Phase I CDTI annual project technical report submitted to Technical Consultative Committee (TCC): Jan 2006 through Dec 2006

I{. RESERVED FOR PROJECT LOGO/HEADIIVG THE REPTIBLIC OF TJCANDA MINISTRY OF HEALTH COTTNTRYNOTF: UGANDA Proiect Name: PHASE I CDTI ADproval vearz 1997 Launching yearz 1997 Reportins Period (Month/Year)z .IAN 2006 THROUGH DEC 2006 Proiect year of this report (Crreb ane) 123{s678900 Date submittedz JUI.Y 2007 NGDO parfner: THE ('ARTER CENTER AND SIGHT SAVERS INTERNATIONAL /^/Gu 8iH cs^(st AIIE tsfo fD i t I )- ? ;tiirt lfifil II t' C @,v ANNTTAL PROJECT TECHNICAL REPORT STIBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Managetnent by 31 Januarv for March TCC rneeting To APOC Mattagement by 31 JuIv for September TCC rneeting AFRICAN PROGRAMME FOR ONC HOCE RCIASI S CONTROL (APOC) ra il t ANNTIAL PROJECT TECHNICAL REPORTTO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the Country. -UGANDA National Coordinator Narne: Dr. Richard Signature. NGDO partnerlZonal Oncho Coordinator Name: rnugyenyi ca ' "' 'f ' "'' appropriate space. OFFICERS to sign the Signature: W'4=g|(.* .. Date: %/ oKloV i fnis report has been prepared by Name: Dr. R. Ndyornugyenyi Designati on : NOCPQpordinator iii Sign Date +Table of contents ACRONYMS............... .............vI DEFINITT.NS """""" """""'vII FOLLOW UP ON TCC RECOMMENDATIONS .......1 EXECUTM StTMMAR!',........... --......---....2 SECTTON 1: BACKGROUND INFORMATION """"4 l. I CIINEIL\I. INTr()l{MA'lloN ..... Descnptton oftha prolect ftrrcflv) Parlncrshrlt PoPI-TLATTON SECTION 2: IMPLEMENTATION OF CDTI........ """""""""""8 2.1. TIMELINI oFAc'flvl[11is..... . 8 2.2 Anvoc.,rc'y.... l0 2.3 M()}IIL]ZAI ION. S]'NSI IIIA IIoN ANI) II-F,AI-'III F])LICN'I'ION oII A I' [I.ISK COI\'{MIJNI I IIS I(') 2.4 Colznatrutt'v INVoLVIIMEN'I . .. " 1I 2.5. Cru'.lcrfv lluil I)ING 12 2.6. TR]']A]'M1,NTS...... ....... " "' 14 2.6.1 'l't'eolrttutt.figttres.. "" "' 11).6.: Il/h(lt ctre the catt.ses of'absanleetstyt'.... "" 16 2.6.3 Wot orc il'te rcasons /br refi.rsols'' " " 16 2 6 1 Brrcfl)'c{e5crtbe ttll knov,n cmd veruliecl senots oclver.se evenls (SAIis) thot....l6 2.6.5.'ti.entl of.treounent achrcvement.liom CDT'l proyct tnL'eptnn to the currettt vear l8 2.7. ORlI,tttNri. s1(x{n(iH ANI) I)lll,lvF.ltY oF IMiRMt;cl-lN l9 2.8 COTzNT,NNI IY SEI,F'-MONITOI{ING AND Sl AKE}IoLD]:IIS MTI] IltIG ' ..20 2.9. StrplRvtstr-tN..... ..........21 2.9 I . Provrcle o flov' c'hctrl of-sttpervstot't hrerarclt. ' 2 I).9.2. W'hat were lhe tnom ts\ttc'\ rclantt./iccl "{tu'rrtg sttpervfloll ""' 2l293 Wttsasltpervtslonchecklrslttscc[l. " 22 2 9.1. Wtcttu,crc the otficotncs at euclt level of'Cl)TI nnplemet"tt(-tfion xtpervrstrttt'' 22 2.9.5. Was.fbeclhttck gt,-en to rhe person or gro?4),t ,st1pcrvrsecl' "" 22 ) g.6. Hoy'v'tt,s tha /beclhack trscd to unprove the overall trterlbrnrunce ol'the prttlect') 22 SECTION 3: SLTPPORT TO CDTI """""'22 1t1 11) t2 4 J 6 7 Eeu['MITNT FTNAN C IAI, C' oNTRlRi ITrcNS OI' .iI]E PARTN]]IIS AM) C OMMI IN]'IIES . . . OITI,N FORMS OF COMMI]NITY S{IPPoR.f 21 EXPENI)I II]I{IJ PFR ACTI\4 I.Y SECTION 4: SUSTAINABILITY OF CDTI """""""25 .+. I IN'lljRNAI.: INi)]:pl-tNl)t-.N]' I,AR'IICIPA'IORY MoNl'loRIN(i: EVai.tiAlloN. ....... ...25 1. t. I Wa,s Moyttttrmg evcrltmtnn c'arrred out c{trrutg the re porttng ytertocl'' (nck ottt' rsl thc jbllov'rng u'htch are as4tltcable) 25 1.1.). Wholu'ere lhe recrtmnten(,lattons) """ 26 1. I .3 Hov' httve lhet' heen rmplentenle cl'' ..... " 26 .+ 2. SI;S'TRNCNBILIT\' t)F PRo.[I]C'1'S: PI,AN AND St]T ]ARGF'I'S (MANI)ATORY AT .. 26 21 31. JJ. 3.4. 22 .24 Yrr 3) iv a/ I 2.L Plotltltt'tg ctl oll relevottt levels I 2.2 l'lutt{s ' 26 1.2.3 7-t'(tt1.spot't (replacemerlt ond mamlenance) "" 26 J.2.1. Olhci resrtttrcc\'.... " 26 I 2 5 7'o v'lrcrt extctll hct.s thc platt heen mrytlemcntetl .." ' ' 27 4.3. IN'|I]GRA l'loN "" 27 1.3 t lvcrnteclttt t{elitert' tttechcuttsrlts ' 27 1.3.2. T't'Lltt1mg " 27 I 3.3. ,lotnl strpcrvt,ttot't onLl monttonngw'tlh othcr prrtgranxs . 2T 1 3.1. Relea,sc ol'.ltntcls.fbr pro.lect actNtfie.t....... . ""' 27 + i.5. Lg ('D7.1 trtcltttlcr{ m rhe I'HC bt.ulget'' ' " 27 1.3 6. De ,scnbe otl.ter l'tealtll progroffinles ilrut are usttlg the CD'l'l ,slrlrcfitre oncl hov' thr.s u'cts ctcluevctl. W'hat have hcan the ochravemants2 ..... J 3.7 [)cscrtbe orher.s t.\,sLte.s cgpsrcleretl m thc uilcgj'olrgn ol-(-D'l'l 27 27 4-+ Opl.RA'ItoNnLRl,lsllAItclL.... " "28 l.l l. Sttwnctrrc tn 1(,t more lhon onc hal.l.of'cr po,qc lhe operatumol rescarclt ttnL{erlctkctl tn lJ'te prolecl oreo u'ttltttt tlrc repot'trttfi perncl. .28 1.1 2. Hou'v'cre tlte rc.still.s applrcd m {he Pro.leL't') 29 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND oppoRTUNITrES..... ..............2e SECTION 6: LTNIQLTE FEATURES OF THE PROJECT/OTHER ]VIATTERS...........30 i' 'i ' - Acronyms APOC Afrrcan Progtamme for Onchocerciasis Control ATO Annual Treatment Objectii e ATrO Annual Training Obleclrle CBO Communttr'-Based Organization CDD Communitr-Directed Distributor CDTI Communitr--DrrectedTreatmenlu'ithlr-ermecttn CSM Communitv Self-Monitonng LG.A Local Govemment Area MOH Ministry ofHealth NGDO Non-Golemmental Der-elopment Organlzation NGO Non-Govemmental Organization NOTF National Onchocerciasis Task Force PHC Priman heallh care REN/IO Rapid Epidemioiogical Mapping of Onchocerctasis SAE Selere adr erse etent SHM Stakeholders meeting TCC TechnicalConsultatireCommittee(APOCscientificadvison.gloup) TOT Trainer of trainers UNICEF United Nations Children's Fund LITC Llltimale Treatment Goal WHO World Health Organization V Definitions (ii ) (iii) (rr ) (r ) tli) (r'tl) (i) Total populatron: the total population living in mcso/hvpcr-cndemic communitics wrthin thc projcct arca (bascd on RENIO and ccnstts tatriing) Eligible population: calculatcd as 84% of thc total popr.rlation in meso/hvper- cndemrc courmunttics in the pro.icct arca. Annual Treatmcnt Objectivc: (ATO): thc estirnatcd uumbcr of persons living rn rurcsofllpcr-endcmic areas that a CDTI project tutetrds to trcat rvith ivcrmectin in a gir-cn vear. Ultirnatc Trcatrncnt Goal (UTG)' calculated as the nraxrtmtm numbcr of people to be trcated annuallv in meso/h1-pcr endcmic areas u'ithin the pro.iect arca. ultimately to bc reached rrhcn thc pro.jcct has reachcd full gcographic coleragc (r-ronnallr the project should be expictld to rcach thc UTC at the cnd of thc 3'd vcar olthc projcct). Ttrerapcutrc cover umber of pcople treatcd in a given \.car oler the total population (this should bc crpressed as a perccntagc) GqoglqphgallAycEge: number of comtnunttres trcated in a givcn vcar or cr the total number of mcso/hvpcr-endcrnic comtnunitics as idcntilled b1' REMO rn the projcct arca (this should bc cxprcsscd as a pcrccntagc). Integration: delivcnng additional health intcn'entions (t.c vitaurin A supplcnrents. albcndazolc 1br LF' scrccning for cataract' etc )through CDTI (trsing thc same sr-stcms. trarning. supcrt'ision and personnel ; tn ordcr to maxitnisc cost- cifcctir-encss and cmpo\\-cr communities to solvc morc of their hcalth problems This docs not includc actir rties or intcrrentions carricd out bv commttnitr distributors outstdc of CDTI. 1r'rii) SUSIA14AbIfq_ CDTI actirities in an arca arc sustaiuable uhcn thev continue to flnctiol cffectn'clv for the loresecable futurc. sith hlgli treatl-ncnt colerage. lntcgrated into thc alailable hcalthcarc scrvice- urth strong conlmunltv ouncrship. tusing rcsourccs rnobtliscd b1 the cornrrunitY and the goYcrnment. 1ir) Communrt!' self-monitorins (CSMI Thc proccss b1' shich lhc comtnunitv ts ernporlered to ovcrsee and monitor thc perfonnancc of CDTI (or attr- cotnmunitr'- based hcalth intcn'entron programmc). u rth a viov to cnsuring that the progralrmc rs bctng executed in the uav intcnded. IL encourages the communitr-to take full rcsponsibllitr of it'crmectin distrrbution and make appropriatc modrfications rhcn llcccssary' vi FOLLOW UP OTI TGG REGOilIUENDATIOilS Using the lable belori. fill in the hou ther-har e been addressed. recommendations of the last TCC on the projecl and describe TCC session -SIXTEENTH SEESION Niruber ol' Reunnnten iltttiott iu tltc K'C RECOMMENDA'I-I0NS ACTIONS TAKEN I]Y'I'HE PRoJECT' FoR T('U,1P0( MGT- ASE 0NLY N ott -fin an ciul cont rib trtiott oJ conmtunitics sltould be ucktrou'ledged hy the Reasons.for reJusul included The project pro't'ile reusotts -/br high refusal rate among v'otrren in Kisoro Encouruged but ('SM und stakeholders not done due to l'he prrlecl crrcot rilgc nwe CSM in othet conutrunitics and the ase of sttkeh oklers nrcetitt gt Advocacl has contutued at all lclels but release offunds specrflcallr lor CDTI relrlains ruadcquate. Integrated cotttrol of Onchoccrctasrs uitlt other health scrrtccs sccrns to bc promising in or crcourtttg thts In viev'oJ hadgeting hul non-releose oJ Jhnds hy' MOH in tlrc pust, ttrttl tto Jinancial provision h)' lhe districts in the Pust, there v,us tlrc necil ttt trtotritor contnitmettt giten lo .finunciul posl APOC Plans w] IO/AI']Ot' 'r5t' ()t'toher r()05 (l'\eo.sc oc{d tnorc nms tf.nace.ssart) Executive SummaIY Prepare an Executit'e silnilrrar),o.f the teport in not nutre than one poge. I Background on treatment and population data - fotil cornmunities. communities treated. total population. UTG. ATO and persons lrea1ed. 2 Background on population mo\ ements. 3. Training data - CDDS. health \\-orLers. Total populalron (communitl; per CDD trarned. -1. Challenges and ho*'thev n'ere olercolne. This report cot'ers the period qf January to l)ecentber 2006 .for phase I districts (Hoinru, Masindi. Kasese uul Kisoro flistricts). 7'1rc total nuntber of conutttutities in tlrc pru2iect urca ure JgB tvith a total population of 283,085 people The NGDQ pafina' in Kusese anil Kisortt is Tlrc Carier Center ffCq'tyhile the NGDO parttter in Hoinn and Masindi is Sigltt Stn'ers lnternotipttal (SSI. These districts started inqlententing CDTI actit'ities with .finuncial support.fiom APOC irt 1997. The tlistricts were evaluated -for sustainabilitf in June 2002 onir.fitin ],ears of APOC.furttlittg antl.intlged to be nrukirtg progress ttntaruls sustaintbilitl' i-lrcr'eafter, the listricts detelopetl sustainabilitl,plans wlticlr thel' 1111t'n been intplenrcnting rtsirtl;'local resowces supplenrcnted with rexntrces .from the |lGDOs parlners- l'hese distrids ure in the l0t' yeur of CDT.I intplenrcntution. Treatilrcnt col'erage (ieogruphic ortd iherapeutic co'terage in phase I districts lttt'e renurirted high tt'itlt 10096 geographic cot'erilge it euch district and therapeutic coverage in the rcporlirtg period was 729i, 529i,, 8196 and 8296 irt Kisoro, Kasese, Hoinru and Masindi, respectfuel.l'. Tlrc annual treatnrcnt ob.iectit e in the project area was 210, 875 people and 232,303 people were treoted gitirrg AT0 clr,erage of 96.196. The LITG bt, 2010 is estinmted ot 260,528. Truining A totul of 1510 L'DDs were turgeted.fttr training and 1510 were trained git'ing an oclie,tent'ett of I0()96. The totul population irt tlrc proiec't area is 30J,358, giring u ratio of I98 per CDD (approxinntely 28 ltouseholtls per CDD). 50 heultlt tnrkers were tatgeted.ftr troining nnd ull usere truined giving I00a'(, tchiet'enrcnl Integratiort CD7'I ac.titities are being integrated witlt other healtlt services especially, sttpport srtpen,isiort and nnnitoring using the stnrc ,rrotor vehicles ond other ktgistics. During the pist.fet, years, the concept o.f integration hos heen enhanced b1' the MOH and its purtners, throlugh o ne-)y strutegst of Chiltt Healtlt Da1,s. 71rn nu4ior inten'entiotts that ore offered during Chitrt Healttt l)a1.s ure: antigens .fbr the inununi?.able diseases, V'iturttin A .fttr chitrtien anl post ptrtum nnthers, and alhenduzole .fttr children. Sfirted initiolly as a plutfttrnt o.f icatirig np the intenentiorts thal target children and nnthers througlr -rcielerafintg intenentions tffireil at static and out reuclt ltosts, Child Health Dul's tvus .found to be u gootl entry point .for intenentiorts tlrut target other sectittns tt' the-populations. It was hence.forth nanrcd Cttiltl Health Days Plns (CHDP) anrl v'as erytanded a WTJ()inI'}(X' Jiilr (Jctohcr ltX)5 ttt irtclude suclt intenenliorts us: treatrnent of tttostptito hed nets, health educatiott, ntass distributitttr of iternrcctirt and praziqunfiel for control of Lynrylrutic Filuriosis and Schisfosorrriusis, respectitell'. NOTF is planning to ittrylenterrt CDTI in phase one districts during the period ,iJ CUne'tplrich is inrylenrcrttetl htice il yeflr in the nnnths of April and October. The ud,tantage witlt this is tltil actitities like conununitT'nuthilizatiut anil sensitiittion .for CDTI which are not adequately.funded by the district health sen'ices will he integrated and wpported b1'CHDPfrmding- SWOT'anabsis Strength o T'he CD:l'l prograrrurre lms built o strong structure'tvhich has heen exploited bv other conmmititS, based intenentiotts. 7"he stntcture includes trained drug tl i st ri hu tors, co n ttttr utitT' sup en' i s o rs an d h ea I t lt ttxtrk ers. o flganfla is one of the.first track cotufiries to receit'e.fitniling .from USAID grant.fir integrated control of neglected trttpical diseases urul phase one districts'tt'ill henefit .from these.funds where i,yennectirt distrihutiort will be integrated with albenduzole to control soil transntitted helnirfih infbctions. Weuknesses . There is no set tinrc when i'yerntectirt tpilt be stopped. Tltis nmkes odt'ocaq' difficult especially urnotrg the youttg cottutttttti$' nrcntbers who hove no experiertce witlt signs untl q'ntptonts of onclutcerciaisis. . The heoltlt tvorkers are.fett and nnstll, irnolved with curative sertices, leaving no tinrc.fbr public health intenentiorts rvhich nrukes s,tpport supen'isiort difficult o Little "financial resources .for troining qf nau CDDs and healtlt wotkers who ore posted in the proiect area Opportunities o (itrenilJ, there ilre nuut), intenentiotts tthiclt are usittg CDT'I as a vehicle to rleliter other conurutrtitT, intenentiotts. These in turn amtewith ntanJ'opportunities in .form of incentites. These intenentiorrs provide at'enue Jbr integrfltittg tvith CDTI and the CDDs gettirtg incentives .from those other progranrnres. Hou'ever, this night he detrinterfial to sttstuinability of CDTI as the sustailrubilitv of these pr oghranmrcs is questittnab le. 7-lreats o While other conutuutilt, intenentiorts protide opportunities.fttr CD7'1, they can also he threuts if not well hantessed. Becouse sonrc inten'entiotrs conre with incentiws, the flistributors of tterntectirt ue likely to absndon CDTI .for tlrc abot'e inten'entiotts Cottclusiott Despite little.financial contribtttion.from the district health sertices, CDT'I actit'ities have cttritinued witft gootl coyeruge. With the new initiative of elininutiort of ottchocerciasis irt the three tlistricts (Hoinm, Masindi and Kisoro) lhrouglt seni-annual treutnrcnl t'itlt itenneclirt and tector control/elininatiott, CDTI actit'ities in these areos will he enhunced 3 \ rll()/nPO(' 75m ()ct,rher lft(r5 SEGTION 1: Background information 1-1. Genera! information 1.1.1 Description of the project (bfiefly) - Ceographrcal localion. topographr'. chmate - Population actii ities. cultures. language - Communication svstems (roads .. ) - .Admrnislralionstructure - Health svstem & health care dehver)' (pror ide the number of health posls/centers in the proiect area if the information is ar-ailable). - Number of health staff in pro;ect area and number of health staff inr olved in CDTI actiyities. Phase 1 CDTI districts are located in westent Uganla (Hointu, Masindi and Kasese) and Kisoro in south il,estent (Iganda. Kisoro und Kasese districts ure highlattd oreas. The nuin octit ityt irt plmse 1 districts is snhsistertce .firuing. The road net work is generally good irt ull the districts. Howeyer, the roatl net work .front the district headtluarters to ottcltocerciasis endenic areas is poor especiolll, i71 Kisoro and Kasese districts tvhere the rouds heatnrc inryassible especially during the rainy seilsott AdninistrativelJ', Ugandu is organized under local courtcils and the district political head is the Local conrtcil chuirytersort (LCS). (lnder hinL there are LL'l ot conttttl let el, LC 3 at sub-coturtJt level, J,C2 at parish letel and LCI ut village level. Organization of the Health $eruices Since 1997, frgartdan goventntent adopted rlecentralii.atiort polic.l'. Decentrulization tukes sef ices and resources nearet to the people, eilses decisiott ttutkittg, itttptotes accotttttttbilitl' unrl creates a sense of otwrcrsltip. At tlrc district, actual intplenrcntttion o.f lrcalth csre is .fitrther decentraliied to the healtlt suh-district letel and lower level health cerrters. U']IO/APOt' lrh Octoher ?(')()5+ Organization of heatth serzzices in tlganda (the chain of command) Other line mintslriesDer elopment Panners Ministn' Oi Health Relerral Hospitals Drstnct Health Office I r*r. nowi,.rt)- HSD,/X Health Centre Ill Health Certlre Il Village Health Teatn (HCI) Corrununities u/f l(li,AI)ax' ?5d' ()L-tobcr 1()05 Table I : Number of health stalf ini.olr ed in CDTI (Pleasc acld more rou's r.f'neccssarr) l)istlict/LG-\ \ umbel' ol'health staff involr ed in ('D'I'l activities' I ,rtui N..rnher of \umbel of he:rlth Pt'rcent:rge health st:rff in the st:rffinolred in entire pxrject area ( DTI Ilr g, ttr:&/B,il I Iorrrrt t2 I ,< Kascse .15 l() 22 Masrndt I(tsot o 25 L5 7 2u -l.l Iotal 117 .10 2l 1.1.2. PartnershiP - Indicate the partners inr oh ed in proiect implementation at all lelels [MoH- NGDOs (nationaliinlemational ). communiti es. local organizati ons. etc. I - Desclbe o\-erall \\orklng relatronship among partners- clearlv indrcating specific areas of proiect actirrties (planning. supervision- adr-ocacr'. plarming. mobilizatron- etc) uhere all partners are invoh'ed. - State plans. if urt" to mobilize the slate/regrorVdistrict/LcA decision-makers- NGDOs. NCOs. CBOs- to assisl in CDTI implementation' .Intplenrcntation of phase I cDTI prqiect is in partnership ttith NGDOs nanrclv The (.urter C'eiter ossistittg iri Kasese drrd Kisoro anil Sigltt Ssvers Intematittrtal (SSI) assisting in Hoinru and Masindi districts. A total o.f 358 conununities are invoh'ed in CDTI in the pro.ied areu- Tlrc conrrrntttities hate contirtued playing theit leading role in organiT.alion -anil atecutisn of CDT'I uctivities. The partners work closely in adwcac.l', ntrtrtitoring and supanisisrt, ptinning antd review o.f the progress qf the proiect. For insturtce, regiurul oir,rr"o"1, nrcitirtgs aie conducted.ioirttll, b1'MOH utul NGDOs. During these nrcetirtgs, the districts ttsuatll,-ptedge to contrihute totvurds CDTI acti't'ities. Hoilserer, due to low ret'enue base collectittrt -iu the districts, the contributiort is ttsualll' ntirtinnl. WITO/APOC 25d' ()ctoher 2(X')5E 'l'leusa ac,lcl n'nra rovt \ tl tlcc'cssot'l CDTI Districts/ LGAs in the entire project area Totitl pqrulation in thc entirc prujcct arta N umb er of co-mrnurliti_es/ylllagep i4 nneili-cnttemi. Ht'p".-entlcmic Totalinmeso/h1'pcr- zone in thc zone in the pro.icct cndcmic zonc pro.iect ltrc:t :lrcil A7 A3 A-r = Ar-| A-- Poprrlation of Meso-enrlemic Hrlcr- Total in zr-rnc in thc entlcmic lltcso/hvpcr- projcct arca zonc in thc cntlemic zone pnrj cct a rea Ar A) A, = [r* [.' Ultimirtc' trcatment Goal (UTG) Hoima I (X).(,09 6 t29 l3-5 I .tt00 9t3.1t09 I (x).609 tt-5.-s 13 Kasese I (X).-s63 lt 120 t3l -3.ti50 96.713 l(X).-5(r3 tt-5.-+79 Masindi 59.5 le 9 til 90 3. I _50 56"369 ,s9"_s I 9 ,s().8.16 Kisoro 22.391 I0 22 32 -+.0(x) 18.394 22.391 19.035 TOTAL 283,085 36 352 388 12,800 270,285 28J,085 240,877 1.2. Population Table l: Communrtles alld populatlon al nsk in lhe entire project area nltelher tlte\ are trealed or tlot durtng the reporting perlod dtab.t,'h(Rdch0ln.1tD1h.Ptol.'cthns was a census lor the project done during the reporting penod'l Yes-- No--/-- Ii No- uhat is the source of the data in lhe table abor e'l + Source :Natlonal censLIS CDD '/ Other source. specll\ Year . lflou are usng the term comnrunilr or \lllage. define \\ hc1 conslilutes the commuml)'or \illage. Thts rrillhelp understand lhe prol'lle ollhe proJect area Communit! ls a geographic area under the leadership ol'local council chairnun (LC I ) lsthereanl-olherlnformalronofintereslaboutthepopuladonintheprojeclarea'Ifso.includeithere \\/li( )/AI']( )('- 251r' ( )ctohcr 2(x)5 SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fi11 in table 3. trmehne Of crctrvttres lbr orea.s lrealecl m cLtrrenl trar'. indtcating $hen the ker actilrties ri-ere implemented b1'the month thev began and the month thev ended I \^4JO/AP(x' ?5tr' oct()hcr 2oo; District/LGA Mobilization of communities Traininq Census/Update Dnrg distribution Sunen,ision Starti ng month Cornplction month Starting month Complction month Starti ng month Complction ln ont h Starting month Completion month Stafting month Conrple tion month Hoima .lan Fcb lieb Iv{alc1.r Apnl Apnl Apnl Jrure Jan .Ilurc Masrndi Aprrl Mar Jtnre .l rrlr' Ar-rg Scpt ( )ct Ntll Apnl Nor Kasese Kisoro .lan Sept Ircb ( )ct March -lNt)\' Aprtl I )cc Mav .larr .hurc l:'ch Jutru^ .lan ,\Lrg I"c-b Jan .Sep ArLg Irclr TOTAI Table 3 Trrnelrne ol-actiritres lorthe areas treated in the current veal' (l'leu:c sdd ntr.tra rov,\ If tlcL'c.\.\ttt'.t') -Please indicate ifall activities iverc undeftakcn as planned, and if ot, ple&se explain' All tlre /alivilies b,erc tfidertaken 4s plotrc . -Fu(her' aomments, done ht befircen thosc trnrtrtht \\1( YAI\ )('- 25'l' ( )ctober 2ot )-5 2.2. Advocacy State the number of policr-/decision makers mobilized at each reler ant ler el during the current r ear. the reason(s) for undertakrng the adr ocacr- and the ottlcome. Describe difficultres/constraints being faced and suggestions on hou-1o improve adr ocacl'. T'here has been sensiti:.ation of political leaders in the districts of'Kisont Masindi und Hoinn on the nav policy o.f send-annuol treatnrcnt witlt h,erntectirt. Efforts lttn'e beett nmrle to deyolte sonrc of ()rtclncercinsis control -ftutctiorts to the nav district of Buliisa, tvlticlt ltos been createtl .front Masindi district. Atl'tocact, has cotttittrtortsly heen undertaken 0.1'.S^iI in the districls of Hoinm and Musintli, tvhile advocuc!' in the districts of Kmese arul Kisoro ltaye heen done byT-the Cater Center in collahoratiott tt'itlt NO?'F. The districts ltffe been encottaged to irtcltule onchocerciasis conlrol actit'ities in tlrcir vork phrts. Sttb Cortnties werc nmde to pletlge in writing horv nmch .furtds t)ere corrrtrtittel In spit of the ilhote efforts the districts tlisbuned snmll proportiorts ttf the.furtds contntitted while sub connties net,er dishurced ant.funds at all. Sttb-counties hatl heen etcpected tu contrihute -from their re,)'enue collectiott, nminly,.frunn graduated tasc which t)as scraped off as u net' got'ernntent poticl,. Tltis nrcans both tlrc disffiils and sub-atunties have a ver! lolt'revenue utllection base. N{ol'F has been ahle to solicit lindted support.from the l-fums Clrtbs in Kantpula. ()ne atltocncy workshop was held in Kasese district tvith the Liorts Clubs of Kunryolu tuttl those.from the t)estern Regiort. 2.3. Mobilization, sensitization and health education of at risk communities Pror ide tnlormation on: - The use of media and/or olher local svstems to dissenlnate information - Tvpes of IEC materials used - Mobilization and health educatron ol communities including \\'omen and minorttres - Response oltarget communtlies/i illages - Accomplishmenls - Suggest u'avs to impror.e mobilization and sensitization of the target communities Cotttntnrritics ure infornred about CDTI b1' the tlrug distributors (CDDs), contntnni4' supenisors and healtlt'tyorkex;. Other ,rrcons of nnhilization and sensitii,atiott ittclude ruklressing urnuttnrtiry, gatlrcrings such as nrurkets and nrcssuges on CDTI passed on to the peopte througlt places of worship. IEC canryaign is u corttirtttttus engogenrcnt that peaks then i.r,enttectitr is ubout to he tlistrihutetl. IEC cantpaign is.fucilitated by posters which sltgw the synqttottts of onclncerciasis. The response of the target cotrtrttttttities is sonrctinrcs is disappoitttittg tts .few cotttnttttti4, 112nrr7rers attend. T-herc is u need to arunine other nrclhorls of' sending reninds to tlrc conmrunity nrcntbers on tlrc need -fbr lutg ternt treulnrcnt with itennectiott to sustain high conqliance and recluce refttsol and ubsenteeisnr rttes. Churches and scltools cottkl be alternatiye ovenues hut the.feasibili4, qf using these flyenues tltis needs to he erunitted through operatiortal reseurch. WFIO/AI)(X' 2511' ()ct()her l(X)5 2.4. Gommunity involvement 7'here is generalll, higlt conuttrutitt'irt'tolvenrcnt irt CDTI actit'ities eg cot rrrrri,ttitJ' nrcnthers selectirtg their ou,tr CDDs. The CDDs und village leaden utllected ivetntectirt .fiotn the nearest healtft.fttc,ilities at tlrc tinrc of distrihutiort. Althouglt there have been repttrts oJ LCs representirtg cornrr,tttities when nukirtg tlecisitttts cttncenting CDTI, the ptoportion is generulll,snqll. Ptrticipatiott of .fbnmles is adeqtate us evidenced b1' cttntrtuutiQ'nrcctirtgs where wonren ottend the nrcetings in large nuntbers. The NOTF poliq' of having l-tvo cprttttgttti4, supen,isors (one nule ond one.fennle) has ensured that wttnrct, are not left ottl. Table.1: Communitres partrcipalion in the CDTI (I'leose otle{ more rou's tf'nece';.snn) Comment on - Attendance of female members of the communilr' at health education meettngs Attendance qf .fenmle nrcnthers during health educatiort nrcetittgs is sntisfactor'l'- Fenmle nrcntbers also purticipate in discrtssiorts and selection of CDDs ittcludirtg selection of .f'enmle L'DDs. T'his coultl be the reilsott tuhy tlrcre are ,rtfltty .fbnmle CDDs altltough the rtrtntber of'.fenmle CDDs is still less than thal of nmles. - In general. hou do 1'ou rate the participation ollemale tnembers of the communttv rneetings uhen CDTI issues are being drscusses (attendance. parlicipation in the discussron e1c). Fenrule's pariicipotion during comnuuitl'nrcetings when CDTI issues tre being discussed is high and their decisions ure respecteil - Incentir es pror ided br- communitres for the CDDs CDDs hate contittuetl to ask .for incenth,es althouglr this does rutt stttp them .fi'tttrt perforning their duties as CDDs. Antottg thc tlrittgs thes,^ tututt are T-shirts, boots and bags to runy nrctlicine untl registers as theT' nutve in lhe conurutnities distributing ircnnectirt .froru lnuse to ltouse. - Altrition of CDDs. Is artrilion a problem for the projecl'l If ves. hou'rs it addressed'l Attritiort rate of CDDs is gcnerallj, lo'ty irt lthase one districts and this is ttot cttnsidered us an issue. - Olher issues ll Distlict/[,( i-\ \umhcr ol' communitics/rillagcs w ith communitr ntemht't's as supct'r isors -\umbet of ('DDs ,\ Iale ( 'l)l)s ['emtlc i ot:rl('DDs B? 88 Bq: llzt tlt \untlrtr of co /rilllqcs sith fi \utnber ol' I communitics I rr ith l'ernale I( I)I)s Il],n I mmunities :male ('l)Ds I'eirtntage Ilr r: Br o/ts{ * 100 'l'otirl no. \umber rr ith PeI ct'nttge communitics communitr in the cntite members as plo jet't at ca supcrr isot's B,; B{ lls B/ Br -100 llotnr i-r 1.3 5 135 100% 2-i6 7t) -335 It2 83ozo I\lasurdr 90 9t) I()(P,, -l5l 190 -i-+ i l.tl )loo Kasr'sc l.r1 l-ll l(X)oo 28.i 2lt ,i25 t.I I ()(I' o ]{r soro t2 .12 I rX )(' o I 5-l I0-l b] l I ()()u o l'otal 3S8 Jtitl lll0o/o 10t8 611 1612 357 92o/o \ IIJ()/APOa' JJ N,r'r'enrht'r ?003 2.5. Gapacityr building - Describe the adequacl' of available knosledgeable manpou'er at all ler els. T.rahing of healttt 'tyorkers und CDDs on CDTI was catied out, witlt fittttncial snpport .fntm the Cater Center [CC) and Sigltt Sfivers Intentatiortal (SSI). With srtpporl.from all partners inclutlirtg Research Triangle Intentatiortal (R7-I), il trot) pilrttrcr tlurt hus cttnte ort board .for integrated control of Neglected fnryical Diseases, intensit'e truining of CDDs mtd healtlt twrkers will be undertaken in 2007. Tlrc health tNtrkers are generalll, krtowledgeahle on CDTI at all let'els. Htnvever, the health workers ure -fau und oyerburden by atratit'e senices at the heoltlt.facilities and this nmkes them unable to protide adequate support supenision .for oll contttutttitT' hased health progranmres includittg CDT'L For this reason, contntttttitTr supen'isors hove heen appointed to assist itt supen ision ttJ CDDs. The conmtunifit supen'isors have continued to 'st'ork tvitlrottt paJ,nreifi although thq' are agitating .fbr incetfiit'es. Most of thern t)ere protided bicl,ctes by APOC and this has been sn incentive.fbr them to cttrttinue doitrg tlrcir work as c tt tt t tttt t tt it1' utp ert is o rc. - Where lrequent transfers of trained staff occur. state nhat the projecl is doing. or intends to do- to remedY the srtuation. ('l'hc most unportont t,\stte to clescrtbe r.s u'Jtot n'teo,tto'e,\ v'cre lcrkan to en.tlrre aclecyrute CDTI un\'slementatton v'here nol etttntglt htou'ladgeablc mcu'tprtv'cr v'ct.s at,ctrlaltle or j.sta.ll-ore.fi'ecprcntlt'trans/bn'et{ clurutg rhe ctxr.se ofthe cantlttttgttl. 'l'lrcre were no.frequent trans.fbrs in phase I districts during the reltortirry period. 1L WI I( YAPOa' 7 5tr' ()ctrihcr 20(15 District/LGA Numbcr of Districts/LGAs staff trainttl \l'r() \. r' i 1<.'tr i -l',,tol I ('r:(" C: i (i i (-2+ cr Number of Health centcr /post staff traincd\t'r() \.r ',, Refi I,aT'(': L'6 " c- i ('6+ (' Numbcr of othcr tr:tintrs of trainces ( TOTs) \lr() ',, tt.,, i lotal I i ('rz:('q (-n i L'r, i ('10+ ('r Number of CDDs trainetl \l r() \( 11 i, Relt i 'I,,tut , i ('rr:(',, cu I C,t i !r,+li [ lornu Nrl l_5 Nrl l5 l5 N11 -i) 168 167 i5 Kascse Nrl ti Nrl ti t7 Nr1 263 (,ll 100 26tt Masurtlt Nrl (r Nrl 6 ( Nrl 92 l(x) r92 392 Klsorrl Nrl I2 Nr1 t2 ll Nrl 5l_5 115 _l(){ ) 5.+5 TOTAL NIL 50 50 Nil 1510 -l8l I i 15-10 %o Achieycmcnt o/o Achicr.emcnt i 100Y, 7o Achieycmcnt 7o Achie-r'ement i 100% Table -5 Trarnrlg at the ditferent le\els oICDTI llnplemelltation (l'laa.st' tt"lcl nrure rov's tl llcc'c\sttt't') If "other trainers of h'ainccs' were tmi ed, ple^se explain nho they are aod their rcle in CDTI' distribtttio or thttirtg tttry CiTI n'ortt it conuna i4' letel' T'hq' dlso help ('DIx in 'lata "Mnuge"E'tt utt'l relx'tl tt'titi'tg' l3 \^,'l l( )/n P( )C'. 2-l Noi'enibcr 2(X t,l @;ivt,lcthcL.OIll'\l)lnc!]t)slOt.lotlll'\l,tL.:tlt!ll,lth,'t,'tsnrll,nlhl.J)1lillIt]B Trainees Tl pc of tratuurg CDDs Olher Commur.ritl' nrcmbcrs e g Conrmrurttl supcn'isors Health Workers ( lrontl iuc hcalth facilitics ) MOH staff or Olher Politrcal Lcaders Others(spccr l\') Progrant nlanagelltellt Hor to conduct Hcalth cducatrou Marragcnrcut of SAEs CSM SHM Data collcclion Data anall sis Rcport u ritrng Othcrs (specilr ) Table 6: Tvpe of training undertaken (Trck the boxcs v'herc specr.fic lraurulg w'os carrtecl otfi dttnng tlte rcporlutg penrxl) - Anl'olher comments 2.6. Treatments 2.6.1. Treatment figures - lf the proiect is nol achier ing 100% geographical coverage and a mintmum of 6-5-0/o fterapeutlc coverage or the coverage rate is fluctualing. state the reasons and the plans being made to remedv this. T'he project is achiefing 100%t Seolyaphical coverilge and therupeutic coveruge is stable nrttl over 70% irt ull phase I ilistricts. IJ 1.\4lO/APOC r"1 Novt'mher 1(X)J Table 7: Treatment and SAEs br dislnct/LGA in all areas at risk (l'laasc udd nrctre rrn's r.f'ttcc'ctscrr)') Formula for computing therapeulic an Thcripe trc colcrage ralc - Numbcr ofpcoplc lrca(cd \ 100 19") Total population I i \ ing rll rneso/h5pcr-cndcnric commulilt es t\ ilhi n thc proj cct area Gcographical colcragc ratD = Nonbcr ofco lmuliliqs/\illagcs lrcatcd \ 100(9/") Total nuntbor of mcso/h! per-cndcnic commrmitrcs ns identlficd b\ REN4O ilr thc polcct arca ATO coYeragc rate = Numbcr ofpcoDlc trcaled \ 100(oi,) Annual Trcatmcnl Objecli\ e 0,6 UTG achi€\ed = Nu rbcr of B@jlqucdld l l.!10 Total lunrbir olpcoplc to bc trca(cd in nrcso,/hl pcr-cndcnic arcas \\ (lir thc projccl area (UTG) ,|.ftt = .fhe 4,u,oj.t! nnnblr ol Pqne bin! ill ,$dhr".F.nlq .' ll.u\ lhll d cl,Tl PrdJ.ll ila'uL\ lo b.ul |'llh i'.tn.&fu tn d Snva J?ul' (nonollt th. Ftti.d sho ld lx ;ri&l to t.ud the t-ft; tt th. lttl ol th. vt rtu of tht Ptoi.tt) I )rslrtct /1.(iz\ Communities,iYr I I ages Populatron NLtntbcr ofllcrsoll\ s htt relirscrl thc Ilsalrlrclll NLrnrber o1' absentccs Nurnbcr- ol'SAljs Nuntbcr o1' \crr()tls adr crsc crcnts I SAI st rclcrlcd to tltc hcalth posl hosprtal Irtlal ol c()rnnltuiltrc\ r r llagc-: irt thc nrcso ltr pcr- endcrtttc arclts I), Annual 'l reatrrrcut ( )h.;cctrr c l), Nurnhcr ol' e ot)) ttt u tt t t i c s i tllagcs trcatcd l)r Oeogntphtcrl C!)\ Crllqu ("0) I), I),/ I)1"100 Iotal prpulattort ol thc rttcso hr pct- endcttuc arc-as I). Anuual I'l crtnr r'ttt ( )hjcclr\e' I)u Nrrnrlrct til pgr\()ns trcatcd I)- l'hcr-apculrc Lio\ r'IIISC (",,) I)r D./ I).^ 100 IIorura li5 135 I i_5 I ()0(); l()() (r()9 tt5 5lli 8.1.s75 llJ,,,6 q8-l 2.6-+0 Nrl Nr1 Masurdt 90 90 9t) lt|ty1,; 5tl 5l ) 50. S-1(, +s.6()7 l{2(lo nl7 r..182 Nrl Nrl Kascsc l3l Iil Ill l(X)9 o l(x).56:l ti5.-+76 32.(.99 g29it Ntit a\'.il labl(j Not alarlablc Nrl Nrl Krsoto -1j 32 \j I()090 22.3e-+ 1 i). 035 16.122 Not il\'alhblc Not a\'allablc Nrl Nrl TOTAL 3rt8 388 388 1 000 283,085 210,875 232,303 tl2o/o Nir Nit l-5 wl I( )/n I\ )C- l-5'r' 1 lct()bcl l()(-)5 2.6.2 What are the causes of absenteeism? 'l'he couses of uhsenteeisn, were: People had ntoved to Kantpala.fot work antl sonrc stuilents in hourdittg sectmdary schools were not available to receit'e lreutnrcnt 2.6.3 What are the reasons for refusals? o Feur qf side elfects ot tottg those who got the side effects tvhen they took the drug .for the Jirst tinte o Luck of proper sensitkatittrt ott the need.for long'term treatnrcnt o Sonrc people perceit e that theT' are already cured and do not see tlrc need.fttr contiinirig ,iitl, iyurrrrnctin lreatnrcrfi after the disappearilnce of the slntptonrs of onchocerciasis. 2.6.4 Briefly tlescribe all known and verified serious adverce events (SAEs) that occurred dur.ing the reporting period and prcvide (in table 8) the required information when available. r In case the prolect drd not har e anv cases of serious adlerse e\-ents (SAE) during this reporting period. please tick in the bor. No SAE case to report i6 W-T{()/APOC' JJ Novernhcr ?00J tr Table tt Cases ol-serrogs adrerse erenls (SAEs)lhal occurred dunng the reporting period (l'lausa ur{c{ ntarc rrnt': tl nrcc,ssor-t') S/N* Age Scr Vrllagc ol ()fl8111 I )ate Mcctrzarr rr as takett I )ate I sr nrptonr s appearcd Sr rrnltortts I lcalth statLrs bclirr-c tlkurg Mccttzau I)atc o1 drsmrssal liorn licalth lircr lr tr Ilcsrrlts ol'tcst: t thrcL blood \tncaI ) Outcorne'ol' Irrtcnrurlrt-tg rrr Alcohol pr()Ero\rs cotnphcattttg tt.utrh etttc crrcttntstat)c$i lll ()r 11()t t7 * Sartul ntrilthL'r o.l tfu' ;tcrttc'nt \\'l l()/Al)( )C. l-l Notembcr l(Xt-l arlntr ssttlr-t t n 2.6.5. Trend of treatment achievement from CDTI project inception to the curretrt y'eat' Table () Treatnrents and cor erage b) calendar ]'ear lbr the entire project area. (Pleuse.fill in the retluired dutu) Please indicate the UTG for the project area:-2'10,877. (use this figure as the denonrinator in all flTC coverage calculations.) hefore those ),eoflr YFAIT C'olr r.nru-ut r es/\''r llnttcs Populalion 'fotal ,, ol' corttrt't ttltt Itcs r r I lag es ur thc rncso ll 1tr- etrtlcnrrc arcas Arrnual l rcalrncnt ( )[cc1rr c llr Nunrbcr o1' conilrrunrte : r rllagcs treatcd llr (icographr A 11) cal c()\crago co\cnrgc (n,,) 1,)rr) Flr lls tri/ Er.100 Fl3/ Iir-100 'lirt.rI l.rtlptrlatrorr o1' tho nreso ll 1lcr- cndcrttre arc'us llr Alrnual 'frcatrrr crrt ( )[lcctrr c E- Nturttrcr ol' pcrsOn: trcatcd llt 'fherapeutrc s()\ eragL- (" ") lls I,;/ E6-l{10 A'l'L) c()\ claq(j (')o) I,l ro l,lsl I.t-- 100 I I'l'( i Cor erag lYo) t997 -\/^: j-t2 372 1 009 i) l r ){)() ; )11 25 18fr.e I 5 I i I al') 70 sl 6'7 I ,) (.) l.i -1 /- 3"t2 -\l: 1009i) 10()9i 217 -7(_,\) I tt5. I2 I I 52.0-17 7() n2 ( I ()(_)9 -17.1 l(100b ll)090 221.61-3 l9(J.1)97 15{).92-l (t7 le (i-l 2(x)0 .17-l 371 71 l0()q6 l()()i,il 2 I 7.lt()5 l35.l3l I (r5-185 76 S9 69 20() I .37-+ i 7-t l(X)()ir l(X)o4r 2.r{.5"1: 207 t<(,1 I !l( ).-l-3() 7e 92 7t) 2()( )2 376 176 l()0(r; 1()()'); lg j-()fi(r 2l('.( )t{8 2l(,-360 nl ()6 90 2()( ) .tfr2 ls2 .tsl 1(t0()i) l(x)()6 279r<lt 2.{6.076 2lg.-5.1() 7ti Q() !)1 200"+ -js: is2 .3tt2 I0()()6 I()()9,o 111 1t I 2-l l.-+()7 2l!).1 l5 8o e5 () I 2(X)i It -.1 .r3.1 ,.t 3i l(x)96 l(x),,6 27"1.(r()S t3-3.-19.3 126.-rt{l n2 97 ()J 20()6 338 -3t+i 3tt8 1 ()09 o l0()(% -r0"t.3 5ti 1,1().n77 2.32.303 76 9(r 9(. l8 Wl l()/Al'}( )C. 25r1' ( )ctolrcr 2o()5 2.7. Ordering, storage and delivery of ivermectin Mectizann" ordered/applied for bs' - (plcase trck rhe opproprtate an,sv'arl na6p z[ wHotr t]NrcEFE NGDOtr Other (please specifi'): _Order br Minisln of Health Mectizan x delir ered b1- - Qtlcasc trc'k t.lrc approprtale an.su'er) MOHE WHOr' U UNICEF N NGDO tr Other (please speci fr): wHo Please describe hon'Mectizan,R rs ordered and holr it gels to the comnruntties Mectitan is cletred uul deliyered to NOT'F stores witlt tltc assistance of lYorld Health Organixation (14'HO). From NOTF stores, the districts collect the dnry utd deliver it to tlrc tlistrict nrctlical inyentories where the heultlt sub-districts collect the drug. The .fitst line hettth.facilities collect the drug.from the lrcalth sttb-district and stored at tltis level. Then the conununities collect the drug.froru the.first line heolth.ftrcilities. Sontetinrcs, the health workers anrl contnuttti|, sllrunisors of CDDs deliver the drug to the conntunities when thet' vis it th e co nunttn iti es .for su pport s upen'i si on Tatle l0: MectizanR [nlenton' (Pleo.;e oclcl morc rctv"s tf'neccs,son) - Hou are the remaining ivermectin tablets collected and *'here are lher kept'? The renmining tnhlets are collected hJ, districts anil curried.fonuord-fitr the next ronnd of treutnrcnt. - List and brieflr-describe the actrrities under irermecttn deliren'1hal are being carned out b1'health care personnel in the proiect area. The actir itres carried out b1'health personnel include: t l)elive4, of' h'erntectin.from the centre up to the.first line lrcalth .facilities where the corrtrttnrtities collecl the drug at tlrc tinrc ttf distributiott o Supen'ision of the CDDs during nruss trealilrctil o ('anryilatiut of'reports on trettnrcnts and uccoruttubili4r of ivernrcctit, ttsilge An] other comments 'l'he acatuntuhility af ivernrcctitt does not see,n to be proper in Masindi district. A.fbllotu - rtp will be undertaken in this district to ensure proper accottntahility. The problent cttrtld he due tut poor reutrd keeping. State/District/LGA Number of Mectizan' tablets Number in rtock Rcquerte d Rcceiyed Used UserUPer son treated Lost Wastetl Erpired Remaining IIorrua t1 625 2"-t0.00(J l-1(,r.(XX ) 2.1().000 () (l 0 0 Masrndr 0 IS0.()()() I tt(I.()( I ) I 8().(X X ) 37 (l () 0 () Kasese )56 251-(X)() l5l -(X)( ) 219.736 2( (l -ll o 1.779 Ktsottr 0 -5-5. le7 55 1 !)7 -16. jq6 I',) () I5.1 0 .1.161 TOTAL 15,18t 726,191 726,191 7t6,132 3.1 0 295 0 6,0.t0 l9 WH()/AP(X' ,J Ntx-enrhcr r(X)J ,l 2.A- Gommunityr self-monitoring and Stakeholders Meeting Has an1-training (of trainers) lor communitv self-monitoring been done in the prolect area'J If so- When'l T'rainilq; u,as done in 200J Table ll. Communrtl-self-monrtoring and Statrreholders Meeting (Aclcl rou'.s rf't'tccclec{) Describe hou the resulls of the communitv self- monitoring and stakeholders meetings hare alfected prolecl implementalion or hon thev s'ould be utilized during the next lreatment cr cle (-onmrunity self'ntortitoring and stakeholders nrcetings .tvere rufi carried out The district heolth sert,ices claim that these activities need.funds to be inqtlenrcnted, tlrc.funds thich the districts tlo rtot huve. Drstnct/ LGA Total # of comnrunitics,/r illages No of Contnrr-rntties that in the etttirc projcct area carricd ortt self l.l.lorlrloring (CSM) No of Communitres that corrductcd stakcholdcrs rncctulg (SHM) TOTAL z0 WH( )lAP(X' li(l'()croher 20f)i 2,9- Supervision 2.9.1. Provide a flow-chart of supervision hierarchy. Organization of health services in Uganda (the chain of command) Village Health Tearn (HCI) there is no physical sflucture at this level. Cornrnun ity supervisors Cornrnunities 2.9.2. What were the main issues identified during superuision? The main issues identified during supervision include: Liltle.futtds tere released b1t the districts.fttr support supenisiorL Howeter, the districts do CDTI supenisiort in an integroted nunner with other heultlt senices. ZI Developnient Parlners Other line mirustriesMinisln.Of Health Relerral Hospitals Drstrict Health Office Distnct Hosprtal Health Centre lll Health Cenlre Il wT{()/AP()C 25tl' octoher,(105 IISD .,' H(' lvr . Accoutrtabilitl, of iyenneclitt was nol proper: In sonte health tutits tltere ttteFe no records of ivernrcclirt received and delh,ered especialll, in Masindi district t [y1rylvsnrcnt qf healtlt'u,orkers in atpenision ltils inadequate due to snrull nuntbers of health twrkers at the lrcalth units . Sonrc.fet, refusols to ivernrcctit, treiltnreilt 2.9.3. Was a supervision checklist used? o Supen,isiott check list lvas useil Art integruted checklist .for integrated control of neglected tropical diseases is beiltg dewbped 2.9.4. What were the outcomes at each level of CDTI implementation supervision? o The iistrict prontised to put in stnne.funds -fttr CDTI actitities. Hottever, now the districts being at)are of the support.from T'he Carter Center, SSI and the grant.front LTSAID .for integrated control of neglected tropictrl tliseases including onchocerciasis, the districts nru1, not.fitffill their pronises as usual. 2.9.5. Was feedback given to the person or groups superlised? . A.feed hack is nornrullS, given to the groups supen'ised with recontnrcndatiorts to be uddressed to intprove the intplententutiort of CDT'I octivities. 2.9.6. How was the feedback used to improve the overall performance of the project? o Accttnrttahilitl'of ivernrcclirt has intproved in all the districts. SEGTION 3= Support to GDTI 3.1. Equipment Table l2: Status ol'equrpment (Pleosc acld nutrc rov's r.f'nece.s.tcr)') *Conditron of thc cqurpmcnt (F=Fturctronal" CNFR{urrentll- uon-lunctional but repairable. WO:Wrrttcn offl. ZZ WTT()/AP(X' -r5rl'()i'krht'r'rot)5 Source Trpe ol equipmcut APO(' MOH DISTRICT/ LGA NGDO Others No (irndrtr on No ('ondrtr on l\o ('ondrtr on \,, ('0nJ1tr rX \o (-ond l1l on I \rehicle J 2F and I CNFR Ni1 NIL NIL NIL 6 F NIL 2 Motor o'cle(s) 43 F NIL N L Ntt. N L 3. Computer(s) -5 F NIL N L N L -l Pnnter(s) 5 F NIL N L N L 5 Photocopier (s) I F NIL N L N L 6. Far Machine(s) t F NIL N L N L 7. Others a) b) c) Hos'does the project intend to maintain and replace exisling equipment and other malerials'l I'he equipnrcnt providetl by APOC tutd NGDOs to the districts is nnintqined by the districts. The equipnrcnl at the center is nruilttuirted by the Ministry: of' Health thile tlmt one hebnging to NGDOs is nnintainecl b! 111s rcspective NGDOs. As reS;ards replacentent oJ' equipntent, especially rehicles, donors will be approaclrcdfor tssistartce where necessilrJ,. Neurlt' all the vehicles used b1'progrnnurrcs in tlrc Ministry of Healtlt sre donated and it is unlikeb that onchocerciasis control progranurrc will be exceptional. 23 WTIO/^ 1)()C Jitl'Octohcr l0[)i Contributor \ear I {'prustttle the ttt'nul )00.J .t \ enr 2 r 'prrn rtle llrc ncnrxl nt 2005 t Year 3 r'provde ilu penod nt )006 1 TOTAL TOTAL CASH CASH Budgeted Released(US$) (LIS$,) TOTAL TOTAL CASH CASH Budgctcd Rclcased(us$) (us$) TOTAL CASH Budgeted (uss) TOTAL CASH Released (us$) MOH (Central +Distnct/LGA) I e.8l u .1,081 16.0-12 3,t22 ll."+5 5 r.7.t I MOH) Local NGDO(s) ( if anr') NCDO parlner(s) NP NI) Nl) NP NI) NI) Others a) b) APOC Tmst Fund .10.f.i12 .+.t3500 0 TOTAL I 9.tt I () l.0n I 97..3-l-t 79 .67 3 55.217 ,.56-l 3.2. Financia! contributions of the partners and communities Table l3 Financial contributions b1'all partners for the last three vears NP: infornmtiort rtot prot'iied Of the.frunds prot ided by APOC itr 2005, 72,710 US$ was .fitr capital equip,rrent. - [f there are problems \\ith release of counterpart funds. hou- l-ere thev addressed'] The problent with release of' counterpart.fitrttls is due to lack of'adequate.funds at all levels. The districts receive Prinrur1, llsslth Care (PHC) grant.from the center.for inqtlenrentutiort of prinnrT heulth acti't ities. 50qi, of PHC -fund is for purchase of drugs and ubortt 25% is .for salaries. Whut the districts receiye is usrtttl less thurt 'uiltut theS' requested .tvlticlt trmkes difficult.fin'the districts to implenrcrfi tlrc planned actitities effectivell,. The districts sre alwslts encouraged to integrute their actitities which thq' hat'e done satisfnctorily, srtch ns integrated silpport utpenision where L'D'l'l has henefited. Additional comments 3.3. Other forms of community support - Descnbe (rndicate forms of in-kind contributions of communities rf an1) o Distrihrttion of iverntectirt b1t the L'DDs c ('ollectiort of iverunectin.from tlrc nearest central poirrt by ilte CDDs or village leaders o (-ttntntunity nnhili;lrtiort.for ivennectirt treatnrerrt b.'1, the CDDs urttl the filloge leaders ilt cutntnurrity level. 3.4. Expenditure per activityr - Indicate in table 14. the amount expended during the reporting period lor each actir ih listed. Write the amounl espended rn US dollars using the current United Nations erchange rale to local currencl- Indicate exchange rate used here )n \ 41()/AP(x' rqti'october l()05 Table 1-l: Indicate hou much the project spent for each actir itr. lisled belou during the repofiing period. - An1 comments or erplanalrons') The figures in table l-l onh'include gor-emment conlribution tou'ards CDTI aclirrties. It does not include salaries and contributtons bv NGDO partner. SEGTION 4= Sustainability of CDT! 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation canied out during the reporting period? (tick any of the following which are applicable) Year I Participatorl' Independent monitoring Mid Term Sustainabililr' Er aluation -5 r'ear Sustainabilitl Er.aluation / _Intemal Monrtoring br-NOTF / _Other Elaluation bv other partners 25 Activity Drug delrverr fronr N-bTF-Aq a."o io Central collection point cornmunitr of Expenditure (s tls) Source(s) of funding Districts I"+o Mobilization and health educalion ol conrnrtmities I t3-5 Drstricts Trainrne of CDDs 2.(XX) Distncls Trainins of health staff at all ler els 711 Districts Suuen'rsins CDDs and drslribution 2.165 Distncts Internal monrtonns ol- CDTI actrr ities Adr ocacr r rsrts to health and political aulhorrties I l3_5 MOH lE(' matenals Summarr' lreportinu) lbrms for treatmenl \rehicles/ Motorcvclesi brcvcles matntenance 2"-l_s0 Districts Ofllce Equiprnent (e.g compnlers- printers etc) TOTAL Total number of persons tl'eated 9,769 232,303 \[4]o/APoC l5t1' ocrohcr afx)5 ao a a 1.1,2, What were the recommendations? T'rainiltg rrure C'DDs where the nuntber of CDDs were.f'et, T-he districts encouruged to illil,aJts include CD'I-I in tlrcir heoltlt plans und budget and release.furtds.for CDTI actit ities 4.1.3. How have they been implemented? More CDD; were trained in all the districts Dislricts including CDT'I irt tlrcir heolth plans nlthongh the.fiutds released.for L'DI'I is still inadequate due to low revenue collectitm hase. 4.2- Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the pro.lecl er alualed during the reporting period') NO Was a sustainabilitr- plan u ritlen'l NO \[,hen n.as the sustainabilitv plan submitted'r 2003 Whal arrangements have been made to sustain CDTI aller APOC funding ceases in lerms ol 4.2.1. Planning at all rclevant levels Adtocact,to the district healtlt senices will corttirtue to ensure that onclncerciasis is ifiegrated in the overill health plan each year. It shortltl be appreciated thnt hedth sector planning (anruml and strategic), is un intportont activitJ', tlhich has the hlessing qf the district/srtb cortrttl' cotutcils and legally spells ottt what the health sector intends to tlo, itt the stated period fltis ryill provide an entry point.for CDTI progranrnrc integratiort. The CDTI trctiyities u,ill be in the districts', healtlt sub districts', sub counties' untl pa ris ltA,illage fiuh ere thel' exist) lrca lth p I an s. 1.2.2. Funds NOTF tvill continue seeking political and tecliltical support of CDTI .frum the district political anrl technical nmnagers. Politicians will porticrilorly be nrude to appreciate that altltough ortclncerciasis does not kill, it has serious social econonic intpact ort corruttrtrtities bectuse of its ossociated debilitating conrylicaliorts. It tvill also he enrylmsixed that the drug (ntec'tizan) will always be atailable.for as luty; us it is needed.free of charge and the need.f'or long-lerm treafinent. 4.2.3 Transport(replacementandmaintenance) The districts hat'e continuetl lo use transport in an integrated ,narurcr und nrceting cost.ftr repair qf the nnktrcT'cles. Htnpeter, replacenrcnt of the nntorq'cles h.t, the heultlt senices nra)' ,tot he.feasible ts nearlT, 1009(, of ntotor yehicles at all let els are donor.fnnded. 4.2.4. Other rcsources Control of onclrucerciasis sltottltl be considered along side witlt other vector honte diseases srrclt that the resources, actitities and support supen'isiort senices are conthirteil Elforts will be nrude where it is operatiortulllt possible to integrote control/elininatiort of Neglected T'ropical Diseases. Atltocaqt and healtlt educutiott ttill he integruted in the integrated unfirol of Neglected Trutpical l)iseases tth iclt tttill vtort get .funding ftom USAID through Research T'riangle Intenmtiortal (RII'I) and Scltistosoniasis Control lrtitiative $CD. 26 WT{( )/APO(' 2511'Ocroher )(X)5 NGDO portners sncl, ils Tlrc L'arter Center and Sight Sovers Intenrutiortul fire still snpporlirtg CDTI nctil'ities in various districts. 4.2.5. To what extent has the plan been implemented Witlt srtpptrrt .from NGDO partners and u grant .from USAID .for integrated ctnirol of neglected tropicul tliseases, integrated training nranutls, supen'isot1, check lists and IEC nmterials are heing developed. Ath,ocac.t, nrcetings hate been planed and they will be corttlucted in 2007. 4.3. Integration Outline the ertent of inlegration of CDTI into the PHC structure and the plans for complete integratron 4.3.1" lvermectin deliverymechanisms 4.3.2. Training 4.3.3. Joint supervision and monitoring with other progmms 1.3.4. Release of funds for project activities 4.3.5. Is CDTI included in the PHC budget: 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? 1.3.7. Describe others issues considered in the integration of CDTI. Deliter!, o.f iverntectirt ltss ttt a large extent been integrated within the PHC stntcture. lVhen the district offtcials atnrc to Kuntpala for an1, other issues (as long as tlrcy haw yehicles) thel nonnally toke iventrcclitr. Htn et'eF, NOTF or the NGDO partner nruyto tuke the drug if'tfficerc.from the secretariat happen to be goirtg to the district that requires the drug. Front the district to the peripheral lrcaltlt rutits, delitery of ivennectirt is.full1' integrated with delivery of other essential drugs. Althouglt there are nnny contntttrtitlt intenentiorts tlmt use the Mass Dntg Adntirtistration (MDA) strategy of tlisease control, none is integrated tith deliverJ'qf ivennectitt. Tltis is nminll'because the intenerfiions take plure at dffirent perioils. Althouglt there was training in the fipo distric'ts srtpported by 'l.he (.urter ('enter, ,rone t)ils integrated v,ith any other truinirrys that take place in the PHC stntcture in 2006. Althouglt.ioirtt nrcetings.for integrated control of neglected tropical diseases were held and a .ioint support supen isiort checklist derektpeil, it was not possible to carryoul.ioirtt sttpport supen'isiort during the reportirtg period The support.fttr integrated contrutl of neglected tropical fill be atailuhle in 2007 tuhen integrated control of those iliseases will be effbaed Althouglt CDTI llus irtcluded in the PHC budget in all districts, there were inadequate .finuncial releases 'l'here ore nran.l, progranunes nndeled on tlrc CDTI structure. Proninent arnrrg them is lhe Honrc Muwgenrcrtt of Fever StrategT,, dislrihutiort of it*nrcctirt and albendaz,ole.for the control of ljurrphatic Filuriasis, tlistribution of pra:iqtantel -fitr the control of 27 wTIO/APOC' 25tl' Ocroher 2005 Iscltistosorttiasis tutd to sonrc actent Directll' Obsen'ed T-reatnrcrfi.for control o/'tuberculosis. All the ahote progronurrcs haye been registered varying degrees of success. Distributors of iyennectin are generillly irnuilwd irt nunl' ttther healtlt and devektpnrcntol inten'entiorts. Also irttolyed in the inteneriiorts ilre conmuuitynrcnthers and lrcalth sta.ff, Their ittl,olyentent in the intenentiorts is lunvever, hupltuard with tn cleor guidirtg principle of pafiicipatiort It can not he amcluded that the add-ou intenentiotts enhanced pafontnnce of CDDS, although in Kanungtt, concotnitant distributiort of Vil A and ivennectirt appeared to haye enlmnced coyerage. HoweteF, it was noted tltut the inten'entiotrs were ofJbring incenth,es to CDDS. It lms also heen ohsened tlmt tthere CDDS are nmde to distribute iyennectitt tpith alhendaiole, nmnl, people turn up as albendaz,ole is a "crtrsed puller" 4.4. Operational research 4"4.1. Summarize in not more than one half of a page the operational reseat'ch undertaken in the project area within the repofting peliotl. With .fundirtg .fiom APOC, a stady enfitled "irttli'tidual and corttntuttity perceptiotts on sa,erit1, of Onchocerciosis and henefits of ivernrcctin treutntent in (lgunda: implications.fitr lortg-terru contpliunce" wils cotrdtrcted in phase 1 districts (Hoinru and Kasese) and phuses 2 distticts (Kj,enjoio and Kannverrye). Thefitilitrgs qf the study ure sunururized belol',. Objective: Few studies huve atantined ivernrcctin coterage over nrilnyleors and.factors trssttciuted 'tvith long-ternt corttpliance A studt' r,as cottdncted to deternine the rate of indiyitluol cttrttltliance to annual iyennectin treotntent and pa'ceived beneJits irt Onchocerciasis endentic oreus in llganda. Methorls: A retrospectire slutlT, ra,iewing conurturtitl,-directed drug distributors' (CDDs) rcgisters from 2000 to 2005 and a population based cross-sectional sun,qt. 3099 people oged >10 .ysars t'ere identi/ied .from the CDDs registers (1523 and 1576 nmles and .fenutles respectbely). 771 perryle were inteniewed during a popululion based cross-sectional sufi,et High conrylinnce wus.fourttl irt J09 and lott, contpliance in 362. Contpliance was ilefineil us "higlt" if an inditidual had tuken ivennectirt )5 tinrcs and "lort" l,hen an ittditidrtol hod taken h,ennectitt < 2 tinrcs. Results: Oterall, 2237 (729(,) people tere fourttl ruitlr high contpliance .frutm the CDDs registers and it was 1130 (7J,o/o) and 1107 (70%) annng nmles and.fenmles, respectively (P0.01). ()yerall, 309 people (1096) hqd low cortrplionce, 112 (9?i,) md 1678 (1lo/o) r,ere nmles and.fenmles, respectivell'(t>:0.07). The nrcan age in lears tas 28.7 and 21.2 anrung the higlr nrttl lol, contpliers, respectit ely (P<0.001). Onchocerciasis was perceiveil as severe in the poprtlutiort based cross-sectiortctl sune), arrnng 9J.9% and 87.8o/o lrigh and lott, corrtpliers, respectivel-y, (P0.001). The perceptions of'seterity of ortcltocerciosis unnng high and low corttpliers included:stignu (OR:0.11;95% CL 0.07-0.26), reduced energt.for wrk (OR=0.37; 95o,(r CL 0.2l-0.59) and it cuuses poor fisiort (OR:0.18: 95o,';) CL 0.36- 0.65). Perceptions ort henefits of it ernrcctin treatnrcnt tltat were asxtciated with contpliance were: uble to work longer/harder (OR:0./,5: 95% CL 0.12-0.22), reduced itchiig (OR:0.17: 95% CL 0.35-0.63), iltcreased strength (OR:0.15;959/o CL 0.09-0.2(r), reduced obrbninal lrrtrhlents (OR=0.18; 95% CL 0.10-0.3) and intprotentent in skirt cotttlitiort (OR--O.17;9So,(t CL 0.12-0.21). Perceptiotrs ot, seteritt, of adverse events of iverntectin trettntent thatlvere associoted witlt lotp cotrtpliance were: itcltirtg (OR:10;95% CL 6.36-15.83), di;iness (OR:I.92: 95o./o CLI.2J-2.98) und bod7, slvullirtg (OR:3.39: 9596 CL 2.20-5.22). About 97o,(t und 750.6 ltigh and lotv contpliers, respectivellt ttere willittg to take ivennectitt et'ery, 7,ear.for nrunr nnre years (P<0.001). Conclusionsz T'he enthusiasm of indifiduals and corttntutrities tu take ivernrcctitt sltottld be nruintfiined by constant nnhiliz.ation anil sensitization, through regular health education of' henefits and inqrortance of regulur unnual ivennectirt treatnrcnt over nrfinl, years and Ag WHO/APOC l5tr'()croher l00i Z. t-- torgeting the youth uulfenrules. Equally intportunt is tinrcly procurenrcnt of ivennectin b7' the health sen,ices.for the distributiott to take place during the tinrc agreed upon h1' the cottttttttttities and properunanilgenreti of adterse eveilts of iverntectitt treatnrcnt. The antcltrsitrrts drawn in this article nuy equalll' ilppb, to other nwss dmg udninistratiort (MDA) progranilrres. Impact assessment studies Impact assessment u'as conducted in some districts of phase l. The results shou that there is significant reduction in microfilariae and nodule prelalence 4.4.2. How were the results applied in the project? Health educution on the need.for long term treottrrent will.focus ott wonrcn and the J,tmth wlto 'tvere lo*, cotupliers. Intpact rssessnrcnl sttulies sltoted sigrtificant reductiou in the disease burden ttltltongh ortcltocerciosis renruins a problent For this Feoson, seni-annual treatntent tyitlt ivennectin srtd vector ctmtrol/elintinatiort has been adopted in an effirt to elininile onchocerciasis irt isolaled.foci irt Httintn, Masindi and Kisoru distrids, tvith the assistance of The (itrter ('enter und Sight Sttvers Intenrutional. SEGTION 5: Strengths, weaknesses, challengcsr and opportunities - List the strengths and n-eaknesses of CDTI implementation process. - List the challenges and indicate hon- thev tr ere addressed. Strengths . l'he CDTI progranmre has built a strong stntcture whiclt has heen acploited bt other conununifv- hnsed intenentiorts. The structure includes troined drug ilistri b utors, cotttutttttitl, supen'isors und h ealt h twrk ers. o (lgunda is one of the _first track coruiries to receive.funding .from USAID grant for integrated control of neglected tropical diseases and plmse one districts tvill benefit .from tlrcse.fitrtds tthere iyennectirt tlistributiut tvill be integrated with albendazole to control soil transnitted helndnth irlfections. Weaknesses o There is no set time'svhen ivernrcclirt tttill he stopped. T-ltis nnkes adt'ocaq, dfficult especially iltrrotrg the youttg cotttttutttitl, nrcnthers wlto hate no erperiettce tith signs and sy'tttptonts of ortclrccerciaisis. o The lrcalth'tvorkers are.fat, and nnstly itttolvedx,ith atutire services, leaving no tinte.for public health intenentiorts tvlticlt nrukes sutrtport supenisiort dfficult I)re-('ontrol I993 Posl control 2005 2006 1),tt;i;-- htl' Drevalencc Notlttle Drevalenc'e ()nc'hotler m(tltlr,\ hfi Nr4lttlc l{)nr'horlr'rtn(ttttt.\prtva lettc'c I Hottntt Not vlona l,lot clonc Not clone 1.6'% 3,1% 9.3% Ivlct.stuclr Not elone 110,/:: ./(t Nol tlonc Ktsoro 53.2%, 27.6% 1.6% 31% Not clone Kcr.sc.vt 70 '7Ot t8.3% 36.2% l() I ()l 3.s% 1.230h n wl I()/nl)(x' 75tl' (),.toher ltlo5 t I t Little.fittuncial resources .fttr truining of net, CDDs and health twrkers who are posted in the project aret Opportunities o CurrentlJ, there fire,nony intenentiorts which are usittg (DTI as a vehicle to deliver otlrcr conurrunitt' inten entiotts. These in turn come tith ntanJ, opportunities in fonn of incentil'es. These intenentiorts provide alefiues .for integrating witlt CDT'I rvhiclt gires an of integratittg ruith CDTI and the CDDs gctting incentives. Hotuever, this night be detrimerttal lo sustainahilitT, of CDTI as the sustuirtabili4' t2f these progh ram,nes is q uestionable. Threats o lV'hile other conutrunity intenentiorts provitle opportrutitiesJ'or CDTI, tlrcy can also be tlteats if not well hantessed. Because sorne intenentiotts corrre witlt incentites, the distributors of ivernrcctitt are likel.l, to abantknt CDTI .ftir the abote inten'entiorts, SEGTIOil 6: matters .4ll plmse 1 districts except Kasese, with the support of fhe Cafier Center and Sight Sat ers Internatiortal in co4inrtctiort tvith the Ministrl, af Henlth,'tvill slart seni-annuol treatnrcnt srtltplenrcnted with tector control itt un e.ffort tu elininote onchocerciasis irt those districts. This strategl, has been udopted because the.fttci irt these ilistricts are believed to be isoluted anil therefore elininatiort of the disease.feasihle withirt 6 to 7 years. Tlrcse districts tvill also get.finuncial supporl.fiont the USAID project ott integrated control of neglected tropictl diseoses (onclncerciasis, lymphatic./ilariasis, scltistoisontiosis. soil tranmitted helminth infections and trachouru). Onchocerciasis is co-endenic with scltistosoniusis itt Httirttu uttd Musirtdi districls tvhile soil tronsnitted helninth i4fectiorts are ur-endenic with ottcltocercitsis in all tlrc districls ttf'phase 1. Unique features of the proiecUother 3n wHo/APO(' 25th ()cfohcr 2(x)i