFs together with community leaders are responsible to mobilize and give health education to community members. I ! L l0 WHO/APOC, 24 November 20M I t : ! 3 !l * J I J E !oSchool children, teachers and their fellow woman CDDs are the ones who mobilize and provide health education to the woman and minorities, with good response. Res pons e of target communities/villages - The response was good Accomplishments olncrease of community participation in CDTI activities. oAble to maintain high therapeutic coverage of more than65Yo since the inception of CDTI activities in the Project area. oMost of the communities know the important of taking drugs regularly. ol-ow CDDs attrition rate and committed CDDs oWillingness of the CDDs to continue to volunteer to be responsible in more than CDTI i.e. Lymphatic Filariasis Elimination and eye care activities. olncrease of ownership by asking Mectizan if they're late Suggest ways to improve mobilization and sensitization of the target communities. oMobilization and health education of at risk communities should be done continuously so as to improve the situation oTo continue to use policy maker and influential people on sensitization of communities .To adhere with time frame suggested by the community ll WHO/APOC, 24 Novembcr 2004 H (ooo c.l c)! E c) oz t6t C) o o. o B (\l ts oU -.: (HgE E >.9 0 '.5 1= b0HH .gF:E ERtr 'AVr- -L-9.- L)oqp .2dtr € .y: a0tsii .E9.rddo.= ai '.5 cl .-'! L L.qdPoo a0Eo .FE.J H orb EA.i6E= oET REtr \./gE *6g Eo.-0) .AE E ^!g IE: E9fr, .s;E 3gSo ^FH(l)3& a - or-1 O.9 -C E{ ;-i .=+, A l-{ ;i -f'1U EgXE EgE.T E(qtrOO xE q a E T:E EO€ E E(D rr G! 'r € Eoo!q.9 tr Ho H.e Yo E E e'Ela8$ E€ E E .F a).E EtrE > d E.,gEEE €rir^O=(,FArr9at ': E 8x sE'= o= (ao = >,tl oo5 Q O(J.E E.sEtE <ghoEtr E E EB*oracdtl5'; tEe I € Es S;ts c E'E P <€E'E & ..trFTJE E 5s 8 o .o (n .o bo tr r, tt C) o)otr an cl JZ o > clt o Eo ,li tr o) -c q Eox c) (A() a tstr oo o (H o rn o E a3 .tt aoU o C) tr c)o C) € o a tt q.) tr H oo BrD- HO 'tr a.)a (H o o cl o bI) tr J' GI tro c) o !{t) Gt troo oo Q)L. GI o (lt e q) a) alo(u .o() ct E > oLd& oI tt <t)(u q) bI) tr o() E o GIo € o) (, o cl (A L.o -o (D E q) cl E -(D t< o oo cg l. EEEEH Gl C) c)EFots-q o {D tr E oU r{5H .E IJ Et 5c tsE r!taE ai! =n,,i o rri ,ii le c a0 6! EoI oti soo soo s oq ort sq €F Egt gEEE coN s g ct (r)o ot) oo o5og9aaa9oZ o.= a(J c o -6 z Itr + tr ld I otr oi\o\o N@ € o €o !tFl\o G. trl 9o EI €e s oN al o\at 6le 0 a eI o 6a 2 5 o\o 6l ('t €e ,a6'iBi >0 Ee 'Ao tro =DEE EEi.svE o=lrEEE50zo co Irtri E o o! 6a q o otr soo sg oo soo tr EaIe !E€E @6l 5 orf o\o crl la 9loa s:Ei g E EiE aN 5 o!t o\ (a (J rl a) O o dNo4 a o eo ov o o a a otr c \S a4 aaq) q) 9r oL q) o E\l q) V) B a) $- t< oO o)t-E Lo.=ctre€ -Eo'5 ,'5EI J(l)E.tE.EIHEEEEOr5(, :.{}lr (EtNFI I : : ! i " r} f! * T ,t I EFlr I I I I I I T I !l 2.5. GapaclQl bulldlng Adequacy of available knowledgeable manpower at all levels. The present of 55 well trained FLHF staffs and 2,624 CDDs in 1309 communities is adequate.l Regional coordinator and 6 coordinators 2 at each District who are knowledgeable are adequate to carry out CDTI activities also availability of RHMTat regional level and CHMT members at District level whom a capable on CDTI activities makes very good knowledge manpower. Where frequent transfers of trained staff occur, state what the project is doing, or tntends to do, to remedy the situation. Normally training is done to the in charge of FLHF on how to carry CDTI activities. He/she trains his/trer colleagues and delegate power to them so that, incase of transfer CDTI activities will continue as normal. Nowdays transfer of staffoccurs in special cases, the issue is when the staffwent for advance haining and when they complete the studies they don't come back to their previous working station. If that occur funds are solicited from Council and NGDO and immediately the training is done for the new ones. So far almost all staff at FLHF are knowledgeable on how to implement CDTI activities. l3 WHO/APOC, 24 November 2003 t r I I t I I ? j !ii II d tloo ol kl) -o EIo oztat CioA b B $ 3o ttr o € GI trq) Eo B lr € o@(g L cl a ko o) k € C)o cl a lro o d o € cr) k o €(l lt)E k() ll) (l) H() B anotro .o o(l) ot) GIo o)s a, aUO ' otr o o Q)Lo o !ta E oBdbo99E 9E ! l oi) R E: o .9 PI E Es tr o ct o E() o. E F aoqi o o() o) tro -(DE ! o GI b0 tr (B 1..Fi ,iit ol -ol'Gt FI : t ? ; !ta It I Eil I I I I I I T d$q :?r(J o-:+Fv.: ir *6 c.l\o\o c.l\o\o o o N € € 6lr- € o@o o €o I !6l\o N ! \c N c € o) 6lL o o o(J 0 L Q)E z Ietr 6t\o\o N € € o €o !t N\cG' \co\ Q) {) (u Cl) -co\ S.iqv =?r() '(J 1r *(j 6t N o (\ (\l o 6l 6l a \o \o o o aDL o) .=cqr frLi E3 :g Lqloh E z (J?F 6t 6t 6l \c soo Q) o, Q) I s sq U. 6 i * Ee3 .t6t c.l6t 6t 6l c\ o\ ci r\ r- n)\o € ra') ra !q) tE 6L #E:Ee0 Qc4 EE 2E oI (J?F $c.l (\l6t r- (.)\o soo o 9 e I s (j.Ltq ()T 8,55 € @ o \o rr) oo € I Nt ! ts6l o 1A () rI9rr9€) -oq o L o)! z (J?F € \o o ti () .1 I o e s c)) o B60o oV o o 6 .l r.I H oti si ia o\ €) €) o I s II I i Table 6: Type of naining undertaken (Tick the boxes where specific training was carried out during the reporting peiod) Comments-NONE 2.6. Treatmentr 2.6.1. Treatment figures The project has attained 100% geographical coverage and 80% therapeutical coverage. Therapeutical coverage is less of 3% compared to last year, due to some of the community members leave their normal place and move temporally to other area to look for cultivativation of seasonal crops. The plan made to overcome this problem is for the CDDs to retain Mectizan for those who went for cultivation temporarily. Trainees Type of trainine CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(speci&) Program management ./ { { ./ ./ How to conduct Health education { ./ ./ ./ { Management ofSAEs ./ ./ CSM ./ ./ ./ ./ SHM Data collection { ./ { "/ Data analysis ./ Report writins ./ ./ Lymphatic Filariasis ./ ./ ./ { ^/ Primary eye care { ./ ./ ./ Ownership ./ ./ ./ ./ l5 WHO/APOC, 24 November 2003 ! i ! ) t * "i II H :foo(\t k C)Dc() oz tGI dogr\o = e) v e) oq li .s E$q) ao .:i t Eq) tl EI'5\i,*isEotg\r :* .tll xtEiE: ESi€ :$\J !rItsSE .s 'sd.F \.ui 8{\ Er H ,EBI FiS:L $ $$S R:F S:i EsS' .sS E E*i $I a' ,Q\E ss TEE s s$\ G't E:i :E\r tr E i.$T {\I SrE E$ r r!P PSi bs ()F e cl c;)k cl oo 'a ka .E E t t) do d o .E oE tr 0.)IL c) o. € o U)(.) ;o G, st t -l olxl € ol I9l ar8tE!l I9l o EI: €l36l ELl 5gl E EIE .=l -oAlll \o olol *l oxl > EI Egl8 -slEoloolE EIE :ln9l?EEJI Ezl< d 0)L c, 9oo 'a8ali C) cl 4 99oo.= 'a -',1LV C) rr]t3&E5 '.96tso.E .- H .=oE'o E3EEO+j .:EE ottr € el E6 "l IH EI :F stg3s PJ F -lF Sl65; El $ frI H EIEtrl t '=l c)!l: aEa.e Et 9BIH 8I E(ll :, rrl *ol i:- ol E rlO gllolo. olc €t: 3tJEIs EIS2l€ ^lE ltil ! 0) o o GI o t< D s g E o bt)!9^0s oo oF () ((lk o@ c! o oo Gtoa !e\ d 00 ooo o c!k C) b0 cl o o(.) C),A Eo\dva(llL c) F ! AtE EE€EEEg o o o o t32z o o o ^6bs -otrEtsAD>d NN \lo € oor\ \cN rn(a Ea'eE oo c.l \o oF- \o @(r) N tr o ((l to opi e il. Ad o o\ o 'Eo ,ooodgg ,88H sN@ sn(r) € \oo\ o\t- sc € A Ear (n rato a7ro (\l r o\ o\(.l o\ a € t!+ vtN nEE='<t6' o\\ott o @\o(i o\ r- oo aa € o\ tcl (r)\aN o c .9 .'3E. EHi€ -?.eB.ts} H? 9€ -oF o\(O$ N \oIr\o. ot-- r\(\I r\ GItFI(r) (r) ahq) a{(\l .Ao oO Qa ilr o'ri a s 6t EH H6 o \o5\oo soo s E s = n :BIE 8q3 E S*tr tr= 453E';b AO o @(\l('l 3 ort r o\o(.l o Eo 5 E'EiEt €e.l( T $ o+i o\oF) tEEg€- €(\l (t) tt o$ra o\ (n .E<gq o\ sC)a o ' 00oHov o o .Eo a Fl Fl t'r otr I I , ! :.A \l V2 B() q) .b btp s) o t B q) V1(l q) s JZ r/) Gt rrt(rt o)L cl (g tr () rl o (n ! h .o U) rrl a ! at P^ o E Gt ID F r-t arl -olGtlFI t ; : IE .E II I l T I I I I I I I I !l ! I 2,6.2 What are the causes of absenteeism? oSome of the young men had Ieft their home/villages go to other place to look for a better job/living condition oChange of drug distribution period due to National election. oMany people from the highlands move to lower lands for farming as this year the rain was not enough. In lower lands there is no Onchocerciasis. 2.6.3 What are the reasons for refusals? . Ignorance for some of the community members who think that they are healthily therefore there is no need to swallow Mectizan. o Other people had never been taken any drug since born so they don't see if it is important to them to swallow Mectizan. In spite of above reasons the number of absenteeism and refusal is 5,912 which is 2.3Yo of eligible people (251,144 people). 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period oNo serious adverse events occurs In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ./ t7 WHO/APOC, 24 November 20(X H too c{koE trt) oz$(\I t,oA b B q) B\ q) ,s o'\q) ,a ct L -q)v) * i.(t B 14 u,q) Qq) .S a4 3 o q)\ o \ .\S B q) V2ltq) $. €o oE bI) Eo O.o q) o0 ir) € €o E oo o (ll (t rq a a G) o q)t,li o) 't, sl ar)) o tro an o tt !) lD GI() ciir 0)l -ol'Gt F.l ! t ? ! j ! I Ei -E 'tt I ili+ !* t I I I I I T ! 00 EEE egEctt o ia fiBE oq, .2 EE EB('o 6 o(l)r €! 99 n?T Eo-c tr&ed *EE.o.9Eo o E t= E€EE t tro?'E=a o'=== E{EE tssrE o E o o E U) _E !:E E()= oHF +*l-aoogl E-* rs! o C) P.s =60ao xo v, o o0 I Ch sgt o q € @ v.) N € r6 \o \o o\ 9 6 a ra6 o cl oo Oi oo ni d!dtti eHs< e- a€ ,Q CO € q c.t o\ \l" o\ \ o\ q o\ cc ll . ri lii td s o 'Eo , bI)o(lgg ooFoF rr .,] o\\o o € € (f) € o € td € ,*9 o!du9otEo 5EA6 6. o s^ o$ \o € r..!t o\(.1q$ c.lN (ft aO r(n c.l o\\ \o riN tt r N td tso ls8 o\ ol\n o\ra \o\o 6r\ t6o o\ 6l 6\o otal r- lt. c.t Fr\tN \tN \o(\.l ts rH -A &HEE€€;n e Et \o o\ € € o\I(\l 6l €r{t\ a6l \o o\ € 6 @(\t €r-(.) $6 e.l N:r6l(.t ('l o ru olld o E a A troo cc I t{ rd I f-IcH' oo o oo oo oo oo ,u= $r*$ oo oo g oo oo oo ti;r grEEEg280 \o o\ 6t r'. o\ (-) oo c{ o\o rA o\o o\o f.l :og B.E EE5 \o o\ Nt. o\ ra €(\t o\o(7) o\o C.} o\o c.l s :Ee {E E E;EE-E E6 8 rn\o6 6lt- o\ (+I €t\ o\o(a o\o o\o(?) F- o\ o\ @ o\6 6 o\ o\ oooN oo(\l Noo c.l c.tooN Io6l ratI e.l \o oN t--oo6l @oo6l 6oo(\l o o o.l \f,6o6t Lt) -o Eq) oz$6t cio c{ b B l a A o! - .9 c,I q) EOqlsbTB\e$ rltLV '!H Er)$L-LqtE{.=i.s EP REI$E\rE&9v9 .:.e) C,Ex9eEH*AEe9(u= .= o- EoH E.Z;9'= Y-LgaFg v= I-r (|) i/h€x;€ee gx :htiEEI 9)EEI ;9*l E(l)ol .- E.tsl i;9,etr!B=PUrr E.qESEFi .=.\,D ; e.3Ei()39trtuLHgF..EE uttsES.r: ol u, =l ctHt gFl F{ I ! I t o\ I +!-t I "5 I Fil t I I t t I T l2.7. Osderlng, storage and delivery of lvermectln Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH (1) wHo( ) UNICEF( ) NGDO ( ) Other (please specifr): Mectizan@ delivered by - Qtlease tick the appropriate answer)MoH({) wHo( ) UNICEF( ) NGDO( ) Other (please speciff) Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project. We calculate the number of tablets require by multiplying the ATO times 2.2 then we get total number of required tablets. The Regional office request Mectizan and Albendazole to National Lymphatic Filariasis Elimination Programme both for oncho endemic and non- oncho endemic areas. The request is sent to Mectizan@ Expert Committee for approval. Mectizan@ arrives in country through the same channel and is cleared by World Health Organization (WHO) which handles over to the National Lymphatic Filariasis Elimination Programme. The LFEP in collaboration with the Ministry of Health are responsible for delivering of drugs up to the Region level where by the CHMT members -Distict authority) come to collect their drugs from Regional Pharmacy under the supervision of Region Oncho Coordinator. The Distict authority dishibutes drugs to the FLHF by following request sent to them by FLHF staff. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Mectizan thereafter the CDD or any selected community member comes to the FLHF to collect Mectizan@ ready for distribution to other Community members. Mectizan ordered/received for this reporting year and last year has change compared to the previous four years because of integration between Onchocerciasis and Lymphatic Filariasis. Table 10: Mectizan@ Inventory) The remaining ivermectin tablets collected and where are thqt kept The remaining tablets are collected from the communities and returned back to FLHF then the DOTs or any CHMT members collects and bring them to the District Pharmacy. The District Pharmacist sent the tablets to the Regional Pharmacy where they are stored waiting for another distribution period or destruction if they are expired I I I State/DistricU LGA Number of Mectizan@ tablets Requested Recelved Used Lost Wasted Erpired Rerreinlng Muhcza 250,000 250,000 241,961 0 8 0 803 I Korogwe 156,085 156,085 r39,674 0 0 0 l6,4ll Lushoto 254,000 254,000 221,510 0 0 0 32,490 TOTAL 660,085 660,085 603,145 0 8 0 56932 20 WHO/APOC, 24 Novembcr 2004 Ei I tl The activities under ivermectin delivery that are being canied out by health care personnel in the project area . Ordering and delivering Mectizan@ starting from National level to the Regional than to the district up to the FLHF level. r Manage minor side effects to the community members also to provide health education on how to handle drug especially to the CDDs r Storage of Mectizan before sent to communities r Storage of remaining Mectizan. 2.8. GommunlQr selfrmonltorlng and Stakeholders i[eetlng The first training of trainer for Community Self- Monitoring has been done in September 2004 to October 2004, but re-training is done before each distribution cycle. Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) How the results of the communtty self- monitoring and stakeholders meetings have alfected project implementation or/and how they would be utilized during the next treatment qtcle. o Increases community ownership hence sustainability can be achieved in the project o Solving the problems in the next treatment cycle if identified and maintain successes 2.9. Supervlslon 2.9.1. Provide a flow chart of supervision hierarchy NATIONAL LEVEL- NOTF t REGIONAL LEVEL- RHMT /PROJECT COORDINATOR I I I Y DISTRICT LEVEL - CHMT /DOCs I D I FLHF LEVEL ./\ COMMI.JNITY LEADERS DistricU LGA Total # of communitieVvillages in the entire project area No of Communities that carried out self monitoring (CSnd) No of Communities that conducted stakeholders meetins (SHIO Muheza Korogwe Lushoto 328 441 540 328 44t 540 378 441 540 TOTAL 1309 1309 1309 CDDs 2t WHO/APOC, 24 November 20M H Level 2.9.2 Main issues identified 2.9.1 Supervision check list used Yes/No 2.9.4 What were the outcome of CDTI implementation supervise 2.9.5 Was feedba ck given to the superv ised YesAlo 2.9.6 How was feedback used in improving the overall performance of the project DISTRICT -hesent of CDTYLF activities are incorporated in CCHP -Committed DOTs and CHMT members Yes Problems and Successes Identified Yes -Council continue to put CDTI/LF activities in CCHP -More commitment of DOTs and CHMT -Maintain high geographical and Therapeutic coverage -Improve performance of the implementation. FLHF -Increase of therapeutic coverage -Some FLHFs did not supervise CDDs Some of the register books were full Yes Problems and Successes Identified Yes Maintained high therapeutic coverage -FLHFs supervise CDDs -Council produce new register books t t t ? , : E t rt 4 I ft t I I I I t T Level 2.9.2 Main issues identified 2.9.3 Supervi sion check list used YesAIo 2.9.4 What were the outcome of CDTI implementation supervise 2.9.5 Was feedback given to the supervised Yes/No 2.9.6 How was feedback used in improving the overall performance of the project COMMI.JNITY Some CDDs are not collecting Mectizan on time -Few drop out of CDDs due to marriage/death -Many communities do not give incentive to their CDDs -Some CDDs are not competent on Yes Problems and Successes Identified Yes - CDDs will collect Mectizan on time - CDDs are willing to continue to do CDDs activities -Communities were sensitize to support CDDs by giving incentives -Well record keeping -Important inforrnation are hained to CDDs 22 WHO/APOC, 24 November 2004 rI record keeping -Newly selected CDDs are lacking important information on CDTI implementation SECTTON 3: Support to GDTI 3.'1. Equlpment Table l2: Status of equipment (Please add more rows if necessary) fCondition of the equipment (F=Functional, CNFR=currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace uisting equipment and other materials? Government is responsible for maintaining the available project capital equipment moreover; the project is expecting that, in six year of CDTI activities implementation, APOC management will provide new capital equipment to the project. If the available capital equipments are not functional, the project will depend on the available government other prograrnme capital equipment as the project is already integrated into the health system. D Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle I F 2. Motor cycle(s) 9 F 3. Computer(s) 2 wo 2 F 4. Printer(s) I F 2 F 5. Photocopier (s) I F 6. Fax Machine(s) I CNFR 7. Others a)Air Conditioner I F b)Oflice Funiture 3 F 8 F l3 F c)Bicycles 62 F 23 WHO/APOC, 24 November 2004 t, ! , I it Et I E !Contributor Ycrr 3('provide the period') Ycar 4 ('provide the period') Year 5 ('provide the period') TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted russ) TOTAL Cash Released rus$) MOH (Cenhal * ProvinciaUState) 22,132 22,t32 t7,r22 t7,122 24,661 24,61 MOH (DistricVLGA) Local NGDO(s) ( if any) NGDO partner(s) 5 r,730 r2,306.53 15,8s0 l 5,850 4,60 4,6@ Others a) Muheza District 1,695 1,695 4,366 4,366 2000 2000 b) Korogwe District 2N 200 450 450 500 500 c) Lushoto District 2080 2080 t,620 1,620 2000 2000 Communities APOC Trust Fund 66,906 54238 37,619 32,929 32,,772 2t220 TOTAL 1u,743 92,651.53 77,027 72337 66593 55,041 3.2. Flnanclal contrlbutlons of the partners and communltles Table 13: Financial contributions by all partners for the last three years Additional comments r Year 3, US$12,668 retained by WHO-for Capital equipment (from APOC tnrst tund.) . Year 4, US$4,690 retained by WHO-for the purchase of the bicycles. (From APOC trust fund.) r Year 5 US$ 13,864 retained by WHO-for the purchase Motorcycles. (From APOC trust fund.) 3.3. Other forms of communlty support Forms of in-kind contrtbuttons of communities oCollect Mectizan from the nearest FLHF oExcepted CDDs from community work during drug distribution in some communities oProvision of venue for training, sensitization and advocacy meetings. There were no problems with release of funds in other counterpart with the exceptional of APOC trust fund were by in fifth financial year (technically the project is in the six year) the amount of money agreed to be released in 2no installment were not all released as agreed. I 24 WHO/APOC, 24 November 2004 ! ! l L I j Ti I J FI II 3.4. Expendlture per actlvlty Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used herel@ Table 14: Indicate how much the project spent for each activity listed below during the reporting period Comments: CDTI activities are integrated with LFEP and almost all activities are funded by program and council. SEGTION 4: Sustalnabllity of GDTI 41. lnternal; lndependent paillclpatory monltorlng; Evaluatlon 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) NONE Year I Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other parbrers Activitv Expendit ure ($ US) Source(s) offunding Drug delivery from NOTF HQ area to central collection point of communiW 12,560 CENTRAL GOVT Mobilization and health education of communities Training of CDDs 6,697.5 N_LJ_EP_ NLFEP, APOC, HKI14,180.2 Training of health staffat all lgyqlq Supervising CDDs and distribution 3,979 APOC, NLFEP COUNCIL, APOC, NLFEP 2,370.1 Internal monitoring of CDTI aclrllligq Advocacy visits to health and political authorities NLFEP10,000 IEC materials COI.JNCIL COI.JNCIL/CG/APOC lllqqqry(rcLo4i!€I&:Eq&{ryeEq.rt - -Vehicles/ Motocycles/ bicycles maintenance 2500 18,600 Of[qe Eqgil4e4@.e colnpgt_e1s,_ pqnle4 qtc) Others 13,790 CONCIL/CG/APOC TOTAL 84,677.4 Total number of persons treated 251,144 25 WHO/APOC, 24 Novcmber 2004 I ? T EI T J E I j I; t ? 4.1.2. What were the recommendations? NA 4.1.3. How have they been implemented? NA 42. Sustalnablllty of profects: plan and set targetr (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? NA When was the sustainability plan submitted? NA What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels CDTI activities are already incorporated into CCHP, and the plan is bottom up plan which is based on the priority of the community themselves. 4.2.2. Funds District Councils are ready to take over the progralnme. Budget for Onchocerciasis has been included in Council Comprehensive Health Plans. The dishict council has started releasing funds for oncho activities. For the past four years, Local Government Authority has supported CDTI activities. 4.2,3 Transport(replacementandmaintenance) In this reporting year (5s financially and 6s technically) APOC management will provide new capital equipment at the same time maintenance will be done by using government funds 4.2.4. Other resources Human resources is stable as all Onchocerciasis team members are govemment Employees As the government employee has more benefits compare to those in private sector the problem of shifting is not there so the human resotuce is very stable. Nowadays transfer is only in special case otherwise staffstays in one FLHF for a long period (human resource is stable) 4.2.5. To what extent has the plan been implemented CDTI activities has been incorporated into CCHP since 2002 and all planned activities were implemented 26 WHO/APOC, 24 Novcmber 2004 I t ! * !t n EIt1 43. Integratlon The extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms Ivermectin is delivered within normal government system using the existence structure. CHMT member delivers Mectizan tablets to FLHF those are within the Onchocerciasis endemic area together with other essential drugs/drug kit and vaccines. The FLHF in charge and his/her subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect Mectizan ready to distibute to the community members. The same CDD are also responsible on distribute Mectizan and Albendazole for Lymphatic Filariasis Elimination. 4.3.2. Training There were only few new CDDs and FLHFs so training and re-training for CDTI and LF were conduct at the same time 4.3.3. Joint supervision and monitoring with other programs Supervision and Monitoring of CDTI activities are integrated within system. Therefore at Region and District level supervision is done by joint team using the developed checklist. The team includes medical staffand program staff. At regional level the team sometimes includes other regional leaders 4.3.4. Release of funds for project activities Funds are released through normal channel according to budget line item and every responsible part plays its role. The responsible part in our budget is APOC, Council, Government and NDGO. 4.3.5. Is CDTI included in the PHC budget: Yes 43.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Other programme that is using CDTI structure is Lymphatic Filariasis Elimination Programme, TASAF r Achievements are: Cost and time effective : Many people are served within short time. .Ownership is high .Increase sustainability 4.3.7. Others issues considered in the integration of CDTI. - Drug used is the same to both Programmes - Mectizan addition is just only Albendazole - Communities served are the same therefore it is easy to conduct HSAM. - Community selects drug distributors themselves and they live together and are the same 27 WHO/APOC, 24 November 2004 ? ? ; I , ? iI tt E !4,4. Operatlonal research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. The Project now is conducting operational on effect of APOC withdrawal from supporting routine CDTI activities of health personnel and CCD performance in Tanga CDTI Project area. 4.4.2. How were the results applied in the project? Results are not yet come out. SEGTION 5: Strengthsr weaknessesr challengcsr and opportunltles STRENGHS oRegional authority and Council support CDTI activities financially, technically, fueling and do maintenance of the vehicle/motorcycle rBoth Geographical and Therapeutic coverage were maintained with high percentage rCDTI is fully integrated with Lymphatic Filariasis Elimination prograrnme TFLHFs have been provided with bicycles oAvailability of Mectizan and Albendazole on time and were adequate oCommunity members are now aware of CDTI implementation and are participating in carrying out some. activities such as drug dishibution & health education. r CDTI activities are supporting at all levels. rCDDs are still willing to continue apart from low motivation they get from their community. oCDTI is integrated in district health plan WEAKNESS oDelay of report submission to FLHF from some CDDs oFLHFs were late to compile the report due to workload oDelay of 2nd installment from APOC lln Lushoto District male CDDs are being selected than female CDDs when attrition occurs CHALLENGES aPresence of other programs which pay allowances to distributors in the same community e.g. family planning distributors (CBD) this is the threat for CDTI as may cause CDDs attrition. oShortage of Staffespecial at FLHF may weaken CDTI activities in some FLHF ol-ow sense of ownership in some communities may weaken CDTI activities. OPPORTUNITIES o Availability of funds (basket fund) in all three districts where by CDTI activities will be budgeted for. olntegration of Lymphatic Filariasis into CDTI oAvailability of knowledgable RHMT and CHMT members on CDTI coordination r Political stability enslue ownership and sustainability " - ? * T 3 I t I I 28 WHO/APOC, 24 Novcmber 2004 I c ISEGTION 6: Unique features of the prolecUother matters Able to conduct Operational research on effect of APOC withdrawal from supporting routine CDTI activities of health personnel and CCD performance in Tanga region I 29 WHO/APOC, 24 Novcmber 2fi)4 I a I - : ? * II ! ?r t