Onchocerciasis Thyolo annual project technical report submitted to Technical Consultative Committee (TCC): from April 2005 to March 2006

RESERVED FOR PROJECT LOGO/HEADING OzuGINAL : English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTAI'IVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: .r. Dia To APOC Management by 31 January for March TCC meeting rcf i* To APOC Management by 31 Julv for September TCC meeting .,r ail:i. rqb(r t,' gi rCii: gi 7c ) l,'/,1 t t4 v I 1 lte-t' )l :-i t-l fr AFRICANPROGRAMME FOR f ONCHOCERCTASTS CONTROL (APOC) 3 0 A0iJI 2006 Proiect Name: 'h^lu* ONCHOCERCIASIS COUNTRY/NOTF:MALAWI Approval year: Launching year: Reportins Period From: MARCH,2005To: APRIL,2006 Month/Y Proiect year of this report: (circleone) I 2 3 4 5 e Ag O) 10 NGD0Bartner:Date submitted t l2rH MARCH, 2006. WHO/APOC, 24 November 2004 T ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: MALAWI National Coordinator Name: ...S.MK.WANDA Date: .d ftf;sit "LrtO ( Zonal Oncho Coordinator Name: rf, Signa Date: LL NGDO Representative Name r Signature Date: . This report has been prepared by Name : A.A NOWA....... Designation /r i? b,. E' , D,.U,[,.j,l (/.,r^r 1 2006 Signature: Date 30'H ll WHO/APOC, 24 November 2004 tL Table of contents ACRONYMS ....................... DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS .......1 EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION I.I. GENBRaI- INFoRMATION 1 .1 .1 Description of the project (briefly) 1 .1.2. Partnership 1.2. PopuLenoN SECTION 2: IMPLEMENTATION OF CDTI........ v ) 3 J 3 4 5 7 7 9 9 TIMELTNE oF ACTIVITIES Aovocecv MoelLIzartoN, SENSITTZATIoN AND HEALTH EDUCATIoN oF AT RISK CoMMUNITIES. Coprvruuny INvoLVEMENT............ ..........:....... ................. l0 CerAclrv BUTLDING ...................... 10 TneerneNrs................ ....... .......,..... 13 6.1. TreatmentJigures........... ....:............. .......13 6.2 What are the causes of absenteeism?........... ........16 5.3 lYhat are the reasonsfor refusals? ............ ........,....,..16 6.4 Briefl.v describe all known and verified serious adverse events (SAEs) thut.... I6 6. 5. Trend of treatment achievement from CDTI proj ect inception to the current year I 8 ORDEzuNG, sroRAGE AND DELIVERY oF IVERMECI'IN..i............... ......-........... 18 CouTuuNIrY sELF-MoNITozuNG AND STAKEHOLDERS MBBTNC ........... I9 SupeRvrstoN ............... ..................20 9.1. Provide aJlow chart of supervision hierarchy. ..........20 9.2. LV'hat were the main issues identified during supervision? .............................20 9.3. Was a supervision checklist used? ......... . ....... ..........20 9.4. l[hat were the outcomes at each level qf CDTI implementation supervision? 20 9.5. Was feedback given to the person or groups supervised? .............209.6. How wa-s the feedback used to improve the overall performance o-f the proiea? 20 SECTION 3: SUPPORT TO CDTI ..20 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2 2 2 2 2 2.7. 2.8. 2.9. 2 2 2 2 2 2 3.1. EqurrueNr 3.2. FININcIRL CoNTRIBUTIoNS OF THE PARTNERS AND COMMLINITIES 3.3. OTUSR FoRMS oF CoMMUNIT SUPPORT 3.4. ExpBNorruRn pER Ac'Trvrry ............... 20 2t 2t 2t SECTION 4: SUSTAINABILITY OF CDTI 22 4.1. INrennal; INDEPENDENT PARTICIPATORY MONITORING; EVAIUATION ....................22 4.1.1 l[/as Monitoring/evaluation carried out during the reporting period? (tick any of thefollowing which are applicable) ............ ........22 4. 1 .2. Vllhat were the recommendations? .. . . ... . ... 2 2 4.1.3. How have they been implemented? .............. ..............23 llr WHO/APOC. 24 November 2004 4.2. SusrnrNeelt-lTy oF IRoJECTS: ILAN AND sET TARGETS (vaNonroRY AT ...............23 Yn 3)......... ...........23 4.2.1. Planning at all relevant levels .. .. .. ......23 4.2.2. Funds........ .........23 4.2.3 Transport (replacement and maintenance) ...............23 4.2.4. Other resources... .................23 4.2.5. To what extent has the plan been implemented ......... .............. ....23 4.3. INrscnauoN ............... ...-.............23 4.3.L lvermectin delivery mechanisms ..............23 4.3.2. Training.... ........23 4.3.3. Joint supervision and monitoring with other programs..... ...........23 4.3.4. Release offundsfor project activities ......23 4.3.5. Is CDTI included in the PHC budget? ...,.23 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. ..... .. .... ...24 4.3.7. Describe others issues considered in the integration of CDTI. .....24 4.4. OpBnarroNAL RESEARCH.. ..................24 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..... . . .... ............24 4.4.2. How were the results applied in the project? ... ......... ..................24 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTI.II\ITIES........ 24 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........25 lv WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF IJTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with lvermectin Community Sel f-Monitorin g Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Or ganization 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 llltimate Treatment Goal World Health Organization WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/h1per-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in mesoAtyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal LUTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geopraphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemrc communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integratton: delivering additional health interventions (i.e. vitamrn A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, trainrng, supervision and personnel) in order to maximise cost- effectiveness and 'empower corrrmunities to solve more of their health problerns. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong comrnunity ownership, using resources mobilised hy the community and the government. (ix) Community 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), with a view to ensuring that the prograrnme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 24 November 2004 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) Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 24 November 2004I Executive Summary Prepare an Executive summary of the report in not more than one page. l. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and percons treated. 2. Backggound on population movements 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. Onchocerciasis control activities in Malawi started in 1984 upot the launching of the Onchocerciasis Control Programme in the Ministry of Health. There was only one and confirmed focus of the disease in the district with over 100,000 people estimated to be infested. In November, 1991 mass distribution of ivermectin was commenced. Since I 99'7,the National Onchocerciasis Programme in Malawi had been carrying out Comnurnity Directed Treatment with Ivermectin (IDTI) strategy and 'Ihyolo is one of the districts implementing CD'[I ploject. The district has 404 'villages which are headed by village headmen." 'Ihe district has a total population of 522,206 out of which 428,402 people were lreated tepresenting 82%o therapeutic coverage. The geographical coverage is 100?i, People of fhyolo move about the districl and outside to conciuct businesses and farming; since these are the main activities in the district. During the dry seasons people who live close to the boundaries with Mozambiquc move into that country to engage themselves in farming since there is plenty of spare and ferile land ttrere. Other people living close to Chikwarva District aiso movc to the district to farm. Sorne people move from their villages to seek employment in the tea estates.lt has also been lbund that a certain section of the society move about the districl and some parts of the country to sell bananas which are the main cash crop. In 2005, Health Surveillance Assistants and'fOTs conducted several meetings with an aim ol' finding out treatment progress and strategizing ways of ach ieving goo<J coveiage The challenges faced by the district are: -Dropping out ol CDDs. -Lack of cormnitment by CDDs. The challenges were overcome by: - Local training of CDDs conducted by H.S.As to replace those that have dropped out. - Conducting frequent meetings with CDDs. 2 WHO/APOC, 24 November 2004 SEGTION t: Background information 1.1. Generat information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads...) Administration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Nurnber of health staff in project area anrJ nunrber of health staff involved in CDTI activities. Thyolo District is sitrrated to the Southern Region of Malawi and it forms part of the international boundary with Mozambique to the South --east, it also borders with Blantwe, Chikwawa, Chiradzuhr and Ivlulanie Districts who are also implementing the CDTI concept. 'ihe district is one of the densely populated districts in the country with about 522,206 people. It is billy with numerous riverline systerns which makc it favourable for the bleoding of the r.rrichocerciasis vector, biack fly. People in the districi. cngage themselves in srnall scale farnring and businesses. 'flre,v grou' tnaize.. baninas and cassava firr consumption, they sell the surlllus. The tribes for.rnd in the district are Lonrrve (vrhich fonn the majoritv), Ngoni and Yao.'fhe favourite dance of the Lornwe is 'Ichopa. 'l-herc is a larnrac road which runs from Blantyre and crosses lhe district to Ivlozambique via Mulanje District. This is the main communication outlet for the district with other orrlside areas.Another tarmac road branr:hes from the above rnain road to Malamulo Hospital, this road is very small and is not used much by traffic. 'lhe rest of the roads in the district do not have tarmac hence slippery during rain season. the administrative structure of the district is arranged in the manner whereby the topmost post is occupied by the District Commissioner,under him./her are Traditional authorities. At the bottom of the structure are Village Headman.'fhe Village lleadman looks after clans of people who have joined together to form a village. A ct'mbination of villages form a very large area looked after by a Traditional Authority. Thyolo District has hvo hospitals namely Thyolo and Malamulo. There arc I I government health centres,6 Christian Health Association of Malawi (CHAM) health centres and 12 tea estate health facilities which pruvide curative, preventive and maternity services. Table l-: Number of health staff involved irr CDT'I (Please add more rows if nece,tsary) J WHO/APOC. 24 November 2004 DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Number of health staff involved in CDTI Percentage Br B2 Br=Bzl Br *100 THYOLO 494 486 97.9"/" 'fotal 4qs 486 97 .9% 1.1.2. Partnership Inrlicate the partners involved in project implementatiorr at all levels [IvIoH, NCDOs(national/interlrati onal), i:omrnunities, local organi zations. etc.] [ )escribe overall working relationship among partners, r:learly indicating specific arcas of proJect activities lplanning, sr.lpervision, advocacy, planning, mobilization, etc) in-here all parhrers are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CD'I'I implementation. The parhters involved irr project implementation are Minisrry of Ilealth, ltea Association of Malawi,Intemational Eye Foundation and W.ILO. 'lhese partners are involved in planning, supervision and implementation of CDTI activities. For [ 1 . I and 1.1.2 see copies attached overleaf 4 WHO/APOC, 24 November 2004 E €(g o c) hI) cd d Eo (g o(n o B tro an or o o0 (t) (g -oE c)dLo o bo ,o cn (n o (d (n(t o o oo oo C! 0 () bod () o 'a a. o (t o q) La 0) E d t) o a o U) F d bI)(n l.<o o c) (.) an() t) oo d C) rE o! () bI)(n ko o C) C) € o0 6 C)L(! 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() o (o &og (.) ,o cO a C)t<o qi o d tr .o lr C) o >' (B c)ti 0) a SEGTION 2: lmplementation of GDTI 2.1. T'imeline of activities Fill in table 3, timeline of octivities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. THYOLO DISTRICT CDTI PROJECT PLAN OF ACTION. APRIL 2OO5 TO MARCH 2006. S o of mectizan. I\lobilisation and scnsitization of community Iocal leaders. Distribution of mectizan to trealth cenlres autl communities. 6 Supervision of CDTI activitries. 7 Collection antl compilation of data. Training of nerv Cl-)Ds in new .rill to NO'[F t/isit to M J _t 1 NO A J I IJ A N D F M I II I I PLANNF,D ACTIVITY TOT and H.S.A. review dateCensus2 3 4 If--- I r+t I i 8 10 9 WHOTAPOC, 24 Nol,:ni[1q1 ]Q64 I I I I I 1..: . i'f&. ' "I fi"ir $ N r(.) ,o 0) o z st GI U o o. > @ >, z a.) .o 0)Lro 7 <D a)a t-. o() t C) t) i) ,i oLr p P- |<s o) tu c (n L(n (B tr () ! c t) B a t-.1 o(, 4) :]L tro Poo r\ (C rF, N 4V) Ui)q) -- i. .l) t' o) q) q d -0) orL)o o 0.\ (o 0)li an 63 otr6 C) l-r ch(l) o(o +r o) C) F earf o,l -oldtFI U) a o EE oU \o N I(J & a!_tr+ d: T;E FaJ L u) OT a EE U & E] IJ.IF oiHa d0EE FE 6{: ,.1 0,, 6l =at) o 0) Q EE o U E] zD .He!iE 6X 2. o( 6t F o ADEE 1itr ac: a" o q) oQ 2 z o.: .EH s= .ol:oo!r c)a o EE o Q rrl z) i I I i I I I --T -* I I I I I I 9-e 1itr d: Fl c.) an a oJ o :EF :l F F 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. N/A 2.3. EUlobilization, sensitization and health education of at risk communities Provide infl:rrnati <rn on: The use of rtredra antl/oi other local systems 1.o disseminate intbnlation -Ijse of posters and calendars. Vlobilization and health education of'communitres including women and rninorities - Converging of group meetings. Response of target communitieVvillages - The respcnse \Yas positive. Accomplishments - A lot of women and minorities are taking part in CDTI activities. Srrggest ways to improve mobilization and scnsitizationof the target commurrities. - By using int'luential leaders in the socities such as village headmen, church Leaders and politicians. I WHO/APOC, 24 November 2()()4 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Connment on: - Attelrlance of temale members of the communiry at health educatiou meetings -'Ihe nrrmber of females attending to the meetings is greater than the number of males. - In general, how do you rate the participation of female members of thc communiry meelings when CDTI issues are being discusses (attendance. participation in the discussion etc) - The females contribute much to the deliberations than males. - incentives provided by communities for the CDDs - No incentives are provided. - Attrition of CDDs. Is atrrition a probleru for the project? .There is attrition of CDDs due to deaths, dropping out and mansferring to other areas fbr marriages. Other issues 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. -There is adequate knowledgeable manpower. -'frhere frequent transfers of trained staff occur, state what the project is doing, or intends to do, to rernedy the situation. (The most important i.ssue to describe is whut measures were taken to ensure adequate CDTI implementation where rutt enough knowledgeable rnanpou,er was available or if staff arefrequently transfened during the course of the campaign). DistricUlGA Number of communities/villages with community members as supervisors T;td il-TNr-b", *tth Percentage communities in the entire project area community members as supervisors B4 B5 Bo= BJ Bd *100 Number of CDDs and the communities involved Male CDDs Female CDDs 'fotal BrJB* Bq= B7+Bn Number of communities with female CDDs Bto THYOLO 404 +t2 Tea Estates 0 0o/o 703 713 1416 404 + 12Tea Estates 1000 I I I I Totel 404-+ 12 Tea Estates. i 0 l%o 701 7 I J t116 404 +l2Tea Estates 100% 10 WHO/APOC. 24 November 2003 Number of communities /villages with female CDDs Percentage Bu= - By conducting local trainings to the new staff using local resources.All health workers in district have been hained so that wherever the worker is transferred should able to carry out CDTI activities without problems ll WHO/APOC, 24 November 2004 o al o -o o oz s6l U o. o B N h{ t o .3 L B o go o a-? N o !.i sB s +. F ! i c) cl 0 U q) z _ .:d ll \-,/ ! 9r F9: U s a o\ Uq o o o 0 6\ i- ev o t.i 6ll S = F -( ., q) .a'o' cEtr (l)' oo .o LGl()L z ra so ra {) () €) o\ o oI I ?)o !o6ELq)l- l-E o)q -a9E*3 zy() o E,'tYF-e' U+-a< o\ N I o\ e{ \co\ o c o () .o o\ ch N GI Q I z F o\ c't o o\ N cl 0 O Fl3e()(D ;.8 o c) z E.'i?F'd o d,Lq c) 6\o () o o o :l o\l Ue o I o IJ J o F I F F -\ a. nq) q) t) V) > a\ il t \) Oj s o o () g F li Oqr o an o C) c)lr .oE E 1) bo lrF .iir ol sldtFI Trainees Type of training CDDs Other Community memberse.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Village heads Program management 0 0 0 0 0 0 How to conduct Health education 0 0 219 0 0 0 N{anagement of SAEs 0 0 219 0 0 0 CSM 0 0 219 0 0 0 SHM 0 0 0 0 0 0 Data collection 0 0 219 0 0 0 Data analysis 0 0 0 0 0 0 0 Report writing 0 2t9 0 0 0 D.og distributiorr 0 0 219 0 0 0 Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving l00o/o geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. 13 WHO/APOC, 24 Novembur 2003 t N Lo O o z $N (J oA oE B $ F D (n()k(! o C) =E s C)\ 'J AJ a '= Eo €qt.s a.iSEks o9 tr.s0J .ts!i OiIU HLorPS ;s0)\tr5 -! .= 'F\ 6) .\ -(BR OI 9 Roi ; ! -l o trxl s r rl s s5l di q8la F tsl I :9l a .idqi S 8t : tolo s ,*l € {3tE i. Et = s =l- SHt 66 =t E I 'zl? : !o .i ll u s u *\\Us I!)s>=o: ! -E:!rEFlDs .o t\ o\\ (d C)Lrd €o() IL(l;i o)H0)o PEOt(.) .=?o 9ElE& dHA =pe> (.) -tr saa)= E .=()tr'oEre Fbto oi- .eEt)tr ol io ol =-o *l HE xl 3 * El ea El tr .h gEH El E or o o{l ,r ClE El E rl s,E Ii 5 ;lN ry glE f;ls > '=l () ;l h .- tst - !t v =I H ()I:t Etts auLIUILH 3lE 3l*A HE tslTO Ll = pl'3 -31 " .8lE(! trl cr tr.l= b =tb =tqF Zl? Zl< o x !() (, 0)k () o C)oqr okost z al()l b0(Et LI 8l ol (Bl ol -clol cdlLI s ,ul b6 rlCI iRl ,rl =l0)loldllil ol -ql $ =lOJ EI ol ol ,.El ,sl =l EI ol tr.l 6hqj() q) h t q) 4 q) E t, L d .D d C)tr d n o 'tr a € )r -o o r! a E (B () (!I F r-f o,l -oldlt-l () 6 0) oo$^(r\ o L,)F q.) (! li() 50(dk C) o d dkbo o() 0.)(! H C) oo(! ! Q) oO(),^ €.\ () a.dL() F : E€Ei a B6:* aEbt:aPE{ =46trh+i;7 9E o' 4 9 0- qsle-< = </) ZE b9SE'EO zd co* o\o @ .f o6 rE ga€EE \oco N \o cl o d Fr o ll {3do^\ o ,b0o6 E9 -93F 6\ e'l @ o\ e'l € o rn- u8E Ebs = !-r! 7. o.l i co a.lt N $ rccl$ H =od o.a /EoL=o 4 P.o' FIJ N 6l6l \o c.l cl c{ \o N c.lN H 9 .'3 E " SHFF€go.:oE E 0'6 ,o \o e't a.lN a c)bod rn c) U ll I G3sE- 9!FU ooa ov o\ o\ n E.9 .- r'I {i9 -3 5 SH = E >Jz6 o c.l o J() <f bi o 6t a+oAE$3 a :oEbZ E€-u7 9-o' FV ".r 3d \?oO-$ii osE foXo+g \Oq !.o= E.o;E.=*E - = os.9A d - O .\ ei E E-Ufi-q o>-6 .r3 sl So?s o d c) o e.I +$ -f .9<;v -! oJ F -i F F tl O !+ a.t Eo .o tr o Z$N U o B (r) q) b6 U > u .! .s E' 0o bo .r\ U q $ B .s P \ s{ 3{i a){ul]s .a U EI riI ll !r 'si \.Yua't\ ET .E *-is'3t$v B! !arsa it'Yr *u!S'.ri Sr!?Bir: t\ \ss$sE.s{r!UU €\ SO s\E-$ s$ tt$ .oisst s:s{ !s :t! .s'+ da.s9 S:h='llsr-t t\O 2.6.2 What are the causes of absenteeism? -Migration of people from the district to other districts during distribution period for employment and business. -Some people employed in the tea estates were laid off during the distribution period but were already counted during the census period. -Migration of people in search of food since the country experienced acute food shortage 2.6.3 What are the reasons for refusals? - Cultural beliefs. -Religious beliefs 2.6.4 Brieily describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information wherr available. N/A 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 Table 8: Cases of serious adverse events (SAEs) that occurred during the reporling period (Please add more rows if necessary) Date of dismissal from health facility Results o (thick bl< smear) 0 0 0 0 0 0 0 I .l I Date Mectizan was taken sn{ Sex ofAge Village origin stDate I Symptoms symptom s appeared Health status before taking Mectizan Date of admission in health facility 0 0 00 0 0 0 0 00 0 0 0 t l6 0 WHO/APOC, 24 November 2004 * Serial number of the patient t7 WHO/APOC, 24 November 2004 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9:Treatments and coverage by calendar year for the entire project area. (Please /ill in the required data) Please indicate the UTG for the project area: use this ligure as the denominator in all UTG coverage calculations.) Number r persons trei 998 ll l8l 12 159 2r2.563 397 Communities/Villages YEAR Total # of communities/villag es in the meso/hyper- endemic areas Er f,z Annual f'reatrnent Objective Er Number of communitie s/villages treated Geographi cal coverage (Y,) Er= E/ f,,*l(x) ATO coverage (%) Es: Ey' E2*100 Total population of the mesoAryper- endemic areas Ec Et Arurual Treatment Objective 1997 466 263 66 t4.t% 2s% 396,494 189.142 1998 500 180 360/o 69% 408,7s7 212,112 1999 500 269 282 212 42.4o/o 75% 421,399 3 r0,036 2000 500 282 282 56.4o/o 100% 434,432 3 Ls.099 2001 500 282 219 49.8o/o 88o/o 447.868 2002 500 282 282 s6.4% 100% 461,720 _p2,s64_ 357,902 2003 500 282 282 56.4Yo l00o/o 369,624 2004 404+ l2tea estates. 404+ l2tea estates. 404+ 12 tea estates. 100% 70.gYo 476,000__ 505,000 505,000 2005 404+ t2 tea estates. 404+ t2 tea estates. l00o/o 82o/o 522,246 s22,206 2006 404+ l2tea estates. I I 2007 2008 2009 20to 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - @lease tick the appropriate onswer)MOH{ WHO tr I'NICEF tr NGDO tr Mectizan@ delivered by - Qtlea.;e tick the appropriate answer) MOH ./ wHo tr UNICEF N Other (please speciry) NGDO Other (please speciry) l8 WHO/APOC--, 24 November 2004 u Please describe how Mectizan@ is ordered and how it gets to the communities MOH Hqrs. By DHO to District by DOC/HC staff to HC by CDD to Community. Table 10: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? Collection is done by H.S.A to DOC and is kept at the Pharmacy. List and briefly describe the activities under ivermectin delivery that are being carried out by health cile personnel in the project area. -H.S.As order mectizan and place their orders at the nearest health centre.The district health personnel deliver mectizan to the health centre where the order originated from. The H.S.As and CDDs then carry the mectizan to the community for distribution. Any other comments 2.8, GommuniQl self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project arca? If so, When? NO Table J l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. State/District/ LGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remaining THYOLO 1,064,686 1,064,696 1,062,342 0 94 0 2250 TOTAL 1,064,686 1,064,696 1,062,342 0 94 0 2250 DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSIQ No of Communities that conducted stakeholders meetins (SHI\O THYOLO 404 +I2 Tea Estates 0 0 TOTAL 404 + 12 Tea Estates 0 0 1,\ 2,9t. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. DHO to DEHO toDOC toTOT to H.S.A. to CDDs. 2.9.2. What were the main issues identified during supervision? Lack of commitment by CDDs. 9.3. Was a supervision checklist used? YES- 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Conducting frequent meetings with CDDs during distribution and we were able to trace the errors and problems faced at each level hence corrective measures instituted immediately 2.9.5. Was feedback given to the person or groups supervised? YES. 2.9.6. How was the feedback used to improve the overall performance of the project? It assisted the district to identiff the existing gaps in the perfolmance ofthe CDTI programme and thereafter came up with remedial Measures such as conducting on the job trairring of old CDDs and Local training of new CDDs to replace the dropped out. SEGTION 3: Support to GDTI 3.{. Equipment Table lZ: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functiona!, CNFR:Currently non-firnctional but repairable, WO:Written ofO. How does the project intend to maintain and replace existing equipment and other materials? By using Ministry of Health resources through the District Health Officer. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condinon No. Condition No. Conditron No. Condition No. Condition L Vehicle 2. Motor cycle(s) 4 3F I CNFR 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) b) c) 20 WHO/APOC. 24 November 2004 I3.2. Financial contributions of the partners and communities Table i Financial contributions by all partners for the last three years If there are probiems with release of counterpart funds, how were they addressed? NO. Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Human resource i.e. the communities assist in drug collection and distribution NONE. 3.4. Expenditure per activity 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 here_ I US_DOLLAR: I35 MALAWIAN KWACHA. Contributor Year I ('provide the period') Year 2 ('provtule the period') Year 3 ('provide the period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central * ProvinciaUState) 145 145 159 ls9 0 0 MOH (DistricULGA) 0 0 0 0 14450 1.1450 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) 0 0 0 0 0 0 Others 0 0 0 0 0 0 a) 0 0 0 0 0 0 b) 0 0 0 0 0 0 0 0 Communities 0 0 0 0 0 APOC Trust Fund 0 0 0 7500 7500 TOTAL 145 145 159 159 21950 2l 950 2t WHO/APOC, 24 November 2004 IActivity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels S upervi sin g Q D D s gq{_-d-i stribution Intemal monitoring of CDTI activities Advocacy visits to health and political authorities ,IEC materials Summary G_"pp!l"g) _&gl &t lpu$gry Vehicles/ Motorcycles/ bicycles maintenance Office Equiprnent (e.g computers, printers etc) Others _ lge 1778 0 250 2;/77 55 14450 MOH. APOC MOH APOC \4qH MOH 1'OTAL 19419 Total nurnber of persons treated 428,402 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 lYas Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) NO Year 1 Participatory Independent monitoring NO Mid Term Sustainabihty Evaluation -YES- 5 year Sustainability Evaluation _NO_ Internal Monitoring by NOTF NO Other Evaluation by other paftners What were the recommendations? The District should plan and budget for CDTI by integrating it into 4.1.2 22 WHO/APOC, 24 November 2004 )The District Implementation Plan. 4.1.3. How have they been implemented? The above recommendations are currentlv being implemented 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? __ YES Whenwasthesustainabilityplansubmitted?March2006- What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1 Planning at all relevant levels Integration with other PHC activities. Funds Incorporating the activities in the D.I.P 4.2.2 4.2.3 Transport (replacement and maintenance) Maintenance costs a.re being borne by the D.H.O 4.2.4. Other resources Integration with other P.H.C. programrnes 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms It is delivered with other P.H.C. materials. 1.3.2. Training. Incorporated into other P.H.C. training programmes. 4.3.3. Joint supervision and monitoring with other programs When supervising other P.H.C. programmes the CDTI is also Incorporated within the supervision schedule. 4.3.4. 4.3.5. Release of funds for project activities Integration with existing PHC budget. Is CDTI included in the PHC budgetl YES. 23 WHO/APOC, 24 November 2004 lr) 4.3.6. 4.3.7. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? DERMATOLOGY. The staff from this department was oriented on Onchocerciasis. The achievements noted so far are that the dermatologist Is able to trace onchocerciasis cases from out-patient department. The department is assisting in the distribution of mectizan to Out- patients. EPI activities. Describe others issues considered in the integration of CDTI. A well developed supervisory checklist . The use of same leadership structure, Min.of Health staff and health infrastructure 4.4. Operational 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. 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation prooess. Strengths: - Abiliry to conduct distribution in all 404 villages of the district, thus achieving 100% geographical coverage. - Attaining an increased therapeutic coverage 8')o/o from 70.9%. Weaknesses: -Some CDDs are still not capable of correctly recording CDTI data. - Lack of commitment by the CDDs. List the challenges and indicate how they were addressed. Challenges: -Dropping out of CDDs. Solutions: -Conducting on the job training for new CDDs to replace the dropped out. -Conducting targeted training of CDDs. - Conducting frequent meetings with CDDs. 24 WHO/APOC, 24 November 2004 It a SEGTION 6: Unique features of the proiecUother matters 25 WHO/APOC, 24 November 2004