Tukuyu CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2012 to December 2012

IA T a THE T]NITED REPUBLIC OF TANZANIA MINISTRY OF IIEALTII AND SOCIAL WELFARE OzuGINAL: Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DBADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting ,] AFRICAN PROGRAMME OI\CHOCERCIASIS C ONTROL (APOC) Lg,' I I' t I .: COUNTRY/NOTF : TANZANIA Proiect Name: TUKUYU CDTI Approval vear: JULY 1999 Launchins year: APRIL 2000 Reporting Period: From: JANUARY 2012 To: DECEMBER 2012 (Month/Year) ( Month/Year) APOCfundingyear: (circleone) | 2 3 4 5 6 7 8 9 10 (f1) 12 13 APocProiectimplementationyearreDort: (circleone) I 2 3 4 5 6 7 8 9 10 11 (12) 13 Date submitted: 24th Jan20l3 Partners: - Ministry of Health and Social Welfare - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (IVIDP) - Sightsavers - 305 communities N E o{Io L .. E€ p tl- r,fr fr .t- Lo tsr WHO/APOC, 14 September 2009 J I I I I I I I a:q$J!g@ygh_o_g:c_gm_ R,ECU I.E ] ffr-;-tl POC I D:I R ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) trNDORSEMENT Please confirm you have read this report by signing in the appropriate space. qEffCfnS to sign the re Country: TANZANIA National Coordinator NGDO Representative WHO/APOC, 14 September 2009 I \, Signature: Date: This report has been prepared by Name: Dr. Abel Asilia Mwakafwilla Designation: Project Coordinator Signature: Date ---'-----'-l ANNUAL PROJECT TECHNICAL REPORT ($ryf TO TECI{NICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the Country: TANZANIA National Coordinator Name: Dr. Upendo Mwingira Signature: $**-6;: Date: ....:11'.:.. I.:. !" ry j? Zonal Oncho Coordinator Name: Dr. Seif Mhina NGDO Representative ' LJu*Signature: ...W.-*/ "tDare: I.t.l.a-. 1..+lZlr Name: Katunzi t Signature: Date: This report has been prepared by Name: Dr. Abel Asilia Mwakafiryilla Designation : Proj ect Coordinator WHO/APOC, l4 September 2009 cdil a EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION 1.1. GeNsRer rNFoRMATroN................ .....................4 1.1.1 Description of the project (briefly).. ..............4 I .1.2 Partnersltip .......... 6 I.2. l'ot,uLATIoN ................. j SECTIOh- 2: IMPLEMENTATION OF CDTI........ ......................8 2.1. I-TMELTNE oF ACTtvrrrES .............. ......................8 2.2. ADVocACY ................ l0 2.3. MoetrIzettoN, sENSITIZATIoN AND HEALTH EDUCATToN oF AT RISK coMMrrNrrIES 10 2.4. ColanruNlry rNVoLVEMENT............ .................12 2.5. C'ap.qcrry BUTLDTNG ..................... 13 2.6. Truerp18xrs................. ................ 15 2.6.1. Treatmetfi figures ................. 15 2.6.2 Ll4tat are tlte cuuses of absenteeism?........... .................. 17 2.6.3 What are the reasons for refusals?................. ................ 17 2.6.4 Brie/ly desc'rrbe all known and verified serious adverse events (SAE) that ....... l7 2.6.5. Trend of trecttlLent achievement from CDTI project inception to the current year 192.7. ORoeRmG, sror{AcE AND DELIVERy oF IVERMECTIN ..........20 2.8. ConlvuNruy sEt-F-MoNrroRrNG AND STAKEHoLDERS MrprrNc ............22 2.9. SupeRvrsroN... ............ .................23 2.9.1. Provide aJlow chart of supervision hierarchy. ..........23 2.9.2. What were the main issues identified during supervision? .............................. 23 2.9.3 Was a sLrpervision checklist used? .......... 23 2.9.4 [4/hat were the outcomes at each level of CDTI implementation supervision? 23 2.9.5 Was feedbock given to the person or groups superviserl? ............. 232.9.6. How was tltefeedback used to improve the overall pe(brmance of the project? a)ZJ SECTION 3: SUPPOIIT TO CDTI ............24 3.1. LIQUIPMENr .................24 3.2. FNANCTAL coNTRTBUTToNS oF THE pARTNERS AND coMMUNrrIES............... ............24 3.3. OrnER FoRMS oF coMMr.rNITy suppoRT................ .............. 30 3.4. ExpBNoIruRLt p',R ACTIVITy ......... 30 SECTION'4: SUSTAIN \BILITY OF CDTI........ .......30 4.1. INrnRNer; rNDr eENDENT pARTICIpAToRy MoNIToRING; Eve1uertoN.................... 30 4.1 . 1 Has the proj( ct ever been evaluated/monitored? (Tick any of the following which are applicable) .. ..........30 4.1.2. What w*cr< the recommendations? ..........30 4.1.3 How have 'ltey been implemented? ...... ....... ..............31 4.2. Susramanrlrr* oF rRoJECTS: rLAN AND sET TARGETS (MANDAToRy AT................ 31 lll WHO/APOC, l4 September 2009 Yn3)......... ..........3l4.2.1. Planning at all relevant levels...... ...........324.2.2. Funds........ ......... 32 4.2.3 Transport (replacement and maintenance) .................... 324.2.4. Other resources ... ................. 324.2.5. To what extent has the plan been implemented.......... ................... 324.3. INrecRerroN ................ ................32 4.3.1 . Ivermectin delivery mechanisms ............. 324.3.2. Training..... ........324.3.3. Joint supervision and monitoring with other programs................................... 324.3.4. Release offunds for project activities ..... 334.3.5. Is CDTI included in the PHC budget? ....................... .3j4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?.............. .................. -i-34-3.7. Describe others issues considered in the integration of cDTl........................ -rj 4.4. OprnarroNAl RESEARCH ................... 3g 4.4 . 1 . Suntmarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ...... 3g4.4.2. How were the results applied in the project?.............. .................. jg SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGBS, AND oppoRTUNrTIES..... ...............38 SECTION 6: UNIQUB FEATURES oF THE PROJECT/OrHER MATTERS...........38 IV WHO/APOC, 14 September 2009 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-GovernmentalDevelopmentOrganization 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 TCC Technical consultative committee (APoc scientific advisory group) TOT Trainer of trainers LINICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization WHO/APOC, 14 September 2009 Definitions (i) Total population: the total population living in mesolhyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iiD Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (") Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) GeosraphieAllevelage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitlr: 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) Communitlr 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. WHO/APOC, 14 September 2009vi 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 35 NAMBER OF RECOMM ENDATIO NIN THE REPORT TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 363 TCC was accepted the previoas well written report with the following re c o m m e n datio ns : Recommendations to improve the report; Tab le 2 : E ns ure pop u lation tigures are correctly computed; In this report effort has been taken to ensure the population figures are correct. Report on the reasons and outcorne of advocacy in more detail than presented in the current report; More reason has been provided in this report on advocacy and outcome. Advocacy to decision makers at all levels is very important, through advocacy the CDTI activities has been incooperated in budgets made at region and district levels. The outcome is that, CDTI activities are integrated with other activities in districts during implementation. Report more speciJically on communiQt response to s e ns itizatio n an d m o b ilis atio n activities qnd on ways of improving commurtity mobilisation. Community response to sensitization and mobilization activities has been reported very wide in this report. Also many ways to improve community mobilisation has been suggested and of are doing better as most of people ask for their medicines when delay occurs. Ensure UTG is cowectly calculsted at 84% of the total meso / hyper endentic population The UTG is being calculated by using the formula provided by APOC management to the Project. 84% (0.84) of total population is taken as an ATO. Recommendations to improve on project impleruentation WHO/APOC, 14 September 2009 Continue to increase the percentage of health staff involved in CDTI in the proiect area; This has been effected as FLHF staff has been increased from 93 to 220 which is equivalent to l9o/o Either avoid treatment during tlte month of Ramadhan or develop alternative strategies for reuchinp the Moslem communitv Thanks for the advice, lesson lent on this. Disseminate the results of the epidemiological survey carried out in 2011. The region Oncho office still have preliminary results will disseminate the results when receive the final report from APOC. (Please add more rows if necessary) WHO/APOC, 14 September 2009 Executive Summary Tukuyu Focus CDTI Project is based in Mbeya region and it operates in 3 out of 8 districts of the region, these are Rungwe,Kyela and Ileje. The region is located in south western part of the United Republic of Tanzania. This report aims to give the information on Technical and financial issues concetning Onchocerciasis control activities implemented from January to December 2012- There are 305 communities in the project area; all Oncho endemic communities were reached during MDA which makes 100% Geographical coverage. The project area has a total population of 117,496 people, out of this 89,i3j people were treated, which makes the therapeutic coverage to be 76%. The Ultimate Treatment Goal (UTG) was 108,222 and Annual Treatment Objective was 9g,696. A total of 2,006,000 Mectizan@ tablets were received for the purpose of treating Oncho and other NTDs in 8 councils in the region. Out of this 252,800 Mectiz,antablets were used for the treatment of Onchocerciasis and other NTDs found in Oncho endemic areas. The remained tablet from Oncho and nou Oncho ares within the project area is 142,394, these tablets has been stored in the district pharmacies. These 3 districts in which Oncho disease is endemic do differ geographically, economically and in social activities, these differences makes people to move from one diitrict to anotherfor wage activities, for example in Rungwe district there is tea plantations therefore in harvesting period people move from one district to Rungwe. In l(yela there is rice farms during harvesting time people go to Kyela. In Ileje there ii Coal mine plant; this plant has no constant production hence causing fluctuation of number of people coming in and out in the project area. In 2012 year , 7 80 CDDs and 220 FLHWs were trained / re trained, advocacy to pHC and CHMT was conducted, social mobilization to communities also were done. The project underwent Epidemiological Evaluation for Oncho in Sept 2Ol2by APOC and the results was NO microfilaria worm in tl.re human body, these results it is similar to the Epidemiological Evaluation which was conducted in September 2011. In this year 2012, APOC/USAID provided Tshs. 246,000,000/: for the implementation of NTDs control activities in the whole region, where by Region and Councils contributed a total of Tshs. 8,467,000, in addition to salaries and building costs. Challenges and how they were overcome. o CDDs and VHWs demands cash as incentives during MDA implementation, this has been given power by the presence of other programs in the project area such as HIV/AIDS and Malaria, these programs does not apply CDTI approach hence they pay much VHWs ranging from Tshs. 20,000 to Tshs. :b,OOO during implementation of their activities hence making even the CDDs to complain on payments. - CDDs are encouraged to volunteer also communities members are mobilized to provide incentives to the CDDs and also to increase the number of CDDs so as to reduce workload. -The spirit of volunteerism is also strongly disseminated to VHWs t WHO/APOC, 14 September 2009 SEGTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Tukuyu Focus CDTI project is based in Mbeya region; the region is located in southern highland zone of the Republic of Tanzania. The project operates its activities in 3 districts having endemicity of Oncho disease, these districts are Rungwe, Kyela and Ileje and all three districts are located in the southern part of the region. In the project area there is a mixed topographic, meaning that there mountains, rivers and low lands. The project area is bordered in the southern by Lake Nyasa and Malawi, Southern west is Zambia Country. There is a good annual rainfall leading to good production of various types of crops such as Maize, Irish, Rice, Cocoa and Banana. In the rural areas, people are engaged themselves in various activities such as agriculture, pastorarism, wage works and businesses. The indigenous people in the project area are Nyakyusa,Nndali,Yao and Kisi,the total population in the area is 122,315. Generally the road infrastructure throughout Mbeya region is good however during the long rain season (Nov - June), other potions of roads in the Region are eroded hence making transport difficult. Mobile phones communication system is good. Currently Tukuyu CDTI Focus Project operates in 305 communities in Oncho endemic districts, there are 23 Health facilities supporting CDTI activities in the project area, total number of the health facilities in all 3 Oncho endemic district is 108. KYBLA DISTRICT PROFILE. Kyela district is located at the extreme south of the region and is about 130 km from the regional headquarters, bordered by Lake Nyasa and Malawi on the southern part, Ileje district on the western part, Rungwe district on the north and Livingstone Mountain ranges on the eastern part. Geographically, the district lays between n 30o-350Longitude east and between gO 250 - 930 Latitude south. It is situated at the altitude of 400 -520 meters above sea level and receives an average rainfall of l200mm annually. The district has two administrative divisions divided into 20 Wards and 101 registered villages. Four wards containing a total of fourteen (14) villages which are under the project area and thus receiving ivermectin annually. It occupies a total area of 1,322 square kilometers (approximately 2.lo/, of the area of the whole region). 965 sq. km is a dry land where as 375 sq. kms is occupied by water. The district has a total of 36 health facilities. Out of these, 7 health facilities are under the project area. The District has four main ethnic groups namely the Nyakyusa, Ndali, Kisi and Yao. The Nyakyusa tribe lives on the lowland areas and depends mainly on subsistence farming and pastorals. Whereas the Ndali tribes lives on the highland and are engaged on farming, livestock keeping as well as beekeeping. The latter two are living along the lake Nyasa are engaged in fishing and pottery activities. Administratively Kyela district is comprised of 2 divisions, 20 wards and 102 villages with the total population of 213857 people according to national census. Currently Onchocerciasis is found in 76 communities. Generally the communication network is good in almost all parts of the district, except some few areas are inaccessible during the rain season (November June) There is one highway crossing Rungwe district through part of Kyela district to Malawi. WHO/APOC, 14 September 2009 RUNGWB DISTRICT PROFILE Rungwe district is among the seven districts of Mbeya Region. The district is bordered by Kyela district on the southern part, Ileje and Mbozi districts on the westerr part, Mporoto volcanic mountains and Livingstone mountain ranges on the northem and eastern parts respectively. Geographically the district is located between 90'05's to 45's and 33o 20'E. The district occupies approximately 2211 sq. divided into four divisions, 30 wards and l4l registered villages. Eight wards (8) comprising of a total of 41 villages are under the project area and hence their communities are receiving ivermectin annually. There are 56 health facilities in the district wliich deliver health services to the inhabitants and people from the neighbouring districts. Out of these, 15 health facilities are within the project area and thus serving CDTI activities The district receives adequate rainfall of more than 2100Mm per annlrm, one of the highest in Tanzania. It is fairly well distributed over the year, but a clean dry season exist from June to October and the rainy season from November to May, being heaviest in March, April and May On the high attitude hill slopes the weather is slightly cool throughout the year with annual mean temperature of 60c. The district possesses many rivers and stieams originating from the northem and western hill slopes that are draining in Lake Nyasa. Most of these rivers and streams have been found to be good breeding sites of Onchocerciasis vectors Rungwe District is inhabited by three major ethnic groups namely: - Nyakyusa, Ndali and Safwa tribes. The Nyakyusa tribe comprises abottt 95o/o of the total population and lives in the highland areas. All the tribes depend on agricultural activities for subsistence and trade. The main crops grown for commercial purpose are rice, tea, banana, and Irish potatoes. Crops grown for subsistence is cereals, maize etc other activities include livestockproduction, trade transportation, Artisan, Mining Industrial production and Harvesting of Forestry products. Tukuyu Focus CDTI Project in the district operates in 180 Hyper and Meso endemic communities. Administratively Rungr,ve district is comprised of 4 divisions, 37 wards and 164 villages with the total population of 380,418 people. Onchocerciasis is endemic 205 corrmunities. ILEJE DISTRICT PROF'ILE Ileje District is located in the southern comer of Mbeya Regional. The District lies between latitude g0' 14" and 90 37" Eastof Greenwich. The district covers a total area of 1,908 sq.km Ileje district shares common borders with other district in Mbeya Region whereby Mbeya in North, Mbozi North East, and East it borders with Rungwe and Kyela South East. The district also borders with the Republic of Malawi and Zambia on the South and South West, respectively. The Topography of Ileje district is of wide plateau and steep hills. The drainage system involves on Major River called Songwe which pours its water into Lake Nyasa. The District lies at an altitude ranging from 1360m to 2500m above sea level. Tl-re Natural vegetation of Ileje district includes tropical Savannah open woodlands. The rain start in November and lasts in April in Bulambya division, while in Bundali division the rain lasts from November to June/July. The annual rainfall is between 700 to 2000mm Temperature ranges from 160C to 210 c. WHO/APOC, 14 September 2009 Administratively, the district is divided into two Divisions, l6 wards, 68 villages, 320 hamlets and 26,852 households. During 2002 Population Census Ileje district had a total population of 1.36,445. Onchocerciasis is found in l7 communities. HEALTH SYSTEM Within project area there are 34 health facilities: each district has a district hospital hence 3 Government hospitals, 3 Health centers and24 Dispensaries. Also there are hospitals owned by voluntary agencies 2 in Rungwe, I in Kyela and 1 in Ileje. Table 1: Number of health staff involved in CDTI (Ptease adcl more rows if necessary) DistricULGA Number of health stalT involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Br Percentage Br:Bzl Br *100 RTINGWE 604 63 r0.4% KYELA 387 t04 110 /L t /o ILEJE 162 53 33% Total 1153 220 lg0h .1.2. Partnership There is strong collaboration with other stakeholders; other partners are APOCruSAID, Sightsavers and Communities. Each partner takes a big role to support the activities of the program financially, equipment procurenrent and in-kind support from communities. With this strong support the project managed to train FLHWs and CDDs, to conduct Advocacy, MDA, supervision, census updates and data collection as the result the project attained good coverage. WFIO/APOC, l4 September 2009 at 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period UIO.= cakutated as the n*i^" *-tu dw.it" reached f tt s@saphic cowruse (Mma y E podt should be apecte.t to rcact ii urc ot tte ena opn" y, y"L, it*" prii""ij Was a census for the project done during the reporting period? yes_rl_ If No, what is the source of the data in the table above? No * Source: National census Year : CDD Other source, specify: Ifyou aru usitlg the teni connuni4t or ilhge, deJitu hat constitutes the cofimuniq) or 'illage, This flill help understand the ptufile oltheIrojecl arca. Community is a Sub village with population mnges from 200 1,000 people rs lhere aay orter informarion of ifikrest abod the popaldtion in the prcject area? If so, iaclude it rerr. None 'Please add more rows CDTI Districts/ LGAs in the entire project area Total population in the entire project. area Number of communities/villages in Population of Meso-endemic zone in the project area At Hyper-endemic zone in the project area At Total in meso/hyper- endemic zone Aj: A,ft A2 Meso-endemic zone in the project area At Hyper- endemic zone in the project area Ar Total in meso/hyper- endemic zone .46 = Aa+ dt Ultimate treatment Goal (urG) RLINGWE 442,919 117 88 205 42,553 36,3s2 78,90s 75,480 KYELA 240,456 48 28 83 I 8,1 88 15,60s 33,793 28,496 ILEJE 148,490 17 0 l7 2,540 2,259 4,799 4,256 TOTAL 83 1,965 182 116 305 63,291 54,215 tl7,496 108,222 WHO/APOC, l4 September 2009 ,l SECTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHO/APOC, 14 September 2009 Table 3: Timeline of activities for the areas treated in the current year (Please add more rows iJ necessaty) District/LGA Mobilization of communities Trainins Census/Update Drus distribution SupervisionStarting month Completion month Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completion month RTINGWE ocT 2012 ocT 2012 NOV 2012 NOV 2012 NOV 2012 NOV 2012 NOV 2012 DEC2012 ocT 2012 DEC 2012 KYELA ocT 2012 ocT 2012 NOV 2012 NOV 2012 NOV 2012 NOV 2012 NOV 2012 DEC 20I2 ocT 2012 DEC 2OI2 ILEJE ocT 20t2 ocT 2012 NOV 2012 NOV 2012 NOV 2012 NOV 2012 NOV 2012 DEC2OI2 ocT 20t2 DEC 2012 TOTAL - Comments All 3 oncho endemic districts were subjected to conduct Phase lb Epi evaluation for oncho in september 2012, this exercise causeal a delay in the startof implementation for the year 20 12. WHO/APOC, 14 September 2009 ,a 2.2. Advocacy A total of 73 PHC members, 54 CHMT members, 172 vlllage leaders and 45 WDC members from all 3 districts were advocated. Reason for advocacy: Leaders in various levels have been changed and some transferred hence needs to be advocated before the implementations of NTDs activities so as to enable them know clearly how people are benefited through CDTI. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information: . The project used various ways to ensure the dissemination of information to communities; Posters, announcement through loud speakers, Local radios, community meetings in affected areas, choir by schools children, and at RCH clinics. Also information was through Village leaders such as Village Executive Officers (VEOs) and Ward Executive Officers (WEOs). Response of Target communities/village. . Was good Accomplishments of the proiect in this year are- o To get high therapeutic covarage o To increase the nurnber of FLHWs and CDDs within the project area. . To sustain advocacy rneetings to various government leaders Suggestion of way to improve mobilization and sensitization of target communities - . The use of local radios and TVs programme explaining the implementation of CDTI as well as co- implementation of NTDs activities should be ensured. Printing of more posters is also important. l0 WHO/APOC, l4 September 2009 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance of female members of the community at health education meetings Is good - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc).- Is good - Incentives provided by communities for the CDDs - Exempting CDDs to participate in community development activities and if there any contribution needed CDDs are not paying. - Attrition of CDDs. Is attrition a problem for the project? In the year 2012 some of CDDs left there settlement went to look for green pasture in towns. Replacement was not done due to lirnited time for conducting community rnobilization as the project was busy with Phase lb Epi evaluation which was conducted in Sept 2012, the project we held mobilization meeting in the year 2013. - Other issues NO District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area Ba Number with community members as supervisors B. Percentage Bo= Bs/ B4 *100 Male CDDs B1 Female CDDs Bo Total Bo: Br*Br Number of communities with female CDDs B," Percentage Bu: B'n/Ba*100 RUNGWE 205 180 88 216 227 443 205 t00% KYELA 83 70 84 133 t54 287 83 l00o/o ILEJE t7 t0 59 22 28 50 t7 t00% Total 305 260 85 371 409 780 305 100"/" t2 WHO/APOC, 14 September 2009 2.5. Gapacity building - Describe the adequacy of available knowtedgeable manpower at all levels. In 2012 the project managed to increase the number of FLHWs from 93 to 220, also we conducted training and retraining to 780 CDDs in 305 Oncho endemic communities. Drop out of CDDs appeared to be a problem for 2012 due to social and economical reasons,l I CDDs was not around in the area during MDA,efforts will be made in this year to increase the number of CDDs. Advocacy to RHMT at regional level and CHMT in all3 districts was done so as to ensure strong integration and have positive implementation of CDTI activities at these levels to community levels. - llthere frequent transfers of trained staff occur, state what tlte project is doing, or intends to do, to remedy the situation. If this happened the replacement is being done immediately for example in this reporting period two experienced project staff left the project in two different citegories. One went for further study and another on have retired from Government services. Replacement have been effected but they need some lecture on how to implement CDTI activities. 13 WHO/APOC, 14 September 2009 Table 5: Training at the different levels of CDTI implementation (Please add more rows if necessary) *'New','Refi" lfdetailnotavailable,prowdethecorrespondmgtotalonly.MakesurethatthereLsnodoublecounting WHO/APOC, l4 September 2009 District/LGA Number of Districts/LGAs staff trained Number of Health center/nost staff trained Number of other trainers of trainees ( TOTs) Number of CDDs trained ATrO cr New Ct Refr Total CF Cr+ C.Ct ATrO C5 New Cs Refr Total Cs= Cr* C,Cz ATrO C" New C,o Refi' C,, Total Cr:= Cro* C' ATrO Crr New C,, Refr C,s Total Cro= Cu* C RLiNGWE l1 0 16 t6 63 16 4',7 63 19 0 19 t9 443 ) : 443 ', 443 KYELA 30 20 10 30 104 66i38 104 20 0 20 20 298 012811287 ILEJE 27 0 27 27 53 45 8 53 l5 0 15 15 s0 50 50 TOTAL 74 20 53 73 220 127 93 220 54 0 54 54 791 780 780 %o Achievement i 99 %o Achievement 100 7o Achievement 100 7o Achievement 99 t, t4 la Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments: NONE 2.6. Treatments 2.6.1. Treatment ligures If the proiect is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is Jluctuating, state the reasons antl the plans being made to remedy this. - The project achieved 100% Geographical coverage and attaining more than 65%o therapeutic coverage. Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) NGDOs Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writins Others (speciflr) 15 WHO/APOC, 14 September 2009 District ILGA Communities/Villages Population Number of persons who refused the medicine. Numb er of absent Number of communities with < 80% therapeutic coverage Numb er of SAEs Number of serious adverse events (SAEs) refened to the health post/hospital Total # of communities/ villages in the mesoAryper- endemic areas Dr Annual Treatment Objective D: Number of communrtres/ vi llages treated D: Geographical coverage (%) Dr= D3/ Dr*100 Total population of the meso/hyper- endemic areas Dr Annual Treatme nt Objectiv D. Number of persons treated Dr Therapeutic coverage (%) Dr= D7l Dr*100 RTINGWE 205 205 20s 100 78,905 66,280 59,708 76.% 224 4013 r99 NIL NIL KYELA 83 83 83 100 33,793 28,386 25,650 76% 724 1 865 83 NIL NIL ILEJE 17 t7 t7 100 4198 4,032 3,775 79% J 68 t4 NIL NIL TOTAL 30s 305 30s 100 117,496 98,696 89.133 760h 951 5946 296 NIL NIL Table 7: Treatment and SAEs by district/LGA in all areas at risk (Please add more rows if necessary) Fomula for computins theraDeutic and geoeraphical coveraqes Thempeutic covera8e rat€ = Number ofpeople treated x 100(%) Total population living in meso/h)4)er-endemic corDmunities withir the project area Geographical coverage rate = Number ofcommunities/villaees treated x 1OO(%) Total numb€r of meso/hyper-endemic communities as identified by REMO in the prcject area ATO coverage te = Number ofpeople treated x 100(%) Ainual Treatment Objective % UTG achieved = Number ofoeople treated x lOO Total number ofpeople to be ts€ated iII meso/hyper-endemic areas within the project ar@ (UTG) ATO - Th..stihabd aunb.t oJpeopk living h d6o/hlpq-eadz;b e.N rto! t CDTI Wi.en,tdr'l.o t .ot wut iwqbt in. gi6 !ar. UTG| - Th. r'Jginar nu^b.t otpeopt .o be treded i, .sdhwren.l.nlc @as ,thin tt ptoj.ct a4o, aldiatdt to ba t@1h.,1 vh6 tt ptuj..t hs Mch.t lu s.ostqhic.l @dA.(nod.lr th. pnka thoaw be q.ct4d to t@h th. ATG .t rh. dd otth. / y.s olthe ptuj.ct). WHO/APOC, l4 September 2009 t t6 lr 2.6.2 What are the causes of absenteeism? Timely drug distribution finds some of community members already in their daily living activities such as agriculture as some community tend to move from their settlenrents to go to agricultural areas. In this reporting period NTDs activities was delayed due lb Epi Evaluation which started in September rvhereby people are used to start the implementation from July which is dry season. 2.6.3 What are the reasons for refusals? The project has distributed the drug for more than 10 year and symptoms/signs has disappeared hence people they think that there is no need to continue taking drug they think they are already cured. Community mobilization being carried prior to MDA. Also the 2011 Epi epidemiological evaluation results came out wrth Negative result NO Positive found, hence some people in few communities they think the disease is no longer therefore no need to continue taking medicine. 2.6.4 Briefly describe all known and Occurred during the reporting Information when available. verified serious adverse events (SAEs) that period and provide (in table 8) the required a a a Parasitologist trained? No Existence of microscope? Some FLHFs has. Has tl.re project reported all SAEs to Mectizan Donation Program (MDP)? Please tick one. N/A No 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 E/ t7 WHO/APOC, 14 September 2009 Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (please add more rows iJ necessary) Results of tests lOutcome of (thick blood ] prognosis * Serial number of the patient l8 WHOiAPOC, l4 September 2009 I ,1 at 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9: Treatments and coverage by calendar year for the entire project area. (Please Jilt in the required data) Please indicate the UTG for the project area: 108,222 (use this figure as the denominator in all UTG coverage calculations.) YEAR Communities/Villages Popr.rlation Total # of communities/villag es in the meso,4ryper- endemic areas Er Annual Treatment Objective F.. Number of communitre s/villages treated E. Geographi cal coverage (%) E4-- E]/ E'*100 ATO coverage (%) Es= E./ Ez*100 Total populatron of the meso/hyper- endemic areas E^ Annual Treatment Objective Er Number of persons treated Er Therapeutic coverage (%) Es= EE/ E6*100 ATO coverage (%) Ero: Er/ Er*100 UTG Coverage (%) 1997 1998 1999 2000 2001 45 45 45 100 100 84,340 70,846 56.2t1 66 79.3 77 2002 53 53 53 100 r00 92,530 77,',725 63,540 69 81.7 84.1 2003 214 214 214 100 100 93.211 78.297 71.200 76 90.9 92 2004 214 214 2t4 r00 100 93,405 78,460 68.4t2 /5 87 86 2005 214 214 214 100 100 98.41s 82,669 78.831 80 95 96.6 2006 234 234 234 100 100 86.361 '72,543 63,536 74 88 7 5.7 2007 240 240 240 100 100 86,172 72,888 67,',794 78 93 78.6 2008 240 240 240 100 100 86,638 72.776 69,812 80.s 95.9 80.s 2009 298 298 298 100 100 107. I 55 90,010 87,235 81.4 97 96.s 2010 298 298 298 100 100 110,742 93,023 89.785 81 96.5 84 20tt 305 30s 30s 100 100 114,432 96,122 88,676 77.4 92.2 82 2012 305 305 305 100 100 117,496 98.696 89, I 33 76. 90 82 t9 WHO/APOC, 14 September 2009 -_--1I ---li 2,7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qttease tick the appropriare answer)MoHy' Ll wHo n UNTCEF tr NGDO Other (pleag specify): Mectizan@ delivered by - (please tick the appropriate answer) MOH Jtr wHo tr UNICEF tr NGDO ! Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communiti€s Since the staft of integration on NTDS contrcl program in 2009, the Prcject Coordinators from regions Ins been sending data of total populations fromdist cts to^the national NJDS control program oflice in the Ministry ofilealth & Social welfare, Ihen the national NTD! office orders Mectizan for theprojects, after arival of Mectizan in Dar es salaam the national NTDS office organises transport through MsD to districts with a distdbution list and covering lette!. wlen the drugs arrive at the district phamacy, the authority distributes the drugs through Health system to the FLHF according to their needs. TheFLHF staffs after receiving the drugs notifies the community leade$ on the arrival ofdrugs at health facility, then the communi"ty leader send CDDs or any community member to come and colleat drugs ready for distribution to the community members feh!S.!!: Mectizatr@ Inveatory (Pledse add more rows ifnecessary) WHO/APOC, l4 September 2009 I State /District /LGA Xr.U.. "f U..tlrmIn stock liorn pre,vious vear Requested Received Used Lost Wasted Expircd Remaining RUNGWE t90,944 1.90,944 1 85,1 02 0 317 Nil 5525 KYELA 74,345 74,345 56,430 0 0 Nil 17,915 ILEJE 12,370 12,370 11,268 t4 Nil 1088 TOTAL 277,659 277,659 252,800 0 331 Nil 24,528 Sent to non Oncho areas. 20 2t WHO/APOC, l4 September 2009 - How are the remaining ivermectin tablets collected and where are they kept? CDDs starts the process of drugs collection from communities, and har-rds over to FLHF, The FLHF also hands over the drugs to DOCs and the DOCs hands over to District pharmacist for storage. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Activities performed by Health personnel in handling Mectizan@l. Retraining and training new cDDs prior Ivermectin distribution2. Supervision during updating census. 3. Mectizan ordering from DOCs. 4. Conducts supportive supervision during distribution. 5. Keep Mectizan inventory at the post 6. Compilation of data from CDDs 7. Report writing and submission to DOCs 8. Conduct Community Self Monitoring and Stakeholders meeting with community members. - Any other comments: None 2-8- Gommunity self-monitoring and stakehotders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? YES If so, l(hen? After completion of drug distribution exercise in Nov and Dec. Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. o Now days most of people in communities are aware of the disease and the importance of taking medicines. o Maintaining high Therapeutic coverage l L: Community self-monitoring and Stakeholders Meeting (Add rows District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meetins (SIIM) RT-]NGWE KYELA ILEJE 205 83 t1 190 6t 6 4t 30 6 TOTAL 30s 257 77 22 WHO/APOC, 14 September 2009 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. GOMMUNITIES/CDDs 2.9.2. What rvere the main issues identified during supervision? o CDDs are demanding to be paid cash during implementation; this is due to the presence of other programs in the area who pays much to VHWs. We advised thern to continue volunteering so as to provide service to community members as they are brother and sisters. 2.9.3. Was a supervision checklist used? . Yes, both APOC & CHMT supervision checklist were used. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? . People are aware on the project, Mectizan n-redicine and CDTI philosophy in general. 2.9.5. Was feedback given to the person or groups supervised? . Yes 2.9.6. How was the feedback used to improve the overall performance of the project? . Communities was advised to increase incentives to CDDs to motivate them. . Discussion was conducted with communities on how to reduce refusals and absenteeism. 23 WHO/APOC, 14 September 2009 SECTION 3: Support to GDT! 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary,) *Condition of the equiprrent (F:Functional, CNFR:currently non-functronal but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? -Both levels regiott, and districts takes care on the available equipnrents, buclgets are made to ensure all equipments are ir-r good functioning state. 3.2. Financial contributions of the partners and communities - Fill tables l3a, l3b and 13c - If there are problerns with release of counterpart funds, how were they acldressed? -Still contribution from Government is not enough hence DMOs from Rungwe, Kyela and Ileje provided a big support to ensure all activities are done as was planled. - Additional comments NO Source Type of equipment APOC MOH DISTRICT/LG A NGDO Others No. Conditio n No Condrtion No. Condrtron No Condition No. Condrtro n l. Vehicle 2 1F& ICNF 2. Motor cycle(s) 4 F 2 wo 3. Computer(s) I F 4. Printer(s) 2 F J F 5.Photocopier I (s) F F 6. Laptop comp 2 F 7. Others a)Bicycle(s) 204 F c)Scanners 2 F 24 WHO/APOC, 14 September 2009 Table 13a : Financial contributions all partners for the last three years (continued Rate used I USD = 600 Tshs Two (2) years previous to Calendar YEAR being reported (2012) GOVERNMENT contribution OTHER partners' disbursement Budqeted Amounts disbursed at the following levels National Reqional District Total disbur sed NGDO s Local NGDO s Communiti es Others APOC TrustFundBUDGET LINE l, Mobilization, advocacy, sensitization et lt e_C.t!D e!"U -cStj e n - . " _ " 1.,J-."{-d"yo.999y$"S-qeielMob.itisatio-n 1_2. S_ensitization . _ 1 .3. Advocacy - 1.4._Health education Sub-total I 1"?50 690.5 945.3 2885.8 0 0 n 0 0 9 0 237.5 237.5 375 325 700 9 375 562.5 sei.s 0 54o/o 60% 32% 0 0 0 0 0 0 0 0 0 0 o 0 13,3"0-5-- 13,30s ll. Training 2.1 .Traininglretraining oi"CDDs * Heitin workers 2.2. T rainngl retraining of Health workers Sub-total ll I I L S u pervisi on, mo nitori n g, Eval u ati o n 2121.6 1BBB,O 4009.6 0 0 0 0 0 0 562.5 320 882.5 562.5 320 882.5 a1 0/ 17% 22% 0 0 0 0 0 0 61,841 61,841 3.1 .-Supervision s.2- Merutqlrs 945.3 s+i.s 0 0 0 0 0 o 3'1 '1.55 311.55 311.55 si r.ss 60Yo 33o/o 0 0 0 0 9 0 48,310.2 48310.2 3.3. Evaluation Sub-total lll lV. lvermectin distribution and management _9f sgv.qp g{-_ve_19-q _eve_n!9 --!,_1,_lygrpgctin djstrib-ution 4.2. Management of Severe adverse events b+o.s 0 0 0 !-1i7 94o/o 0 0 0 7728.30 25 WHO/APOC, l4 September 2009 0 0 o_ 410.7 Sub-total lV 645.5 0 410.7 410.2 164%l o I o I I o lnza.zoV. Additional expenses 5. 1. S_alaries . _5-._2_.[gujg1_e-{ 5.3.C-ommunication_ 5.4.Vehicle and fuel 5.5 Others Sub-total V 470,797.8 31 00 473,897.8 0 470,797.8 0 U 470,797.8 0 9 0 1 330 1 330 1420 1420 470797.8 2750 473,547.8 100% g70k 100% o 0 0 0 0 0 0 0 0 0 0 0 19147.3 19,147.3 GRAND TOTAL 482,384 470,797.8 1567.5 3724.75 476,090.5 98.6% 0 0 0 150,33't .8 Nb; The covernmettt has provided rooms for NTDs offices at regional and district levels, also pays the costs of electricity and water. 26 WHO/APOC, l4 September 2009 at Table 13b : Financial.Frnancial contributions all partners for the last three Calendar YEAR being reported (201 1) GOVERNMENT contribution OTHER partners' disbursement Budgeted Amounts disbursed at the following levels National Regional District Total lo disbur sed NGDOs Local NGDO s Communi ties Others APOC TrustFundBUDGET LINE l. Mobilization, advocacy, sensitization et health education 1.1. Mobilization _ 1.2. Se_nsrti,itron- 1.3. Advocacy --l, -+. " rl S_e llh. e9 g.g g t Lo_ry-... Sub-total I 3,825 890.6 4715.6 693.75 693.75 2816.87 0 2816.87 2816.87 693 75 3510.62 7 4o/o 100/lo/o 74.4% 0 0 0 0 0 0 IN-KIND 0 0 0 2275.88 '1300 3535 4525.5 '11,636.38 t!.._Tpjtt-itlg. ._ 2.1 . Trajning/retraining of CpDs - 2.2.f raininglretraining of Health workers Sub-total ll lll. Supervision, monitoring, Evaluation 3,331.25 2,006.25 5,337.5 n 0 0 U I 0 0 0 0 0 n 0 0 0 0 0 23075.5 26929 50,004.s -3.1. Supervision 3.2. Review meetings Sub-total lll 450 450 156.25 156.2s 218.75 218.75 J/5 375 83% 83% 0 0 0 0 U 0 32,007.5 1 1,564 43,571.5 lV. lvermectin distribution and managlement of severe adv_erse eyerrts , -4.1 . lvermectin distribution -._1?,-Mqmg-e_f_q1!_9!_S-eyqpadverseevents Sub-total lV 393.75 263.13"_ " - 656.88 0 291.75 "0 293.75 tg,V" _.0 45Yo 0 00 0 0 2647.3 264i.3 V. Ad d i tlo n a ! _gIge3g_er ip*r-t^ lgg,qrs i.5 1+9?.13*". 200,510.88 1007.e 0 : ti-. 0 -sJ.-Qe!grpglqg:vgs" 199,018.75 0 0 _Q.Z:Egglm_e-nJ Sub-total V 199,018.75 199,01 8.75 l,?19.__8_q" 1,210.88 29L2p._ 281.25 Vl. Add i ti o n al Expenses 6.1. Supplies 0 0 0 0 0 0 0 0 't,037.25 27 WHO/APOC, l4 September 2009 6.2. Communicailon 0 0 0 0 0 0 0 0 187.5 6.3. Maintenance of Vehicle/Motorbikes 1562.s 0 1210.9 281.25 1492.13 0 0 0 17,509.32 6.4. Other administrative charqes 0 0 0 468.75 Sub-total Vl 1562.5 1210.9 281.25 1492.13 0 0 0 19,202.82 GRAND TOTAL 211,741.23 19901 8.75 3271.78 389't.87 206,182.38 97Yo 0 0 0 129,425 \ lr 28 WHO/APOC, l4 September 2009 Table 13c : Financial contributions all partners for the last three vears (continu _One (1)year pre ed) rvious to Calendar YEAR beinq reporled e010) GOVERNMENT contribution OTH ER partners' disbursement Budqeted Amounts disbursed at the foltowing levels National Regional District Total otto disburs ed NGDOs LocalNGDOs Gommuniti es Others APOCTrust FundBUDGET LtNE l. Mobilization, advocacy, sensitization et health -education 1.1. Mobilization 1.2. S-ensitization 1.3_. Advocacy- '1 .4. Health education Sub-total I 2540 2540 0 0 0 0 2540 2540 2540 2540 100% '100% 1828.'13 1828.23 0 0 IN-KIND 0 0 75,302 tt. lnini"4s 2.1. Training/retraining of CDDs 2.2. T r ainingl retraining of Health workers Sub-total ll lll. Supervision, monitoring, Evaluation 7738.23 4349.75 12087.98 0 0 0 0 0 00 1821.37. 0 1821.37 1821. 0 '1821., 37 37 24Yo 0 15o/o r,a"go.oz 1,903.17 3,793.84 9 "q 0 0 0 0 3.1. Supervision 3.2. Monitoring - _ 33. Evalualion Sub-total lll 943.75 0 0 943.75 0 0 0 0 268.75 9 0 268.75 0 o 684.37 0 0 684.37 953.12 0 0 953.'' 2 100% 0 0 100% 1548.44 0 0 1,548.44 0 0 0 0 0lV. lvermectin distribution and managlement of seyere adyerse eyents "{.! l"v_q qm e"g_ti 11 gj9[i Q u_t1o n -4.2. Management- of Severe adverse events Sub-total lV 399.5 399.5 0 " ?e9r5 399.5 100% 100Yo iru 325 0 0 0 !. -L! ! lti 9 ry a ! _e-Ipe?9 qs- .Q.J .$_alq1ie.s "._ -_ _ Q,!, -E_q-u_ipqr-e-qt ---_._ -- - Sub-total V 197075 3875 200,950 188,790.8 -0 0 0 316.25 iid.is 188_,790.8 3749.58 192,540.38 96,0/0 ?l_% 96% 0 1500 1 500 0 0 0 0 0 GRAND TOTAL 216,921.23 188,790.8 3702.08 5761.49 198,254.37 910h 8,995.51 0 0 75,302. 29 WHO/APOC. l4 September 2009 0 b,+si.st 3,433.33 3.3. Other forms of community support - Describe (indicate forrns of in-kind contributions of communities if any) -Collection of Mectizan from nearby health facility, and taking the remaining medicine after MDA back to health facihty. Also they prepare treatment report and submit it to FLHW. -Conducting Mectizan distribution and community self monitoring -Incentives provision to CDDs. 3.4. Expenditure per activity - Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here $1 : Tshs. 1600 - Any comments or explanations? NO SEGTION 4: Sustainability of CDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) {__Year 1 Participatory Independent monitoring J-- Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Epiden-riological evaluation by APOC Other Evaluation by other partners 4.1.2. What wcre the recommendations? At region level: -Device strategies to find dependable sources of resources -Provide evidence of successful ir-nplementation of CDTI plans -Improve monitoring and supervision beyond the existing state -Workout means to sustain the existing monitoring and supervision quality -Exernpt mectizarr frorn taxation -Strengthening the government system of delivering drugs including Mectizan -Clearly spell out costs of CDTI activities in the health plans -Develop feasible specific and realistic plans to replace and maintain ffansport and other Materials -Strengthen the existing incentive system -Increase thelapeutic coverage 30 WHO/APOC, l4 September 2009 District level -There should be District Onchocerciasis Coordinator in each district -There also a regional CDTI project coordinator (The present coordinator to be based at the -regional level) -Proper reporting systern should be put in place -Undertake tar,eeted supervision or-rly in areas where there is need -DOTs should use supervisory checklist/matrix -Plan all subseqr-rent visits according to needs -Early application for Mectizan to MDP by NOTF Tanzania -All future training should be planned and targeted to areas of need -Training duration sl-rotrld last2-3 days and not 1 day -Advocacy visit to council management to release budgeted funds -Transport shorrld be rntegrated with other health programs in Kyela district -DOTs should cmpower RHWFLHF staff to carryz out supervision at their level -Treatment data slrould be transmitted by FLHF through existing District health information System -Incentive shor-rld be put in place to motivate the staff -The village leadership is encouraged to keep up their interest to their project -CDD should provided ivith transport -Communities are encouraged to rnaintain and sustain this activity -Comrnunities are encouraged to support their CDDs -Comrnunity lcaders and their menrbers are encouraged to provide CDDs with transport in Areas with difllcult terrain -Accurate data entry betrveen the levels CDDs and FLHF staff -DOTs should ceetse from directly collecting treatment data from FLHF 4.1.3. How have they been implemented? - CDTI activities ale incorporated in districts CCHPs, funds for CDTI activities implementation is buclgeted and disbursed though are not adequate, also CDTI activities has been integrated r.r,ith other activities at region ar-rd district levels, activities like supervision and data collection is done in integrated manner to FLHFs. The region and rlistricts supports marntenance of capital equipments in a government routine to ensure good working ol'the equipments. In fact all the above recommendations have been implemented. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evalual.cd cluring the reporting period? YES, Epidemiological evaluation Was a sustainability plan rvritten? N/A When was the sustainabilrty plan submitted? N/A What arrangements have beeu rlade to sustain CDTI after APOC funding ceases in terms of? 3l WHO/APOC, l4 September 2009 Governmettt has orclered the region and distlicts to ensure that all CDTI activities are included in health plans, includrng setting budgets for equipments maintenance a1d replacement. 4.2.1. Planning at all relevant levels o CDDs plans on when to do updating census and collection of drug from FLHF.i FLHF plans on updating census, ordering drug from DOCs, distribution to cDDs, supervision dr.rring distributron to the community, data collection and reltort writing. o The I)roject Coordinator compile report form districts, prepares Technical A POC anrrttal report, Mectizan@ retirement, supportive supervision to district. 4'2'2' Funds Fr.rt Js fbr GDTI activities was receivecl frompartners of thisprogram: These are Government, APoc, ssI and community through their in-kind support. 4'2'3 "'l'oJ:liJ,"Jlil'ffi:;?:,ffi1','"::l!!,,, 0",n, carried by region through basl<et fr-rnds and districts through CCHP respectively.4'2'4' othe,il',ffi,,,., 4.2.5. To what extent has the plan been implemented ' Cottncils continue to budget funds through their CCHP although is not aderlLIate, also CDTI activities are carried in integrated manner with other activrlrcs. 4.3. lntegration Outline the extent of integratiorr of CDTI rnto the PHC structure and the plans for complete integration: 4'3't' *.,:*Tll:J,"rl:"fl1,T;ffiBlffirration in year 2ooe, the,redicines has been()rdered and received from the donor, stored at MSD in Dar es salaam. The\IoHSw transports the medicines through MSD direct to districts. In the clistricts the medicines are stored in district pharmacies. The DoCs are losponsible to ensure the drugs are reached to FLHF. The CDDs collects rlnrgs from FLHF to their communities ready for distribution according to lherr updated census. 4'3'2' ttulntt'F,',,,,i,g is being clore through a cascade system, meaning that the Docs ,r'ains / retrains FLHWs and Teachers, FLHWs do the same to CDDs in their rlreas. 4'3'3' "'T "J'.,";.T|,",:J [t]:; :ffi: r1l,#;l ;f,T]:,he NrDs coordinators is(r1')ong the supervision team members at region and district levels. 32 WHO/APOC, 14 September 2009 4.3.4. Releasc ol'funds for project activities r irunds for project activities are received from APOC, Councils and SSI. 4.3.5. Is CDTI included in the PHC budget? Yes 4.3.6. Descrille other health programmes that are using the CDTI structure and how this was ae hieved. What have been the achievements? CDTI philosophy was instituted in Tukuyu Project in the year 2000 with the aim of controlling Onchocerciasis ir-r affected community. The strategy Tukuyu CDTI went well antl 'n the year 2009 the region started dealing with Neglected Tropical Diseases(NTDs) lrv rntegrating vertical programmes. Oncho programme was doing well by using C[)T, philosophy hence CDTI well used as platform for integration. The achieverrent is good as the region is getting good coverageby using CDTI strategy. Fill tabl:s I4 and l5 . For cach intervention listed in table 15, explain what rvere the roles played by the CDDs (census, mobiLization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? . Explarn what are the combinations of interventions co-implemented? o How were the interventions implemented? (at the same time?) 4.3.7. Descrihc o,hers issues considered in the integration of CDTI. 33 WHO/APOC, 14 September 2009 Table 14 : Co-implementation Type of control Type of intervention Roles played by CDDs (explain in bullet points) Number of districts Number of communities Number of CDDs involved Number of persons targeted Number of persons reached Iarge ted Reached Target ed Reache d Males Female s Total Males Females TotaI Males Females 'otal Onchocerciasis conftol o lvermectin distribution o Updating Census r Collection drug o Distribution to communities members . Submission of data and remained drugs J 3 305 1,646 30s 4.646 371 409 780 45,693 53,006 98,699 40s68 148565 89,1 33 Lyntphatic filariasis n Distrrbutron of lvermectin o Distribution of Albendazole activitie S: Updating Census Collection drug Distribution to communities members Subrnission of data and remained drugs 8 8 1s83 940 r 1448 804 303 I 1,134,51 4 1,2J9,65 6 2,414,11 0 gg5 r ?1 1,163,245 2,1 59,3( r Distributron of praziquantel teachers activities; o Registration o Collection of drug o Disffibution of drug to children o Management of 8 8 lo71 I 074 1744 254964 2565t3 119,903 231663 226491 58154 ll 34 WHO/APOC, l4 September 2009 aa minor SAE Data collection Submission of data o Distribution of Albendazole CDDs activities ; . Updating Census o Collection drug . Distribution to comurunities menrbers . Submission of data and the remained drugs Census ,646 ,646 1t448 303 l l,l3 4,5 lll,27 9,65 12,4 | 4,17 1,163,245 alaria control r Distribution of LLI Ns Malaria control o Home management of malaria Malnutrition o Vltamin A supplementa tion 2,159,3( NB: the interventions listed in the table are justfew examples 3s WHO/APOC, l4 September 2009 Table 15: Other programmes using CDI structure (tick as appropriate) Type ol'control Type oI interventinn Involvement of communities in Planning SHM Implementation Monitoring CSM Reporting Provision of resources activities period mode selection of implementer s collection of conrmodit ics storage of commodit ies distribu tion supervrs ion In kind financial Unchocercrasrs control .lvermeciin distribution .,\ Lrgu st &Sept hrtegrat ed L r)llllll till I ly nrembers CDDs Drsrltct and FLHF Ci-.rl.rs V H !\,S, Conrnrr-r n rty leaders and CHMT Sub vrliage leaders and CDDs CDDs. Communit y ieaders, FLHWs and NTD Coordinato r Coln munit yllead ers APOCIU SAIDiC CHP Lymphatic filariasis r Distribution of a lbend azole August &Sept lntegrat ed Comr.nunity members CDDs District and FLHF CDDS VHWs, Commu nity leaders and CHMT Sub vrllage leaders and CDDs CDDs, Conrmunit y leaders, FLHWs and NTD Coordinato r Com munit y/lead ers APOCru SAID/C CHP Schistosouriasis . Distribution of praziq ua ntel Sept Integrat ed School health Head Teacher Head Teacher Health Teacher FLHF staff and CHMT N/A Teachers, FLHWs and NTD Coordinato r Com munit v (Food for childr en) APOCru SAID/C CHP STH o Distribution of mebendazole Malaria control o Distribution of LLINs N/A Malaria control . Home management of malaria N/A Malnutrition o Vitamin A supplementation N/A 36 a, WHO/APOC, l4 September 2009 tl Others (specify) h'B: tlte uttct'\'aulton; li,tccl irr tlte lttble ut.clLrstfew c.rtrrttpla.s. )/ WHO/APOC, l4 September 2009 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research underrake. in the project area within the reporting period. NONE 4.4.2. How ri cre rhe results applied in the project? SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities - List the strength r ancl weaknesses of cDTI irnplenrentation process. Strengths; o Presence of gr,,rd lrealth system within project area. o Presence of political stability in the country. o Continued str.ug support from Govt, APOC, SSI and Communities Weaknesses; . Inacle,l rate funds from Councils o Funds and drugs for implementing Oncho activities are being mixed with those for NTDs tlris rnakes difficult in reporting on the actual amount of funds and drugs used for CD-l-l only in Oncho area and NTDs. - List the challengrs and indicate horv they were addressed. Challenges and how lltev were overcome. - After 2 Epi evaluations which came out with the results of NO positive found, some people have started to reltrse taking medicine giving the reason that the disease is now not in the area. To fight with this Irtisunderstanding, we continue in encouraging people to continue taking the medicine until scierrtific proof on the elimination of tlie disease will be out. sEGTloN 6: unique features of the proiect/other matters, Phase lb EPidemiological Evaluation for Oncho which was conducted in Sept 2012 by APOC; the results ag:rin rvere Negative, it means NO positive found. 38 WHO/APOC, 14 September 2009