Extension Phalombe annual project technical report submitted to Technical Consultative Committee (TCC): January 2010 to December 2010

) RESERVED FOR PROJECT LOGO/HEADING (including e-mail address) ORIGINAL : Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) COUNTRY/NOTF: Malawi Proiect Name: Bxtension-Phalombe Annrov al year: 1999 Launching year: 2000 From: January 2010...To: December 2010(Month/Year) ( Month/Year)Renortins Period: APOCfundingvear: (circleone) I 2 3 4 5 6 7 8 (9) 10 11 12 13 APOCProiectimplementationyearreport: (circleone) I 2 3 4 5 6 7 I 9 l0 (ll) 12 l3 Date submitted: Ministry of Health African Programme for Onchocerciasis Control (APOC) Mectizan Donation Program (MDP) SIGHT SAVERS INTERNATIOAL 62 communities Partners: I WHO/APOC, l4 September 2009 t I I I I I i ! I I 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: Malawi DHO Name: R.Piringu Signatuie: Date DEHO Name: . . .S;S.' Signature: Date _7 l- t National Coordinator Name: L.Si Signature: h 1{ Date: \\O l.[ff This report has been prepared by Name : ...C. MAGERETTA Designation Signature : Date 3l-t- ?oto .ADOC... ll WHO/APOC, 14 September 2009 t t' Table of contents .....v DEFINITrONS......... .................... VI FOLLOW UP ON TCC RECOMMENDATIONS ..........1 EXECUTIVE SUMMARY......... .......................2 SECTION 1: BACKGROUND INFORMATION 1.1. GpNpRalrNFoRMATroN............ 1.1.1 Description of the project (brieJly) ........ 1.1.2. Partnership 1.2. Popur-arroN ............... SECTION 2: IMPLEMENTATION OF CDTI.... 2.5 Ennon! Boorm,rnK Nor DEFTNED. ........ Error! Bookmark not deJined. .,,.4 ....5 ....6 ..17 ..18 ..18 ..19 ..19 ie ..21 ..26 ..26 2.1. TrvplrNeoFAcrrvrrrEs............ 2.2. Aovocecy 2.3. MostI-rzeuoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNrrrES 2.4. 6 8 8 8 9 2.6. TRparveNrs............. ......1I 2.6.1. Treatmentfigures........... ...........11 2.6.2 What are the causes of absenteeism?.......... ....... ....... . ...1i 2.6.3 What are the reasonsfor refusals? ................ ... .... ., /{2.6.4 Briefly describe all known and verified serious adverse events (SAE) that........I3 2.6.5. Trend of treatment achievement from CDTI project inception to the current yeai I 52.7. ORoenmG, sroRAGE AND DELIVERy oF IVERMECTIN ............17 2.8. CovvlrNrry sELF-MoNrroRrNG RNo SrerpHoLDERS MpErmc 2.9. SupBRvrsroN............... 2.9.1. Provide aJlow chart ofsupervision hierarchy. 2.9.2. What were the main issues identified during supervision? 2.9.3. Was a supervision checklist used? 2.9.4. What were the outcomes at each level of CDTI implementation supervision?.19 2.9.5. Wasfeedback given to the person or groups supervised? ................................19 2.9.6. How was the feedback used to improve the overall performance of the project? 19 SECTION 3: SUPPORT TO CDTI....... ........19 CovuuNrrY INvoLVEMENT .... Clpactry BUILDTNG EqureveNr FmaNctRt- coNTRTBUTIoNS oF THE pARTNERS AND coMMUNTIES OrueR FoRMS oF coMMUNITy suppoRT................ ExppNorruRE PER ACTIVITy 3.1 3.2 J.J 3.4 SECTION 4: SUSTAINABILITY OF CDTI........ ..........26 4.1. INreRNal; TNDEeENDENT pARTrcrpAToRy MoNIToRINc; EveluarroN.......... ...........26 4. 1. 1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable).. .... .. 4.1.2. What were the recommendations? 4. L3. How have they been implemented?.............. 4.2. SusrarNearlrry oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy AT Yn 3)......... 4.2.1. Planning at all relevant levels lll WHO/APOC, l4 September 2009 Error! Bookmark not deJined. 26 26 26 27 27 4.2.2. Funds........ .....Error! Bookmark not deJined. 4.2.3 Transport (replacement and maintenance).............Error! Bookmark not deJined, 1.2.4. Other resources.. .............Eruor! Bookmark not deJined. 4.2.5. To what extent has the plan been implemented...Error! Bookmark not deJined. 4.3. INrpcRarroN............... ......................27 4.3.1. Ivermectin delivery mechanisms.........................Error! Bookmark not deJined. 1.3.2. Training.... .....Error! Bookmark not dejined) 4.3.3. Joint supervision and monitoring with other progroms.... Error! Bookmark not deJined. 1.3.4. Release offunds for project activities ... Error! Bookmark not defined.1.3.5. Is CDTI included in the PHC budget?................Error! Bookmark not defined. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............ . . ... .. ......28 4.3.7. Describe others issues considered in the integration of CDTI. ... ..28 4.4. OpenarroNAL RESEARCH. .......................33 4.4.1. Summqrize in not more than one half of a page the operational research undertaken in the project areawithin the reporting period....... .....................3-l 1.4.2. How were the results applied in the project? ............ .....................-t-1 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND 0PPORTUNITIES.... ....................33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS............33 IV WHO/APOC, l4 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo DC DEC DHMT H.S.A. MDP CHAM DIP NOTF African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment 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 District Commissioner District Executive Committee District Health Management Committee Health Surveillance Assistant Mectizan Donation Pro gram Christian Health Association of Malawi District Implementation Plan National Onchocerciasis Task Force V WHO/APOC, 14 September 2009 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 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate 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) 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 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) Communitv 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. VI WHO/APOC, l4 September 2009 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) Number of Recommendution in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT USE ONLY NA NA NA NA WHO/APOC, 14 September 20091 Executive Summary CDTI program in Phalombe started in the year 2000 with I 1 villages. The program is now in the 1 1 '" year of treatment. The program is being implemented ion 62 villages and the villages were covered indicating a 100Yo geographical coverage. The total population of the impact area is 39,568 out of this 33,079 people, were treated and our coverage is 83.6%.Our ATO was 33,237and we managed to treat 33,079 population and the current UTG is 33,237 . The farmers go to farm in neighboring Mozambique. Likewise others go to work in estates and farms in Kasungu and Mzimba district. Big trucks came to collect these people. This is especially done during the distribution period o f Mectizan drugs. The district had 400 available CDDs in which 50 were new and 350 old CDDs and 42 health workers. The ratio of CDD to the population served isl CDD to 99. The main challenge faced by the program is the movement of people to and from Malawi to Mozambique during the distribution period. The second challenge is CDD drop out.CDD drop out solution, we selected new CDDs to replacing those who left the program. Movemqnt of people the solution is we distribute the drugs before movements begun. 2 WHO/APOC, 14 September 2009 SEGTION 1: Background information Phalombe district borders with Mulanje to the south, Zombato the west, Mulanje Mountain to the north and Mozambique to the east. The area has two types of climate:-summer and winter. The impact area is to the east of the district and covers two health centers (Nkhulambe and Sukasanje) The people of this area are lomwe and kokhola tribe and they speak the following languages Chichewa,Lomwe and Kokhola.The main dances among these people are mainly Likwata and Tchopa. The people of this area are farmers who work in their gardens for their living.They grow different crops like:-maize is their main staple food,cassava, rice, peas, groundnuts and pigeon peas just to mention a few. The district has three main roads:-one from Mulanje boarder through Phalombe to Chitakale and the second road is from Phalombe to Zombathrough Jali, the third road is from Chiradzulu through Migowi to Chiringa. The district is being run by the District Assembly under the District Commissioner. The District Executive Commitee is looked by the DC as the leader of Administration.DEC is comprised by heads of government departments under the DC Apart from the DEC, there is traditional Authority(TA),Group Village Headman and Village headman. z\ll health system in the district is being looked after by the DHO who is the leader. of DHMT. There is only two health center s in the impact area and in total there are 15 health facilities in the district out of these 3 are CHAM facilities. All42 health staff were involved in the CDTI activities. aJ WHO/APOC, l4 September 2009 Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage Bs=Bzl Br *100 Phalombe 42 42 100,4 Total 42 42 100v, 1.1.2. Partnership The partners involved in the CDTI implementation in our district (Phalombe) were the following:-Ministry of Health, SSI, WHO, Traditional Authority (TA),VHCs, CDDs and the community. International partners are APOC for technical and financial support and MDP for Mectizan drug donation. The above partners were all involved in the planning, supervision, advocacy, sensitization and mobilization of project activities in the CDTI impact area. The district is planning to mobilize other partners working in the impact area to be involved in CDTI activities and co-implementation. These includel: o Concern universal - Malaria Project o Catholic Commission 4 WHO/APOC, l4 September 2009 o' ot E()p 0,) a.() a$ U o B C)Lr(.) () C) aqi (c q)tr(t o o) 'a lr o o 03 q o o -o tt) oLroP qr li ,o Lr C) (s (.) l< 0) a E E oo 0) a t-.1 t-.]O U) L<o -o o OFTt (€(.) c.) bo(o (.) qr o rhL o C) Ch o (d t o o oo o (n C) P U) o() bo(c (.) F ,t' o O (h do 5o c/) H C) 5 U c-' C) o (c 0) -o () (B o qi () oLr o c/) 0) (h (s B o zqi z =l Ith()/ c\. .o o tr c.) o. bo tr a C)tr() oo =)E 0) o o C) 'a Li o lr ,E a)a C)o c/) 4 Uq) o'\\ q) > U \ .a =\) sv Ff= $\s\ p\ \(l u9 .sA >.\ %o'Bx9: sq) :s tB qJ( qJ!$q: ^\_ UB \x BiTS s* e-6s\II P'S !J, \8\\9\:r .a: \.s :bo .:Lpv sp $. ^s .Y sE :b. Gq) :bo *: ild t\!\qJ %q) Uq) %I !L a)\ tat q)q g I I Lr c.) bo I ! U O.oLr 0) bo H o Lro €o (g 0) Lr C) l-r(d >'o Lr C) 0) d(,)L q) q) .E L * q) L c) (.) va k (d (! q a (! E3o.5 fltrG2 F JCo.HOr:r: c\l .C)lNEI . 631FFI (r) U) cn C)o CB4.. (.) oLlr5(g;ao a> F D o; E xO t-rcaN c.) ca r- ?oN ?n ?t) + il .6) -oo .= o.N - ),o !\goo=F 8# oo\ota) o\ ca €\o ra o\ ?a -.cE , oE f r.'= ! 6tsE.=;: >'€ o c, \r659'Na o\\oN o\\o al CE 'Eg8 *i H ?orUgsi o\o\NooN o\ €\ .I6 al I o ON(, .= cEq) oF +_ il N\o N\o e) .9 q) 9E E i!tg6)tr >i q)+rg N o)ob! cl unq) c) L o) z E:C,):! h ?oUgsi N(n (\Ila EEo9cl 9.- .! -i: E:{d = qJ.:X *or 9'vu-t LA=.r^ oo\o ta) o\ c.) 6\otn o\ ?a tar '!t o cJ .9E {) EtrEc5'; ?E;< E cEr()5 eFl F C) o(t Ei F] F F SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 6 WHO/APOC, 14 September 2009 o\ N () -o OJ g oa$ O t, o FJi = c- c/) o E Q q 4\)Qq) q o\ q) s* t s q) 4 sq) 5 Lr 0)x c)l-r! o C) C) CB otr a (.) ti C6 C) l< € rh 0) o qr o o C) F c.ir 6)l -ol(tt FI ah P q) a EO 5trI 0)p 0) o. 0) a 6DEE a- (! z L U) OI L o ET I 0.) -o E C) o. 0) U) aoEE a' oo q) CE U) at) c)U EOEtr I 0) a0CE a- (B a0 dL t'r EF U 6DEE ?E 6t= a- o rQ iiE ii= Etr r-()a o c)e Etr Q q 60 a0EE rhj C) tr an () -o o F] Fr 3 2.2. Advocacy During advocacy we use drama and band to disseminate Oncho messages to the broader community.They perform by using songs,testmonies by those who took Mectizan in the past years.The number of policy makers mobilized were 100.These Include the Local leaders, political leaders, church elders and other influential people in the community. We targeted the villages with low coverage in order to boost their coverage this year. People turned up in large numbers in all areas visited. 2.3. Mobilization, sensitization and health education of at risk communities We use megaphones and motorcycle to sensitize and mobilize the community during Mectizan distribution. The CDDs gave health talks before Mectizan distribution to their broader communities. The communities respond by turning up in large numbers. In future we suggest of using a vehicle to sensitize and mobilizethe community. Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: Women turn up in large numbers during meetings than men because women are usually available in the villages. Men go out in search of food for their families. Usually women are more active in the program in terms of attendance and participation during meetings The CDD attrition rate is very low than the past l0 years.This year attrition rate wass at 125%. 8 Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area Bd Number with community members as supervisors B{ Percentage Br= 85/ 84 * 100 Male CDDs B7 Female CDDs Bfl Total Bq= B?+Bs Number of communities with female CDDs Bl Percentage Btr= B,JB,* 100 Phalombe 0 0 0 208 192 400 59 95.20/o Total 0 0 0 208 192 400 59 95.2% WHO/APOC, 14 September 2009 District/LGA 2.5. Gapacity building AVAILABILITY OF KNOWLEGDEABLE STAFF AT ALL LEVELS To strengthen the capacity of all partners in CDTI, the program manages to build capacity of all partners in form of training of its members. For example, the Project planed to trained 11 district staff i.e. TOT training, it also trained 31 H.S.A.s .In addition the program trained 400 CDDs. We also trained I I community monitors. We also sensitized and mobilized 100 community members in their respective villages For transfer of staff, the program trains the new staff who have just joined the CDTI impact atea. 9 WHO/APOC, 14 September 2009 *-!d \.) I o -= + .U av oO\i- O ca t l,o f.) tA q) 6B ar) U o o z ?2L $ t o\ q F9 =U av 0 0) .a'o' !B Fr Ltro): oo ,*9 r.G6)L z O O 0) 0,) q,) o\ s F Uil Q +U q (-) = : O : f.) ?a) q) -tr adL !i: .tH E:- zi. 0) CJ Q co ?o ^\ : 0,) o () s +. q trz .i o.i + O o G at) O l]Se90) !'= 0) z Q rl a 0 () -o o Fl F t- q) o 0) (J ^\ s o\ N q) -o 0) a. C)a rt (-) oA o60 o o s B o B b0 .E * L t o\\ o t .* g =; -:. !4q q) U a) q > L- q)\ N q) 4 !q) 5 d o q) a E F IJ(-)(H ch o C) C)Lr _c)!H (.) bo l-rF ,iir o-, I -t -ol(Bt FI Table 6: Type of training undertaken (fick the boxes where specific training was caruied out during the reporting period) Any other comments; o Field results after activity implementation indicates changes in the knowledge gap, i.e learning has taken place. 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Community Self Monitors Program management How to conduct Health education *;F ** ** Management of SAEs CSM *:f SHM Data collection ,F,F :F:f {<* Data analysis * rl. ** :f* Report writing :k* ** *{< ,F rF Others (specifo)Sens itization &mobilizatio n ,F:rk FEED BACK MEETINGS *{< 11 WHO/APOC, 14 September 2009 o'O c.l Lo -o E(J o.() a$ U o o ts N \) 0oll a :s s s s\) Oo U 3 E :\Yi .a{oo] sa .si FaJirqJs =E: E! sd \i!tF .s '5CE \.u o- .l\LEq \ Eq) :\ '=St\ :,-|! la' : kb = l\ -i!! : ss t !Y.t! ib .! Yrs bss s.-: s "E'sY \:b 3! = tvs' s\ E \UH i,s .s sEba qrdS- 'Q\ : u\lE SE rN. ,* $i 5tt E:: s.E\ s*s !slI Sir da.3 SyqJ q/iS Srt\ !\ ='tt tt! o ()th F! 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LrF r-t o.r I -ol(sl FI 2.6.2 What are the causes of absenteeism? o Farming in Mozambique o Selection of pupils to national schools 2.6.3 What are the reasons for refusals? o Religious background o Ignorance 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. o Parasitologist trained? No o Existence of microscope?Not available In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report l3 WHO/APOC, 14 September 2009 D Oo c.l ! 0) -o q,) o.() a s (J \J Or - = $ q) a, q) l*q) .s L.q)q * qq q) oq) q l \ q)\ 'd ! q) 4 q) 5 o H()q bo Lr o. 0.) Lr 0) oo tr E ! C)Lrt< L)o o (B U) r! a (h C) (.) 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EO o N N\o N\o N\o N\o (\\o N\o N\o N\o (\\o N\o IJ.] N OON N N c..l tO N ON N t-- N oo ON o\O N N O a.l C) -o c)q()(h s (-) o > \o ot, IJJ YR2010 YR2009 YR2OOB YR2007 YR2006 2YR005 YR20@1 YR2003 YR2002 YR2001 YR2000 rNaaoo ooaaII oooooooNO@(o$N IJJ m =oJ II 0. u o lJ. o z IJJtF oF (9 Ff luocscrv/lcrn 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH i ./ WHOtr UNICETE Other (please specify) NGDC Mectizan@ delivered by - (trtlease tick the appropriate answer) MOH f] N WHOD UNICETE NGDC Other (please specify) The communities after doing census up date, they order drugs through their respective health facilities, the facilities sends those orders to the District Coordinator. The district sends the facility orders to the National Coordinator. The National coordinator sends the districts orders to MDP. Then MDP sends the number of drugs to the country requesting the drugs. The national imforms the districts to collect drugs according to their orders/ allocation. The district does the same to the health centres who sends their orders to the district. The CDDs collect the drugs either from the nearby H.S.As or health facility. Table l0: Mectizan@ Inventory (Please add more rows if necessary) Please note that 3162 tablets were takenfor use to the non oncho area The remaining Mectizan (ivermectin) are taken by the CDDs and are being surrendered to their nearest health facility and lastly the facility send the drugs to the district Pharmacy where the drugs are kept. Activities under the ivermectin delivery carried out by health care personell include: o Collection of drugs o Reporting of drug usage o Supervision of MDA 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? o YES State /District ILGA Number of Mectizan@ tablets In stock from previous year Requested Received Used Lost Waste d Expired Remai ning Phalombe 3,162 90,000 90,000 89,550 0 450 0 0 TOTAL 3,162 90,000 90,000 89,550 0 450 0 0 17 WHO/APOC, 14 September 2009 If so, When? It was in AUGUST, 2010 Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Supervision 2.9,1. Flow Chart of Supervision Hierarchy. NATIONAL COORDINATOR DISTRICT(SUPERVTSORS) HEALTH CENTERS (H.S.As) + DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meeting (SHM) Phalombe 62 10 62 TOTAL 62 10 62 COMMUNITY (CDDS/ MONTTORS) l8 WHO/APOC, 14 September 2009 2.9.2. What were the main issues identified during supervision? .Supervision was not adequate oSome registers did not have column for Albendazole 2.9.3. Was a supervision checklist used? a Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? BEFORE o Census up date was done o Drugs were timely ordered DURING o Drugs were timely delivered in health facilities o Drugs were timely collected by CDDs o There was proper documentation of all relevant statistical data o Mass drug distribution was timely done AFTER o Statistical calculations / summations were timely and correctly done rTimeliness was observed in reporting oRemaining drugs were returned on time 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? oThe feedback were given at the same time, mistakes corrected and pave the way forward. rWe further discuss the way forward for the past year during CDD/Health workers planning meetings. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO Others No Condihon No Condition No Condition No Condrtron No Condrtron 1. Vehicle 0 8 F 0 2. Motor cycle(s) J F 6 F 1 F 3. Computer(s) I F 7 F 4. Printer(s) 0 I F 5. Photocopier (s) 0 1 F 6. Fax Machine(s) 0 t6 F 7. Others l9 WHO/APOC, 14 September 2009 a)Generator I F I F b)Bicycles 15 F 0 c) *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? 20 WHO/APOC, 14 September 2009 3.2, Financial contributions of the partners and communities - Fill tables 13a, l3b and 13c - If there are problems with release of counterpart funds, how were they addressed? - Additional comments 2t WHO/APOC, 14 September 2009 o\ c.i () -o o.(Ja$ U -r o ro @ lo_ EE oo,o_o oo(.) o) oa6ru-o,N oo,(oo) ooooolo oN CO illt ot, o a-x-oc,Ea E ^\ 'E O- .cG'- .E(5d q:<\1 s to, r,) t,c(J= olr rE N oqN@o $on3 $lr) O) NF- Or- co N f-- O)- cf) (ON a)N g, o ! o .E =CO =oE '51 oo oEOq3 tr o E o 23 .cl .12t, e, ocE GI CL tr UJ I o ooo(9 z s !t o g. 5 .Ct .t2!, -o -o .-rss$SBooPB s ss(t? qqNOt(,@NF- S ss $(t) O O C,, ssro ;< u?o)o(D(o(o G' c')$N o@@o)lr)rOO$ O)(o(o rO I o)ol- O)$- N(f) ooNN ooNNOO o(D co o O)(o o @(t$(\t oco,@O)'lr) oo$ o)(o(o t(, o)oF- O,vN(Y) oo oo(\l N ooNN o(n(.) o O)(o o o o -AEEDOtrF '= o =Oa) Lo+a .q .t!! =oGItOGoc5.9Il ..E,oo8tr, o =(!E5iE z a o(\t Go\ o t ao CL .tt, ttot o CL o E"tr '6 .cl tr UJt .E!ttr o(! o tr o alt L o(., z IJJ =zt UJ oo ! 0, o o|Efo oooooN oo ao N oo @ ooo,oo' ro(os oolO F* oo ooo(, ooo c) oooN oooN o IIJz IIJ(9 of o t o I GN 'a so to S(r,iG,OCoo>=Es - E I:O 6.Y l ,EE E E T E Si E H : E i eE - c.i c.j + d<O - - -; fiq u, OF oo .Y, E :G;{ -G a6uJiLr'#$ isl *, 1.=33 E ccoEEE oroiEb,.9 Ei = = +-'3 E I I$ s ^i^il{ =(rt= cOolc'.a .= .eH eE =+ EE E - ".ie'i ic"i c,j e.i d o o) o o) th q) E o o b: 9 =o);a EO .9. _0) oo tr(U66 E INao+; tro o trt G G E E G 5s ,trtr50,o> 'Io EBEbtr>EEOG9o sbqr> >o Ib t, Lr(s o() ! q) 0) k ,o (s a Lr o CO o cd t c6(r) C) F ON L c) .o q) a.()a $ () - o. - > \f O)(o so so O) ro(oo caN o lf) (r) o O ro co C)() t-r .h(d o tr o O o: c o) (D: oo o) E(! o) Or oa Or c,(l) tri 0), t,J(U, Or Er c.ir$ o o tr) G G Es(! 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U) o =) -o Lr oo (d (.) (d t I ?a o) 6l t-r G o IaI att ooN o oN oo(o N S\tco c,rr, lo o)No(o sSSb$(oo<ci ttr, o) s T\(n t d(tooo_F rOS o, c)(O(v) + t -d ol oo o-F lo$O)r (9(o(, t o ooo o ooootoloo_N(\l ro loo) o) oo o- F. v, o t4 oaxo Gtr o EE J E .9OE(u '=(U 6+ia[uo -^i ddd; J Fo oz t(, I I o\ N Lo -o E() o.oa $ O o tr)N o o o$toi\ e) t-Nt sq t- ;e\oSCD O\ C') c, tr crj6G' sq(, E' ooN (O(o N F.sN -N sN oot-(o co oo(\a (O(0 v(\t NFIcrr\ rS. F.- oot-(o E' oN @N ooooooONN od@@ o ol(o- o G o IaIq to o 9. o a-x-oc ,^ o)! U E.\'tro-2 .c(g'=: .=(EdEE.(r)UOEI Jd'd; J F oF oz E o 3.3. Other forms of community support o Provision of transport inform of bicycles to ferry drugs to communities and during MDA o Selection of CDDs o Collection of drugs o Selection of monitors. 3.4. Expenditure per activity Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here lUS$=142 a Please refer to the table above SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Make sure drugs are equally distributed since other areas experience drug shortage . During supervision check the registers because some have biank spaces and also check for Albendazole column. Make sure CDDs record two families per page in the hard covers { 4.1.3. How have they been implemented? .Recommendations were implementeda 26 WHO/APOC, 14 September 2009 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 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.21Planning At All Levels. o DEC Members will be briefed at any possible meeting arranged by other program implementers . DOC and district supervisors will plan for the activity in their routine meetings o Health center staff and CDDS will have their local plans also. 4.22 Funds The district will sustain the CDTI program by including the CDTI activities in the DlP(District Implementation Plan).Funding will be obtained through that plan. .lt will also be integrated with Lymphatic Filariasis program which has the same concept as to CDTI. The plan is being used every year. 4.23 Transport o The program will use transport from the DHO's pool. The DHO maintains and replace its fleet routinely and when need arises. 4.24 Other Resources o The District health officer in conjunction with the DOC shall lobby for additional resources as per need from NGDOs or they will be obtained through the DIP. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.31 Ivermectin Delivery Mechanisms) Drugs are delivered to health centers using vehicles operating on routine/any other official duties supervision schedules. 4.32 Training meetings in addition to community awareness about CDTI concept. and during Child Health Days briefing 27 WHO/APOC, 14 September 2009 tr ' 4.33 Joint Supervision during CHDs activities, Malaria week etc. We integrate CDTI with EPI activities 4.34 CDTI/PHC Budget and Release of Funds plan. The DOC forwards a proposal considering the time of implementation and the funds are timely released for activity implementation. 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? 'F Refer to toble 74 and 15 o 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 ...)? Explain what are the combinations of interventions co-implemented? How were the interventions implemented? (at the same time?) 4.3.7. Describe others issues considered in the integration of CDTI. 4.3.6. a 28 WHO/APOC, l4 September 2009 o\ N 0) .o o o. C)a $ (-) o r o o\N 0) a) CE c) 0 q) o q) z Cq F o\ c- ca ca I-*\r) o\F-N co aa N r) caq c.l c) 0)h o{) Gt 2 c) o bo c! o o q) z cq F r- cn o* cn ca oo\or) ca F- ca N oo F- q o €B q)h q) a, o Ut .o o> -atr z c( F + O+ \oN +N .+N oq) C! q)fr No\ No\ oo co tr-$ aq) a oo N ooON oooo F-,f\- 2.9 -o=EE z6 I c) cl(,) & N\o N\o N\o N\o N\o c) q) o! rqF c.l\o N\o an\o N N\o oq !l- t.2 =az- q) (J q) & o) q) OD c!F a-i x.s v\ >,h -o{ q)s -o.t q)iESczs's- (/) LYioa': o-.= !,(tC)ci'ieC)t:i EIZ c.= = 9Ptr5iii6oF A r\ C *t-{\J9 aaa oo -v o..= !,EU=g -C* H= = 9Ptr5(g ? I'aH9viOOE aao o (st ! t-t a t-l aa E b6 srr .i.i )9dPH N = N 3og r.iHLlJ - Li -! '- -:? d H-o:'o 3 38 E E gE aao H(!fN E .i-H _-o5'o(rtr o (: .=o: a)|' -> f- C) -E .=oP_'E qJ; LL Oi6 >= a s o CO .9oPNf(I, €EP(U OE a o_ coJ .eE =(o €6b'tr6(I, .-LOo- a oo cE oNE(oiE io .i -o6(U OE a o c .9) -o '=o --Zi5i a C oC(! oJ=q H-;Ectro 9; -Eo a .F(! C <or cE '= (u >6o a a a c, o.) 6.=(I,o ot(J >9 a oo &: -'-. oFo (n U) 6J c)!a9-99 *5 58 o d.9 ,E ui o.(n tl tr= th(! o(n o ch oa V) FJr -a lr oo d t<(d(! =z olr o c!3 Lr d z o H z (.)(t l-rF IA o(d l-r (g O sa \+{ E8 oJ2 I +) CE:) Io 0) ?1 I U $ rrl q) tr o\ c.l ro C) o. 0)(, $ O o E o 'i cn q a) k$ > 4 q) L S q) q) q) 4 q q) \q) co R Cd N oob lJo a o 'F (I, PC qJ E o o- o- l o\ c.l r() (.) ()a s O o o ca 0q) oI l+r o 0) o t.( Oq) oo c) o q c, G6 tE tF IF b! () t+ l+ * AD 'i= oaEA 5 \./ 2 cg c) o o oo t+ tEtt Lo .rf It .l€ 16 ()o aD- O tu =.9 Itl( 16IT .9!?tZq -E " E.e t( t+ :(r =a,'Eiq o() q= tF tF tF .ta ho '=> s(, 0) o C) 0o G tu€ )JUlia-H--o-:ioorr!I6aH!v<-r) € v n a t a I -X.iFvFL.J^\-/ tr E'r= TEE.= d oI) = bo.:E-g P * +E+g cBPb.=v)=H6 -5tEEj3Exr\-r.at-dv VLL!V9.r -bO = bo.=(u(,io- c) -V il ar' +E+g o () o c)a F -C.=otsE(u: LL Q)o>= a I o coJ .9oPNll! €E!(U o-6 a o CJ q) F a rh oL oo_O- \.J C) a a(! Ld E o cd a. E J a q) \ o'\ q v *\e U (.) O tr a nO bo U) ao 6J b0 o A. C) i-; F{ q) ll E-l I o\ N 6) -o c) a.()a$ Q o tJ. c.l c.) q q) kq) l ,q) 4 q)\ s q) ^a ! a) !q) q q a) L. a) a) ca R * .16 .n * tF * tr(B -l th t-i e-OaUAHo >.: o V.iH€ bo >. (d I Io_ coo: =(o €+!'F6(! .-LOo- a ooJ c6ON =(It -E ;o .! -o6oOE a thz =J o c .9Pf ! L P .9o a c o E o oo(! E(E.g ELL (13 o-6EEOs -o a c .9P(! c <o)CE '=(UL_ 6= >6 a a a a a a a a a CA a E a o a C) V) Fa o oo(i L G z oL oo L 2 ! E o C) lrF a o CO (0 c! O a oo0. eh aL O o t{ 4.4. Operationa! 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. Not done 4.4.2. How were the results applied in the project? NA SEGTION 5l Strengths, weaknesses, challenges, and opportunities - List the challenges and indicate how they were addressed. STRENGTH o Communitylnvolvement o Present of partners like APOC, SSI, WHO, MOH, CDDs and Communities. WEAKNESS o CDD drop out (working on voluntary basis) CHALLENGES o Staff tum over o CDD commitment o Other programmes are providing better incentives for volunteers OPPORTUNITIES . Staff availability o APOC funds o DHO funds SEGTION 6: matters Unique features of the proiect/other o a Availability of health workers (H.S.As) providing direct supervision to CDDs during MDA Availability of community monitors assisting in measuring program progress and success. JJ WHO/APOC. 14 September 2009