COTJNTRYAIOTF: Tanzania Proiect Name: CDTI Moroqoro Focus Approval year 2002 Launching year 2003 From: l't January 2008 To: 31't December 2008(Month/Year) ( Month/Year)Reportins Period: Proiect year of this report: (circle one) I 2 3 5678910 Date submitted: 31'tMay 2009 NGDO partner SSI THE UNITED REPUBLIC OFTAI\ZAI\IA ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTYE COMMITTEB (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting fro To APOC Management by 31 Julv for September TCC meeting RECU LE I I Aotii 20C9 APOC/DlR For To: For Tor n.Bq\@l AFRICAN PROGRAMME FOR ONCHOCE CONTROL (APOC) qoP ClTo ao c.ogFo Fo caltrt Etot csb WHO/APOC, 24 November 2004 4
ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSTILTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: I I : I I I I I I Country: Tanzania Ag. National Coordinator Name: Dr. Edward Kirumbi Signature: ... Date Zonal Oncho CoordinatorName: Dr. F. T. Mokiti....... Signature Date NGDO Representative Name: Dr. Ibrahim Kabole.. Signature Date: This report has been prepared by Name : Dr. D. K. Kabudi Designation : Project Coordinator Signature Date WHO/APOC, 24 November 2004u
Table of contents ACROI.IYMS v FOLLOW UP ON TCC RBCOMMENDATIONS....... 7 EXECUTTYE SUMMARY 8 SECTION I : BACKGROUND INT'ORMATION......... l.l. GBNpnar rNFoRMATroN......................... 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. PoPULATIoN SECTION 2: IMPLEMENTATION OF CDTI TIvTpLTNe oF ACTIVITIES .... ADVoCACY Mostt-IzartoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RrsK coMMUNITIES.. 2.4. CovUUNTTYINVoLvEMENT 2.5. CapacnyBUrLDrNG............ 2.6. TREATMENTS....................... 2.6.1. Treatmentfigures......... 2.6.2 l[hat are the causes of absenteeism? .............. 2.6.3 V[rhat are the reasons for refwals? ..2.6.4 Briefly describe all lcnown and verified serious adverse events (SAE;) that........ 2.6.5. Trend of treatment achievement from CDTI project inception to the current year .....2.7. ORDERING, SToRAGE AND DELIvERY oF IVERMECTTN 2.8. CourvrtrNrry sELF-MoNIToRTNGAND STAKEHoLDERS MeprNc 2.9. SupeRvrsroN................ 2.9.1. Provide aflow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision?............ 2.9.3. Was a supervision checklist used?.......... 2.9.4. What were the outcomes at each level of CDTI implementation supervision?..... 2.9.5. llas feedbock given to the person or groups supervised?2.9.6. How was the feedback used to improve the overall performance of the project? SECTION 3: SUPPORT TO CDTI 24 EqurueNr FTNANCIAL CoNTzuBUTIoNS oF THE PARTNERS AND CoMMUNITIES OrupR poRus oF coMMUNITy suppoRT .......,,........ ExpeNoruRE PER ACTTvITY SECTION 4: SUSTAINABILITY OF CDTI ........26 4.1. INrrRNal; TNDErENDENT pARTrcrpAToRy MoNrroRrNG; EvALUATroN................ .............26 4. l. I Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) . . . . .4.1.2. l[hat were the recommendations? .. 4.1.3. How hove they been implemented?.................. 4.2. Susranqasrlrry oF nRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT .... YR3) 2.1 2.2 2.3 3.1. 3.2. 3.3. 3.4. 4 5 7 7 9 9 I I I I I I I ..19 ..21 ..22 ..23 ..23 ..23 ..23 ..23 ..23 .. 23 ..24 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. Planning at all relevant levels........ Funds Transport (replacement and maintenance)....... Other resources ............... To what extent has the plan been implemented .......,..,24 ...........25 ...........25 ...........25 26 26 26 26 26 26 27 27 27 27 lll WHO/APOC, 24 November 2004 9 ::::::'::lif itii*'; t2 .............EnnEUR ! SIGNET NoN DEFINI. 4.3 INTgCRaTIoN 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. 4.3.6. Iv e r me c tin de I iv ery me c hanis ms Training..... Joint supervision and monitoring with other programs Release of funds for proj ect activities..... Is CDTI included in the PHC budget?...... Describe other heolth programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements? .......... ......................27 4.3.7. Describe others issues considered in the integration of CDTI. ................27 4.4. OppnarroNAl RESEARCH ............28 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...... .................. 28 4.4.2. How were the results applied in the project? ................ .......28 SECTION 5: STRENGTHS, WEAKNESSES, CIIALLENGES, AND OPPORTUNITIES........29 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ......29 lv WHO/APOC, 24 November 2004 .....,.,,.,....27 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 CEDHA Center for Educational Development in Health Arusha CSM Community Self-Monitoring IMCI Integrated Management of Childhood Illness LGA Local Government Authority MCH Matemal Child Health MoH&SW Ministry of Health and Social Welfare MTUHA (HMIS) Mfumo wa Taarifa za Uendeshaji wa Hudumaza Afya(Health Management lnformation System. NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TANESCO Tanzania Electric Supply Company TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization v WHO/APOC, 24 November 2004 Definitions (D 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 x 84%o of the total population in meso/hyper-endemic communities in the project area. 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. (i ii) (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end ofthe 3'o year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) lntesration: 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 govemment. (ix) Community self-monitoring (CSM.): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the 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. vl WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 7 FORTCOAPOC MGT ASE ONLYACTIONS TAKEN BY THE PROJECT Number of Recommen dalion in lhe Report TCC RECOMMENDATIONS 143 Report-related(i) In future reports, the project should provide information on the outcomes of advocacy Advocacy done to all level as a result the number of refusal and absentees reduced The situation was the same that is why the report was presented the same as year 2 (ii) On supervision (Section 2.9), many of the responses were the same as those given in Year 2 report. Is the situation the same? The community own the project, that means they take drug accordingly in time so as to easier CDDs work. (ii) The type of community support for CDTI was not explained in Section 3.3. The situation was the same that is why the report was presented the same as year 2 (iv) Many of the strengths, weaknesses, challenges, and opportunities provided in this report were the same as in Year 2 report, Is the situation the same? Proiect related:(i) The project is commended for having strategies for reaching women and minorities and is encouraged to develop additional strategies for reducing absentees and refusals Before start of drug d istribution sensitization and mobilization meetings were conducted in there area where many people refused to take drug. This included also Policy makers and influent people in those areas. Due to limited funds for training FLfm staff some of them are being trained by those who come to attend training from Health facilities. (ii) The project trained only 50'h of the health centre staff planned for Year 3. Can the project explain why the ATO was not reached? When will the remaining health centre staff be trained? There was a typing error but the number was not the same (iii) The number of refusals in 2007 was exactly the same as in the Year 2 report. Are the figures the same? (iv) The project should begin to plan for cessation of APOC funding for the provision of equipment and equipment maintenance. Proj ect sustainability p lans which included purchasing and maintenance of capital equipment has been incorporated in the Comprehensive Council Health Plans in both districts. WHO/APOC, 24 November 2004 Executive Summary This report covers the fourth year of CDTI activities implementation for Morogoro Rural Focus CDTI Project. The project was launched in 2003 and started to implement CDTI activities in the same year in 146 communities. Currently there are 871 communities in two endemic Districts namely Morogoro Rural and Mvomero. CDTI activities are implemented in 871 communities (Sub villages) with a total population of 337,364 people living in Hyper and Meso endemic zones. Treatment using Ivermectin (Mectizan@) drug commenced in early December 2008 - January 2009 and a total 2 70,904 of people were treated. The project attained a chemotherapeutic coverage of 80.3o/o. The geographical coverage for the reporting year is 100% whereby the UTG is 283,386 and ATO is 284,989. The activities which already done in this year are training of FLHW, training of CDDs, sensitization of Community members, distribution of Mectizan and Data collection. The CDTI activities were integrated with Lymphatic Filaliasis prograrnme. According to Mass drug admistration approach used by Lymphatic Filaliasis, the distribution of Mectizan done to all community in the District. The drug are delivered by National Lymphatic Filaliasis Elimination Programme (NLFEP), at this year the drug delayed to be delivered from National office causes delayed distribution of Mectizan to the community. During the reporting period a total of 180 FLFIF and2279 CDDs were trained and retrained about Oncho disease and integration of LF, its public health importance and treatment. The CDD ratio to population ranged from 1:100 tol:120. In addition to this, other activities conducted during this Ivermectin & Albendazole distribution cycle were monitoring and supervision and collection and compilation of treatment data for report writing. The major challenges are: - Inadequate support of CDDs from the community. -Inadequate advocacy to some program which distribute drug through mass treatment like schistosomiasis programme -To strengthened HSAM to the affected communities so that they will get sense of community ownership of the program hence increases incentive to CDDs. - To encourage community members to select more CDDs in sub village with larger area so that to reduce the walking distance to CDDs. 8 WHO/APOC, 24 November 2004 SECTION 1: Background information 1.1. General information 1.1.1 GeographicalLocation Morogoro Rural and Mvomero districts where CDTI activities are being implemented are found in Morogoro Region which is one of the 2l regions in Tanzania Mainland. It is an inland area lying towards the East and Southern boarder of Tanzania Mainland. The region lies between latitudes 5o 58" and 10o 0" South of the Equator and between longitudes 35" 25" and 38o 30" east of Greenwich. It has a total area of 73039 sq km which is 8.2Yo of Tanzania. According to the 2002 population and human settlement census, the region had an estimated population of about 1,759,805 people with a growth rate of 2.6Yo anntally. The two districts lie between latitude 8o and l0o south of Equator and between longitude 37o and 38o East of Greenwich. The region is inhabited by Luguru, Kaguru, Kwere and Masai tribes. These communities consist of indigenous and nomadic population; the mountainous areas being much more densely populated than the low land. The young people keep on migrating to look for employment in towns and to areas or neighboring regions where there are newly discovered mines. The main occupation of the community is farming of foods and cash crops, cattle herding, small scale fishing and timbering. Several rivers and tributaries originating from the mountains cut across Morogoro region. Major rivers include Kilombero, Ruaha, Luwengu, Ruvu, Wami, Ngerengere, Mkondoa and Mkindo. There are about 143 rivers, which form very large plains in the lowlands consisting of fertile alluvial soils. Due to the climatic influence of the lndian Ocean, the Eastern Arch Mountans have unique plant and animal life. Although environmental degradation has affected the area for many years, there are still different species of fauna and flora. This is particularly true in the case of the Udzungwa and Uluguru Mountains. Topography The two districts are divided into three geographical zones:- (a) Mountainous or Highland Zone (25oh) This zone covers the Uluguru Mountains located at an altitude of 1200 - 2000 m, above sea level with the clay type of soils. The zone is suitable for the production of maize, beans and horticultural particularly Mediterranean types of fruits. (b) Semi-Mountainousllow Land Zone (20%) This zone covers most of the Southern part of MorogoroAvlvomero districts, at an altitude of 800 - 1200 m above sea level with sandy clay loam type of soils. The zone is suitable for the production ofmaize, cassava and sorghum as staple food crops. (c) Savannah Zone (55%) This zone is located at the altitude of 600 - 800 meters above sea level; with same clay loamy type of soils. The zone is suitable for paddy, maize and cassava, for both food and cash crops; and also suitable for sugarcane, cofton and sisal as cash crops. Part of South East of the zone falls under Selous National Park, further the district has big valleys and numerous fast running rivers such as Mgeta, Ruvu and Wami-Luhindo. Climate The region enjoys two rain seasons - the short rains, which normally starts in October and ends in January and the long rains which commence in Mid-February and end in May. The annual rainfall ranges between 600 mm in the Savannah areas up to 1600 mm in the mountainous areas. . The temperature ranges between 20oc up to 28oc. 9 WHO/APOC, 24 November 2004 Population According to the 2002 national population census, Morogoro Rural district has a population of 263,970 with an average household size of 4.7 where as Mvomero district has a total population of 260,525 with an average household size of 4.5. Majortribes are Luguru, Kutu, Zigua and Kwere; minor ones are Kaguru, Sukuma and Masai. Their main activities are:- - Subsistence farming - Business - Livestock keeping Cultures Main cultures are:- - Traditional ngomas, (dances), - Use of traditional medicine, - Conduction of church sessions over the hills. Languages Main languages include:- - Kiswahili as a National Language - Local languages ie. Luguru, Kwere, Kikutu and Masai. Communication The total road network in the district is 1168 km. The roads are divided into the following categories:- - National truck roads - 188 km (tarmac) - Regional roads - 343 km - District roads - 295 krn - Village feeder roads - 342 km (40% are passable throughout the year and 600/o seasonal). Most of the road network is passable during the dry season, but some feeder-roads to the villages are impassable during the rainy season. Administrative Structu re Administratively the two districts are divided into l0 (ten) divisions, 42 wards and 233 registered villages. They also constitute 3 parliamentary electoral constituencies. Health System The Morogoro Focus CDTI Project area is constituted by 3 hospitals. One owned by the Government, one (l) by Parastatal organization and the 1 (one) by Voluntary Agency. There are seven (7) Rural Health Centers; six (6) being Government owned and one (l) belonging to Parastatal organization and 105 dispensaries of which 72 are owned by the Government, 16 by Religious agency, 13 by Parastatal organizations and four (4) by individual/private organizations. WHO/APOC, 24 November 20044 l0 WHO/APOC, 24 November 2004 Table 1: Number of health staff involved in CDTI District/LGA Numbcr of health steff involved in CDTI activitics. Totel Number of hcrlth staff in thc cntirc projcct arca Br Numbcr of hcelth steffinvolved in CDTI Bz Perccntage Br=B/Br *100 Morogoro Rural 286 2s6 89.5 Mvomero 256 221 86.3 Total 542 477 88 1.1.2. Partnership The Project involves the following partners in its implementation at all levels from region to community. They are as follows:- Ministry of Health, NGDO (Sight Savers International), APOC, District Council and Community. Working Relationship l. M.O.H.* + + Provides strategies and guidelines in approaching any planned activity Provides furancial support to the project. Support supervision and internal monitoring during implementation Provision of funds for different activities like advocacy, sensitization, mobilization of the community. Provide building capacity to implementers. Provide funds for renovation of the project offrce, fumiture etc. Monitoring of project activities and expenditure periodically 2. S.S.I + + + + 4 District Council:-Provision of human resources and non human resources to ensure sustainability of the project. - Provision of support supervision and monitoring. Community:- As owners of the project - Collection of Mectizan from nearby FLHFs. - Selection of Community Directed Distributors (CDDs) - Provision supportive supervision to CDDs - Self-monitoring and evaluation of themselves and the CDDs. - Is supposed to motivate and provide incentives to CDDs ll WHO/APOC, 24 November 2004 $o a.l ru -o tr() o z $(\ p. o > N Cli C)L CB oo 'a L a. C) (t o C) rE oL9. o G tn LoE o. 0.) .2o -o) bo c)(dE >o ob2 tr ct. Eg) o oo -q(De'= ge.I o.r ac,E o()E eo -trd}Eo+ -U '= O. oc) s'E 6 .-EG .16oots >\ogP6'F = oqitr bOC'E(!aE- =Y >ii --o =g;€ a 2.= .- Y O)9P,E .=!;. 5Q>-&-od)= d-Q 6€_g rrr0 oooo a.l L d C) o(.)p. o ooL oth k C) o t-1 O (^ o oQ (! tr cA ooL o v) .n C) o -od C) .o(t C) (g Cd o (! o C)ok oo 0) rh d o z(H 0 o c-. o L C) o. oo ii o oLr o bo t< o ot o 0) 'a Lr 0) L _o ah U) oo d U'(d > .R,\q) B\)L 4 oq) L q) q) ! osq)\ q) o I U B $q) L ()\) '= -\\()\.Y$o' s\ .:9sIi:' hL6S$p Br '9 c't SF *\. 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Advocacy The integration system between the two programs namely LF and Oncho sensitized the respondent of the drugs to the extent that the whole mass drug administration activities were easily conducted by CDD's. The sign boards provided by NGDO partners (SSI) who are placed at main roads, accessible by many passers by also accelerated the process. Different promotional materials for the same activities that included Posters, leaflet and T-shirts escalated the MDA by CDD's. 2.3. Mobilization, sensitization and health education of at risk communities The integration system, local radios were used in sensitization, also an event of annual Mectizan launching was organized where facilitators were drawn from the regional and district levels. The event was entertained by local drama group and primary school children. The main messages delivered were to make the MDA's progressive and create more awareness to the community, about Oncho and LF, its transmission, its quencequences, treatment and the safety of the drug (Mectizan and Albendazole). Posters, leaflet and T-shirts with message are used to educate community. 2.4. Gommunity involvement Table 4: Communities participation in the CDTI Comments. Attendance of female members in health education meetings high compared to the previous year. This is attributed to extensive dissemination of information to all communities about the health education meetings by community leaders. Support to CDD's is poor as they largely depend on the training allowances, community do not support them in any how, we comment that are excepted from other communities activities which occupy them, and therefore less time is devoted to the whole MDA activities. CDD's drop out is not a problem Ratio of CDDs to population in the project area ranges from I : 100 to l:120. a a a DistricULGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Total no. communiti es in the cntire project area Br Number with community membcrs ts supervisors Bs Percentage Bc= By' B. "100 Male CDDs Bz Female CDDs Br Total Be= B7+Bs Number of communities with female CDDs Bro Percentage Brr= Bro/Br*100 Morogoro 424 424 100% 560 569 1129 422 99.5 Mvomero 447 447 100% s89 570 1 150 443 99.1 Total 871 871 100% 1,150 1139 2279 865 99.3 l4 WHO/APOC, 24 November 2003 2.5. Gapacity building Training for front line health workers was conducted at project level the aim was to create awareness on integration system through CDTI philosophy. Generally, the project has greatly benefited from the trainings conducted for diflerent cadres at different levels of project implementation as these have been the key persons in advocacy and community mobilization and sensitization. We have also included in our work plan for the next year to conduct training for primary school health teachers and community development officers residing or working within the project area. Currently, frequent transfers of the staff working within the project area were not observed. But since these are the government employees and may be transferred at any time, the project has taken precaution measures to overcome this whenever it happens by training 2 -3 staff in each health facility in both districts. l5 WHO/APOC, 24 November 2003 c'l o -o () o z vN U o o. ^ > \o ri) o € € I I tr .$ e o U o ho E e ,t L o t o\ \i a G E I trt\ .t s i = :. C'' Era V)\)Q\J S V)IS \.) t \)4s\J s o c! q) q) t'r aU o q) 0) q) .q) q) c! u0 c!trF rat 6)l ,.oldl FI q) fit q n Q 0) z o -= +F v.+ -s .:qv G .izv o)N co c* o\ \o o rI,) $ o\ o\ c.l o\F. al al tc o\ rA\o t) oo q) c) a) -o .\ UF o\ c.l o o\r- ol al oq q) .a'o'Gtr< o: o9t LC!oh z o ,= +F e,i ts *6 e.l e.l N t t €,) q) o c\U N N ! () dL != .!i P3 E\ 2E c)q) E.q?F-u" --:&'u Uz \o oo @\o \o c.l e.l € s\o c..l ol o6 6l ?a : €t al o\ Ao q) q) \oIF ooo\ @o\ \o o\ 6 0 o I Fl3e(.) o ;'e q) z .1 E,'i+F'd ri \.) t. = * co co s $ co oo(\ \o €\o € ra eo () () () v U .fco + €\o 11 O a d & o o oo o o2 o o o o tr o 2 Fl F oF ol I qv Trainees Type of training CDD's Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci ry) Program management How to conduct Health education Managemen t of SAEs CSM SHM Data collection Data analysis Report writing { Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments o Front line Heath workers should continue to educate other community members on the importance to support the CDD's on the MDA activities. o Political and religious leaders who play a key role in this activities ie in mobilizing and sensitizing the community should continue to get more knowledge about the program. 2.6. Treatments 2.6.1. Treatment figures This year as we are in fourth cycle of treatment, distribution done in 871 endemic community and 270,904 people treated. Treatment coverage is 80.3%. Although still refusal and absentees is high, advocacy and sensitization is playing role to insure the rate decreasing. Table 7 below shows in summary the treatment figures for the Morogoro CDTI Project for the fourth year of its implementation. r7 WHO/APOC, 24 November 2003 s N o o z $ c.l \J o o > oo t !otq g \l '5\\ a) s B\ a qJ Oo a\ -Q) s Es L bosu o6 \\o9 FU EUv\ dqes x8 oo'gs \o-Yn()-'EilS =.a-i.=ooi -Ct:i 'E.sS un'SSUU\H S3 .9ss EEE d)E.:t xtgs$ \u €rsosy =E'=E'\P;EN .:\ .Y\E o, E F Sol * H ];13 : F -ol q E I9l c, S ; EIE H S;l 8. b I d: s [RtsIT F SF El = E_ ps!ta-\\trlE s' s s' 1lE $ Ses tl-' .S TLs esrr E s\'t. EER$s\. :'ET +Ps s5 : E\)\ -.EE \ \S -o) g :*a € t: .: S BNE k ss(! u aJ\o I EtFrrttPD o p$s \ sr ol toxl > El Idl '= sl6 sl E01 c)ol tr 8iEt*l 9.> vl r-Hl '9lE trt cJl d zl< do L(n Io C) 'd ctH6J*l- O)(g.C o-6)-= 'A^ LV ^- 2O) rrl €a i-HA =-o€>c) oH L .= c)CE 1Atrd EU, ^6)o .rjotr tr or tr() ol =! -l EF :l 3b ul.ea. El tr = !t EA ol Cat6 ()l ()ol 6) a4.r;l tr dl 6{; Et * €l s EIEgl't .El [i el .- =l Col- 2l H EI E EIts 9l'r !l -BIE 8IEi+.1 = qrl =olo- olE ulO ulfolo- olE -ot _ -ot -Ets Ets ,lo ,loZlt- Zlt- at o)l b0(Bt LI ol >t ot ol EI .91 -qlol cdlLIbo ol ol brl =lcldl ,.ll 0.)t o.ldtLI ol el bd trI oI EI ol :l €l ol =lEIt-{ OIEI -\ G?) v)q)() q) U2 L q) L -x s \) a4 q) s i4 rrt ! d o(d c)L(d -] o L o >t a trl CN d 0) Cd 0.) F r-t orl -oldlFI C) (d H 0) bI) oo' o oF o cdL 0) oo Lo oo (d^ -cvo.(B L o0 o()(.) o L c) bo H c) o ,.r G '5 o\ o o. G, o F Fl tr ola o o o 5 o o bI) o o .E<iqo\ ao., o -^^lj€'A En€gsEi€= F.l z Fl z Fl z 9qlE< >, u) AO Fl z r-l z Fl z bs5cEA =-ozd r- oo\ ca co c.t o o\6 \o ts€E=rr-U -t eE Etr69i; 2LFY oo o\6 c.i" @ \o $ \o ra c- \o ll{ix a o '5o =bood *b ootoF et) @ ct') o\r- ro € a ,o o6 u9OE2- =5 =6ab o. oo$q r-N \o rnt ca+ t o\ r-N =od O.= t gFFU O o\ ca o\ ooq tr) .t o\ € o\ s €N o d o oA .9 .,H =xo*. F.F5_4 ?o o=ots 6 llE -oF ca oo\o \o r oo\o oo v\o?'I r- ?a ?a a ll r o'o' E .9o -uEs!!!d m> uo H qdoo.9 E o'= L -EeS z 88, + c.l$ tr- .t$ r-€ 6tsi EEEgE<F o +N$ t-*++ r-€ b C) 00(d an C) E oQ -oC o.-- a I o .*coe'=o * 5 boo ?Ei (6 -E Es€=* Ea E EE E E' ' u> E sN$ F=$$ tr6 2.6.2 What are the causes of absenteeism? . Community members at time program is conducted they are busy with their informal economic activities. 2.6.3 What are the reasons for refusals? . Mainly due to misconceptions and ignorance . The negative impact of other drugs like Praziquantel for schtosomiasis. 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. No SAEs occurred during this period 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 l9 WHO/APOC, 24 November 2004 $oo c.l q) ,o c) z$ e.l o o. o C\ q) a, q) Lq) .a B Lq)q .t$ U) %q) Qq) S q l q) L t q) riq) s o Lo b0 L o a.q) Lr 0.) bo L Eo L o o o d cr) sl a o C) C) o rttLo d t) o Lo ch t) 0) </)(! O ddr ol -ol(dt FI c(.) o9: Zz co<E <.E ; a E] V) o z ;e3 5ESoota tr o= flEEq.r 5'5 o o'2E3 EF. aQoa I 9t!=99: 13D^ =i di, .= q)o-E trd,3 d d€ a;()-o.9 -E 6o e c= doooOEE.E EoO.d v qE o'= = .xE oIJ d3 d9C od € e qp.S E€:!€;I-oj:Z o a ;=o -iHo =ruHEO.x >,qH66 !() .Nt fi58o> B (s o C)tOc o.- =bo?o x C)a o oo * z U) C) oo P ES/o O v,l r-\o 9 o\ oq $ o\ v,) o\ o Cd g o Or 8fli r,i td tl o ^ bI)P ES<. >v -o o c\ o oo \ o\ @ o\ @ c.l$ o\ t ll r ri l{ rI] \o o5o =b0o6Pb ooFoF r-\o c1 r* F- -) oo ri o oo'o ,o od .o o5 -o E z \o$\ r- c.t c.lq @ co c.l N6^ \o$N $Oq F-(\ r.l :o d O.=2EE c d.:j9s' FU \o(\ o\ a.l o\r- oo- \o N sOol r-N o\ ooq$ oo N =*sv Oo = 8.aH .::'5 > o e € * r'E' - =tro9oE*€o O\o o\d\o cl o rat \o c.) .+ oo od N c.) $\o c'I t- c.l c.) o bI)(d o o(J o lL'- rdII] rI1 o 9H<at- oo\< B-o cl co o\ oo o oo '=M! $:8*!Eo >,OE E c..l co o\ oo o O rI] f E fl,I3 = s:i E E= iJitr>!lz E- \o co @ c.l @ r- oo r- oo e :oE 6.2 E E.g .l9-o' FU \os coN oo F- € r- oo 8r* -:: o6q'= i-' o :;E F+ O o ,t - -.- o.=r:t ,o5od Eco Oa \o * oo c.l oo F-@ r-oo & rI] r* o\ o\ € o\ o\ o\ o\ o\ ooo c.l o c.l Noo c.l co e.l $ N oo c'l \ooo(\ F-oo ol @ c.l o, e.l o e.l $ooN o .o E 6) z\t(\ U 1-\ > c'l rr) o 6l o G(J o u0d e o F D 6l cg o o q) q) e( 0) bo th 0)o (a € 'l 6l 0) 6l oq) o q) -o(, F o 0) 6l(J 0)o cl 0) F{ t.tt\q,) !.,qJ cl q)c* !S 9* =\.)(J.a clS €N E6,;c) :c! 6)X2U Ea EL aE -q)Fo l-l =Uk E€ €9 E5ltrclo6)l3El €xlGt -':906Etrc) s3 e=tsEI 59tEFE . 0.)ia .L \O( e.i o,r o.r I -.ol cdlFI 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH O WHO N UNICEF ! NGDO E Other (please speciS): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH U WHO E UNICEF E NGDO E Other (please speciff): Please describe how Mectizan@ is ordered and how it gets to the communities 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 by multiplying the ATO times 2.2thenwe get total number of required tablets. The Regional office request Mectizan@ oncho endemic areas by sending the Application forms to the LF National office. The national office then sent the request to Mectizan@ Expert Committee for approval. Mectizan@ arrives in country through the same channel and is cleared by WHO country office who handles them to the Ministry of Health and then the drug handled to the Medical Stores Department (MSD) and then MSD sent the drugs to districts. The CHMT are distributing drug to the FLHF according to ATO in that area served by FLHF. CDD or a selected community member comes to the FLHF to collect Mectizan@ ready for distribution to their Community members. Table 10: Mectizan@ Inventory (Please add more rows if necessary) . How are the remaining ivermectin tablets collected and where are they kept? The remaining Ivermectin tablets are collected into bottles and taken back to the District pharmacy to be stored for next distribution. Activities performed by Health care personnel in the project area:- l. Advocacy and sensitization to community members and political leaders in the area of jurisdictions. 2. Training to CDD's 3. Collection of Mectizan from district pharmacy 4. Distribution of Mectizan to the community members and CDD's 8. SupportiveSupervisionduringdistributions. a a Any other comments - No State/District/LGA Nr-b* of Mccti-;o irbtets Rcqucstcd Received Used Lost Wasted Expired Remainins Mvomero 45t,702 45 t,300 388,640 4,276 58,384 Morogoro 391,708 391,700 348,620 3,055 40,025 TOTAL 843,410 843,000 737,260 7,331 98,409 22 WHO/APOC, 24 November 2004 2.8. Gommunity self-monitoring and Stakeholders Meeting self- and Stakeholders 2.9. Supervision 2.9.1. Provide a flow chart of super-vision hierarchy. RIIMT PC 2.9.2. Main issues identilied during supervision a Poor record keeping facilitated by working environment and culture. 2.9.3. Use of a supervision checklist Yes we use integrated supervision checklist which includes all contents. 2.9.4. Outcomes of supervision at each level of CDTI implementation. There is clear improvement at each level. 2.9.4. Feedback given to the person or groups supervised Feedback is given to them. + No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) District/ LGA Total # of communities/villages in the entire project area Morogoro 424 46 Mvomero 447 30 46 76 46TOTAL 871 CHMT FLHW COMMUNITYCDD 23 WHO/APOC, 24 November 2004 2.9.5. How was the feedback used to improve the overall performance of the project? Feedback improved performance as the supervised community knew that the activities were done for their benefit, and this resulted into over all performance of the project. SECTION 3: Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add 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? - The project conducts regular maintenance of vehicle and motorcycles through funds from council (CCHP) Source Type of equipment APOC MOH DISTRICT/L GA NGDO Others No Conditron No Conditron No- Condrtion No Conditron No Condrtron l. Vehicle I F 2. Motor cycle(s) 5 F I CNFR 3. Computer(s) 2 F 4. Printer(s) I F 5. Photocopier (s) I F 6. Fax Machine(s) I F 7. Others a) Office chairs 9 F b) Office tables J F c) Computer table I F d) Photocopier table 1 F 24 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years - If there are problems with release of counterpart funds, how were they addressed? There was no problem in releasing fund from all source - Additional comments a 3.3. Other forms of community support Community are supporting the project by taking drug at time and to easier CDDs to work 3.4. Expenditure per activity Table 14: Indicate how much the project spent for each activity listed below during the reporting period Contributor Year 2 ('provide the period') Yezr 3 ('provide the period') Year 4 ('provide the period') TOTAL Cash Budgeted (US$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) MOH (District/LGA) 0 0 9,496 9,496 18,998 18,998 Local NGDO(s) ( if any) NGDO partner(s) 34,000 18,652 19,479 18,353 15,216 15,216 Others a) b) Communities In kind APOC Trust Fund 89,254 40,000 60,436 60,436 60,307 60,307 TOTAL 123,254 58,652 89,411 88,285 94,521 94,521 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of ggrn4q!!ity 2500 GOVT Mobilization and health education of communities 5000 APOC/ COUNCIL Training of CDDs 24,830 APOC/ COUNCIL Training of health staff at all levels 17,500 APOC/ SSYCOUNCIL Supervising CDDs and distribution I 1,000 APOC/ SSVCOUNCIL 25 WHO/APOC, 24 November 2004 Internal monitoring of CDTI activities 4000 APOC/ APOCAdvocacy visits to health and political authorities 5,700 IEC materials Summary (reporting) forms for treatment 6,900 APOC / SSI 200 APOC Vehiclesi Motorcycles/ bicycles maintenance 10,391 APOC/ COLINCIL Office Equipment (e.g computers, printers etc) 4000 SSI Others 2500 TOTAL 94,52t Total number of persons treated 270,904 a Any comments or explanations? No SEGTION 4: Sustainability of GDTI 4.1. lnterna!; independent participatory monitoringl Evaluation 4.1,1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2 Recommendations on faults in lilling treatment registers. registers. Implementation stqtus o n Correction of faults.4.1.3. 4.2 Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? YES Was a sustainability plan written? YES When was the sustainability plan submitted? YES Arrangements have been made to sustain CDTI after APOC funding ceases in terms of:- 4.2.1. Planning at all relevant levels Planning done to all level 26 WHO/APOC, 24 November 2004 4.2.2. Funds Councils started to contribute fund supporting CDTI activities. Increasing each year 4.2.3 Transport(replacementand maintenance) Maintenance of vehicle and motorcycle done by council 4.2.3. Other resources CDTI activities integrated with other health activities in council, so we use same vehicle and funds provided by other activities. 4.2.4. To what extent has the plan been implemented Plan started implemented in this fourth cycle. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: ' Integration with LF activities- the program integration assisted uses of same CDD's. ' Use of Oncho vehicle in other health issues - The project vehicle was used in the supervision and activities mentioned above. Consequently, the project also used other government vehicles in project activities e.g. collection of IEC materials from Dar es Salaam. ' Car maintenance - General Service of the car is done by council. ' Oncho activities to appear in CCHP - The two district councils have incorporated the CDTI activities in the Comprehensive Council Health Plans (CCFIP) budgets. Activities like supervision training of FLHW, CSM, SHM and maintenance. 4.3.1. Ivermectin delivery mechanisms The delivery of ivermectin is within the government system whereby it is taken together with other kits of drug from District Pharmacy to health facilities within the project area. 4.3.2. IntegratedTraining Currently there is integrated training. Both programs are merged to make the activities more efficiency and effective. 4.3.3 Joint supervision and monitoring with other programs Joint supervision and monitoring is being practiced as indicated in bullet I & 2 above 4.3.4. Release of funds for project activities During the implementation of the project activities in the fourth year, the two district Councils released funds for fraining, CSM, SHM and supporting supervision. 4.3.5. Is CDTI included in the PHC budget? The budget were included since year one and is increasing every year 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? LF programme used CDTI and help the community to understand importance of taking drug. Treatment coverage has also increased. Describe others issues considered in the integration of CDTI. - Lymphatic filariasis - Eye care activities. - Schistosomaisis 4.3.7. 27 WHO/APOC, 24 November 2004 a 4.4. Operational research 4.4.1. Summarize operational research undertaken in the project area within the reporting period. No operational research was undertaken during the reporting period 4.4.2. How were the results applied in the project? N/A 28 WHO/APOC, 24 November 2004 tSEGTION 5: Strengths, weaknesses, challenges, and opportunities SEGTION 6: Unique features of the project/other matters None Other lssues: None Strengths Weaknesses Challenges Opportunities -Integration of CDTI activities with lymphatic Filal iasis -Inadequate knowledge of community ownership of project -Inadequate support of CDDs from the community. -To conduct more advocacy at the community level, so as to increase awareness on ownership of the project -Uses of Radio and news papers to disseminate information to the community about integration. More integration with other health activities in the district -Inadequate advocacy to some program which distribute drug through mass treatment To insist on multisectorial collaboration lncreased community awareness in knowledge of LF and Oncho diseases, drugs, and its side effects To develop enough IEC material for adequate health education CSM done through CCHP funds Council Health Management Team (CHMT) and FLHF staffs are fully aware of the implementation of LF & CDTI activities. 29 WHO/APOC, 24 November 2004