Ruvuma CDTI focus annual project technical report submitted to Technical Consultative Committee (TCC): from January 2007 to December, 2007

i' I : I I I i I L, RESERVED FOR PROJECT LOGO/HEADING C OUNTRY/1.{OTF : T anzania Proiect Name: Ruvuma CDTI Focus Approval vear: 1997 Launchinq vcar: 1 998 Reporting Period From: January 2007 To: December 2007 (Month/Year) ( Month/Year) Proiectyearofthis report: (circleone) I 2 3 4 5 6 7 8 (9) 10 Date submitted: Mray 2008 NGDO partner: Sight Savers International ORIGINAL: English AI\NUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) For Acti To: t{z Yrl+ For lniorrnotlon To, -\i R Ao. Ahl siH l csb CoP hHE Bfo I1o H. Bo 0 4 A0Ur 2003 WIIO/APOC, 2.1 Novenrber 200'l 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: Tanzania National Coordinator Name: Dr.Grace Saguti ... Signature: ZX .'.7 *?=o.or ' Date This report has been prepared by Name : Dr. Wade Kabuka Date Zonal Oncho Coordinator Name: Dr Malekela Signature Date NGDO Representative Name: Dr le Signature 21 :? zo98 Designation : Project Coordinator Signature: . t^^*W Date 1..1., ..0. {.... .2. .a./. .8 . . ... I Table of contents ACRONYMS DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS 5 7 8 ; ;;;;i i;;; i ;;,;; ;; ;;; d$";;. :':?': ::: ::::: ::: !"1':"i6 EXECUTIVE SUMMARY. SECTION 1: BACKGROUND INFORMATION 1.1, GENeRal rNFoRMATIoN ....................... L1.1 Description of the proiect (brieJly) L 1.2. Partnership 1.2. Popur-arroN ......... ERROR! BOOKMARK NOT DEFINE,D SECTION 2: IMPLEMENTATION OF CDTI... ERROR! BOOKMARK NOT DEFINED 2.1. 2.2. z.). 2.4. 2.5. 2.6. 2 2 2 2 2 2.7. 2.8. 2.9. 2 2 2 2 2 2 TlrvrElntE OF ACTIVIIIES .............. .... EnnOn! BOOrntaRx NOT DEFINED. Anvocacv .................12 MosrtzettoN, sENSITIZATToN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIBS 13 Covl,tlrNtry INVoLVEMENT............ ................. 15 Capactrv BUILDING ...................... 16 TRgerupNrs................ . Ennon! Boorntanx Nor DEFINED. 6.1. Treatmentfigures........... Eruor! Bookmsrk not deJined- 6.2 What are the causes o.f absenteeism?................. Error! Bookmark not deiined. 6.3 What are the reasons for refusals? .................... Eruor! Bookmark not deJined. 6.1 Briefly describe all known andverified serious adverse events (SAE| thatError! Bookmark no' 6.5. Trend of treatntent achievementfrom CDTI project inception to the current year22 ORDERING, sroRAGE AND DELIVERY oF IVERMECTIN ..........24 CouvuNtry sELF-MoNIToRING AND STAKEHoLDERS Mnsrmc ...........25 SupeRvrsroN ............... ........,.........26 9. I . Provide a flow chart of supervision hierarchy. .......... 26 9.2. What were the main issues identified during supervision? .............................26 9.3. Was a supervision checklist used?......... .................26 9.4. What were the outcomes at each level of CDTI implementation supervision'/ 26 9.5. Was Jbedback given to the person or groups sttperttised? ....269.6. How was the feedback used lo improve the overall performance of the project'.)26 SECTION 3: SUPPORT TO CDTI 26 3.1 3.2 3.3 3.4 27 28 29 30 EeurpupNr FnnNCIaT- CONIRIBUTIONS OF THE PARTNERS NND COMMUNITIES OrttgR I.-oRMS oF coMMUNITy suPPoRT ExppNonuRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI 30 4.1. INrsRNal; INDEpENDENT PARTICIPAToRY MoNIToRING; Evar-uarloN ...................30 4.1.1 lVas Monitoring/evaluation carried out during the reporting period? (tick any of the followingwhich are applicable)............ ........ i0 1.1.2. What were the reconurtendations? ........... 3l 4.1.3. How have they been implemented?..... ... .... . ..........31 4.2. SustelNnsrLITY oF PRoJECTS: PLAN AND sET TARGETS (MANDAI'oRY A1' ............... 3l 3 WIIO/APOC, 24 November 2004 Yn 3)......... """""' 31 4.2.1. Planning at all relevant levels """"""""' 3l 4.2.2. Funds........ """"" 31 4.2.3 Transport (replacement and maintenance) """""""" 31 4.2.4. Other resources... """"""""" 31 1.2.5. To what extent has the plan been implemented......". """""""""' 31 4.3. INtpcRattoN ............... ...'.."""""' 31 4.3.1. Iyermectin delivery mechanisms ......Error! Bookmark not defined' 4.3.2. Training.... . Error! Bookmark not deJined. 4.3.3. Joint supervision and monitoring with other programsError! Bookmark not deJined. 4.3.4. Release of funds for project activities .... Error! Bookmark not deJined. 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? ..... Error! Bookmark not deJined. 4.3.7. Describe others issues considered in the integration of CDTI.Error! Bookmark not deJined- 4.4. OppnarroNAl RESEARCH.. ..................32 4.4. 1 . Summarize in not more than one half of a page the operational research undertaken in the proiect area within the reporting period. " " " 32 1.1.2. How were the results applied in the proiect?............. ... ." """ 32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTTII\ITIES...... 32 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........33 4 WIIO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I-,TNICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed D istributor 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 5 WHO/APOC, 24 November 2004 Definitions (i) (iii) (ii) Elieible Total population: the total population living in meso/hyper-endemic **n]r"rti.s within the project area (based on REMO and census taking) calculated as 84o/o of the total population in meso/tryper- (iu) 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 of the 3'd (normal year ofthe project) ly the project should be exPected to reach the UTG at the end (v) Therapeutic coverage: number of people treated in a given year over the total populition (this should be expressed as a percentage)' (vi) Geosraph coverage: number of communities treated in a given year over the total number of meso/hyper-endemic commun ities as identified bY REMO endemic communities in the project area' AnnualTreatment Objective: (ATO): the estimated number of persons living @areas that a CDTI project intends to treat with ivermectin in a given Year. in the project area (this should be expressed as a percentage)' Integration: delivering additional health interventions (i.e. vitamin A .,rppl".""ts, albendaiole for LF, screening for cataract, etc) through CDTI luiing the same systems, training, supervision and personnel) in order to maxiirise cost-effectiv.n.r, und.*power communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainability: CDTI activities in an area are sustainable when they continue to fu*fion effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownirship, using resources mobilised by the community and the government. Community self-monitoring (CSM): The process by which the community is ..p*a to oversee and monitor the performance of GDTI (or any community-based health intervention programme), with a view to ensuring that the progr#me is being executed in the way intended. It encourages the "on1.n,Inity to take fuliresponsibility of ivermectin distribution and make appropriate modifications when necessary. (vii) (viii) (ix) 6 WHO/APOC. 24 November 2004 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 25th 7 Number of Recommenda tion in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 315 TCC recommendationfor improvement of project implementation Ensure a good strategy for release of adequate fu nds from council The project has conducted advocacy meeting to District Councilors and also invited high level officials to attend project annual review meeting. In this year most of CDTI activities have been incorporated into the CCHP and some of councilhas released funds to implement CDTI activities. Provide a strategJ) to replace or repair ofaging capital equipment e.g motor cycle by government or APOC We would like to thank APOC management for replacing capital equipment. The project has now new capitalequipment. The aging one are now repaired by Government through region funds. t Keep on sensitizing new political leoders Advocacy, sensitization is now a continuing process to the new leaders. All new leaders in the project are already sensitized and they are all aware of CDTI. Ludewa district is expecting to conduct advocacy in this financial year by using APOC funds. t Improve treatment and treotment data management In this report treatment data is well improved because collection was done by using the form provided by APOC. Moreover the project has managed to install Apocbase software for data management. WHO/APOC, 24 November 2004 ) ) Executive SummarY Ruvuma CDTI project which is now in the lOth year of implementation of CDTI activities cover four Onchocerciasis endemic districts namely Songea, Mbinga, Namtumbo and Ludewa. Three districts (Songea, Mbinga, and Namtumbo) are found in Ruvuma region whereby Ludewa is locaied ii tringa ."gion. This report is for 9th year, and it covers the financiil and technical issues of the project for the period of January to December,2007 ' From January to December,2007 the project managed to conducted the following activities: training of I DOTs from Mbingu on borputer Skills, Training of FLHF Stafl CDDs, and Commirnity leaders. Also the pioject conducted advocacy to policy makers in Namtumbo as this is the new district split from Song.u district. By using donors funds the project managed to do maintenance to the capital equipment such as motor vehicles/cycle, computer and photocopier. Annual Review Meeting of the Project, and also supervision and Monitoring was also done. The treatment cycle of this reporting period started in October and lasted in December 2007 where by a totai of 290,49lpeople were treated in 1,307 communities. The total population in Hyper und M"ro endemic communities is 393,552 people, whereby the geographical coverage foi ttre reporting year is 7O0o/o and the therapeutic coverage is73.8%o. The ATO is 330'917 and UTG is 330,584 The project received total of 1,018,500 tablets of Mectizan@ for mass treatment in the project area.^ Tttal of 914,500 Mectizan tablets were used by people living in the endemic area, total of 2,000 tablets were lost and 102,000 tablets remained and they are stored at regional pharmacy. The total sum of $ 82,219.9 was received by the project for CDTI activities implementation. This amount was from different sources such as APOC they contributed $ 18,098 the four districts in which the disease is endemic their contribution amounted to $10,259'9, MoH/Region contributed $ 49,950 and Sight Savers International (SSI) contributed $ 3,920. Also the project received one motorcycle from APOC. Major Challenges and how they were overcome . Administration as the focus includes the district of Ludewa which belongs to Iringa region. Plans are underway to split Ludewa district from the Ruvuma CDTI Focus project o The influx of people moving to the mining areas in Mbinga, Namtumbo and Songea Rural districts makes it difficult to control population fluctuations. More mining prospective activities are being carried out in Ruvuma' . Seasonal road infrastructure and bad geographical terrain is a challenge especially in Ludewa district. . High cost of maintenance of motor vehicles/cycles drain the little funds we receive from the district councils. o Integration of CDTI activities with the Programme of Neglected Tropical Disease will need more human resource development 8 WHO/APOC. 24 November 2004 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 Tanzan\a' and lies between latitudes l0 degrees south and ll.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. lt 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 neigbouring district of Iringa region, Ludewa. It covers approximately an area of 64'333 sq' km of which 1,006 sq. km ire in-land water bodies from Lake Nyasa. With the exception of a small area along lakf 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 l4 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 una nuhrii drain into the Indian Ocean' In between you have many seasonal rivers draining into these two drainage partten' Major food cro"ps grown in this area-are maize, rice and potatoes' Legumes such as beans and soya are also cul-tivated 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 beiween the poor, who forms the majority' and the few effluent grouP. The road netiorkin the project area varies considerably. Seasonal roads.that are only passable during the dry ,"uron-un important factor during ivermectin distribution' serve Ludewa and Mbinga disiricts. Feeder roads going to meso and hyper endemic communities in all districts u.. only passable during the dry season. Songea district is served by a tarmac road, which purr.i in the oncho u..u und therefore offers easy transportation to those communities situated along this road. Songea town, situated 1,000km southwest of Dar- Es- Salaam port, served by aii weather turrnu" road, is the administrative headquarters of the Ruvuma CDTI Focus Project' Ivermectin mass distribution was instituted in The Ruvuma Focus in October 1992 funded by RBF up to 1995. IMA provided bridge funding in 1996 while SSI provided bridge funding for the year 1997.Dr.rring all this timi the project was being implemented using mobile teams to distribute the medicine. Year I APOC funding started in October 1998 with the new concept of CDTI. In the Ruvuma CDTI Focus Project the village structure is basically the same as is found in other parts of the country. a vittage chairperson assisted by the village executive officer heads it. The community members eGct the village chairperson whereas The District council employs the village Executive officer. The size of each village varies; some are 9 WIIO/APOC, 24 November 2004 large with population up to 5,000 people and others are small with population of 500 or less' The government system at viilage i"r"t i. well organized with established village government offices, which are easily u"".rrlbl. in terms of bureaucracy, giving easy entry-point into the community. The next administrative level is the ward, which is headed by The ward Executive officer also employed by The District council. The ward Executive officer heads several villages in his/her catchment area' Almost all villages in Ruvuma GDTI Focus Project have a number of village Health workers (vHW',s) andihese are people who have beentrained in a number of simple health interventions by Ministry of Healih Tiainers. Allvillages utilize these people to assist CDD's in collecting, distributing, und data collection during Mectizan@ distribution' These village health workers are not riinistry of health employeesf they are recruited by the community to ferform simple heatth tasks inihe village and are motivated by community' Table 1: Number of health staff involved in GDTI (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 82 Percentage B3:B2l Bl *100 Songea 225 100 44.4 Namtumbo 110 43 39 Mbinga 271 77 28 Ludewa 72 36 50 Total 678 256 37.7 1.1.2 PartnershiP The project is currently supported by APoc and SSI as an NGDO partner by providing funds and capital "quipm"ni to project. The District council supports supervision, planning and faying'projeci siaff salaries and other benefits during CDTI implementation' Community member are willing to take Ivermectin and some motivate CDDs by exempting them in communal work. l0 Wf{O/APOC, 24 November 2004 o3 - Hqr-.vO trr-S/ a o, N (g'i -FUL-F.EP 6c.rtA fi 5.iq) n-&tU-.\! t- 5>., -.di-.-C.O:UC! o-r "a .Sz 7'-x i 8.FsI = tsn q)v-\ *N6 6t iE .ov: = H9t\'t EEr?t a! E cB aJsF 9Eo\ . 6 E"OE, EEES ;,G .:- '-+ u . o-=5 E 3Sb B Soetr ii= Be g iuE .=-ico : E6!v6(, E ;'S9 .9 o\! .E E:'p Es iE 6-oE HA; H-H(\ Y, (dV+ ! 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AE F- 6l o(J F- c.l o o F- a.l o o r- N o L at o =!EtrOO F- c-l o a) F- a\l oo t-- N oo r-- ol oo EO AE t-- N o t-- c.l o o t'- a.l :i o (-. c! o ol a3 o U EpOOrr E c- N o() ! r- c.t oo c- N oo t-- a.l () oo cgo AE a- a.l o r- a-l o o t-- C.l o o F-- e.l o o ad trl F o EtroO t*. cl o o t-t a-.1 o o a- c.l o t-. c-l o o u0 AE F- N o.oa r- c.l o.oa t-. c.l o.oa r- a.l o. CN (!= oo 2 q) EtroOqrtr F- ol a) o r- c.l o c) ! t-- c.l o a F- a.l oo 00 c!O AE r- c.l o o t'.- cl o t-t N o F= al o o c) ho a -o E d z bo o J F F 2.2. Advocacy The reason for mobilization and sensitization: Problems encountered Suggestion to improve advocacy The following table shows the number of policy/decision makers advocated at different level per each district. 2.3. Mobilization, sensitization and health education of at risk communities Mobilization and ltealth education of communities including b)omen and minorities o The two radio stations in Songea and Mbinga are the main means of disseminating health education on onchocerciasis to the communities. o We received IEC materials from SSI which included T- shirts and posters. 'fhese were distributed to districts for dissemination to FLHF and communities. o In most communities the signs and symptoms of onchocerciasis has disappeared following long term treatment with Ivermectin. The need to strengthen health education and sensitization is being emphasized in all affected communities, especially in those with high refusal rate. o We involved leaders at all levels in the districts in conducting mobilization to targeted communities. Response of target communities/villages o The treatment coverage has remaine d at 7 5%o in the last Mectizan distribution. Communities are often demanding Mectizan when the time for swallowing is due. Accomplisltments of the project in this year are- o The project managed to conduct CDTI activities depending on funds provided by Councils, APOC and NGDO partner (SSI). o Community ownership of the Programme is stillmaintained amongst community members. HSAM was conducted to all district councils following the general election done in 2005 which brought changes to district leadership. r CDDs are willing to continue to distribute Mectizan@ voluntarily. In all districts targeted training of CDD'S were done according to their needs. We had very few drop outs (l l) in the entire project. DISTRICT DISTRICT LEVEL WARD LEVEL COMMUNITY LEVEL Songea 8 2t 64 Namtumbo 7 20 56 Mbinga 67 37 30 Ludewa 0 22 2t Total 82 r00 t7t l3 WIIO/APOC, 24 November 2003 Suggestion of way to improve mobilizotion and sensitization of target communities - o Mobilization and sensitization meetings should be conduct every year prior to Mectizan@ d istribution cycle starts. r Health education should be done continuous to remind the community their responsibility.) To strengthen Community self Monitoring and Stakeholders meetings in allaffected communities t4 WIIOiAPOC. 24 November 2004 I E9 E EEe E Etoz a'; q) OD C)q) () .h 0) != !: .q) E-o u'i E ? E9iu0 =-<z $ co$ \o C. an oo\o ao rr (.) Eh Q ra Q c! F q) cl 0)t* q) z ct[n -.9 A EE!r=Arv sl oE; z oo $ ra) o\aa N ca aa € F- ao (..] $\o(..l c.l c.] tr) t o\ € tr) N \o t-* c'.1 o\ oo t'r\o rr €6 rt) 0)oo? =?>o C)E ri6.)92 =atr.: a 5ja *ao o)v z EaHrr-'= - o b = E'r -a tr: x -trvErir* =o:=Zec't' q) a0 C! q)() o O O o\ aa s oo$ \o aO co oo\o rr t) =.= q, Ei 3 i€!.: i= ' U'= *, o. $@s \o co aO oo\o o\ aO rr (a q) .= u) .c) oE .6O c-o-EA ov z 3 Q q) - 6 E r.!'!'lE€E;:E.63 vHrlvU-?21fi8 t* q) O q) q) oo o(.) c) q) z cl € ao 9 c.l(r) oo c.l tr) ia a ?o \o oo NN o\ tr- It*F- rr) ca r- F-(.{ I-*(tn oo\o o\ r- C) U) irl(, z oo o Et z DF z z ca z rrl l-.1 -] 3 a.l a) C) z sf al o o-{o q a Uq) \- q L L. -x$ ! q) q N q.) e-! F U o 0)(g o)c) >'E trth rI -ao $t orl .alr=l 6I FI 2.5. Capacify building There has been no change of staff at the project and district levels. Few transfers were effected at FLHF level but all those transferred to other areas were replaced by trained personnel in implementing CDTI. - Describe the adequacy of availoble knowledgeable manpower at all levels. As stated above the staff at all levels in the project has remained stable for the last four years now. We had no shoftage of staff in the last distribution. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. We have extended training of FLHF staff to include other competent staff at this level in order to decrease the work load of the FLHF in charge or when he/she is transferred. t6 WHO/APOC, 24 November 2003 (t? c-ia \0 F- It* o.lN o\ ca o\ oo co C.I Q 3+$ .lRv C) ra Q q) z cl! ilf a\; u f ,a< \,, q) q) o () s tf) o\ia tn O t-* c..l c.l F- t ('- ao a-] o C) z <. a.l _aU tu o F- lbb lE lpU o) ,s s .s qJ Lq) p a *\e N >. 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I .= : rr\ qJY ^ ob\Frueds ss = €ts :S g*= i?;I N* a U= E$ Si E EE 6$ it a Ei Et i$ : ?E rts I$ = <E 30:q3U;1ae).= = qJ<, : '= = -z '!: I = o 4 S €s *e E: I 's i; E+ :E ES x"$ ;i E; ryi rF ,; !: Ei $s trf; !; eS SS :E* €E 6i Et ;f; :F Es s: E= I ". ? .s S: =E EE 3$ s$ ;.q [E rE S\ E; :E Nt sS =.= ea a$ $E ;E E; EF :E EF EH E -B tv 13 E€ HS SY" E.H s: :i := eE -cr E! SE E: ;-8 ns st, E.= ii= Ps ss I>, ,E= ; E i! ;E €E FS Se ;.e s: It\ t\.s ;€ E: =$ eoi Er if E \ \J \ -E = t- C)L o C) 'a La C) (r) 0)Lrd o o 0) ILoo >' oa C) E C) -r (.) vtLot ! -l o-rxlf €l g ,91 o,iil qLl ^!l dol o Elo 0l gol()ul !ol tr _t= C)l a -ol -trlG =t 'izli (,) 0) o F \oo\ +N () -o Eo z + c.l (J o] \) a,) s. A)q 44 U AJ q > p -N N q) $ 5 E !() bo L o o. 0) 0.) bo L C)&L ooo (6 v1 r! a a C) o C) cnL(,) C! a o Lo6(H o Cl) 0)a O <idr -l -t -ol cdlFI ZarX -c>" ll>()= <.= E E ti oooOI)FO L'-* Pd(go'a -H -g-06.)t) x - 5.!l....... oou) ln U) o oo oL a. (H o o E oo c L (H * 6-) --9a 6)tha E(rr 6o.2 -c i6r--€= 9LLr'- -s.9 I U I H9k!F . O-cOUJE6 o.)'= o=uE-.- lu- ^U-d - (U.- H obO C!Y -(,iicd -c o.l .N *€ B ,: 0)<iJi-OZ z z a E o o. E a -YL()=o) e!d h E 3= N L wa - fr-E EgO2cS oo o Ax (H o() bo Xoa o bo I bo L] LF 9,S O c.)\o $o\ F- ooo' oo aoco \ooo n o\ oc F- co o (o otu ll -adHn- rc o0AcB\J!-.r:'5 o co\o +o\ trr ooo\ oo caoo ul tr) oo n o\ \ t-- oo d'Fl *- Fi =c)obo cd (J L\obE9aSoFC) ao n \o trr \o\o o\ \o\o 9 F-\o v? o\\o oq (-r c.itr- oq cn I-r a rc (* o q_ .)=() !6dEbs = Q.!Z o\ F- \o$ tr) ao oo I-r oN $t--\o- C.l c.] $F-q oo(-.] c.] oo$ oo oi o\ oo aa C.l o\ c.) t-* c.l o\$ C.l r f-l Ea> cd C).= =qe.) <r I -o' o\ c.) c..l aa c.l oo F- oo ar; ol o\ ca oo(.'l cac.l $tr) + ca ol co It- a.) $ o.l \o rr) d r/) N caq o\ o.N c- o, co c.) LXQ<.rv g.- EEE.aEH.s -u =r- A-o trl=F o-o i6 tr (0oC)q)d tr)\o\i(-- c..l F- \o + ca ooO N aa t--(...l co6 c.t aa co t--ol oo a.) ca $ a.) tr- ooN \o oo\o t-* c\ o\\o o? rr) F- aa N v} aa o\ ao a o bo U) C) E oO ddi F] () o Bo-F 6S< >v -o o O O O 9.o=rv-4Ldi:,^ll-v9PU o oS i.t:'8= = :ilrlE*-O- 5 ri o ti r-o eaA tr.= ()L 5rJ (k o L 0) z c.l ra) co CO r)(r) v\o $\o $\o $ooaa I-t co N Ei E o.rE 6.2 :tr1) <f I -o' FU c.] lr) aa ca rattn $\o $\o $\o $co aa t- ca -- u)r.q b Ei'E g *Fl--U t1 \-E PL!VL O q '- ch aF X 9!LFo"6 N rat ca co(r) tr)tf) s\o s\o s\o soo ca a- ca r! /. t-ro\o\ oo o\ o\ o\ o\ o\ c..l N c.l c.l ao c.l $ O C.l rrl o c.l \o N r-O N <.O N o -o o z +N () o { o NN -a) A .-Id I cg o o bn dLE' 6) b-tU \ rrtv \ l-lL i- p= L a,YIus': !.:.YtrcnSJ;TEE\'= 63o o \J :'i\ rJ!\v vA9Y!i- I :9u) ; - I ola=(roil^tw :' lr Eq.2 .gPf, t-aie tv L.6Jv l-le6U=VI ,Y ELt*tedro .Lr C) !lCqtrEl s)d)nltrEl c!6-el E >(Bl G,)c)ol IAExiI r-rl tr.tY0) ebO: 9b,- !aLcs5EEY!trf lr cg iJV6 I L-tro!gtrc) L-- -iics'(-)o ia-E c.i o\l ';()l o -l €l u Fl Cr $ 6l L() -o E() z + c.l (-) o oo oi o\ c.I N aoN 2.7. Ordering, storage and delivery of Ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH! WHO UNICEF NGDO Other (please speciff) Mectizan@ delivered by - Qtlease tick tlte appropriote answer) MOH i WHOtr TINICEFtr NGDOtr 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 inTanzania. (Medical Store Department- MSD) o The MSD notifu the NOFT Secretariat on arrival of Mectizan@ who then informs the Project Coordinator also. . The Project Coordinator collects the drug from the zonal Medical Stores Department and enters the received drug to the Regional Pharmacy. o District Coordinators makes orders from the Project Coordinator and distribute the drug through the normal channel of the Government system to the health facilities according to their requisitions. 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@ lnventory (Please add more rows if necessary) How are the remaining Ivermectin tablets collected and where are they kept? Districts Number of Mectizant tabl"t. Requested Received Used Lost Waste Expired Remaining Songea 346,375 346,375 320,500 700 0 0 25,175 Mbinga 192,375 192,375 166,500 512 0 0 25,363 Namtumbo 276,375 276,375 250,000 488 0 0 25,887 Ludewa 203,375 203,375 177,500 300 0 0 )5 \7\ TOTAL 1,018,500 1,019,500 914,500 2,000 0 0 102,000 24 WHO/APOC, 24 November 2004 The remaining tablets were collected from the communities and returned back to FLHF then the DOT'S or CHMT members collected them and bring them to the district pharmacy where they are stored. List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. Activities performed by Health personnel in handling Mectizan@ o Supervise census update in his/her catchments area' o Mectizan ordering by filling in the forms and sending them to the District Onchocerc iasis Coord inator. r Makes follow up to the District Office. . 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 They come for collection and distribution to the community members in their area o Conduct supportive supervision during Mectizan@ drug distribution to CDD's. r Data collection and report writing and send it to District Oncho Coordinator . Conduct feedback meeting with community members. Any other comments NONE 2.8. Communify self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? NO If so, When? Table I 1: 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: District/ LGA Total# of communities in the entire project area No of village that carried out self monitoring (CSM) No of villages that conducted stakeholders meeting (SHM) Songea 484 l0 6 Namtumbo Mbinga Ludewa 336 168 319 7 12 9 4 8 5 TOTAL 1307 38 23 25 WHO/APOC, 24 November 2004 ' - r ealn ent covcrage has irrcreased rn c,lmmunitie s which conducted CSMr'SHM 2. Record keeping has improved 3. Ite[usal rate has decreased. 4. We have noted a sense of ownership to the Programlne 2.9. Supervision 2.9.1. Proyide e flon'chart of supervision hierarchy NOTF J tLfilO lringa J jRMO Ruvurna DMO Sc''ngeal PCj DIIO lVlbinga J DOM l.udr:waJ Dislrict Oncho. Coord I DOT'S I FT,}IW'S J CDD's J Community' ,o, \4;hat ll'ere the n:ain issues itlentified during supervision? lnadec,uate CDD nrotivation. Inadequate IEC nr:ttcriutl Inrproper recc'rding in trcatmen.r registers in villages w'here the CDD was ne\\, CD'l'l fbcal Staff transfer to r:on endemic area 2.9.3. Was a supen,isir-rn chccklist used? Yes, integra'"ecl developed check list is always used ?..1).1. What rvcre thc outcornes at each level o1'CDTI implementation supervision? tach lcve I ga'!'e {i positivc ansr/or to improvc their performartce during the next disu ibution 2.9.5. Was I'bc'dbacli given to thc person or groups supervised? Ycs 2.9.6. How w:ts the ft'i.ubaclu uced to imllrovc fhe overall pe-.'fbi'mance of the project? l. Many commuilit,,' leaders provide incr:ntives to CDI)'s in kind and nc.t cash 2. Cctntr:ttnity nrctnbers wci!'e noouragcd to provide itrcerttives during d:striLruliorr. ?.6 Wl IO/;\POC, 2,1 Novemb.:' 2004 SECTION 3: Support to CDTI 3.1. Equipment Tabfe l2: Status of equipment (Please add rnore rows if necessary) *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? - All the district councils have incorporated CDTI into CCHP. The equipments are being run by thc councils. Plans to replace them follow the normal process in the Local Government. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Conditio n No Condit lon No Condit lon No Conditio n No Condit ion 1. Vehicle 3 F 0 I F 0 2. Motor cycle(s) 4 F 0 5 CNFR 0 3. Lap top Computer 1 F 0 0 0 4. Printer 5 F 0 0 0 5. Photocopier 4 F 0 0 0 6. Fax Machine I F 0 0 0 7. Others 0 a)LCD Computer Proiector 0 I F 0 b) 0 c) 0 27 WHO/APOC, 24 November 2004 s c.l () -o E a) Z +6l U o o oo c.l *E o=6qiootrn 0.) =- 9>. oo oO -g(d6 -qo2v) <99C 69 at* Bor!9()=(o;9 o-r95 =c)OLCcd da :: cd c-) _.c OI) +. -.-E'ii" aq) =re(n-?\a\)*oE (, ;:cnG O7) - o_r.'F (t - Io.rE-EZ o)eLBs-3 >O€ic o-l # ooE =E orio.r x a.z l- lr-c) ,!, a!-= =Ex0)UEh.L c):Yo oo2 qr::C o =,r aU> 9.'q Ur,!*:x u g =E A3!< E6 ,.()YLEF E p.r o ' .@ (sLoia!-J_ I-,= Y YAHLL JIUJ()EsO '- cB <g i'rG.E ()- o:>.9l9 ort &-F rC)uEEt€,ts s S ?.1 o a -(d!rr gA ,_Eqd o3 ^&F ro\o\$ q c.l c.l o\ an o\ o\ oo q o\ N(\I 6 a@Za(t'f 'r -(J?s .- 6-)<bo(JE 'cn Orn o\ oi$ ca cn(..i O c.l ao c-l oo \o oi fa[n N al 6S e] 6l C) U) cdr c./ gA F.l tr(,st" ^&F ah(BEr) o ^r 8oA<-oD bmF @ .1 a..l$ c.) c.l q \otr) trr + q a o\t o\\c iA d; € € ra o\ o\ o\ .1 ca co F- ca O cO aa$ v? oo o\ c- a! o C') d-U 9A' ,_Eq LVv,^d F oo a.t o\ ao o\ o\ o\N in t@ 'da cB -r r -(,?er- o<oo(,Et-= 'c0 o\ o\ a.) aa a.] o\ ao c.l I-r c.lc\ Nrr _=^ l,n\o (, I,r^0J trsEAE\ _0)E \JO ZO. J o L a IJ rJr o 2 (H tt) c IJ rF) z (B oo tJ C) C) P d o. c IJ z (u o /-\ -o ln C) O tu 6 LF Q o l] t-r F (h L C)E>. .: 9) ERE(o Oc:rCJ- dci cha oq Lcd cq o-()E rH -oOu) v)E '-c EoU.g (!g- tr. cql -l(Jl (N =lf.) Fl sf al (_) -o E(.) z + c.l (-, q o o\ c.l bb C)v E() € o9 f o a. o. a (H o L o C)() -F U Ca) a(s Po C! 0.)L _ak C)L 0) -9 ! L .9L a. s (,) .z bo C)cr=AAF!Vh.Y't oE1j-.1 n6 _d t. Xt;-6)H .iL=r\ !!vt) ih P6.r.-L= .-6!He-90) '! b0e Etr6,j.tsU^ :LLd =;usE--E0)Q-4o.ri v- Lrv!\ o'5 nA -gaar.^L*^o;i(s o -.-X! a E_C! -slv-Fi5';orEE::g-e'Eo o.= z='7A.cJ !-7-AE = !? I 9 - tr trLJg 6 Hq.-_--;rv VUAJ. .gitj 9':.'"E.) t X = =iLHU!_w= -^-ig9Hr-aEV)aa'-f\A E E.p:-E.= : E -3 H.=.Eo o F f +z E?EXe05E(Jqr=tt r-; 0) () -'aAYL-^.-E tr (d - EE LV69rvvo c"r O'E.9 A €€A I or EA Lr) E I Ov(r-c9=d E.E bF=r;NFU=N ,ool o cd o o .O .uE o= €o oe()E ^() Pv,(!i h€ r\ > *'tq5n :EX ,o\ -ao !e aJEa -0)6.)->9) eA 87) O_(g =c)C).= OL >. o.9 q.r ^-.cOe oo o.; =Eo-LF o- l-.1 6Q E,O o)H crt @ -Q(dYBa -r -q c..1 .9i -E@9-c!H +()\o o-r <rLS# rC) ,iE EiY<J(6 =O6)6Jv ad')ov -L-6E;.E IVAU F L ')E 9,gE(JtBOa -HLPESE>.5zE 3 iJ(J C) Y .-^-U 9VP- 'AEFU < <.= ed 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here I US$ : TSH.1,1l2l: Table 14: Indicate how much the project spent for each activity listed below during the reporting period - Any comments or explanations? Funds approved by various partners were not released in fully, thus affecting implementation of some activities. SECTION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) None Year 1 Participatory Independent monitoring None Mid Term Sustainability Evaluation None 5 year Sustainability Evaluation Acti Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Monitoring and Evaluation of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g. computers, printers etc) Others:- italE ul t le 3,920 6,000 12,164 6,693.9 3,500 SSI Council APOC Council/APOC APOC 32,271.9 290,491 30 WHO/APOC, 24 November 2004 TOTAL Total number of treated None None None Internal Monitoring by NOTF Other Evaluation by other partners Year 1 Participatory Independent monitoring 4.1.2. What were the recommendations? NONE 4.1.3. How have they been implemented? NONE 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan written? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of cash: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementand maintenance) 4.2.4. Other resources 4.2.5, To what extent has the plan been implemented 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI activities are executed under the directive of RMO/DMO who is the in charge of all matters pertaining to Health and therefore all plans to implement CDTI activities passes in his/her office then are table in RHMT/CHMT. The District Onchocerciasis Coordinator is a co-opted member of this team at district level and always they conduct routine supervision as a team. All the districts have included CDTI in the CCHP budget. CDTI structure is being applied in many projects in our Region. InternationalTrachoma Initiative is using the same structure in Tunduru, Songea and Namtumbo Districts in 31 WHO/APOC, 24 November 2004 Implementing the SAFE Strategy. The Neglected Tropical Disease Program has been planned to take off in 2008. Essentially this Programme is going to be linked with CDTI in its execution and the same CDD's are going to be involved in implementing this Programme. The structure is not identical but has many components similar to CDTI. The Mectizan@ drug is transported through the existing PHC structure during supervision and monitoring. 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. No operational research was carried out in this period 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses' challenges' and opportunities - List the strengths and weaknesses of CDTI implementation process. Adequate working facilities are available List the challenges and indicate how they were addressed. STRENGTH WEAKNESSES The project has prominent Partner (SSI) who supports the implementation of CDTI activities Late disbursement of funds from APOC for implementation of CDTI activities CDTI activities are incorporated in the CCHP Council are providing limited funds to implement CDTI activities Community acceptance to take/swallow the drug Mectizan and implement CDTI activities Some of the community members had Misconception on the effect of the drug Key project staff are committed to work in the project In adequate funds to conduct frequency follow up visits to the community level Brake down of traveling facilities Motor vehi c le I cy cle affects support ive supervi sion CHALLENGES SOLUTION Population fluctuation in mining areas Involve government and political leaders to solve the problem Farm activities during period of Mectizan distribution Distribute Mectizan at harvesting and Wedding period "June -Sept" Demand of CDDs motivation especially allowances Community , Government and Donors should consider motivation to CDDs Delayed disbursement of funds Timely financial and narrative reports to be submitted to the Donors 32 WIIO/APOC, 24 November 2004 SECTION 6: Unique features of the project/other matters Separation of Ludewa district from the Ruvuma CDTI Project has not been effected. The problem of administrative communication remains especially when it comes to budgeting at project level. Both the two Administrative Secretaries from Ruvuma and Iringa Regions are not willing to budget for the project office based in Songea Municipality. The office depends on funds coming from the NGDO partner (SSI). a JJ WHOiAPOC, 24 November 2004