Thyolo district annual project technical report submitted to Technical Consultative Committee (TCC): from March 2006 to April 2007

{ RESERVED FOR PROJECT LOGO/HEADING COUNTRY/I'{OTF: t\A&t k\N \ Proiect Name:ffi THYOLO DISTRICT Approval year: Launching.vearz 1997 Reporting Period: From: MARCH,2006To: APRIL,2007 (Month/Year) ( Month/Year) Proiect year of this report: (circle on9L1234s678e(10) Date submitted. " rH FEERUARY"O0T. 2s 5ur'f,Aou8 NGDO partner: ORIGINAL: English For Action To: t?{cL for hlormottott Tor $1f;, AO AAI (r. A FO AH B csI COP 0 8 JUll-. 2000 WHO/APOC. 24 Norember 2004 MALAWI L, I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) lt WHO/APOC. 24 Nov'ember 2004 t t Ir 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.MKWANDA Sienature: .[tf. District Health Officer S ture NGDO Representative Name Si Date: This report has been prepared by Name : A.A NOWA. Designation : ...D.O.C 1 .-:-' ' ' '..:'i(.... lc;s\'lrta\ A. atx Signature , 4h.{:... Date I 1'h JL]-NIE, 200g.... lil WHO/APOC. 24 November 2004 Date lTable of contents Acronyms vi Definitions vii FOLLOW UP ON TCC RECOMMENDATIONS Executive Summary 2 SECTION 1: Background information 3 l.l. GpNeRalrNFoRMATroN............... 1.1.1 Description of the project (briefly) ..... 1.1.2. Partnership 1.2. PopulauoN SECTION 2: Implementation of CDTI 7 2.1. TrruelrNs oF ACTrvrrrES 2.2 Aovocncy... 2.3. MoetLIzanoN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT RrsK coMMUNrrrES.. 2.4. CourvtuNrry rNVoLVEMENT............ ................. I2.5. CRpacrryBUILDrNG.... 2.6. TnearrrleNts............... 2.6.1. Treatmentfigures 2.6.2 What are the causes of absenteeism?............. ............17 2.6.3 What are the reasons for refusals? ................ ............ 172.6.4 Briefly describe all known and verified serious adverse events (SAEq that.... l7 2.6.5. Trend of treatment achievement from CDTI project inception to the curuent year l92.7. ORDERING, sroRAGE AND DELIVERy oF IVERMECTrN......... ..................20 2.8. Coirruururry sELF-MoNtroRrNG RNp SrersHoLDERS MeerlNc ...........21 2.9. SupeRvrsroN ) I .....1 .....t ... .. I 7 9 9 0 0 J 3 ............21 2.9.1. 2.9.2. 2.9.3. 2.9.1. 2.9.5. 2.9.6. Provide aflow chart of ,supervision hierarchy. ..........21 What were the main issues identified during supervision? ........... 21 ll/as a supervision checklist used? ......... ....................22 Ll'hat were the outcomes at each level of CDTI implementation superttision? 22 Was feedback given to the person or groups supervised'? .............22 How was the feedback used to improve the overall performance of the project? 22 SECTION 3: Support to CDTI 223.1. EqurruuNr 3.2. FrNaNcral coNTRTBUTToNS oF THE pARTNERS AND coMMUNrnES.... 3.3. OrusR FoRMS oF coMMUNtry suppoRT 3.4. ExpeNorrunE pER ACTIvtry ............ SECTION 4: Sustainability of CDTI 25 4.1. lNreRNel-; INDEIENDENT eARTICIpAToRy MoNIToRTNG; EvaLuatroN....................26 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)............ ........26 4.1.2. What were the recommendations? ...........26 4.1.3. How hcne they been implemented? .............. ..............26 4.2. SustaNaatLITy oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy AT ...............26 Yn 3) 4.2. l. Planning at all relevant levels 4.2.2. Funds........ 1.2.3 Transport (replacement and maintenance) 1.2.4. Otherresources... 4.2.5. To what extent has the plan been implemented........ 4.3. INrpcRarroN............... 1.3.1. Ivermectin delivery mechanisms 22 ./.3 24 24 ..26 ..27 ..27 ..27 ..27 ..27 ..27 ,,27 IV WHO/APOC. 24 November 2004 t4.3.2. Training.... ..........27 4.3.3. Joint supervision and monitoringwith other programs..... ...........27 4.3.1. Release offunds for project activities ......281.3.5. Is CDTI included in the PHC budget? .....28 4.3.6. De.scribe other health programmes thot are using the CDTI structure and hov, this was achieved. What have been the achievements'? ............. ..................28 1.3.7. Describe others issues considered in the integration of CDTI. ..... 28 4.4. OpsnarroNAL RESEARCH.. ..................28 1.4. l. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period........ ..................28 1.1.2. How were the results applied in the project? ............. ..................28 SECTION 5: Strengths, weaknesses, challenges, and opportunities 28 SECTION 6: Unique features of the project/other matters 30 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 UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organ ization Non-Governmental Organ ization 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 VI WHO/APOC. 24 November 2004 Definitions (i) Total oopulation: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible pppulation: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso4typer-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper 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). (u) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-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) Sustainabilit),: 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 community ownership. using resources mobilised by the community and the government. (ix) communit), 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 programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vll WHO/APOC. 24 November 2004 FOLLOUU UP ON TGG REGOTITIE]IDATIONS 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 2004 Executive Summaly Prepare an Executive summary of the report in not more than one poge. l. Background on treatment and population data - Total communities, communities treated, totalpopulation, UTG, ATO and persons treated. 2. Background on population movements. 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. Since l997,the National Onchocerciasis Programme in Malawi had been carrying out Community Directed Treatment with lvermectin (CDTI) strategy and Thyolo is one of the districts implementing CDTI project. The district has 404 villages which are headed by village headmen.and12Tea estates.. The district has a total population of 567878 out of which 479614 people were treated representing &4.3%oherapeutic coverage. The geographical coverage is 100%. People of Thyolo move about the district and outside to conduct businesses and farming since these are the main activities in the district. During the dry seasons people who live close to the boundaries with Mozambique move into that country to engage themselves in farming since there is plenty of spare and fertile land there. Other people living close to Chikwawa District also move to the district to farm. Some people move from their villages to seek employment in the tea estates.lt has also been found that a certain section of the society move about the district and some parts of the country to sell bananas which are the main cash crop. In 2006, Health Surveillance Assistants and TOTs conducted several meetings with an aim of finding out treatment progress and strategizing ways of achieving good coverage The challenges faced by the district are: -Dropping out of CDDs. -Lack of commitment by CDDs. The challenges were overcome by: - Training of new CDDs conducted by H.S.As to replace those that have dropped out. 500 CDDs were trained - Conducting frequent meetings with CDDs. - 29 H.S.A.s were trained and 3T.O.T.s 2 WHO/APOC, 24 November 2004 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads. . .) Adm inistration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. Onchocerciasis control activities in Malawi started in 1984 upon 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, l99l mass distribution of ivermectin was commenced. Thyolo District is situated to the Southern Region of Malawi and it forms part of the international boundary with Mozambique to the South -rast, it also borders with Blantyre, Chikwawa, Chiradzulu and Mulanje Districts who are also implementing the CDTI concept. The district is one of the densely populated districts in the country with about 567878 people. It is hilly with numerous riverline systems which make it favourable for the bleeding of the onchocerciasis vector, black fly. People in the district engage themselves in small scale farming and businesses. They grow maize, bananas and cassava for consumption, they sell the surplus. The tribes found in the district are Lomwe (which form the majority), Ngoni and Yao. The favourite dance of the Lomwe is Tchopa. There is a tarmac road which runs from Blantyre and crosses the district to Mozambique via Mulanje District. This is the main communication outlet for the district with other outside areas.Another tarmac road branches from the above main road to Malamulo Hospital, this road is very small and is not used much by traffic. The 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.The Village Headman looks after clans of people who have joined together to form a village. A combination of villages form a very large area looked after by a Traditional Authority. Thyolo District has two hospitals namely Thyolo and Malamulo. There are I I government health centres, 6 Christian Health Association of Malawi(CHAM) health centres and 12 tea estate health facilities which provide curative, preventive and maternity services. J WHO/APOC. 24 November 2004 Table I : Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area B. Number of health stalf involved in CDTI Br Percentage B.=B,/ B' *l(X) THYOLO 528 5r8 97.9o/o Total 528 5t8 97.gvo 1.1.2. Partnership lndicate the partners involved in project implementation at all levels [MoH, NGDOs(nationaliintemational), communities, local organizations, etc.] Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in project implementation are Ministry of Health, Tea Association of Malawi, International Eye Foundation and W.H.O. These partners are involved in planning, supervision and implementation of CDTI activities. For l.l.l and 1.1.2 seecopiesaffached overleaf 4 WHO/APOC. 24 November 2004 <f al o -o E a) z + .J a - B (o E (! C) (.) bo(d 63 (l) (g O U) U)() o. O) bo U) -o 0.) C) o bI) J3 a (! o (! E(r) (H o o oo C) U) (.) bo oL(€ oo 'a o. (,) (F o C) oLo o (! th o (.) (r) F C' oo(! o o o(.) lr) o C) (B o (,) (.) ho L E E o C) EL C) 0) bo a a)L(o o (ts \o c\ L C) 0) (B ! (r) U) C) c) I e" C)o o-(r) ootr a L C) o 6.() o -oa6x 0J l-1 (,) 6 (B!o o2 = o-)vc) 0)- o6 6? 6A-FZ a9) L _c9>u) z(L i: q+ ai! t<o o. bo L o oL (.) bI) J 'o o o .o oo L () .o U) a C) C) (,(o ! Uq) qJ $ i A) () p -a n) :8 r.i '= SIs\ip .Y\ .Y\ \Go!u -S A'\> SE hO' SUH Bqr !,S '== S!stcqr< L\ $q, :- %trgsrP \- B< est i.\ EdBx \I3* LU :5\;\\g\t !=' *i \s '>L59 SP u. -s .Y ci u' :b^ E::e := ils t\B\s 4: T\ lv ! t q) a q) ! o L C) bo L o-oL 0) o0 L ! tr o o) (€ C)L oL CB C) (.) 0) B c! o) ,r 6l 9 0) q)L o o v) L (d o (c o0. 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EsxlEgE E *- U!= 85 h gEUDE*r,iIE,ro,:alliall, SoEEEES EH 8 g,HE LO =FFil qh;i:o-(o=(!(! =(L < a(L(L(!(-o o.O O'a 6 o o o o LLUL._)_LLLLoo(go.,Cgoooo -o -o = -o.:, o -o -o -o -o = = == ?= = - - - = f o = 4) e= = = 5c E o-c +s E c c E 6 G (g (g - x-(g G (! GUUVo o o o-c 0) o o o oFFFFFL7FFFF U) tr.l&) tr F zEI F trl&F I o o! C) a(! (! oL(c oo 'a L o. 0) (B Ja o. o o -o(! t) ol-o (r F .o o d()L(l) (t I SEGTION 2: Implementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities 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 2006 TO MARCH 2OO7 7 NO PLANNED ACTIVITY A M J J A S o N D J F M I TOT and H.S.A. review meeting. 2 Census up date. J Ordering of mectizan 4 Mobilisation and sensitization of community local leaders. 5 Distribution of mectizan to health centres and communities. .jl:'.#'S {i._ YL 6 Supervision of CDTI activities. 7 Collection and compilation of data. 8 Training of new CDDs in new villages. 9 Report to NOTF WHO/APOC. 24 November 2004 .'; ,1,';, ,.;d! ,.; ' ,'tr')" ',' l <f, c.t o -o E CJ o z + cl o r :E co o\o= c{ .= 2a oo: <9 aC) €t >ro =< -a 0)-c> il a) (.) * o.])E>(s a6l- ()F ()() I oooo A.-.J ,X ctr ct ' FF :\a 4q) Uq) q r. P t q) Fi!q) s L o c)t-L o o ! C) (6 0)L (t) cBoL(s() t- (r) .9 .= (.) (H o() 6 Ei: c.ir 6.)l -ol(€l FI A) Lq) a o q) o Q r N + U& a0_E|- l.E a' NJ d o L o al o EOEE Q & lJl @ F(, L.) b0aEftr J f q) 6l U) qh o Q o a6EE o Q J) a0_tr+ ,|JE 6: J) o0 GILF o o-:EE(, F .h -of Sr 1itr aE q.lz = vu, -6) EEE= EE !r e)e o o.6EE (.) q H F(, a0aE rE -lf I I t- U) a -.] F I Fr 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. 4O4 Ghiefs and lnfluential leaders were mobilized and this helped to increase treatment coverage and those who were refusing to take ivermectin started taking the drugs making low refusals and absentees compared to previous year. So far no difficulties were found in advocacy. 2.3. Mobilization, sensitization and health education of at risk eommunities Provide information on: - The use of media andlor other local systems to disseminate information -Use of posters and calendars. - Mobilization and health education of communities including women and minorities - Converging of group meetings. - Response of target communities/villages - The response was positive. - Accomplishments - A lot of women and minorities are taking part in CDTI activities. - Suggest ways to improve mobilization and sensitization of the target communities. - By using influential leaders in the socities such as village headmen, church Leaders,Politician and Village Health Committee Members. 9 WHO/APOC. 24 November 2004 2.4. Gommunityr involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance of female members of the community at health education meetings - The number 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 the community meetings 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 attrition a problem for the project? -There is attrition of CDDs due to deaths, dropping out and transferring to other areas for marriages and employment Other issues 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. -There is adequate knowledgeable manpower. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation . (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was qvailable or if staff are frequently transferred during the course of the campaign). A Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of cqmmunities /villages with fcmale CDDs Total no. communities in the entire project area B. Number with community members as supervisors B. Percentage Bo= B./ B. *100 Male CDDs B7 Female CDDs B* Total Bq= Br*B* Number of communities with female CDDs B,N Percentage Bu= B,JB.* 100 THYOLO 404 +'12 Tea Estates 0 0"/, 904 893 1798 404 + l2Tea Estates 100% Total 404 + 12Tea Estates. 0 lYo 904 893 l 798 404 +l2Tea Estates l00o/o l0 WHO/APOC. 24 November 2003 - By conducting local trainings to the new staff using local resources. - Training new staffusing Ministry of Health Funds ll WHO/APOC. 24 November 2004 () ct O (-) o c)E z ! 9r LV I .U s.:c<v o q) o o \c (,?F 0 () .a'o'CL c): oq, ,. q) La!6)L z = --d *-=qv zv it) o q) UF ?a) (u 8! !E :H E:- zE o() E,q? U*q t = o,F- 1 a.l o. c.l o\rr(\t ra al o\6l q) o e I U o\ a-'t o\t\ F q) O -]9,eq)qJ '!7 c q)E z I + U il(J 6l = o q) q) \o U?F (, -l I -] F I t'r Fr ca c-n o -o E() z +N (-) o > s bh o o \ I s o B P t I\ o t q. 8'. :. ; -:\ qq Uu 4: s, { q) 4 q.) s o o C) a F IJU(+- (h (.) C) (l) .o)F () (d oo (€ F ra)l o.ll -ol(€l ITable 6: Type of training undertaken (Tick the boxes where specific training was caruied out during the reporting period) Any other comments 500 CDDs were trained using MOH funding and other 500 CDDs were trained using APOC Funding. 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100%o geographical coverage and a minim um of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of training CDDs Other Community memberse.g Community supervisors Health Workers (frontline health faci I ities) MOH staff or Other Political Leaders Village heads Program management 1000 0 32 0 0 0 How to conduct Health education 1000 0 32 0 0 0 Management ofSAEs 0 0 32 0 0 0 CSM 0 0 32 0 0 0 SHM 0 0 0 0 0 0 Data collection 0 0 32 0 0 0 Data analysis 1000 0 0 0 0 0 Report writing r000 0 32 0 0 0 Drug distribution 1000 0 32 0 0 0 l3 WHO/APOC" 24 November 2003 l4 WHO/APOC. 24 November 2004 ;o I s 9< 0='6.3 6 6 ?ZA e suieHeSz HE e E? =u)zZ bg E8 z6 o. @ o\ \o oo ^=! "E 5:i EE['EEz t- F- o (! o o- ll * o\ O 'Eo = bI)o.d 9a F o\$ + oo \o n <+ € o --EEE ETE3 q!z F-+ o, a-+ r-+ o\r-$ =od o.= < 9*'FV € F-QF-\o 00r- € F-\o c .o .a E o 9G5--tr i o E.AdE oF € a- oo F-\o oo F- € ar\o an C)00 cd U)o I I I lL r- o\ E .9o -d) -o- F!vo da do(, ^\ 6\ E.o .^ L.= [i ! -t E px =E>!za o orB G x0)+u o e.l +o+H 'o) -Esd o.= < 9P'F9 ol 3 6+ar<r o oc-l = fo ,\(dYg >9.' 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