RESERVED FOR PROJECT LO GO/ITEADING OzuGINAL : English ! i3 t ., J COUNTRY/NOTF: Proiect Name: THYOLO Approval year: Launching year: neeorttne Pertod: erom: IvlffiftTflLl'T' APRrlfo2,0,Trv.u.y Proiect vear of this report: (circleone) I 2 3 4 5 6 (7) 8 9 10 Date submitted ; lzrE MARCH, 2005. NGDO partner: ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTBE (TCC) DEADLINE FO SUBMTSSION: To APOC Management by 31 Januarv for March TCC To APOC Management by 31 Julv for September TCC !_ 2 4 trout zoo5 ll r 'i AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) For To: ltttL for Tor -\ &Al .,,1 tl &BEA cx\ CoP At{E Ct.,'l Brn 3h tro ftF ! a WHO/APOC, 24 November 2004 t J I t aANNUAL 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 National Coordinator Name: . ..L. SITIMA.. .. ... Signature: . Date: . n lr1es 6'-r' .f r"t L]j* Zonal Oncho Coordinator Name: . . .E.J. BAKALI.. Signature: P0. Date: A$ .{. ,;i-\ *,i a)ti ,,u'rttil a' , .. c t!. \,"',' CI+ P"f;. NGDO Representative Name Signature Date: . ThisreporthasbeenpreparedbyName:A.ANowA. Designation Signature : ..,D,E.H.O ){AM.r Date 12TH MARCH,2OO5 ll WHO/APOC. 24 November 2004 ,!t a Table of contents v DEFINITIONS.... VI FOLLOW UP ON TCC RECOMMENDATIONS... EXECUTIVE SUMMARY ........ SECTION l: BACKGROUND INFORMATION........ 1.1. GpNpRer- rNFoRMATIoN..............., 1.1.1 Description of the project (briefly) 1.1.2. Partnership I.2. PopuLnrroN SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. TIUBr-rNp oF ACTrvrrrES .............. ......................1 2.2. Aovocecy ....................9 2.3. Moett-tzarloN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT zusK coMMuNrrrss..g 2.4. Couurxlry rNVoLVEMENT............ ................. 10 2.5. Cepecrry BUTLDTNG ...................... l0 2.6. TRperuevrs................ ................. 13 2.6. I . Treatruent figures ........... ....... I 32.6.2 What are the causes of absenteeisrn?........... ......................16 2.6.3 What are the reasonsfor refusals? ................ ............16 2.6.4 BrieJly describe all known and verified serious adverse events (SAEs) that. . . . I 6 2.6.5. Trend of treatntent achievementfrom CDTI project inception to the current year lB 2.7. ORorzuNG,sroRAGEANDDELrvERyoFrvERMECTIN......... .. .... ... ..18 2.8. ColIurxIrY SELF.MoNITozuNG AND STAKEHoLDERS MperINc ...........19 2.9. SupsRvrsroN ............... ..................20 2.9.1. Provide aflow chart of supervision hierarchy. ..............20 2.9.2. Vflhat were the main issues identified during supervision? .............................20 2.9.3. Was a supervisiort checklist used? ...........20 2.9.4. LV'hat were the outcomes at each level of CDTI implementation supervision? 20 2.9.5. Was feedback given to the person or groups supentised? .............202.9.6. How was thefeedback used to irnprove the overall perfornrunce of the project? 20 I 2 3 3 3 4 5 7 SECTION 3: SIIPPORT TO CDTI.... 3.1. EqurrveNr ...............20 ...............20 3.2. FtNeNclaL CoNTRIBUTToNS oF THE pARTNERS AND coMMUNrrrES.............. ............21 3.3. OrseR FoRMS oF coMMUNrry suppoRT................ .............21 3.4. ExpeNolruRE pER AcTrvrry ..........21 SECTION 4: SUSTAINABILITY OF CDTI.. .............22 4.1. INrpnNel; TNDEpENDENT pARTrcrpAToRy MoNIToRTNG; Eva1uarroN....................22 4.1.1 LVas Monitoring/evaluation carrted out during the reporting periorl? (tick any of the .follouirtg which are applicable) . . .. . .. . 2 2 4.1 2. Wltat y'ere tlrc recoruntendations? ... . ..........23 4.1.3. How lrute tltey been intplemented? ... .. .. ......23 lil WHO/APOC'. 24 November 2004 T 4.2. SustRrNRuLITy oF rRoJECTS: ILAN AND sET TARGETs (iraeNoaroRy AT ...............23 Yn 3) ......... ...........23 4.2.1 . Planning at all relevant levels .. . ..... .....23 4.2.2. Funds ..................23 4.2.3 Transport (replacement and maintenance) ... .. .....2 j 4.2.4. Other resources... .................. 23 4.2.5. To what extent has the plan been implemented ......... ... ... . .....23 4.3. ItrtgcReuoN ............... .................23 4.3.1. Ivermectin delivery mechanisms ..............23 4.3.2. Training..... .........23 4.3.3. Joint supervision and monitoring with other programs..... ...........23 4.3.4. Release offundsfor project activities ......23 4.3.5. Is CDTI included in the PHC budget? .....23 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achtevements? ............. ..................24 4.3.7. Describe others issues considered in the integration of CDTI. .....24 4.4. OpsnarroNAl RESEARCH.. ..................24 4.4. 1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period..... .....................24 4.4.2. How were the results applied in the project? ............. ..................24 SECTION 5: STRENGTHS, WEAKNESSES, CIIALLENGES, AND OPPORTUNITIBS.......... ..........24 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........25 IV WHO/APOC. 24 November 2004 t Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objecfive Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment 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 WHO/APOC. 24 Noi,ember 2004
Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elrgible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (tit) Annual Treatment Objective: (ATO): the estimated number of persons living in mesofttyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTGI. calculated as the maximum number of people to be treated annually in mesolhyper 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). (") Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (ur) Geoqraphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemrc communities as identified by REMO in the project area (this should be expressed as a percentage). (vtt) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, traming, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include acttvifies or interventions carried out by community distributors outside of CDTI. (viir) Sustainabilrty: 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 tlie government. (ix) community self-monitoring (cSM): The process by whrch the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensurlng that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectrn distribution and make appropriate modifications when necessary. VI WHOiAPOC, 24 November 2004
FOLLOW UP ON TGG 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 rnore rows if necessary) Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY WHO/APOC, 2.1 Novenrber 2004 Executive Summary Prepare an Executive summary of the report in not more than one page. l. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. 2. Background on population movements. 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. Since 1997,the National Onchocerciasis Programme in Malawi had been carrying out Community Directed Treatment with Ivermectin (CDTD strategy and Thyolo is one of the districts implementing CDTI project. The district has 404 villages which are headed by village headmen. During the year 2004 the district reported that it has 500 villages but after conducting a thorough check it has been found that there are 404 villages consisting of small clans which were initially classified as separate entities hence the number 500. The district has a total population of 505,000 out of which 358,397 people were treated representing 70.9% therapeutic coverage. The geographical coverage is 100%. People of Thyolo move about the district and outside to conduct businesses and farming since these are the main activities in the district. During the dry seasons people who live close to the boundaries with Mozambique move into that country to engage themselves in farming since there is plenty of spare and fertile land there. Other people living close to Chikwawa District also move to the district to farm. Some people move from their villages to seek employment in the tea estates.It has also been found that a certain section of the society move about the district and some parts of the country to sell bananas which are the main cash crop. In 2004 the following trainings and briefings were conducted: -67lCDDs were trained in 57 new villages. -211 H.S.As were briefed on Community Self Monitoring. rhe cha,en*.. ,u"";uto;!iIT#1?, Self Monitors were trained' - Some CDDs can not manage to record data effectively. -Dropping out of CDDs. The challenges were overcome by: - Conducting targeted training to CDDs who are having problems with recording - Local training of CDDs conducted by H.S.As to replace those that have dropped out. 2 WHO/APOC, 24 November 200.1 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads. . .) Administration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. Onchocerciasis control activities in Malawi started in 1984 upon the launching of the Onchocerciasis Control Programme in the Ministry of Health. There was only one and confirmed focus of the disease in the district with over 100,000 people estimated to be infested. In November, l99l mass distribution of ivermectin was commenced. Thyolo District is situated to the Southem Region of Malawi and it forms part of the international boundary with Mozambique to the South -east, it also borders with Blantyre, Chikwawa, Chiradzulu and Mulanje Districts rvho are also implenrenting the CDTI concept. The district is one of the densely populated districts in the country with about 505,000 people. It is hilly with numerous riverline systems which make it t-avourable for the bleeding of the onchocerciasis vector, black fly. People in the district engage themselves in small scale farming and businesses. Tlrey grow maize, bananas and cassava for consumption, they sell the surplus. The tribes found in the district are Lomwe (which form the majority), Ngoni and Yao. The favourite dance of the Lomwe is Tchopa. There is a tarmac road which runs from Blantyre and crosses the district to Mozambique via Mulanje District. This is the main communication outlet for the district with other outside areas.Another tarmac road branches from the above main road to Malamulo Hospital, this road is very small and is not used much by traffic. The rest of the roads in the district do not have tarmac hence slippery during rain season. The administrative structure of the district is arranged in the manner whereby the topmost post is occupied by the District Commissioner,under him/her are Traditional Authorities. At the bottom of the structure are Village Headman.The Village Headman looks after clans of people who have joined together to form a village. A combination of villages form a very large area looked after by a Traditional Authority. Thyolo District has two hospitals namely Thyolo and Malamulo. There are I I govetnment health centres , 6 Christian Health Association of Malawi(CHAM) health centres and 12 tea estate health facilities which provide curative, preventive and maternity services. 3 WHO/APOC. 24 November 2004 Table 1: 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 BI Number of health staffinvolved in CDTI B2 Percentage B::Bzl Br *100 THYOLO 486 486 l00o/" Total 486 486 100% 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, etc.] Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/t.GA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in project implementation are Ministry of Health, Tea Association of Malawi,Intemational Eye Foundation and W.II.O. These partners are involved in planning, supervision and implementation of CDTI activities. For 1.l.I and L1.2 see copies attached overleaf a 4 WHO/APOC, 24 Novembcr 2004 tat .+ N o -o () o z $N o o. o +r ; (d (c o C) oo c! 0) o a o aL 0) c) bo a (t >. -o () L C) o bo a O a qi o o o(J oo h obo d o C) 'a L o (ri C) Lp. C) d aL(.) -o G) t/) F C'bo L o E o C) o o a oO (d (,) (.)E obo L o oo Eko 0.) bo o () L(o a) A()qrL I I I I I I I I I I I I I I I g' oo a d P 6 l-() 6 I I I I I I sz I I I t-l c-.o6.) rr >v o -o orl -ol(!l ol €l cl' s>cnlEl a2 Zq v(J 0)-Oc€ qP P2:E .. .. ;H=:^() >q/ d z -r+ at! -o o (.) bo li o o.() () bo t< o o o() 'a L o. o H .o q O C) o q lbtd t*lolut.\to'lL lo t- lx ls ! $ -a u \J IB J.: SLt\ \:V9:t L.a-t up -s A, Sp %o'sxU: sa)is -ts t t\\\ $u LrU!s\iu >! Bd rps* B-as> rN -5> o>:; a!Pa-\9h:: -a: 5su t! -t .: t,+ N$q$ s= il;etF,\ S 4t I\ ^N ! 4 ! -: C) a. bo L o a.oL (.) bo rr o L o (.) cd ok () !(s () ! C) (.) Gq) Iq) q) q) o JZO k o a. a. (! a o E Q ojr o,l -I -ol cnlFI c o *. IE fc otr N F F :6- EEc o\ <f in o\ t+ + il .o -()o,= aN e{ E ooHF 3€ ra) ia to r.:€ H&E.Eu; >.E o o \ iI :.,1 = o' -xL an o'l c..l 6i oo rANN N € A E:q, :€6tr.=:?oU gsx. c- c-r- c.i c'l ca r-r-F- el(\l ro I o ON -q) 6o oF + il o 0)(! 0o cn c.l + $Os ahq) (ll aq) 6 c) (\l +s .+ .eE o:E*_tr o :''lqrE iiec! >oFE N $V) $V- U)q) b! cl .t)q) qJ o z E:q);!c ?oU .qJ. x : e V)co tr)cO 6,tr9)o9=rr L r! Ge:'i a = or.!194..^'A:V- -^-a O O^ t/^)O rr)\a ;oe tseIor5'; aE' <rr C/ cn nr F cJc ,J<F '.] F 3 .f O e.l {) -o () o z$ c.] o a. o \o dl-io C)E o oaq< !B '1)li(! 0) 'a l-g 6) 9. o D" O op a oi-ro qi o o (B li .o H liO o t) -O a I SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. THYOLO DISTRICT CDTI PROJECT PLAN OF ACTION. APRIL 2OO5 TO MARCH 2006. 7 NO PLANNED ACTIVITY A M J J A S o N D J F M I TOT and H.S.A. review meeting. 2 Census up date. 3 Ordering of mectizan. 4 Mobilisation and sensitization of community local leaders. 5 Distribution of mectizan to health centres and comrnunities. 4tvh'*. 3'lr, t$ rilii;:;Jl :3 -',ttl! A, ;ai &:friffi ,{f -' .4 . .;.:. :!. l', , .a', ! ,:a ,'-:'!it;*t $r'l ,;;4;;' 5 Supervision of CDTI activities. 7 Collection and compilation of data. 8 Training of new CDDs in new villages. 9 Reporting to NOTF 1i l0 Visit to Nigeria r,ll WHO/APOC. 24 Novernbcr 200.1 st N E(.) -o () o z +(\ Qo a.{ oo a () E o(-) I Nqq u \,) q: \ t c q)4 s AJ 5 L 0) C)LL o (.) 0) oL a(!(.) L(n C) .o 6 C) o (H o 0) o E F ;1 d)I *t -ol(!1 FI i o) > (,) a EE Q <f N () d a0-tr- 1itr u)- ON J & U) o! EE Q tr.l ca z rl.) z a0EE co 2g.l F IJ.] u') o CE a) ah q) U EE U J boEE ?tr a- gr zp at 3 o o! EE I & IJ.] ztll oz bntrE '!i tr #E & ul a oF(J (J ijEc!=N: z o! EE Q 2 EOEE 1rtr a- J a o. Fl I O) oJ o F l-] Fr F 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. N/A 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 -Use of posters and calendars. Mobilization and health education of communities including women and nrinorities - Converging of group meetings. Response of target communities/villages - The response was positive. Accomplishments - A lot of women and minorities are taking part in CDTI activities. Suggest ways to improve mobilization and sensitization of the target communities. - By using influential leaders in the socities such as village headmen, church Leaders and politicians. 9 WHO/APOC, 24 Nor,'cmber 2004 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance of female mcnrbers of the community at health education meetings -'Ihe number cf females attending to the meetings is greater than the number of males. - In general, horv do you rate the participation of female mernbers of the community rneetings when CDTI issues are being discusses (attendance, participation in the discussion etc) - The females contribute much to the deliberations than males. - Incentives provided by communities for the CDDs - No incentives are prorrided. - Attrition of CDDs. Is attrition a problem for the project? -There is attrition of CDDs due to deaths, dropping out and transferring to other areas. - Other issues 2,5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels -There is adequate knowledgeable manpower. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The ntost irnportant isstte to clescribe is wlrut nleasures were tukert to cnsure udequate CDT'I intplamentatiort v'ltere not enough hrcwledgeable ntanpov'er tr.'es available or rf sta/J'are fi'cqtLerrtll' trunsferrecl rlurirrg tlte course of the ccunpaign). District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved ale CDDs Female CDDs Total Number of communities ivillages with female CDDs Total no. communities in the entire project area Br Number with community members as supervisors B5 Percentage Bo= B/ Br *l0o Number of communities with female CDDs Br Percentage Brr= Brr/Br*100 THYOLO 404 +12 Tea Estates 0 0. 706 693 I 399 404 + 12 Tea Estates 1000h Total 404 + 12 Tea Estates. 0 0% 706 693 I 399 404 +l2Tea Estates t00% 10 WHO/APOC, 24 Noverrber 200-3 a - By conducting local trainings to the new staff using local resources t1 WHO/APOC, 24 November 2004 Ic.) c.l 6) Eo o z <f ol Oo o C.l o a € o s a n o s o bo o * |. o \ o\ sa5 B G o 5t\ g = a 44 !JQq) S q l ! a,) ! 'd q,) 4 !q) ea o C) Eo a. Fcr) (H o a C) () 0)L -o!l '15 0) cC bo (,3 LF ,;; dlt -l =tFI 4) CB O n U o z 6 -= +FU.: s,:a<v ir =v r-r-\o F-. F-. F-t-\o F- F-\o s a o\ o o o \e a tf, t-- !+F- 0 q) .1 o'FF OJ: oq) .c) Lcl ol- z = o -= +Fe,: +-u- 'lqv is =w s ql I €) \o UF o dt =s Qq!x tr':- zE q) U + : U U. Errx -"irr \'q t \o \o rA lrJ s q) () o\ o\ t o\ UF o\ o\|r) 0q Fl ()o o z (, + U U Q il IF a< a -o q) o o ULF J rr oJ o F F] F Fr a a Trainees Type of hainmg CDDs Other Community memberse.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Village heads Program management 677 0 221 0 0 0 How to conduct Health education 677 0 221 0 0 0 Management of SAEs 677 0 22t 0 0 0 CSM 63s 0 221 0 0 0 SHM 0 0 0 0 0 0 Data collection 677CDD 635CMS 0 221 0 0 0 Data analysrs 0 0 0 0 0 0 Report writing 677 0 22r 0 0 0 Drug drstribution 677 0 22t 0 0 0 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%o 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. 13 WHO/APOC. 24 November 200-l t$ O(\ 0) .o Eo o z .f(\ (-) O o. o $ ri FD cdo !(6 o C) oh .= oo h.:USds o9 el EL 0-)trruL\i)!gS iqtL\;s6)s Cd\9A OB -o^t,U.Sg3 9EU- oi -.o.t;-trs' d 60 ,\ \ .a ! .: S il l\\ O x 0) Cd() H 0) I o C) (H o Hq)p z Eq) C) O UF D \co\ OI *l o:xl > EI E EIE el ;ot(Jot trot Eol ir tsltpl ' .8lE trl c zl< (c C)h P(-)() '= U -H6) HC)6t e Oi().= 'aA LV :z(D rrlr& d ! U >0)?,J q a I H .= 0) !Y tthtr(dEr()€ otr t)E OI tr(J OI E1, -l HE "l 3i. El ,,5. EI E ^ ol i * &l e rGl nF-l UH-l ^'at FHat ^bo 3l= -.ilV .tPl 6t '=l o ltrc El .*o cl o H 9t 6E ;l*i1 ol tr C pl !Jo- 0.)lc 'cd trl d b =l oF Zll- x -o() () k () I o a(H o L() .o z a 0) b{ L 0) o () p(n LbI () b{ E cd o 0) (c lio bI p U o ! .o ! tJ< -:\ 6 t4q) QqJ 6 + o s- q) L. o 'd q) 4 q) s- .:z(n ! ad 0)L CB r f') rl l-i a E p a r! c/) E (n 0) 0)!F Ir -l -ot(dl FI il 0) cdk() bo !^'0)^\ o O F o d () b0dH() o(J cd o': d r bD o 0-) () cd ! 0) bo H() o I o -:. o d() F 3eE H6:*8i:a I E{itrh-;qG oi9 0- o Lo o o z IEll4\a2z bs EO $ @ od s\o € qo O6 EZ 3 9€t EEE}EE z- oE N \o N o d g o H H ll H o '.= o =boO d^ E-uo: oo .CoF o\ ,1 r- o\q Or- H o --:iEU Eb9 z r- o\ d) @ F- o\ d) 6 daa L:O ,: u.a FU OO o 6 9i F€ig x = 6,: oF O o- O o. O a C) bo a 0) (, ll * HH H .\ hD s) o o d bo oo L) \o o\ O o :Z -- o tr d9? .ofdE ==-Fz6 O C\U d So o(\ +o$li 'o tso dAa b: a rlDS -io o o C) al + \i- oct! -a+o =l-3s 1U v; c o= + = j >-'- - i o.q 9iq E 9on E -3 E 6 [i I o o d O o (\ +$ <t o o do : + -fO -i- : r-lo-r o\ o .l o F '.] - 3 $ O c..l C) .o Eo z $ c-l Uo or o tn $ bo E\ a) ! \\b, q) bo s{i U\ d{ ! o' tr .s N .s Utia $ ,a o s -i L a h U '\ -{. \.Y .s\ '=.S .: (-10' =tUY Bt Eq)s{ !\ =SYrs S'.S G* B-Es() T\ aJrts-S.St:$G ss a\ElSY x"& .a\ s:r€ :E .S '8. d\ s: F\ ='ils t\s a 2.6.2 What are the causes of absenteeism? -Migration of people from the district to other districts during distribution period. -Some people employed in the tea estates were laid off during the distribution period but were already counted during the census period. 2.6.3 What are the reasons for refusals? - Cultural beliefs. 2.6.4 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. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (Please add more rows if necessary) a Resulr (thrck smear S/N* Age Sex Village of orrgrn Date Mecttzan was taken Date 1't symptom s appeared SyTnptoms Health status beforc takrng Mectrzan Date of admrssion ir-r health facrlrty Date of drsmissal frorn health facrlity 0 0 0 0 0 0 0 00 0 l --L-- 16 WHO/APOC, 24 November 200.1 a* Serial number of the patient a t7 WHO/APOC. 24 Novenrber 2004 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9:Treatments and coverage by calendar year for the entire project area. (Please fill tn the required data) Please indicate the UTG for the project area:_(use this figure as the denominator in all UTG coverage calculations.) 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate ansvier)MOHJ WHO tr UNTCEF tr NGDO Other (please specify) a pefsonr Num _)9 11 181 522 12 159 000 2t 239,030 lsR jg7 a ? Mectizari@ delivered by (please tick the appropriate ansv,er) MOH J WHO tr rrNrCEF n NGDO Communities/Villages YEAR Total # of communities/vrllag es in the meso./hyper- endemic areas EI E: Annual Treatment Oblective Er Number of communrtie s/villages treated Geographi cal coverage (%) Er= Ey' E,*100 ATO coverage (%) Es: Ey' E,*1OO Total populatron of the mesoAryper- endemic areas E. Ez Annual Treatment Ob;ective t997 466 263 66 t4.t% 25% 396,494 189,142 1998 500 269 180 36% 69% 408,757 2t2,1t2 1999 500 282 212 42.404 7 5o/o 421,399 3 10,036 2000 500 282 282 56.4% 100% 434,432 315,099 200t 500 282 249 49.8% 88% 441,868 299,s64 500 282 282 56/% r00% 461,720 357,9022002 200i 500 282 282 56.4% 100% 476,000 369,624 2004 404+ 12tea estates. 4Q4+ 12tea estates. 404+ t2 tea estates. 70.9% t00% 50_s,000 505,000 2005 2006 2007 2008 2009 2010 Other (please specify) 18 WHO/APOC'. 24 November 2004 aPlease describe how Mectizan@ is ordered and how it gets to the communities MOH Hqrs. By DHO to District by DOC/HC staff to HC by CDD to Communiry Table 10: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? Collection is done by H.S.A to DOC and is kept at the Pharmacy. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. -H.S.As order mectizan and place their orders at the nearest health centre.The district health personnel deliver mectizan to the health centre where the orcler tlriginated from. The H.S.As and CDDs then carry the mectizan to the community tbr distribution. Any other comments 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the proj e ct area? If so,When? YES. In the year 2004. Table-l1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the communiry self- monitoring and stakeholders meetings have affected project implementation or horv they u,ould be utilized during the next treatntent cycle. State/District/ LGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remaining THYOLO 1,448,812 1,448,812 I ,183,448 0 3,1 78 262,186 TOTAL l,44g,gl2 1,448,812 l,lg3,44g 0 3,178 0 262,196 a DistricU LGA Total # of communitiesivillages in the entire project area No of Communrties that carned out self monrtonng (CSM) No of Communities that conducted stakeholders meeting (SHM) THYOLO 404 +12 Tea Estates 282 0 TOTAL 404 + 12 Tea Estates 282 0 19 WHO/APOC, 24 Novenrber 2004 0 a 2.9, Supewision f Provide a flow chart of supervision hierarchy. DHO toDOC toTOT to H.S.A. to CDDs. What were the main issues identified during supervision? CDDs failing to record properly in the treatment book. Was a supervision checklist used? YES. What were the outcomes at each level of CDTI implementation supervision? 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? It assisted the district to identiff the existing gaps in the performance Of the CDTI programme and thereafter came up with remedial Measures such as conducting on the job training of old CDDs and Local training of new CDDs to replace the dropped out . SEGTION 3: Support to GDTI 3.{. Equipment Table l2: Status of equipment (Please add ntore rou,s iJ- necessary) *Conditron of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Wrrtten of0. Horv does the project intend to maintain and replace existing equipment and other materials'/ By using Ministry of Health resources through the District Health Officer. 2.9.1. ,o, 9.3. 2.9.4. a Source Type of equlpment APOC MOH DISTRICT/ LGA NGDO Others No Condrtron No. Condrtion No Condrtron No- Condrhon No Condltron 1. Vehicle 2. Motor cycle(s) 2 IF ICNFR 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) b) c) 20 WHO/APOC. 24 November 2004 t3.2. Financia! contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years If there are problenrs with release of counterpart funds, how were they addressed? NO. Additional cornments 3,3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Human resource ie the communities assist in drug collection and distribution NONE. 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here lUS LLAR: 110 MAI.AWIAN KWACHA. a Contributor Year I ('provtde the period') Year 2 ('provde the period') Year 3 ('provide the penod') TOTAL Cash Budgeted (US$) TOTAL Cash Released (rrs$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAI Cash Budgeted (us$) TOTAL Cash Released (US$) MOH (Central + Provincial/State) 120 r20 145 145 159 r59 MOH (DistricVLGA) 0 0 0 0 0 0 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) 0 0 0 0 4,618 4,638 Others 0 0 0 0 0 0 a) 0 0 0 0 0 0 b) 0 0 0 0 Communities 0 0 0 0 0 0 APOC Trust Fund 0 0 0 0 5,9'34 2,967 TOTAL 120 120 145 145 10,73 l 't,'764 21 WHO/APOC. 24 November 2004 0 0 Activity Expenditure ($ us1 Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities fpi"ile_qJ_cPPp Training of health staff at all levels and distribution Iltgrnal m of CDTI activities Advocacy- visits to heSJlh g4d tical authorities IEC materials Suprygrylreporting) forms for treatment _!_eh!c 19 q/ It{otorc yc Ie s/ bicycl es maintenance O!fice Eq_uipment (e.g computers, printers. eJ_c)_ Others 105 MOH MOH wHo MOH 335 4,639 689 2,464 50 APOC MOH MOH APOC r40 3,470 TOTAL 11,891 'fotal number of persons treated 358,397 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanaticms? Funds were not enough on the training of CDDs and Community Self Monitors. SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) --No--YearlParticipatoryIndependentmonitoring I ) a Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners _NO 22 WHO/APOC. 24 November 2004 a4.1.2. What were the recommendations? The District should plan and budget for CDTI by intergrating it into The District Implementation Plan. 4.1.3. How have they been implemented? The above recommendations are currently being implemented. 4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting Was a sustainability plan written?_ When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. 4.2.2. Planning at all relevant levels Integration with other PHC activities. Funds lncorporating the activities in the D.I.P. Release of funds for project activities lntegration with existing PHC budget. Is CDTI included in the PHC budget? YES. a 4.2.3 Transport (replacement and maintenance) Maintenance costs are being borne by the D.H.O 4.2.4 Other resources lntegration with other P.H.C. programmes. 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. Ivermectin delivery mechanisms It is delivered with other P.H.C. materials 4.3.2. Training. Incorporated into other P.H.C training programmes. 4.3.3 Joint supervision and monitoring with other programs When supervising other P.H.C. programmes the CDTI is also lncorporated within the supervision schedule. I 4.3.4. 4.3.5. 23 WHO/APOC, 24 November 2004 4.3.6. 4.3.7. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? DERMATOLOGY. The staff from this department was oriented on Onchocerciasis. The achievements noted so far are that the dermatologist Is able to trace onchocerciasis cases from out-patient department. The department is assisting in the distribution of mectizan to Out- patients. I I Describe others issues considered in the integration of CDTI. A well developed supervisory checklist . The use of same leadership structure, Min.of Health staff and health infrastructure 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths: - Ability to conduct distribution in all 404 villages of the district, thus achieving I00% geographical coverage. - Attaining an increased therapeutic coverage of 70o/o from 650/o. Weaknesses: -Some CDDs are still not capable of correctly recording CDTI data. List the challenges and indicate how they were addressed Challenges: -Dropping out of CDDs. -Failure by some CDDs to properly record data. Solutions: -Conducting on the job training for new CDDs to replace the dropped out. -Conducting targeted training of CDDs. 24 WHO/APOC, 24 November 2004 I SEGTION 6: matters Unique features of the proiecUother t a a a I 25 WHO/APOC, 24 November 2004 *t rt a I Ia a a