Mwanza CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2006 to December 2006

I II I I I I : I I I I I MWANZA DISTRICT HOSPITAL CDTI PROGRAMME - MAI.IIWI ORIGINAL :English COUNTRY/NOTF: MALAWI Proiect Name MWANZA CDTI Approval year: 1998 Launchins vear: 1997 Reportins Period: From: ...JANUARY, 2006 To: ...DECEMBER, 2006. Proiect vear ofthis report: (circleone)l 2 3 4 5 6 7 B 9 l0 Date submitted: 2 MARCH,2OO7 NGDO partner ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by tl /lrtt-tl c l{ To APOC Management by AFRICAN PROGRAMME FOR ON I CHOCERCIASIS CO rfz TCC meeting l€n^ l"+CC meeting NTROL (APOC) * 'rccge 'eEl 8iH rsl CaP A(e Bfr Fo , ." ,i:.., )-;-; -\iB Ao ::i,cn H. I - ,l o agtt WHO/APOC, 24 November 2004 \e3r he tANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: MALAWI (-)li Signature: D F\ .) Date: ' 'Lt:"["'"'['''r""' Zonal oncho coordinator Name: ff. .\. . tt Uqt. CS.]. . . . . . .. Signarure: f,.Lro" S:A Date: i,tlfr,Il\ r\ t NGDO Representative Name Signaturg:. .. :. . . .. Ilate: . This report has been prepared by Name: NC KAMANGA Designation : Ag Date Table of contents ONCHO COORDINATOR S ACRONYMS ...IV v FOLLOW Up ON TCC RECOMMENDATIONS...... ..............1 EXECUTIVE SUMMARY ............ 2 SECTION 1: BACKGROUND INFORMATION .....................3 1.1. GeNpRar- rNFoRMATroN........................ l.l.l Desuiption of the project (brie/ly) 1.1.2. Partnership 1.2. PoPULATIoN SECTION 2: IMPLEMENTATION OF CDTI ........................6 J 3 4 5 WHO/APOC, 24 Novemb er 2004 "{ -!t o 1 ll 2.1. TrupLrNp oF ACTIVTTIES ............... 2.2. ADVoCACY 2.3. MostltzarloN, sENSITIzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNruES....2.4. CouuuNny TNVoLVEMENT ............ 2.5. CapacrtyBUILDrNG... 2.6. TRearuENrs................. 2.6.1. Treatmentfigures.............. 2.6.2 What are the cquses of absenteeism? .............. 2.6.3 What are the reasons for refusals? ..2.6.4 Briefly describe all known and verified serious adverse eyents (SAEs) that........... 2.6.5. Trend of treatment achievement from CDTI project inception to the curuent year ........2.1. ORDERING, SToRAGE AND DELIVERY oF IVERMECTIN......... 2.8. CouuuNITY SELF-MoNITORING AND STAKEHoLDERS MggTmc2.9. SuppRvrsroN................ 2.9.1. Provide aflow chart ofsupervision hierarchy.2.9.2. lf/hat were the main issues identified during supervision?............2.9.3. ll'as a supervision checklist used?.......... 2.9.4. llhat were the outcomes at each level of CDTI implementation supervision?.........2.9.5. Was feedback given to the person or groups supervised?. . ........ ......2.9.6, How was the feedback used to tmprove the overall performance of the project? .... SECTION 3: SUPPORT TO CDTI......... 6 8 8 0 EqurruENr FTNeNcIaT- CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES. OrueR FoRMS oF coMMUNrry suppoRT ....,............ ExppNoITuRE PER ACTIvITY SECTION 4: SUSTAINABILITY OF CDTI 4.1. INTEnNaI; INDEPENDENT PARTICIPAToRY MoNIToRING; EVALUATIoN....................4.1.1 Wqs Monitoring/evaluation carried out during the reporting period? (tick any fo I I ow ing w hich are appl ic ab I e)............... 3.1. 3.2. 3.3. 3.4. 22 24 24 24 o/,:n'n 25 25 254.1.2. What were the recommendations?.. ................... 254.1.3. How have they been implemented?................. ...................... 264.2. SUSTRTNRSILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT ....................,..,26 1.2.1. Planning at all relevant levels ........ 264.2.2. Funds .......264.2.3 Transport (replacement and maintenance)......... ...................264.2.4. Other resources ............ ........... .....264.2.5. To what extent has the plan been implemented .......... ........... 264.3. INTEGRATroN................. .......264.3.1. Ivermectin delivery mechanisms ..... 264.3.2. Training..... ............ .... 261.3.3. Joint supervision and monitoring with other programs ........ 264.3.4. Release offundsfor project activities..... ,..........264.3.5. Is CDTI included in the PHC budget?....... ........ 261.3.6. Describe other health programmes that are using the CDT| structure and how this wasachieved,,t,,tlhothavebeentheachievements?.,.,,.,.,. 4.3.7. Describe others issues considered in the integration of CDTI. ....firuor! Bookmark not deJined. 4.4. OpenarroNAl RESEARCH ............264.1.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ...................... 261.4.2. How were the results applied in the project? ................ .......26 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND oPPoRTUNITIES........ 27 SECTION 6: UNIQUE FEATURES oF THE pRoJECT/orHER MATTERS............. ............27 lll WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organ ization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o 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/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 of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). lv WHO/APOC, 24 November 2004 t' t (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. Section Break (Next V WHO/APOC, 24 November 2004 FOLLOW UP ON TCG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) 1 Number of Recommendatio n in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC,MGT USE ONLY WHO/APOC, 24 November 2004 Executive Summary Prepare an Executive summary of the report in not more than one page. 1. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. CDTI PROGRAMME Mwanza is on sustainability phase since 2003 when the programme was launched. Since then efforts have been made to improve both geographical and therapeutic coverage through hard working and thorough the support spirit of the DHO and NOTF, Mwania has managid to improve both therapeutic and geographic coverage since 2003 which curently stands at 80.30yo. Captioned below is the 2006 Mectizan distribution summary SAIO ACTIVITY DECRIPTION TOTALS 1 Total number of vges 256 2 Total number of hhds 34,038 3 Total population 169,625 4 Total children less than 5yrs 24,461 5 Total number of pregnant women 2,736 6 Total number of yg4r sick people 343 7 Eligible population (to be treated) 141,855 8 Total treated 136,319 9 Coverage (Therapeutic) 8030% l0 Geographic 100.0% 1l Total number of refusal 2,231 t2 Total number of absentees 4,466 l3 Total of people with severe reactions 100 14 Total of tablets received 481,369 l5 Total number of people treated with I tablet 33,911 2 tablets 39,613 3 tablets 36,53 8 4 tablets 26,257 16 Total number of tablets used 327,779 t7 Total number of tablets remaining 150,080 18 Total number of tablets not accounted for 3,509 t9 Total of present CDDs 680 20 Total number of female CDDs 316 2t Total number CDD drop out 10s Background on population movements. Training data CDDS, health workers, Total population (community) per CDD trained. Challenges and how they were overcome. Last year with the assistance from WHO and our DHO the district managed to train 200 new CDDs and refreshed 200 old thus bringing a total number of CDDs trained to 480. The current CDD coverage is thus I CDD to every 355 persons which is the worst so far. The contributing factor has been lack financial support since Oncho activities have not been given a priority in terms of district monthly financial allocation. With support from the DHO as well 107 HSAs were refreshed on the concept of Onchocerciasis 2 WHO/APOC, 24 Novemb er 2004 SEGTION l: Background information 1.1. Genera! information 1.1.1 Description of the project (briefly) - Geographical location, topography, climate Mwanza district is located in the Southern Region of the republic of Malawito the Western side and shares borders with Mozambique to the West, Ntcheu to the North , Balaka to the East, Blantyre to the South east and Chikwawa to the South. The total area of the district is 2,295 sq km uni i, cut across by three main rivers of Mwanza, Mkulumadzi and Lisungwi. The Iand is generally flat on the Eastern side and hilly to the North, west and South. climatic condition is that type savanna - Population: activities, culturesr language Currently Mwanza has a total population of 169,625(acording to population figures for 2006 by head count). The avereage annual population growth rate is 2.4%o Due to intermarriages, the Ngoni culture which was dominant in the district is now dimishing and the most common local language is chichewa - Communicationsystems (roads...) In Mwanza district there is only one main tarmac road which joins Blanytre and the republic of Mozambique. There are a number of secondary roads and feeder roads most of them in very bad shape - Administrationstructure The District Commissioner is the overall boss of the district. Most of the activities in the district are run by the District Assembly. There are seven Traditional Authorities in the district - Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). The district has seven government Heath Centres, four CHAM Health Centres, two private clinics and one company Health Centre. - Number of health staff in project area and number of health staff involved in CDTI activities. Table I : Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage B3:BylBr *100 371 262 70.62 Total 371 262 70.62 J WHO/APOC, 24 November 2004 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels [MoH, NGDOs(national/international), communities, local organizations, etc.] In Mwanza there is no any NGDO,NGO and CBo which-assist in the implementation of CDTI activities on a regular basis. Otherwise its only WHO and UNICEF which at times have come in withfinancial assistance though on an irregular basis - Describe overall working relationship among partners, clearly indicating specific areas ofproject activ.ities (planning, supervision, advoiacy, planning, mobilizati]on, etc) where allpartners are involved. The overall work relationship with partners is not all that rosy considering the fact that most of them operate within their project scope in which Onchocerciasis as a programme is not their interest ====_.Section Break (Next page) -======, 4 WHO/APOC, 24 Novemb er 2004 ((i C)l<(! o 0.) 'a ! o. o (t C) L q) (! (nk 0) a o .2 ci -c) d boo(o! >o ,- .Eobe E;\L}'UO o,l 5 \l ,tc)e'F[ik PC) ?tr oc .Ed}E o- =^ ,= o- oo P"E 6U =(6)p ^o Vo -aJ LLo.o o.Es boP C€ .IA a o= td4; 4c) (ha sIq) o'\ q) o' s) q) I\qJ U q) L q) "a o S) s .b oo a (.) oL oa r< c) o c) o -od C) 0) (! (.) Ck o C)ot< o U) 0) (t) z(F o z I .4 .ol/tJ Ia 0) o o bo iP o c) bo C) o o(.) 'a k c) L an a C)o (d (h(! l- s$ S\ ttnUU x.:.\o'\ q) q) B S' b.\5 q) U q)\ q) uq) :..\ qJ !) "a\ 4 Uq) o'\ !,) o q) MvI\q) U U s bo oU bo \q) U q) U) Uq) o'\\ q) : b L U U t U L\J * ^\ qj >. B\q) AJL !) "a o q){U\) '\ LqJ .a )< F{ q) a S\q) B R v I F\ 4: L q)L o tN a,)q q) o H C)p. bo L oaoL C) bo li E o lr o Cd C) C)k c0 C) L(.) 0) 6lq)L c! I 0) L 0)L 0) O j a L d o o. o (! (n C) o() nir ol -ot(ct FI E oEJ G -fc oL IN a F ooQ U) a oo o 4 oo =(E ^0)6> s cr; oo 0) .'.9€riE.=.i$ rE E i. N eF E + I o)ir =E6 .=!; = !!v E+ $ Fisgsi .c) rC)O .= qN r -?.9E> Ft 8.3 -6) (rI N\o ol\o ca\o $ o\ o\q .t tr- (J o) EEEo -Nlr ,a o ch C) il i (hq) (J q) z o o o tq) 'Egs *E h FIggsi e8 o0) \o(r) N \o \o o\ -E9o9=r-Lrr9.-- -5- -i: c 9{'.d = o.:E *o 9' -VU-LH AE q (\ \o^ o\\o 3iE!cPc8{ iH FrYEa- 6 U (d N z rI 3 lr .,( SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicatins when the key activities were implemented by the month they began and the month they ended. Section Break (Nelt 6 $ N H C) -o 0) o z$ c.l O o ah P 4) a 0r= QO L 0.) -o C)o o o S.e riE c!: h c0 (o E o AT o: eo k0)s o o o E'I;tr a bo ql th o q)(') qrE QO 0) H.e 1itr >' Cd o[ L t'r q,E ro 0) S.c;tr CE:(h- 2 oq) O o 6l N ! oria 5-o+t EO EEUq (h oo o a0 .li 6l a Ha Fl o L o N a Fl F l'r r- a C) (-) I q 4 s)U qJ S 4 . oL q)L t a)4 qJ s L (.) (.)Lti C) o C) (d C)L (h(!(.) L(n 0) ,o a o o C) C) F ".itol !ldtFI 2.2, Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information Mobilization and health education of communities including women and minorities Response of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. Information transfer from health providers to communities on Oncho and Mectizan distribution members at risk was largely done through a drama group which district hospital. All health centres and surrounding communities were reached during drama sessions on Oncho. Coupled with drama sessions were health talks as well as question and answer sessions. During the occasion leaflets and picture codes on Oncho were also being distributed. Apart from drama sessions health talks at OPD and outreach clinics were always being conducted by HSAs and other staff Response from community members has always been encouraging through large turn ups as well as relevant questions the were being put to the flow by the audience. However just to improve on that use will have to made of politicians and the Health Education band in order to more attention and focus 8 WHO/APOC, 24 November 2004 g WHO/APOC, 24 November 2004 co Nk 0.) -o c) o z$ c.l o. d d a. o E a C)o (! 0) d aoat, oa bo 0.) C)t< IA C) C')(A t- nO C) t) bo c) o 61 Ol) F ajE 6)^95tr o:r o,: tso<)? o; = (.)(dtr(),, edaltr >\,o o6oo. C)o (* cdoa. -La () c)t €;,>6tr tr1 0)9 EOHf O(E>0) a<ro== *vo ^'a ..9= 0erlv=os o !2 tr h oEo.Yo0-,F!UE..1 E Ed\H9 ()rr o $x ! E f''i:<\J o a: EE E = =tz=- O-I ll {.-dE- ^i o a0 q)(JLo Fr E.E* E EEEz i'i c- t-- q) Ec :.: cBPO:Z n8v5 c)EEE =oz 6 +F Iatr c! otr oo\o o@\o €E 9n,cE6tr;d 0) ri \o c.) \o co r ot 2. au $\o co \r\o co o) dJhnA 6t .r =?>o) 87 .E9etrEo =-u)E .g.F E-Eatr= ,-7o EE z rr pq= = "-BF q) oo 6l q)(J Lq) A N9 r- o.l9 t- tr L .}H E II EE Ez Ebg eEr: \o(r) c.l \o N c) : =8 iEs sE;Erh N\o ol\o c.l\o^ o\\o o Fl o Ir o (! N (t B c! t'r 4aq) I 4 \ q) t N q) 4 q) a- v F n() nPEEo.sEEo.9 o .L& Etr .-d IY!EEItrE=LHEEo.q(, r./ ,i Il6{ f;l tf, o a.l H C) -o o o z$ c.l o > t OL: d l-]>(JHts4a9()sa .= a u,17eH: 6 >.-7 E .=\JE * o(F3 a stPi:)\c)(HOb E op\ a) -YPO)S E o:E5 ,- >- 'o I -- o.rti^>O O tr'{= ^H .! s t3ts E h.=E g -H!o-oCU!F 6+{lgF &3 O cd€- 0t* ^. E;.9 [oir i'i o: 5 .o o) r EET Ef,i iF,.e [-8 A 'J,^ =E .i; .eEri ;E .2 Es€ nE - trE r .= c)I bq, I 'EE -E BEE =5,; R'6s E II Y>tr ECdi H!I sx ^ n h.= 90"i X 6.= tuq 2== Bre .^E7,aeEhX a. Fl{ c! cr(il! o OH g P -H€ UiE > 6q, t r:v O E c o.l .o d oa o.'-E- r?- -^Fi r .E i:* E"6 €* He; EE3E .=.b€ *E .Eo- cIE 5cCcdo.5.,'Ec) =-trsExEL ,rnE:E XE€EEE."gt ;EiE€€tE; E >il..6' =6 .F E hoE'r^ .e ;5E9U E Eh5'aq[ii! 964?oinrO>bO3si8i E,u.E ,r o '- F (, C) E:E EE 6 5;E:5 H i:i e&eF- m ti o"r , , , E << A 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meosures were taken to ensure adequate CDTI implementation where not enough ltnowledgeable manpower was available or if staff are frequently transferued during the course of the campaign). Key implementers of the programme have at least adequate knowledge about the concept of programme i.e. HSAs CDDs and health workers. Incase of transfers for trained replacement is always there though posting in of addition staff. At ground level for the drop out replacement is through identification of other members in consultation local leaders thereafter trainings are conducted t2 WHO/APOC, 24 November 2003 q) 6t ar) n U o q)E z dll +h!9ti €cot"' S.; : q) = oo\o oos C\ o 0) O) o \o U L t'r (t)Lq) Ea CE Ertsbhtrf* .d X+r z 6ll + INOi F riOu U S +. 1 U R 0) q) q) I saQio 0) dL !ij E3E>- Zi. q) o E s"to \U ,\9 .t-}\ A< : q) = (\$ : tr- q) o) 0) (J sUio !E CE at) o Fl 3p90) ij '= a!Y o 0) z U + NU $ \) lt U cl o Et +. A< l q) E c.l c.t :. tr- ta) c.t q) q) 6) I s dLt'r Fl o o c! N cd 2 Fl F F coo N ()p o o z$ c{ U o0. > ca ho ou q) -a € o 'j q) Lq) q) I\ 4 q) .t s x o bo \ \ q) LL () q) t oL\ qi "a N U tb .\ $'F : q)i J+ U1 V)q) Uq) qi L q)L r: G a,) Fi S) eJ o (n c) o E F oO o a C) C) oL _ (.) E 0) (g bo lrF .iit o..r I5t(BI FI Table 6: Type of training undertaken (Iick the boxes where specific training was coruied out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifu) t4 WHO/APOC, 24 November 2003 $ oN F()p C) o z$N U o. rn F D (d ok(d oo 'd li a. (.) a(6 c) l-< o o 0)IL C)a o an 0) O (d oL o -o o o a o C) a.(: o Ho -o (d oF x (.) (B(.) tr (.) o ooo tff li C)s z il olol -l crxl > EI E clE ol =ol, 6)ol trol .= o,l, ir El8 Ll ' -8lEtrt tr =l czl< (! oL(d o 0) 'a La C) o z trl& >. E c) r.E 0.)E o(! ar) 0) ot E xl Erl Q ol eEl c) PI E*l o> ol F sq =l a)>l Q >t >qrl t '51 o 'al u)Ht 0) =l E!l LEl oOl uol oql s ol tr -t= 3l =trlE =t 6Zll- (€(.) L(€ o C) 'a l< C) P B an 0) o(-) o o o Iti C) >, € b 0) oo o d a oq F X 'o 0.) (B oL (.) o C)a(H o ! 0) -o z 0) C) o(6 F o\ C) L C) bo!B^0s o o oF C) dL 0) bI) lio C) (d o- Eo\ (B L bo o o (.) (dL 0.) oo L 0.) o(J, tso\ o a.(d L< C) l- 6l ol hodtLI 0)l >l ot -l cdlol -cl o.ldlEI b0 ol()l b{ '(,l (dl ol Pl JI ol a.ldtLI()t EIPI dd .El rjl JI ol EI ol 3l €l .ol EIt-t ol rI.I ;susaEEg= E s € a e*.8 Ez-rPo- ,aq fr.l2<Ea zz o ,anx6):< o) EE 6) t)z€ \o\o .f,$ \o\o$$ E*3eE,E LUY'\.J*92 f,"E-E cac.lc{ caNN P(E *Ar =c)obD a. tBa(B O l-\ob'E 9C FO 1Oo\ o yO o\ r-.o=O)'r9V9Ho!r(€r 6gZ or{i o\ c.) \o co o\ c.) \o c.t tsar cd c).= =tr-oE E.g <.P*', c.l\o o\\o ra) c.t\o o\\o tsi - E &9." Ea*;* g ocAL o1\o o\\o tr) c.l\o^ o\\o tn C) o(d ao o() ll * oc)E9pSlia FBCBo(r(t \o6\o s o.= iiLEooEo)=(u!l ! F- (d ,=E;tsAoo \otr)a.t \otnN c 0.) 4E =H-Ui9 F -F O \oc.t \otr) cl (*c)CX A .q .i u a)A-=+'E 3.,5E HE =:o€<g gaE E= 3 E,s ri E'- () (l) 'o.ao \o(r)(\ \ocl .9<;v 6d N B Fl t'r i't 4q Uq) .\ q o\ a) L. o t q) V) q) 5 !(h L (€ a(B C) d J o L th :o -o ah E] a (! C) oLF r-f o.,l -ol(6l FI $ o at H 0.) -o E C) o z$(\ O o Or \o { u $5e.\.i $" :si s$ .s E\FUEJ v l.rs x eEI Ss '\ : I'i - \.1 ^YE E:"E .iqrN ts\\ sil!\ sr\b\-E :I * uss '=sPb\!$tl \--$ sE \ :bF ssH i{\] ,"9s ssb:u\ s -N; .Hr S\Lu$u\ EH.(.)$X s [Is ^ht "s'NY \Tt 3.i * S: * .s.u; \S'R B\i rss 3s '=aB tst\q.t EES B. Eu:. s'I - \q)\ qi>9 .ssE Si s! '.:s sEB S5S EHB SEqr \)=N TS r tt Uo !)t\ SN 2.6.1 2.6.2 2.6.3 What are the causes of absenteeism? . Migration into neighboring country for various reasons . Intermarriages . Insearch for greener pasteure . Fear ofunknown What are the reasons for refusals? . Rumors and misconceptions Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. . Skin rush . Swollen face, hands and legs t7 WHO/APOC, 24 November 2004 $ o c.l Lo -o c) z$ a.l {o oo q) o' Lq) *a T\q)4 li q v) s) Uq) .b 41 L q)L * U a q) el E t<o bo ii o. C) C) bo L 0)LL o o o d b trl a a c) () 0) chk(.) cd a L 0)a a 0)th Q #r o..l -ol cdlFI ogtrE"o7 09i= <.E b L ;loBC.= E P(6-i:cEoi, 6 ==X E.EIJ.l o o o.2taE^UC,gqo (JOO- q a9t .*9 9s <- o .= C)o-q trded da*6o.2 -c 6o c c== €LEd'-63(,O:Y(JnEq:=e . O-trH'6 = 7'va6P o)'= o= 'd:- oO H.Ed d (6 €.9 99'E? 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A-L-5c) \o \otn c..l \o(r) C\ & rrl r- o\ o\ oo o\ o\ o\ o\ o\ N N (\ aO(\ coO c'l $ o(\ tat c-.1 \o N t-- N oo N o\ (\ +ooN L C) -o o o z $N (J o Or o o\ -o o I s (') d() q) bo 6lliq)Iv CJ 7tg/ F D (! t'E \L -l! o*!1NE L-'sE SEP6)L\E c!qJqr'S= :.soEN TL\IT =$=; FtrESeA :t-E -- ;c) .Eg3 :G-rEI -0,t E I =otH.+l AI rLlEr. IoloLl!'ElaEl roltr o.r Ia€lULI _.otEHI ollEol -h-E!l gtrYl GrELI6J0)l !hcl E .= ol '=!Irl !,H.at E. ! -('J^ q) t- €)i:eEC)L :3€ o 9 rhL-Vi.jYtrtsEb a VL -L -flEsFEA .G)q)in_r= .!9\o Ele.i o.1 '; o)l .h =l cl =l 0)FI cr $ ON H 0.) -o q) o z$ o.l() o O. otTr a.l c.l I ) I 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) ,/ MOH f] WHO E UNICEF E NGDO E Other (please specifu) Mectizan@ delivered by - Qtlease tick the appropriate answer) ,/ MOH E WHO E UNICEF N NGDO E Other (please specifo) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan is ordered by the Oncho Coordinator from NOTF in Blanytre. When it gets to the district it is stored in the hospital pharmacy. Basing on the need of a particular health centre, the drug is transported to that particular health by vehicle where the drug is also stored in the health centre pharmacy prior to distribution. Table l0: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? Collected using ambulances and motorcycles and being kept at the pharmacy - List and briefly describe the activities under ivermectin delivery that are being canied out by health care personnel in the project area. Mectizan distribution Village census Information, Education and Communication Referral of complicated cases Drug ordering Report writing 2.8. Gommunity self.monitoring and Stakeholders Meeflng Has any training (of trainers) for community self-monitoring been done in the project area? No Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 2s6 State/District/L GA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Mwanza 481,368 481,368 327,779 3,159 250 150,090 TOTAL 481 ,368 481,369 327,779 3,159 250 150,080 DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) 2s6 2t WHO/APOC, 24 Novemb er 2004 2s6256TOTAL Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle' 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? Inadequate supervision from the district to HSAs to CDDs Mectizan distribution started late in some other areas No availability of CDDs in other areas Other CDDs provided with inadequate mectizan Some of the CDDs lack committement 2.9.3. Was a supervision checklist used? No 2.g.4. What were the outcomes at each level of CDTI implementation superuision? 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? Wilt work on the weaknesses identified and maintain the strengths SEGTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTRICT/L GA NGDO Others No. Conditi on No. Conditi on No. Conditi on No Conditi on No Conditi on 1. Vehicle 2. Motor cycle(s) 4 2 Functio nal,2 non functio nal 3. Computer(s) I Functio nal 4. Printer(s) I Functio nal 5. Photocopier (s) 6. Fax Machine(s) 7. Others 22 WHO/APOC, 24 November 2004 a) b) c) *Condition of the equipment (F=Functional, CNFR:Currently non-functional but repairable, WO:Written off). 23 WHO/APOC, 24 November 2004 3.2. Flnancial contrlbutions of the partners and communitles Table 13: Financial contributions by all partners for the last three years Contributor Year 1 ('provide the period') Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) MOH (District/LGA) NIK375,694 M'K375,694 Local NGDO(s) ( if any) NGDO partner(s) MK814,625 MK814,625 Others a) b) Communities APOC Trust Fund MK6,000 MK6,000 TOTAL NIKL,196,344 MK1,196,344 If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community suppoft Describe (indicate forms of in-kind contributions of communities if any) Not any available 3.4. Expendlture per activity Indicate in table 74,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 USDI.00 to MK140.00 24 WHO/APOC, 24 November 2004 lr, ,Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monltorlng; Eyaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Partic ipatory Independent monitoring Mid Term Sustainabil ity Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners What were the recommendations? A checklist should always be used during supervision so that important areas are not missed out To make sure that distribution for mectizan starts early HSAs and CDDs to be adequately supervised CDDs to be adequately motivated Activify Expenditure ($ us) Source(s) of fundine 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 l-gVglr_ Supervising CDDs and distribution Internal monitoring of CDTI activities 4dyggegyUl'!s*t9_heq!1[eryh9lit]9al*1u_ther ities IEC materials S ng) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Of!9e Equipment (e.g. computers, printers etc) _ Others 253.71 682.s0 3,943.57 )sie .[z isq.z r - 3,57t.42 71.42 DHO wH9 wH-q{DHo WHQ DHO DHO DHO DHO DHO 178.57 553.77 TOTAL 12,081.09 Total number of persons treated 4.1.2. 25 WHO/APOC, 24 November 2004 )4.1.3. How have they been implemented? Through financial and material support from the DHO and other partners (wHo and LJNICEF) 4,2. Sustainabllity of proiects: ptan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting Ni Was a sustainability plan written? No When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1, Planning at all relevant levels. Funds to be met by the DHo 4.2.2. Funds To be met bY the DHO 4,2.3 Transport (replacement and maintenance) To be met by the DHO 4,2.4. Other resources To be met by the DHO 4.2,5. To what extent has the plan been implemented Not done 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3,1. Ivermectin delivery mechanisms-Already being done 4.3.2, Training -Already being done 4.3.3. Joint supervision and monitoring with other programs- Already being done with other programmes 4.3.4, Release of funds for project activities - Oncho activities already included in the DIP 4.3.5. Is CDTI included in the PHC budget? -Yes 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertakenintheprojectareawithinthereportingperiod. Not undertaken 4,4.2. How were the results applied in the project? 26 WHO/APOC, 24 November 2004 t 'a ) SECTION 5l Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths -Knowledge on the concept of Oncho always being provided -Resources for running the programme always provided more especially health workers -Progress towards eradicating the problem of Onchocerciasis slowly being achieved -The programme receiving huge support from the government and other partners Challenges -There is no motivation for community volunteers (CDDs) in terms of incentives -Financial support being provided towards the programme is just too small -Health workers are not being provided with incentives as used to happen in the past SEGTION 6: Unique features of the prolect/other matters 2l WHO/APOC, 24 November 2004