Kilosa focus CDTI project v/s VAS proposal : submitted by national onchocerciasis task force & nutrition program

KILOSA FOCUS CDTI PROJECT V/S VAS PROPOSAL SUBMITTED BY NATIONAL ONCHOCERCIASIS TASK FORCE & NUTRITION PROGRAM @ÿ Page I of10 PROPOSAL OUTLINE Title Linking Vitamin A Distribution to Community Directed Treatment with Ivermectin (CDTI) in Kilosa District inTanzania Prepared by (District and partners) Submitted to The African Program for Onchocerciasis Control (APOC) General Objectives of Programme 1. To enhance the sustainability of the CDTI framework by demons.trating its ability to deliver Vitamin A to children 6 - 59 months and post partum wonien. 2. To contribute to decrease child mortaliÿ in Kilosa district by providing Vitamin A supplements to children 6 - 59 months. 3. To lay the foundations for extending CDTI+VA to adjacent communities Specific Objectives 1. Reaching postpartum v/omen with VAS 2. Attain >75 yo Ivermectin Treatment 3. To reach 20% of chlldren between 6 - 59 months. 4. All of the above in a sustainable manner. Target Groups: Children 6 - 59 months, post-partum women in Kilosa CDTI Time Period: 3 years Estimated Budget: YEAR ONE Tshs. 8g,8l2,g}5l: Page 2 of 10 Executive summarv Definitions CDTI project definitions Treatment coverage and how calculated Theraoeutic coverage rate Number of people treated x 100 Total population living in meso- and hlper endemic communities in the project area Geographical coverage rate Number of communities/ villages treated x 100 Total number of meso- and hyper endemic communities as identified by REMO in the project à1ea VA program delinitions Coverage: Number children aged 6 - 59 months who have received two doses of VA in a Total number children 6 - 59 months In Tanzania, Vitamin A supplementation is done through two different approaches, namely Mass and Routine Vitamin A supplementation (VAS). Mass VAS, conducted twice a year, is targeted to children 6-59 months of age while Routine VAS is targeted to children (9, 15 and 2l months of age) under the age of two years and Women within four weeks post delivery. During the year 2004, Kilosa district targeted 95,165 children 6 to 59 months of age for mass vitamin A supplementation and children for routine VAS. The mass VAS approach reached 94.80 percent of the targeted children, while the routine approach VAS reached (18,888) 92 percent of the targeted 201612 children during the year 2004. During the year 2004, 4694 women postpartum were targeted for vitamin A supplementation of which 70 percent of them were reached. Page 3 of l0 1) District Information Demographic information Population: Kilosa district has a total population of 528,696 people. The district is administratively divided into 9 divisions,3T wards and 168 villages with 1110 sub villages. Topographic information: Kilosa district may be topographically subdivided into central and southern (floody) plains, at an altitude of 400 metres above sea level, the steppes in the north at 1100 metres above sea level and the north-south spine at about 2200 metres above sea level. District's main rivers drain to the east, providing most of the headwaters of the Wami River. The southern part of Kilosa drains into the Great Ruaha River. The same climatic conditions are experienced throughout the district with the maximum average temperature during February and March (28-30 C) and a minimum in July (18-22 deg C). Rainfall varies from the north to the south with an average of 600-800 mm annually in the drier areas and 1600 mm annually in the southern plains. Dry season starts from June through October while rainy season starts from November through May. Access to the main administrative centre is generally very good but deteriorates sharply as one move into the hinterland. The administrative centre of the district is 80 km from Morogoro, the regional capital, and270 km from Dar es Salaam. Roads are not well maintained and most of the road network is cut offfrom the administrative centre during heavy rains. Using motorcycles, much of the district can be reached by supervisors especially during the dry season. VA information Under-five mortaliÿ rate in Kilosa district is estimated at 90 per 1000 live births. The major causes of childhood mortaliÿ in the district are ranked as Malaria, Pneumonia, Diarrhoea, Anaemia, Malnutition and HtV AIDS ??? The population at risk of Vitamin A deficiency includes children under the age of five years, pregnant and postpartum women, making a total of 991859. This may be considered as the target population for Vitamin A supplementation to be integrated with CDTI Page 4 of l0 2) Rationale for proposal Brief outline of district Kilosa district has 168 villages, 110 sub villages, g divisions,3T wards and a total population of 528,696 people. Population per sub village is ranging between 250 to 1000 with the population at risk of vitamin A deficiency being 99,859 a) Treatment goal 404,401 a) Brief outline of VAS Mass vitamin A supplementation is done twice ayeartwith the first dose provided around the Day oïAfriru, Child around June 16ûwhile the second dose is provided at the end of the year around World AIDS Day in December for children 6-59 months of age. a) Vitamin A supplements through mass approach is normally done by health workers at service delivery posts in the community as well as at front line health facilities. The community is mobilized by Village health workers, village government and social mobilisers at community level b) The main challenges/constraints encountered during mass vitamin A supplementation include inadequate funding, delay in releasing of fund from donors and quality of coverage data. To overcome these problems, councils/districts have always been advised to incorporate the costs of the activity into comprehensive council health plans (CCHP), involving community in planning and implementation of the activity and establishment of village registers. c) Through these cooperate efforts; Kilosa district has achieved coverage o194.80 of the targeted children 6 to 59 months of age during December 2004. Also during the year 2004,70 percent of the targeted Post-partum \ilomen were supplemented with vitamin A. Challenges of VAS: Since inception, mass vitamin A supplementation faced a number of challenges, including{. Poor compliance of few individuals, particularly in urban and semi urban areas * Late arrival of supplies (vitamin A capsules) to district level .:. Inadequate funds for implementation and social mobilisation.{. Delayed release of funds from donors{. Poor involvement of community leaders in activities during implementation.{. Inadequate incentives/allowance to service providers Page 5 of 10 Possibilities of integrating VAS and CDTI There is a possibility to integrate VAS with CDTI basing on the following: * Presence of skilled CDDs to implement the two interventions t!. Established CDTI system in the District .f. Presence of equipped Oncho Zonal coordinators.{. Utilization of already existing heath care system such as PHC{. Presence of communities that are already implementing CDTI progann. n CDTI is already reaching 33 out of 37 wards in the district. * Government leaders arc akeady sensitized on implementation of CDTI{. Vitamin A capsules and Ivermectin tablets can be easily handled and delivered to the communiÿ through established health care system Anticipated challenges of integration: -Diffrculÿ in data handling for the two interventions -availabiliÿ of all the supplies (vitamin A and Ivermectin) ahead of implementation -variabiliÿ in targets for the two interventions -limited cooperation from the community/misconception of the purpose for interventions Benefits of delivering Ivermectin and Vitamin A together.{. Time serving * Considered cost effective as the two are administered by the same service providers at the same time.{. Increased incentives to CDDs{. Accessibility for VAS to PP women who could not be reached through Reproductive and Child Health Services.{. Reaching under fives who could not be reached during Child Health Days and AIDS Day. * Increase of therapeutic coverage for CDTI Main VAS challenges that may be addressed by integration -Reaching children at hard to reach areas using CDDs -Increasing post partum women VAS coverage -Improving data qualiÿ through auditing -Establishing actual targetpopulations through head count in comparison to projection from the last census Challenges of integration{. Different period of implementing of the activities. * Ability of CDDs to carryout those activities. * Communiÿ acceptabiliÿ for integration. * Possibility of conflict between VHWs and CDDs. Page 6 of 10 * Refusal of CDTI implementation might refrain integration eventually reduce the coverage. n Some Villages are not covered by CDTI activities. Second dose ofVA Vitamin A supplements through mass approach is normally done by health workers at service delivery posts in the community as well as at front line health facilities. Village health workers, village goverTrment and social mobilisers at community level mobilize the community. Routine VAS to children under the age of two years and post partum women is done by the health workers at front line health facilities The main challenges/constraints encountered during mass vitamin A supplementation include inadequate funding, delay in releasing of fund from donors and quality of coverage data. To overcome these problems, councils/districts have always been advised to incorporate the costs of the activiÿ into comprehensive council health plans (CC[IP), involving community in planning and implementation of the activity and establishment of village registers. b) How will VA be distributed in non CDTI areas In non CDTI areas, vitamin A supplementation is done at front line health facilities as well as at supplementation posts by health workers with community mobilization done by village and sub- village governments c) Children 6- 59 months if obtain Vit A via other mechanism what will be the impact on the coverage of Child Health week. Increased opportunities for distribution of vitamin A supplements accompanied by social mobilization will result into increased coverage c) Brief outline of CDTI Distribution time In Kilosa district Ivermectin is usually distributed during the months ofAugust through September with the previous year coverage of 68 percent Challenges of CDTI: * Community resistance due to lrrong believe (drug cause infertiliÿ/ sterility) * Poor support from communiÿ Leaders during implementation. * Poor recognition of CCDs in some communities. i) Possibilities of integrating VAS and CDTI -distribution done by the same CDDs -both supplies are easy to handle at communiÿ level Page 7 of 10 -no specialized skills are required for administering vitamin A and Ivermectin -community is involved right from the planning to implementation stage Benelits of delivering lvermectin and VAS together * Time serving{. Cost effective.{. Increment incentive to CDDs. * Accessibility for VAS to PP women who did not get access to RHC services.{. Accessibility to under five who are not turn up during Day of African Child and World AIDS Day. * Increase CDTI therapeutic coverage Main CDTI challenges that may be addressed by integration -lncreased acceptability of Ivermectin as communities are already aware of vitamin A -increased incentives for CDDs as resources from different sources will be pulled together -Increase sustainabiliÿ of CDTI Main CDTI anticipated challenges of integration.{. Differences in current implementation time{. Ability of CDDs to carryout those activities. * Community acceptabiliÿ for integration.{. Possibility of conflict between VHWs and CDDs. * Limited acceptability of CDTI program might refrain integration eventually reduce the coverage Strategies for integration : Communities will be sensitized and empowered to make decisions on integration, time, place and modalities of distribution. They will also be technically supported, assured of supplies by the national and regional levels d) Review of resource availability . Integration of CDTI with VAS intends to utilize CDDs recruited from respective communities o Materials and equipment required during integration may be handled by CDDs o Finance and sources: Community will plan for incentives of the CDDs in addition to council and central govemment's contributions. Page 8 of 10 e) Institutional arrangements r) Roles of stakeholders (l) National level: The National level will be responsible for pursuing such aspects as: a) Ensuring consistent and timely supplies b) Development of favorable policies for integration c) Development of guidelines for integrated interventions d) Provision of technical support to different implementing levels e) Development of a joint training guide/manual 0 Development and distribution of IEC materialsg) Training of trainers at regional level h) Development of monitoring and evaluation modalities in collaboration with the implementers Conducting monitoring and evaluation Preparing and submitting quarterly, mid yearly, annual implementation progress reports to intemal and extemal partners and donors k) Installing in qualiÿ assurance mechanism of the supplies (2) Regional levels: In collaboration with the national level, ensuring consistent and timely supplies Provision of technical and supportive supervision to councils Oversees that implementation is done in accordance to developed policies for integration Conduct training of trainers at council levels Translate policies and guidelines to implementation plns Distribution of IEC materials to respective councils Development of monitoring and evaluation modalities in collaboration with the implementers h) Conducting monitoring and evaluation i) Preparing and submitting quarterly, mid yearly, annual implementation progress reports to internal and external partners and donorsj) Installing in qualiÿ assurance mechanism of the supplies i) i) a) b) c) d) e) 0 s) (3)Council level: Page 9 of l0 a) ensuring consistent and timely supplies to the community ahead of implementation time b) development of a joint training guide/manual c) development and distribution of IEC materials d) conduct training of trainers at Front line health facilities e) ensure that monitoring and evaluation modalities are within the implementation plans 0 Conducting monitoring and evaluation g) Preparing and submitting quarterly, mid yearly, annual implementation progress reports to internal and external partners and donors h) installing in quality assurance mechanism of the supplies 4) Community level: a) Advocacy sensitization at communiÿ level b) Recruiting efficient community directed distributors c) Planning and coordinating distribution at communiÿ level d) Planning distribution time e) Devising an efficient follow up mechanism to cover missed population Community mobilization during distribution In collaboration with the council, ensuring that sufficient supplies are in place ahead of distribution time In collaboration with the council, ensuring that monitoring and recording tools are in place ahead of distribution time Conduct monitoring during implementation Efficiently collect and validate implementation data Ensure timely development of reports In collaboration with the council, ensuring that IEC materials, facts sheets and job aids are in place ahead of distribution time m) Plan motivation/ incentive for a CDDs n) Conduct training of CDDs 0 s) h) D i) k) l) Page l0ofl0 VAS{DTl Budget 2006 -KILOSA CDTI PROJECf {s DETAILED BUDGET AND COSTING FOR INTEGRATION OF VAS AND CDTI IN KILO5A CDTI PROJECT fô §E ;utlÈ , l,:.:i;r;É;,jii.:..jj:i rsw:rffi ôâtnflffi .!:râu :. -: O, t IàÈgffit and ..r, Four dàÿs §.sdd of âàmrng rnd @üÉbd hæ6n9 wlül 15 ndbês àt distnct lêvd to ddêlop {lowàr@ hr àÉici9ànb 25,000.0 ! 190_m-0 Màncc ffi :eiüàb6 30,000-0 TO OOO-OI 15,000.0 t20 0m ff 3-M-O 2t 180-000-0 40_ôm.ô 20-m.o 1Jo0.0r 2§. 319,950.0 41-000-0r 41.0,00.O sUB TOTA 2go-450-or ffi llov/DEc DüO -2 Oiê da, Start up mdrrg wü 5 PioiêGt fÊÿ hdaâEs.t thê Xsi(t L.vd ü @ting àeæ n hhÉüm VÂS eiti CDn. Ulow.@ 6r r0.m-0 2 250.000.o âciliffiÉ 30,000.0 t20.m_0r h,.oÊ!.àôs m_m_m 300,m0.01 uwane Msppotr 7_ff.O 15,æ0.0 §_m_m 50,000.0 Eftldrmênl 3,o(xr.o , to2 m-o s-m_0 so-000.0 Ir{ L500.o UI 199,500.0 27 )il.ù 27.79,n iIJB TDTAL 1-tta50-or sl EBRI'ARY Dû4O t.3 Èruffitof Ofie Eouio.m ùtuÿ.ifrde 25_m_û I 250.000.o )6t toD ComDuE 2.1m-S§-fl 2-160-905.0 § lmffiôrtrldo6 250,lM}.Or 7§0_00t).o 700.000-0 7û0,m0.o \rrdEse ofn4 HV 200.æ0.0 tmmû !'æOIæÙ lo-m.m It 720.m0.01 lôinënane ofmobr ûir6/ dd6 2,{rc0,000.0 2_m_m.û sel llm.o 10 190,00o.u 8.mo-o 1r 160,000.0r ,larld Din§ 2m-û 20-0m.ol suB mTl 7r10ro5.ol ffi ffiWY Dito t§w6mrmElffrqil àdê.t C@diÈb. b Tôr9â CDTI tqiêdto.ùrdyi.t gEthn Ud.ne brOIMT 4t0(}0.0r 2,50-000-o krha 6rDi 30.0,00.o 150.000.0 tud L500.0r I ,$_m.o ;UB IOÏAL t-roioo.ol APOC l.lÂRCH ll Oic d.ÿ Diffi llYd asiüa(û mæting b 17 üld.ncc for CHMT t 10,000 0 I 170.000.o ülilrm 6.CilT 10,m0.0 1 tsm0 UHàNæ U t€prstâüvë of tomo so ooo Ô 10,000.0 smo rmo m_m-o 10-û00 0 100,000.0i VAS.CD]] Budget 2006 -KILOSA CDTI PROJECTnS lm01 141_000-û s5.400.0r 56,,{00.O süi mT l.olr.400.ot @LilOL t'tÂY \llowàncê lbr ,o m.0 2_000-000.0 lrF Sbfr d CD'II .nd VÀS \llowàræ for tdmoo 1&-m-o 3m_o 2lr 648-000.0 ;t tiffii6 )11 2Sr-2m.0 ;UB TOTAL 3r57200.O( APOC I.IAY DMO 3 Onê d.ÿ 6iDm UMI@H àrüciünb l0.lD0.o lmmoo DTI ànd VÀS ,tE9Êbo at tiê 2S-m 0 L775.000-O É-m.0r 555,000.O !d 1500.o 1m t.s0-m-o 2-lx)o.o 1.110,mo.o iom0 370_000.û ;UBrcTl ,.0.o10,ooo.or m INF lM nxl 2,0{l0.or 16 a-oî_m.or DTI ànd VAS inEgÊtid .t ,DC 2.q,0.0r 16 ,5aamû Èds s.000.0 16 ,-580.æ0.0r SUB DTA a,.aOO,OO0.Ol AP(T 1.5.1 onê d., DBm ldd l.dân ülorà@ b. hûrq 30,000.o 1,200,000 0 lêpênblv6llm tæ/ilæ l0.olx).o u0.000.0 'Bm, c8!{r 25,000,o 2Sm-D ,dYæ.llilr@ ,oom0 .40-000.o ïC 6r iî, l.5o0.ot 10 150,000.0(È9lgOOV6 Ult.ÉlÈdi6@ÉïïE :l}|F L.vclE:6ffiffi tus Fæ m_m.û 50,0æ.o 20_m_o r.000.000.o Smoo :t00-t 00.o he@up §-m-0 150,000.o 10,0q).0 20_m.0 têf.dlm6tr tm_0 v 210.æ0-o ilB loTAl. 3rroroo.ol SI ,. 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Z T6.spo.t fom !6D to Dkfid hiilhr:BlhlkBdltu {lE lôfr 700-t)00.0 1.,t00,m0.0 25trO_O 225.(x'0.0 t5.ofl).0 ttçmo itd t m-0 s0 lJot).000-0 ;UB TOIAL ,26û.0OO.Or cEF lt{E DM t?s UWàÉHGËI lêmbêB 25-000-m 2rs-m-o )rlvê/s rllm@ 15.000.0 2r-m,o i,C 1.500.o 100 3,000,000.0 $fl.ne br RllF ibll §mûm 16r s.fi0.000.0 ]UBDTI 1û.5aOrOO.Or Al )c'BF AIJG/DÉC GM Ul,ûdàre 6r Ppjæt 25,000.o ts_m-o 15.00t).o 270,00ô.0 1500.o 50 ! mmo il8 TOTÀ »o-ooo-or § g,Drc ÆrDcto 35Orbml.hdmdn 75mm 75.0æ.0 VAS€DTI Budqet 2OOO «ILOSA CDï PROJECT)ds ,ooææ 2«),tx)0.o 0-m.ô ruB Tol[ 315.O00.0t BF S[PÏ/DEC FC'DæÔ 1.5 Mmtofolhs t.m_m r-110i00.0 §.000.00 1t1t 5J5{r.000.0 ilm B 1S.m-O iuB m1[ 3r39rOO.Or ilE lm a.l TÉiâim of RfiF Sbl illom@ôrâkê 1s,000.d 13 6,9ü'.0û) O ùId.re 6. 25.mO.0 $0,tx)o.0 3.000.o 1{r 420_000.0 t§mo 4§mo tsm_o 14 210.00ô.o lTmt t1 168 m.0 à[ m_m.or s.000.o 5,{X}0.0 13 6mmd iuamru tlo3-mo.o ffiÆY ilE mrBc 'm ül@@b.@Osir ,s.0 33? t_?2§.m-o WEU àdlihtors 15,(x)0.0 5r 840r00.0 m0 B 1f,tr-m-0 ;bhrüÉ mil ?1? ,6-m-0 ;UB MTÀl tza9sroo-ol ffimY ilÉ [,,Dffi} r.r ruuerry.ru nr*ryrrc. updi.im ôælrst hb tiê oôs {|ry.@6lw b. 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