Phalombe annual project technical report to Technical Consultative Committee (TCC): 2003

RESERVED FOR PROJECT LOGO/HEADING ORIGINAL : English COUDLTRY/]TIOTF': Proiect Name: Phalombe Apnroval vear: Launchins year: Renortine Period (Month/year): 2003 Date submitted:218104 NGDO narfner: MOH I I I I I I I ANNUAL PROJECT TECHNICAL REP. TO : I PORT hN:o : TECHNICAL CONSULTATIVE COMMITTEE (TCC)| 'tCC4g olo ilr L I i i i I I : .t{?. I i I i Nh Ai} HC ! I i I i I I I ,I I I I I I I I I c 6l.t\1 bfc t0 AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) 2 7 mi;i l[]4 o/lrXl"rj WHO/APOC, 26 September 2003 lI\rltrrrr hAii fr iJAi, PROJECT TECIIMCAL REPORT TECIINICAL CONST,,'T8^* COMMITTEE (TCC) ENDORSEUIENT Please confirm you have reag this report by signing in the appropriate space. I : I I I I I ! I I I I i ! I ! ! I i i I l I I I i ! I I i ! I I I I ! I ! OF'F'ICERS to Counry, MALAWI National Coordinator sign the Signature: report: Narne: ..f.qoh, ?il,* .. Dater .{ls.lpy Distrint Heatth frffioo* rr*..,,# .,4,...,!l.l.rr.:t.., A.*.q ffi,0{o This report has been prepared by Name , ..5.... Designation Signature Date -.,-,.t.,!t,. I bq* rl I WFIo/Apoe, 26 $eptcmbcr20o3 I I I I l I : I I i I : I l I ! I ! I I i l I I I ! I I i j Il I 1 i t I I I I I I I ) .t Table of contents ACRONYMS... DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS...... EXECUTIVE SUMMARY............... ..................... 5 ',,...,,,............. 7 ,..,,,,.............. 7 ,,...,,.'............ 7 ..................... 8 ..................... 9 .,,,................. 9 ..........,,....... 1 1 ................... I I .,..,,',........... T2 ......,.,.,........ ] 2 current year I 6 ................... l8 v 1 2 SECTION 1: BACKGROUND INFORMATION........ ..................3 I.I. GENERAL INFoRMATION l.l. l. Description of the project (brieJly) 1. l. 2. Partnership......... I,2. PoPULATIoNalvoFIBaTTHSYSTEM.. SECTION 2: IMPLEMENTATION OF CDTI ........... s 2.1. PERTOD oF ACTrvrrrES ................2.2. ORopRnqc, SToRAGE AND DELIVERY oF IVERMECTIN...............2.3. AovocacyaNl SBNsrzarroN........... 2.4, MOELTZATIONANDMALTHEDUCATION OF ATRISK COMMUNITIES....2,5. CoIavtxTTTpS INVOLVEMENT INDECISIoN-MAzuNG 2.6. CapacnysuiLDrNG..... 2.6.l. Training..... 2.6.2. Equipment and humnn resources CouorrroN oF TFIE EetTIpMENT * PLEASE srATE.........2.7. TREarwi.rrs................ 2.7.1. Treatmentfigures............ 2.7.3. Trend of teatment achievementfrom cDTI project inception to the2.8. SrppRvrsroN.,.................. 3 3 3 4 3.1. 3.2. 3.3. Fn.IANcIAL CoNTRtsUTIoNS oF TI{E PARTNERS AND CoMMUNITIES OTmR FoRMS oF CoMMUMTY SUPPoRT E>epNonunp pER AcTrvrry................ 18 19 19 SECTION 4: SUSTAINABILITY OF CDTr.. ............ te 4.1. IvrrnNar; INDEPENDENTPARTICIPAToRYMoN]Tonntc; EvarUATIoN........4.2. Comvrulnry sELF-MOMTORTNGAND SraxpgotopRs Mparmc.4.3. Susranraelt-lTy oF pRojECTS: pLANAND sET TARGETS (MANDAToRy Ar yR 3)4.4, INIEGRATIoN 4.5 OpSRATIoNAL RESEARCH.. sECTroN 5: STRENGTHS, WEAKNESSES AND CHALLENGES ...........21 19 20 20 20 2t I Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.INICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Govemmental Development Organization Non -Govemmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epidemiol ogical Mapping of Oncho cerciasi s 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 tt, Definitions (iD (iii) (iv) (v) (vi) (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO arrd ..r.r, taking) Eligible population: calculated as g4o/o of the total population in mesolhyper- endemic communities in the project area. Annual rreatment obiective: (ATo): the estimated number of persons living in mesofttyper-endemic areas that a CDTI project intends to treat with ivermectinl aglven year. ultimate Treatment Goal (JTG): carculated as the maximum number of people tobe.treated annually.in_ meso/hyper endemic areas within the project mea,ultimatelv to be reached yE, tiri prqect has reached fuii;;g*phic coverage(normlllv the project should be expected to reach the UTG at the end or trre :?year of the prqect). Therapeutic poveraee,.number of people treated in a given year over the totalpopulation (this should be expressed asi percentage). Geographical coveragq number of communities treated in a given year over thetotal number of mesorryper-endemic communities as identifiJt uy nEuo in theproject area (this should be expressed as a percentage). WHO/APOC, 26 September 2003€/" FOLLOW 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 session (Please add more rows if necessary) I Number of Reconunendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 26 September 2003 EXECUTIVE SUMMARY Wd Treatment with 1 vermeftin (CDTI) Programme in phalombe is now in its foufth year of implementation since 2000 when the flrst group of community volunteers was trained. In the first year, 11 villages were involved in the distribution of mectizan. The number of villages increased from 11 to 59 in 2001 and 2002. In 2003, the villages covered were 62. During all the years, the number of CDDs dropped and were being replaced immediately. The treatment covered a population of 4L37 in 2000, 27001 in 2001, 27,ti)2 in 2002, 28820 in 2003. See table 10. A total of 26 health workers were trained since 2000 but but keep changing due to transfer of staff. In 2003, distribution of mectizan was done very late because the drug arrived very late, therefore, distribution was affected by rain. In 2003, all our activities done were funded by MOH and no APOC funds were used. A totat number of 93,000 tablets were received from NOTF. SECTION 1:O PROGRAMME BACKGROUND Onchocerciasis controt activities in Phalombe started in 2000 while health personnel, and village communities became involved with CDTI Programme. Since then the District Assembly was briefed. The district of Phalombe borders with Mozambique to the east and it is densely populated. Most of the areas are very hilly and difficult to move during rain season. The rivers from the mountain, private good breeding sites for the vectors. The district is divided into five constituencies and consists of Traditional Authorities and 2 sub Traditional Authorities. The local community is mainly headed by a traditiona! chief and several assistants from his village. Several villages cin be grouped together under one group village Headman (GVH). The highlst ranked rulei is the Traditional Authority called the TA. The TA is the m6st powerful and respected traditional ruler. There's also a gender equality in the inheritance of headship. The estimated population for Phalombe is around 264,000. The community select their own distributors and mobilize themselves to take the drug for along time in order to control the disease. In sustenance of the CDTI the NOTF Malawi facilitates CDTI Implementation by closely working with the District Health Teams. These teams are DHMT, TOTs, Health Centre Staff, Local Leaders, CDDs and the communitY. L The CDTI is centred on training of village volunteers called community Directed Distributors (CDDs). The CDDs distribute the drug to the rest of the members of their communities. The District Health Personnel were also been trained in the first, second and third of the programme except in 2003 whereby CDDs were trained. The Health workers (His, H A s, H S A's) both (TOTs and as superuisors of CDD's or CDTI in general. In additional to training and superuision, district and health centre staff also carry out advocancy and mobilization at district and village leve!. The members of NOTF works hand in hand with our district in CDTI implementation. In the villages dosage is managed by a measuring stick (to measure height) of an individual for dosage determination. In some villages measuring stick refers to a dead body while other communities considers that the drug is for family planning. All these misconceptions were overcome by health education campaigns in 2002 whereby a drama group was used. The current repoft covers activities for 4th year of CDTI in 2003. Section 2:0 CDTI Programme Implementation year 2003. CDTI implementation in the year 2003 covers 62 villages marked by REMO. The distribution started late because mectizan came very late that is why we were affected by rain. The distribution time is from June to October. This year 2003 our theuraptic coverage is 6L.2o/o. The coverage is going up yearly since the inseptive of the programme. The reason for not reaching 650lo therapeutic coverage are (a) dropping out of CDDs, (b) overworking of CDDs. The plans are to replace the drop out CDDs, train new CDDs, refresh old CDD's increase the number of CDDs from 265 to 337, visit each CDD's in her/his home twice a month. 2:L Most of the people did not take drug because some people farm in Mozambique. Therefore, the distribution should be done between June to October when people are free and back from Mozambique. 2:2 S A E cases which were reported were minor side effects which were not repofted to the health centres but to the H S A's . The victims get better after a short time without seeking medical aid. See table: 8 for more information 2:3 TRAINING 50 new CDDs were trained in 2003. Those CDDs replaced the drop out CDDs. The attrition rate for Phalombe is high every. The district had 205 CDDs in all which are not enough to reach the whole community. In 2004, we have planned to trained 337 CDDs including new and old CDDs. In 2003, we planned to trained only 205 CDDs. We have increased the number from 205 to 337 because 3 OO e.l 0)! o o. 0) a \o c.l op. -H B (l) r. -CG#\HEoRg LH\o ^.L -io. :o) =P TH :RI :P\aNb LV -6tsge'9$*]i ll;;Ss Bluo$$ Eha.JE oiI 'il bo$tsL. s$ .e\ :\\9 E* E;b a$r EL\s$ o o$()'E* e *E tjNr*, aIF g$u ei\ $ .:S'!\ u)Dt t9B ()s9Fs €s\ 6Si o s$ E\u e oit* 8, E$-n Rl ,-arN = H3S 'F ED As l< Otu 3 E -ts-P' 6 o$i E ;h.sEEas E g{s I .ESt(!FS F os: E 5 s$'-g E SH E E st 3 N E{ T H 5E{G-HO;^ s$ ie;fF E&< IB 9t '! 'HG\$ $ .t; oorq Lo o I a o € ( z q) o o.oa> o H EE= €86iJ r- co\o\o" co e.I c?)\o\o^ C.) c.l I\c .oLtr i()O '= gN E -?.eE> EF 3€E!t Noo6 c.l ol € 00 C.l . ..H IL'=e 6 HE 3 s +E E 5'gNci ) O c.lq r-. O c.lq r- s* g q is *sx. o\ON O o\ C.l + il 6loL ;e€tr.= ]i?oU 9sx. I 0) *g ON (,) .: cl 0) oir .gE EO3Etra)o -ctle oE >r 0)ITI E N 0(l) o() o fr €)E z o c.l6 odN O cil@ od c.l O O c-l l, c.l\ c!tr9o9= .TLhY d+j!i E 5 6.ga- -E 3e e',E^-^(- H9 E c! oo oo c-l ot@ @ c{ !.'l (l) aJ .=E q);;'g* :{ i'HF(.).56t s o ,o tr o (d A El H oF q) o .N q) 4 a-S o L 0) o. bo t-oaolr o oo L E o l-ro oH(E ot< o)L ad (I) lro 0) cl o)tr G Iq) 'g EL o)ti q,) o) J U) l< d o (B aoa_ rli CgB a-o!o 'F \) tr .\) ob\(J){ tt -ol(Bt FI E o# o o t# -o o -* E E .U E orrU .E -Je oE 6,i aF { SEGTION 2: lmplementation of GDTI 2.1. Period of activities Insert Plan of action indicating activities by month, which were implemented. 5 WHO/APOC, 26 September 2003 8GI 0)! 6) o.o V) \o c.I C)o A. d 'JrB U) o) tr oQ I \ B +: qj (.) q) \.- s L q)L o t q)q v a) Q:- t-(U o c)LH o o) Eo d C)l-r a cd c)L Cd (I) lr € <n o) o COqr o (l) o)tr F oit o-ll -ol(Bt FI \o E =tr*oEE U oo Eo.c liE o o E .F an tr E 0) E o U o. a)a Er= r.tr o0 q) G D o un (l)(J tr EOEI-EE U EOEEI r.E o a0 cllLI ,-l E 6)€ aaEE o Er. (!: 0) oa2 :(D €.E s= EtrooEr92 5tr U o. 0)a 0) (J Fl I L a) o 0)p d o. Fl tr F 2.2. Ordering, storage and detivery of ivermectin Mectizan@ o q{pred/ap plied MoH N Other (please specif,) : for by_- Qrlease tick the appropriate answer)wHil rnibnitr NGDC the appropriate answer) UNICEil NGDC Please describe how Mectizan@ is ordered and how it gets to the communities Table 3: Mectizan@ Inventory (please add more rows if necessary) - State activities under ivermectin delivery that are being carried out by health carepersonnel in the project area. - Any other comments 2.3. Advocacy and Sensitization State the number of policy/decision makers mobilized at each relevant level during thecurrent year; the reuNons for the sensitization and outcome. Descnbe diffrculties/constraints being faced and suggestions on how to improve advocacy. 2,4- tlobilization and hearth education of at risk communitiesProvide information on : The use of media and/or other local systems to disseminate informationMobilization and health education of women and minorities - method and responseResponse of target communities/villages Accomplishments Weaknes ses/C onstraints Suggest ways to improve mobilization of the target communities. 7 State/DistricU LGA Number of tabletsReceived Used Lost Waste Phalombe 93,000 93,000 46,280 0 1,284 0 TOTAL 93,000 93,000 46,280 U 1,284 0 WHO/APOC, 26 September 2003 Requested Expired OO e.l o .o o o. c) a e.l O q !o B ;.. o d 6) oQ lt d q 8-se5 d I EEEz E'l o hD a! o o oEA 5H =t e) EE8e cE 9-Eg, .6, >= -t !f, t'-. \o$ oN t oF 9o ER o €) ts tr o €aE9H? s,a U ! oE tr z o oo e)E o o o! Eo tr E o o €) b0 a! €, o! z o ll { laol ca 1 q0 6 oo o& Er.n e EFfE ?.oar.= L oE.EE K SEgU iF:Pu.! a ct\o F o 9 .=d r.9 6.F o5 €H 6l o o 6)E z t ll .dd E o h06 o o d') o\ d =tE E r#8EZ E.E et !iocgfi e -E6Eo-?eE -t ilF t E z F c..l I FI o o o -o o q, o. 6l oF -\ ir N b4q) t)q) \- 3El6E\ r- q)J\IUNE-IINENOoi '68(rso\:- EF E,i a- #QEAO+3E.E9EOE Eo .- 'E Lo(doriEE l- IE -1EHEEOX(r: -+l . cllnElc,i fil w do d -o o) (B t) c)oo oa .d oo o) -o o)tr Cu 0(l) U) v) F CIU (D (n o0 o 0) 9pELi !l ..E Fo=95 HG) eE o;. Ho <) lt) =o)o= E(l) 9or -d(€tr b& :lo =ooaBoo.(l)ii €E(lr d^o o.g ,ca O.f O6E c € ;.ets-a6tre Er() o 5.qE -.ecoo P:E(H <.=ov-oraS Eo-.-{E EiT fi *= (D o..=F 6.9 h +5 00tr= < s 85 2.6. Gapacity buitding 2.6.1. Training At\! WHO/APOC, 26 September 2003 OON 0)p o a 0) a \oN doE oH B 0o; o ct t o E- 'GE o *s o ot s -\ ? q) c) v k- s o\ q) t\ N q) % S) $. tro (B o (D F aUqr o U) 0) o oH ,gq-1 E C) CB oo (skF .;t o)l -ot CBIFI ot + tr 0) E 0) o s tr 0) tr o o s tro o \c F] nF oF O|r) o O O : O O O : O o O O dil O O 0) ! C€ Or b' i t o F dI F< IJ il Q :,L Fv o F] tr A c) €! 0AAU 3 = LF F = LF .L () z qJ .E !+r 0 t o F OFoF O 6)q,) c) z 0) GIL ?, c) cn q,) o c) z CE a O (, F] O() O c q) z tr 0)tr q) q) s Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political LeadersProgram management How to conduct Health education Management ofSAEs CSM SHM Data collection Data analysis Report Others Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments 2.6.2. Equipment and human resources Table 7 : Status of equipmen t (please add more rows if necessary) (Functional, Currently non-functional but repairable. Written off). Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equiipment * Please state I functional l. Vehicle 2. Motor 3 4. Printers 5. Far Machines 6. Others a) b) i-- *Condition of the equipment Ir WHO/APOC, 26 September 2003 How does the project intend to maintain and replace existing equipment and other materials? - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were talcen to ensure adequate CDTI implementationwhere not enough l*towledgeable manpower was available or staff ofien transferred during the course of the campaign). 2.7. Treatments 2.7.1. Treatmentfigures t2 WHO/APOC, 26 September 2003 OON op 0) aoa \o ol o o B ca $ E ,t$ L$ 0o ,tR(J\FS \gP (6\g3(g-t hAU .:t 'Flg$ $olt 9^-S .E 'Eo tir;E TSHi $H iT .e.xsE.se,(,) .E SEssF HS!-. S llEs$ €NE9SEHS fs - \) *\)H '\ U'= ; { :{g lt .: !,r 8r g 5 EB *l o s 35J: E FS9l . 5 'XiaEIE N -$S EI+ s iSEls I s$6l tr rq K?ts bl = S SpEl $ It ztP s $Ss t$ 'l "Qt{ ss " E$i * F'$s S'ot tE * E S*E E S$ .E € {a,H S S*9 E ESFrrttS? R PSo\ \ Ds E H Io $cOA9e(B+i otroge az cr frl -C tl .E .8. '+j EE3u) 'Eoc '5 c) )vH'H)6trc, CU)5.e I o= )tr ot trH^ILA =I FH *I EI El .,& EI E -c' sl 'd EIE SH EI "l ! El * "l I El y ElE gqEl:= El E sl63; Elb €l H EIE 8I3 EI Etsti Et5 tstE "ElE #l: -Elrtrl ci til .:: tl =al1 zt9 EII o Cd C) bo(B^bs' oo oF C)O,lHEi:kc) c, oobo !o i:995ooo .eG .8c. E 9 .EOo. sEi: ooiio .cC)HO q A€EI = 9( o='E-3.0 b9;* 3E b€ e P E{ = o d C h-Ez 94i o6g o- o O er! Ea* AO O O -o 8EEO z<d @t" \o 00t'- ts." -3= E a€EE vao c.)q ! il o o5o =ooOda *us oo .EoF o -- edE EHE = Q.!z Fc)? 6.U < P€'F I'J o-qE EE = o tsd !a-E s o atsE FE 9d oF ol \o N \o \o$\o t--' \o$\o t-- ao\o\o m(\ a.) \o N (\ @ 00N Oal @ co cl ! il A qB€ u E + =.= XI - 16E Ici = o> =! E 009 tr ,eE6Yio o>-6 = .9o -iboo.F-\ Egc'Eoav 6o E9.- E.i O Y!) tr oo -Sl .r.l=ddF tr= O = c t# AO o tsoEEE ,tr i)!= otgg g e.l\o e.l\o N\o c.l\o N\o N .9<iu H a)p Cd H Fl F oF ?\\n V)q)(.) q) V) =oI\ q)\ "d q) V1 u s) E J((n L P(d IA CBoL{ Cd GI o rl o L o ,o U)I! a cd c G) d o)kF #r orl -ol(Bl FI a n d ). If the project is not achieving 100% geographical coverage and minimum of 650/o therapeutical coverage rate or coverage rate is fluctuating, state reasons and plans being made to remedy this. 2.7 .2 What are the causes of absenteeism? 27.3 2.7 .4. ln case the project has no case period, please tick in the box. of serious adverse event (SAE) during this reporting No case to report Briefly describe all known and verified serious adverse events (SAEs) and provide in table 9 the required information when available. t4 WHO/APOC, l0 April2003 OON o Ootu o FJr > la) q) q) \- Lq)s S \ s)4 It \ L. 4UQq) \- s\ q) I\ o NS q)q \) s. o ti o)a b0 .E t-o o. o)H o) oo li E o) H)oo o d U' r! a 0 o (l) (D U)lr(l) Ed V) o li o) U)qr o U)(l) tn CBO orl ol 3l col FI o EEE _E95 <.EE O ;P03c.= cEEg E'A 5EEP El ()0 o o o.3E?, 12&30 \JQ a 0)- QQ oeaE^ b.= oo-d tr 9vA O ,*93.o ot- o'E cI (d@aO O €,E eE O '', .9E3=b A€ U 9l. d-trc: O d € - gr oo.NiSilgx fiEEEg O a o a F,a ;5 E o+ 3 l-1 0@d O =oN-l 9!2- o> x o 0)OOa Cd .E =oo>5 O x() a (D bo o O *z\a oO ct o .o 0) o a \o cl O oA - FJr B \o q) s G' €) E9 Ec!!ri'? I to oEt F(D .= .- Eq)tro) I .oxP' ci clF(DTh UdI - 'otEit o(1)l q.(BlE3l() ,>tEpl9o) .qsskU(D6r> eOtrc)otrE 6t (s9-ts6!EEHgE Ei ,L .F(7) r- Ol ^i -lo)l6tdIFI s rtsl F () o0 C€k 0) oO $@ $@ $6 +co ll r rEi r,l ld o9SaF Oo\< B-o r\r- \o o; t'-. \o ci @ t..i00 a 6\ ll r H fEl o 'Eo =o0od3b ooEOF s o\sf U$ o1 cl \o I{ ,,o OhdpPAEuc2 a6 t--!i- O e.l $ c.i € e.l + \o$\o c.- trl EoE 6.U E E.O < P*'FLJ N o\a N $r- o\ NN \o GI Gqh.r6 ' xo - x 16d-Y r\ > : EE€€ E"i' + q€x Eco F- co =t: OO riGl (\o@ F-(\ ON 00 co e.t E1 rr] EI o9Sai to o\ (\ N\o c.l\o €-9"tE= Earr r S u 9 ar,Jrn O o rE)' \o od ri o\ rio\ Oo ri aoO'r= o E=SEtr tr= U = Eir17 Od o\ o\ TN o\ c.l\o EI tsod o.= Itro < g€'FU o\ c.l\o c.I\o e.l\o @o o0(d o O oo(! .€"EE .9 E b:: tr'- d E E E E€EO o o\ o\ r N v t'- o\ o\ 6 o\ o\ o\ o\ o\ OoO c.t OO e.l GIOON ooN $oO C.l OO e\t Oo e.l t--OON 00OOGI oGI Oc.I 2.8. Supervision 2.8.1. Provide a flow chart of supervision hierarchy. 2.8.2. what were the main issues identified during supervision. 2.8.3. Was supervison checklist used ? 2 8.4. What were the outcomes at each level of CDTI implementation supervised 2'8'5' Was feed-back-given to the supervised, and how was the feedback used in improving the overall performance of the project SEGTION 3: Support to GDT! 3.1. Financial contributions of the partners and communities Table I l: Financial contributions by all partners for the last three vears If there are problems with release of counterpart funds, how were they addressed? Contributor Year L ('provide the peiod') Year 2 ('provide thepenod') Year 3 ('provide the TOTAL Budgeted 6us$) TOTAL Released (us$) TOTAL Budgeted 1us$) TOTAL Released 1us$) TOTAL Budgeted (us$) TOTAL Released lus$)Ministry of Health (MOH) Local NGDOG) ( if any) NGDO partrrer(s) District/LGA Others a) b) c) Communities APOC Trust Fund TOTAL l8 WHO/APOC, 10 April 2003 we want to reduce the workload of CDDs hence increased coverage. The training of new CDDs in 2003, was funded by Ministry of Health ie Phalomb€ DHO. See table 5 2:4 SUPERVISION The superuision hierarchy is as follows: In Phalombe we use the following personnels in supervision of CDn activities. DHMT, TOTs, DOC, Health Centre (ie MA, Nurse, H S As) chiefs, community members.2:5 Issues identified during superuision - CDD drop out - Some CDDs record wrongly in hard covers, others teaching the hardcover. - Some refuse to distribute mectizan because they had no refresher training. - Some villages are far from health centres. - Some CDDs cover a large area. - The community did not give any incentives to the CDDs. 2:6 A check list was used. CDD selection - the all drop out CDDs were re[placed. The all H S A's were supervised during the selection process. All TOTs were involved. The mistakes made by some CDDs in hard covers were corrected by su peruisors i mmediately. The local leaders were approached and discuss with them the refusal of CDDs to distribute the drug. We discussed together in the presence of the CDDs. Then all agree to distribute the drug to the community. We have increased the number of CDDs from 205 to 337 to reduce CDD work !oad. The community should over a pushing bike to the CDDs to use for drug collection at the nearest health centre. 2:7 Feedback was given during H S A's zone meetings. The H S A's then the local leaders CDDs. The CDDs gives feedback to the community on how the CDTI programme was carried out in the year 2003. SECTION 3: SUPPORT TO CDTI3:1 Financial contributions of the paftners and communities. The DHO Phalombe support the CDTI Programme both flnancially and materia! suppoft. To give you a clear picture of what was done see table 12. Section 4. SUSTAINABILITY OF CDTI4:l Interna! monitoring was done by NOTF Malawi during the reporting period. - Comments 3.2. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) 3.3. Expenditure per activity - Indicate the expenditure on actrvities below in US dollars using the current United Nations exchange rate to local currency Table l2'.Indicate how much the project spent for each actrvity listed below during the reporting period Activity Expenditurc ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities ofCDDs of health staffat all levels CDDs and distribution ,In1g_mal mgnilqrilg of CDTI activities vocacv visits to health and political authorities IEC materials forms for treatment Vehicles/ marntenance _Offig_._ Others (e.g computers, printers etc) 115 5 943 3 373.4 TOTAL tAs2.2 Total number of trrated 17,646 Comments SEGTION 4: Sustainabitity of GDTI 4.1. lnterna!; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) Year I Participatory lndependent monitoring Mid Term Sustainability Evaluation 19 WHO/APOC, 26 September 2003 IMectizan was collected from NOTF Blantyre by using EPI vehicle and the same vehicle was used to deliver it to the health centres. In the communities some H S A's borrow EPI pushing bikes their CDDs for mectizan collection from the nearest health centre. DHMT do joint superuision and monitoring of CDTI during routine visit of the health centres. The other programmes that are using CDTI structures are EPI, family planning and malaria. SECTION 5. CDTI implementation: strengths - 50 new CDDs were trained in 2003. - The DHO funded the training - All TOTs and H S A's were involved in superuision of CDD's. - Other motorrycles were used a paft from onchocerciasis motorcycle. - Al! CDDs were superuised - All 67 village heads were reached like other members eg Church elders. - The communities mobilize themselves to the take the drug. - Rain weaknesses distribution - 60 CDDs dropped out - large number of refusal and absentees WEAKNESS - Replacement of drop out CDDs - Increase the number of CDDs from 205 to 337. The drop out CDDs have been replacement while the number of CDDs have been increased from 2045 to 337. I4:2 In Phalombe all the 3 years mectizan was not kept in the district pharmacy. The National Coordinator recommends that from now on mectiozan should be kept in the pharmacy. The mectizan stock record was not available or seen. The National Coordinator recommends that the mectizan stock record should be in place.4:3 CDn activities are now being incorporated in the DIP in order to sustain the CDTI since 2003. The DHO is maintaining the NOTF motorcycle and also released other motorcycles to supervise the CDn. We have been, using the DHO's funds since the inception of the programme (ie 2000). tt=ll INTEBGPATIOIy