Ruvuma Focus CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2013 to December 2013

THE UNITED REPUBLIC OF TANZANIA (inqludiqe s:mli! addrsq!) ORIGINAL : Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINB FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) COUNTRY/I'{OTF: TANZANIA Proiect Namg: Ruvuma CDTI Focus Approval year: 1997 Launching year: 1998 Repo rtins Period: From: - January 2013 To: - December 2013 ( Month/Year)(Month/Year) APOC fundins year: (circlc one) I 2 3 4 5 6 7 8 9 l0 11 12 t3(14)15 APOCProiectimplementationyearrerrort: (circleone) I 2 3 4 5 6 7 8 9 l0 1l 12 13 (14) Date submitted Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - 1,396 communities t1 .5 WHO/APOC, 14 September 2009 I I I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space OFFICERS to sign the report: Country: TANZANIA National Coordinator Name: Dr. Upendo Mwingira Signature Date Regional Medical Officer Name: Dr. Daniel Malekela. Signature: .. Date: NGDO Representative Name: Mr. Katunzi Gosbert Signature Date This report has been prepared by Name : Dr. Ida Medard Ngowi Designation: Regional Project Coordinator Signature: .. Date a t J ll WHO/APOC, 14 September 2009 I I '/t Table of contents Acronyms...... Definitions FOLLOW UP ON TCC RE,COMMENDATIONS.... Erreur ! Signet non defini. Executive Summary Erreur ! Signet non d6fini. SECTION 1: Background information...... E,rreur ! Signet non defini. 1.1. GpNpnal INFoRN4ATIoN.... ERRBUR ! Stcxpr NoN DEFINI. 1. 1. 1 Description qf lhe project lbrieflv) Erreur ! Signet non ddfini. 1.1.2. Parlnership 1.2. PopulATroN EnRBUR ! SIcNBT NoN DEFINI. SECTION 2: Implemcntation of CDTI... 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2 2 2 2 2, 2.7. 2.8. 2.9. 2 2 2, 2 2 2 TtvElrNe oF AcrvrrEs.... .. 1 ADVocACY ..........9 MoeILIzRTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES 9 CovuuNrrY TNVoLVEMENT.. . l0 Capncrrv BUILDTNG .. .. , . . ...1 I TRearvENTS..... 13 6.1. Treatment figures... .. 136.2 What are the causes of absenteeism?........... 16 6.3 What are the reasonsfor refusals?................ .. 16 6.4 Brie/ly describe all known andverified serious adverse events (SAEs) that l6 6.5. Trend of treatment qchievement from CDTI project inception to the current year .............18 ORoeRrNc, sroRAGE AND DELIVERY oF IVERMECTIN ......20 CovuuNrry sELF-MoNIToRING AND STAKEHoLDERS Mpprmc. 2l SupeRvrsroN ............22 9.1. Provide a/low chart of supervision hierarchy.. 23 9.2. What were the main issues identified during supervision?................. 23 9.3. Il'as a supervision checklist used?......... 24 9.4. What were the outcomes at each level of CDTI implementation supervision? ... ... ... ....24 9.5. Was feedback given to the person or groups supervised?..................... 249.6. How was the feedback used to improve the overall performance of the project? ....24 SECTION 3: Support to CDTI. 3.1. EeurpMENr. 24 3.2. FnnNCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMLNITIES 3.3. Oruen FoRMS oF coMMUNITy suPPoRT... . 3.4. ExpeNDrruRE pER AcrtvITY.... SECTION 4: Sustainability of CDTI...... 29 4.1. INTenNAL; INDEeENDENT IARTICIPAToRY MoNIToRING; EveluertoN. 29 v vi J 7 ; 24 25 29 29 lll WHO/APOC, l4 September 2009 4.1.1 Has the project ever been eyaluated/monitored? (fick any of the follotuing which are applicable)... ... ... ....29 4.1.2. What were the recommendations? 29 4.1.3. How have they been implemented?......... . . 29 4.2. SusraINABILtry oF IRoJECTS: ILAN AND sET TARGETS (t,taNoaroRy AT Yn 3). ... ........ 30 4.2. 1. Planning at all relevant levels.. 30 4.2.2. Funds . . ....30 4.2.3 Transport (replacement and maintenance)...... .. 30 4.2.4. Other resources.. .. 30 4.2.5. To vthat extenl has the plan been implemented... ... ... .. 30 4.3. INrpcRAroN ...........30 1.3.1. Ivermectin delilery ntechunisn s...... 30 1.3.2. Training... .. 30 4.3.3. Joinl supet"vision and ntoniloring with other programs... ...... 30 4.3.1. Release of .funds fot' prof ect activities ... ...311.3.5. Is CDTI included irt the PHC budgef?............ 3l 4.3.6. Describe other health programntes that are using the C'DTI stltcture and how this v'as achieved. W'hal hat:e been lhc achievements?.... ... 31 4.3.7. Describe others issue.s considered in the integration qf CDTI... ... ... 3 I 4.4. OpEnarroNAL RESEARCH. 36 4.4.1. Summarize in not more than one half of a page the operalional research undertaken in lhe project area y,ithin the reporting period... 36 4.4.2. How v,ere the resuhs applied in the project? .....36 SECTION 5: Strengths, weaknesses, challenges, and opportunities...... 36 SECTION 6: Unique features of the project/other matters 37 ANNEX I : Population variables taken by CDDS and by National Projected Census. ....47 ANNE, :',:f :: ::T:i',]"::"':::::i -:l:i::: -',1 -::: i:: :T::::::l:o'"oT a lv WHO/APOC, I 4 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM FLHF FLHFW LGA MDA MOI-I MSD NGDO NGO NOTF NTD PHC REMO SAE SHM SHT TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community- Based Organizati on Community-Directed Distributor C ommunity-D i rected Treatment r.vith Iv erm e ct i n Community Sel f-Monitoring Front Line Health Faciliry F-ront Line Health Facility Worker Local Government Area Mass Drug Administration Ministrv of Ilealth Medical Stores Department Non-Governmental Development Organiz,ation Non-Governmental Organization National Onchocerciasis Task Force Neglected Tropical Diseases Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting School Health Teacher Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 14 September 2009 Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking) Elieible population: calculated as 84Yo of the total population in mesolhyper-endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper- endemic areas that a CDTI project intends to treat rvith Ivermectin in a given year. 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). Therapeutic coveras,e: number of people treated in a given year over the total population (this should be expressed as a percentage) Geograghical coverage: number of communities treated in a given year over the total number of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Inteqration: 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. 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. The process by which the community is empowered to oversee and monitor the perfornance 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. High treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. Community self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the perfornance of CDTI (or any community-based health intervention programme). with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. VI WHO/APOC, 74 September 2009 FOLLOW UP ON TGC RECOMMENDATIONS Using the table below, filI in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 37 Number of Recommend ation in the Report TCC RECOI\T I\IEND,ITIONS ACTIONS'fAKEn* BY TIIE PROJIICI' FOR TCC/APOC TIGT TISI] oNr.\ 201 Recommendations to improve the report (i) Correcl llte inconsistencies between tlte execulit,e suntnrurlt orttl the bod.y' of the report. Correction has been made with consistence of summary and tablcs (ii) Correct inforruation otr Ludewo irr table 2; Correction has been made (iii) The numher of CDDs trained - 3,477 ore higher tlton tlte total numher of CDDs in place - 2,636 but there is no explanotion given. The same discrepancies h,ere noted in the 2011 report; Number of CDDS trained in CDTI project area was 2,641. However total trained inclusive non CDTI project areas is higher. (iv) Report on reasonsfor and outcomes of advocacy and monitoring and evnlustion activities as required; Reasons for advocacy are to educate people on need of treatment and remove misconception of MDA. However outcome is average because of decrease of funds for Advocacy, M&E every year. (v) Re-examine table 7 on the reported 2l SAEs in Ludewo and the high number of tbsentees; Repeated MDA was done to those Sub villages which had low therapeutic coverage. Coverage was initially low because MDA was conducted during farm preparation. (vi) Figures in table 10 on drugs do not add up. Corrections have been made and it includes all the districts receiving drugs for MDA. This includes districts not in CDTI proiect. Recommendation to improve the project: @ Pay attention to Ludewa, which hos low coverage, a high number of absentees, and poor reporting; Communication with Ludewa has been made, and promised to increase better performance in future (ii) The progromme team should explain how tlte desktop and printer disappeared and the outcome of the report to the police on the stolen laptop. The Desktop and printer are not stolen we have them in the Office. The Laptop was stolen and we reported to the Police however it has not been found to date. Police Report was sent to the National Office. (Please add more rows if necessary) WHO/APOC, l4 September 20091 Executive Summary The Ruvuma CDTI Project was launched in 1999 and started operating in four endemic districts, which are Songea, Mbinga and Namtumbo located in Ruvuma region while the forth district Ludewa is located in Iringa region, north of Mbinga District. This report is of the l5th year of MDA and covers the financial and technical issues of the project for the period of January to December2013, it focuses on activities carried out during this period, which are; sensitization, training, monitoring, mobilization and drug distribution in the hyper and meso endemic areas. The Project received drugs from Ministry of Health and Social Welfare (MoHSW) which are delivered by The Medical Stores Departmenl (MSD) to each district in the Ruvuma CDTI focus. The project managed to conduct the fbllowing activities in this reporting year which commenced January to December 2013; Training of FLHF Staff-, CDDS, and Communitl' leaders. Advocacy meeting to the Regional Secretary. the District Commissioners/Municipal Director. Ward and Village leaders were advocated. Meetings were also held at different levels. being Wards, villages and sub-villages. We trained a total of 2,641 CDDS of which 1.299 were male and 1,342 female and the ratio of male to female CDDS being I :1. The project has a total of 1,398 communities which are Hyper and Meso-endemic for Onchocerciasis. The total population in Ruvuma CDTI Focus is 423,896. The Number of people treated this year 2013 was 366,790 with a therapeutic coverage of 81%. The Geographical coverage was 100%. The ATO was 339,117 and the UTG was 356,073. The project received a total of 1,633,485 of Mectizan@ tablets this year and we had remaining stock of 392,470 Mectizan@ tablets from last year. At the beginning of MDA the project had a total of 2,025,955 Mectizan@ tablets. The drug was used in CDTI as well as non CDTI project areas (NTD).7,612,994Mectizan@ were used, while 1,409 tablets were wasted and 156 lost. There are 411,396 Mectizan@ tablets remain after MDA in CDTI and non-CDTI endemic areas. These remaining drugs are stored in respective District pharmacies in each District. The program received a total of Tsh 97,8261,223.00 from APOC and Tsh. 19,757,104.00 from the Government to support CDTI activities. This Year we received 70% of approved APOC funds. Major Challenges and how they were overcome. o Vehicle: - Having a project vehicle which is working for the tenth year now and its service is costly while we have a merge budget to service it. . CDD Identity:- We need an identity to the CDD's while they are working in the communities, for example a carrier bag, cap or T-shirt especially in the Towns where some people demand identification . Measuring sticks: - Measuring sticks produced at one point customaries them and one means of this tool acting as an identity to the CDDs. . Inadequate training manuals for CDD's and FLHW - We produced photocopies of previous training manuals in each district. . Inadequate financial assistance in some district to assist in MDA activity . MDA to families who have migrated to their farms which are situated far away from the villages 2 WHO/APOC, 14 September 2009 SEGTION {: Background information General information Description of the project (briefly) The Ruvuma Focus CDTI Project is situated on the southwest part of Tanzania, and lies between latitudes 10 degrees south and 11.5 degrees south and longitudes 33 degrees east and 38 degrees east. It shares borders with The Republic of Malawi and Mozambique to the west and south respectively. It borders Mtwara and Lindi Regions to the east while Iringa and Morogoro Regions forms a border to the north and northeast. The Ruvuma Project is made up of three endemic districts of Ruvuma Region, Songea, Namtumbo and Mbinga as well as one neighboring district of Iringa region, Ludewa. It covers approximately an area of 64,333 sq. km of which 1,006 sq. km are inland water bodies fiom Lake Nyasa. With the exception of a small area along Lake Nyasa (altitude approximately 100 m above sea level) most of the project area lies between 500 and 1,600 m above sea level. The project area has a tropical clirnate characterized by two distinct seasons, nolably wet and dry seasons. Temperatures are also modified by the seasonal variations so that the area becomes hot (average temperature is 27 degrees Celsius) during the dry season and cold during the wet season (average temperature is 14 degrees Celsius). The dry season lasts from June to November/December and the wet one December to April/May. The peak of the rainy season is from March to May. Miyombo woodlands mainly form the natural vegetation although in Mbinga district artificial forestation is now taking shape. The drainage pattern of the area is mainly two fold. Permanent rivers of Hanga, Lutukira (these two rivers join to form river Ruhuhu) and Rwekeye drains into lake Nyasa. River Ru'v.uma, Luegu and Ruhuji drain into the Indian Ocean. In between you have many seasonal rivers draining into these two drainage pattern. Major food crops grown in this area are maize, rice and potatoes. Legumes such as beans and soya are also cultivated in large quantity. Cash crops cultivated include tobacco and coffee. Economically the area is quite well-of although the wealth so generated is not equally distributed among the people, giving a wide range between the poor, who forms the majority, and the few effluent group. Songea town, situated about l,000km southwest of Dar- Es- Salaam port, served by all weather tarmac road. Songea is the administrative headquarters for Ruvuma CDTI Focus Project. The road network in the project area varies considerably. Seasonal roads that are only passable during the dry season-an important factor during Ivermectin distribution, serve Ludewa and Mbinga districts. Feeder roads going to meso and hyper endemic communities in all districts are only passable during the dry season. Songea district is served by one tarmac road, which passes in the Onchocerciasis area and therefore offers easy transportation to those communities situated along this road. With the current construction of "Mtwara Corridor" which transverse from East to west of Ruvuma that is from Mtwara, Masasi, Tunduru, Songea, Mbinga to Mbamba Bay Towns we will have an easy transportation along this road, however we also expect fluctuation of population along the road. Ivermectin mass distribution was instituted in The Ruvuma Focus in October 1992 funded by RBF up to 1995. IMA provided bridge funding in 1996 while SSI provided bridge funding for 3 WHO/APOC, 14 September 2009 the year 1997. During all this time the project was being implemented using mobile teams to distribute the medicine. Year I APOC funding started in October 1998 with the new concept of CDTI. The residents of Ruvuma Region are served by 10 Hospitals, 24 Health centers and 227 Dispensaries owned by Government, NGO's as well as private. In Ruvuma CDTI Focus Project area the village structure is basically the same as is found in other parts of the country. A village chairperson assisted by the village executive officer. The community members elect the village chairperson whereas The District Council employs the Village Executive Officer. The size of each village varies; some are large with population up to 5.000 people and others are small with population of 500 or less. l'he government system at village level is rvell organized with established village government offices, which are easily accessible in terms of bureaucracy, giving easy entry point into the community. The nexl administrative level is the Ward, which is headed by The Ward Executive Officer also employ'ed by The District Council. The Ward Executive Olficer heads several villages in his/her catchments area. Almost all villages in Ruvuma CDTI Focus Project have a number of Village Health Workers (VHW's) and these are people who have been trained in a number of simple health interventions by Ministry of Health Trainers. All villages utilize these VHW's as well as the CDD's in updating Census, collecting and distributing drugs, and submit data to FLHW at the Health facility during Mectizan@ MDA. These village health workers are not ministry of health employees; they are recruited by the community to perform simple health tasks in the village and are motivated by community. There are plans in some districts to use the CDDs and VHW in implementing/mobilizing community in simple Health Tasks from various health projects e.g. Vaccination. Table 1 : Number of health staff involved in CDTI (Please add more rows if necessary) A 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 Bz Percentage Bs:BzlBr *100 Songea t67 154 92.2% Namtumbo 263 100 38% Mbinga 378 186 49% Ludewa 240 58 24% Total 1,048 498 24.|',/" 4 WHO/APOC, 14 September 2009 Partnership The project is currently supported by APOCruSAID. SSI has withdrawn supporting the program since year 2008. The region of Ruvuma and its administrative District council supports supervise, plans, and pays health workers who work in Ruvuma CDTI Focus project Community members are willing to take Ivermectin and some communities motivate their CDDs by exempting them in communal work. 5 WHO/APOC, 14 September 2009 \o o\OON L 0.) -o E o o. 0)a .i- Q o c - qi o ti6 0.) >' tr ca() (H E () (.) \JF 0) (! 0) li 0.) o a) o. >< C) 0) -o tr I)lol -l(hl PIotol Io'l!lr). I €2 >. EFFI =th €; c)oo= Lt)fiac)og.(J og) i: a.oo()ot{o0)b0 -q =-oo,tr .EE=3€()o(Ed95 ;E -0)6'aoH *ts o-)o. -q €()L t qYqv) o= .CC U)BgB t'=o oSJd *Qra(g o -(vg€, o -o c) C! () li o C) 'a L o. o a cO 0) L< o 0) 0) Lr() o. >.{ (t o E >. = cO 0) (s()tr C.) -o o 0) A.oo0.(* o tr 0)I E) E x(q o an(d 0) (B o o il F +< .h B o r< q) Lr o !!(o C\ c.1 l- () >'() oo L t o L o c.) Cd 0)ti otr 0) rr() (,) (!() Lr rd (-) c) 'a L< a. (d E & 0)k o 0) ! .t) fr d o d o a. 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This will ltelp understand the proJile of the project area. Community is a sub-village, which is the lowest and smallest administrative structure in Tanzanian government. The number of people varies from 250 people to 1000. Each sub- village is served by two CDDs. In most sub-villages the female/ male CDD ratio is 1 :l . Is tltere any otlter information of interest about the population in the project orea? If so, ittclude it here. We have noted presence of Onchocerciasis of the skin affecting children who are under five years, elephantiasis in a nine year old boy and they responded well afier treatment with Mectizan and Albendazole treatment. They are on follow up on three monthly treatments. 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C)a s O - O. c Fr< a.l \ .a a)\ \.) i q) \- \ o_ ?) q)q a)?) L_) e0! o\o* O:5t -Y 5r,v qr-o>E .e .s o%()- Cg!ri()P a a-)N -vpgbo zo tri\ ^ t\r (gr, oo= &ooSU)sr.9xBtr xsO "S b'ro':- /1 _E.=u 0,) ^. .: .YL?S o'\ *<\L\ql dt : iit v '4.: x =\ U (d.^ I 908 <- t.-l .s \JL ^\\la .{= -\() Lxd9P;:R^s: '-SOO6<.=7.q Ex R! qq q) : q) s \ \)4 q) S c( q) q) F U (h o q) q) L c) 0) d uo c!L t-, ral orl -oldl FI c!ll+ :€!r/IF!?UU e)-&(, , ZU =U q) - ql U) U q) z F- r- OO oo c!lr)(o O) cr) u-) cn c\ rn @ oo ca -1- $ .f, \o .f, ca CA C. rn \ov c.) -{-\o N @ c\ ca C. \o C.\o CA a 0) q) I4 \Y r.)r-oO)@ O\o Err + :No-UFUUQ 6U U U q) z t-r<o I L I a q) 6 .ah !vOF Qv) e)Lo)oE zz oo$ o.l .i- \o s c! c\ \c) rn CO ca oo n oo(-.l r-- ca q) o\ riq) q) () tr) C\ oor N t U9 ii !H v) v) or< -O rraG) =o/-a ell + o6\Ot-H cE99U U F. Q c) ()z> N(r) N$ @ rr) tr)$ cf) \o c.l o\ ca \otr) cnr) r/.) Nr- CN ca cO N + q) trq) o) <J s\o r-m U3<o co$ Oa & rn @ra) o\tr) ca U) :] at) CJ o 0,) ;! Z-- E,L*^ -FUQU U d U .l- q) 0) z r- $ ca .sf c! c! o\ @ O r $$ \o o q) q) q) .\ € dF tr- O c! (r)N N\o -l I L 0 a d 0) o0 oa o -o E d z (B b0 -o o) .13)J Fl F F Table 6: Type of training undertaken (Tick the boxes where specific training was carried 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%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The Project has achieved geographical coverage of 100% and a therapeutic coverage of 8lo/o during this year 2013. Trainees Type of training CDDs Other Communit y members e.g Communit v supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (FLHW Zonal Managers) Program managem ent How 10 conduct I lealth education Managem ent of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Mobilizing Community Mobilizing Community Monitoring, Mobilizing Community Supportive supervision, M&E, monitoring Mobilizin ob Communit v supervlslon of CDDs during MDA and coordination with District NTD Co. 13 WHO/APOC, 14 September2009 OO C..l ! 0) -o o o. G)a -f, Oc c <. QI:ttoxl.z EI E EIR!l;alool tr(.)t .5otd Elt "glEtrt d5l tr zl< 0)L o 0) 'a k o- 0) 5 z lf.,l >1 -o 0.) 0)E CN rn 0) E E o o E() 0) I l-ro P. {o U) 0) +i o l<o -o oF O X o (n() Lr a 0.) o{(g (r) 0.) ooqr o l-r o) E z 0.)L Cd O(.) '= ! o- 0) a 0) oo o (.) € c.) I L< 0) a. ^lUv a#l () xl E3ql c oo .lgl '- c'J tll OI)!0)l caJ Lt.r>Pl >P ()I= " oltr? ol oU EI.5 .= e{(i .!i (Hl =sold.!LrlAoo0)l xo'ol *0.) El =bo=l r Ezl8 cd o oll o.(d r<() -c()+je (\l OII L{ .= a)P OL) =(d3btr> oo a.YadiJ-a '' 3 o\ cUIv =o.tsLtrq) I&F o c0L o oo(dLr^()ro)o\ ov o oF () P. tr o oo(d L< C) o L) (d o^ 'I .o O. </ L bo o 0) Oq)4;i-L = -. E= .nq.).=: ^6 Of r f :fr i =s2E?->,9'1, €-c c.t: O q)EE] =& 4Z E td - O o B =E:r'-Gti-e, -iE-=I.gi Ez nE E = E ; g . \o oo o)@ tr)aa oo !?$ ra :otri- O) s) rz3 lE iiZ-eeta N co (r) O F-_ caN(-.l (-- \o ra r- v -. l-A-9--v9 avLF^rE Fe>AeFA> L(.!O;;9Z-L-'iaf,i c.)$$ @O) A .i- o\ s\ot- (\T s! o ll :*@rr/AAA- ---u e(U!Y G)-I')-a.oF E U ;oe.) .o o\ N co sc!@ o\car- o\ ca co s € r l-P ?r ^gv9tr?c< =- :.: q)Z o aE N f- c.) tr) F- @_ F- 6l N ra) \n F- ,o^ o\ rn o\r- \o\o(n -t -d -99ic o)E .r)Yii;5, N @ =f .+ @ o)tr) C\i(\l eo(r) o{ \o \o ra) o^ C\\o o\ r-- o\t) m .- (!to -? .= -alA)g *. P I *t EF QOE E Qo) CE o\ oo|'-\o (f, C7) e.l$ .sf sNc\ r- ca t- \o\o ra v ra = rh c) u0 cll U) 0) o(, ll -+ i!Bu0x 9-O c irorrr cJ Y o-V.-9v \oo\ O oo .o o\ \oo\ o\ 9-, .rgL tr boEor5C!q)! E=:E'TIYE C.> 9) = !aEZE 3.9 . N(r) + Cf) (f) ca<f, ca tr- 6 o\ ?n d -; - E -!v =6(o)E9:i-., <F- 6C; Ntr) -1' cf)s cr) ca$ c.) tr- 6 o\(a l-9 1 ^.iAvi- += ? F .e;E g. : tri ; u #; E ' t =. N(a)$ cr)s (f) cn$ ca tr* @ o\n I .a l) cn C) bo oa o -o I (d z (! b{ .o z d o ..] Fl F t-( qk IqJ a AJ IJ q) t.) AJ s an L cq U) o)L cl rl I r< an ! U) rd a c{ q) c!q) h3 r-l ,l EI cqlt-l lt o\o c.,l ri o -o Eo o.oa $ O \J o. cF (r) c)q, 0Je -u c)_ I t) oJ q) A,) 3e q) E! d-cr i- c, ye e,lI- -o .E <,r >q) a*,C! cl 6)Lq)C!! E=6)oEE(): .r(|):1 0) -?1 €- o)vzEC)! tr>. ol t- -o91 r tr!ol 61 boAGt oq)e> o)e Od e) c) -G C) hns5E() ib0 a,ztrq) xc)6tdtr s') O) u)Ecl ll(]q, rr C) () r-99D oa () u! (J q) q) q) aa o cJ c) U G v) cqq) tr G I q) q) I () o U)o a0 0) 0) trq) 0) c! Oq) 0l F il frG F (d C) li o C) 'a L o.() a C)H o E(.)E () I l-r() { a C) tq) do!Ls€*\() |< .o >.. O 3 o.r $LI\o\(J QQ 6.o Q)La-q(*_.'iJ O,H $E -a_ <F €(.) 0) c) F D o\ What are the causes of absenteeism? Frequently MDA activity is conducted during the farming season, and overlaps with the period when peasants start preparing their farms from September/October so that by December planting of seeds is done. Secondly farms are located far from their domicile and it is a custom for some member of the household or the whole household to migrate to their farms which are located miles from their homes. In areas where there are mines people migrate to these areas and the village which are near to the mines have population reduction of men therapeutic coverage during mining seasons (Dr1' Season). What are the reasons for refusals? Major reason for refusal is poor sensitization on Onchocerciasis and the advantages of treatment before the disease presents. Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and is provided (in table 8) the required information when available. Parasitologist trained- We are using the Laboratory Human Resources of Regional and District Hospitals Existence of a microscope? - From Regional and District Hospitals There are modern Microscopes in each District's Hospital, Designated District Hospital and Regional Hospital In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report l6 WHO/APOC, 14 September 2009 LooE :>ql: ./9E=\.-rE ao S.,L- L.-H € d2 6i:i .2?E *=!)<q ->1 r 5.L -II]Oo(JOJ oc CJ hi ^5t* L(J o Qa F4 z Av () AA u)y:C)av il Q= O v) U) e) Oir .- ad7,2tr, q- €ts.-a5 ()A = E.6l -N.-- L cl E E i E'l fiEEEg z t) a qoL F9 * i- i-a rE e-u SK .ila -,--E *E EAE cE q) EDtr -: aD )o /,q) a q) a0 Ax ON L() ,o o.() U) sl- c o cr o (€ o (F< o Lrop E) tr (! l-<o(n t+ 4 qj Q\J s) \Jq U \l q) oo q) fr q) u0 0) <J <J 6 ah ri a q) q) o q) U)Lq) e€ a q) a a 6) v) U €l o,l .al cEl FI 0) D.0 G Y >^F o\eh r \ o- C.)\o $o\ c- @ oo caoo oo n o\ oq car- q \o ca -t € o cll o. o Or 't- * rI] ri ri q) oo6 k 8a CA\o $o\ r- oo oo co@ ,r? tr) oo n o\ \f- oo ts soo + tllt : ri t! Xbo 6:' o Y^ ---aF.9 U- c.)n \ot-- \o\o \o\o \q F-\o \o oe t-. c..i(-- oq ca F- t--C. c-\t \o F- E] L .3 EE =:'q,zaL tr- \o$ Otr) aa @ \O N $ t-- ,o" tr)NN <f, t-. oo NC\ oo$ oo @ ca N ca o\ r- N o, <: N r- C.Ntr) $ aa r E] Eq)o> =6q,tr;!<Fo O o\ ca c.i caN oo t-- oo^ (r) nN o\ ..i oo c\ C.N $(r) { oo c..l car- c1 stN \o ra) O n c'l ca <.^ o\ o\c\ F- o\ ca ca \o ra ra 6l o\ a- tr) s 6) -l!L!=-c) v*5 >..9dE- g *= Et E. (a) \a) \o^ \or-N F- \o + c.) oo (r) N ce t-- c.l oo\i ca c.) oo t-*c\ € ca ca + ca c- oo N \oa .o^ tr* o\(\ o\\o €^ lr) tr- co C.ltr)(n ca o\ ca ra 6 r- o\(\l \o oo @\i -{-\t q) OT cq t q) Q ll :+ ri rll r! o bD o b^Lr >-ok 8a OO O O o\ca O rh o LV i"E i G rr-={() = U 3l r-l- rn-ra O O O OO o\ c.) frl .ts q,)r tr bO!o=cgq,) E e-> 9 ).;quzz J.9 ; c.l (r) c.) cntr) (r)(r) v\o s\o $\o $oo ca t'-O ca N+ t--N H trq)q)> =6qltr;,o<Fo N tr) C. catr) (r)tr) -f,\o $\o sf,\o +oo ca t-- co \o t'-C\ !- qr a!q3 rilrt5 - c) = = >..9)Et E = 3 3s .o 5 :D 9 E _=F (.)J tr ol-l c'l n ca cA(r) tr)ta) $\o $\o $\o $oo co r-O ca \o F- ctl & Ii o\ o\ o\ ON N c.l N c.)O N $ c..l \n c-.1 \oOON r- ON ooO N o\ c..l N k C) -o 0.) o. 0)a $ o k c € U) I C) q) UD q) I F q) q) U) cq q) u0 an q) an = = rn c)l- cE ()q) fr a) F D o c) dI c) v) clq) gr qJ s.q) \){ q) U) q) S 6iq) L C,q) o Lr () tr q) 0) *< ,o L<(s 0) o () bo L 0) o cS U) o E (q()trF o,r 6)l -ol(dt FI ra (\l 0) q) LL I q) ao() (.) q) t< F aU 0) 0) q) (J c! q) clq) L q) LF ia \o N o\ c'l L(.) () o.(.)a -$ (J o C o\ cn @ 9 o\tr- q C. o\ oo ca oo c\ NO q ca o\ v aa oo \o O.(-- c.n@ oo t--t-. m- eat- ca C.s F. ca \o o\ c.) ca t-- \o\o ca oo @\o" N ca ca s1.$ ce r- \o ca o\ \O o\tr) @ ca la)s $r-v} oo o\ c.) caO $ \o\o(r) d ra) v o\ o\ O o\ o\ N \oo\ ca N o\ ca oo co NO \oo\ ca c- o\ ca oo o\ ca N \oo\ ca r- o\ cn @ o\ c.) N (\ N ON ca ON 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - (please tick the appropriate ansu,er) MoH ./ LINICEF tr NGDO t] Other (please specify): WHO: - MDP (Mectizan Donating Program) Mectizan@ delivered by - (please tick the appropriate answer) MOH ./ WHO LINICEF tr NGDO Other (please specify):- Please describe how Mectizan@ is ordered and horv it gets to the communities At the end of MDA Mectizan retirement is done by the FI-HW Zonal Managers who collect from the Health Facilities within their zones and deliver the drugs to the District NTD/CDTI coordinator. The NTD/CDTI Coordinator check the retired drugs and the drugs are stored in the District Pharmacy. At the end the balance of the drug remains is known and the District NTD/CDTI coordinator submits his/her drug requirement to the Regional NTD/CDTI Coordinator. At the Region the Regional Coordinator balances drugs remains and requirement as ordered by each district and fill in ordering forms to the National Coordinator at the MOHSW and program Pharmacist drug request for each district in the program. The NOTF Secretariat goes through the Application Forms, approved them and sends it to the National CDTI coordinator at the MOHSW. The MSD delivers ordered drugs to appropriate district and information is sent to region about each districts consignment of Mectizan@ sent and Quantity. District Coordinators informs the regional MSD/CDTI Project coordinator of amount of drugs received and this information is relayed back to National CDTI Coordinator/lrlational CDTI Task Force District Coordinators and district pharmacists distribute drugs to FLHW and inform the Zonal managers, FLHW and sub-village leaders and CDDs about the arrival of Mectizan@ at their nearest FLHF. CDDS collect Mectizan@ and distribute to the community member soon after training. Table 10: Mectizan@ Inventory (Please add more rows if necessarl) Number of Mectizan tablets State /District /LGA In stock from previous year Requested Received Used Lost Waste d Expire d Remaining Songea 102,622 500,785 500,785 377,718 0 534 0 247,719 Namtumbo 23,215 440,000 440,000 362,524 0 689 0 100,000 Mbinga 23,283 560,000 560,000 762,288 116 0 0 25,786 Tunduru DC 200,444 724,000 724,000 554,840 0 1,452 0 368,152 Municipal Songea of 52,604 538,000 538,000 371,599 0 1,598 0 217,407 TOTAL 402,168 2,762,785 2,762,785 2,429,029 ll6 4,273 0 959,064 20 WHO/APOC, l4 September 2009 Table 10 b: Mectizan@ Inventory for Ludewa DC (Ludewa Dc receives its drugs supply th*"g- nga Region and not through Ruvuma CDTI focus) NB. - Drugs to Lndeu'a is sent lhrough lringa Region' How are the remaining Ivermectin tablets collected and where are they kept? The remaining tablets are returned back to FLIIF by the CDD these drugs are then collected by the FHW and kept in Facility Pharmacy to be collected by Zonal managers or CFIM'I members and are returned to the dislrict Coordinator/Pharmacist for recording and then stored in the District.s pharmacy under the supervision of the District Pharmacist until next year's MDA. List and briefly describe the activities under Ivermectin delivery that arc being carried out by health care personnel in the project area' Activities performed by Health personnel in handling Mectizan@ Supervise census update in his/her catchments area' Ivermectin ora"ring uy filling in the forms and sending them to the District onchocerciasis Coordinator. Makes follow up to the District Office' FLHW inform the sub-village leaders and CDDs about the arrival of Mectizan' Organizeand attend mobiliiation and sensitization meeting to the community members They collect and distribute Ivermectin to the cDDs in their respective area under the supervision of District coordinator and Pharmacist Conduct supportive supervision during Mectizan@ drug distribution to CDD's' Data collection and report writing and send it to District Onchocerciasis Coordinator conduct feedback meeting with community members at their village Health committee meeting. Any other comments 2.8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Not all TOTs received training on how to conduct cSM (pharmacists and other new Health staffs transferred in the CDTI project area) letstabMectizanofumberN Expire d Remainin ob Wast ed LostUsedReceivedRequestedIn stock from previous year State /District /LGA 22.070r86 0401 10,404132,700132,700243,350Ludewa 2l WHO/APO C, 14 SePtember 2009 Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows d needed) Describe how the results of the community self- monitoring and stakeholders meetings have aflected project irnplementation or how they would be utilized during the next treatment cycle. The results will be utilised to follow up those who are regular absconders of MDA activities as well as make means/assistance to deliver drugs to those who are located far from the community for one reason or the other. These meetings are venues used on horv to collectively motivate Drug distributors working in their community. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meeting (sHM) Songea Namtumbo Mbinga Ludewa 452 343 430 173 452 343 415 173 452 343 415 173 TOTAL 1,398 1,383 1,383 22 WHOiAPOC, I 4 September 2009 2.9 Supervision 2.9.1. Provide a flow chart of super-vision hierarchy. ZONAL MANAGERS Zonal Manager FLHW are FLHW who are selected to supervise other FLHW and CDDs within their zones. They assist the District Coordinator in relaying important information to non network areas with worktools as well as drug shortages during MDA activity. "They are the hands of the District coordinator." 2.9.2. What were the main issues identified during supervision? The CDD requests of simple motivation to them such as T-shirts, caps which will also identiff them in their communities. Inadequate integrated IEC material Insufficient registers as the ones currently used are full and worn out. There is need to provide washable, rainproof carrier bags for CDDs to carry in their register books, pencils and drugs during MDA. This will also be as an incentive and identity to the community where they work. 23 WHO/APOC,I4 September 2009 MOBSW <0Tl '.olt IEADTRs tlHl,vM^il rrf,5, r)ro IUVTTUI )Frf 16r gprr roorDHArgit IDilTA 0ltGEA l ttlur,^to ,|uilEtrAt or 5(,nGil ,ro&a icH00[ HtAl:l{ rrAcutR9 :OM {LADTR5 :otruultnY fOIUS CrsrdlnAer 2.9.3. Was a supervision checklist used? Yes, APOC developed check list and it is always used. 2.9.4. What lvere the outcomes at each level of CDTI implementation supervision? Each level was ready to improve their performance in all activities so as to improve therapeutic coverage and reduce absenteeism and refusals to take the drugs. 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How rvas the feedback used to improve the overall performance of thc project? Community members were ellcouraged to provide incentives during drug distribution, fbr cxample exemption fiom community work. Feedback to the District coordinator helps in improving his future performance and of the FLHW as well as that of the CDDs. SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTRIC TiLGA NGDO (Sight Savers) Others No. Condition No Con ditio n No Cond ition No Conditi on No Condi tion 1. Vehicle J 3-F I CNFR 2. Motor cycle(s) 6 4-F l-wo 1-CNFR 3. Computer(s) Desk Tops Lap Tops 2 aJ 1-F 1-WO I Stolen Annex attached Polrce Docs 2-F 4. Printer(s) 2 l-F 1-WO 5. Photocopier (s) 2 1-F 1-CNFR 6. Fax Machine(s) 1 wo 7. Scanner 2 2-F 8. Others a) Bicycle with CDDS 187 187-F b) Elson Projector 1 1-F c) 24 WHOiAPOC, 14 September 2009 *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable. WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? All the district councils have incorporated CDTI into CCHP. Some of the equipments are being run by the councils as well as APOC. Plans to replace them usually follow the normal process in the Local Govemment. The Vehicle at the Regional Office "Toyota Hilux Double Cabin' is over 8 Years in the project and its maintenance costs are very high, we request a replacement of this vehicle please. 3.2. Financial contributions of the partners and communities Fill tables 13a, 13b and 13c If there are problems rvith release of counterpart funds, how were they addressed? Some districts have no problems in releasing additional lunds to support CDTI/NTD activities however more advocacies and lobbying is done in some districts to get the funds disbursed when needed timely. Additional comments We suggest a special advocacy meeting to be organized by The MOHSW, APOC and other NGO partners to DMO's and RMO's so that CDTI and NTD are incorporated into Health plans at all levels and that funds are released timely when needed during activities implementation. There is also a need of Regional Coordinators to be part of Regional Health Management Team and not only as co-opted members in the RHMT. Now that CDTI has increased its scope to prevention of NTD's which has a big impact in reducing Child underdevelopment and morbidity. 25 WHO/APOC, 14 September 2009 OO(\ L 0.) -o a) o.q) U) <- U o c \o 6l s6r CL a0 & & FT d t IIU L L ti U- Ytr <lr F oototco o, c! O)- NF-lf)o_ s- @_ o.(tF- F-N!tscoq$N(Or}otr)@- o- @-(oNo oova \t!tt@- (o- @GO to .:a @(o$to- o- @(o oooou? 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CJ (-) a) cl3 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The CDDs are exempted from the public works particularly during drug distribution. Drugs are distributed to the nearest health facility for collection and CDDs collect Mectizan as well as working tools after their training. In case the CDDs runs short of drug during MDA. she/he contacts her/his zonal Manager FLHW who delivers the drugs to them, these zonal managers are particularly useful in reaching those hard to reach areas. Comrnunity leaders mobilize the communities and encourage people to take treatment. NTD Coordinators sensitize and encourage Health facility leaders at all levels to use CDDs in other health related community activities lor example Measles & Vitamin Vaccination, Malaria conlrol activities ect. Expenditure per activity Indicate in table 13. the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here is; 1 US Dollar: 1,600 Tanzanian Shillings. Any comments or explanations? We want to extend our sincere thanks to The APOC Management for providing funds to the CDTIA{TD project. We appreciate the role that Sight Savers in supporting CDTI activities in supporting CDTI activity in the region. SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) YES Year I Participatory Independent monitoring YES Mid Term Sustainability Evaluation YES 5 year Sustainability Evaluation YES Intemal Monitoring by NOTF YES Other Evaluation by other partners 4.1.2. What were the recommendations? their CCHP annual budget plans. Each council to include CDTI activities in 4.1.3. How have they been implemented? District's CCHP annual budget plans are approved if there is a CDTIA{TD activity included in their budget by the Region Administrative secretariat. 29 WHO/APOC, 14 September 2009 Sustainabitity of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan written? -No- Yes_ When was the sustainability plan submitted? Not Applicable - What arrangements have been made to suslain CDI'I after APOC funding ceases in terms of 4.2.1. Planning at all relevant levels NTD/CDTI has been included in CCHP in each district 4.2.2. Funds Three districts have disbursed funds to support CDTI/Nl'D activities rvithin the project area. 4.2.3 Transport(replacementandmaintenance) There are project vehicles in the Regional office, in Mbinga and Ludewa Districts. Namtumbo and Songea District share vehicle with the Regional office, therefore the timetable has to accommodate the use of vehicle for these three areas if the vehicle from the DMO's office in not accessible during CDTI activities. 4.2.4. 0ther resources Time. Coordinators spend their extra time in supervision, data correction, mentoring and report writing. 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. lvermectin delivery mechanisms -lvermectin is delivered by the MSD to the DMO/District CDTI coordinator -Ivermectin is stored in District Pharmacy, using usual procedures. -Information is sent to Regional CDTI coordinator on amount of drugs delivered in the district. This information is relayed to National CDTI Coordinator. -Prior/During Training Ivermectin are distributed to FLHF by Coordinators and CHMT ready for Distribution. - CDDS collects drugs from Health Facility and start MDA soon after training. 4.3.2. Training CDDS are trained in different zones to enable them to travel. Training is facilitated by District coordinators, District Pharmacist, District School Health Teachers, and some CHMT members. Regional Coordinator/Pharmacist facilitates in some of these training during supportive supervision as a mentor. 4.3.3. Joint supervision and monitoring with other programs School Health Teachers are involved during supportive supervision of NTD program 30 WHO/APOC, 14 SePtember 2009 4.3.4. Release of funds for project activities Fund release was done timely this year 4.3.5. Is CDTI included in the PHC budget? YES 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and hon' this was achiel'ed. What have been the achievcments? For the first time CDTI slructure rvas used during National Vitamin "A" and Measles campaign in Songea District Council this year rvith good success. Data came back earlier and it was more reliable. It is now being used in NTD program in MDA administration. F-or each intervention listed in table 15. explain what were the roles played by the CDDs (census, mobilization. distribution, data collection, storage, collection of drugs, referral of SAEs, etc...)? Explain what are the combinations of interventions co-implemented? Intervention co-implemented was MDA of Mectizan and Albendazole by CDDS Lymphatic Filariasis Elimination Program, TASAF Schistosomiasis control and treatment to primary school Children with Praziquantel. All the mentioned above interventions are conducted personnel from education and health and these are trained together so it saves time and encourages networking of different departments (Health & Education). How were the interventions implemented? (At the same time?) Interventions are implemented consecutively after mass sensitization using local radio in the region to sensitize the whole community in the region. Co-implantation of Mectizan and Albendazole MDA was done in the first two weeks. The third week no MDA. Forth week MDA of Praziquantel to primary school children. Data collection was done soon after the MDA and working tools retum to appropriate locations for storage. Describe others issues considered in the integration of CDTI. There is need for carrier bag (Cloth material for easy washing) wherein the CDDS can put his/her working tools and medicine so as to protect from rain and easy carrying in case she/he is riding a bicycle. Integration of CDTI and NTD has increased the work load of CDDs therefore they ask for more incentive. However they ask for some kind of a short employment during these activities or to be selected to work in all health activities taking place within their communities and therefore benefit from cumulative incentives. Example in Malaria program, vaccination programs ect. 31 WHO/APOC, l4 September 2009 OO c\ t< 0) -o c) o. 0)a $ Q o Or (, 9U Ec) 29, ./) o U)L() o. (H o Cd F o.r \c\o o.r- .o\o (.) 0.)fs- vt rf, a c{ (\ ar) o (g z gE co Eg0zs v) o CN L C) a. o (d F r- o o. r- -io. (,) '= E() Q-a r al r--C al ao a o =]. € O =j-- 6 c/) t-.,1 o O (H 0)() -o> J> z.= E oF s N .+ \o. N € a N l-h6qf! cd N+ n 6l -j-dl 00 @ 6l+ a? C) cU Za o\ al o\a.t ao @ o\ at U) 0) o)J .otr z3 o € C) c) C6 0)& r-. codI trr € a? al o\ o\ 6l o\ o\ .d c.) (.) oolr(€F € o\ .') € <' O <. be €.9)-< L av) AN o q) o o tr) (a) n (r) co 0.) a) oo L(dFc v-) tr) tr) tr) ca >.tr *(g(, 'E o.co x'i a'.o. x ur C.) 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Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NO OPERATIONAL RESEARCH CONDUCTED How w'ere thc results applied in the project? Not applicable SEGTION 5: Strengths, weaknesses, challenges' and opportunities List the strengths and rvcaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. a STRENGTH WEAKNESSES The incorporation of CDTI activities in the CCHP in all Districts Councils are providing inadequate funds as compared to the budget Community acceptance to take/swallow the drug Mectizan and imp lement CDTI activities Misconception of the effects of drugs among some community members. Key project staff are committed to work in the proiect Drop out of CDDs in some communities necessitating training of new CDDs New vehicle in Mbinga District to support CDTI activities Sharing same vehicles in Namtumbo DC, Songea DC and Region office during MDA activities, M&E during the same peI&d CHALLENGES SOLUTION No uniform or identifying Caps/T-shirts to CDD's especially in the Towns where people demand identification and request for a carrier to workin tools in CDD's to wear uniform during MDA in future (T-shirt, cap, Jacket, badge). Not enough training manuals to CDD's and FLHW Produced photocopies of training manuals in each district. Not enough financial assistance ln some district to assist in MDA activ NTD activities have Council's lans been for next included ln 2012 Delayed data submission from the districts to the Region Division of districts into Zones and allocation of Zonal managers to each zone as supervisor during MDA and Data collection. Zonal managers work closely with the dlt!r,9199_ Insufficient Household registers q€. f4 exercise booksUse of 36 WHO/APOC, l4 September 2009 ?Namtumbo district No posters to sensitize people on NTD's Photocopied materials on NTD rvere used in public places Need for the CDD's to cover large geographical areas on foot and in some areas there are game reserves inhabited by ivild animals e.g. Lions, elephants The project has motivated some CDDs in the project area rvith bicycles. Not enough funds for CHMI'to colect data and remaining drugs from FLHF Selected Zonal managers u,ho o\\'n motorbikes/prolect bikes to u,ork rvith the district Cooordinator. 'fhev collect data and remaining drugs from CDDS and deliver thern to the District CDTI coordinator. Varying populations during MDA 'fo request District, Ward and village/community leaders to govern population migration before and during MDA a SEGTION 6: Unique features of the project/other matters Visited by representatives from WHO Dr. Nanai A. and from the MOHSW Mr. O. Kaitaba as well as International representative from Ethiopia; they supervised some villages and met some Zonal managers FLHW and CDDS. )l WHO/APOC, l4 September 2009 aI