Ruvuma Focus CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2009

T]NITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AI\D SOCIAL WELFARE t if s" Is lJolrstt ro-)iR. H-g*kbtrl ORIGINAL : Enelish For Tot AO ai csb 6P TD8fi,{o I COUNTRY/NOTF: TANZANIA Proiect Name: RUVUMA CDTI Approval year:1997 Launching year: 1998 Re Period: From: JAI\UARY 2009 To: DECEMBER 2009(Month/Year) ( Month/Year) APOCfundinevear: (circleone) I 2 3 4 5 6 7 8 9 (10) 11 12 13 APOCProiectimplementationvearreport: (circleone) I 2 3 4 5 6 7 8 9 10 (11) 12 13 Date submitted: JUNE 2010 Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sightsavers Tanzania (SST) - lrl27 Communities ? t I ? E J]i,:. APOCIDIi{ RECU LE WHO/APOC, 14 September 2009 I I // tl/ - at RUVUMA TIDC 2009 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTBE (TCC) DEADLINE FO SUBMISSION: To APOC Management by 3l Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) a{ I aa ll WHO/APOC, 14 September 2009 firntc^Lx pRocRAMME FoR oNcHocERctAsIs coNTRoL (Apoc) AI\hruAL PROJECT TECHMCAL REPORT TO TECHNTCAL CONSULTATIVE COMMITTEE (rCC) EI\DORSEMENT Pleese confirm you have read this report by signing in thc eppropriate space. OF'FICERS to sign the report: I Country: Tanzania National Coordinator Name: Dr Signature: Date: ..... Regional Medical Officer Name: Dr. Daniel Signature: Mwakyusa LAslo Malekela.v ou,", ..1tT...9y.y9,..?.:.+:, .rFctsilt- utDtGlL GT[lf R ft P'rtt]I I i Our",......3{ fu-U This report has been prepared by Name : Dr. Ida M. Ngowi Designation : Project Coondinator Signature: ...kt.:: ,}{t -\. *r-' J)- r r-, NGDO Representative Name: Dr. Signature Date Kabole I I I t I I I I I I I I I I I Dircctor,Country ES SALAAM Dox2513 L-TCO 2 WHO/APOC, 24 Novembcr 2()04 t a a ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: TANZAMA National Coordinator Name: Dr. Nkundwe Mwakyusa Signature Date Zonal Oncho Coordinator Name: Dr. Daniel Malekela Signature Date: . . .. NGDO Representative Name: Dr. Ibrahim Kabole Signature: Date This report has been prepared by Name : Dr. Ida M. Ngowi Designation : Project Coordinator Signature Date WHO/APOC, 14 September 2009lll EXECUTIVE SUMMARY SECTION I : BACKGROUND INFORIVIATION....... 1.1. GBNpnal rNFoRMATIoN............. 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. Popu1euoN............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.t TNrer-Np oF ACTIVITIES . 2.2. Aovocecv. 2.3. MostLIzetIoN, SENSITIZATION AND HEALTH EDUCATIoN oF AT RISK CoMMUNITIES Ennrun ! SIcxBr NoN DEFINI. 2.4. CovtMUNrITy IIwoLVEMENT......... 2.5. CapRcnv BUILDING. ... 13 ... 15 ...15 ... I8 2.6.3 What are the reasonsfor refusals?................ ....'.............. ,18 2.6.4 Brie/ly describe all lmown ondverified serious adverse events (SAEs) that....... 18 2.6.5. Trend of treatment ochievementfrom CDTI project inception to the current year20 2.7. ORorRrNc, sroRAGE AND DELIVERY oF IVERMECTIN --.........21 2.8. COvrutxtry SELF-MONIToRING eNo STITpHOLDERS MpErrNC ............22 2.9 SuppRvrsroN...... 22 a 2.6. TRrarupNTS.............. 2.6.1 . Treatment figures ............ 2.6.2 What are the causes of absenteeism? ........ 2.9.1 . 2.9.2. 2.9.3. 2.9.4. 2.9.5. difinL 2.9.6. Provide a flow chart of supervision hierarchy. ..........-' 22 What were the main issues identified during supervision? ......'-.......-.......-...... 23 Was a supervision checklist used? Erreur ! Signet non diftni. What were the outcomes at each level of CDTI implementation supervision? Erreur ! Signet non diJinl Was feedback given to the person or groups supervised?... Erreur ! Signet non How was the feedback used to improve the overall performance of the project? Erreur ! Signet non diJinl SECTION 3: SUPPORT TO CDTI ..............24 3.1. 3.2. 3.3. EqurrueNT ............... FnieNclel coNTRIBUTIoNS oF THE PARTNERS AND coMMUNITIES..'..... OrHeR FoRMS oF COMMLTNITY SUPPORT ............... 24 25 29 3.4. ExpeNorruRE PERACTIVITY ..... .29 SECTION 4: SUSTAINABILITY OF CDTI....... ..........29 4.1. INTpRNIL; INDEPENDENT PARTICIPATORY MoNITORINC; EvelUnTION.......... ..........29 4.1.1 Has the project ever been evaluated/monitored? (fick any of thefollowingwhich are applicable) ........... ........-...29 4.1.2. Wat were the recommendations? .......-..... 29 lv WHO/APOC, 14 September 2009 4 .......Erreur ! Signet non dilinl ................. 1 I 4.1.3. How have they been implemented? ............. .................294.2- susrarNresrlrry oF IRoJECTS: rLAN AND sET TARGETS (MANDAToRv AT...... ..........29 ......29 Planning at all relevant levels Funds 4.2.3 Transport (replacement and maintenance) 4.2.4. Otherresources.. ;;;;; ;; i i;;,;,,; ;; ; dc;:t Erreur ! Signet non deftnl Erreur ! Signet non deJinl 4.2.1. 4.2.2. 4.3.I. 4.3.2. 4.3.3. 4.3.4. 4.3.5. 4.2.5 4.3. . To what extent has the plan been implemented........Erreur ! Signet non definl INrecRarroN ............. ..... 30 Iv er me ctin de I iv ery me chanis ms Tratning.... Joint supervision and monitoring wtth other programs Release offunds for project activities Is CDTI included in the PHC budget? .............. ...30 ...30 ...30 ...31 ...31 ........31 ........34 4.3.6. Describe other health programmes that are using the CDTI structure and how thts was achieved. Wat have been the achievements? ............. .................... 3 t4.3.7. Describe others issues considered in the integration 4.4. OppnarroNAl RESEARCH of CDTI. 4.4. I . Summarize in not more than one half of a page the operational research undertaken in the project orea within the reporting period. ........ 344.4.2. How were the results applied in the project?............. .................... 34 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND oPPORTITI\ITIES....... ................ 34 :::::: : :: T* :: :YY: :: ::: :-:* Effi,H t,Xffiii.K DEFINI v WHO/APOC, 14 Septemb er 2009 a Acronyms African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo a vt WHO/APOC, 14 September 2009 a Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (ii i) Annual Treatnent 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 ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraphical coverage: number of communities treated in a given year over the total number of meso/ltyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vll WHO/APOC, 14 September 2009 . FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 1 NAMBEROF RECOMMEN DATION IN THE REPORT TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FORTCAAPOC MGT ASE ONLY WHO/APOC, 14 September 2009 I EXECUTIVE SUMMARY The Ruvuma CDTI Project was launched in 1999 and CDTI activities are being implemented in four oncho endemic districts, which were Songea, Mbinga and Namtumbo found in Ruwma region and Ludewa district which is located in the region of Iringa. Onchocerciasis in Ruvuma region is found in all five districts but Tunduru is recognized as a separate project operationally. In this report for the llft year covers the financial and technical issues of the project for the period of January to December,200g.Implementation of activities for the year focused on the integration of CDTI activities with other NTDs control programme. Implementation mainly focused on sensitization, training, monitoring, mobilization and drug distribution of the medicine in the whole region areas. The Project received drugs late from Lymphatic Filariasis Control Program. The project started co-implementation of Onchocerciasis and other NTDS in Mass Drug Administration this year and Songea District succeeded in performing all activities within the timeline. However some districts lag behind due to new staff in the area or delayed fi.rnding. Drug distribution of Mectizan was implemented by using previous year's and new drug supplies. The project managed to conduct the following activities in this reporting year uihich commenced January to December, 2009 which were training of FLHF Stafl CDDs, and Community leaders. Advocacy meeting with the Regional Administrative Secretary, the Director of Municipal of Songea and at District, also at ward and village level were conducted. Due to administrative and financial barriers, the project did not provided any support to Ludewa district. In this year Ludewa district was supervised through Iringa region but in order to make a report complete we requested people from Ludewa to sent to us data from Oncho endemic areas only. Treatment in Ruvuma region started in October and lasted in December 2009 whereby in Ludewa district, treatment started in December 2009 and lasted in January 2010. The total population in Hyper and Meso endemic communities is 376,187 people, whereby total of 302,507 people was treated n 1,127 communities. The geographical coverage for the reporting year is 100% and the therapeutic coverage is 80% The ATO was 316,165 people and UTG being 316,132 people. The region received a total of 2,427,600 Mectizan@ tablets from MSD for treating NTDs, and we had 34,308 Mectizan@ tablets stock from last year. Total of 1,718,697 Mectizan@ tablets were used by people living in Oncho and none oncho endemic areas, in Ruvuma region. Ludewa being part of Ruvuma CDTI project, have not received its Mectizan@ Tablet allocation from Iringa, when they wanted to distribute, we were advised by the National Office to give them Mectizan@ tablets so that, they can distribute to oncho endemic areas only. Therefore a total of 146,500 Mectizan@ tablets were sent to Ludewa. The project received funds amounting Tsh I17,974,153 from difference sources. These are: APOC Tsh 66,740,153, Sight Savers International (SSI) contributed Tsh 2,700,000 Councils Tsh 42,434,000 and Regional level Tsh 100,000. Major Challenges and how they were overcome. o Ludewa district has a new coordinator in the progrirm and needs close supportive supervision and cooperation at every stage; however the district has another administrative structure that is Iringa region. Ludewa received their activity firnds from Iringa region allocation. It has not been possible to do a supportive supervisory visit from Ruvuma this year due to the introduction of NTD which is regional approach method. We overcame this by giving him only advice and 2 WHO/APOC, 14 September2009 amedication for use in MDA in Meso and Hyper Oncho endemic areas in Ludewa while awaiting his 2009 drug allocation. Implementation of NTDs MDA and having to write separate reports; one to carter for CDTI and another for NTD while the activities were carried at in one progra.m with the same people remain to be a challenge. I J WHO/APOC, 14 September 2009 . SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) The Ruvuma Focus CDTI Project is situated on the southwest part of Tanzani4 and lies between latitudes 10 degrees south and 11.5 degrees south and tongitudes 33 degrees east and 38 degrees east. It shares borders with The Republic of Malawi and Mozambique to the west and south respectively. It borders Mtwara and Lindi Regions to the east while Iringa and Morogoro Regions forms a border to the north and northeast. The Ruvuma Project is made up of tluee endemic districts of Ruvuma Region, Songea, Namtumbo and Mbinga as well as one neighboring district of Iringa region, Ludewa. It covers approximately an area of 64,333 sq. km of which 1,006 sq. km are inland water bodies from Lake Nyasa. With the excepion of a small area along Lake Nyasa (altitude approximately 100 m above sea level) most of the project area lies between 500 and 1,600 m above sea level. The project area has a tropical climate characterized by two distinct seasons, notably wet and dry seasons. Temperatures are also modified by the seasonal variations so that the area becomes hot (average temperature is 27 degrees Celsius) during the dry season and cold during the wet season (average temperature is 14 degrees Celsius). The dry season lasts from June to November/December and the wet one December to April/May. The peak of the rainy season is from March to May. Miyombo woodlands mainly form the natural vegetation although in Mbinga district artificial forestation is now taking shape. The drainage pattem of the area is mainly two fold. Permanent rivers of Hang4 Lutukira (these two rivers join to form river Ruhuhu) and Rwekeye drains into Lake Nyasa. fuver Ruvuma, Luegu and Ruhuji drain into the Indian Ocean. In between you have many seasonal rivers draining into these two drainage partten. Major food crops grown in this area are maize, rice and potatoes. Legumes such as beans and soya are also cultivated in large quantity. Cash crops cultivated include tobacco and coffee. Economically the area is quite well-of although the wealth so generated is not equally distributed among the people, giving a wide range between the poor, who forms the majority, and the few effluent group. The road network in the project area varies considerably. Seasonal roads that is only passable during the dry season-an important factor during Mectizan @ distribution. Feeder roads going to meso and hyper endemic communities in all districts are only passable during the dry season. Songea district is served by a tarmac road, which passes in the oncho area and therefore offers easy fransportation to those communities situated along this road. Songea town, situated l,000km southwest of Dar- Es- Salaam port, served by all weather tarmac road, is the administrative headquarters of the Ruvuma CDTI Focus Project. Mectizan @ mass distribution was instituted in The Ruvuma Focus in October 1992 funded by RBF up to 1995. IMA provided bridge tunding in 1996 while SSI provided bridge funding for the year 1997. During all this time the project was being implemented using mobile teams to distribute the medicine. Year 1 APOC funding started in October 1998 with the new concept of CDTI. The updated census conducted by distributors before this distribution indicates that there are 393,049 people in 595 endemic communities in Ruvuma CDTI Focus Project. In the Ruvuma CDTI Focus Project the village structure is basically the same as is found in other parts of the country. The lowest administrative structure of a community is a sub-village and a village may consist of 4 or more sub villages. A sub village is served by2 -3 CDD's and administatively has a sub village chairperson and executive officer who are selected by the people in the community. A village chairperson assisted by the village Tunduru district is located far south of Tanzania between 10"15 and 11.45 south of equator 4 WHO/APOC, 14 September2009 and longitudes 36o30 and 38o East of Greenwich. It borders with Namtumbo district to west -in Ruvuma Region, Liwale and Nachingwea to the north in Lindi Region, Masasi distict (Nanyumbu district) in Mtwara Region to East. In south there is the Ruvuma River which forms a physical International boundary with peoples of Mozambique. The Ruvuma Focus CDTI Project is situated on the southwest part of Tanzania, and lies between latitudes 10 degrees south and I 1.5 degrees south and longitudes 33 degrees east and 38 degrees east. It shares borders with The Republic of Malawi and Mozambique to the west and south respectively. It borders Mtwara and Lindi Regions to the east while Iringa and Morogoro Regions forms a border to the north and northeast. The Ruvuma Project is made up of three endemic districts of Ruvuma Region, Songea, Namtumbo and Mbinga as well as one neighboring district of Iringa region, Ludewa. It covers approximately an area of 64,333 sq. km of which 1,006 sq. km are inland water bodies from Lake Nyasa. With the exception of a small area along Lake Nyasa (altitude approximately 100 m above sea level) most of the project area lies between 500 and 1,600 m above sea level. The project area has a tropical climate characteized by two distinct seasons, notably wet and dry seasons. Temperatures are also modified by the seasonal variations so that the area becomes hot (average temperature is 27 degrees Celsius) during the dry season and cold during the wet season (average temperature is 14 degrees Celsius). The dry season lasts from June to November/December and the wet one December to April/May. The peak of the rainy season is from March to May. Miyombo woodlands mainly form the natural vegetation although in Mbinga district artificial forestation is now taking shape. The drainage pattern of the area is mainly two fold. Permanent rivers of Hanga, Lutukira (these two rivers join to form river Ruhuhu) and Rwekeye drains into Lake Nyasa. River Ruvuma, Luegu and Ruhuji drain into the Indian Ocean. In between you have many seasonal rivers draining into these two drainage pattem. Major food crops grown in this area are maize, rice and potatoes. Legumes such as beans and soya are also cultivated in large quantity. Cash crops cultivated include tobacco and coffee. Economically the area is quite well-of although the wealth so generated is not equally distributed among the people, giving a wide range between the poor, who forms the majority, and the few effluent group. The road network in the project area varies considerably. Seasonal roads that is only passable during the dry season-an important factor during Mectizan @ distribution. Feeder roads going to meso and hyper endemic communities in all districts are only passable during the dry season. Songea district is served by a tarmac road, which passes in the oncho area and therefore offers easy transportation to those communities situated along this road. Songea town, situated 1,000km southwest of Dar- Es- Salaam port, served by all weather tarmac road, is the administrative headquarters of the Ruvuma CDTI Focus Project. Mectizan @ mass distribution was instituted in The Ruvuma Focus in October 1992 tunded by RBF up to 1995. IMA provided bridge tunding in 1996 while SSI provided bridge funding for the year 1997. During all this time the project was being implemented using mobile teams to distribute the medicine. Year 1 APOC funding started in October 1998 with the new concept of CDTI. The updated census conducted by distributors before this distribution indicates that there are 393,049 people in 595 endemic communities in Ruvuma CDTI Focus Project. In the Ruvuma CDTI Focus Project the village structure is basically the same as is fotmd in other parts of the country. The lowest administrative structure of a community is a sub-village and a village may consist of 4 or more sub villages. A sub village is served by 2 -3 CDD's and administratively has a sub village chairperson and executive officer who are selected by the people in the community. A village chairperson assisted by the village Table 1: Number of health staffinvolved in CDTI (Please add more rows if necessary) 5 WHO/APOC, 14 September2009 t District/LGA Number of health staffinvolved in CDTI activities. Total Number of health staff in the entire project area B1 Number of health staff involved in NTD 82 Percentage B3=B2l Bl *100 Number of school Health Teachers involved in NTD Songea 146 ll6 80% 103 Namtumbo 210 105 50% 107 Mbinga 403 r20 30% 660 Ludewa 253 65 26% 36 Total 1J38 498 37Yo 906 1.1.2 Partnership The project is currently supported by APOC and SSI as an NGDO partner by providing funds and capital equipment to project. The District council supports supervision, planning and paying project staff salaries and other benefits during CDTI implementation. Community member are willing to take Ivermectin and some motivate CDDs by exempting them in communal work. 6 WHOiAPOC, 14 Septemb er 2009 t*- o\O N Los Eq) g(.)a s q, o or so J< q) lr o o olre q) E 6l rr)L() q) ? t, tr q) b0 cl L o E E E o() q)E ln €) T') Eoq.) CTE B q) oE q) a0 6l L o E A oI L o) (l) E b0 ea: -0)6t|LLCl6l rrr() =()>oHL - llr o\ o C.l Lr(B o oc..n 9Q o -o(d o o Itru) -ts8 (D-?<- (sl PLi +rO CdazH o U) (l) a -0? L EEEa d zH* \s\)\ \ cfl q) \-r \ q) q) r|\ t\\ a) u Bq)L o a) g q) s-)<-q) q) .o\ =rol \l bl :=lvt$l '\lo'lLIs. 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EE =o()H F o.rEE HHd\t Nla+.d-jHluddg -'-H-!H9I ,o--. =EH5 + .f\vA'.HY .E = _^^.k d E $S frE= I I9 >l\ UE+S hEa $ E .2A x .gc OE- o- '= tr p' !\*Es* -EEfit ;EE S EE:( '€ 'rrlP EE9 B OCtr F.x O ;!oo e0)EoO q) -\\)9vtr\+.osaQ,oO €.sS € : $s E .9= p 6 €.' G E 3e x E8;; E = HS E?rr.r\ H Es I E ,.rO O E!Y_ '3sF b .B-e : i E 3.= ; E tx Etra!{ <uEKU i E oo o SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treqted in current year,indicating when the key activities were implemented by the month they began and the month they ended. 9 WHO/APOC, 14 September 2009 o\ooN k(upq c) o.o CA .+ d o Pr i<o 'Jr l< € a z lr € €o L<o €L o H o d o o) E o o Lr a) B oLrI fo d H tko oo o Lr t, a F Uqi o tr .o+{ V) dL OE '(DG)- 'o9 9Lo3 'E -b4.2 'AE cotr rd Fl 3 .aa !bo GaECdH}Eg-E 3F,; ER o k\Jh=: 'oO- no=T#fi ,; !! Lir- H(1);< q)EX EE tr.9o'- Err\ O) lr'vu?E r l-i q) Uq) L q)\ *x v q)q q) S o\O c-.1 tr ct o >\ oL{ *< o o E ID (d ok V)(B oL ct o t< € v)o I Io CB(H o C)tr o tr F e.ir c.rl -l.ol(dl FI o 0 (l)q (n o oE.cEEooUE o\ L o)p o o o o\o o z o\o o(I) o o o C.t -oO trr oo4- LE6lo(AE o\o o\o o0 a o\ ()(,) o o o c.l ,oo tr{ o & O E ol e o oE+ ooUE o\ L() -oo o o\ o z o\o o(l) o o c.l d o E a0 GI(h o\o (.) = o\o >. o\o o z o\ P oo a (l) cEq o O (u Q o (l)Z.s =rjt troo\J I: o\o o z o\ o z o\o o z o\ 1.lo o o0 LE6tO AE o\o C)c o\ (.) tr o\ () o\ P oo a b0 6 F o q) O.EI oo\Jtr o\o o o o\ o o o\o o o\I() ID UD LEGlo AE o\o C)E o\O oc) o\or() a o\ ooA Oq .9 .:9E s= -aEoo 2 oZ.c 60QE o\o o z o\ o z o\ a 4)(r) o d o,0 rr Et6tO q) El o\o otr) o\ otr o\o b0 o\ P oo a (, 0 GI C) o0tr oa o -o tr Itr cl z GI oo -o c, B()! J Fl F oF 2.2. Advocacy The reason for mobilization and sensitization: Regional level:- New administrators at regional level. District level:- Transfer in of new district leadership within most of the progrirm area. Ward and village level:- Induction of newly elected ward leaders within the program area and retraining of previous leaders in order to we increase Mectizan @ uptake by the community. Problems encountered Funds allocated were delayed for the scheduled activities and MDA have to take place in the beginning and during farming season. Induction of new Coordinators at the Regional program office, Songea District Council, Songea Municipal is also initiating the program in their area and Ludewa Districts. Ludewa will start activities in 2010 because of logistical barriers. We experienced delayed Drugs and HH registers delivery to the FLHF due to delayed logistics in some Districts. Suggestion to improve advocacy o Adequate funds should be allocated and released timely. o Advocacy should be done just before mass drug administration and before farming season. o Timing of mass drug distribution should take into account availability of community members (during off season of working in the farms) . Collaborative work with HMT during MDA's and data collection from the Region to District level. The following table shows the number of policy/decision makers advocated at different Ievel per each district. 2.3. Mobilization, sensitization and health education of at risk communities Mobilization and health education of communities including women and minorities o The two radio stations in Songea and Mbinga are the main means of dissemination of health education on Onchocerciasis to the communities; these were used for advocacy and sensitization during MDA. a We received IEC materials from SSI which included T- shirts. These were distibuted to districts for use in FLHF and in the communities. a In most communities the signs and symptoms of Onchocerciasis has disappeared in some communities, following long term treatment with Ivermectin. The need to DISTRICT DISTRICT LEVEL WARD LEVEL COMMI]NITY LEVEL Songea t2 85 106 Namtumbo t2 74 145 Mbinga 18 37 30 Ludewa 15 22 35 Total 57 218 316 WHO/APOC, l0 April2003 strengthen health education and sensitization is being emphasized in all affected communities, especially in those with high refusal rate. t Leaders at all levels in the districts were involved in conducting mobilizationto their communities. Respo nse of target communities/villoges Accomplishments of the project in this year are- t The project conducted CDTI activities based on fi.rnds provided by Councils, APOC and NGDO partner (SSD. 0 Community ownership of the Programme is still maintained amongst community members by selecting their own CDDs and giving them motivation and incentives. The village leaders are supervisors of the CDDs activities at sub-village level. o CDDs are willing to distribute Mectizan@ to their appropriate sub-villages. In all districts targeted, training of CDD'S was done according to plan. Suggestion of way to improve mobilization and sensitization of target communities -0 Mobilization and sensitization meetings should be conduct every year prior to Mectizan@ distribution cycle starts. a Health education should be done continuous to remind the community their responsibility. a To strengthen Community self Monitoring and Stakeholders meetings in all affected communities. 0 Involve other stake holders to share activities which are relevant in their projects and which could be beneficial in improving community sensitization and MDA activities o Training of New CDTIAITD coordinators after retirement/Transfer of previous coordinators at Region and District levels. 2.4. GommuniQl involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: o Attendance offemale members of the community at health education meetings Numbcr of communitics/villages with community members es supervisors Numbcr of CDDs end the communities involved Numbcr of communities /vilhges with femrle CDDs Totrl no. communitics in the entire project area B. Numbcr with community mcmbers rs supervisors B. Percentrge Bo= Bs/ B. *100 Male CDDs Bz Femrle CDDs Br Totrl Be= B7*St Numbcr of communities with femelc CDDs B,n Percentrge Brr= Bro/B.*100 SONGEA 446 446 100 489 573 1,062 446 100 NAMTUMBO 335 335 100 335 335 670 335 100 MBINGA r85 185 100 r88 185 373 185 100 LUDEWA r6l 16l 100 r67 154 321 154 9s.6 Totel 1,127 1,127 100 1,179 1247 2,426 1,120 99 t2 WHO/APOC, 14 September 2009 DistricULGA Attendance of female members in most of the communities is usually higher than of males the approximate ratio of Female to Males being 1:1 or in some places 2:1 I In general, how do you rate the participation offemale members of the community meetings when CDTI issues are being discusses (afrendance, participation in the discussion etc). In spite of the women in most of our communities being shy to speak in public however when prompted they contribute in asking questions and put their inputs on the extent of the problem in their communities and the need of ffeafinent and care not only for Onchocerciasis but other health issues within their community I Incentives provided by communities for the CDDs Incentives provided by the communities for the CDD's are exemptions from communal work during MDA, being elected to participate/volunteer in other health programs taking place in their communities and recognition. t Attrition of CDDs, Is attrition a problemfor the project? If yes, how is it addressed? - Attrition is not an issue to Ruvuma CDTI i Other issues 2.5. GapaciQr building There have been major changes of staff at the project regional offtce and district levels. Changes effected at FLHF levels were affected by replacement of on job training of personnel in implementing CDTI - Describe the adequacy of available knowledgeable manpower at all levels. As stated above there have been major changes of staff in the regional office with retirement of Ruvuma CDTI project coordinator in July 2009, the Transfer of Ludewa District Coordinator early 2009 and retirement of Namtumbo District Coordinator in December 2009' However there has been stability of workers involved in performing major tasks with successful implementation of CDTIAITD activities in spite of these changes. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if stalfs are frequently transferred during the course of the campaign). Coordinators at Regional and District levels attended seminars and annual meetings in planning and budgeting. Competent health workers have been selected for smoother Coordination of CDTI activities in Namtumbo and Ludewa Districts as well as in the regional CDTI office. 13 WHO/APOC, 14 September 2009 I ca o c.l L o. o o Or o bo ou q) "a \ o V) \)\q) B q) L V2 q) ,\a\: $ ot\IB o\ bo \ o *q) :\ o() a) .s sS o\ a. st l*oIB B B s Bth +.$' 8< = .q) R * q) E sltr u) nU(l( o L(l)E E z ?rr +b -\ot;iF cSOu t) U +. q 1 q) R oOt .--__.1 o\ o\ *l o\ o\\o ca $ oO$ .----l ca cor- ca $ o\ ot o\f- c-l ca o\ cf) c..t (n\a\o o\t\It :_ ttaN €t- Eq) EI (D q) EI c, sU olrtr c.l\oO cn .+ o * eO C.l ca \oN GI (- .AL €) lrA qtF LF(Dv E8 +r O)otr LGl(l)L -Q'.-E z cll v o-.+tru =Q U 3s *d +.$'q cao o coo -----i O r-t r- .+ \o C.l ool \o ?a NN o\ o E €) E o I EI sg\U oLtr \oo C-l F-t \ool ?a t) oe Lq) 6r9q) GL()-H l-rtl rrrr-. !! v4D Lq) E z .\ € Jh;F-d N U Q. +. o)' A< = .q) = c.l$ c-- c-l tat .+ cn € ra) ----i co \o c.l N \o 6\o t- \oia =o\ Eo Eq) €) EI ra(,oLFr ca+ la) € \ool o\t- qi G rr, EA c) o4) ,- Si Lq)E E z € J!Yts-d \) $ ,r* n< : * O -----i ol c.l \o \o rr .t t-(fJ t-. ULt'r o o oc.l lal ra(a (J Fl I L 02 a rqt) zoa m F z z e A > rq a D Fl Fl ti o Er -\ 44q) U \- L q) :\ o t q) ra Sq) 5 o 0) o a E F t-]O +ro v) C) 0) d() k .oE .d () (s bo tr ctkF .iir orl -oldtFI tr(D Eo (!) E e) s raO Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatmentfigures If the project is not achieving 100% geographical coverage and a minimum of 65oh therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. N/A Trainees Type of raining CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci&) Program management { { { { How to conduct Health education { ./ ./ { Management of SAEs { { { CSM { { { { ./ SHM { { { { { Data collection ./ { { Data analysis V { ./ Report writing ./ ./ { Others (specifr) { Primary school teachers 15 WHO/APOC, 14 September 2009 t a o\oo c.t tsr o) -o tr C) a.(!) U) * oA o Jr g .9E ct H trGN Eq) tlla E c) €)9(!(l)9rhEEEOE.F -coHEE;r ;ft(u.=o?'aotDX 89t!oP&E.gh =='(l).=EEZeA.D =(rEBE.E€ =ehFU) '==(! -r_E.t) .. O .9e,)jj .9o'E E E 8I EE ! -l Hs. F :l I '"d b El gE.E B Ei E ,tts * ;lE aEg;lF#${lE rEfl EI: EI€ {i? EEEI EIE EIg TIEna-iil ol o. ol E ol r:f + H slg El! slE!EE EIE EIS EIE: ? El 2l€ 21,3 zle S oo.9l E:= ff| ,, ,, ,, trEol .9 ti€l o EEH E E EFEI g I EIE r_.1 o = bO ?HEl Es fs $s;sEl $ $ 5A- ol -E 6 F \o oF (d(l) rr(d oo 'a lia o € .ts B an dq) L CB .9 troEtr() rloa >. o(t) C) E o (B or Iot € *l o> xl ! *l o EI ;8lE!l I9l p oI qroloOl golo <*l D ol tr r-l E 3I trtrlE =t Bz ? ll €(I) o s(,) d()F s o_(l<Ed ;pEsfr'se'* E Ht xE$E€299'9s o o o o o €i>a2z o o o o ct 9U =vq) (d @ @l() (f) N o, o o,l() c.i oNaNN :€ s - EEiE :[EE os o) @ O)(f) c\t so(o_ (o (f) G'o o_ ro n o ll * oa F a F e I a \oo\ t -_E8E EEE z ts c.> cl o,=:Jtr1ri E E.q < g4'FU aa6 *8 E.E, S3o.nE<'= e Et oUO =00octO. !i(ds, ooF(JF (o tri @ rod @ (ot- sf(o o@ (o$ o) .t c.,t-N 6io s s$ t-$ -$ No ro- No c, s o) (a o) rO$_ oo (f) @!t- @s o)No$lO ro @ d G' lr)lr) F- s(o $ o)|r, o, @ r- F-l{) oN(f) s@ o d1\(i) n HE E 8., t E+,f$€ e.F 8} E 9 o ll *dd a a oc) '= bI) !s ():dFBCE()OE s ESu E=Etg tsarE 6.2 =E6E .q<.s*' F\J oo oo oo oo oo @tt rt lr) (f, (f) |o @ (o r N @\t\t lo(9 (f) r() @ (o N (o$!t lr,(Y)(r) lo @ r(o r NN E*BV E] o zo v) o Fq F z () z ca A >H a 3 j ti oF t CrB 4 s)Uq) \- ? o\ q) L t q) h' vq) U J1 v, Lr cd U)(t() L GI (B tr Fl o t< th >\& v) rI] a cl (l)t cl(D l-rF r*f c-rl -olGrlFI ao\ oNk o)s €,) o.(1;) a $ o. o r-- q) s q) I l! .ss$ s c)!o E\q) Eq) a{t us s\i,* .:s oo1 Bj !a .{S .ss :! qrE\s3SG .. :.EE EE s!i \IelSE .S 'SsE \.ui *H\ sq)F Sti-{ } a': HSE (1S ;L s ssd ib .3 Ytr$ \sI s:'sY E:s 3-q * si)rs' sX B tsuI ts .s sEoa uds' €\ : qi\E E$ .8. SS\I sSt Er: s.s \! SsE T.gs 'nE 's dEB SP$ $'iiSi :llrt\ t\ ='r nlS UT\ sc ta 2.6.2 What are the causes of absenteeism? Drug was distributed during rainy season in some area of the project therefore people were already in their farm 2.6.3 What are the reasons for refusals? High number of refusals in some part of the project was caused by the fact that people did not want to stop taking alcohol the day of MDA. In many areas there is no sign and symptoms for Oncho therefore people think that the disease is no more and not a public health problem. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. There were no reports of serious SAE's reported from any district in Ruvuma CDTI project o Parasitologist trained? NONE o Existence of microscope? NONE In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to V 18 WHO/APOC, 14 September 2009 o\ooN Lo -otr oq o U) .+ (J o Or o a o\ q) kr o'\ a) "a s\q)q * e v;q) uq) \- s L q) Lo t a)4Bq) U Eo t<oa bI) ts oa(.) l< C) o0 l-< E o)t<L ooo P v) rrl a v) (l) 0) o(h L{() an o t<(l) v)(rr o V)(l) V) CB O #r 6)l -ol GtlFI a =EP -EE 5<.E E PHg 'EESC'()i,2E E fi $g o.9E3OE ESqJ a. I0(l)n €!etc 7E Eo-c tril9d *98-o.9E6 C) H c=!HL'-d@aoO E E..E t-l o!'A xv qEb' o'= -g =F€ U 9I-.1 (B E +; z sst€E o otr o a >.q) z r.g H o= q) A>, A!oa6 s* .9 !.a -as s o o)b0c6.= = bI) ao xoo (l) o0 * a \o @ n o\ e c- q \o ra a- o\ v.) a -t Oo\ \r- oo t$ \oo\ e c- ..i r-. e c- r- c.t € oo N o\ o\ t.- 6.t 01\t o\ al t-. c- c.l ro \o j N *^ o\ o\ e.l F- o\ c.l \o c.l \o \o \o @\o r- o\N o\\o @ r- m al vl ca o\ co oo F- o\ a.l t-@ \it-. co oo o o\ca o O o o,(o \t o $00 F- Nv r- a.,l <.\o € m t'r \o F-6l -i =f\o r+@ F- \o r-a.l oo ol \oao c.t t'-oo c.I € o c.l o\ooal o o a.l o\o cl L<() ! Q)q(I) V) !+ d o O.{ trr O ol a tr € E - - .9 GII q) a0 GI <L!tg)NE\rhuyL- .Efsi-Sr-LP?g.*.F 9r= x.st9\ct;BE6q)ts= 5$tt :N.; .:\)tu ctgX9'..j .EHH Lfr Ic)oYe()= - .= o- a0eltEi[ E:,.r- aFg F= -0)\/b€orUHgEE g -E U r.)e( >\rlGtEEI fltrEl cl0sl E?(g1 €)ql ()l .-631 EGloli +.bo=E Bi :orFrPoot9 € :Eb;E-3tr(l)-4.gtr0) :H€FiEaE(r9uir:E\oaei ?l ', =l 6tHl IFt c a C) 00 P8oFf ><r -o(.) ca\o € € oc il. rd il Id GA9 *$ E6E'E o ho ' F q€ o. "6 C)5c) , bI)O Cd-sus ootoF -Ee6, o.=5trlia c d.= < 9P'Fq, () bI) Gl c) oo .,o oa€u9()E2qEtr50A6 o. c.t\o 6 6 \o F-\o oi\o o\ t- \o tf \o € a-{ 00r+ € o\ o\ o\ ca N N o\ a.t o\ F- + c.l \o\ri F-N $r-q oo a.l a.l o\t(?) r- €N a C) bo(tl q It) tr oO eo ll r r.i ti ri e$' oo o B= g.t*s o Ll kOo'E q E E SE E L;i O '706 a.t =t\o Ii -E.od o.= =Eoc (d.= < g€'FU N $\o o0(g =qtE g E.Ert ()E >i:: -'E a E -!,S'E'= > E8 E E EgE Htrtr() oo el s\o & rrl t-. o\ o\ € o\ o\ o\ o\ o\ o c-.t t o o^l tro cl oo Fr td ri 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate onswer) ,/ MOH WHO tr I'NICEF tr NGDO Other (please specify) .E Mectizan@ delivered by - Qtlease tick the appropriate answer)/ MOH f] WHO N IJI\IICET f] NGDON Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan retirement by filling in the ordering forms and sending them to the National Onchocerciasis Control Task Force in the Ministry of Health. . The NOTF Secretariat went through the Re - Application Forms, approved them and then send it to Mectizan@ Donation Programme (MDP) o The MDP scrutinize the Form and send the drug to the Ministry of Health through the Government Clearing and Forwarding Agent in Tanzania. (Medical Store Department- MSD) o The MSD notifu the NOFT Secretariat on arrival of Mectizan@ who then informs the Project Coordinator. o The Project Coordinator collects the drug from the zonal Medical Stores Department and enters the received drug to the District Pharmacy. . The Coordinator sends Mectizan to the nearest health facility for distribution to the community through normal drug distribution channel. o FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan@ . They come for collection and distribution to the community member in the entire area Table l0: Mectizan@ Inventory (Please add more rows if necessary) State /District /LGA Number of Mectizanre tablets In stock from previous year Requested Received Used Lost Wasted Expired Remaining 104,828 From MSD From Songea DC Songea 1,500 0 840,000 590,000 172 0 0 Mbinga 24,881 0 l,l 18,000 0 787,600 363 0 0 354,918 Namtumbo 0 0 469,600 0 341,097 50 0 0 128,453 Ludewa '7,927 0 0 146,500 89,125 132 0 0 65,170 TOTAL 34,30E 0 2,427,600 1,807,822 717 0 0 653,369 How are the remaining Ivermecfin tablets collected and where are they kept? The remaining tablets were collected from the communities and returned back to FLHF by CDD's and then the DOT'S or CHMT members collected them and bring back to the district pharmacy where they are stored. Reallocated to other FLHFsfor NTD implementation in the whole district Distribution exercise was done simultaneous with other NTDs. 2l WHO/APOC, 14 September 2009 ::::::::::::- - 0 - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project areu Activities performed by Health personnel in handling Mectizan@ o Supervise census update in hisftrer catchments area. e Mectizan ordering by filling in the forms and sending them to the District Onchocerciasis Coordinator. o Makes follow up to the District Offrce. r FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan. o Organize and attend mobilization and sensitization meeting to the community members o Conduct supportive supervision during Mectizan@ drug distribution to CDD's. o Data collection and report writing and send it to District Oncho Coordinator . Conduct feedback meeting with community members. Any other comments NONE 2.8. Gommunity self-monitoring and Stakeholders Meeting Has uny training (of trainers)for community self-monitoring been done in the project area? YES If so, When? 1n2005 Table l1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- mon'toring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatmcnt cycle. o Increases community ownership hence sustainability can be achieved in the project o Solving the problems in the next treatment cycle if identified and maintain successes 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF T J DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSIvt) No of Communities that conducted stakeholders meeting (SHM) Songea DC 446 120 72 Namtumbo 33s 0 0 Mbinga 185 128 185 Ludewa 161 0 161 TOTAL 1,127 136 418 22 WHO/APOC, 14 September 2009 RMO Iringa I IRMO Ruvuma DMO SongeaJ RNTDC J DMO Mbinga J DMO Namtumbof District NTDs Coord. J DOT'S I FLHW'S J CDD'S t Community 2.9.2. What were the main issues identified during supervision? o Motivation to CDD's was not enough compared to other community workers who work for other programs for example those working for Malaria Program are said to get a better incentives. o Inadequate IEC material and shortage of HH treatment registers in villages. o CDTI focal Staff transfers to none endemic area 2.9.3. Was a supervision checklist used? Yes, APOC developed check list which is used, we request that is be reviewed to carter for all NTD's. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Each level was ready to improve the performance of distribution however there was late drug delivery this year and to separate report for CDTI and NTD is very tasking. 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? 1. Many community leaders provide incentives to CDD's in kind and not cash 2. Community members were encouraged to provide incentives during distribution. a 23 WHOiAPOC, 14 September 2009 SECTION 3: Support to CDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) Others Condition APOC MOH DISTRICT/LGA NGDOSource Type of equipment No Condition No Condition No Condition No Condition No 1. Vehicle Region Office 1 F I F Mbinga I F Ludewa 1 F 2. Motor cycle(s) Region Ofhce J CNFR I F I F Songea DC 1 F 2 CNFR Ludewa 3. Lap top Comp. Rqgion office I F Namtumbo 1 F 4. Printer 2 F Regional HQ 1 F Regional HQ I wo 5. Photocopier Regional HQ I CNFR 6. Fax Machine 7. Others I F Regional HQ I F 1 F c) Bicycles 70 F r.ramtumbo a)LCD Computer Pro r b) Desktop +Condition of the equipment (F:Functional, CNFR: currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? o All the district councils have incorporated CDTI into CCFIP. The equipments are being run and maintained by the councils. Plans to replace them follow the normal process in the Local Government. o Location of some equipment is not clearly known since there have been changes of and retirement of previous Regional coordinator, transfer of Ludewa Coordinator and death of Songea Distict Council Coordinator and no proper handling over has been carried out. 24 WHO/APOC, 14 September 2009 a 3.2. Financial contributions of the partners and communities Fill tables 13a, 13b and 13c If there are problems with release of counterpartfunds, how were they addressed? Additional comments 25 WHO/APOC, 14 September 2009 o\ooN L()p () o.() U) $ ri o O.{ o B \o al o =F:(J= olr o- € F-t) o\ .+ ooo Fa -i OoO oo t\.t c.i o € ! o\ 6 o\F. \o ca o o o\ F- \otl o o o o E o o u) N + (a cl f YT (.T (a CTc\loFo F(l g, o .c o trfEO =oE'Eo'-o E8qE -z tr o Eo e = -o .12t E oct .U CL ooo(, z ttq, e =It oSE NF- ot- o\a o\ \oc.l oi c= CI6 o o o oo GG o $\o N ooo$ oo o o F- o t- o el ra oOori ..i o\ c- o\\t o o\ GTla)ta (r) <f oo O o\6 o (7t o\oll\l oi o \o o\ c.l oour (fl\a6\ e{ o O I o o\ c.l Oa do € ri o 8doF cdc et')tti o o!+\o a.t o sf € ooo o €n (7) oo ,.i o oi o\ r- o\ =t c o\ N la1ta $ € o c.) o\ € o rtl o\ GI(\t oi O \o o\ a.l ooYi (.l\a o\ (.| oo O c.l@ oo o c.l t6 oo ra !6 ot QG'F 6r GI o o c- ot otnt- oO o\ o -t o o to-t GI !! eg 6\ YtI L oBE oC"Fc '= oEELol- =3Gt,o-OG d€l EflI sl ol rEt ol rElzl '6 lt E UJ (!!tE -g(! o o)oao{ os tr o , ,tt L c o(, Fz UJ .z E, LrJ o(, F-\o Fa o\\o oo o h e{l ooYr .t\oF. ta GI O o \ot ooo \o =o o\ ooO st @ o o- c.|$l hiil t o" clg\! (r) at ro\o o\ N o ta (.1\a6\ .I o O o\ N o oo € otdot- ao ot+lo o\ oi\o IUz IIJ(, o =o o c o .EN ao tro o *(,I o E IE soE6N ao = tro G() SEo Go 5 o =i c o o .N =oc o U) ..i (') -c =ooI a G o IaS .o oooo o oic cl (U1 LI otLI tsJcl .cl(!l Fl rlNl Ots tr Gt o ovL o =E =oo - o olE c (E1 L] ol \l c,tel .cl EIiql 'l =l8lol dl5l U,I c o (! S G ur dtr 'tr o tr o E o UIil ot AJSI ,r.l =l c!(o E o o .= o lJJ "i(f) G o aaIta tro Eoo Gs G E s o o o eo E G eo o o1 oi lcto IE o s o E 'lt(, o to $ c o ,o L .,2E U' c o o oo o !o oLq) (, o $o c ol EI oloi olct ol =lo{l$l >l al 9l{llSI arrl oo 2 oq x o o1trt olEIUEI <t rl oo L(I, o U) -d qrf, J] <tFI olFI ol zl f,l ol o)oLr V)(B o tr € Cd U) tro s t{ tr oo CB o Cdtr ? 6l(.l q) cl t'r o\oo cl l.r(,) -o (D q o) v)$ ri o { to c I OF-o c.l t)k(t, o >. oo l.i P U) (l) I L{ € v)trotr Ldg CB p (n tro s Lr o() ct o d trt I(a q) ! ct Er o of E q)(l)k I(n Cd o l.r € Cd a o)! L c oo cl oc cttr fr{ji(.) o) ! c! H co o.t =l' (.) CI t la (.t (a: caq. \at-o t- at o o\ F.. \o co o 6\F \o(.) o ooo o ta) oJ EE(J= olr o- oo c-6 o\ <t F- o o c.l N o 6( o\ 6 o o .c o oo .E =E E oo E8q8 -z EI E o U' 3lt o E h otrE .E GLt UJ o ooooz oo o o oc 66o\ \oc.l i o F-- GI€!,q, U' lloSE NF- or- \o ooo ooF 6o oI Y't-\a6! o (?I o\N GI o\ O \o o\ e.l ola (t)\a o\ GI o o\ (..l O o € ooo ooGI la1 o a.l O o\ Fa o\$ og\ FItota rr) oO o <t @ o o\ €+\o c.l O o+@ oo o r.. to oo rn !6 o a Y1alF (.) al (.l o\ GIat o\ \o o\ a.l 3l.r(.)\oq 6l O Oo .{ @ OO o e.l oo 6 =(.) e.l o o\ r- o\s o\ al Y1 ra (.t o otO 00 O (o o\@+@ N o os6 ot oft o\ vit o\ + oOo o (., oooo6 GI !i o o ota r-. o o t- Lo o ;EEX}F -9 o 9EfE58oo =(! €.EEB9tr,c_ 6.9 E E= ooOdo € ooo o6F oo ot !\a6\ o\\o O 6t st o o" GI o\t t) al CN\o o\ e.l o o\ c.tO oot/i 6l\oF ta cl Oo o o \o .+ o \o!o o\ Oto @ '6tt G IIJ (E E'cg (E o o oEo tr o =ll E oo Fz UI =zt !.1 o(, !,o o EDE' o t-\o r- o\\o ooo N N lf) I o aaI 30 o oz t o o1 c otr oU' GtrG E ! tr G tr .9Eo{ttr 'tro EB!o .s8 o: EE bErg IIE o C o(, oo o E'(E o o oo o c o Eoooc o = ..i s c o fll L ..2!, .E o o EL o .: -+ a o aaIq > d c o (o ofEo .c =o o - a G o Ia5 U, os tr Gt I "lOI 'El GISI GI >tUI ottr 'tr o c o E i o o .E o CLI U, {tl ol -YlLI o1 rl!v.([ o - o o, .Ec (tr L o cnc c .G F ..,i N oooo o c,c :E E o oc c EF -oi G o IaS(t) C o E .9 o) o lrJ d UJz ITJ(, oDo GIot{l oltrlot G] .Nl tt, tro ta s(, Go o E G tr o !EC seaao9 =€{o c o og -oo =i C o oN '6 c oa "i (.,(E o o !, .i oovi (?t\o6\ e-l o\oo c.l k C) -o E o) a. C) v) .+ d o O. ,l oo ol ofF;O=olr o. o a o\ oI\o r+ t+ on o\ocl e.l Fq G'C'GI Q o oE o o "c .=c =E E oo E8q8 lcto E o 2 =tt .9t, 2 oct o o,t UJ I o ooo(, z t o Pftt .9It s c.l o\ 6to\ o\r- 6 6 \oo\ F- FI@ CI6 o\ o\ O \o !o\ 6 o o\o ot o\a oa o o o \o o Ej 6 o o €a ca N N o o\o o\ o ae\o a oo o\o rf E3 o\o ra i o6t F 6f o \o t!i citF GY) q c G €G \o ooo-o\o o oa <l o o \o oI oo6 o o@@ ol et N o \o o\ o c. o\o c\ oo \o s oI o\c ra i $ r e.l oo \o t --.o F G rf) q c G6G !! og_ g,-gtrb '=F -9 o e6!5 s8{,o_ =GiEEglgEl egl Esl6l =l tr lu oEt o .Eo o o =o E o. e6 o N o = toE o a- E c o =.Et L tr o(, =IU =ztr lrJ o o o alt-\o (.t -lolol ..1 I \ol -l -l sl =l slbi x: N, 11i elslsladldldle5; ;55, r "l f io a.l+ o o 6l t * a- c{ sl e --al o =l 66r o "tl ,i t9 raF6 t o\ s o .E G(, SEo t Go E a o GN ttt o ta * .J Go o E a c o G .N a o = F UI(, o =o clol ol .NI .ol ol >t;l;l cI oi GI .Nl 6lcl olol orl -l a? a c o (E o =t, o s o aaS U, oooo o N 2 ov o! -c =ooI o olc c (U] LI drlLI\lolcl .cl sltl6tl *l G o aaIto tr o GI G tr.| 6tr 'tr o tr o E o olil ol OJSI 2l c .o .a z ol o.l fl @l -lol CD .c L ol 'El ot =lorl ail E o (El f,1 (El >t uJl .l al -l G o IaIt4 IEItrII o5Ia 'tr o E c (, o Eg > o trI o o e o, t G o o o o o + c o f -o L ah E aD c o o oo o Eo o)L o o U) o cl ol EI orl oT olCI(!l >t .t o{l ol G o IaSq oo oco o.xo Gc o E]Ei <l sl o o L -g(U U) -d ql() 3.3. Other forms of communitlr suppoft - Describe (indicateforms of in-kind contributions of communities tf any) o The CDDs are exempted from the public works especially during distribution. o Community leaders and CDDs collect Mectizan from the nearest of the FLHF 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. lndicate exchange rate used here USD$ 1 : Tshs. 1.300/: Any comments or explanations? NONE o SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated"/monitored? (Tick any of the following which are applicable) No Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? N/A 4.1.3. How have they been implemented? N/A 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? N/A Was a sustainability plan written? N/A When was the sustainability plan submitted? N/A a 29 WHO/APOC, 14 September 2009 What alrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels CDTI activities are already incorporated into CCHP, and the plan is bottom up plan which is based on the priority of the community themselves. 4.2.2. Funds District Councils are ready to take over the programme. Budget for OnchocerciasiVl.lTD has been included in Council Comprehensive Health Plans. The district council has started releasing funds for co implementation of Onchocercasis and NTD control activities. Local Government Authority is supporting CDTI activities. 4.2.3 Transport (replacement and maintenance) In this reporting year, the project received one new vehicle for Mbinga district from ApOC. Maintenance of both new and old motor vehicle will be done by using Government frrnds. 4.2.4. Other resources Human resources is stable as all Onchocerciasis team members are government Employees, the problem of shifting is not there so the human resource is very stable. Nowadays transfer is only in special case or if the staff went for further study were by the chances of stay at the same FLHF is after complete his/her studies is minimum, otherwise staffstays in one FLHF for a long period (human resource is stable) 4,2.5. To what extent has the plan been implemented CDTI activities have been incorporated into CCHP and most planned activities are being implemented by using council funds. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms lvermectin is delivered using Govemment structures, CHMT members deliver Mectizantablets to FLHF those are within the Onchocerciasis endemic area together with other essential drugs/drug kit and vaccines. The FLHF in-charge and his/her subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect Mectizanready to distribute to the community -.rib"rr.The same CDD are also responsible on distribution of Albendazole for Lymphatic Filariasis and Zithromax for Trachoma Elimination. 4.3.2. Training o There were only few new CDDs and FLHFs so training and re-training for CDTI and LF were conducted at the same time. 4.3.3. Joint supervision and monitoring with other programs Supervision and Monitoring of CDTI activities are integrated within system. Therefore at Region and District level supervision is done by joint team using the developed checklist. The team includes medical staffand program staff. At regional level the team sometimes includes other regional leaders. t a 30 WHO/APOC, 14 September 2009 a4.3.4. Release of funds for project activities Funds are released through normal channel according to budget line item and every responsible part plays its role. The responsible part in our budget is APOC, Council and Government 4.3.5. Is CDTI included in the PHC budget? o Yes 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? r For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? r Explain what are the combinations of interventions co-implemented? o How were the interventions implemented? (At the same time?) 4.3.7. Describe others issues considered in the integration of CDTI. . Drug used is the same to both Programmes - Mectizan addition is just only Albendazole and Zithromax o Communities served are the same therefore it is easy to conduct HSAM o Community selects drug distributors themselves and they live together and are the same. 31 WHO/APOC, 14 September 2009 o\oo cl LoI E(l) q oa l+ o o Or o B c.l c.) l%ls)$ B Rq) .q) Va s q) B q) -a s) q) 14 V) o q) t s) a) &e o (J Gq) O o0 (l) o (l)E z cll olr F-o 6i \oq oo+ <t c.l o t- e.l \oq ooss F-- a.lt) O(l) G €)Ir o €) 6, o o o0 ct 0 0 (l) a (l)E z 63 o t'r \o \o ca r-Or- € a.l c- @ € \o sl' c-OF- € a.l @ oo @\o o o) 6t o) f= 0(l) 6t 2 0 aAUsu9 lOo>EE z 6l oF \o c.lt of + o tt o\\tt-- ..i O(,) cl, oE t't+c\ 0o 6l E o\F- EE 5c -o=EE z6o q) ()ql o)& t-. e.l (l) (l) o! clF F. 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(r) o o & L9a l-{ o 3 3i tt) o () C) o o F .E5TE9E LLLP 0Jt,>= a (} o cgOo !N =(o#Eio, .9 llOE a (tso_ coo= =(!s6 .b 'Fi,(E Oq o ooJ co ON .- (OEEE5jf, -oq, 0,OE a z J J rts o c .o P) -o L P .9o o PC o E(u oo(o E.eELs(E OJEEEOs -o a c .9 l!Pc<ocE '= O,k* >6 a x(! E oL v-N a a a o c E oI o o F o t,(g oLoo-o.i -EIo= \J() U) U)d (d rE o (dEq >. rl (t) (n(0 tr ot) o .t) oa Fa oL oo (B L d (0 z oL oo (B L(d (o o (rltrz (0 o(0lrF tt)!o6 (d clU a oo o. ah v) o o q) S. a-o'T\ s-N$' o.a s .\c(.) () O L{ u) a(-) bI) a a(.) E cd b0 o *<a () o ra trl q) -s G t-t 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 4.4.2. How were the results applied in the project? NONE SECTION 5: Strengths, weaknesses, challenges, and opportunitieso I a List the and weaknesses CDTI List the challenges and indicate how they were addressed. . Opportunities:- o Permanently employed government and council employees who are committed to their work are located at all level of the Region to the village. o SECTION 6: Unique features of the projecUother matters We were visited by the APOC Director, Madam Dr. Uche Amazigo, she was accompanied by USAID representative from Washington DC, Ms. Angela Waiver. Dr. Amazigo hada meeting with the regional Administrators and had time to visit 2 villages namely Likarangiro and Lyangwe,ii in Songea D.C. She had time to speak to the health workers, village leaders and the .o.-uoity * well. The communities were pleased to see their donors and also had time to ask questions and have pictures taken with their visitors. STRENGTH WEAKNESSES Having a prominent Partner (SSI) who supports CDTI activities Late disbursement of frrnds from APOC Councils for implementation of CDTI activities incorporation of CDTI activities in the CCHP in all Districts The Councils are providing inadequate funds as compared to the budget. Community acceptance to take/swallow the CDTI activitiesMectizan and Misconception of the effects of drugs among members. ect staff are committed to work in theKey proj ect Drop out of CDDs in some communities training of new CDDs working facilities are availableAdequate Old and worn out Motor cycles affects drug distribution, data collection and supportive supervision CHALLENGES SOLUTION Population fluctuation in mining areas Involve government and political leaders to solve the Late arrival of Ivermectin drugs in the districts Distribution of Ivermectin to the the available stock of Need for CDDs to cover large geographical area and in some areas there are game reserves and wild animals The Project should consider motivating CDDs with bicycles. Dela disbursement of funds Timely disbursement of funds Delayed annual reporting Quarterly reporting, dissemination and feedback meetings 34 WHO/APOC, 14 September 2009 community