Rapport technique annuel du projet TIDC Tukuyu Focus au Comité Consultative Technique(CCT) : janvier à décembre 2008

+I THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE ? a COUNTRY/NOTF TANZANIA Proiect Name: TUKUYU CDTI FOCUS PROJECT approval-g: JULY, 1999 a 2000 Rerrorting Period ( From ): January, 2008 - December,2008 PROJECT YEAR OF THIS REPORT:1234567 (8) 9 10 Date submitted: January, 2008 NGDO partner: SIGHT SAVERS INTERNATIONAL (SSD I I ? ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATTVE COMMITTEE (TCC) DEADLINE FO SUBMTSSION: To APOC Management by 3L January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC)I ! I I I I a (9} 6i I' o 5 c(q'EA: "ES C 3 Ul,- --d-lcio^ -h;; t': € 5;9 Epe I RECU LE 1 I A0tii 2003 APOC / DIR _hE < WHO/APOC, 2,1 Novcmba 2004 TUKUYU CDTI 2008 ANNUAL PROIECT TECHNI CAL REPORT TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report : COUNTRY TANZANIA Ag. National Coordinator Name: Dr. Edward Kirumbi Signature: Date NGDO Representative Name: Dr. lbrahim Kabole Signature Regional Medical Officer Date: . Name: Dr. Haruni Machibya Signature: Date: . This report has been prepared by Name: Dr. Abet Asilia Mwakafiryila Designation: Project Coordinator Signature: Date: . TO 2 WHOiAPOC, 21 Novembcr 2004 Table of contents Project Name: TUKUYU CDTI FOCUS PROJECT ..............1 SECTION I : Ba.crcRoLrND rNFoRMArroN............. .................. ...... l0l.l: KYELA DISTRICT PROFILE.. . t01.2: RLTNGWE DISTRICT PROFILE .................. I I I.3 ILEJE DISTzuCT PROFILE TOTAL 13 TOTAL 14 2.2. ADvocACy.. 2.3. MoBILzATIoN, sENSITzATIoN AND HEALTH EDUCATToN oF AT RrsK coMMLrNrrrES ........,.2.6.1. Treatmentfigures........... Table 7: Treatment and SAEs by district/LGA in all areas at risk 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year23 1l ....... l5 ....... I 5 .20 20 2.7 ORDERING, STORAGE AND DELIVERY oF IVERMECTIN................ 2.8 CoMMtrNrry sELF-MoNrroRrNG AND STAKEHoLDERs MEETTNc Supe RvrsroN .24 .25 .26 26 26 26 30 30 30 2.9. t. 2.9.2. 2.9.3. 2.9.4 2.9.5. 2.9.6. Provide aflow chart of supervision hterarchy. What were the main issues tdentified during supervision? Was a supervision checklist used? Planning at all relevont levels... Funds....... Transport (replocement and maintenance) Other resources .. To what extent has the plon been implemented. 4.2 What were the outcomes at each level of CDTI implementation supervision? 26 Was feedback given to the person or groups supervised? ............................... 26 How was the feedback used to improve the overall performance of the project? 26 3.2 FTNANCTAL coNTRrBUTtoNs oF THE pARTNERS AND coMMuNrrtES ......... 283,4. EXPENDITURE PER ACTIVITY 29 4.1. INreRN,+r; INDEPENDENT PARTTCTPATORY MONTTORTNC; EVALUATION................ .........2g4.1.1 Was Monitortng/evaluation carried out during the reporting period? (Tick any of thefollowingwhich are opplicable)............ . .. .. 294.1.2. Vfhat were the recommendations? NON\....... 4.1.3. How hove they been implemented? NONE . SusrArNABrLrry oF eRoJECTS: nLAN AND sET TARGETS (MANDAToRv AT........... Yn 3) 30 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. 4.3. INTEGRATIoN 4, 4 OppRarIoNAL RESEARCH... 4.4.1. Summarize tn undertaken in the project orea within the reporting period. 3t SECTION 5: Strengths, Weaknesses, Challenges, and Opportunities 31 SECTION 6: Unique features of the projecUother matters 32 .. 30 .. 30 ..30 .. 31 .. 31 ....3 I ....3 I not more than one half of a page the operotional research 3 WHO/APOC, 24 Novcmbcr 20fi 56 7 8 9, Acronyms 1. APOC 2. ATO 3. ATrO 4. CBO CCHP CDD'S CDTI CHF' CHMT I I. CSSC 12. DMO 13. DOC 14. DOT I5. DPHC I6. IEC 17. tMA 18, NGDO 19. NOTF 20. PHC 21. PORALG 22. REMO 23. RMO 24. RHMT 25. RFIS African Programme Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Council Comprehensive Health Plan Community Directed Distributors. Community Directed Treatment with Ivermectin Community Health Fund Council Health management Team Community Self-Monitoring Christian Social Service Commission District Medical Offi cer District Oncho Coordinator District Onchocerciasis Team District primary Health Care. Information Education and Communication Material Interchurch Medical Association Non Govemment Development Organization National Onchocerciasis Task Force. Primary health care President's Office Regional Administration and Local Government Rapid Epidemiological Mapping of Onchocerciasis Regional Medical Officer Regional Health Management Team Rural Health Staff Stakeholders meeting 4 WHO/ pOc,24Notcmbcr2004 IO. CSM 26. SHM 27. SS I 28. STAMICO 29. TCC 30. TOT 31. UTG 32. IINICEF 33. WHO 34. WPHC 35 LF Sight Savers International Subsiding of state mining Cooperation Technical Consultative Committee Training of Trainers Ultimate Treatment Goal United Nations Children's Fund World Health Organization Ward Primary Health Care. Lymphatic Filariasis 5 WHO/APOC, 24 Novcmber 2004 Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in mesolhyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesofttyper-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 rvithin 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'o year of the project). (v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage) (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc). Through CDTI (using the same systems, training, supervision and personnel) in order to maximise costs-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distribution outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) 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 prograrnme), 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 modifi cations when necessary. (i) 6 WHO/APOC, 2{ Novcmbcr 2001 FOLLOW UP ON TCG RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. COMMENT/QUERTES OF TCC 2s 7 NUMBER OF RECOMMEND ATION IN THE REPORT TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 319 TCC was accepted the previous fairly well written report with the following recommendations : a Correcl discrepancy itt IIeje districl p op ulatio n Jig ures The Oncho endemic area in Ileje is near by Coal mining plant, instabiliry of this plant has caused big number of people to shift to other places and hence fluctuation of population figures in Ileie. c Correct the UTG calculation UTG calculation corrected. a Indicate clearly, if sustainab ility plans are being implemented . CDTI activities are incorporated in CCHP and RHMT plans. . CHMT and RHMT conducts supervision inclusive CDTI activities . Funding by districts has been increased From $ 2,500 in 2007 to $ 8,121 in 2008. . CHMTs and RHMT provides funds for project equipments services and maintenance Clearly give sn accounl of integration effort. . Integration now has taken place; in 2009 CDTI activities will be implemented in conjunction with LF activities. . CDTI activities are incorporated in districts PHC routines. . Some activities are done through CCHP tunds. Project related . More advocacy to districts to increase fundtng support to CDTI Efforts has been made to advocate the districts to increase funding, increase of funding in 2008 is a result of advocacy. a Upscale CSM and SHM Communities' sensitization was done with good results, CSM was increased to135 communities from 13 communities, and SHM increased to 49 communities from 2l communities. Get more healtlt staff involved in CDTI In 2008 year we managed to increase the number of FLHFs from 71 to 88, efforts are being made in collaboration with Districts to train all FLHFs within the proiect area. WHO/APOC, 21 Novcmbcr 2fiX o Train more CDDs to increase ratio to I:I00from 1:176 Following community sensitization more CDDs were kained and their number has increased from 493 in2007 to 63 I in 2008, we are struggling to train more CDDs in year 2009. a Calculale Mectizan accurately to reduce left over needs amounl The problem will be corrected in 2009 application. a Districls to improve funding to project Slowly the districts has started to increase amount of funds for CDTI activities, further advocacy to district leaders will be continued during Project annual review meeting 2009. (Please add more rows if necessary) 8 WHO/APOC, 24 Novcmbcr 2004 EXECUTTVE SUMMARY Tukuyu Focus CDTI was launched in year 2000 and CDTI activities implementation was started in 2001. The Project operates its activities in 3 districts namely, Rungwe, Kyela and Ileje. This report provides information on hnancial & technical reports of activities conducted in the period of January to December, 2008. During this period, the project managed to conduct the following activities: Training of PC on computer skills, training and re-training of FLHF staff, Sub-village leaders and CDDs, conduction of community mobilization, Community self Monitoring, advocacy to Ward Executive Officers, census update, Mectizan distribution, Supervision and monitoring of the implementation of CDTI activities, Project Annual Review Meeting and maintenance of project capital equipment such as Motorcycles, Vehicle, Computer, Photocopy machine. The project conducted training of 142 new CDDs at the same time re-trained 489. l7 new FLHF staff was trained in this reporting period whereby 71 were re-trained. The project conducted advocacy to l5 RHMT members, also 30 PHC and CHMT were advocated in Ileje district. The total population in both Hyper & Meso Endemic areas is 86,638 people who reside in240 communities. Mectizan distribution was started in September to November. Total of 69,812 people were treated which is equivalent to 80.5o/o therapeutic coverage. Geographical coverage was maintained at 100% while UTG is 72,776 and also ATO is 73,642. The project started with a balance of 218,903 Mectizan drugs whereby a total of 193,000 Mectizan tablets received from Merck and 25,903 Mectizan drugs were stored in the regional Pharmacy. A total of 194,234 drugs were used by the people who are living in Oncho endemic area, whereby 84 tablets were lost and24,369 tablets remained and they are stored at the districts pharmacies. The project received funds amounting $ 44,292.5 from difference sources. These are: APOC $ 19,304.3, Sight Savers Intemational (SSf contributed $ 16,876.4, Council S 6,396.9 and Regional level $ 1714.9. The major challenges are: To increase the number of CDDs, especially femalea a a Most of the project capital equipments are old hence they are expensive to run (Vehicle, Motorcycles, Computer, and Photocopier). Transfer of Project Staff to non Oncho areas. 9 WHO/APOC, 24 Nowmbcr 2004 SECTION { : Background information 1.1. General information lntroduction : Tukuyu Focus CDTI project operates in 3 districts out of 7 in Mbeya Region located in southern highland zone of United Republic of Tarzmia, these district are Rungwe, Kyela and Ileje and all three district are located in the southern part of the region. They are 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, fuce and Banana. People in the rural areas are engaged themselves in various activities such as agriculture,pastorarism and small busneses.Generally the road infrastruchue throughout Mbeya's countryside is good however during the long rain season (1.{o,, - June), small section of the Region are cut off from the rest of the country. Tukuyu CDTI Focus Project operates in 240 communities from three Oncho endemic districts in Meso. The project started as a vertical approach under National Institute of Medical Research in 1994.ln 2000 the project was handled over to DED under heath department and in 2001 the project started CDTI activities implementation. 1.1: KYELA DISTRICT PROFILE. Kyela district (Fig. 1) is one among the eight districts of the Mbeya region. It is located at the extreme south of the region and is about 125 km from the regional headquarters, bordered by Lake Nyasa (Malawi) on the southem part, Ileje district on the western, Rungwe district on the north and Livingstone Mountain ranges on the eastern part. Geographically, the district lies between n 30o - 350 Longitude East and betwee n 90 250 - 930 Latitude south. It is situated at the altitude of 400 -520 meters above sea level and receives an average rainfall of 1200mm annually. The district has two administrative divisions divided into 14 Wards and 84 registered villages. Four wards containing a total of fourteen (14) villages which are under the project area and thus receiving ivermectin annually. It occupies atotal area of 1,322 squarc kilometers (approximately 2.1%o 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 25 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. Where as the Ndali tribes lives on the highland and are engaged on farming, livestock keeping as well as beekeeping. The later two are living along the like Nyasa are engaged in hshing and pottery. Administratively Kyela district is comprisedof 2 divisions, l5 wards and 101 villages with the total population of 191,832 people according to national census. Onchocerciasis is found in 58 communities. Generally the communication network is good in almost all parts of the district, except some few areas are inaccessible during the rain season Q.{ovember June) There is one highway crossing Rungwe district through part of Kyela district to Malawi. l0 WHO/APOC, 24 Novcmbcr 2004 1.2: RUNGWE DISTRICT PROFILE Rungwe district is among the seven districts of Mbeya Region. The district is bordered by Kyela district on the southem part, Ileje and Mbozi districts on the westem part, Mporoto volcanic mountains and Livingstone mountain ranges on the northern and eastern parts respectively. Geographically the district is located between 90'05's to 45's and 33o 20'E. From the 1988 census projections the district has an estimated population of 3 I 8,019 people with a growth rate of l.4o/o and it is the most densely populated district in the region. The district occupies approximately 2211 sq. divided into four divisions, 30 wards and l4l registered villages. Eight wards (8) comprising of a total of 4l villages are under the project area and hence their communities are receiving ivermectin annually. There are 56 health facilities in the district which deliver health services to the inhabitants and people from the neighboring districts. Out of these, l3 health facilities are within the project area and thus serving CDTI activities The district receives adequate rainfall of more than 2l00Mm per annum, 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 amual mean temperature of 60c. The district possesses many rivers and streams originating from the northern 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 about 95Yo 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 livestock production, 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 Rungwe district is comprised of 4 divisions, 30 wards and 162 villages with the total population of 317 ,611 people. Onchocerciasis is endemic 180 communities. 1.3 ILEJE DISTRICT PROFILE Ileje District is located in the southern corner of Mbeya Regional. The District lies between latitude g0 14" and 90 37" Eastof Greenwich. The district "ou"., a total area of 1,908 sq.km Ileje district shares colrunon 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. The Natural vegetation of Ileje district includes tropical Savanna 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 amual rainfall is between 700 to 2000mm Temperature ranges from l60C to 270 C. ll WHO/AFOC, 2'l Nowmbcr 2fi)4 Administratively, the district is divided into two Divisions, 16 wards, 68 villages, 320 hamlets and 26,852 households. During 2002 Population Census Ileje district had a total population of 110,194 including 58,408 females and 51,786 males. Onchocerciasis is found in 2 communities. HEALTH SYSTEM Within the project area there are 4 Hospitals, 3 are district hospitals for Rungwe, Ileje and Kyela while one is owned by voluntary agency in Rungwe district, and also there are 3 Health Centers and 21 Dispensariesl Table 1: Number of health staff involved in CDTI Districl./LGA Number of health staff involved in CDTI activities Total Number of health staff in the entrre project area ul Number of health staffrnvolved in CDTI u2 Percentage '3= B2lBt 'Ioo RUNGWE 524 ltl 2t% KYELA 293 64 22% ILEJE 124 9 7% Total 941 184 19.5y" 1.1.2 Partnership Cooperation between APOC, Councils, SSI and communities enables the project to implement the CDTI activities in a positive side. APOC and SSI support the project financially and by procuring equipments, while the districts councils play a big role in supporting supervision & monitoring. The councils also pay salaries, allowances and other costs. Both APOC and SSI stand to be the main supporters for the implementation of CDTI activities. Both have been supporting the project on various activities especially training of CDDs, FLHF staff, Policymakers, Vehicle/Motorcycles maintenance, supervision and monitoring, conduction of Annual Review meeting of the Project and procurement of working capital equipments. t2 WHO/APOC, 24 Novcmbcr 2004 oo b E oz O oq o E C) a" oop. O I O c\ tr o ..E V)o bo (d t< o (d A.o A. () bI)(B .o V) il >' trt oQ e z o z) t/) o/ c-. l'Edlo .:1 .n(.)UP a o0d0) .=otrH B6LH;9 !P b0 \J .S)k)A c\J €) 90(-) a0()'a .Ftr E()i.(J oG + Era) -v9 Arivd dc\(/) z 2ii;'{oLU IE(6 O'!(A c/) . (B>* \- o' s\ ! ^. su €-r'' *::'*t dQJ ;v\ VB U T\ Qt .v '\ F! P'b \ q., aJ .\\.s .SH -sd la 3sp: v$J(Jtr. t3 qr a3 $o A% ^\vq.\$o, .S qr \aS\' Fi :! x! $\- S8" $9 -oi v Q.! $$ .s. So\oUAr lbo Q)* -a= s\\IS t{' \Q) s> :sBSa) kaHJ NNst\.Y $\ X q.r (J*.; u 9^Ei 3 ";.pil d9-et \HBsrb P* -.: l-< C) o. bo ts o o.() L 0) oo L o ko t() cd oH () L<(! (.) ! C) () 3 (d()!(g oo 'a H o. o! () o l( ah L Cd o (d 9. og. (d U) C) E oO C.i op 6JF E o +, o o =G o& ! tr G E o +ag o.0tr ol F ca 6 d o .l .= o!- -;v o vl o\C\C\(\ c--C\\ o\ o\ @ \o F-r- Nr- .9 €? '-9or EEEK €F",, o4 o E co c- c.i\o @q c.l c.l F- o\ €(.)\o tri € _. a .go cF9a aEY4 otr >rotsE*o N c.l oo $ co crl rI s t rarI o\ = 6oo '='= 12 0. E g 3-,?r E< oc o., >c .-o N r- c.I F- c! N q € c- o\ $ €cl r- cO q) bo q) o a) o o z oc oN o A4c5,- '-!f E 6< ,voil - tr-' o E o @ €rn c.t tGI .eEE'asaE o: (^ ,i€ E< or )\oHE *O N oo oo @(\ \o !1-c d:!o ?oxocx o a.=oNo', Zo- c.l o\ c.l (\ tal o '-OdE.= I 4dd OOe8p I -= o'dar F \o r- c.t N c.l oo^ o\ @ € \o a \o al\o <Eraois'7) o,. oo6 'tr.= o .9tr(dOo'o t<tQco'- H B ozDd J E] M rI] BI .l r1 F oF trH U oo a.l rr.l o ooO N()t! o @O N r) r! IJ u) P c) rn a0Et rh- @OON zD oo ON zp @O c.l zD (.) : HO trE U oo (\ Olrl o oa a.l rl] o oo N U rrl a a bo L bo Ftr a- € N o z co c.l o z oo ol o z vo oo c.t F() oo c'.1 FQ o oo N F(J o sn U) o) U a0EE ?tr (h- coOON s.la @ o C.l r!a @ (\ AI!a 0)e d=IIH U ooOoN o.gl a oo c.i A rrla @ c.l rr.la u0 dLF T.o1-E (h- ooO N oo c.l rFl D oo N \J D 0) +, IJr OtrE U oooON JDl- oo ot rl oo c'.1 rl h0sE !tr (h- =O Etrd50) ooFr(Ja coO N zp oo ol z oo o c.] z Fl rrl M I! H Fl () L U) a rr.1 o Z. & Fl F oF o o E o (-) oA o $ qJ \) a o lik o o o ok U)d 0)L 63 (.) ! .o V)() o Cdqr o C) o F o o {J .E (, G la- o ! o L oo F aN F a o l& o z o -F F z ut E uIJtr =N z o -F(J UJ o 2.2. Advocacy The project managed to conduct advocacy to 15 RHMT members. During the advocacy meeting the following were included in the discussion, quick review on the disease, roles of the NOCP/MOH, APOC, SSI, and RHMT, it was insisted that RHMT supervision should include CDTI activities. At district level the project conducted advocacy to district PHC and CHMT, this was done in Ileje district. At community level VEOs and sub village leaders were advocated in all 3 districts. The follorving table shorvs the number of policy/decision makers advocated at different Ievel per each district 2.3. Mobilization, sensitization and health education of at risk communities Info rmation dissemination : These activities were done through communication with village leaders, and community leaders using telephones and letters. Also head teachers and their school children in all affected areas. Head Teachers and their pupils played a big role in information sending to communities. It was agreed that in any meeting conducted in the community whereby many people will attend, implementation of CDTI activities should be one of the agenda. Usually FLHF staffs who are very close to the communities at risk do attend community meetings and they disseminate information. Response of target communities/village . Was excellent Accomplishments of the project in this year are- ' More community members were involved in the implementation of CDTI activities. . There was no doubt on the side effects of the drug. Suggestion of way to improve mobilization and sensitization of target communittes - . Use of communities meetings conducted by FLHF, hence funds should be added. a a a DISTRICT DISTRICT LEVEL WARD LEVEL COMMUNITY LEVEL Rungwe 0 0 183 Kyela 0 0 98 Ileje 30 0 2l Total 30 0 302 l5 WHO/AFOC, 24 Nowmbcr 2004 \o v ca c.l ,a: a o t-t o .o q< o lr() -o 0) (H (Jn a= cc [l0);, L \-/o^ =(U Ad o!!(J0)> !o ot a? =()tto 6=5gNo .a at) H(d cao\o(/) au){:A f-' n o \-/Nq.lkbotr >\H -0)* at) ca c)$H -L(+i 'd *tDU9a*U9ri>(-) .u- Poo A^OXOc9G vc.) Laio trr- JA Z C'I a I a) _s\) oz V-<F e- Vv an Ucfrl o a'€Za 6: 9aaq) oe >rE Et -o cl\J= IGt ei t-,( o o b E o z O o d o E o o0s 3a EG o.o O9 L> E z co CQo[5 o oo6 o\ ^\O o\ \a .: . 3b o .: ts:-L EL)Ho = -. oo ootr) N $(\l o o o U o E z ca + lt E F c\ c.) $C. C\ ra FaU3 I E olr c\ ca(a) ca \o\o ?a ca ^qa o(J I({ z N@ @ N ra \c) GI o >l ot o.]5t I cq o Eo o u0 c! o E e z la il q o0(! e o \oo\ qO^\ \oo\ \e 'EnE r- ='i ? 9eo = o'=? E? b 2zEz oo @tr) N .+(\T CE -P .9; =3EOEa:^Oo(J.: oqtro f.s oo oo(r) N v(\l ()J .9 A t! B O 7 & -lEl V r!h rI] F.l rl F oF 2.5. Gapacity building Adequacy of available knowledgeable manpower at all levels. In this year 2008 the project was managed to train new RHWs 17 and re-train 71, also we trained 142 new CDDs and re-train 489 in all240 Oncho endemic communities. Training of new CDDs was aimed to increase the number of CDDs, but also was to increase the number of female CDDs as this move less than Male CDDs. Advocacy to RHMT and CHMT in Ileje district was done so as to enable project sustainability. LVherefrequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy tlte situation. The issue of frequent transfer of staff is being solved by sustainable training of new FLHWs to increase their number at health facility and also the project discusses with CHMTs to avoid frequent transfers of staffs from Oncho endemic area. t7 WHO/APOC, 21 Norcmbcr 2004 b E o z U o o. o - oo q) dfr t) U o Lq) z dll v o .--f [-, t- .] *.q > qJ = No\ ca \or- ca \o $ ca c..l oo \o N n r) ca\o o\ oo$ N+ \e q) q) C) (J \o t-<4 N o\ ca v caN (r) O ca\o U) q) .a'a' cq F-rl- >, (r' oq) .c) t-GCll- z : c!llv o .--t-: L q\J q) O O O q) q) 0) I \:UF O q) c! li Ets o) q)6O E:- zE o() E.'!lro ,!- *.q > * c-+ $ \o oo ca cr c..l c.l crt €6 t- F- \o q) q) q) (,) .\ULt-r t--+ ooco ca €6 c€ U) a) J!q) (.) tr U) LoE -ao zl ?r++) '+ ;i . ,'Or',t \-/ --- .L1\ q q) e O O ca ca ra ca o\ q) q) q) I s L F. co ca () Fl q) L u) a t! ts(, 7 & *l rq M rJ] rI1 .l Fl Fi o Fr cn q) q) a F U o U) q) q) q) L c) c) a0 dLF rnl ol el GllFI oo D E o z U o o. o :E i o\ h 9-- o,v0adOfrz 3 ) ) ) ) ) ) ) ) ) iBYraFQ -< EJ ) ) ) ) ?*E r_r <i l-l ih t- z. ) ) ) a| u)idf:ilhJ,FH']FE 'IVF,l!<ciz<) E9'H9 '9 d ) ) ) ) ) ) ) ) F Z=za za28 =E=>XtaEE( ;EEEl{ ts rr,4Z.Ya F ) ) ) ) ) ) a a (J ) ) ) ) l* o rd o. c)>z ,NZE], r.1 Jzi dF q) () oo(€ Cd d l-< o0 okA (d c) A o ! odQX O.H €iE Po o= Ff{ O) U)H a q-< o Ptr C) Eol oo(dldldl >l aO z FJra o oo oo d (d a U) .hx(! d d d a oo F Eo a. C)& IJ] o & oFa z Nt-() rq z q) cl L G) u0 c(fr q)E F. \01 orl EI cllFI oo o EI z O oq o :( F (d o t<d C)o ak (_) cn(!()L (J E 0)E o Itro o. >' o alt o tr o(! C)H G) -o o C) o. oo o.(+{ tro .o CU €oF OO X O (d(.)lr o (.) oq< o L<o -o z () L{ o() 'a L o.() o z rr) >\ -ot 0) H () CJ) U)o oo o o <, tri =lJ- YI() I()o. xl> ill €{ gt I9, *15CJ iI APt vtr ol e(! -l l-iH OJ(): o[trl'i ()l -ux oltd = ol c.ltr ol 'L' = . tr<i 6l=E *l tsE EI EF 2l< x (.) CI ot-! v c G U) c) + E E E (-) q L o tr z cd ot< o o 'a t< o. o a o oo o () ! C) I r<o9. or >ol ; *l 0.r xl E ol c()l 'i El 3',l-<l '5 -l .a9t- 8l t()l '5 old ,*l Eol 6. *l O -gl atrlE3l x zlJ c'l lt () (B L< (.) bo(d t< C) oo o^j-j roJo\G)vg(g ko t- "3 b0 sl ol BIol -t(dtOI -clol(Bt Lrl o0 ol c)lE trldt ,-: I !l )l ol ol(dt Lil 6)l -cl ;J trt al a EI ol :l €l (dl 5l EI ol TLI il C) o o cd F s 0) =fr() bo(ckG^) ro >o\ovo oF o d t< 0) oo(d l<() oo cd9n 'F ro O. </dt< bo o(l)(, q?.?E ? - oq ! rla O= 03 E9;;3E?sgq<teE&*Eg6e G J z J z ..1 z €? Ecn zz J z J Z *l z hoJ;. s z€ \o o.l co r- catr) \o o\q t\l () (6() L o Ldo=-o .o;o92dL-vl E EEq Zrr* Lo ca rz^) coo' 6t\o r- : -.7 -J-5 9<-r E.E -g X.E re .o =; <.9 IF +o; - d!1 6J q)aE =c)ooO o- cda8.9 ESo >v .(oFo -o7,(D EEE Zr* Fo (€ o.= E H..D < 94'F L.,) o\ @ \o N oo .o o\ t-- s u? a cn\o\ o\ -{- N@6l o\ @\o tr- ol rc- o\\o \o N(a) c..ltr) dC\ O @ oo N .+\o car- oo c- c-l\o (r) @+ c.) c..l r)r- €(.) \0- \o € l+ q- GOPLo'.8'; 3_.9+ E P". bE 3 E E5*;T Hf-!:>(.)() ' 3- E ,.- KQ'A a -.= o,l -<JiD E O0o) -o=diiE E= PJtr>TJ z-oo (d .9 q.riood 6^ =Li6iI 9o\ do E c.r d O-=5trli?|i=c)i.utr FV rO6\ \oo\ \oo\ 1Oo\ @ ootr) N r+at oo @(n N {at oo oo(r) c.l tN .9<;v o\ r! B oz d J rl.l v rrl lrl .l j FoF q) L cg o q) tr G (J c (.) L U) E u)(, rrlc)< ,a q0:(lrc( trF(): *, cdGl q) o-LLFtr{ .. .q)n=Y -c{CIF € q o 2.6.2 What are the causes of absenteeism? o Human daily Iiving activities such as moving business, schools, agriculture and employments found in other areas far from Oncho endemic areas. 2.6.3 What are the reasons for refusals? . Some people in endemic areas has no symptoms hence they don't find reasons to take drugs. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box a No SAF, cese fn rennrf 2t WHO/APOC, 24 Nowmbct 2004 oo9tr \o b oo8 xnEo .=dd d.= o ()Ei votrfi ''5 O.a Q,qtro ox. (k lZOo !t o cd =-o9?,2n8e9 td z o z q-Eo2*8.€ t E.9 3'a ^O--Ou.< E .J o^o o'i qE '=(EYo) € = P XoN d P,Y.r efisEfg q o o. U) - ?.o -Eo ,,;ad .Y o.()(ico- lJ >\ :f e.E = SAE}I o-oo -HSq oo xoa o hO 4 v) oo ! E o z O oq o > NN o H C) O. bn li o oLr() oo l< () H oo o (6 U)r! a U) o () 0)(nLq) rr) l-r C) u) q< o ch 0.) U) ed O # C) -odF oo .I o E o U o o. o <h o (g o Cd() caN o F (s r< o (B Eo c) (.)&P v)d U) o U) \orr r*. (ti C)k ct o -( k € oF o (,) cdo tr o V) Cdo o< () oo15 F^r- 6S /O U sr-F. s t-- +@ s(\ 6\\o oo o\9\o o\ \o 6\\tr) r-- \oo\9 oo c- \oo\q ra) o\ a6A.rcg -oy/ = b gEiY's () ='o co (d-q<'=t!t-=-oE -=qaf EEo o G IJ ,obE .o6b .o.- z-,o o. EoE 6.2rE6 j .o -a' F\J 6) 50 11) >^ :A \Oija o F. l- -r -t '4 o PO:J oo o ciaCLProi: oo\L>v oro -EoF i:' \o co O. c- \oo\\ oo \o o\ o\r- oo .o o\tr) o\ \oo\ oo oo \o ce o\ .o o\ t-- + o\ \oo\\o o\o\\o \oo\\otr' 1O o\ ca t-- \o oo rO o\ .f, c- \o @r- \o l. I oo c.t \o(r) $v} co\o (..l tt. N =r: co\o CN oo @ tr- \c) cer1 ca\o $ \ t--\o N @ o\\o \o$ oo t-- rnN\F- c- t-- o\ c.!. oo t'-- \o$ oo tr- \o\o c.l oo c.l *n c.i c- oo oo co c.it-- c'lv ,o^ ca t-- -+ c-l $@ ca t.1 N o\ cl co o\ ra) .+ c.l o\ (a) ={ oo o\ \o ca \o oo Ntr-\\o oo oo ca \o^ \o oo (d- '= rio c UL,,-l,vtd iu ro "- '-b i 3) r,l r.t o-?rh- i, ql aockb'.='- I c-rlt'E 3 ,. H'E gE = SE<T U5 E= ; E,!F E} () Oo-tr H i,J t q) a tr o(J :o d c).= =EEE .STj .o -(j'FL' o oo(! (.) SE oF ll 'x r! !3I.E 3.oiD E bo() -or(!:E E= iJitr>Ez 5-o \o o\OO \oo\ .oo\ \oo\ O o\O \oo\ \oo\ \oo\ O \oo\ s O -o o\ O \o o\ \oo\ -oo\ sO yO o\ O (a) .+ cat.) sf N $ N $ N $ ca cil .t C\ OvN (r)$ cn(r) $N $ N $ c.l .+ caN OvN vN rn$ c.)ra) tf,N \f, C.t .f c'l .+ coN O$N O$ C.I d 9.1 oo6l NOo c\I cnOo(\l $Oo c{ rnOo c{ \ooO c{ r-OO c{ oooO c{ o\ooN O oC! dq) q) tr (.) q) !6itroorr .- Cll A€ ;rE .I.ti o' ! ! * o(') trE t-9AE v_o ElrEE{.. rlEdloElEtrI5elB3I .r -l €51cE (.) !bO 9EE' clo G)LY (*d Ov) tr90)H fr(d ulF \oei ?l EIdttl 2.7 Ordering, storage and delivery of Ivermectin a Mectizan@ ordered/Applied by: MOH wHo UNICEF NGDO Other: o Mectizan@ delivered by MOH Other:- NGDO Please describe how Mectizan@ is ordered and horv it gets to the communities o Project Coordinators requests drugs by filling in the ordering forms and send them to the NOTF in the Ministry of Heath & Social Welfare. . The NOTF passes through the application forms, if they are okay, the forms are forwarded to Mectizan@ donation progamme (MDP). . The MDP also passes through the forms, approves then send the drug to the MOH and Social Welfare through MSD which is a govemment agent for clearing and forwarding. . The MSD informs the NOTF on the arrival of the drug, and then the NOTF notifies the Project Coordinators. . The Project Coordinators takes the responsibility to collect the drug form Zonal Medical Stores or arrangement is made to go in Dar-es-Salaam to collect drug direct from central MSD. The received drugs are sent to regional pharmacy for recoding and storing. e Project Coordinators receives request from DOCs and drugs are delivered to the district through the Health system to the district pharmacy. o District Oncho Coordinators also receives drug request from FLHW and distribution is done accordingly. . The FLHWs notifies the community leaders on the arrival of drugs at health facility, then the community leader send CDDs or any community member to come and collect drugs ready for distribution to the community. Table 10: Mectizan@ Inventory - How are the remaining Ivermectin tablets collected and where are they kept? CDDs collects the drugs from communities and hands over to FLHF, The FLHF also hands over the drugs to DOCs and the DOCs hands over to Regional Onchocerciasis Coordinator whom he hands over to Regional Pharmacy for storage. PROJECT/DISTRICT NTJMBER OF MECTIZAN TABLETS Requested Received Used Lost West Expire d Remaining Regional Merck TUKUYU CDTI 193,000 25,903 193,000 RUNGWE 151,353 10,353 141,000 142,600 84 8,669 KYELA 56,050 10,550 45,500 44,783 0 11,267 ILEJE 1 1,500 5,000 6,500 7,L51 0 4,349 Total 218,903 25,903 193,000 194,534 84 24,,285 24 WHO/APOC, 24 Novcmbcr 2004 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@ o Retraining and training new CDDs prior Ivermect distribution o Supporting supervision during updating census. o Mectizan ordering from DOCs. o Conducts supportive super vision during distribution. o Management of serious adverse events (SAEs) when occurs. . Compilation of data from CDDs . Report writing and submission to DOCs . Conduct feedback meeting with community members. Any other comments - NONE 2.8 Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? YES Table 11: Community self-monitoring and Stakeholders Meeting Describe how the results of the communify self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle .Progressive decrease of refusals .CSM and SHM has enabled the project to increase therapeutic coverage to 80.5% from78%o of 2007. .Coverage above 80% will be maintained District/ LGA Total # of communities in the entire project area No of communities that carried out self monitoring (CSM) No of communities that conducted stakeholders meeting (SHIO RUNGWE 180 58 2 90 31 l6 2 KYELA 43 2ILEJE TOTAL 240 r35 49 25 WHO/APOC, 21 Norrcmbcr 2004 NOTF R.M.O D.M.O DOT FLHF Gtla#f COMMUNITIES/CDD rE Superuision 2.9.1. Provide a flow chart of supervision hierarchy. National level Regional level District level Health Facilities level Community level 2.9.2 2.9.3. 2.9.4. 2.9.s. 2.9.6. What were the main issues identified during supervision? . Still there is a problem of below standard recording . Inadequate motivation to CDDs . Some CDDs needs external force to perform CDTI activities Was a supervision checklist used? Using both APOC & CHMT What were the outcomes at each level of CDTI implementation supervision? a Most of people are much aware of the CDTI activities and problems are being solved through discussion. Was feedback given to the person or groups supervised? Yes. How was the feedback used to improve the overall performance of the project? a Training on proper report writing to CDDs a Dissuasion with communities on how to improve/ increase motivation to CDD. 26 WHO/APOC, 24 Novcmbcr 2004 Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condition No Condition No Condition No Condition No Condition l. Vehicle I Functional 2. Motor cycle (s) 3 Functional 2 Functional 3. Computer (s) 0 J Functional 4. Printer (s) 2 Functional 3 Functional 5. Photocopier (s) I CNFR 6. FAX Machine (s) I wo 7. Others a)Bicycle(s) 20 Functional SECTION 3: SUPPORT TO CDTI 3.1 Equipment Table 12: status of equipment * Condition of the equipment (F: Functional, CNFR=currently non-functional but repairable, WO: lltritten ofl). How does the project intend to maintain and replace existing equipment and other materials? CDTI activities have been incorporated in CCHP and RHMT, through this system maintenance of project equipments is being done. The project still requires assistance from APOC financially and on replacement of equipments. 27 WHO/APOC, 2'l Novcmbcr 20011 oo E o z O oq o co c\l Eg -o r< o. cnk \ ^..; Eq E E;:? esy, ,trroa €r: oni". EcU 'ob'E ? E -trE G 3yCrqr= 9ro 5Lr.lOq)E o aBq .E ;>9 ll c)a= ! = - -Er .e E sS.; r, lnx'EEF € U.slHoo r=(JcH.=-trE ? - o''\J og! 'ri -.! r.I PE f r€I*tEg E iEhgI ;c € iE,:Et:; BP;{EEu2c,LE.=Y,tr6gH. E =tgeiI = (,) I--.=-'iho E $ nE Etf i2qgdol-.E9SHSf,PTEEI7c E v .E : t E JcEts E.H 5.gE EH *gaE:E330F.qEE3?EEE E8T8JE € L( ina 5+3_ € € o\ o \or@ .d €o € oE zPq =86 .-8 .1 +O c1 6 € ! r!?flal- u.n ^'o =)'=v @ € a.{ o n €r .o q € o, I lO m.^ =dzVFO =6t-(J r N rd 6 t-- :6(, L o EF ;@- € o\ € F6>z9o vdz z2- U a+ *o *- c1 r6 ati 6 al a <Xe'f- 6v) OO € € N o ON ao d 6d o6 € €r I L .E lAa oO €- N r O^ N r a tr6= zLq?(= *o (J N N m € a d;q = qa L a O O ac] N € ciN o\ a c1 N o od N € r\o L 6o d:.6 €r O o d l- 6=76 | =HO9Ez zEo -oU o\ o9 I .; s hr 1' 2 4(h L r r; 6 O € oi 6 .1 N dq r € alal !n = .+( d Y^iae_:a ' !v r r' o^ o € a r € d dq €r h- € I$ N O t- 6 rE EJg r r; O o O a{ o OO. N r nh al t o -\!s rr) \LO .us iEa 5€3 O € O !f O O o\\ oat- rn iEa9E?FcQ O O € oO o O O o\\ ar-\o ra t =-o\ -a. i dO.( o rEaZa 5+3ri o Oo ra ra F- €- al\o <E?eI- uD(,ar!D o O OO r O r € t mr6 N\o =-o\\o -\i L iEa E+3r4, O o r N r$ 6a \o iEaI &(hi-\!= F!Q O O r ct r$ 6a \o o D o(J o 6=* E dV =fE x 3EE oo oz .E E Eo() a =LF(JAE tE ,l Fot- U)Ld C) >.()() H .t) -c0J {j tr(d to (.) .9H =9cg 0)?EodEo- xcg oa cHCoo <h 'E o-o .aC o(go'5 (JE 6t& la c.tl ,l(\ EldFt o o 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here US$ I : TSH. 1,300 Table i4: Indicate how much the project spent for each activity listed below during the reporting period Drug delivery from NOTF HQ area to central collection point of cornmunrlv Mobilization and health education of communities CDDs Supervi sing CDDs and distribution Internal moni of CDTI activities Advocac visits to health and political authorities IEC materials forms for treatment Vehicles/ at all levels b maintenance Comments SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) None Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Activify Expendit ure ($ US) Source(s) of funding 0 4,436.5 i,,oio 5,983.6 l,l4l i 3,3 65.8 5,260 APOC SSI & DISTRICT 4ryqqsl SSI & DISTRICT APOC,SSI APOC,SSI APOC SSI SSI, REGION, DISTRICT. SSI &DISTzuCT SSI,APOC & DISTRICT 1,000 667.2 7,157.3 Office Equipment (e.g. computers, printers etc) 1,032.7 Others 5,228.2 TOTAL 44,292.5 Total number of persons treated 69,812 None 29 WHO/APOC, 21 Novcmbcr 2004 None 4.1.2. What were the recommendations? NONE 4.1.3. Horv have they been implemented? NONE Internal Monitoring by NOTF Other Evaluation by other partners None 4.2 Sustainabilify of projects: plan and set targets (mandatorl, at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan ri,ritten? NO. When was the sustainability plan submitted? N/A. What arrangements have been made to sustain CDTI after APOC funding ceases in terms of cash. o Every year CDTI activities are presented during CCHP Plans meetings for funding o The spirit of owner ship is insisted at all level 4.2.1. Planning at all relevant levels r CDDs plans on when to update census, and collection of drug from FLHF and also with community decide mode and time of distribution. a FLHF plans on updating census, ordering drug from DOCs, informing community to come and pick the drugs, supervision during distribution to the community, data compilation and report writing. o DOCs plans on to execute CDTI activities and make sure that they incorporated into CCHP, ordering drugs from ROC and make sure they reach FLHF through normal health system, monitoring and supervision, report writing and submission to ROC. a The Project Coordinator compile report form districts, prepares Technical APOC arurual report, Mectizan@ retirement and Re- application, supportive supervision to district and attend various Planning meetings at district level. 4.2.2. Funds o Project depends on District Councils, APOC and SSI 4.2.3 Transport (replacement and maintenance) i The present vehicle is old hence expensive to run but replacement is expected in year 2009 according to 2008 Letter of agreement o Maintenance of existing equipments is through CCHP support. t Maintenance of existing equipment is done through RHMT & CCHP support. 30 WHO/APOC, 21 Novcmbcr 2004 4.2.4. Other resources NONE 4.2.5. To what extent has the plan been implemented CDTI activities are incorporated in PHC routine under supervision of DMOs 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: . CDTI activities are implemented in line with Health system. . CDTI activities are now full incorporated in the CCHP . DOCs are members of CHMT. . CDTI activities have been included in the supervision check list of the district. . From 2009 CDTI activities will be performed together with LF activities. 4. 4 Operational research 4,4,1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NONE SECTION 5: Strengths, Weaknesses, Ghallenges, and Opportunities List the strengths and weaknesses of CDTI implementation process. Strengths: - Government is ready to support implementation of CDTI activities - Accessible roads in the project area. - The Community members are willing to take Mectizan drug - Presence of Health structure in the country from National level to community level Weaknesses: - Delay of release of funds especially from Council - Most of working equipments are old hence they are expensive to run Challenges: - Funds for the implementation of CDTI activities to be released on time by council - Replacement of old capital equipment - The council has to maintain roads in the districts so that they can be accessible through the year. - Change of Government leaders in the coming election 3l WHO/APOC, 2'l Nowmbcr 2fiX Opportunities: - Permanent structure in the project area (Availabirity of buildings) - Enough manpower to perform CDTI activities SEGTION 6r matters Unique features of the proiect/other 32 WHO/APOC, 24 Novcmbcr 2004