Kilosa focus CDTI project annual technical report submitted to Technical Consultative Committee (TCC): January 2010 to December 2010

RESERVED FOR PROJECT LOG (including e-mail address) ORIGINAL : Enelish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE 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 AFRTCAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) For Âction tr- lo3 ,! {I , o I .t ÿ ,? i I I Proiect Name: KILOSA CDTICOIINTRYÆ{OTF: TANZANIA Launching vear: September 2001Approval Year: 2000 From: January 2010 To: 31 December 2010(MONTH/YEAR) ( MONTH/YEAR)Reportins Period APOCfundinsyear: (circleone) I 2 3 4 5 6 7 8 (9) 10 ll 12 13 APOC Proiect implementation year report: (circle one) I 2 3 4 5 6 7 8 (9) 10 11 12 13 Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan l)onation Program (NDP) - Kilosa District Council (KDC) - 970 Communities I)ate sutrmitted: 07'h June 2011 2 I JUIL. 20ll rà^-rÊrÔ RECU LE ïo, llr .3o-Ko TÔ- R. 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 siqn the report: Country: TANZANIA National NTDs Coordinator Name: Dr. Upendo Mwingira Signature: Date: .. Zonal Oncho Coordinator Name: Dr. Frida Mokiti Signature: .. Date: ....... This report has been prepared by Name: Ms. Rosemary Nguruwe Designation: Project Coordinator Signature: Date o o , o AI\ITUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate spâce. OFFICERS to sign the report: \(t"r^ t Country: TANZANIA National NTDs Coordinator Name: Dr. Upendo N,fwingira Signature: Date: ...., ç. \ o Zonal Oncho Coordinator Name: Dr. Frida Signature:... Date: \6 6 }rr This report has been prepared by Name: Ms. Rosemary Nguruwe Designation: Proj ect Coordinator Signature:... Date .1.( I o6 lt*tr o ll ô ;1 l a,,r-L. Iil,i,i ?Clf RECU TE Apo CiD,R WHO/APOC, 14 September 2009 Table of contents ACRONIYMS................. ...... v DEFrNITrONS.............. .....vI FOLLOW UP ON TCC RECOMMENDATTONS....... ...-.........1 EXECUTTVE SUMMARY .-..................3 SECTION l: BACKGROUND INFORMATION......... """"""4 1.1. GeNpRelINFoRMATIoN..................... 1 . 1 . 1 Description of the project (briefly) 1.1.2. Partnership 1.2. PoPUL4TIoN................ SECTION 2: TMPLEMENTATION OF CDTI ...... ERREUR ! SIGNET NON DEFINI. 2.1. TIMELTNE OF ACTIVITIES ..,............ 'ERREUR ! SIGNET NON DEFINI. 2.2. ADvocACY .........'.................8 2.3. MOSTLZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES.......... 8 2.4. Cotvttr,ttxtty INVOLVEMENT................ """"""""""""9 2.5. Capaclrv BUILDING... ..:....'...............""' l0 2.6. TREATMENrs................. .................'..""' 12 2.6.1. Treatmentfigures............. ............8rreur ! Signet non déJinî. 2.6.2 ÿT/hat are the causes of absenteeism?............... """ 15 2.6.3 \ÿhat are the reasonsfor refusals? """""""""""" 15 2.6.4 Briefly describe all lcnown andverified sertous adverse eÿents (SAEr) that................... 15 2.6.5. Trenà of fteatment achievementfrom CDTI project inception to the current year .........-.. 17 2.7. ORDERING, sroRAGE AND DELIVERY oF [VERMECTIN......... """"' 18 2.8. COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEPTTNC .................... 19 2.g. SuppRvtstoN .........'......."""' 19 4 4 5 6 o 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. Provide aflow chart of supervision hierarchy. Erreur ! Signet non déiîni. Vfrhat were the main issues identified during supervision? -.........-. """"" 20 W'as a supervision checklist used?.......-.. """""' 20 What were the outcomes at each level of CDTI implementation supervision?..-......... 20 llas feedback given to the person or groups supervised? -----........'.""""' 20 How was thefeedback used to improve the overall perlormance of the proiect? .......20 o SBCTION3: SUPPORTTOCDTI......... """""""'21EeUTPMENT .....'21 FTNANCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES..............' ..................,..22 3.3. OTupRronus oF CoMMLTNITY suPPoRT........ 3.4 ExpsNoIrURE PER ACTIVITY ........'.ENNNUR ! SIGNET NON DEFINI. SECTION 4: SUSTAINABILITY OF CDTI 26 4.1. IUrnRNar; INDEPENDENTPARTICIPATORY MONITORING; EVALUATION..... ..26 4. I . t Has the proj ect ever been evaluated/monitored? $ick any of the following which are applicable)................... """"""" 26 i.1.2. What were the recommendations?...- """""""" 26 3.1. 3.2. 4.1.3. 4.2. YR3).... 4.2.1. 4.2.2. 4.2.3 4.2.4. .........26 How have they been implemented? SUSrerNastLITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT ... ,...27 ....27 ....27 Planning at all relevant levels.....'.. Tr ans p or t (r epl ac ement ond maintenanc e) ... -. -..... Other resowces -.-.... Erreur ! Signet non définL Erreur ! Signet non déftnl Erreur ! Signet non défini Erreur ! Signet non üfïnL 4.2.5. Towhat extent hos the plan been implemented...................Erreur ! Signet non déftnl 4.3. INTEGRATION 4.3.1. Ivermectin delivery mechanisms .. Erreur ! Signet non déjini 4.3.2. Training..... ................ Erueur ! Signet non déftnl 4.i.3. Joint supervision and monitoringwith other progratns ......Eneur ! Signet non définï 4.3.4. Release offundsfor project activities..................................Eneur ! Signet non défini. 4.3.5. Is CDTI included in the PHC budget?....... ......Erreur ! Signet non delinl 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements? .......... .Erreur ! Signet non déjinl 4.3.7. Describe others issues considered in the integration of CDTI....... Eneur ! Signet non déJinL 4.4. OppnaTIoNAL RESEARCH.. ERREUR ! SIGNET NON DEFTNI. 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. . Erreur ! Signet non déJinl 4.4.2. How were the results applied in the project? ...................... Erreur ! Signet non définl SBCTION 5: STRENGTHS, \ilEAI(Nf,SSES, CIIALLENGES, AND OPPORTLINITIES........32 SECTION 6: UNIQUE FEATURES OF TIIE PROJECT/OTHER MATTERS ......32 o o Acronyms o APOC ATO ATrO CBO CCHP CDD CDI CDTI CHMT CSM DC DED DHRP DMO DPLO FLHF HUC KDC LGA LLIN MCH MDP MOHSW MSD NGDO NGO NOTF NTD PC PHC REA REMO RMO SAE SHM TCC TOT I"]NICEF UTG wEo wHo vEo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Comprehensive Council Health Plan Commun§-Directed Distributor Community Directed lntervention Community-Directed Treatment with Ivermectin Council Health Management Team Community Self-Monitoring District Commissioner District Executive Director District Human Resource Person District Medical Officer District Planning Offi cer Front Line Health Faciliÿ Hang Up Campaign Kilosa District Council Local Government Area Long Lasting lnsecticide Net Mother and Child Health Mectizan Donation Programme Ministry of Health and Social Welfare Medical Store Department Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Neglected Tropical Diseases Project Coordinator Primary Health Care Rapid Epidemiological Assessment Rapid Epidemiological Mapping of Onchocerciasis Regional Medical Officer Severe Adverse Event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal Ward Executive Offrcer World Health Organization Village Executive Offrcer o Definitions (i) (ii) (iii) (iv) (") (vi) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84Yo of the total population in meso/hyper-endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be tieated 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'o year of the project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year over the total nu*b"i of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Intesration: delivering additional health interventions (i.e. vitamin A supplements, atbendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness und "-po*er communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainabiliry: 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 re.sources mobilised by the community and the government' Communitv self-monitoring (CSM): The process by which the community is "rnpo*"r"à 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 respànsibiliÿ of ivermectin distribution and make appropriate modifications when necessary. Community in Kilosa CDTI: is the hamlet/sub village where census and data collection start being collected. o (vii) (viii) (ix) (x) O FOLLOW UP ON TCC RBCOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 30 FOLLO\il UP ON TCC RECOMMENDATIONS FOR TCC/APOC MANAGENT USE ONLY ACTION TAKEN BY THE PROJECT TCC RECOMMANDATIONNumber of Recommendalion in the Report Report related The project will make sure that executive summary is consistent with the rest of the report by presenting the report to CHMTs for proof reading and revisiting to ensure maximum consistencY i. Ensure thal information in lhe executive summtry is consistent wilh the rcst of the report The project remained with 209,282 drug from CDTI area but this drugs were used in non CDTI area for teatment of Lymphatic Filariasis together with iA.lbendazole ii. Reporl on, and accounl of about 400,000 drugs that are not accountant lor ) The project will make sure all necessary parhers endorse the report before submission to TCC committee iii. Ensure thal the report is endorced by the relevanlpartner§ It has not happened to our project iv. Provide informalion on reasonfor consistent under utÎlizolion of APOC approved Funds and re co mmc ndatio ns fo r imP rov eme nt The total population for Kilosa district is projected to be 575, 506 according to 2002 government census and in CDTI areais 482,954 v. ConJirm the total populalionligure Projecl related The project is waiting for the team to come for the activity L The team should condact M & E The project has been conducting the activiÿ of CSM in collaboration with extension health workers right from the beginning of CSM implementation ii. Train and implement CSM and explore lhe collaboralion toith the health assistant The project has been doing this every year iii. Utilize Meclizan daY lor mobilizalion The project request APOC to increase budget for the project especially this time when we are implementing NTDs. This should go together with Kilosa district council increasing its allocation to the project in order to ensure sustainabiliÿ of the proiect. iv. The team should develop realtstic budgets- the cunent budget is 30% of what was projected The percentage of health workers who are currently in service in Tanzania is 35% of the required. The MOHSW has continued to employ new health workers v. Increase the proportion of heallh workers engaged in CDTIfrom 33% ev€ry year in order to reduce this gap. This will automatically increase the number of health workers engaged in CDTI every year o o Executive Summata Kilosa CDTI Project was launched in 2001 and it is now in the year eight of implementations of CDTI activities. To easy the implementation of CDTI activiÿ, the project has been divided into five zones namely, Gairo, Kilosa, Mikumi, Magubike and Magole. This report provides information on financial and technical reports of activities conducted in the period from January to December,2010 but due to unavoidable circurnstances the activities has proceeded in the year 2011. The project managed to conduct and to accomplish the following activities: - Re-training of 2,138 CbDs, train and re-train 93 FLHF staff, (74 old and 18 new), sensitization to newly - ^ppointed community leaders in all four Zones. Social mobilization to all community mèmbers, and we conducted advocacy meeting to 32 CHMTs & other Head of department- . The project also managed conduct annual review meeting where by participants were ,.q.r".t"d to participate full in the implementation of CDTI activities which are now integrated with other NTDs Programme.- Kilosa CDTI Project has 970 affected communities with a total population of 504,519 people, ^ out of them 397,188 people were treated with the therapeutic coverage of 79oÂ.The Ultimate O Trearment Goal (UTG) was 442,173, whereby the Ànnual Treatment Object (ATO) was 423,796 and the Geographical coverage was rhaintained at 100%. The Project received a total amount of 2,005,000 Mectizan drugs from deferent sources in the county including those sent from Merck &, Co through MSD for treatment of Oncho and for use in non Oncho areas. 1,032,848 tablets were used in Oncho endemic areas whereby 68,792 tablets used in non Oncho areas. 127 tablets were lost and remained are 1,112,515 tablets which are store at the district Pharmacy. In this reporting year, the Project received funds amounting Tshs. 45,305,308 from difference sources. ThesJare: APOC Tshs 27, 473,3641=, Council Tshs. 17,831,9441:. Sightsavers did not send funds direct to the project' Challenges and how they were overcome: o Lack of Integrated reporting format - Report was written as per Programme and Donor requirement by using their format. o Lack of BCC/IEC materials forNTDs - The project has used individual Programme BCC/IEC materials Inadequate supplies of medicine as per district population - MDA was conducted in three phases depending on the availability of drug MDA was interfered with National election therefore distribution was forced to be conducted during the rain seurson. - Ddistribution we have to wait till election passed. o a a a Meager funds used to implement CDTI activities now the same amount are used to implement NTDs activities. - DMOs offtce provided the funds from other source to fill the gaps Due to late arrival of medicine, distribution procedures were not followed. - Distribution was done depending on the availability of drugs. a SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Kilosa Focus CDTI Project is situated in Kilosa District that is one of the six Districts in Morogoro Region, located in east Central of Tanzania. It is 300km West of Dar-es-salaam, and is bounded by latitudes 5'55'and 7.53 South and longitude36'31'and 37'30 east. The total surface area of Kilosa district is 14,245 sq km, which is 20%, of total surface area of Morogoro Region. Average length (North -South) 180 Km. Average width (East-West) 80km The project has a population of 504,5 l9 The topography varies significantly within the District. The Central and Southern flood plains of Wami, Mkata and Ruaha rivers stand at 400m above sea level, while the cultivation steppe in the north around Gairo riches 1100m. The highest parts of the district are found in the Ukaguru, Rubeho and Vidunda mountains, which form almost continuous north-south mountains, range long the Western side of the District and reach an elevation of 2200m. Flood plains zone comprises both flat and undulating plains extending from the foothills in the west. Altitude is typically 550m. The plains are dissects by many rivers, principally the \üami and Ruaha systems. The central plains are.subject to seasonal flooding. The mountain ranges running North-South are part of Eastern Arc system and comprise pre-Cambrian metamorphic rock covered by coarse soil. With altitudes up to 2200m Drainage of the District's main rivers is to the east. The area provides most of the headwaters of the Wami river of National significance. The southern part of the District drains into the Great Ruaha River. Kilosa District's rainfall is fairly tropical region and is largely bi- modal with 'short rains' in November/ January and 'long rains' in MarchÀtlay with a peak in April. The average annual rainfall varies from year to year and between ecological zones.lOOOm - 1400mm is common in the southern flood plains whilst Gairo in the north averages 800-1100mm. However, the mountains forest areas can receive up to 1600mm annually. The l0-year mean for Kilosa (1982-91) is 1040.3mm, with 82 rainy days per year. All over the district, the dry period extends from June to October. The average annual tgmperature is typically 25'C inKilosa town with extremes in March (30'C) and July (19'C). Thevegetation is characterizedby both tropical and Meditelranean §pe, depending largely on altitude. Typically though it consists of Miyombo V/oodland with grass and shrubs. There are 83,12ha. (Or I - l % of the total forested area) of catchments forest whilst these come under the jurisdiction of central Government,24,65ha (0.3%) of productive, prolected reserve are the responsibility of the district Council. A further 169haof softwood plantations have been developed. Economic Activities: Agriculture is by far the most important activiÿ in Kilosa, accounting for approximately 80% of household income. More than 90 % of Kilosa people live on subsistent farming. Mojoriÿ of people in Kilosa are farmers so they shifted to the field areas for cultivation and yielding Culture: Tribes in Kilosa district are Kaguru, Sagara and Vidunda, . Most of people in Kilosa are farmers and livestock keepers, other cultural activities are traditional ngoma and healers, also there are taboos and culture which affect health of the people. Communication system: Kilosa District road network comprises 3565 Kilometers, which make accessibility of 70%o throughout the year on tarmac and gravel roads. There is a railway line passing Kilosa town from Dar es Salaam to Mwanza and Kigoma. Also there are two airstrips situated at Kilosa town capable for twice otter flight and helicopters. A modern network communication system for mobile and landline are installed, and is almost accessing 80% of the Kilosa area. O o Kilosa District is administratively divided into 9 divisions, which in turn are subdivided into 46 wards, and 168 registered villages. The district has sevenÿ five (75) health facilities (three hospitals, one of the Government (owned by the Kilosa district Council) and the other two are owned by FBO, six health centres (of which 5 of Government and 1 owned by FBO) and 65 Dispensaries. 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 B1 Number of health staff involved in CDTI Bz Percentage B::B'zl81 "100 Kilosa 1,257 350 28% Total 1,257 350 28Y" 1.1.2. Partnership Kilosa CDTI Project implements CDTI activities under the support of Communities, District Council, MoHSW, APOC and Sightsavers. The District council provides salary to CDTI implementers, 'WEO and VEO. The Council also supports the project with transport to the head of departments when they are conducting HSAM, supervision, planning and monitoring. The MoHSW provides technical supporÿguides for the implementation of CDTI activities in the project. Sightsavers as donor provides technical and financial support to the project. Community collects Mectizan@ and other commodities from the nearest Health Post/facility and mobilizes other community members to participate in the implementation of CDTI activities. Also they are providing incentives to CDDs for example exempting them from voluntary work in the village. o o ao\OoN Lo ()À() v) r U o a. B C)! Io o) 'a L9. 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(J Frp 0)ê:6- ::trd E xcpË cl tr- c.i .d- .tr (a§- êltç + I .o)Étr -oo .= aN d.E.- E}EÉÉ o\ tr) r{- o\ rf)ç tf.) t-- oo \o s F- æ \o .<f , (Jt-È-v-otrEo:\ ËË Ë gËo o c! o s+ § Ç'; so E'=§*x ôl cî s^ oo oo ôt raç- æ æ r- o\ r*o\ +{ I o 0) '=9. =l-Ér:9ôo 3N oo ra) cî r,f)(a o E-Ë È .lÿ61 .r6)q) g. E'g' >.N Ê. c.l\o eôI\o aa) Q)â! CÉ U)o E o e) o 6) z Ëriç; E§si o\ tr) -ülo tr.) c\ ia tû ia .ES trLo!,)Gl =EËEÈ *o 9' -v9i-HÈEÈ tË8"Ëï iËI-{Y: âF ôU G,U' o M Fl tr otr o !()p. bo IJ o a.oL o èo L t< o E C)(! oL C)L(d o li C) (!) B (Ë oL cÉ oo o oL o o &(A L €(! o CÉ À oa (Ë a C) etr 6tÉ 3.qÈ: c.ll a.rl ôr *l 'jÈl o\ ô.1 Eo -ô 0) Ê.{)a .tr O o Eo U) Èo a o EOEE o() o c.lù à Èr=ËÉ CE:ù\ é, O O c.l F C) o o E r< U) êI Lâ o 6lr IÊ.6EE oU cl à àorE ÿE C.l F(J q) c! O çnÉ o)U o *ôEEo U o(\ à S-ÿÉ 6= o O c.l FO o âI É 6lL t-{ oÉ o oÊ oQ o cl o z 3o= 1iE Gl= o o c..l F(J o vaà -o cÉ5N;< §troot'{ ()à o È6EE o(J o c.t & è0_EÉ .FÉ d= o c.l F(J o (J l.l I L çÀ â U) oJ v È Er o t'r r- z U) É(.)ÉH EoU I ô Vj a4§ § à > vL §)L§ ÈR §)U) §) § L{ o >. o)Ll< o() É o Cü c)! ./) (,) l.J(g o) t< ,P ü)q) I ()(§(t.r o c) (l) E F e.it o-rl -ol§!lFI (Ë (d ô0 0) >.() o () >. -o (.) o C) a. E 0) l-< §) ar)() o(d (I) Ju 0) -c o) o0 (c o 'U r- §à §)Li\ § §) §)§- 4 §)i\§\ .§(r\ r-'t (/)E.9 =:E -oE-i .(§\.J ô( o.> o6E r-r ll OEI a' l-{ Q) efrlî= =EE-otr.= E -rE crôrt!Ë HâU fi o z o l-{ l-rz F]|!rla hl FlÈraÀ ôl z o tr() Ha o o 2.2. Advocacy The advocacy started in September 2010, whereby DC, DED, DMO and PC attended regional advocacy ,"àtirg. In that meeting the RC was the chairperson. There after the district conducted an advocacy meeting which was attended by l3 head of departments, l5CHMT members including co- opted mÉmb.r. und 7 decision markers. The main topic was on the implementation of CDTI activities tôgether with other NTDs. This meeting helped the decision makers to understand well NTDs pÀg.u**". Also the advocacy helped the project to get extra fund from DOMs officer for the support of MDAs. Suggested ways to overcome the difficulties: o Increase reallocation of funds for the implementation of CDTI activities especially in budget line of advocacY . provision of BCC/IEC materials which combine all NTDs instead of having individual programme [EC. o Timely implementation of NTDs activities which goes together with early disbursement of funds from APOC trust funds to the project. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other local systems to disseminate information Mobilization, sensitization and health education was done by using community Council owned radio station which is sited at Kilosa town and other radio stations in Morogoro town. The project managed to mobilize community through traditional dance groups, community leadàrs and public meetings conducted at different levels. During drug distribution, we use mobile vehiôle with the loud speakers informing people on the importance in taking NTD drugs. Also during mass prayer in the Churches an Mosque community member are told on the need of their participation in CDTI and NTDs activities' - Mobilization and health education of communities including women and minorities Communities are being mobilized and sensitized prior to drug distribution and when the exercise is going on because this depend on the availability of time to FLHF staff. The information was also provided during the MCH clinic days to mothers who come for health check up to them and their child. - Response of target communities/villages Most ofihe community members respond positively when needed to do so especially in the implementation of CDTI activities and sometimes they ask for medicine when agreed period has reached and no sign to get medicine. - Accomplishments . Maintained high therapeutic coverage o No drop out of CDDs o Decreasing number of refusal and absentees Suggest ways to improve mobilization and sensitization of the target communities. . Availability of IEC materials at community level o To increase funds for community sensitization and mobilization. . To incorporate WEO and VEO in FLfm stafftraining so that they can trainer CDDs in area where there is no health facilitY. o To commemorate Mectizan day at each level, and produce and distribute IEC materials with massages on community participation in CDTI activities' o o oO 2.4. Community involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: Attendance offemale members of the community at health education meetings Majority of the women in Kilosa are actively in attending meetings than men because most of men think that they are busy than female members of the community, so many of meeting members are females. In general, how do you rate the participotion offemale members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc?) The participation of female members in the communiÿ meetings when CDTI issues are being discussed are increased years by year, due to the fact that women/females are now empowered to take chance of being leaders by 50%uts men. Females can always raise their concerns and they do also contribute to discussions. Incentives provided by communitiesfor the CDDs . Exèmption of CDDs from participating in voluntary development work for the whole month of Mectizan distribution. . Providing some cash during the month of distribution . CDDs are being involved in other Programme activities, which provide incentives like Malaria Programme. . During farming session some community members do help CDDs in their fields. . Recognition of CDDs by other communiÿ members as their health care service provider Aîtrition of CDDs: The attrition of CDDs in Kilosa is not a big problem because majority of CDDs are willing to continue in implementing CDTI and NTDs activities together. rict/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communitie s in the entire project areâ Ba Number with community members as supervisors B5 Percenta ge Bo- By' Br *100 MaIe CDDs B7 Female CDDs Bs Total Be: B7*86 Number of communities with female CDDs Bro Percentag e Brr: Bro/Bn*10 0 KILOSA 970 970 100% 1069 r 069 2138 970 100% Total 970 970 lO0o/" 1069 1069 2138 970 1000 2.5. Capacity building Training and Education The project managed to re-train and train 93 FLHF staff and conducted training and re-training to 2,138 CDDs in Oncho endemic areas. CDDs have then been involved in distributing Mectizan where they also insisted to the community on the importance of taking Mectizan for l5 consecutive years. Type of materials develops for use in Training health staff and CDDs In this year training was conducted in integrated manner, as we are now implementing NTDs. Training material used are those integrated one, but we still using Oncho training manual in Onchocerciaiss endemic areas. Measures taken if there is no manpower or knowledgeable manpower available to ensure adequate CDTI implementation: At every FLHF there are two or more than that trained staff. If transfer occurs the project will make sure that the new staff is trained on how to implement CDTI activities and lack enough the whole area of the district is now implementing NTDs activities using CDTI philosophy therefore all FLHF staff in the district are knowledgeable on CDTI. Moreover all community leaders are responsible for mobilizing community members and the district makes sure that all leaders are aware on how to implement CDTI activities. o o 01 CI !{) ,..o C) o.{) U)§ O oÀ o èO § ô\§ \ ,§ à o § èo o§ §) L o 'Ë § .§ .: § §§§ È. E È a €) (! ch âU o tr o z Gll v o-i+ §ô ::Èu æ cô c.t oo c1 ô.1 o a(f) al ætr) :. (l) q) q) (, s ULF oo cl ôr ælo (.l o 0 6) .a'o'(6 t-( ,-à bF 9çhêq) . 6.) r- c!6)L z 6 ll \./ È:ëu §d ô]ôl c.lôl clÔI ôi al q) q) 6) () \c (,LF ô.1(\ ôl(.l §) dl ,gi ç§ ËE tr':-)6)Z2 o) C) Ëit+F-d È. È co o\ +r- oô rO o\ !üt- æ ê q) €) () o \o O oLF côo\ roo\ cË ü) ah o F] 9e9q) a!t o li 6) z .?Ëi\+F-d ü ü È q * cl ra) cî o (A rt) (.l ra o raê ro o 0) o I \êê\ O oLF ta)o tôo () Fl c) a â u) o rl M F] H o I-i .\ § à§)()§ Vaè l'.§i\ È v §) F§ §) § o (d É C) 0)È É Fâ() (t< o v) o o Ê()Èia +.1 E (t) (d ô0É É (§ l-rF lrrl 6)l -ol(dl FI o o Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or 0ther Political Leaders Others(speci&) Program management ^i { How to conduct Health education ^i ./ { Management of SAEs { { CSM SHM { Data collection { { Data analysis ./ Report writing ^/ ./ Others (specifu) Table 6: Type of training undertaken (Tick the boxes where specific trainingwas caruied out during the reporting period) Any other comments The project had stopped to train its staff on CSM due to lack of funds. This happened when we started Co-implementation with other programme §TDs). CSM is now implemented in Oncho endemic areas only where training had been conducted t a o o 2.6 Treatments 2.6.1T r eatment fi gu res 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 plons being made to remedy this. - The Project is achieving l00Yo Geographical coverage and attaining more than 65yo therapeutic coverage. o o Io\ O(\ L() -o o a. 6) cr) v O o. o FJ< > -dr è6§ §§() È s\§ù§O \o§ o -)èv§3;L!6d§ 5§q)'5 ^'.\t\\f \§ +..\§ é.is .=§oÈà§*E:§ 6.:§E§IE §À§§ .=>ÈÀ1F-\.OEÈ9t= o§§itÈ c)o-§§ àÈ §À§ÈüsüI .§ '§îiHE\.§ .E .$ §§LÈ*H §. §§Ë § §§ st s I ⧠-l c) § §§:zl P :: P Ë,ds § :T.,Ële § '§§ stH' Ë ÈÈ9l È .Ë i§8its § §§tslb s s'§ TIE § §';3l É §' .ss EIE § §*Zt- i Èt\§è. §§S' '§\:ë ssr §È§§ §üè §$.s- Io l §§ È §§ \-bu § §s .E § .§'§ _É § §\H § §§o È §§F n n§) § p§S \ S§- olol -l o.rxl > EI Egl8 el =o.t c)ot É(l)t .:oI aÉ <*l !r 3lÈ -8lEtrt É5l E zl< (n oL(B 9o() 'a L(§ô c)H0)(§é 99o().= 'Aô L (1) rÿlÈ& P^ I .i9 - Ia oP- .E()Ê'o fàûtr(t Hûii() oe oÉ Jts ot É() ol =-o -l EË xl 8È El.go. (ül tr .à 8g o, È 3l E =lË Ëlbvl - =l o-;l.E .rl zi .91 oo 3l= Et.= E rËlÉ =l E =l C tl çrE+ô Èlo9l .É Hl -elË 9lb H-vt^q.l = çl =olo- olËulô rl5(,)lô- olç -ol _ -ôl -El§ El§ =lô =loZll- Zl? o a (l) €(Ë L o o0É^ -ôs oo ot- o (§ () bo(n !o oo (d oâ -C o\ (d L bô ooo () Cdk oèo(Ë L<(.) oo()^ Ëo\ c)È(d l"{ o) F al 6)l bo(Él L{l6)l >l ol :l(ül ol -clol(dI L{lb{ ot()l brl cl cl(dt ol 9l ,t C)l oldtKI6)l -ÉlPI èdÉl Ël ol EIol :l €l .cl 5l EI olEI fllt i .:<É dH9 Bô€* â *€HÊË9q: oâE o- () o {)D z o o 9a qE ôI!3 -{ 'r/ o uD o ,- t) ;i =+:-c o i:*tEz=339 =É'æ-a = ô u rr/-uor- O.* e (") ra c.l LOoo =H c -troo"' é-o t .ct') ço § E:Ë e E[=ËE \c)§ c?l c.l \o§(4, al Éo (d Èo Êi ll {Àê â \o o 'E.o ,à0o.d =iùoô -Éot* o\f.. o\r- o :iE €qô9Èo!a!6 = ô9 z ê! oo oo Ë o\ € æ r- o\(.) =9 .àÉE;*"<Ë ô \o o\r- c1 c.l§ \o o\t- rô al .ü ô ^-rdv!1o _ E ë.8§Èoàoo 6€<'= ' â 39o c:p- o\ §O o\ raç ro râ C) èo rË V)(l) ÉHÉ oQ ll +âd\o E .9oéd)E- tü ào<8Eo oO o E.9 .^ L.Ë üç -3 E $ËE É= O =É>e7ôo o F- o\ F-o\ Ëo -d ô.à lÉaE:C)ë sE'FU or- o\ ot-q\ >9_' 3ç oÈ :: ooE c ÉHr* E'; È-e x Ë E§c*- or- O, F. o\ .9< Hqô\ U)oJ Fl Hê\ -:\ qq§ §) ç- qè \§L§ È § a4§U 5 J4 v) Lr (§ (n(d() L Cd cü É (, F] o 3i ü) E p v)H (n € (d Êq) (ü()trF Ër orl -olGllFI 2.6.2 What are the causes of absenteeism? Drugs were distributed during the rain session due to the shortage of drugs. Moreover distribution was forcéd to be done in phases accordingly to availabiliÿ of drugs. As majority of people living in Kilosa are farmers so during MDA most of them have moved to the field areas for agriculture activities. 2.6.3 What âre the reasons for refusals? As mentioned above, MDA was conducted during rain session, many community members fear the side effect therefore refused to take drug fearing that they will not participate well in agriculture activities. 2.6.4 BrieJty describe all known and verified serious adverse events (SAEI) that occurred during the reporting period and provide (in table 8) the required information when available. There is no any cases of SAE o Parasitologist trained? Nil o Existence of microscope? NA 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 o o a { o\oo c.l o -o tro a.() v) .tr \JÀ o l o o \o I t §) §\§ aro' L§ "§ §\§v) * =§e.EE b4 a3 *'t Ë §EE (+{ o o.9É2oɧ.1 o0EO(J o. H G)É q-Q o9 ^ 7E 3()-c É&eà r-l g =dq<üo-O.9E G(r) É c:=(€@oqâ E,ir,§ É o vo.c{J (Ë-=:Y oO HË.§ oèOaÉ EE s .q o.Nçe IÈ-8> O 0É oÈ E >rU) ?o -L.T Ho !lc)  *F Fl É(d X§ s* À É 80:S cik 5ts x G)(r) t-< (u b0 o *z (r) z !-'§q 4§) v 4è o\§L ȧ§ h v§) 8a o tr C) O. ô0É tsoÀ(l) l.r o -q èoÊ lr) Eoti È< C)o o §l v) tI] a .t) q) o) (u U)l-r(u Ë cü t) ao L(l) u)q-l o v) C) v) «,O ôr c.rl -ol(Ët FI o\Ooôl () .ô () Ê.oa s (J o r- q o\ s oo a o\o\oo \q§ oo q o\ æ lr) r- \o c- (\ cô () èo P ËS -o O \CJ o, -{(\ æ \ cî o\ q o\ æ c-.1 r* æ \s o\ \ r- r- c- oo ll -9 .îri *ET ri (.) ^609 gâF 6)ô\ < >v -o o \q o oo o\t-- (-r V"] rat t-. r- oo tr)\o noo\o I r- cl\o EBoô (!^S.g bsd.) ?v -qOFo ll -È'trr .k ôl c.l oo^ ôt æ c1 c1 .{- c.l o\ æ al oo oo t-- o\ cêl \otc* t-- cl cl carô o- r--(\ ca t.- t-- aî c.l O(\nôr(r) c.I or- oo c.l\oôl o\c.I o -- .EHgEb9 = o.€z ri -f,t-C.I o\t-cî cô§ c.I oo o\ c1 \o o\t- cîôl$t--cî ôl o\ oo + c- a1 c1 o\§^ c1 c- crl o\o ci cî c1 tr- o\\o^ o\ cî c1 \o\o t-lr) cî Ëc>(d ().a dtrô!=()à ÈtrFe r rc oo c.l§c- rd. srâq(\ oo§ o\ t/.I $o oos rat \os$ \oc\ o\o§ s clq oo\o$ r* o\rr o+ o s^ to§ oo o\ ./î cil$ iô 9e -'-00.)a-rûtd;=_éatr<É € EEËËË Ë*o oc)ÈE a a ooa aoo o o 0) e§aF ()ê\4 >! (.) ua * tEl Oo oOo oa ooge gssÀa ar-o\ ar- o\ srô o\ ot,- o\ ot- o\ $lr}ô\ str) o\ sl t/.)ô\ strl o\ .Ë ootE(d() Éç cg.e 3 ()p z (H o ri tr- o\ rro\ r-o\ $râ o\ <l rat o\ r-o\ $ rar o\ s\a) o\ tf, rat o\ ËoE 6.à ,tro =:a)< P€'F\J d f-1 o c- o\ r-o\ strl o\ atr- o\ a c- o\ rftrl o\ § rr) o\ str} o\ s rat o\ *§ e n Ho.9E Ë.kIt'E.E à,-t - L È.r l-l§ 2 Eè E-o E àor.., oÉi È <§ 9,tg- - 6 ooooN o\ooôl o aôl rrtêoN \ooo(.l t'-ooôl ôlo ôl c1 oC{ sooN d rq â ah .5§ I c§I 6)ê! cɧb§à \tJ§ rhl-v '§ t-r §i ,)p .È d§o§É Ë.§ ËË È.E =§''=(J.4È˧Ee.q)t Ë€iû :c!6t§H ertH.ê ôà0E âZ 'efl:E L.'!l-56 iI-(ol9â€(a(Jx§ ,YtsôtE ESÈ TH6) ..:!l L9t é) (l)l !''l *Ël E .: ol .= -t IEà!6tÉ :gr9Ioüÿtrl oLi à€ôorhÈEÉôt- Lo -LÈii(1)eËE.sHË!! ui -g 'Ë, .!v\0É ôl O\l ô(l;)l .r)El §t-l È o o a 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH { EWTTO tr LINICEF tr Other (please specifu) NGDO tr Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH { N WHOE UNICEFE NGDO E Other (please speciÿ) Please describe how Mectizan@ is ordered and how it gets to lhe communities Yearly Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project and requests drugs by filling in the ordering forms and send them to the NOTF in the Ministry of Health & Social Welfare. We calculate the number of tablets required by multiplying the ATO times 2.2 then we get total number of required tablets. But in this distribution year we received the drugs direct from MSD HQ whereby the allocation was done at the Minis§ of Health and Social Welfare. When the drugs arrive at the district pharmacy, the District authority distributed drugs to the FLÉIF by following request sent to them by FLFIF staff. After getting Mectizan the FLF{F staff informs the Village authority on the arrival of Mectizan thereafter the CDD or any selected community member come up to the FLHF to collect Mectizan@ ready for distribution to other Community members. Table l0: Mectizan@ Inventory @lease add more rows if necessary) NB Drugs used in Oncho endemtc areas are 1'032,848 tablets Drugs used in non Oncho aress are 68,792 tablets These remained medicines arefor the whole entire district which includes Oncho and non Oncho - How are the remdtning ivermectin tablets collected and where are they kept? The remaining ivermectin tablets are collected from health facility when CHMTs visit the faciliÿ and some collected during data collection ready to be stored in district Pharmacy store. List and brieJly describe îhe uctîvities under ivermectin delivery that are being carried out by health care personnel in the project area . To inform communities that Mectizan is already at the facility for them to collect . To collect the remaining Ivermectin tablets and bring them to store in the district Pharmacy for next treatment cycle . Issuing Mectizan to communiÿ according to their needs r FLFIF staffs are involved in monitoring and supervision on Mectizan distribution. o Provision of informationÆIealth education to Patients attends at OPD on the importance of taking Mectizan during the distribution period. o Oa o o a i State /District ILGA Number of Mectizant tablets In stock from previous year Requested Received Used Lost \ilasted Expired Remaining KILOSA 209.282 998,103 2,005,000 1,101,540 127 0 0 1, I 12,5 1 5 TOTAL 209,282 998,103 2,005,000 1,101,540 127 0 0 1,112,515 oAny other comments - Nil 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, ll/hen? Training on CSM was carried out in 2007 to the FLHF staff. Table I l: Community selÊmonitoring and Stakeholders Meeting Ç4dd 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. o In area where CSM have been conducted, people are aware on CDTI and they are participating in the implementation of activities. . No drop out to CDDs o Therapeutic coverage is stable 2.9. Supervision 2.9.1. A flow chart of supervision hierarchy National level Regional level level CDDs /COMMITNITIES o a a District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meetins (SffUl KILOSA 970 62 970 TOTAL 970 62 970 R.M.O (RTIMT) RI{MT DMO, PC DOT RHWs Health Facilities level 2.9.2. ÿYhat were the main issues identiJied during supervision? . Fear of side effect among community members as the drug was distributed during rain season. o Good cooperation from community leaders shows their commitment on the elimination of Oncho and otherNTDs. . Willingness of CDDs to conduct drug distribution during rain season and working a long distance as many community member have shifted their settlements 2.9.3. Was a supervision checklist used? Yes 2.9.4. lYhat were the outc7mes at each level of CDTI implementation supervision? o District council is ready to top up funds to facilitate the implementation of CDTI/NTDs activities. . Community leaders are able to make a follow up on MDA at every stage of distribution o CDTI activities are being incorporated in the CCHP in the district council. 2.9.5. lltas feedback given to the person or groups sapervised? Yes 2.9.6. How was thefeedback used to improve the overall pperformance of the project o Requested for timely distribution of drugs not during rain season o To include V/EOA/EO in training of FLHF staff so that we get good report from CDDs o Communities agreed to provide more incentives to CDD as they are doing CDTI and NTDs at the same therefore more work to them. o a t a oo SECTION 3: Support to CDTI 3.1. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, Vy'O:Written Off). How does the project intend to maintain and replace existing equipment and other materials? The project makes sure that all capital equipment APOC and other donors given us are well used in specific CDTI activities and sometime the district makes some repair. CDTI activities are already integrated into the health system; the project capital equipment will be serviced through PHC system. a Source Type of equipment APOC MOH DISTRTCT/L GA NGDO Others No. Conditi on No. Conditi on No Conditi on No. Conditi on No Conditi on l. Vehicle I F 0 NA 0 NA 1 CNFR 0 NA 2. Motor cycle(s) 4 CNFR 0 NA 0 NA 2 F 0 NA 3. Computer(s) I wo 0 NA 0 NA I CNFR 0 NA 4. Printer(s) i F 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) 1 v/o 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) I wo 0 NA 0 NA I F 0 NA 7. Others a) b) c) 3.2. Financial contributions of the partners and communities Fill tables 13a, 13b and 13c If there are problems with release of counterpart funds, how were they addressed? The district council is ready to intervene if there is delay in the release of funds from counterpart. But sometimes funds which are being released are not sufftencient to conduct many activities. Additional comments: Last year the project did not get any funds from counterpart SSI without any explanation. It is better for càunterpart donor if cease the support to officially notifu by writing the reason for stopping its support to project. I o o a t o\O c.l o -o E C) o.() a\t (-) op. o > ca C.l al rOla) la æ-(.) ç\o r.t r.)r- -T-r- al o ô,1 d oo^ o o o Oo s\o o\ c.l æ ô.i 0ôq cl o o oo o oô oô o (l) o o oÊ(, z üri tr o 4o tr! U-, !r -xEXi9 i(lo(a){ o oo o\ô \oc.l o al o Ë o\ (A æ È- oO coo o +t+q c.l ro- § =o\ cl(-)\o É) Oo oo rn o La) rO o\ N T ôl o ô- o\ TT o\ (.) æ F.' trc cl(.,\o orft ooo ooO o *to\ôi .o- aêt t al o o o oin ra o\ O =f a.to\ oo ô ê o\q ?o æ(tl t o\ ?a) o\ o\(.) 6(.)§ o\(a o o\q cl ooo -f o\ oo o o\ o\ cô oo c.I s o\ cl O o\ o\(.) æ ?a) To\(a) o\ o\ {.) 6ïTï oo c.l 6 N o tçq e.l .o- t!c o\ç\o o\ ia oo O o oo \o + o :t æ |.) o\ roêl o êt(a) ral T o t- oo -t N T \o o\ oo r-'\o oo .+ ôl oo \o ooô c.l §§ .ri § § N § aÈq s T3§ S §N ê§ Ë§ § Éo G,o !o G' c) §§T èl§ § H a() r* o o{É (n o àÉ tr 6, F ()IZ ' d() o § § §àlrl ao q Èoê v) ôIé o Éo a Éo Cd §l ÊI §' §) §Èô § § § .§ § Ë U§§§ù & §§ e) ù T!§ o ! ! É o()é o a) () o () Ed() o ()(h o § ù § 13 § itÈ â C) (t ct v) \ §§ -À rl H oF âz (l) (.) ti -c +J V)(ü o) tr .oq-{ (d (r) Éo =,.o l{ É oo (É oé(dÊt rÉ(a (9 & clF o o a ao\OO(\ () .o o a. c)a (J oÀ E! I o o + c..l I ù o æ 6 Id æI æ æ æ\o æ æ o L L)t o o ooô oO æ I æê ra d o O Oo o O Oq o o o O oo O O o U o O o o o O o o oo o o o o o d o ,] oâoz o \3 \o o\ æ N ô o æ æ o O :tr d ôl al o d N cl d ôO o\û cl  E L6Ê Irl o âoz oc.l o O Fâæ o o û æ ç o & c\ ô o O ææ O r e o\ t. o\ ôr æ \o r o æ \ê tr a{Ôl do\(a: § a'l T ra al al æôr æ€\r o\ r ôl o êI 6 F- o\* ô.1 a r- d o o e{ O æâr o æê\t'- o O oo Oo o æ a r o o æ(1 et- æ ra F. o oo o §§§§S c§ S§S§ N € æ la æ \o æ t- atT râ mêlt §SS§ o\æ e^l o oô ôl S§g\ êâ6§\d O æ o\Ô r §S§§§§ Ôr S§S§\êNS o æ §§§ c\ a\ c§ Ss§ SS ha oo d o frlÀzü Ée o(} o oôt Êe o\ æ .+ § §§§§ .1Ë § § Èù ôË()§È§ §rt§N ê Ès§ o6oo E o da !o do § -§ èl § ! !(J o d É 6 o àtr ÉÉ t- olz o do o ȧ § È kl èlÉ o .Ë o o d d E] È -§ ù È b § èô§ È §§§ §§ 'È § E ȧ §È &s§ È ù3 Eo 3 :3 o o o I 'od ô oo oo d 6 s § -§ !1 §a§t Ë § § o & o oÉo .É c dN ooÉ o Èo o G tr s \ §§ !l F oFÊ z o o do 6 , a§ Eoo 6 oc6Ê fl À &cF ooq æ Vt attêt oêl o O e.l ô ola)T a- o æ \o ô.1o\ oi o c- \o æ Ët \o EEU-:, Êi;<i F o {-r- o o oEO o(J 6I o Fl o oâIz ô o\ç æ o\ r- o @ oo o c- c.l æ a.l t æ r.)\o coêl ra co a- or- o\ c.l rn t'-. .Çôl |r) \o \o o â oz o æ(.) \ê lôt-(a) æ t- rf) la æ o ô ot-\o N ô ral(.t ôil or-\o o rA(.l ô o t'- o\ o\c.l O o t.-\o () Èr\o êo o o æ(.) \êiaF. ra æ \o ra F-(1 o oo \o §-Cî oo ô C) {, () oo oo \o §- 6(.) \ê rar-(ÿ) æ(1 r- rA ia æ o rA 1+) cl o ciâ rl o o t-.\o o r- \t) o aô e.l § §§ .ai § § § N § û§a s T3§ § §§§t§ Eo do to oaU o èI É «t ()Èàé E d Ir o .v o ' do o ôIé '= c, o à É d t- § § § § § lrl Éo a È()ê U) èI .E o co Éo G' (Ë rq §' § Èù s Ts § § §§§6t u§ §ù §§ù E§ !§ Éo I 6 EÉ o() () ' I I I l l l l o o o q) !d() () ()a aH o o tsq) ox «lÉqt z \ § §q) Bü § § tÈ {) GI ql U) .: d8 \ Èl§ l. FT tr oFâz o\ooôl C) ,§ É C) a.oü)§ O oê. a tôN Ë() =É PÉ o c) o C) r< ü) cd () Lr ,E o o (ü U)Éo § Lr Ê oo (§ o «lÉt e)(ç) o) & rl Er a 3.3. Other forms of community support Provision of transport to CDDs or any community member to go to nearby health facility for drugs collection. Some communities prepare drama group to Mobilize and sensitize community members prior to drug distribution and during distribution. Some of communities support CDDs by excluding them from voluntary development work. To convince/encourage other members of the community to take Mectizan Any comments or explanations? Nil SECTION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Has thc project ever bcen evaluated/monitored? (Tick any of the following which are applicable) Year 1 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? -Proper reporting system should be put in place -Undertake targeted supervision only in areas where there is need -Use supervisory checklist/matrix developed by APOCoT CHMT -Early application for Mectizan to MDP by NOTF Tanzarria -Conduct targeted training to areas of need -Training duration should at least 2-3 days and not less than that -Mobilize funds from council by conducting Advocacy to council management and make sure funds are released -Provide incentive to CDDs and other staff to motivate them -Sensitize village leaders to encouraged them to participate in the CDTI activities -To provide transport CDD -The council has to maintain and sustain CDTI activities -Accurate data entry between the levels CDDs and FLHF staff -DOTs should collect data at FLHF level and cease from going directly to the CDDs in the community. t o o I D a4.1.3. How have they been implemented? -CDTI activities features in the CCHPs, funds for CDTI activities are budgeted and disbursed even though are not adequate. - Village leaders are now supporting the implementation of CDTI activities in their areas - CHMT members they are conducting supervision using checklist which include also CDTI activities - Training is targeted to the project need All of the above recommendations have dealt with. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? NA When was the sustainability plan submiued? NA What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels CDTI activities are incorporated in the CCI{P, and community is empowered to make their plans according to their priority. 4.2.2. Funds District council has been encouraged to release funds budgeted for carrying out CDTI activities and the contribution is increasingly yearly. Communities are encouraged to take their full responsibilities in CDTI activities. 4.2.3 Transport(replacementand maintenance) The project thanks APOC for vehicle provided recently. \Me still have problems with motorcycles. District council is taking part for service and repair of the vehicle as CDTI activities are already incorporated CCHP. 4.2.4. Other resources The Project dèpends on Government and Council and they are committed in the sustaining the project. 4.2.5. To what extent has the plan been implemented In this year the implementation of CDTI activities has followed the Sustainabiliÿ Plan developed after the mid- evaluation of project. 4.3.Integration 4.3.1. Ivermectin delivery mechanisms lvermectin is delivered through the existing Health system from National HQ to project level through MSD. 4.3.2. Training Training had been integrated with NTDs. \Me trained CDDs on all five NTDs (Oncho, LFEP, Stchisomiasis, Soil Transmitted Helminthes (STH) and Trachoma). To Some extent the project started to co implement with Vitamin A and ITNs distribution as pilot in one area. 4.3.3. Joint supervision and monitoring with other progrâms CDTI activities are incorporated in the district supervision matrix using the existing Onchocerciasis checklist. o o a 4.3.4. Release of funds Funds are not released on time from both part (APOC and Council) this cause delay in the implementation of activities. 4.3.5. Is CDTI included in the CCHP budget? Yes, and some of CDTI activities are being financed by Council and budget has been increased year by year. 4.3.6. Describe other health programs that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is being used in Malaria Control by distributing Insecticide Treated Nets (ITNs), Vitamin A supplementation and now co-implementation of the five NTDs (Oncho, LF, Trachoma, Schistosomiasis and STH. 4.3.7. Describe others issues considered in the integration of CDTI. The district in collaboration with NIMR, working on how they can use CDTI in identification of TB patient and distribution of TB drugs to Patient at household level. p 4.4. Operttional research No any operation research done The extent of integration of CDTI into the PHC structure and the plans for complete integration is stipulated in table 14 & 15 below: o o t o\ o(\ () -o () o.o cn !t OoÀ o o\Ct 4§) §)<§) > .§ 4 §)\§§ "a § \§) ..s Ua o § L§) § È ts !q) q)6o O oat- 6)a o q) E z 6 ot- oo oo t-- o\ cô o æ s c.l -f, o ooÿ c.l .+ r-O$\o cî C.t oo cî rô$r- c..l$ a() d q)I ao 6 2, () () èo c§ oa (l)È o ,-q) ! z o F. o\ ral§Orô \o cî\o oo cî rr) \o ca\o oo cô(ô r- cô\o tr) tr- ra) oo\o cô o\ oorr o\ oo\ô q) É! q,)fr O c) c(à o âUeq9o,z r9oa -oÉ z GI oF oo ca cil \o cî cî \o co c.l ô.1 c..l cô oo \o cl c-t oo d 0)l* o\\o ootr) oo tr) \f, oo tr) o cl,À o\\o oolr) oo rt <f oo tr} hé)e5 -o=EEaeZo c) () I(§ 0) Ot-- o\ rr) ra)o rat rat tô(r) .+ tr} rôO q) () bD É!F Or-o\ rô rô ta)(a) tr)rri Os \ô ralO ô.9 -o r<é.2 =,Éz o 9(ll q) & o (l) è0 cg t< x.si!§\J§ À'§r,§o§ 6.Sg§ 6JÈ E§ i9r,(n)li ovo-o()ô' eE|.r95 d -;r.!1 () =v)iiOâÉ aaa 19 80(n?Li (L)eo. oo.)à) eËl.9-d .d5 :r. o) =.htiùE> aaa 9 fo u)ë!rÉ5 0ovo.oo)à) eËl-{PE d €'Ë -gEü.iü6> aaa () U)(È) oÉéO OÉ 4.dZ ,É Ëe 'ÉZ É FlET EhrE5ets aa € c) ÉoÉ (!)ÈÉ C) >. !oz çro OJ I =Êp'= LL<Ësâ> o a:i bn V) iJ Li (,) v o-oC)q) eELraÀct €Ë g =t)L;()âÉ aaa -o o:9U xÈLr O) EE! Ex=(dijx-o F o --trÈarl]= qËËe#6€ (H aO oo '.5 N <(t tsc)ô9Â< a (H oqz ON 'j](d ".oE.-(l) th 6)ô> a (+< o Eo 9vt';zEH oJ a (* o É() O.Ëo E)'ÉÉ::(É o(É(ÉFçÉ a o (É 4Éa6) i(D =o.iJ it 7da a qr OX 'E(Ë €bLL oË ON a a o a oo eË ,>o .rt art(g o() c) .t)u) o d olr E oo cË 't''! o Éoo (B 'l: o a (Ë ts oé U'+)o cl ,È a o o o cl o II o) a E Iê(J ç q) cÉl'( a o\OOôl k o) -o (:) Ê. c) v)§ oÊ. a o o cô YdC) :/aÀU^ HH\H<<oE xd(J!/!àO^ PH\H<<âE ts3s^*H\H<<o!Éts39^Hh\H<<o:( () 6t 6itr.- sEÉ'= (ÉH i9 - -Y-\LU tr >'C) çt E.E q - -:;\L(J ts >\o) etc'= (oh !9 - -: F\ LLJ tr >'O) eË c'= (§:;9 - -xi\LLJ tr >'() oa6 ës 'â= ÉgÈ rr'c 'Ë "r4!O ,, E€> H E§5(.) U >-fr.â5ËË?Ë. eO'Ei-nE S EËà28;-i h OEit Xl-l 9È-J ê vc)(J >,r.q EC) r o a,f^cÉâ -é aV c, ; ! otsiE Yt-t (Jâ-J ê e(J (J >,i:. Ë U r ê0 t o o& 0)EôoÊ(!(Ë =@'-çaa ()^ -oËXi (§ l-J6gu ()tô0tr(§cdAe- -o!X69t) OEèoÉ(§«3 =a'-L(, . c)^ -orQX - (§ l-.1ô9o oËè0ɧ(n '=Lo - C.)t\ -oEX< CUIJâ ou I r:r .E ooâ à ,Â= aFHâ7,-eIEô6Ë >(J.Egd FÀF O ,;2 aLÈL *= s:Ehàx>ù'=s F F(J ,;a- a{FEu= sEbÈ"Ë>()'E g c)ô!'ôû ûro (.) d FàF() }E l!O >Q û nâO aâ t-tU a o o L) aâ o() LO .9E -bBLâ-éÉiâ Ët\ fJ" JrJ trr o U) t-.1 'o Cd lJ- l-.1 J o Ia t-,{ o,Egp- I - ;= EÊ o !I t/) â (o l+< tl ao (J aâA(J qâ l-lU OE EE E.s =Étrj'ieE ûâo() És, =oH9 Htr oqlUE É2 =aH-o _e9\Jtr =e =a) ô() IJtr IÉv) =ats.o ôc)(Jtr o d Éq) 0) (r q)o: Eo) .9Ë,ç!'lo)L q)Êr6r0.= (Ë L b0 0) É €o (Ëtr bo 0)9 C) d li bo o E o oro (Ë l<èo C) C) oà,- z3 o o z tr 0)! o o z L C)§ () L z.é o Lq)È ü2 é) (, (Ë o 0) E oI o q) o q0 'Ëà cÉ f/DÈ çro o 9a , -2,PH@.i oi a o (l) èo(d =dEh(l)d EEJl tr;to a o (n <6 Cl- ;o) =o.Èiî a (H oq) oX1E(! ptr .- 6.)E-oo()ô> a (H o 9() ÈDNâÈ op od ,=oô=0)i 0:)a,È€ a e o o o q) F oL É o() o i) u) an(ü oL C'o .A ./)(\l !(! rE o (Ë _-e ot< troo rü otr oo (g o +J t § §-§- §-§ a§ +Ê() q) L o L aÀ U ê0 o q) q) Cq â0 o li trq) o rii 0) & 6, t'{ o\oo c.lÊo -o (l) o(.)(t) + O o Or o ca § x§) è ,§) \é §)L ù .a § .É V) § §è §) § ,§ Êo ts o ts3s^Hh\H<<oE rE b 5=9 ç"(J t >\û) o /1 (Ë 2E -o dlJ L âEâË?Ë- otèoc(!«t aa '=LA)/ ()/1 < 6U r 9A ,Â= 0 tr E bÈëEE>O.E9 E(J.od Fà U a oÊO o r -t 'Titâ!tsl i5 Ed o âO xI =c,=aEEôoOE CdLboo t 0) C)i- z3 a aa a a a a (t o cF .e x ..!5+j«r((lP E.N J= H-o(/JÈ oâN> aa (! ô ü) o ,à o(l) o. rn û a a a SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: o lntegration of Oncho activities with other programs ( NTDs Implementation) . All Policy makers at all level participated well in the implementation of MDA activities. . Kilosa District Council increase their allocation to NTDs activities o Active participation of CHMTs, Councillors and community leaders to ensure the campaign were successful. . CDTI activities are incorporated in the CCTIP . CDDs are willing to volunteer in NTDs ChallengesAüeaknesses : . Lack of Integrated reporting format and IEC materials for NTDs o Lack offeedback from both project and national level r Late arrival of medicine from MSD to project area also late transfer of funds from national to project level . lnadequate supplies of medicine as per population which made the district to distribute drugs in three O phases o Distribution of drug during rain season and national election time has interfered the distribution hence we have to wait till election has completed. r Same amount we were used in the implementation of CDTI activities, now the same amount we are using to implement NTDs activities, which are found in the whole area in the district. . Drug distribution does not follow community proposed time. We distribute drug as they are arriving in the district \ilays to overcome : o Next year MDA should be done according to the time proposed by community to avoid distributing in the rain season. . Conduct more advocacy to the community on Onchocerciasis for further compliance to MDA exercise and sustainability o To increase fund so that to implement NTDs activities in a smooth way. OPPORTT]NITIES: ao LonB stay of FLHFs in CDTI alea (No inegular transfer of FLHFs) o Availability of funds (basket fund) for implementing CDTI activities o Integlation of CDTI activities with other NTDs programme o Availability of knowledgeable CHMT members and FLFIF staff on CDTI coordination o Political stabitity ensure ownership and sustainability Major achievement of the Project during the Year - Number of absentees and refusal had reduced. - Advocacy meetings were conducted targeting all representatives from political parties on NTDs implementation. t q a I SECTION 6: Unique features of the projecUother matters - Nil