Tanga Focus CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

\ i { THE UNITED REPUBLIC OF TANZANIA (irr gln d_it_e e_-_m 4!l i : I :p_d_dress) _____ 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) ,i t (9) ORIGINAL : Enslish COUNTRY/NOTF : TANZANIA Proiect Name: TANGA FOCUS CDTI PROJECT Approval vear:1999 Launching year: 2000 Reportins Period: From: JANUARY 2011 To (Month/Year) DECEMBER 2OII ( Month/Year) APOCfundinsyear: (circleone) I 2 3 4 5 6 7 8 9 (10) ll tZ 13 apocprolectimpte (circteone) I 2 3 4 s 6 7 8 9 l0 (11) lz 13 Date submitted: Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - NTDs NGDO partners - 1320 communities I I ForActlon To: a<-JP\tL Forhforurdon To: I\*\o( il,-Ba WHO/APOC, l4 September 2009 t- I I I \a 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: TANZANIA National Coordinator Name: Dr. Upendo Mwingira Signature: Date: Zonal Oncho Coordinator Name: Dr. Ally S Uredi Signature: ..... Date: NGDO Representative Name: Signature: ..... Date: This report has been prepared by Name : Dr. Rehma Maggid Designation : Project Coordinator Signature : ..... Date ii WHO/APOC, 14 September2}}9 I Table of contents ACRONYMS ........... ...................... v DEFINITrONS......... .....................vr FOLLOW UP ON TCC RECOMMENDATIONS .........I EXECUTIVE SUMMARY......... ..................... 2 SECTION 1: BACKGROUND INFORMATION........ .....................3 1.1. GeNpnel rNFoRMATroN............. .........31.1.1 Description of the project (briefly). .................. j1.1.2. Partnership ............... 71.2. Popu1RrroN............... ....... g SECTION 2: IMPLEMENTATION OF CDTI....... .......9 2.1. TrneLme oF ACTrvrrrES ............ ......... 92.2. Aovocacy ..................... l l2.3. MoelLtzartoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES Ennnun ! Slcxnr NoN DEFrNr. 2.4. Covvuxrry rNVoLVEMENT......... Ennnun ! SrcNBr NoN DEFTNI.2.5. Capacrry BUTLDTNG.. ...... 132.6. TnperveNrs.............. ..... 152.6.1. Treatmentfigures.......... .......... 152.6.2 What are the causes of absenteeism? .......... ..................... l72.6.3 What are the reasons for refusals?.............. . ................... I72.6.4 Brie/ly describe all known and verified serious adverse events (SAEs) that ....... l7 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year lg2.7. ORDERING, sroRAGE AND DELIVERy oF IVERMECTTN ...........202.8. covvlwrry sELF-MoNrroRrNG aNo SrarsHoLDERS Mpermc ............212.9. SuppnvrsroN ............... ......................212.9.1. Provide aJlow chart of supervision hierarchy. . ......... 2l2.9.2. what v'ere the main issues identified during supertision? .......... . . .............. 22 2 9 3. Was a supervision checklist used? .........Erreur ! Signet non cldJini.2-9.4 What were the outcomes at each level of CDTI implementation supervision? Erreur ! Signet non ddJini.2.9'5. Wasfeedback given to the person or groups supervised?... Erreur ! Signet non ddfini. 2'9'6. How v'QS the feedback used to improve the overall performance of the project? Erreur ! Signet non ddJini. SECTION 3: SUPPORT TO CDTI ..............23 3.1. EqupurNr .....................233.2. FINRNcral ..NTRIBUTI.NS oF THE 'ARTNERS AND .,MMLrNITIES............. ..............243.3. OrHpn FoRMS oF coMMUNrry suppoRT............. ..................2g3.4. ExpENorruRE pER AcTrvrry .............2g SECTION 4: SUSTAINABILITY OF CDTI........ .........28 4.1. IxrenNar-; TNDEpENDENT pARTrcrpAToRy MoNrroRrNc; EveluarroN.......... ..........2g llr WHO/APOC, 14 September 2009 4.1 .l Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) ....... ... ............ 28 4.1.2. Wat were the recommendations? ............. 28 4.1.3. How have they been implemented? ............. ................,28 4.2. SusraNesrllTy oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT................28 Yn 3) .......28 4.2.1. Planning at all relevant levels... ... ........... 29 4.2.2. Funds....... Erueur ! Signet non ddfini. 4.2.3 Transport (replacement and maintenance) ....Erreur ! Signet non ddJini. 4.2.4. Other resources ..Erueur ! Signet non ddJini. 4.2.5. To what extent has the plan been implemented........Erueur ! Signet non ddJini. 4.3. INrpcnlrroN............ ......29 4.3.1. Ivermectin delivery mechanism,s............... ...................29 4.3.2. Training.... Erueur ! Signet non ddjlni. 4.3.3. Joint supervision and monitoring with other programs...... Erreur ! Signet non ddJini. 4.3.4. Release offundsfor project activities ....Erreur ! Signet non ddJini. 4.3.5. Is CDTI included in the PHC budget? .....................Erueur ! Signet non ddJini. 4.3.6. Describe other health programmes that ore using the CDTI structure and how this was achieved. Wat have been the achievements?............. .................... 30 4.3.7. Describe others issues considered in the integration of CDTI. ..... 30 4.4. OppnnrroNAl RESEARCH .....34 4.4.1 . Summarize in not more thon one half of a page the operational research undertaken in the project area within the reporting period. ........ 34 4.4.2. How were the results applied in the project?............. .................... 34 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES .....34 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 lv WHO/APOC, 14 September 2009 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring LGA Local Government Area MOHSW Ministry of Health and Social Welfare\ NGDO Non-Governmental Development Organization NGO Non-Governmental Organizationt NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers LINICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization WHO/APOC, 14 September 2009 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: 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 meso/hyper-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 mesoihyper 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). (r) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (ri) Geographical coverase: 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) 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 community ownership, using resources mobilised by the community and the government. (ix) Communiti, 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. VI WHO/APOC, 14 September 2009 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 32nd Number of Recommendation in the Reoort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Reoort related: i) Government Jinancial co ntrib utio n is reported in Tanzania shillings - please convert and report in US$for better understanding by other people; The Project has taken care of this and in this report the Government contribution are in US$ ii) Table 12 should have been updated with information on new equipment since this wns known; otherwise it gives the impression that most equipment are WO. Correction had been made and table 12 has information on both new and old equipments. Proiect Related i) Explore the possibility of attracting an NGDO Dartner Through integration the Project is benefiting with NTDs partners. ii) Ensure thut treatment takes place before the farming season to reduce on the number of sbsentees as reported; The last distribution takes place on time suggested by community members compared to the 2010 distribution which interfered with Epi Eva and forced the drugs to be distributed during farming season. iii) The average number of tablets per trealment appeors lower than sverage - please conJirm und ensure that correct dosages are being given by CDDs. There was a typing error. The actual tablets used were 579,940 instead of 518,962 (Please add more rows if necessary WHO/APOC, 14 September 2009 Executive Summary Korogwe, Lushoto, Muheza and Mkinga are the districts which initiated the implement of CDTI through treating Onchocerciasis in Tanga Region. Nowadays CDTI philosophy is used in the whole region for the implementation of integrated NTDs activities which are Onchocerciasis, Lymphatic Filariasis, Soil Transmitted Helminthes, Schistosomiasis and Trachoma. Treatment of Schistosomiasis which is among of the NTDs, by using Mass Drug Administration normally it had been done at Schools and supervised by School Teachers. Moreover CDDs are also involved in the primary eye care, family planning and some in National Immunization Day (NID) campaigns Since the inception of the project in 2000 the main objective was to establish an effective and self-sustainable community based ivermectin treatment for Onchocercasis disease in endemic communities by involving community members in decision making. The objective is well achieved as all four districts are allocating funds for the implementation of CDTI activities in Comprehensive Council Health Plans (CCHP). The project has a total of 1320 communities which are Hyper and Meso endemic. The total population is 312,693 Number of people treated was 253,37 5 makes the Therapeutic coverage to be 817o the project attained 100% geographical coverage. The ATO was 250,154 while the UTG was 262,662 The Four Endemic District have the balance of 45,445 Mectizan tablets remained in last distribution also received a total of 648,586 Mectizan tablets, out of this 607,967 tablets were used and 85,957 tablets were remain. Only 106 tablets were lost equivalent to 0.01% of the tablets used. The Project managed to conduct training to 86 FLHFs, where by 5 were newly trained and 81 were re-trained. There are total of 2,640 CDDs in Oncho endemic areas and all were trained on how conduct CDTI activities in the integrated manner. Other activities conduct in this distribution cycle is sensitization of Community members, drug distribution, monitoring and supervision, collection and compilation of treatment data and report writing. The CCD ratio is 1 :l 18. Major Challenges and how they were overcome Inadequate staff in most of FLHF in endemic areas - This will be solved by involve school teachers to perform some simple activities Other programmes which provide financial incentives to and CDDs to implement their activities. - To overcome this problem is to ensure that other Programmes are adopting CDTI method, and use motivate CDDs. the Village Health Workers Community Based Health the available resources to WHO/APOC, l4 September 2009 SEGTION 1.1. General information 1.1.1 Description of the project (briefly) Muheza, Korogwe Lushoto and Mkinga are four endemic districts were CDTI is implemented among nine council in Tanga region. The Tanga region is located in the extended north - east Corner of Tarzania between 40 and 60 and below the equator and, 370 - 390 East of the Greenwich Meridian. The region occupies an area of 27,348 Sq. Kms, being 3 per cent of the total area of the entire Country. Tanga shares borders with Kenya to the North, Morogoro Region and Coast Region to the South, Kilimanjaro and Arusha region to the west. Indian Ocean borders it on the East. Tanga region have nine councils which are Lushoto, Korogwe District Council, Korogwe Town council, Muheza, Handeni, Pangani, Kilindi,Mkinga and Tanga City. There are 38 Divisions, 175 Wards, 790 Villages and many sub-villages. The population of Tanga region is 2,010,480 out of this 98 I , I 80 are male and I ,029 ,465 are female. The number of inhabitants in most of the villages varies between 1500 to 3000 people per village. Their main activities are peasant farmers, as well as few traders. The farming activities are more active during the long rain from April, May to June with the harvest soon afterwards in the months of July up to august. The major ethnic groups are Sambaa, Zigua, Bondei, with few Digo and Segeju and are almost similar to all 4 districts, Sambaa, Zigua. Also are other many small ethnic groups These ethnic groups speak, their mother tongue, but most of the younger people speak Kiswahili, which is the national language, and has become the most important language in the country, spoken nearly by 100% of the Tanga Population and the Tanzarianas a whole. Few of the population in oncho endemic area are also able to communicate in English. The major religions remain Moslems and Christians. Access to the endemic districts (Lushoto, Korogwe , Muheza and Mkinga) from Tanga and Dar es Salaam is via a well maintained tarmac road although the final32 km winding road to Lushoto District is through mountains. Most of the roads from district headquarter to the peripheral are muddy, rough and mountainous roads which are risky and not easily passable especially during rain season. Other means of communication are telephone radio call and Mobile phones, which are working effectively from regional to the district level and even to the FLHF /Community in some villages MUHEZA DISTRICT: Is situated in the Northeast corner of Tanga Region, is about 39 km from Tanga town and 3 l0 km from Dar es Salaam. It is the second largest district in the Region next to Handeni. The district is bounded in the North by Republic of Kenya, East with Indian Ocean, South with Pangani district and West with Korogwe district It covers an area of 4,922 sq.km. resulting in a population density of 55 persons per sq.km. 1= Background information WHO/APOC, 14 Seprember 2009 The district altitude is between 0-2000 meters above the sea level, the temperature ranging from 30 -32 degrees however the climate varies mainly with altitude with Usambara 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). Number of health staff in project area and number of health staff involved in CDTI activities. Mountains (forest) posing a great deal of influence. The district can be divided into three climatic belts as follow; - Coastal belt - Mountains - Low plains There is a series of major and minor rivers Pangani, Zigi and Umba are few of the major rivers, which pour their contents into the Indian Ocean. Mkurumuzi is one of the minor rivers in the District. The district generally gets three rainy seasons in the year, long rains between March and June (Masika) scattered showers (Mchoo) in August and September and short rains between October and December (Vuli) average annual rainfall is between 1000-1500mm. 90% of the population live in rural areas about 20o/o of them live in a radius of l2-14km from the nearest health facility while 80olo have to walk a distance of 5-1Okm to the nearest health post, and most of them are peasants in which they grow Maize, Cassava, Rice, Bananas, Beans as a food crops. Black peppers, Iliki, Vegetables are the cash crops. However there are big tea and sisal estates, which are owned by foreigners. Administratively Muheza district is comprised of 4 divisions, 23 wards and I l3 villages .with the total population of 213,470 people according to projection of 2002 national census KOROGWE DISTRICT: Is located in the center of Tanga region, is 87 km from Tanga town and 290 km from Dar es Salaam. It's bounded with Muheza district to the Eastern side, Lushoto district to the Northern and Western Southern part is bounded by Handeni District. The district covers anarea of 3,756sq. km resulting in apopulation density of 69 persons per sq. km. The district forms a narrow lining to the whole Southern half of the Usambara Mountains. The district is divided into three zones, which have different physical features and weather as follows; - Arid lowlands on the western part rainfall is below 800 mm - Wet lowlands on the south and eastem part average annual rainfall 800mm-1000mm WHO/APOC, l4 September 2009 - Mountainous on northem part with cool weather and more rainfall ranging from 1000- 2000 per year, so the average rainfall of the district ranges between 800-2000 per year, with heavy rains on April to July and October to December within the year. Most of the population live in the rural area and are depending in agriculture small scale farming grow Maize, Cassava, Rice, Bananas, and Beans as food Crops, while Coffee, Cardamom and vegetables are grown as cash Crops. Like other Districts in the Region there are big Sisal and Tea Estates, which are owned by foreigners. Administratively the district is comprised of 4 divisions, 16 wards andl2Z villages. with the total population of 301.855 people according to projection of 2002 national census LUSHOTO DISTRICT. Is situated in the Northern part of Tanga Region, is about 187 km from the regional headquarter where Tanga CDTI office situated, and 350 km from capital city Dar es salaam. Its bounded with Republic of Kenya on the Northern part. Korogwe district on the South and Kilimanjaro Region in the Northwest. The district covers an area of about 3500sq km. resulting in a population density of 127 people per sq. km. Much of the district lies in the midst of the Usambara Mountains where altitude range is 4500 meters above the sea level. The District divided in two physical features the highland, which cover almost 75Yo of the land, and is characterizedby cold weather and the low of 25oh, which is having a hot weather. An average amount of rainfall is 1100mm with heavy rains mainly in the months of March and May which is the wet season, from June to September is cold season with the temperature dipping as low as freezing. The dry season is from October to March. More than 80% of populations live in rural area and are peasants engaged in small-scale farming and petty Business. Main food crops are Potatoes, Bananas. Rice, Maize, Beans and Cassava. Cash crops are Vegetables, Fruits, Tea and ginger Administratively the district is divided into 8 division, 32 wards and 776 villages and have the total population of 517,305 People according to projection of 2002 national census MKINGA DISTRICT Mkinga District is one of eight districts of Tanga region with an area of 2948sq Km. It is bordered by Tanga City to the South - East, Korogwe Distrct to the West, Lushoto District to the North-West, Republic of Kenya to the North and Muheza District ti the South. Based on the National population and housing census conducted in2002, the annual growth rate of 1 .4 Mkinga has an estimation population of ll7 ,7 58. MkingaDistricthastwodivisionstheseareMkingaandMaramba, l2wards and75 villageswith3l2 hamlets. The population of Mkinga District is living in rural areas, as almost 90% of people are smaller farmers and livestock keepers. About 20%o of the residents of Mkinga District live in a radius of l2-14 Km from the nearest health facility while 80% have to walk a distance of 5-lOKm to the nearest health post. The Residents of Mkinga District are of the following tribes: Wadigo, Wasegeju, Waduruma, Wasambaa, Wataita, Wamasai and Wakamba. WHO/APOC, l4 September 2009 1.1 Physical features and weather conditions: The District altitude is between 0 - 1200 meters above sea level, with average annual rainfall between 1000 - 1500 mm and temperatures ranging from26 - 32". However the district's climate varies mainly with altitude, with Usambara mountains and forests posing a great deal of influence. For that matter one can earmark 3 distinctive climatic belts namely. Coast belt Mountaneous Lowland plains The soil is fairly good with the coastal belt charactenzed with sand, red clay in the plains and loam on the mountains. The Mkinga District network of roads can be classified into earth (362.8 Km), grave (163 Km) and which sum up to 524.8 kilometers. Despite the number of road and kilometers shown, some parts of District are only accessible during dry season. The district is also linked with other centres in Tanga Region through the 138 Km of Regional gravel Road and 640 Km of earth road. Agriculture is the main economic activities in Mkinga District which based on household labour strength. Crops that are grown for food include maize, cassava, paddy, banana, sweet potatoes and legumes. Cash crops include coconuts, cashew nuts, oranges variety of spices, sisal in grown on large estate. Production is about 127 ,000 tones of food crops each year from about 37,500 ha, while cash crop produced is about 60,420 tones from 42,000ha. Animal husbandry is another people's occupation in the District and it is practiced in the North dry part of the district where free range gracing is possible. The zero grazing of crossbreed is being carried out in Maramba area. There are 29,985 cattle, 509 dairy cows, 27,864 goats, 7055 sheep and 11,515 local chickens. Fishing industry is another important activity in coastal areas in the District. About 450 metric tones of fish have been produced in 2006. Trading fish centres are Moa and Kwale. Administratively have two division ,21 wards, 85 villages with the total population of 179,700 people according to projection of 2002 national census Korogwe and Lushoto district hospitals owned by government, while Muheza District hospital owned by the church as a Council Designated Hospital (CDH) perform district hospital services under special agreement with the government. Mkinga which is the new district have no Hospital depend on Muheza Council Disignated Hospital and Regional hospital which is near to it. DMOs in collaboration with CHMT members are in charge of all health facilities, both under the government, private and Faith based organization. Previously District hospital was responsible to deliver drugs to health centers and dispensaries that are under government but since 2010 Medical Store department send drugs direct to all dispensaries and health centres which are under the government.. One of the Health Sector Reform policy is to strengthening Public Private Partnership (PPP), in the places were there is no government health facility the drugs like vaccinations and Mectizan which are only access in government health facility are delivered to privatelFaith based organization health facilities so that the community member WHO/APOC, l4 September 2009 can simply get it There are health facilities in most villages in Tanga region and the big population (70%) has an access to health facility within a distance of 5 Km. The remaining 30% which is one third of the Tanga population has no health facility in their catchments area. There are number of private health facilities mostly concentrated in urban areas except for Faith based organization health facilities which are mostly in rural areas. There is a viry good mix up of public and private services and even working relationship as partners in impioving people health. There are 46 FLHF in the project area. 16 in Muheza, 12 in Korogwe and l2 in Lushoto.6 in Mkinga Table I : Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area B, Number of health staff involved in CDTI B, Percentage Br=Brl B' *100 Muheza 108 38 35 Korogwe 50 t4 28 Lushoto 76 22 30 Mkinga 58 t2 2t Total , o,, 86 30 1.1.2. Partnership Ministry of Health and Social Welfare (MOHSW), Regional Authority, District Councils in collaboration with APOC are supporting CDTI activities in Tanga Focus by provision of Manpower, funds and supervision. Supportive supervision and monitoring are conducted in cascade way as MOHSW conduct supervision to the region, District support FLHF and finally FLHF supervise Community (CDDs). In the supervision exercise the region and district provides transport support by fueling the vehicle/motorcycles as well as incurring the cost of vehicle/motorcycles maintenance. Tanga Focus CDTI Project has currently implementing CDTI activities for the l lth year, and we are entering third year for co-implementation with other Neglected Tropical Diseases Q'JTDs). We have no NGDO partner in the project; the CDTI activities are being supported by region and respective district councils. Project staff at regional level are the employer of Regional Administrative Secretary who is responsible to pay salaries to the staff while those at the District are under District Executive Director who are responsible of paying salaries and other human resource management. Region and District also support the project to conduct HSAM, Supervision, plaruring and training of CDDs at the district level. Community members are willing to coliect Mectizan from the nearest Health Post and encourage other members to swallow Mectizan every year. Some communities provides incentive to CDDs by exempt them in developmental work done by community members in their areas. WHO/APOC, 14 September 2009 'Please add more rows if ne CDTI Districts/ LGAs in the entire project area Total population in the entire project. area Number of communities/villaees in Population of Meso-endemic zone in the project area Ar Hyper-endemic zone in the project area At Total in meso/hyper- endemic zone 4, = [7* Ar Meso-endemic zone in the project area A.y Hyper- endemic zone in the project area A5 Totalin meso/hyper- endemic zone A6= Ar+ Aj Ultimate treatment Goal (urG) Muheza 62,768 tz0 94 214 39.268 23.500 62.768 52,725 Korogwe 74,290 91 352 443 9,864 64.426 74,290 62,404 Lushoto 118,422 364 176 540 55,414 63.008. 118,422 99,474 Mkinga 57,213 55 68 t23 35,437 21,776 57,273 48,059 TOTAL 312,693 633 687 1,320 139,983 172.710 312.693 262.662 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period. UTC = calculated as the norinun number oj people to be treated ankualb in neso/hypet endenic areas within the poject area, uut totelr to be reached when the prcject has reochedfu seosaphic coyerase (normally the yoject should be expected to reach the UTG at the end ofthe 3d yeat of,he project). Was a census for the project done during the reporting period? Yes-r/ No If No, what is the source of the data in the table above? + Source:National census Year : CDD Other source, specify: If you are using the term community or village, define what constitutes the commrmity or village. This will help understand the profile ofthe project arca. . Community is a sub-village, which is the lowcst and smallest administative structure in an area. Number ofpeople varies ftom 80 people to 480. Each sub-village served by two to thlee CDDs. IJl all sub-villages, the female./ male CDD ratio is equal one male CDD and one female CDD. Numbers of communities/sub-villages constituto a village. Is there any other information of interest about the population in the project area? Ifso, include it here. WHO/APOC, 14 September 2009 ar 'r SEGTION 2: lmplementation of GDT! 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. I a 9 WHO/APOC, t4 Seprember2009 District/LGA Mobilization of communities Training Census/Undate Drus distribution Supervision Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completion month Muheza JLTNE JULY JULY JULY AUG SEPT SEP OCT JUNE DEC Korogwe EARLY JTINE END OF JUNE EARLY JULY MID JULY MID JULY END OF JULY EARLY AUGUST END OF AUGUST JI-INE SEPT Lushoto JUNE JULY JULY JULY AUG SEPT AUGUST SEPTEMB ER JTINE DEC Mkinga JUNE JLNE JULY JULY AUG AUG JULY JULY JLTNE AUGUST TOTAL Table 3: Timeline of activities for the areas treated in the current year (Please add more rows if necessary) - Comments The project implemented CDTI activities in integrated way with other NTDs control programme 10 J. {. WHO/APOC, 14 September 2009 2.2. Advocacy Advocacy of Region Health Management Team and District Political / Government leaders were done together, in cascade way followed by Ward development committee members then sub-village leaders. No constraint were faced as majority of leaders/policy makers were the same people since we started the implementation of CDTI activities so they are well advocated. Advocacy meetings were undertaken before distribution cycle aiming at creation of more awareness for those who are familiar with CDTIA{TD and for others few which is the first time to attend these meeting. Advocacy also aimed to build and maintain the sense of ownership to the community leaders and members. The outcome of this advocacy meeting is that Region and Districts has included CDTIAITD activities in their Comprehensive Council Health Plans. The outcome at community level is that community members are fully participating in taking drugs from the nearest FLHF and support of the CDDs hence stable high therapeutic coverage. Suggestion on improving advocacy is to involve staff of other sectors in the Region and districts such as Culture officers and Social workers who are expert in advocacy compare with technical people Since 2009 as the project start to integrate elimination of all NTDs, school teachers were full involved in advocacy and mobilization, hence increase awareness. The following table shows the number of policy/decision makers advocated at different Ievel per each district DISTRICT DISTRICT LEVEL WARD LEVEL Region 18 0 Muheza 14 s80 Korogwe 30 130 Lushoto 32 283 Mkinga l5 160 Total 109 I 153 At ward level depend on number of vilrages in entire ward 2.3. Mobilization, sensitization and health education of at risk communities Information on: The use of media and/or other local systems to disseminate information oThe way used by the project is through political and government leaders then the leaders disseminate information to the community members during community meetings this is the commonest way of information dissemination. ousing the school children through their teachers is another method used. oPosters are also used for information dissemination. Mobilization and health education of communities including women and minorities ll WHO/APOC, 14 September 2009 .All village leaders including sub- village leaders were sensitized in the current year; this was done after sensitization at the district level. The FLHFs together with community leaders are responsible for mobilize and to provide health education to community members. .school children, teachers and their fellow woman CDDs are the ones who mobilize and provide health education to the woman and minorities, with good response. Response of target communities/villages - The response was good Accomplishments olncrease of community participation in CDTI activities. oAble to maintain high therapeutic coverage oMost of the communities know the important of taking drugs regularly. .Willingness of CDDs to take responsibility in the implementation of NTD activities. (onchocercasis,LymphaticFilariasis&SoilTransmittedHelminthesandeyecare activities. olncrease of Mectizan acceptance by community and when the drugs late, community members start to complain. Suggest ways to improve mobilization and sensitization of the target communities. oMobilization and health education of at risk communities should be done continuously so as to improve the situation oTo continue to use policy maker and influential people on sensitization of communities .To adhere with time frame suggested by the community 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 attendance of female members at health education meeting is less compare with male because female are concentrated more on taking care of home affair - 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). District/LGA \umber of communities/villages with :ommunity members as supervisors Number of CDDs and the communities involved Number of communities ivillages with female CDDs Total no. communities in the entire project area B, Number with community members as su pervisors R. Percentage Bo= BJ B, *IOO Male CDDs B, Female CDDs B. Total Be= B7*$* Number of communities with female CDDs B," Percentage Brr= B.JB,*100 Muheza 214 2t1 100 214 214 428 210 100 Korogwe 443 113 100 413 443 886 443 100 Lushoto 540 540 100 540 540 1 080 540 100 Mkinga t23 123 100 123 t23 246 123 100 Total 1320 1320 r00 1320 1320 2,640 1320 100 t2 WHO/APOC, 14 September 2009 o In trainings female/male CDDs attendance rate is good in most communities. Participation of female CDDs during training discussion is good, compared to public meetings sessions Incentives provided by communities for the CDDs . Few communities provide incentive to CDDs by exempt them from voluntarily work as incentives during distribution period other communities not give incentive neither except CDDs from communal work. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? o Attrition is not a problem in the project; most of the CDDs are still the same since the project started the implementation of CDTI activities. CDDs attrition occurs in rare occasions, like death or marriage for a female CDD. Likewise in Muheza district only one CCDs is new as the old one died makes attrition rate is 0.23% while in Korogwe attrition rate is 0.45 %o,Lushoto attrition rate is 123%( among of them 12 died and others married /shift to another place) while in Mkinga the CDDs are the same since inception of the project. Regardless of other responsibility CCDs are participating in Elimination of other NTDs and eye care activities a Other issues 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. o There 86 trained/retrained FLHFs most of them have CDTI knowledge for more than l lyears, 2,640 CDDs most of them are CDDs since inception of the project in 2000. A well experienced Regional coordinator and 7 District coordinators are adequate to carry CDTI and NTD activities. One District Coordinator have 3 years experience, the CHMTs provide support to the Coordinator to ensure proper implementation of CDTI and integrated NTDs activities. - 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 implernentation v,here not enough knotuledgeable manpower was available or if stalf are frequently transferred during the course of the campaign). . There is no much problem in Tanga region as now the whole region is implementing NTDs activities using CDTI Philosophy. Before that, training was done to the in charge of FLHF on how to carry CDTI activities. He/she trains his,&er colleagues and delegate power to them so that, in case of transfer CDTI activities will continue as normal. 13 WHO/APOC, 14 September 2009 Table 5: Training at the different levels of CDTI implementation (Please add more rows if necessary) Nev', 'Refr' If detail not available, provde lhe correspondmg total onll WHO/APO^ 14 September 2009 District/LGA Number of Districts/LGAs staff trained Number of Health center/nost staff trained Number of other trainers of trainees ( TOTs) Number of CDDs trained ATrO CI Netv Cz ReJr C: Total Cr= Cr+ C: ATrO Cs New i Ref, CdiCz Total Ce= C6+ C7 ATrO C" Nev' Cto Refr C,, Total Cr:= Cto* Crr ATrO c,. Nett Ct, Refr Cts Total Cro= Crr+ Crs Muheza 19 I 18 l9 38 r9 19 38 2 0 2 ) 428 I 427 428 Korogwe l6 0 l6 l6 14 0 l4 t4 5 0 5 5 886 0 886 886 Lushoto t2 4 8 l2 22 0 22 ,1 6 0 6 '6 1080 0 l 080 r080 Mkinga 14 2 12 t4 12 2 10 12 3 0 3 3 246 0 246 246 TOTAL 6l 1 54 6l 86 2l 65 86 l6 0 r6 t6 2640 I 2639 2640 7o Achievement 100 7o Achievement : 100 7o Achievement 100 7o Achievement 100 t , b, Make sure thdt there w no double t4 Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Primary School Teachers Program management ./ { { { { { How to conduct Health education ^/ { ./ { { { Management of SAEs { { CSM ./ ./ { ./ SHM Data collection { { { { { Data analysis ./ Report writing ^/ ./ ./ Advocacy/Sensitization ./ { { ! ./ { Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments: Nil 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. l5 WHO/APOC, 14 September2}}9 Table 7: Treatment and SAEs by district/LGA in all areas at risk (Please add more rows if necessary) District ILGA Communities/Villages Population Number of persons who refused the treatment Numb er of absent ees Number of Numb er of SAEs Number of serious adverse events (SAEs) referred to the health post/trospital Total # of communities/ villages in the meso/hyper- endemic areas DI Annual Treatment Objective Dr Number of communities/ villages treated Dr Geographical coverage (%) Dr: Dr/ Dr*100 Total population of the meso/hyper- endemic areas D. Annual Treatment Objective Dr Number of persons treated Dz Therapeut ic coverage (%) Dr: Drl Ds*100 communrtles with < 80% therapeutic coverage Muheza 214 214 214 100 62,768 50,214 51,243 8l.6Yo 0 lt4 20 0 0 Korogwe 443 443 443 100 '74.290 59,432 63,435 85o/o 68 310 38 0 0 Lushoto 540 540 540 100 118.422 94,738 95,420 80.5Yo 63 150 l6 0 0 Mkinga t23 t23 t23 r00 57,213 45,770 43,277 75.6Yo 0 45 55 0 0 TOTAL 1,320 1,320 1,320 100 312,693 250,154 253,375 SlYo l3l 619 129 0 0 Fomula for computing therapeudc and eeogmphical coverages Therapeutic coverage rate = Number ofpeople heated x 100(%) Total population living in meso/h)?er-endemic communities within the project area Geographical coverage rate : Number ofcommunities/villages treated x 100(%) Total number ofmeso/hyper-endemio communities as ideotified by REMO in the project area ATO coverage rate = Number of pceple]Eg4lgdll("1") Annual Treatnent Objective % UTG achieved = Number ofpeople treated x 100 Total number of people to be treated in meso,/h,?er-endemic areas within tlrc proje.t arca (UTG) AfO = The eninut.d nunb.r of peopb nving in neso/hrp.hendedic at N that a CDTI pnject lkta.lN to trect -iit iverln clln in a gitat reot UTG = Th. m@iruh tumbe, of peopk to be t .ated ia ,tuso,hypeFe"d.nic ue6 eithin the proj.d Neo, ufi dt b to b. t.o.hed |h.n the Noj.a hss r@hedlull geogrophl.rl coverage(nonalb th. pruj.ct shoutd be .xped..t to .ea.h he ATG at th. ,"d of th. Ja y.ot oI tte ptuject). 16 WHO/APOC, 14 Septembet 2009 aa 2.6.2 What are the causes of absenteeism? Day to day activities makes people to move from one place to another especially those who are engaged in business, they have to follow market day which differ from one area to other area. 2.6.3 What are the reasons for refusals? Very few ignorant community members who don't have symptoms they think that they are not suffering from Onchocerciasis, therefore no need to take medicine, but the number has decreased. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. Parasitologist trained? None Existence of microscope? None In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report t7 WHO/APOC, 14 September 2009 r Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (Please add more rows if necessary) SAI* Age Sex Village of origin Date Mectizan was taken Date l't symptom S appeared Symptoms Health status before taking Mectizan Date of admission in health facility Date of dismissal from health facility Results of tests (thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involveme nt or not * Serial number of the patien2.6.5. Trend of treatment achievement from CDTI project inception to the current year Lr l8 WHO/APOC, 14 September 2009 It Table 9: Treatments and coverage by calendar year for the entire project area. (PleaseJilt in the required data) Please indicate the UTG for the project area:262,662 (use this figure as the denominator in all UTG coverage calculations.) YEAR Communities/Villages Population Total # of commun ities/v illag es in the mesoihyper- endemic areas Er Annual Treatment Objective E, Number of communitie s/villages treated E: Geographi cal coverage (%) Er= Erl Er*100 ATO coverage (%) Es: Er/ E2*100 Total population of the mesoftryper- endemic areas E6 Annual Treatment Objective Et Number of persons treated E* Therapeutic coverage (%) Ec: En/ En*100 ATO coverage (%) Ero: E8/ E7*100 UTG Coverage (%) 1997 I 998 1999 2000 2001 965 965 965 100 100 188,196 159,s29 140,640 75 88. I 88.9 2002 972 972 972 r00 100 213,249 179,166 t47,856 69.3 83.5 82.5 2003 1283 I 283 1283 100 100 281,228 239,004 224,439 80 93.9 95 2004 I 309 I 309 1 309 100 100 289,896 240,68t 23s,353 81 97.7 96.6 2005 I 309 I 309 1 309 100 100 294,378 247,277. 236,559 80.3 95.7 95.6 2006 l 309 I 309 I 309 100 100 3t3,242 263,124 251,144 80 95.9 95.4 2007 I 309 I 309 1309 100 100 357,002 312,586 293,562 82 89.8 97.8 2008 I 309 r 309 I 309 100 100 299,967 271,275 241,252 80 89 9s.8 2009 l 309 1 309 I 309 100 100 302,488 2s5,284 244,7t2 8r 9s.8 96.3 2010 1320 1320 1320 100 100 30s,s83 244,703 246,121 80.5 100 95.8 201 I 1320 1320 t320 100 100 312,693 250,154 253,375 8l 100 95.5 19 WHO/APOC, 14 September 2009 2,7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the oppropriate answer) MoH{ tr wHon UNICEF tr NGDO tr Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer)MoH{ tr wHotr UNICEF E NGDO E Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities c Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project. We calculate the number of tablets require r by multiplying the ATO times 2.2then we get total number of required tablets. The Regional office request Mectizan and Albendazole to the NTDs Secretariat after getting request from District. The district received request from respected FLHF. The request is sent to Mectizan@ Expert Committee for approval. Mectizan@ arrives in country through the same channel and is cleared by Medical Store Department (MSD) which handles over to the NTDs Secretariat. Then through the normal channel, drugs are delivery to the district Pharmacy. The District authority distributes drugs to the FLHF by following request sent to them by FLHF staff. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Mectizan thereafter the CDD or any selected community member comes to the FLHF to collect Mectizan@ ready for distribution to other Community members. Mectizan ordered/received for this reporting year has change compared to the previous three years because of integration between Onchocerciasis and Lymphatic Filariasis and decentralization were by district(Councils have given full mandate-where by drugs are sent straight to districts)Region remain with supervisory role. However since 2010 other drugs are sent direct to FLHF by MSD it may be also used for Onchocercasis drugs. :M,ectizan@ Inven 'Please add more rows if necess State /District tLGA Number of Mectizant tablets In stock from previous vear Requested Received Used Lost Waste d Expired Remai ning Muheza 3637 150.337 150.337 140,91 3 0 0 0 r 3 .061 Korogwe 39,320 139,465 139,465 164,346 59 0 0 \ 4,319 Lushoto 50 260,528 260,528 20'7,504 0 0 0 53 ,014 Mkinea 2.438 98.256 98.256 95.204 47 0 0 5.443 TOTAL 45,445 648,586 648,586 607.967 106 0 0 85,957 - How are the remaining ivermectin tablets collected and where are they kept? . The remaining tablets are collected from the communities and returned back to FLHF then the DOTs or any CHMT members collects and bring them to the District Pharmacy were they are stored waiting for another distribution period or destruction if they are expired. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. 20 WHO/APOC, l4 September 2009 ' Ordering and delivering Mectizan@ starting from National level to the Regional than to the district up to the FLHF level. ' Manage minor side effects to the community members also to provide health education on how to handle drug especially to the CDDs . Storage of Mectizan before sent to communities . Storage of remaining Mectizan - Any other comments 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Table 11: Community self-monitoring and S 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. o Increases community ownership hence sustainability can be achieved in the project . Solving the problems in the next treatment cycle if identified and maintain successes 2,9. Superuision 2.9.1. Provide a flow chart of supervision hierarchy. NATIONAL LEVEL- NOTF J REGIONAL LEVEL- RHMT /PROJECT COORDINATOR I I + DISTRICT LEVEL - CHMT IDOCs I I + FLHFLEVEL .FLHFs ./\, COMMUNITY LEADERS uonqnq rt l-- i takeholders Meeting (Add rows District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meetinq (SHIO Muheza r&ogwJ ruinoio irati"ei 2r! 443 214 443 2t4 443 540 u s!0 123 540 123 TOTAL 1320 1320 1320 CDDs 21 WHO/APOC, 14 September 2009 Level 2.9.2Main issues identified 2.9.3 Supervisi on check Iist used Yes/llo 2.9.4 What were the outcome of CDTI implementation supervise 2.9.s Was feedba ck given to the supervi sed Yesll\o 2.9.6How was feedback used in improving the overall performance of the project DISTRIC T a) Incorporate of CDTIA{TD activities in CCHP b)Committed DOTs c)Some District budget small amount of funds Yes Problems and Successes Identified Yes -Council continue to put CDTI/NITDs activities in CCHP -More commitment of DOTs -Maintain high geographical and Therapeutic coverage -Improve performance of the implementation. FLHF a)Maintained High therapeutic coverage b)Due to shortage of staff supervision of CDDs are mainly done in nearby communities Yes Problems and Successes Identified Yes Maintained high therapeutic coverage -FLHFs supervise CDDs& to involve pr. School teachers to do supervision to CDDs COMMU NITY a)Distribution period was carried out during rainy season when most of the community members are at farming hence many absent seem b)Distribution period was too short which resulted to low therapeutic coverage esp in Lushoto District. c)Full involvement of community leaders d)Most of treatment registers not well fitled Yes Problems and Successes Identified Yes - Distribution to be done per community Need hence high therapeutic coverage c) Increase ownership and sustainability of the project. d)Improvement of fi lling of treatment registers 22 WHO/APOC, l4 September 2009 SEGTION 3: Support to GDTI 3.{, Equipment Table 12: Status of equipm ent (Please odd more rows if necessary) *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condition No Conditi on No. Conditron No. Condrtlon No Condrtion 1. Vehicle 2 IF, lCNFR 0 0 0 0 2. Motor cycle(s) 9 F 0 0 0 0 0 0 0 3. Computer(s) 2 F 0 0 0 0 0 0 4. Printer(s) J F 0 0 0 0 0 0 5. Photocopier (s) I wo 6. Fax Machine(s) I wo 0 0 0 0 0 0 7. Others a) Bicyclcs 0 0 0 0 0 0 0 b) c) 23 WHO/APOC, l4 September 2009 t 3.2. Financial contributions of the partners and communities - Fill tables 13a, l3b and 13c - If there are problems with release of counterpart funds, how were they addressed? No problems in releasing of counterpart funds - Additional comments None 24 WHO/APOC, l4 September 2009 Q1 Table l3a : Financial contributions by all partners for the last three-hlna t l n tr n l Calendar YEAR being reported (2011) GOVERNMENT contribution (US$) OTHER partners' disbursement (US$) Budqeted Amounts disbursed at the followinq levels % disbursed NGDOs LocalNGDOs Communi ties Others APOCTrust FundBUDGET LINE National Regional District Total l. Mobilization, advocacy, sensitization et h-91!tl3._elucation . -1 .1 . Mobilization _ 1.2. Sensitization - _1.9..Adyocqgy LJ. Hgqllh education Sub-total I 8,500 2,800 2,500 2,000 15,800 0 500 ""0 500 8,5_00 2,800 _ 1,500 2,900 14.800 e,spo " ?,800 " ?,000 _ 2_,00_0 15,300 109 100 "89 , 1.09_ 93.6 0 0 0 0 0 0 0 0 ln kind ln kind o ln kind 0 0 0 0 0 4,271 1,900 loob o 7,171 !!-Tratruls _ 2.1_. Training/retraining of CDDs _ .&?="Trqining/retraining of Health workers $r1p1t9!a-tJt_ lll. Supervision, monitoring, Evaluation 6,828 4.101 10,929 ; q "e 6,828 4,101 10,929 o,aze 4:1"0J 10,929 100 109 1_0"0 0 0 0 0 I 0 0 0 0 0 0 0 '19,200 4,38i"". 23,584 3J. Supervision 3.2.- Monitoring 3.3.. Evaluation Sub-total lll 6,550 3,000 0 9,550 1,700 600 0 2,300 4,850 2,400 "0 7,250 6,550 3,000 0 9.550 100 109 1gg 100 0 0 '0 o 0 0 0 0 ln kind ln kind 0 0 0 0 0 20,100 o 0 20,1 00 lV. lvermectin distribution and management of severe adverse events 4.'1 . lvermectin distribution _ 4.2. Management of Severe adverse events Sub-total lV 1,400 0 1,400 0 0 0 1,400 0 1,400 1,400 0 1,400 100 0 100 0 0 0 0 0 0 ln kind 0 0 0 0 3000 0 3000 V. Additional expenses 5.1. Salaries 5.2. Equipm_ent Sub-total V 800,000 0 800,000 40,000 0 40,000 760,000 0 760,000 800,000 0 800.000 100 100 100 0 0 o 0 0 0 0 0 o 0 0 0 0 0 0 GRAND TOTAL 837,679 42,800 794,379 837,179 99.9 0 0 0 53,855 25 WHO/APOC, 14 September 2009 Table 13b : Financial contributions ry all partners for the last three years (continued One (1 ) year previous to Calendar YEAR being reported (2010) GOVERNMENT contribution (Tshs) OTHER partners' disbursement (US$) Budgeted Amounts disbursed at the following levels Nation al Reqional District Total olto disburs ed NGDOs LocalNGDOs Communi ties Others APOCTrust Fund BUDGET LINE l. Mobilization, advocacy, sensitization et 0_eel_t_h ed-ucation _-1.1. Ivlobilization 1-.2. Seqsitization 1-3*. Ad-vocacy 1.4. Health education Sub-total I 8,382 2200 1 999 1 309 13,890 q 400 0 400 8-,382 2200 1 599 " '1309 13,490 8,3"82 .2200 1 999 1 309 13,890 10_0_ 109 1q0 0 100 0 o o 0 0 0 b 0 ln kind ln kind 0 ln kind 0 0 0 0 0 3,271 i,osz 152 0 5,160 ll. Training 2.'1 . Training/retraining of CDDs 2.2..f raininglretraining of Health workers sub-total ll lll. Supentision, monitoring, Evaluation 5,628 2200 7828 0 0 0 5,628 2200 7828 5,628 2200 7828 100 1q9 100 0 0 0 0 0 0 0 0 0 0 0 0 36,938 "32,311 69,249 _3.1. Supervision 3.2. Monitoring _ 3.3. Evaluation sub-total lll 6,234 2777 0 9,011 1 650 600 0 2250 4,5p4 2,177 0 6,761 6,234 2777 0 9,011 190 100 100 100 0 0 0 0 0 0 0 0 ln kind ln kind 0 0 0 0 0 24,652 0 o 24,652 lV. lvermectin distribution and management of-severe adverse events ,-4. 1 . lvermectin distribution 4.2. Management of Severe adverse events Sub-total lV 1,240 0 1,240 0 0 0 1,240 q 1,240 1,240 0 1,240 19; 0 100 0 0 0 0 0 0 ln kind 0 0 0 0 3209 0 sibg V, Additional expenses 5. 1_.- Salaries 5.2. Equipment Sub-total V 711,225, 0 71',| ,225 37,400 0 37,400 673,825 0 673,825 "."711,?25 0 711,225 . roo "100 100 0 o 0 0 0 0 0 0 0 0 0 0 3,s94 0 3,394 GRAND TOTAL 743,194 40,050 703,144 743,194 100 0 0 0 105,664 lr 26 \rr WHO/APOC, 14 September 2009 C1 IJ Table 13c : Financial contributions all partners for the last three years (continued Two (2) years previous to Calendar YEAR being reported (200g) GOVERNMENT contribution(Tshs) OTHER partners' disbursement (US$) Budgeted Amounts disbursed at the followinq levels % disbursed NGDOs Local NGDO S Commun ities oth ers APOC Trust FundBUDGET LINE National Regional District Total l. Mobilization, advocacy, sensitization et lpqtlh ed!!q1!!on_ 1 .1- -Mob_ilization - 1-2. 9ensitization 1.9- Advocacy 1.4. Health_education Sub-total I 5,200 1,400 '1,300 8,000 15.900 300 300 q,?00 _'1,400 1,090. 8q0_0 15,600 5,200 1,1q9 1,3q9 " 8000 15,900 :1"00 100 100 10q 100 0 0 0 o 0 b 0 0 ln kind ln-kind 0 ln kind 0 0 0 0 0 2,677 2534 ll.--Training_ 2.1. Training/retraining of CDDs 2.2. f raininglretraining of Health workers Sub-total ll I I L S u peruisi on, m onitori no, Eva I u ati o n 3,500 1,400 4,900 3,5_09 1,400 4,900 3,500 1,400 4,900 19q 100 100 0 0 0 0 o 0 0 0 0 0 0 0 15,356 9308 3.1. Supervision 3.2. Monitoring _ 3.3. Evaluation Sub-total lll 3,900 1,700 5,600 1,000 300 1,300 2,900 1,400 4,300 3,900 1,700 5,600 100 100 100 0 0 0 0 0 0 0 0 ln kind ln kind 0 0 0 0 0 4210 lV. lvermectin distribution and management of severe adverse eyents -4.1 ._ lvermectin distribution -4.2. Management of Severe adverse events Sub-total lV 800 800 80q 800 800 800 100 100 0 0 0 0 0 0 ln kind 0 0 0 0 V. Additional expenses 5.1 . Salaries 5.2. Equipment Sub-total V 565,800 3,800 569,600 23,400 2,400 25,800 542,400 1,400 s43,800 565,800 3,800 569.600 100 100 100 0 0 0 0 0 0 0 0 0 0 0 0 GRAND TOTAL 589,600 27,400 562,200 589,600 100 0 0 52,085 27 WHO/APOC, 14 September 2009 3.3. Other forms of community support - In some of the communities CDDs are excepted from communion work 3.4. Expenditure per activity - Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here US$ 1486. - Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Has the pro.icct cver hecn cvaluated/monitored? (Tick an-v of the follou'ing n'hich are applicahle) {-Vear 1 Participatory Independent monitoring ^/ Mid Term Sustainability Evaluation {- 5 year Sustainability Evaluation n Internal Monitoring by NOTF { Other Evaluation by other partners 4.1.2. What were the recommendations? The project was found making good progress to sustainability. Therefore a need to develop sustainability plan 4.1.3. Horv have they been implemented? Sustainability plan have been developed and - implemented 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NONE Was a sustainability plan written? N/A When was the sustainability plan submitted? N/A 28 WHO/APOC, 14 September 2009 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels . CDTI activities are already incorporated into CCHP, and the plan is bottom up plan which is based on the priority of the community themselves. 4.2.2. Funds o District Councils are ready to take over the programme. Budget for OnchocerciasisA.{TD has been included in Council Comprehensive Health Plans. The district council has started releasing funds for the implementation of NTDs activities which include also Onchocerciasis. Local Government Authority has supported CDTI activities. For the past five years council has released funds for the implementation of CDTI activities. 4.2.3 Transport(replacementandmaintenance) o In 2010 project received one new vehicle and four motorcycles from APOC. Maintenance of both new and old motor vehicle will be done by using govefirment funds. 4.2.4. Other resources o Human resources is stable as all Onchocerciasis team members are Government Employees and there is no frequent transfer. Nowadays transfer is done only in special case orif the staff went for advanced study. However if transfer occur, the remaining staff are capable of conducting CDTI activities because the Project makes sure that all staff in a respective Districts or FLHF at have the knowledge on CDTI. 4.2.5. To what extent has the plan been implemented o CDTI activities has been incorporated into CCHP since 2002 and most planned activities were implemented but sometimes it was difficult to implement some of the activities due to different period of financial year of APoc and that of the government. 4,3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms o Ivermectin is delivered within normal government system using the existence structure. CHMT member delivers Mectizan tablets to FLHF which saves community affected with Onchocerciasis. However the Government is conduct a study in some districts since 2010 for the essential drugs/drug kit and vaccines to be sent direct by MSD to FLHF. We hope that Mectizan and other NTDs commodities will be delivered by the same channel. The FLHF in charge and hislher subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect NTDs commodities ready to distribute to the community members. 4.3.2. Training o The project conducted refresher training to CDDs and FLHFs endemic areas where the project has started implementation integration manner. Oncho and none Oncho NTDs activities in the in of 29 WHO/APOC, 14 September 2009 4.3.3. Joint supervision and monitoring with other programs o Supervision and Monitoring of CDTI activities are integrated within PHC system. Therefore at Region and District level supervision is done jointly by a team using the developed checklist. The team includes medical staff and program staff. At regional level the team sometimes includes other Policy makers who are not health personnel. 4.3.4. Release of funds for project activities . Funds are released by using Government procedures and follow the budget line item and every responsible part plays its role. The project depends on APOCAJSAID, Council and Government. 4.3.5. Is CDTI included in the PHC budget? Yes 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? r Filltables 14 and 15 and provide describe other programmesthat are usingthe CDTI structure and how this was achieved. What have been the achievements? r For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ..,)? . Explain what are the combinations of interventions co-implemented? . How were the interventions implemented? (at the same time?) 4.3.7. Describe others issues considered in the integration of CDTI. . Drug used is the same to both Programmes - Mectizan addition is just only Albendazole . Communities served are the same therefore it is easy to conduct HSAM. . Community selects drug distributors themselves and they live together and are the same 30 WHO/APOC, 14 September 2009 ft Table 14 : Co-implementation a, Type of control Type of intervention Roles played by CDDs Number of districts Number of communities Number of CDDs involved Number of persons targeted Number of persons reached (ocplain in bullet poirtts) Targe ted Reache d Iarget ed Reache d Males Fema Ies Total Males Females Total Males Females Total Onchocercia sis control lvermectin distribution Census taking, Drug Collection from nearest FLHF Distribution of lvermectin to the communrty Data compilatron & sent to FLH F 1320 1320 1320 1320 2640 250,t54 253,375 Lymphatic filariasis lvermectin distribution Distribution of a lbendazole Census taking, Drug Collectron from nearest FLHF Distribution of lvermecttn to the communrty Data comprlation & sent to FLHF 9 5270 5270 3254 29t2 6166 735,497 766,845 1,502,342 763,233 660,659 1,423,892 Schistosomi aSiS o Distribution of pra ziq ua nte I STH Distribution of mebendazole Census takrng, Drug Collection from nearest FLHF Distribution of lvermectrn to the communrty Data compilation & sent to FLHF 9 5270 5270 3254 2912 6166 735,497 766,845 1,502,342 763,233 660,659 1,423,892 Malaria control r Distribution of LLINs Malaria control o Home management of malaria 31 WHO/APOC, 14 September 2009 + ) Malnutrition o Vitamin A supplementati on frachoma Distribution of Zithromax Census taking, Drug Collectron from nea rest FLH F Drstflbution of lvermectin to the community Data compilatron & sent to FLH F I I Cataracts a Cthers (specify) a a a a a a The data available is for the intervention which was implemented during reporting year. r(9 32 It WHO/APOC, I 4 September 2009 (f Table 15: Other programmes using CDI structure (tick as appropriate) a'n Type of control Type of intervention Involvement of communities in Planning SHM Implementation Monitoring CSM Reporting Provision of resources activities period mode selection of implementer s collection of commodit ies storage of commodit ies distribu tion supervis ion In kind financi al Onchocerciasis control o lvermectin distribution Yes Before distribu tion Meeting s yes yes yes yes no yes yes yes no Lymphatic filariasis a lvermectin distribution Distribution of albendazole a Yes Before d istribu tion Meeting S yes yes yes yes no yes yes yes no Schistosomiasis . Distribution of praziquantel STH o Distribution of mebendazole Yes Before distribu tion Meeting S yes yes yes yes no yes yes yes no Malaria control . Distribution of LLINs Malaria control o Home management of malaria Malnutrition o Vitamin A supplementation Trachoma o Distribution of Zithromax Cataracts o Others (specif) a a a NB: the interventions listed in the table are just few example 33 WHO/APOC, 14 September 2009 4.4. Operationa! 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. NONE 4.4.2. How were the results applied in the project? N/A SEGTION 5: Strengths, weaknesses, challenges, and opportunities STRENGHS . Regional authority and Council support CDTI activities financially, technically, fueling and r servicing proj ect vehicles/motorcycles . The project has good Geographical and Therapeutic coverage and maintained it up to now. . CDTI approach is now an entry point to other NTDs for the implementation of activities. . Availability of vehicle/motorcycle provided by APOC . CDTI activities are integrated in region/district health plans and funds are released to implement those activities. WEAKNESS . Delay of report submission at all level . No replacement of capital equipments needed to be replaced by APOC(Photocopier machine, scanner. CHALLENGES o Inadequate staff in most of FLHF in endemic areas . Other programmes who comes with different approach by providing payment to Village Health Workers and CDDs to implement their activities. OPPORTUNITIES . CDTI activities are incorporated in the CCHP in all oncho endemic districts. o CDTI approach is norv used by other community based programmes. . RHMT and CHMT members have good knowledge on how to implement CDTI activities . Political stability ensure ownership and sustainability . Willingness of the CDDs to continue to volunteer in the implementation of NTDs activities SEGTION 6: Unique features of the proiect/other matters. NONE 34 WHO/APOC, 14 September 2009