Annual NOTF Tanzania secretariat technical report to Technical Consultative Committee (TCC): January 2007-December 2007

/t I I I I I I I I i I I I THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE COUNTRY : Tanzania Approval year:.lgg7 Reportins Period (Month/Year): JANUARY 2007 - DECEMBER 2007 Proiectvearofthisreport: (circle)l 2 3 4 5 6 7 8 (9) 10 11 12 13 14 Date submitted: ORIGINAL : English NOTF: TANZANIA ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting @,v AFRICANPROGRAMME FORONCHOCERCTASTS CONTROL (APOC)t{z b *tc(26 . siv f$.u CnF AH6 Seo (suo th Iin ffit*t* 11, ri,k;une. I '! FFll zotlfi I ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMEI\T Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: TANZANIA NOTF Chair Name: Dr. Donan Mmbando Signature A,aw.*. Date: . National Coordinator Name: Dr. Grace Saguti Signature Date: lalaro*['''] "'." " This report has been prepared by Name: Mr. Oscar Kaitaba Designation: Depufy Coordinator Signature Date ,ffiffilfltrt*,-. qlc.,.97J WHO/APOC, December 15, 2004 I I 'l'a.z-*r6' TABLE OF CONTENTS . Acronyms ii o Definitions iii o FOLLOW UP ON TCC RECOMMENDATIONS 4 SECTION l: BacrcnouND TNFoRMATToN 111.I. GBNener INFoRMATIoN I I1.2. PopureuoN AND HsarrH sysrEM 13 o SECTION 2: Summary of CDTI Implementation 132.1. DrstRrsurroN pERroD 132.2. Aovocecy eNo SBNsrrrzATroN 142.3. INroRuerroN, EDUCenoN AND coMMLTNICATIoN sTRATEGv AND MATERIALS DEVELoPMENT 14 2.4. CouuuNIrIES' TNVoLVEMENT IN DECISIoN-MAKING 14 2.5. Cepecny BUTLDTNG 14 2.6. ORDERTNG, sroRAGE AND DELIVERv oF IvnnlaBcrN 172.7. TRrerusNrs 192.8. SuppnvrsroN 222.9. covtrruNrry sELF-MoNrroRING aNo SrerrHoLDERS MBgrrNc 23 o SECTION 3: Other activities of the NOTF 24 o SECTION 4: Support to CDTI 3l4.1. FnqaNcteL coNTRIBUTToNS oF THE pARTNERS 3l4.2. OTUSRFoRMS oF coMMLrNrry suppoRt 324.3. RrsouncB MoBrLrzATIoN EFFoRTS 324.4. ExpBNorruRE pER AcTrvrry By rHE NOTF sECRETARTAT 334.5. EqunueNr 34 o SECTION 5: Evaluation for sustainability of CDTI, Independent monitoring and other reviews 355.1. INospBNorNT pARTrcIpAToRy MoNrroRntc/gveluATroN 355.2. SusrerNesILITy oF IRoJECTS: rLAN AND sET TARGETS (MANDAToRy nr yR3) 3s5.3. INrBcnetoN 36 5.4 OpsneuoNAl RESEARCH 37 o SECTION 6: Strengths, weaknesses, challenges and opportunities 37 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.INICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental 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 ll WHO/APOC, December 15, 2004 Definitions (i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached fuIl geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (u) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of mesoAtyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: The bringing together of two or more health programs, removing barriers between/among them, in order to maximise cost-effectiveness and permit free and equal association. For example delivering additional health interventions(i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coyerage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. lll WHO/APOC, December 15, 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 4 Number of Recommendation in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE NOTF SECRETARIAT FOR TCC/APOC MGT ASE ONLY 333 TCC accepted the report but asks that the Coordinator take the following into account for future reports: 1) Provide better insight into progress on implementation of the sustainabiliSt plans of the projects. 2) Ensure that reports are submitted on time by the CDTI Projects 3) Conduct the drug distribution at the period chosen by the communities 4) Ensure communities undertake CSM and SHM to reduce refusals and absentees Progress on the implementation of the sustainability plans the projects have been well addressed in the report. The NOTF HQ have stressed this in it annual review meeting 2007 November. Due to late submission of Mectizan procurement forms to NOTF HQ from projects some of CDTI projects received Mectizan very late their distribution was done from October to December . The reports are were then submitted in January instead of November during annual review meeting. This takes time for reviewing and correcton as most of the projects need to correct the reports after the secretariat review. Communities received Mectizan very late but were informed the cause and they agreed to take Mectizan even though it was not the period which they were proposed. CSM and SHM are implemented by communities in some projects and the results shows that the number of refusal and absentees are now reduced WHO/APOC, December 15, 2004 5) Sensitize c o m mu nities fo r proj ect ownership. 6) Add the Total summation in Table 5. Data in tables should be clear and precise. If there is nothing, one should put "0", as "-'t may also meons tltat the information is not known. 7) Add APOC contribution in Table 12. 8) Clarify the inconsistency of data on refereed SAEs between tables 6 and 7. 9) Address the problem of used equipment (non- functional) Most of the projects are sensitizing communities on project ownership prior to the annual Mectizan drug distribution. The secretariat has noted the comment and taken into account in this reporting year. APOC contribution has been in the table 12 This was a typing error. SAEs occurred in Ruvuma CDTI project not in Tanga CDTI where new communities were treated in Mbinga and Nantumbo district. During the reporting period there was no equipment which was Non- functional. We have Functional and worn-out functioning old equipment. 5 WHO/APOC, December 15, 2004 Executive Summary CDTI activities implementation at the National Office Head Quarter support project is entering in lOth year with the big role of technically supporting CDTI fioiecti on execution of Onchocerciasis control activities in the endemic areas. The National Office also review budgets, financial reports from all CDTI projects and VE project before sent to APOC management and Mectizan application forms before forwarding them to Merck & Co. The National Office Head Quarter support project, in this reporting period was able to achieve the following: i) In collaboration with APOC carried Independent Participatory Monitoring in two CDTI Projects of Morogoro and Tunduru. This was done from 02nd - l4th August 2007. ii) Maintained the Therapeutic coverage of Mectizan at above 7Oo/o to these reported six (6) projects iiD Hon. Minister for Health led Tanzania delegates to attend the Joint Action Forum in Belgium whereby Tanzania as the Chair of JAF 12 was handing over the Chairmanship. irr) The Annual review meeting of the National Onchocerciasis Control Programme was conducted as scheduled using govemment funds whereby all stakeholders and CDTI implementers attended the in Iringa l2rh - l5rh November 2007. v) Managed to provide technical backstopping and guidance to sampled LGAs in Mahenge and Tunduru CDTI Projects on District support and ownership for Mectizan drug distribution activities. Emphasis being allocation of funds through the CCHP and implementation of the sustainability plans. vi) REMO data of Njombe and Mufindi districts were reviewed by experts in NIMR are now well elaborated and endemic communities are known. The NOTF is now waiting to start drug Mectizan distribution in the next year after all initial procedures are taken on board as an extention of Ruvuma CDTI Project. In Tanzania Onchocerciasis now can be found in 18 districts after the result of REMO conducted in 2006 which shows that some communities in Njombe and Mufindi districts in Iringa region were found to be Meso and Hyper endemic. CDTI activities are being implemented in l6 endemic districts which form seven (7) CDTI projects namely Mahenge, Ruvuma, Tanga, Tukuyu, Kilosa, Morogoro and Tunduru but this report covers six (6) CDTI projects excluding report from Ruvuma CDTI Project. Vector Elimination Project activities have continued in Tukuyu Foci in this reporting year. The National Office managed to receive financial reports from seven CDTI projects and technical reports from six CDTI projects. Tukuyu Vector elimination Project has also submitted a report on taxonomic and molecular analysis of Onchocerciasis vector species. MAHENGE CDTI Mahenge Focus covers two districts of Kilombero and Ulanga. The project has a total number of communities of 531 with a total population of 449,640 people living in meso-hyper endemic areas. Treatment in the affected communities corrunenced in November 2007 and ended in December 2007 whereby 332,785 people were treated and this makes the coverage to be 74%o. Geographical coverage is 100%. Ultimate Treatment Goal (UTG) was 390,870 people and the Annual Treatment Objective (ATO) was 377,698 people. TANGA CDTI Tanga CDTI Project completed seventh year of implementing CDTI activities in three districts namely Muheza, Korogwe and Lushoto. There are 1309 communities in Hyper and 6 WHO/APOC, December 15,2004 Meso endemic which were all treated in this reporting year. The population in this area is 357,002 people; where by ATO was 312,586 people. Out of this 293,562 people was treated achieving a therapeutic coverage of 82o/o, which is showing an increase compare to the last year coverage of 80%. The project attained 100% geographical coverage. Project UTG for 2007 was 299,882.In this project Oncho activities are integrated with LF activities hence they are implemented at the same time with the same team. TUKUYU CDTI Onchocerciasis disease is endemic in three districts out of seven districts in Mbeya Region, hence CDTI activities is being done in Rungwe, Kyela and Ileje Districts. The total population in Hyper and Meso Endemic is 86,772 people who are living in 240 communities. Mass drug administration activity was started in September 2007 and lasted in November, 2007. The project managed to treat a total of 67,794 people and attained the therapeutic coverage of 78%o. The geographical coverage for the seventh year of the project is 100% whereby UTG is 86,171and ATO is 72,888. KILOSA CDTI CDTI activities in Kilosa district is being implemented in five zone constituencies, namely Gairo, Kilosa, Mikumi, Magubike and Magole.The implementation is now entering in the seventh year whereby year six activities which are reported started in January 2007 and ended in December 2007. The Project has 970 affected communities with a total population of 468,434 people in Meso and Hyper endemic areas. In this treatment cycle 353,707 people were treated with the therapeutic coverage of 75.5% whereby all 970 communities were treated which give 100% geographical coverage. Eligible people were 393,485, Ultimate Treatment Goal (UTG) was 393,485 and Annual Treatment object (ATo) was 373,493 MOROGORO CDTI Morogoro Rural CDTI Project which covers two district of Morogoro Rural and Movers is in its third year of CDTI activities implementation. This report is covering the third year of CDTI activities implementation which were implemented in 871 communities (Sub village) with an increase of 43 sub village from 828 communities treated last year. Increasing number of communities was due to REMO which was conducted May 2006 and result shows that 2 Wards with 10 villages were affected therefore need to be included in third year treatment. Total population living in Hyper and Meso endemic area is 328,814 people. Treatment commenced in September - November 2007 and a total of 246,821people were treated. The project attained chemotherapeutical coverage of 75o/o and geographical coverage was IOO%. UTG are 288,833 people where by ATO are 276,204 people. TUNDURU CDTI The treatment cycle in this project started in October and lasted in November 2007 where by a total of 93,516 people were treated in 531 communities. The total population in Hyper and Meso endemic communities is 120,714 people. The geographical coverage for the reporting year is 100% whereby the therapeutic coverage is 77%o. The ATO is 101,400 and UTG is 93,969. RUVUMA CDTI The Rggional Medical officer has submitted a request for submitting the technical report by the 25ft February 2008 due to logistical problemi the Project coordinator had encountered. This information has been sent to APOC management. 7 WHO/APOC, December 15, 2004 TRAINING The National Office in this reporting year received report from six CDTI Projects with training undertaken in the project areas. Due to the financial constrains in the LGAs some of the projects didn't affain the training annual objectives. Training data received in this reporting period are as follows;FLHF staffs trained were 492,CDDs trained were9,24l, Trainer of Trainers (ToTs) trained were 44, whereby Health staffs traine d arel97 . The total population in these six CDTI projects being reported is l,8l1,376. CDTI activities in all 16 endemic districts are being implemented under the health existing systems. Projects staff at all levels are employed and paid their salaries by Government. Also procurement and delivering of Mectizanto endemic areas is within the health structure. Moreover there is an initiative to integrate all Neglected Tropical Diseases in the country. Some of the Projects are in areas where National Lymphatic Elimination & Trachoma Program within the country are overlapping these programs have adopted CDTI philosophy in drug distribution examples are Tanga CDTI for LF, Tunduru and Kilosa CDTI for Trachoma. These projects have distributed Xithromax, Ivermectine and Albendazole respectively under the guidance of the National programs. Strengths and Weaknesses of the National Onchocerciasis Control Program Strengths o The National Onchocerciasis Control Programme is within the structure of National Primary Health Care under the directorate of Preventive services in the Ministry. o The District Councils continued to support CDTI projects by inclusion activities into CCHP and releasing the allocated funds. o CDTI implementers are well knowledgeable of CDTI philosophy at all level. o Ordering and delivering of Mectizan@ tablets is within the existing health system in the country which allows the community to collect their drugs from the nearest health facilities. o Government release funds for the support of monitoring the implementation of CDTI activities through the MTEF to support NOCP activities. Weaknesses o Late submission of financial and technical reports from CDTI Projects due to unavailable of Bank document this resulted in delay of disbursement of funds from counter part which caused some CDTI projects to delay in implementation of activities. o Unavailable of past data in CDTI projects office which makes difficulties for the National office to have data base and in following up realistic project coverage and responding to urgent data needs from the APOC managements. To alleviate these circumstances the National office has requested Bank to provide Bank Balance sheet which indicate the amount of funds available. Moreover the National office has requested Project Coordinators to make available past data to the National offlrce to enable development og a National data base and also to send report in the APOC database format. Challenges and Opportunities. Challenges o Lack of IEC materials to support CDTI and other education campaigns hence low sense of project ownership at community level. o Frequent change of decision makers especially at district level needing more advocacy and sensitization. The National office has sent a proposal to APOC management to request assistance in producing IEC materials. Also district has been encouraged to set aside funds in their 8 WHO/APOC, December 15, 2004 budget for conducting advocacy and sensitization in the districts and encourage community members to conduct CSM and SHM. Opportunities o Some of CDTI projects has prominent and committed donor who are likely to support the project by providing more resources o Availability of knowledgeable staff in the CDTI projects areas. . All Onchocerciasis endemic districts have incorporated CDTI activities in their Comprehensive Council Health Plans (CCHP). o Integration of CDTI activities with other programme in NTDs. o Most of CDTI Projects have sustainability plans and are well implemented. Progress on VECTOR ELIMINATION activities Tukuyu focus vector elimination project which started in late 1998 had its first large scale Larviciding implemented in the Tukuyu focus in 2003. Phase 2Lawicidins was implemented in 2005 and in 2005 Larviciding was intem-rpted due to financial constraints. By the time of the last insecticide treatments biting had been reduced to zero in the main focus and at Lumbira (at the lakeside), but biting continued at high altitude up the Lumbira river. The biting flies identified at high altitude up the Lumbira River were Njombe form which is not a vector. Collections in the few weeks after the last larvicide application revealed no immediate resumption of biting although five larvae were collected in the main focus, which were not identified. After the second large scale ground larviciding aimed at eliminating S. damnosum complex (also known S. thyolense) vector of Onchocerciasis in the Tukuyu focus in 2005 no evaluation was done to assess in terms of success or failure of the project. Therefore as study with the main objective of confirming whether breeding populations of S. thyolensehave returned to the main focus by larval prospection, cytotaxonomic identification molecular analysis and assessing whether it is likely to be a recrudescence of the existing population or by immigration was conducted. Results: It is now clear that S. thyolense has retumed to the Tukuyu focus of onchocerciasis, and is anthropophilic. It is probably transmitting onchocerciasis again. Vector elimination has clearly failed. The reason for the failure is likely to be reinvasion from the Songea focus. The population that now exists in the Tukuyu focus has inversions characteristic of the Songea population, not the old Tukuyu population. It seems, therefore, that the insecticide campaign was successful in eliminating the local vector population, but it has reinvaded from Songea. Conclusion: Insecticide application can temporarily eliminate the vector population in Tukuyu, but this is subject to low levels of immigration from Songea focus which is sufficient to re-establish the vector population. Vector immigration is probably not sufficient to threaten a parasite elimination programme by immigrant flies bringing in parasites. Vector control over l2 years with ivermectin distribution would probably eliminate the parasite in the focus. If ivermectin distribution were sufficient it might be able to eliminate the parasite 9 WHO/APOC, December 15, 2004 Vector immigration is probably at ayery low level and is unlikely to threaten parasite elimination by ivermectin (with or without vector control over 12 years). Way Forward for Tukuyu Vector Elimination Program (2008i2009) o Conduct a feasibility study for vector control in CDTI foci in Tanzania (Already the proposal has been prepared and submitted through NOTF to APOC and Ministry of health and social welfare of Tanzania for funding) o Conduct operational research in CDTI Projects ( research proposals are being developed) 10 WHO/APOC, December 15, 2004 SECTION l: Background informationtl.tl. Genera! information 1.1.1. Description of the country program -CDTI and vector elimination Tanzania is situated on the east Africa coast, and lies between latitudes 15 and 12S and longitudes 29E and 41E. It shares borders with 8 countries i.e. Kenya and Uganda to the north; Rwanda, Burundi, Zaire and Zambia to the west and Malawi and Mozambique to the south. It covers 940,000Km, of which 60,000 are inland water bodies. It is surrounded by the Lakes of Victoria to the north, Tanganyika to the west and Nyasa to the southwest, while the Indian Ocean is to the east. The country physical geography and associated drainage patterns are largely influenced by the Great Rift Valley that runs northwards from near the mouth of the Zambezi River, through Tanzania, Kenya, Ethiopia, across Red Sea into Israel. It is topographically extremely varied, often within very short distances. Except for a 900 Km coastal plain, most of the mainland is above 200 metres altitude, and much of this is even higher than 1000 metres above sea level. Onchocerciasis is endemic in 18 of the 135 districts, namely Lushoto, Muheza and Korogwe in Tanga Region, Morogoro Rural, Kilombero, Ulanga, Mvomero and Kilosa in Morogoro Region, Songea, Mbinga, Nantumbo and Tunduru in Ruvuma Region, Rungwe, Ileje and Kyela in Mbeya Region, Njombe, Mufindi and Ludewa in Iringa Region. It is estimated that more than one Million people living in the endemic area are affected with Onchocerciasis and three Million are at risk. Seven CDTI Projects and One Vector Elimination project have been launched up to now to control Onchocerciasis in the country since 1997. The projects are Mahenge Focus, Ruvuma Focus, Tanga Focus, Tukuyu Focus, Kilosa Focus, Morogoro Focus, Tunduru Focus and Tukuyu Vector Elimination Project. Almost all villages in CDTI Focus Projects have a number of village health workers and these are people who have been trained in a number of simple health interventions by Ministry of Health trainers. All villages utilize these people in collecting, distributing, and data collection during Mectizan@ distribution. In other area these people are selected to be CDDs and they are performing a good job. In principal, the structure and function of the PHC system starts from the community level at the village, therefore the health system is decentralized. One vector elimination project covers the Tukuyu Onchocerciasis focus, which includes two main administrative districts of Rungwe (Tukuyu) and Kyela, and small portions of Ileje and Makete districts which are on its eastern and westem flanks. The area is situated in south west Mbeya Region of Tanzania. The focus was considered isolated in terms of vector ecology and disease transmission enough to presume that vector elimination would be feasible due to its unique geographical natural barriers. Vector elimination, if successful, will shorten the duration of Community Directed treatment with Ivermectin (CDTI), and ensure rapid disease elimination in the area, as its ultimate goal is stoppage of transmission, there are over 500,000 persons within the focus. ll WHO/APOC, December 15, 2004 1.1.2. Partnership The partners involved in the implementation with the National Onchocerciasis Control Programme (NOCP) are Ministry of Health and Social Welfare (MoHSW), IMA World Health, Helen Keller International (HKI), Sightsavers International (SSD and Christian Social Services Commission (CSSC). In the past three year the NOCP has been collaborating with Rotary International (RI) in Kilosa CDTI project to implement Oncho activities, Malaria and Pit Latrine construction using a CDTI method. This program has come to an end therefore Rotary International has stopped to fund Kilosa CDTI. Moreover, during the annual review meeting conducted in Iringa, the Country representative for IMA World Health announced that, they are stopping to support Mahenge CDTI in terms of funds. They will provide technical support the project if they will be consulted. Ministry of Health - Provision of office space, - Pay salaries to her employee - Provision of Human resource - Provision of additional capital equipment - Provide technical backstopping and guidance to sampled LGAs on Mectizan drug distribution activities. IMA Providing technical support to the Mahenge CDTI Project NGDO coalition chairman HKI Support Tanga CDTI Project - The NGDO partner provides funds for training of FLHF staff especially in eye care, logistics (transport) and technical advice on how to execute integration of CDTI activities with other Programme. ssr NGDO partner in Ruwma, Tukuyu, Kilosa, Morogoro and Tunduru CDTI projects - The partner has been particularly instrumental in the provision of interim funds to the projects for conducting advocacy, mobilization and sensitization meetings; assist in capacity building of project staff and provision of capital equipment. - Provisions of funds for development of IEC material CSSC Supports National HQ and CDTI Project in the respect of financial control form APOC trust funds. t2 WHO/APOC, December 15, 2004 Name of CDTI Project Total communities in meso/hyper- endemic zone Total population in meso/hyper-endemic zone Ultimate Treatment Goal (UTG) by 2010 MAHENGE 531 449,640 424,631 RUVUMA 284,871 TANGA 1309 357,002 287,396 TUKUYU 240 86,772 92,599 KILOSA 970 468,434 421,531 MOROGORO 828 328,814 258,709 TTINDURU s3t 120,714 104,944 TOTAL 1,974,690 1.2. Population and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not the Source: From Oncho Project reports: National census: Other source, Year of source: UTG: Calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). SEGTION 2: Summary of CDTI lmplementation 2,1. Distribution period 2: Overview of distribution undertaken ect { Distribution Period 2007Project Name Jan 07 Feb 07 Mar 07 Apr 07 May 07 June 07 July 07 Aug 07 Sept 07 Oct 07 Nov 07 Dec 07 MAHENGE RUVUMA TANGA TUKUYU KILOSA MOROGORO TTJNDURU l3 WHO/APOC, December 15, 2004 2.2. Advocacy and Sensitization The following are number of policy/decision makers mobilized at each relevant level during the current year :- National level - 5 RMO, 5 RAS, 16 DED, l6 DMO, Regional Level -30 District Level - 182 Ward Level - 917 Sub-village Level - 3,645 Reason for sensitization - To create awareness to new policy makers who had been elected or appointed and go to work in oncho endemic areas. - To provide oncho knowledge to community member and encourage them gain sense on project ownership and to conduct community self monitoring meetings - To encourage district leaders to incorporate and release funds for the implementation of GDTI activities which have been planned in the ccHp. - To aim higher in achieving for Therapeutic and cover all affected communities to get 100 % Geographical coverage in project areas. o O 2.3, lnformation, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the country for CDTI. The IEC plays a vital role in the control of Onchocerciasis in Tanzania. This has been evident through the use a mass media in promoting the CDTI implementation at project level using local TV stations and radios. The Program has sent a proposal and budget to the APOC management to request release of funds to produce IEC material by using communication strategy developed inTanzania in the year 2000 and 2002 with assistance from Apoc and HKL 2.4. Gommunitiest involvement In decision-making In general communities make their own decision on when and what mode to use for drug administration. The participation of female members in the community meetings when CDTI issues are being discusses is increasing year by year although not much as most female are concentrated more on taking care of home affair and some are being hindered by culture which do not allow women to attend meeting with men. 2.5. Gapacity building Training of national, district level staff in CDTI and general management skills With the assistance from APOC management the program sent a team of eight (8) people from CDTI Projects, National office and collaborating Institution to go to Uganda to attend a workshop on Resource Mobilization and Capacity building. The workshop was conducted in Entebbe, Uganda from l6 -20 April2007 . a a t4 WHO/APOC, December 15, 2004 Table 3: Type of training undertaken at national level by the NOTF Type of training Project staff MOH staff Opinion Leaders Others(speciff) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speciff) Resource Mobilization { { Technical assistance provided to the CDTI projects. The National office provided technical assistance to the Tunduru CDTI Project by sending one officer from National level to go Tunduru to conduct training and reorientation of health workers on APOC philosophy and CDTI process. Also the officer sensitized the Council Management Team (CMT) together with Council Health Management Team and the implementation of CDTI activities. Moreover technical assistance was provided through monitoring and supervision and also during the annual review meeting in Iringa. l5 WHO/APOC, December 15, 2004 $ ON r 0.)! ooo n Q o o \o !b s ,s S\ S A) \){ q q) *a\i B B$q\q)\\ s Sl q) \, 0o BL {q$l \. ts\ B $ F \J .s q)L U2 r! * U() q) "a . '.:q) q) *s q)L q q) -le q)\L Uq)L p bo ie Lq) \' s< > q) R s q) q fr.l i s U2q qJ Uq) ? I p t B q) V) s 5 U) o() 'a Lr a. x -o o oE bo (! Lr(t o tr(! a sr ol -ol6dlFI o< F9_: i- tv o\ ca\o\o r* aO o.l s \o N s c.l\o c.l ao o\$ N a-s N € c.t e.l oo c.)(\ \o o\ o\ O o\\o \o co F- oo$ r-N s(\l o\ t\o € \o o G 0 (.) o 6,) z ?!FO ta)o\ s \o e.l c.t o\$ € cO N \o o\ o\ ra) t--o !c al o\ \r 4) q) 0) s Uz = ia(; s.:qv o o\ c.t o\ ot \o $ s O la) s !+s (?)t o 0! -=o .r t-r bF .ob L 9rl35 z I ? c..l$ \o r- s $\o {) q) q) I \v s o\\o U Q - .l E,?+ t a< = v o\ co\o co @ oo c.t a- F-v rf N r- or- oo\o ot cA \o co cO c.t aN (\I o\\f € o\(f) r-g\ O q) C,E <)q) ad l- ;crt c) z ()?F $o\ @ Fr r- t-rNcO c.t (a al\o c) o 0) I \r s o\r- o'\.q z Ei'r+F-d r- cO s oo e.l oo c.t $ Ov o c.l s c..tN \o\o .+ cO N c.) F- € N !f, = \olf) o) G G o () o) '5 q) z U ?F r- ooN rt rf \o\o \n 6l q) GI o Fr H z rI] z z D D& o z F v F a o Fl V o& o o d,o =z & o zDF F] t'r o Er s q) 6) 0) 2.6. Ordering, storage and delivery of lvermectin Mectizan tablets are ordered by projects after conducting census in the affected community and getting the total population of the project. Project coordinators calculate the number of tablets require by multiplying the ATO times 2.2 thenget total number of required tablets. Re-Application forms are filled and sent to the National Onchocerciasis Control Task Force in the Ministry of Health and Social Welfare. The NOTF Secretariat goes through the Re - Application Forms, approved them and then sends it to Mectizan@ Donation Programme (MDP). The MDP scrutinize the Form and send the drug to the Ministry of Health and Social Welfare through the Government Clearing and Forwarding Agent inTanzania. (Medical Store Department- MSD). The MSD notifz the NOFT Secretariat on arrival of Mectizan@ who then informs the Project Coordinator. The Project Coordinator collects the drug from the zonal Medical Stores Department and enters the received drug to the Regional Pharmacy. 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. 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. For the case of Tanga CDTI, the Regional office request Mectizan and Albendazoleto National Lymphatic Filariasis Elimination Programme both for non-endemic and endemic Oncho areas. The request is sent to Mectizan@ Expert Committee for approval. Mectizan@ arrives in country through the same channel and is cleared by World Health Organization(WHO) which handles over to the National Lymphatic Filariasis Elimination Programme. The LFEP in collaboration with the Ministry of Health and Social Welfare are responsible for delivering drugs up to the Region level where by the CHMT members come to collect their drugs through Regional Pharmacist under the supervision of Oncho Coordinator. The CHMT are distributing drug to the FLHF according to ATO in that area served by FLHF. CDD or a selected community member comes to the FLHF to collect Mectizan@ ready for distribution to their Community members. Ivermectin delivery has been integrated into the essential drugs delivery system from the National and lower levels which is community. Activities of Ivermectin delivery that are integrated into the national health care system in the country. o Ordering Mectizan@ from MDP t clear and forwarding drug at the entry point using the existing system. o sending the drug to the affected areas using the existing hearth system The remaining Ivermectin tablets collected: The remaining tablets are collected from the communities and returned back to FLHF where the DOTs or CHMT member collects them and bring them to the District Pharmacy. The District Pharmacist sent the tablets to the Regional Pharmacy where they are stored. L7 WHO/APOC, December 15, 2004 do Xoa\JE ztDS 6= 6.Oq: qi-,GtiJr:N 1; E|'r:\-5;. 3P9ii >z ahLq) o o 2 z tra -2 o FT2 !r2 =a (n c)fr o a !l2 =2 o -2 oga =a o =a =a to q) o!i2 =2 o 2 o 2 rata -a 2 ar, q) t'r @ cq N g) q) !(a Lq) z AT cl 0) & 00 o.l oo^ cA!t aO$ cO co o\ ra) c.l o c\.1\o^ 00 a.l € oo oo cot- TA r*N \o c.l c)L X Fi O a rJq) an 6t o\\ c.i a-\o ooc- s atC\ co ra) N c..l o\ la) U) oI o r5q) U) D ao \o o\\or- N c.)q \o r* c.lNq o\ \o ra) € a-r- r-rr o\ aO rn Ntr-q or- c-.1 q) c|l o c.l cOoq lr) c.l o €6 a@ o\ c.) € N o c)() c)& orn ra) o\ t-- c..l$ sr- OO N o\ O(aa o a- \o o\$ oo h o\N o (o 0) TA lr) € a]$ ri$(-r o\(\I \o^ r- c.l Oo o € o 00@ -il6\n o\(n 6^ r- o\ c\t g)()q)tr oct:-z f-]I zri 2 ria D D I z F V 3 (a Fl v & I o& =a D z t< $ c.l ri k()p (.) o 0) a oA o € t) o oo L 0) o trt!<z o 'Z -s.A 44q) Qq) q- U1 p q)\ o t q) V)(J q) s- L o (.) @ (o N o() z :t 5l(!l FI a a.l r, op c)oo o o o|rr o F ai crllr q) bo Lro oo o C) a. li C) yO o\tal\o (! 0) ti o bo o o oLr(€ o o 00 r<o oo (d o a.(d! bo oo oo o\ s6 oo oc) -cso(g(oE 9€ c0H BE Xdb'g H() utd o-o5 'FotrtrQca LO)xbor-.1 (dr\ L ?8 S L o \ .A L (d U)(! C)ti (n an o 0) u)H a (g C) cd()EF o bo(n& u)s t s -oHE9 o=^cgw/\ Erro:: HYFq)=I#E(nr!r=ou.=LLFIrE .c)t-an\NEN..iE AtE €?ieg9E od9 0. o o -o z o o 9u qE ou.lj u(Zov> o be3trE8 =9z.n co tr-r: o @ I-* ra) \o\o o\ + F- €^ @ c.l ot 00 .'I \o ot a o\ t-r r- (.) € o.^ ;: ,E H..ei E Er'€c rr cO oo^ o\$ rr $ o o\ I-r o\ $ c..l o c.tr- €(n N ia(a 6\ ll * on o !o =o0odFoi:>ooFoF $ c- c.l oo @ rr v1(.} r- ( c,- t-rr- \o \o r- a o a_ e5s '{Jp(! E E.Ez rn oo\N co ca o.t\o ,rr co o\ c.t $ o\\ trr\o r- I-* c-tir} ca c.l@ .d$c\ \o r co o\ l,a € €6(f) -Eed o.a =E' ==o< 9a'FU oo o\\o^ F- c- cO \o @v} c\ co cO(--q$F- cO o\ =r: aa F- co !+oc\ \o I-r N $ o t rn(?) \o ra ol (dt .9 .,k = iioT. EHF€.?.g o.:oE oF $\o oi$$ N t-* ra) crt c!r-\\o € $ caq oo\o$ s @^ @ N ca $ r- c\l \o r-(.) € o\ ll r a'o a o,, EoO +E *eEie('l o o E.9 -- -8 E SXtr tr= ii = E't ir AO o co(rt o\ co o!t c\ t-ro\ @ ol oo e.t( o\{ s o -E.od o.=2EE ==o< 94'FU cO r o\ c.t .tN rro\ @N@ corr o\ot !+ a o 00d v) G) l oO .oEE:E I 8_.e * C ilo !-C a * EgE*E E;: C >.= t tr.8 ': E> E 9 c.) ra o\ co O$N O tr- o\ € c\ @ colat o\ !f !+ o() 'a H o< riI z t-1 !r2 z D D () z ti 14 t'r C,) l.l v o& o z &p z DF J t'r t'i 2.7.2 Causes of absenteeism and refusals: o Most of absentees are people who are migrants, business people and some who go away from their villages and even districts for preparation during farming seasons. . Ignorant to few people about Onchocerciasis and Mectizan drug especially to those who don't attend community meetings. . Some of the community members stay out of their homes for farm activities throughout the year o Mainly due to misconceptions and myths build against Mectizan that the drug is used secretly for family planning purposes. o Because the drugs is given to all eligible and is free of charge there is a rumors that the drugs are for contraceptive purposes so some people refuse to swallow it. How is the NOTF dealing with them? The National office has advised projects to intensifli HSAM in the endemic areas and requested projects to conduct CSM and SHM after the distribution cycle so that problems will be identified and dealt with. 2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. N/A 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report : Cases of Serious Adverse Events that occurred the ./ Name of project Number of verified* SAE cases reported Action taken Number of cases with sequelea Number of deaths MAHENGE NONE NONE NONE NONE RUVUMA TANGA NONE NONE NONE NONE TUKUYU NONE NONE NONE NONE KILOSA NONE NONE NONE NONE MOROGORO NONE NONE NONE NONE TUNDURU NONE NONE NONE NONE 20 WHO/APOC, December 15, 2004 <f N ri op () C)o H Uo A< o > c..l 6iq) 6l Iq) otr c) c) 0) k € L(o C) L.l G, 'o C) o >' -o o bo(€ L c) oo (o U) 0) CO() LF q) q) I q) o Iq) o t- U U) o q) g) 0 0) LE L o) tr c-' o=ed .i()rE .. a.)(.) ts\o : =rrE US(l) E Yd !?UD cl c) .OF- -L *o .dvE Ec'rE O.Et 9 -6 EeL u=!LH9 E6E 9() rE t: c.lrL ,\ .i =tr0.rtL!* _9 LEJLT d q)d ' thh Ui ED * -(9:i >t ^\ rl1 F o oo dEq) oO a.t a-t \o roF c.l oo F- .{- @ oo t-* @ \t? a.t o\ r-r- 6 o b0(n o o 'E 9-. oo6 o F ll *a9 rd Fl €ri o\ c-t co cl t,-\o t-\o t*\o r- v,.) r- o\F- sr- ,q \o F- o tsod>o5 -L aJFO d= ri c.l\o s c.t c..t Fr cal \o\o o\ c.)N od $ r- a.t € $ o\ N c.) € @ oo c.l o\o o\ o\ n o\ o\ \o c.) o\ s\ * \o .=-rd ::'iot, FE5.€ lo .gq E.E , = o; oF rr cO c.t @ C.l c\ CN c{ co $\o rc c., €('I s o\N c.) o\ o\ \o a.t .f, .(- F-N c?i $ cOrI a.) @ c- F-$vl co € @^ r-$ € c! \o F-(.l € E .9o ?rqp =A!e-ll r E,x5dgEU trT o !Bg b I;EE*I E EeEE. e>-o o\ o\ N e.l @\o e.l @ t--a\ $.f- a.t c.l\ a.l $ o\ e.t \o o\ €$ \o\o f: o\ $$ El F.. o\ o\ oo o\ o\ o\ o\ o\ C.l oN N a.l (\.t $ C.l oN \o (\l rra N € N o\ oN c{F T2.8. Supewision 2.8.1 Note the supervision that was undertaken by the NOTF (Project supervised, date, by whom, objective of supervision mission, outcome, follow-up needed) undertaken the NOTF add more rows neces, 2.8.1. What were the main issues identified during supervision? o Some of activities in the sustainability plan were not funded by Council o Community leaders are not supporting CDDs neither CDTI activities in their areas o Community members were not given a time to decide mode of Mectizan drug distribution and selection of CDDs was determined by FLHF staff and community leader. 2.8.2. Was a standard supervision checklist used? yES Project Name Supervisor Date Objective of supervision Outcome/follow- up needed MAHENGE Dr. Kirumbi To monitor the implementation of sustainability plan and sensitize Council leaders to incorporate all CDTI activities in their CCHP Need to make a follow-up when the council's are in the preparation of CCHP to make sure that oncho activities are incorporated. RUVUMA N/A N/A N/A N/A TANGA N/A N/A N/A N/A TUKUYU N/A N/A N/A N/A KILOSA N/A N/A N/A N/A MOROGORO Mr. Kaitaba To sensitize Govemment leaders and community leaders on community project ownership and community participation in the implementation of CDTI activities. Government and community leaders participated in implementation of CDTI activities especially during drug distribution hence coverage raised. TTINDURU Dr. Saguti/ Mr Kaitaba To supervise the implementation of CDTI activities at FLHF level and see if APOC CDTI philosophy is properly followed. The NOFT sent one office to sensitize CMT and CHMT who made a follow- up to FLHF staff to make sure that APOC is properly followed 22 WHO/APOC, December 15,2004 2.8.3. What were the outcomes at each level of CDTI implementation supervised? o District Council were informed on the impact of withdraw of APOC in funding Mahenge CDTI in year 2009 hence they agree in principle to fund all CDTI activities in their area. o Community leaders were agreed to support CDDs and CDTI activities. The dishict leaders have agreed to make closer follow up to the Community leaders to make sure that CDTI activities are well implemented. o The Project conducted training to FLHF staff and urged them to adhere to APOC philosophy in the implementation of CDTI activities. Community members were given mandatory of selecting CDDs in the community meetings and also they decided on the mode of drug distribution. 2.8.4. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? Feed-back was given and the supervised were agreed to deal with all issues identified during supervision so that to improve the performance of the projects. 2.9. GommuniQl self.monitoring and Stakeholders Meeting Table l0: Community self-monitoring and Stakeholders Meeting (Please add more rows if How the results of the community self- monitoring and stakeholders meetings have affected proj ect implementation: In the area where these were conducted there is an increases of therapeutic coverage also community members have gaining sense of project ownership hence project sustainability can be achieved in the project by community members participating in the implementation of CDTI activities. 2.10 Compliance to long-term treatment with Ivermectin Mention specific activities in the Table 11 what the NOTF has done to ensure that CDTI projects comply with long-tenn mass treatment with Ivermectin? (For projects 4 and above years old) Project Name Total # of LGAs or districts in the entire project area No. and % of LGAs or districts that carried out self monitoring (CSM) No. and % of LGAs or districts that conducted stakeholders meeting (SHM) MAHENGE RUVUMA TANGA TUKUYU KILOSA MOROGORO TTINDURU J I 2 I 2 4 3 ) )1 l(50%) 00%) 00% 00% 1 2 3( 3(100%) 100% (l (1 (l 3Gq0%) l(10070) 1(100%) 1 s0% 0 0 TOTAL 16 tt(6e%) 8(100%) 23 WHO/APOC, December 15, 2004 Specific Activities Proiect targetedObjective L Promote Integration of CDTI with other health care services To use the CDTI approach in the endemic districts for any CBI - Areas of co existence of LF - Areas with Trachoma distributing Xithromax 2. Maintain high therapeutic (>65%) and geographic( 100%) coverage -To maintain & strengthen HSAM -To win governmenV political leaders support during Mobilization & sensitization to communities with difficulties in accepting CDTI National All project areas 3. Promote strong community ownership To encourage projects to assist communities to conduct CSM & SHM All project areas 4. Promote high government commitment Continue having advocacy meetings. This can be done in collaboration with other CBI e.e. LFEP All LGAs & National level 5. Support strong partnership Continue conducting stakeholders meetings at all levels. ALL levels 6. Put in place a strong IEC strategy that encourages continued treatment To review existing IEC materials and strengthen the project specific. All project areas Activities of that to treatment with Ivermectin SEGTION 3: Other activities of the NOTF a Describe any additional activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). NOTF with assistance from APOC management conducted Independent Participatory Monitoring of Community Directed Treatment with Ivermectin in Morogoro and Tunduru Projects. As is customary with the APOC partnership, CDTI project undergo independent participatory monitoring after one or two distributions. This aimed at ensuring adherence to the CDTI process, early in the age ofthe projects. 3.1 Recommendations from findings Morogoro CDTI Project o Use community leaders to facilitate community members to conduct Community Self Monitoring o Strengthened health education, sensitization, advocacy and mobilization to community members information and education material in form of posters, drama and radio talks. o Initiate advocacy for supporting the provision of vehicles (bicycles, motor vehicle) to every health facility in the project area for all activities. 24 WHO/APOC, December 15,2004 Tunduru CDTI Project o Continued reorientation, training and involvement of the health service personnel at policy and implementation levels on the APOC philosophy and their roles. . Adequate time should be devoted to the project for proper dialogue with community on the benefit of the Ivermectin treatment, their roles and commitment in the long-term sustenance of the treatment process. o The CHMT should ensure that communities are empowered to make decision on implementation especially with to timing. o Training and retraining of CDDs should be improved by increasing the number of days. o Improve quality of record keeping o The district should have a plan in place to train new CDDs o CHMT should endeavour to retire funds early in order to access more funds for distribution activities o APOC and the NOTF should arrange technical support for Tunduru CDTI as they plan for the next round of distribution 3.2 3.3 a a What was done to coordinate CDTI Project activities? Supervision, monitoring, NOTF meetings and annual review meeting were conducted in the past year for strengthening coordination among key stakeholders. Partners such as SSI, HKI and IMA World Health have been in close collaboration with the NOTF secretariat to follow up the projects they support. Conduct review meetings with stakeholders. Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow-up need a DATE OF MEETING MEETING ISSUES ADRESSED OUTCOMES & CONSTRAINS, FOLLOW UP MADE 29TH JLTNE 2007 3o'n NorF meeting SSI was responsible for collection of funds raised for the family. Funds have been divided into the 3 families. Funds for the late Dr. Kanyika were deposited in Morogoro CDTI accounts while the rest funds are still in the NOTF account waiting for transfer to the beneficiaries. . Funds for the family of late Dr. Enyinnaya were transferred to his father in Nigeria through \West Union BanL The Ministryis in the process of trarsfening of fturd of late Dr. Ruhiso's family from NOTF Account to Tukuyu CDTI Account so that the widow can use this moneyto travelto Dar to complete formalities of Insurance compensation at \(GIO office. a a 25 WHO/APOC, December 15, 2004 Change on SSI Country Representative who was also NGDO Coalition Chairman. Moreover HKI also has new Country representative therefore a need for these partners to select among them the NDGO Coalition Chairman The NGDOs held a meeting and Dr. Daniel Nyagawa the CR for IMA World Health was elected as the Chairperson. Policy Guideline Draft Member requested if possible to circulate draft zero by mail to the NOTF members so that they can chip in inputs. NOTF Secretariat is still working on it by doing corrections. When work will be complete the document will be circulated to members Country Plan/lVITEF 3 bilions 3 years plan and budget proposal was forwarded to Tanzania Govemment through MTEF to combat NTDs. We are waiting for funds to be approved. No funds allocated for NTDs in MTEF therefore this issue had been presented to DPP MoHSW and promised to allocate funds for NTDs implementation Onchocerciasis and Malaria co-implementation The second meeting is scheduled in July 2007 and will be held in Ouagadougou. This was a meeting of Programme Managers of Onchocerciasis and Malaria. The meeting had a total of 16 participants. Tanzania was represented by Mr. Oscar Kaitaba, who represented the Program Manager, Onchocerciasis Control Programme and Dr. Azma Simba from the National Malaria Control Program representing the Program Manager. The specific objectives of the meeting were to share experiences in joint implementation of disease control interventions at country level, to obtain a consensus on the protocol for joint implementation of malaria and onchocerciasis programmes, to develop country projects based on the protocol developed during the workshop, to put in place a methodology for the evaluation of the performance of the pilot project and to frnalize the protocol with the evaluation of the budget. At the end of the meeting participant managed to develop country plan and it was submitted to WHO/AFRO in Zimbabwe waiting for 26 WHO/APOC, December 15, 2004 14.I'H NOV 2007 3l'tNOTF meeting Inadequate of IEC materials in Project areas The meeting requested project partners to look into the possibility of supporting a workshop of key stakeholders to review and improve IEC materials that had been developed by CDTI projects, leading to reproduction of those that are most appropriate. The National Programme Manager promised to submit to the partners a proposal for this workshop. The national office has submitted a proposal to the APOC management requesting for funds to produce of IEC material by using massages developed during workshop conducted in Tanzania in the year 2000 and2002. Workshop on Resource Mobilization Capacity Building held in Entebbe, Uganda from 16 -20th April 2007. The meeting suggested that those who attended the workshop should put into practice the learning they received by mobilizing resources for holding a similar workshop for other NOCP partner staff The NOTF is preparing a proposal to request funds from APOC so that a workshop for other NOCP partner staff could held. Update on REMO The Secretary briefed the meeting about the results of the REMO update carried out in collaboration with APOC in 2006. The results have shown that a number of communities' in Mufindi and Njombe district have high prevalence and should begin CDTI activities. It is proposed that the activities be implemented as an extension of Ludewa CDTI activities as APOC cannot start a new project now. The NOCP has initiated consultations with Iringa region authorities to see how to carry this forward. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. l. Resource Mobilization Capacity Building held in Entebbe, Uganda from l6 - 2Oth April2OOT. 2. Onchocerciasis and Malaria co-implementation meeting in Ouagadougou July 2007 3. Workshop for the preparation of country presentation to the JAFl2th from 08th - 1Oth October 2007, Morogoro , Tanzania.4. 4th NOTF meeting in Ouagadougou from 29th - 31"t October 2007 27 WHO/APOC, December 15,2004 5. JAFl2th meeting in Belgium from 03'd - 07th December 2007 3.5 Briefly state any administrative duties undertaken: The project was the secretariat to all NOTF and the annual review meetings hence arranged for date's venue, prepared minutes.It also facilitated obtaining both financial and technical reports from CDTI and Vector project. This can be measured through : - Number and type of reports reviewed (technical, financial), - Reports forwarded to APOC management, - Administrative assistance or trouble shooting for projects. 28 WHO/APOC, December 15, 2004 a c! Vi Ho .o c)o 0) H () ol-r B o\ o.l 00 :{ 6r :r- ENed3< ;, o)ll}E fOr.: -ll-:,^ Atri< 9FrrE - .- B==8UF =<>(nUAc6< ao!.rEIJEdGl i.-i e)tsr EO Gt \J o,7>.'i E5 av I-{ €FOZo lrJ '- tA c F.rF>F-oilzo o[rrz b1 -0r .22 3F ow e{6 Fr \o (t) 6 zp l- -€20 € & @ & ria a Fq Fi tu € z l- UEl* r-oz r- t'r U o r- Fr f.la ?s r- Fl Dl- t'r F(J E.gNC '-!:C) q)Y 2, O) a.9 -- cn -o .= .F c) ;^U .=oEO E* .VA€C)voHroo .y-oltc>. 6U)eotio o7! 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U) C) l-r(€ CB ./) o o th -l( U) o I L oo c) .o o o U) ook 00 rE ti o z oot '5 li oaotr H C) I d J l-r cd C)x E ! Lr € U) Ioo 'a L Or F oO CB I IAobLdOEEAgIlLtuE 9o- -!EF;.;ooP(roE o 5E+rE(J +. 1<oL ,r ':-'lt=:E! Es 556::, r. IUH\.oE .,Ets -a5oEa -arI- lt NltrlO.olUEEI(r,tf#t q) rt) G c) oL ah 6) L o c) o o L U a!() =f,ot r.} la) +$ oo $ caO o\ N \oN$ \o \o cO .+ \o .+ @ ca o aO t.aia !c ?aN N o L a tl I-r r- I-r\o ca$in rn N O U,) aO\oc\ \o o\!t o\ o F- (n $ O la (r)s\o o\ € \oA6) c0 .: dtrOE H(J .\z Ji .o Ji }l J,4 cf)\n (?) ra L c) L d o ,-l z o o\ @ + € o.l r- \o o\ cn O c.iin ca € in @ F- 6 € rr) 6l o\r- (n C) (* o xL 0 z O q in o\ t-r oo\o ca 00\o o.l$ oA \o\o C.t\o(\ oo € r.l ca .') co ca cO oo (Y) ?a r-$ ra Io() 'a A. o 0) dz ri z l.l 2 e D z F v F U) Fl & il z & D z F frF z oH Problems with release of counterpart funds were they addressed as follows: - Communication is done to remind the counter part by emails and official letters. - Reminders were sent to the counterparts when the initial communications were not responded. - Altemative funding from the government were requested to do the activities. Number of projects that had no funding from APOC Trust Fund: NONE Number of projects that had no funding from any outside source: NONE Number of projects that are late in submission of the financial reports to APOC: Two projects are late in submission of the financial reports to APOC these are Ruvuma CDTI project and Tukuyu Vector Elimination Project. Outstanding is as follow 1. Ruvuma CDTI project: September 2007 to December 2007 2. Tukuyu Vector Elimination Project: August 2007 to December 2007 4.2. None Other forms of community support 4.3. Resource mobilization efforts All CDTI activities in the project areas are incorporated into the CCHP and at National level, the NOCP activities are supported through the MTEF. 32 WHO/APOC, December 15, 2004 4.4. Expenditure per activiQr by the NOTF secretariat Table l3: NOTF secretariat project expenditure each activity done during 2006 period Comments: None Activity of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to projects, districts, etc Monitoring and supervision of CDTI Projects To attend JAF meeting Annual review workshopsA.{OTF meeting Bi annualNOTF meetings Fuel and maintenance of Vehicles, Maintenance of office equipment Stationery & communication Others - Capital equipment & Personnel 0 6,000.00 0 0 I 800.00 0 08,791.67 29,277.50 0 57,480.93 0 0 0 0 0 0 0 10,993.33 0 -18,700.00 0 0 0 0 0 0 0 0 0 0 2,200.00 13,300.00 0 3,550.00 5,060.00 TOTAL 30,110.00 117,033.33 0 0 Total number of treated 1,399,195 JJ WHO/APOC, December 15, 2004 I 4.5. Equipment : Status of ul of NOTF Secretariat ect *Condition of the equipment (Functional, currently non-functional but repairable, written off) How does the project intend to maintain and replace existing equipment and other materials? - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign). APOC MOH Other donors NGDO Private Type of Equipment Source Condition of the equipment * Please state 1. Vehicle 3F 1F 2. Motor cycle 3. Computers 4 (2F,2WO) 2F IF 4. Printers 4 (2F,2WO) IF 5. Fax Machines IF 1F 6. Others a) Photocopier lwo 1F b) Air conditioner 1F IF c) LCD Proiector lwo IF d) Dieital camera lWO 34 WHO/APOC, December 15, 2004 SECTION 5: Evaluation for sustainability of GDTI, lndependent monitoring and other reviews 5.{. lndependent participatory monitoring/evaluation 5.1.1Was any independent Participatory monitoring and/or evaluation carried out during the reporting period? No Table l5: Overview of when monitoring and evaluation undertaken (Please add more rows if n 'roject Name (After Year l) participatory independent monitoring Mid-term sustainability evaluation (3'd year) Independent monitoring after 4th year Evaluation For sustainability (5tn year if necessary) Internal monitoring by NOTF Other evaluati on by partners {AHENGE YES TUVUMA ]ANGA ]UKUYU IILOSA doRoGoRo YES YES ]UNDURU YES 5.l.2It is recommended that . Use community leaders to facilitate community members to conduct Community Self Monitoring o Strengthened health education, sensitization, advocacy and mobilization to community members information and education material in form of posters, drama and radio talks. o Initiate advocacy for supporting the provision of vehicles (bicycles, motor vehicle) to every health facility in the project area for all activities. o Continued reorientation, training and involvement of the health service personnel at policy and implementation levels on the APOC philosophy and their roles. o Adequate time should be devoted to the project for proper dialogue with community on the benefit of the Ivermectin treatment, their roles and commitment in the long- term sustenance of the treatment process. o The CHMT should ensure that communities are empowered to make decision on implementation especially with to timing. o Training and retraining of CDDs should be improved by increasing the number of days. . Improve quality of record keeping o The district should have a plan in place to train new CDDs o CHMT should endeavour to retire funds early in order to access more funds for distribution activities o APOC and the NOTF should arrange technical support for Tunduru CDTI as they plan for the next round of distribution 5.2. Sustainability of proiects: plan and set targets (mandatoty at yr 3) Arrangements have been made to sustain CDTI after APOC funding ceases: 5.2.1. Planning at all relevant levels. 35 WHO/APOC, December 15, 2004 PCs and DOCs are co-opted members of RHMT and CHMT in their respective working areas and they are involved in planning hence Oncho activities are incorporate into CCHPs & MTEF Funds Fund released for most of the activities planned under CCHP and MTEF 5.2.2. Transport and equipment (replacement and maintenance) Funds are set aside in the budget for maintenance of capital equipment. 5.2.3. Human resources All staff in oncho areas are Government employee. 5.2.4. Which projects have submitted sustainability plan? NONE 5.2.5. To what extent have the plans been implemented? N/A 5.3. lntegration Extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms It is incorporated into the general delivery of government drugs up to FLHFL 5.3.2. Training Efforts are made to use train sessions to deliver information of other communicable diseases like Lymphatic Filariasis, Trachoma. 5.3.3. Joint supervision and monitoring with other programs: CHMTs at district level. At National level only Eye care as this is coordinated in the same office. 5.3.4. Release of funds: Integrated in CCHPs and MTEF 5.3.5. Is CDTI included in the PHC budget? Yes at National level and in the District level. 5.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Two programs for Lymphatic Filariasis and Trachoma this has contribute to rise in their therapeutic coverage. 5.3.7. Describe other issues considered in the integration of CDTI: Integration into the on going NTDs initiative. 5.3.8. Integration of other programs into CDTI in your country and the results of this integration on CDTI (as described above) 36 WHO/APOC, December 15, 2004 5.4 Operational research 5.4.t1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. By the support of APOC, Tanga CDTI Project conducted an operational research based on effect of APOC withdrawal from supporting routine CDTI activities of health personnel and CCD performance in Tanga region. The study has completed and the report is on the final touches when ready will be sent to APOC Management. Two districts Ludewa and Kilombero has submitted proposals to the NOTF HQ which are still in review before being submitted to APOC management for request of funding. Note the issues that have been identified by the NOTF for future operational research. Issues noted by NOFT for future operational research are - The increases in number of refusal and absentees in some projects even if the therapeutic coverage is high but still some people are refusing to take Mectizan drugs. - Issues related to community participation and community ownership of the to the CDTI projects. SECTION 6: Strengths, weaknesses, challenges and opportunities Strengths and Weaknesses of the National Onchocerciasis Control Program Strengths o The National Onchocerciasis Control Programme is within the structure of National Primary Health Care under the directorate of Preventive services in the Ministry. o The District Councils continued to support CDTI projects by inclusion activities into CCHP and releasing the allocated funds. o CDTI implementers are well knowledgeable of CDTI philosophy at all level. o Ordering and delivering of Mectizan@ tablets is within the existing health system in the country which allows the community to collect their drugs from the nearest health facilities. o Govemment release funds for the implementation of CDTI activities through the MTEF to support NOCP activities. Weaknesses o Late submission of financial and technical reports from CDTI Projects due to unavailable of Bank document this resulted in delay of disbursement of funds from counter part which caused some CDTI projects to delay in implementation of activities. o Unavailable of past data in CDTI projects office which makes difficulties for the National office to have data base and in following up realistic project coverage and responding to urgent data needs from the APOC managements. Challenges o Luck of IEC materials to support CDTI and other education campaigns hence low sense of project ownership at community level. o Frequent change of decision makers especially at district level needing more advocacy and sensitization. 37 WHO/APOC, December 15, 2004 Opportunities o Some of CDTI projects has prominent and committed donor who is likely to support the project by providing more resources o Availability of knowledgeable staff in the CDTI projects areas. o All Onchocerciasis endemic districts have incorporated CDTI activities in their Comprehensive Council Health Plans (CCHP). o Integration of CDTI activities with other prograrnme in NTDs. o Most of CDTI Projects have sustainability plans and are well implemented. Indicate how challenges were addressed. o The National office has sent a proposal to APOC management to request assistance in producing IEC materials. o District has been encouraged to set aside funds in their budget for conducting advocacy and sensitization in the districts and encourage community members to conduct CSM and SHM. I n dicate h ow opp o *Ti:H"#:;' t'"TiiilTiffi :l,'ji r corr proj ects w,r enabre CDTI activities be implemented effectively and efficiently. Integration of cDTI activities with other programmes will reduce the work load to CDTI staff hence smooth running of the project. CDTI activities are incorporated into the CCHP hence funds for implementation of oncho activities will be released by the Council. 38 WHO/APOC, December 15, 2004