Phase 4 annual project technical report submitted to Technical Consultative Committee (TCC): January 2009 to December 2009

RESERVED FOR PROJECT LOGO/HEADING MINISTRY OF HEALTH ORIGINAL: English t-l : R\ TRg 6) EPTgrM s TO cAo gF0 A{ AfiI i.: jlc , L.L Lys-jto' lr*oln<ation Io'$rR , fl.Bahc.6 A i) '.., R COIINTRY/NOTFZ UGANDA Proiect Namez Phase 4 Approval Yearz 1998 Launchine yearz 1998 Re'portins Period Month/Year): January 2009 thru December 2009 1234s6789 11 t2 Fe 2010 NGDO Partners: The Carter Center The Sight Savers' International Neglected Tropical Diseases I NOCP-Phase lV-Uganda 25 January' 2010 i ) I I I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATryE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) ll NOCP-Phase IV-Uganda 25 Janwry 2010 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEME,NT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rePort: Country: Uganda National Coordinator Name: Tom Signature: .. NGDO Partner: Date: 31" January 2010 Name: .....08 '€nrA?D h'ur Signature: Date: 11\ tr- r.sla This report has been prepared by Name : Tom Lakwo Designation : Senior Entomologist signo:tur", frM.. .: . . . ... lll NOCP-Phase IV-Uganda 25 Jantary 2010 ITable of contents ACRONYMS............... ............ vI DEFINTTTONS ......... ..............vII FOLLOW UP ON TCC RECOMMEI\DATIONS .......1 EXECUTTVE SUMMARY ........2 SECTION 1: BACKGROT ND IIYFORMATION........ ...................3 1.1. GpwpRalrNFoRMATroN................ I .1.1 Desuiption of the project (brielly) LL2. Partnership 1.2. Popur.arroN.................... 2.1. TItvtslll.{E oF ACTIvITIES ...... 2.2. Aovoca,cy 2.3. MogtLlzarloN, SENSITTzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUMTIES 2.4. CotrluuunY INvoLvEMENT.... l0 2.5. CapacrryBUrLDrNG 2.6. TRparrraen-rs.......... ....... I 1 J 3 5 6 8 9 9 2.6.1. Treatmentfigures............. 2.6.2 llthot are the causes of absenteeisrn?......... 2.9.1. Provide a/low chart of supervision hierarclry. 2.9.2. Whot were the main issues identi/ied during supervision? .. ......... 13 ..,.,..,. l 3 .,...',.. ] 52.6.3 ll'hat are the reasonsfor refusals? ................ ............152.6.4 Briefly descrtbe all btown and verified serious adverse events (SAEr) that.... 15 2.6.5. Trend of treatment achievementfrom CDTI project inception to tIrc cunent yearlT 2.7. Onopnnvc, SToRAGE AND DELIvERY oF IvERMECTIN ..182.8. CouurrNlrY SELF.MoNIToNNG AND STAKEHoLDERS MperrNc .........., 19 2.9. SuppRvrsroN.. l9 t9 19 2.9.i. 2.9.4. 2.9.5. 2.9.6. Was a superttision checHist used? 20 What were the outcomes at each level of CDTI implementation supervision? 20 Was feedback given to the person or groups superttised? .............20 How was the feedback used to improve the overall performance of the project? 20 SECTION 3: SUPPORT TO CDTI ...........21 3.1. Eeurpuevr. 3.2. FruaucIal CoNTRIBUTIoNS oF TTIE PARTNERs AND CoMMT]NITIES.... 3.3. OrHenroRMS oF coMMUNITy suppoRT 3.4. E><pptrDtruRE PER ACTIvIT .... 21, 2t 22 22 SECTION 4: SUSTAINABILITY OF CDTI.. .............25 4.1 . In'renNal; INDEeENDENT pARTrcrpAToRy MoNIToRTNG; EvaruanoN....................23 4.1 .I ll/as Monttoring/evaluation carried out during the reporting periodT (tick any 23of the following which are applicable) lv NOCP-Phase lV-Uganda 25 Jnvary 2Ol0 4.1.2. What were the recommendations? 4.1.3. How have they been implemented?.............. 4.2. SustaNesrlrrY oF PRoJECTS: PLAN AND SET TARGETS (tUaUOarORY AT .. Yn 3)......... ........23 .,.,.''' 23 ........23 ....,..,23 ,.,..'.' 24 ..,'...,24 ........24 .',,.,,.24 ...,,,..24 ........24 ',,.,,..24 ,.,.'..,24 4.2.1. 4.2.2. 4.2.3 4.2.4. Planning at all relevant levels Funds........ Transport (replaceme nt and maintenance) Other resources... 4.2.5. To what extent has tle plan been implemented 4.3. INrpcRarroN..... 4.3. r Ive rmectin de I ivery me c hanisms 4.3.2. Training. 4.3.3. Joint supervision and monttoringwtth other programs..... ...........24 4.i.4. Release offunds for project acttvities ......244.3.5. Is CDTI included in the PHC budget? .....25 4.3.6. Describe other health programmes thot are using the CDTI structure and lnw this was achieved. What have been the achievements? ............. ..................25 4.3.7. Describe others issues considered in the integration of CDTL .....25 4.4. OpenarroNAL REsEARCH.... 25 4.4.1. Summarize innot more thanone half of apage the operational research undertaken in the project areawithin the reporting period........ 4.4.2. How were the results applied in the project? ............. 25 SECTION 5: STRENGTHS, WEAKI\TESSES, CHALLENGES, AI\D oPPORTUMTIES......... SECTION 6: IINIQIIE FEATIIRES OF Tm PROJECT/OTHER MATTERS ...........26 v NOCP-Phase lV-Uganda 25 January 2010 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TJNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatnent with lvermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Govemmental 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 vl NOCP-Phase lV-Uganda 25 January 2010 Definitions Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible pooulation: calculated as 84%o of the total population in mesoftryper- endemic communities in the project area. (iii) 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 (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraphical coverage: number of communities treated in a given year over the total number of mesoftryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for catarac! 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. [t encourages the community to take full responsibility of ivermectin dishibution and make appropriate modifications when necessary. (D vll NOCP-Phase lV-Uganda 25 January 2010 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:26 (Please add more rows if necessary) I Namber of Reconunendation ln the Report TCC RECOMMENDATIONS ACTIONS TAKEN BYTHE PROJECT FORTCC/APOC MGT ASE ONLY I 2 3 NOCP-Phase lV-Uganda 25 January 2010 people. The phase 4 districts started implementing CDTI in 1999 Qdh year of implementation) with ftnanctal support from APOC, rne carUr center Qcc) and sight savers International -(ss1. rcc is the-partner in Adiumani, Moyo, Gulu, Amuru and oyam dislricts while ssl handles Kibate district. The disfricts were evaluated for sustainability in June 2003 after five years of ApOC lunding and were judged to be maktng ryogress towards sustainability. -ThereaIter, the distiicts deieloped susiaUanifiE plans, which they have been implementing using -local resources supplimented with resources lrom the NGDOs partners' Co- impfementation of CDTI iit*tttrs has been adopted with other NTDs covertng Mass drug aiministration oj tvemectin, albendazole and Praziquantet, Vit A and also immunization during Child days plus in all districls of phase Treatment coverage Ag the districts in phase 4 have sustained 100% Geographic coverage. The number of people treated in tie proiect area was 611,078 giving coverage of E0%. The ultimate treatment Goal was 630,096. 2. Background on population movements. The popilation olihi districts in this phase is now stable. But during the conflict there weri a-lot of population movements especially in Adiumani, Moyo, Gulu and Amuru 3. Training data A total oy Zi,SSO CDDs were targeted for training and all were trained giving an achievement of 96.1%. With a total poptdation of 767,533 people in the ryoiecf area, the rario of persons per CDD was I:33 (apprortmatuly 7 households per CDD). A total of 310 health workers and 1r7E4 TOTs were trained during the period under review- All these training were conducted with the support of other partners involved in onchocerciasis controL Challenges and how they were overcome. Some oj *" challengei encountered during this reporting period among others included: The aioption of use of integrated register is taking a slow pace in districts where partnerc operate. There-is "oriiouout dialogie with partners to embrace integration and to perceive i as the only way to go. The issnc of limited number of front line health workers still persists, bU wifh fiaiing of more VIITs, parish supervtsors, community supervisors and -health assistants, gaps crealed in supetvisory roles are being bridged. Executive Summary Preporc an Excculive summaty of the report in not more than glg.page' l. Background on treatment and population data The report ior"r, the period Januory to December 2009 for phase 4 districts (Adiumani' Gulu, Moyo, Kihaale, byo^ and Amuru). Amuru is a new district, which was createdfrom Gulu in 2006. This'project area has 892 communities with a total population of 767,533 2 NOCP-Phase lV-Uganda 25 Juuary 2010 SEGTION {: Background information 1.{, General information 1.1.1 Description of the project (briefly) - Geographical location, topography, climate - Population: activities, cultures, language - Communication systems (roads...) - Administrationstructure - Health system & health care delivery (provide the number of health postVcenters in the project area if the information is available). - Number of health staffin project area and number of health staffinvolved in CDTI activities. Phase 4 CDTI districts (Adjumani, Amuru, Gulu, Moyo and Oyam) are located in Northern Uganda Adjumani, Amuru, Gulu and Moyo share the border with Southern Sudan while Kibale is located in mid Western Uganda. Kibale district is mainly hilly with numetous rivers. The main economic acttvities include small-scale agro- larming and small commercial enterprises in trading centers. The districts in Northern Uganda hove had a civil conflict for the past 20 years and people have been livtng in congested camps. However, with the coming of peace in early 200E, the internally displaced peoples camps have been abandoned and currently reseltlemcnts have tahen place in villages. The government is making effort to improve on the infrastructures that were destroyed during the conflict. Adjumani and Moyo districts hove Sudanese refugee camps, and these camps were also abandoned when the Sudanese were repafiiated The infrastructure that has broken down, rouds lhat are funpassable during rainy seasons, administrative and health centers that were destroyed is now being slowly lixcd. Adminktralively, Uganda is orgonized under local councils ond the district polttical head is the Local council chairperson (LC1. Under him, there are LC4 at county level, LC 3 at sub- county level, LC2 ot parish level and LCI at village level Organlzation of the Health $erylces Since 1997, Uganda government adopted decentralization policy. Decentralizption talces sentices and resources neatet to the people, eases decisto improves accounlability and creotes a sense of ownershtp. At the district, actud implementation of health care is further decentralized to the health subdistrict level and lower level health centers. Health indicators According tu aDHS 2006, infant mortaltly rate (IMR) is about 77/1000ltve births, child mortality is 137/1000, totalfertility rate is 7fiuomon,323 populations per nurser life erytectancy is 52 yearcforfemales and 50 yearsfor males. 72% of population lives within 5 km of health unit although most health units are understaffed.Ihese health indicators have not change. Health Careftnancing Povefi eradication Action plon (PEAP) in place: reduce povefi, (Jniversal Primary and Secondary education, Prtmary Health Care, fmprove communications and debt relief, Central government budgetfor health is about 9%. Estimated per captta on health ir US,tr 3040. The health budget is overwhehned by the 3 mojor hiller diseases (Malaria, HIV/AIDs and TB). 3 NOCP-Phase lV-Uganda 25 January 2010 Fig 7: Organization of health seruices in Uganda (the chain of command) Development Partners Healthof Other line ministries Referral Hospitals District Health Office District Hospital HSD Health Centre III Health Centre II Communities 4 NOCP-Phase [V-Uganda 25 lanuary 2010 Table l: Number of Health staff involved in CDTI (Please add more rows if necessary) District/LGA Numbcr of heelth steff involved in CDTI activities. Totel Numbcr of heelth staff in the cntirc projcct erce Br Numbcr of heelth stalfinvolved in CDTI B, Pcrcentage B.=8,/8, *lfi) Adjumani 78 62 79 Amuru 38 30 79 Gulu 35 27 77 Kibaale 59 37 63 Moyo 74 60 81 Oyam 24 I9 6l Total 308 235 76 1.1.2, Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs(nationaUintemational), communities, local organizations, etc.l 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/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Implementation of phase 4 CDTI project is in partnership with NGDOs namely, The Carter Center assisting in Adjumani, Amuru, Gulu, Moyo and Oyam districts, and Sight Savers International (SSl assisting in Kibaale district NTD control programmc came on board in 2007and is also providing support to all the phase 4 districts. A total of 892 communities are involved in CDTI in the project area. The partnerc worh closely in advocacy, monitoring and supervision, planning and review of the progress of the projecl Dwing these meetings, the districts usually pledge lo contribute towards CDTI activities. However, due to low revenue base collectton and the ctvil war that has been prevailing in most of phase 4 disiricts, there are limited contributions made. It is anticipated that the situation may slightly change now that lhese districts are relatively peaceful they may concentrale on developmental projects that would improve the revenue base. 5 NOCP-Phase lV-Uganda 25 January 2010 O cl h (€ c{(, db0 I () o(d A I 0<O z Ht $) St S \) ,s * U1 ss3 \. e. lt s$ *€S- ra ET!lsXSqaYEIi% .ci s $ssscia IE .'r'd\.\ s \'.$s SEll .9p .ri SEillr'p{ YE ES :u ri .=lq) sriSll SE $s ss !ll SE €$$\EE* ES $ \o ds o\) 'o\ P q) \q) "suBq)\ q) .a o a q) B lie\r8 B''tslSLh\:s 'St. \h uS) "sA -tSs bo'B*PXBq) .s -Ps${rsr\$( $v$q)6d\.s ca() HS .Sgs\te NB ES E.xtl!U\:ss3t s'\ s\. *sb* "s:s\\s EvS$RS 'E .b N$ S.c 8$ E$Sq) =bo*=ilt HB\s v'): oL s)L o N s o l<o0. oo o a.() L C) P bo ! !o o Lro .d C) (s(.) LP()!(d >t(u F L o) (I) ' ct c)L6l q)(l) oLa c)t- q) a) J1 rn h cl o GI o.o o. tr Gl CA 0) tr F oU c.it a.ll -ol(Bl FI E ot- +a(! -Tc otr f{ IF Itr sE- =E6 E-EE r-\o .f rat eO \o € € O $\oq o\ ca o\ t+N \o cos \o \o o\ tt)\o o cO F- oin + il ,€) rlE -tDO .= aN " E.e EEEtrE r- c-.1 c\ o\i., o\ oo o\ .+ \o c-)lat cr) @ rr) oor- co$l.) r+ rn c-(a)\o o\ (at)ia rr\o r-- r.:8 g&E.E;; >rr5 o O 1E E F'g o o cl c Ei 'Egs 3: H F.: Eo E'=gsx. t a)3o ON 3.e -t €o ot* + il € c- r\r- oo\ co6tca o\ oo |r)co alo\6 .eEE'Aoh E f,x 3€ F &.E >r a)tsEEO N ah €) at cl an e) o() o L()E z sE g Fiso E'= 3sr GIE9)o9= .iLtt .s:E? = A.gE 3g E'H ELt5 A c-6I6l olrl o\ € o\ \f \o ca\n e-l €in @r- cas rat $in r-trl\o o\ ra(t)in r-\o F- E "E.9E a)lli e'=RcEc Er f Ht<(,5E.; cl E L tr (, () d GI -og o >to GI o Fl F o t-r Was a census for the project done during the reporting period? Yes-/-- No If No, what is the source of the data in the table above? Source:National census - CDD{. Other source, Year : If you are using the term community or village, define what constitutes the community or viilage. fnis witl help understand the profile of the project area. Community is a geographic area under the leadership of local council chairman (LCl) Is there any other information of interest about the population in the project area? If so, include it here. 7 NOCP-Phase [V-Uganda 25 Jamnry 2010 () tr5 q.)c5 (, E3 o. o. o. o. Lo. EoQ oE R, 0 oO lEo H 2, l.qo G' A (tt 1r' l5 o\oo c.,t5 00 (ur, d o0 I C)qdgp. d, L) z io CS (U bo(.) .o x 4) o (.) x .o t G) tr c)tr c) o. E oo Bi!! st AJ s dl E.s 8'S ESUSE8 t-8!!* .rs r:$EScH ESErtr ,s' cl5 Qra zrScts ss ss s$!s ss]i,sC'NctN =E) .is OhH.S().It Eri fsctSc)\F\ }\A$ .i\tU s \ o\ P o N B a.) se a- L.(s C)x c) ts () o q t0)$lt) U' crt C)l<(I, (.)rro ch C) I o(u x C)J4 o o oo (d o '1J L's S) $I a .t \ S) \lp s s .q) E\ .s ot U$ s' o rr .o q C) oGqr o q) o f- e"ir c.rl -o, AI 'lJ(l) .<, C) x C) tratr (l) q, sq) s co C) .o Gt t\ Fo o h o c .9 *J IU{.troooEEL'ro.= -tIo.oEtg --E(ii EZEOE af .-l- l-(, tlljCO c,i -Further comments. 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. Advocacy on integrated control of neglected tropical diseases was done in all phose 4 districts during the reporting period. All policy makers and politicians welcomed the idea of integrated control of neglected tropical diseases using CDTI structures and pledged support. Post conflict districts were given priority since during the insurgency CDTI activities could not be odequately performed. 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 Types of IEC materials used Mobilization and health education of communities including women and minorities Response of target communitieVvillages Accomplishments Suggest ways to improve mobilization and sensitizationof the target communities. Communitics were informed about CDTI by the drug distributors (CDDs), community supervisors and health workers. IEC campaign is a continuous engagement that peaks when ivermectin is ahout to be distributed IEC campaign is facilitated by posters, which show the symptoms of Onchocerciasi* The response of the target communities is sometimes disappointing as few community members altend In most of lhese phase 4 districts the use of FM radios is qaite useful in social mobilizttian, and has proved useful also in other developmental programmes. During the sensitizttions the importance of compliance to all NTD drugs including onchocerciasis was emphasized 9 NOCP-Phase IV-Uganda 8 July 2009 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows tf necessary) Comment on: - Attendance of female members of the community at health education meetings Attendance of female members during health education meetings is satisfoctory. Female members also participate in discussions and selection of CDDs inctuding selection of female CDDs. This could be the teason why there ore many female CDDs although the number offemale CDDs (38o/o) is still less thon that of males. There is a need to train morc female CDDs for gender balanca The policy of women emancipation is encouraging women at all levels lo get involved in activities that affect the well betng of communilies. - [n general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). Female's participation during communigt mcetings when CDTI issues are being discussed is high and their decisions are respected.fn some of the communities fitomen are local council chairpersons, and this makes them get involve in social mobitizttion in various health programmes - Incentives provided by communities for the CDDs CDDs have continued to ask for incentives although this does not stop them fromperforming their duties as CDDs. Among the things they want are T-shirts, boots and bogs to carry medicine and registers as they move in the communitics distributing ivermectin from house to house. Despite their continuous demand they still participote in mass drug administration, evidence that they value thetr communities. fn some of the dktricts where NTD control Programme has provided T-shirts they are more motivated, and have a lot of pride in the communities they serye. - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Attrition rate of CDDs is generally low tn phasefour districts and this is not considered as a maior issue. The communities in somc of the phase 4 districts have suffered so much during the war that they do not wish to miss chance offree medicament. - Other issues Numbcr of communities/villages with community members es supcrvisors Numbcr of CDDs Numbcr of communities /vilhgcs with femele CDDs Total no. communities in thc cntirc project erca B, Number with community membcrs s supcrvisorc B5 Percentagc Be= B./ B. *100 Melc CDDs Bz Femele CDDs & Total B"= Br+B. Number of communitics with femele CDDs B.^ Percentage Brr= 8,"/8.r100 Adjumani 178 178 100 3,172 2,798 5,970 178 100 Amuru 77 77 100 2,560 1,360 3,920 77 100 Gulu 90 90 100 2,608 914 3,522 90 100 Kibaale 323 323 100 3,441 689 4,130 323 100 Moyo 189 rE9 100 2,656 t,769 4,425 189 100 Oyam 35 35 100 393 330 723 35 100 Total 892 892 14,830 7,E60 22,690 892 100 10 NOCP-Phase lV-Uganda 25 January 2010 District/LGA 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. Troining of health workers and CDDs on CDTI was carried out, with tinancial support lrom the Cater Center (TCC), Sight Savers International (SSl and RTI. The health workers are generally knowledgeable on CDTI at all levels. However, the health workers are few and overwhelmed with curative services at the health facilities. This makes them unable to provide adequate support supertision for all community bosed health programmes including CDTL FoT this teason, communigt supervisors have been appointed to assist in supervision of CDDs. The community supervisorc have continued to work without payment although they are agitating for incenttves. The new initiative of Vittage Health Teums may be a soltilion to some of the gaps created in the communily due to few health workers. The VHTs are now tnvolved in a number of health programmes al community level - Where frequent transfers of trained staffoccur, state what the project is doing, or intends to do, to remedy the situation . (The most important issue to describe is what measures were taken to ensure adequate CDTI implementationwhere not enough knowledgeable manpower was available or if staffs are frequently transferred during tlrc course of the campaign). There were nbfrequent transfers in phase 4 dMricts durtng the reporting period fn areas where such transfer mfly occur VHTs, community supervisors and Heolth assistants can bridge the gap. l1 NOCP-Phase lV-Uganda 25 January 2010 o\o c.l a dEcd b0p I o GI Or AUo z c.t - .-!r E$$ s.$E .SI P ^ s\iss E,$S$sv *sN EEs = sfls ?i'$$!sEe E $$$ EE Sg -d\hCE S E €E I i E*t.'g :ISs ES$ sg:S.F sts s sE r S E i$E :.8 }E g $.EBE il. l >. .-lLa. E 3 B-E i'E' ;-s EssE IEsE $ sI6q Ss ,3 s p E o E o $ -s E ts o i * I -\ r\ B U2 14q) q) V2: oL q) Lo NB q) dq) 5 o GI o)E o o E F aU(H o ./) c) o (l) -c)E (l) cB bo q clLF ,iir orl -oldlt-l E €) 6l li oo nU o Lo € z 6ll + - F ciOe S$ (jE F. o\ o\\o .+ t o oNq : o(\l o\ c,) o c.l ol co l----. o @ o\ N$ C\l oo \o F-ra rt c\ ia c.l .+ + la) o\+ N co o\ (7) Nt. |r)6t a o\ F- ia\o o\ al u) o\\o \o soo t---- EI E 19 I EI s IF o 0 o .=G c! frrb Lf<9U :E L6' otr €- z o .i + '(J S.iqv ictd €o$ coo+ \o6 \o o\ oo o @ €t-. ca ;t- ra c- oFr 6l(a N al(o 6l a) EI a) o sI o F €o!+ \o o\ € €t. ao r\ al({)6l ro(D tC :rd co -L =S$u) .oQ tr> 2E o)I E {I3 (.) d (' a( = €r\ @ca hc7) :_ <tr- +N (o soo : (l) E t) e) '= q) sU?tr ts 6l u) U' I :I 8rs9(D ;.F QT o oE z E JiY $ $ s a< e €) E a) I !o s U?F I hI a) 0 o ($ tr B aE () o (B cls M oxo E GIxo Fl tr o t'r Table 6: Type of training undertaken @ck the boxes where specific trainingwas carried out during the reporting period) - Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving l00Yo geographical coverage and a minimum of 65Yo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The proiect has achieved 100% geographical c(Nerage and therapeutic coverage was stable and ranged between 76% to 83oi in all phaselour districts. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(specifo) Program management Howto conduct Health education r' Management ofSAEs CSM SHM Data collection Data analysis r' Report writing Others (specifu) 13 NOCP-Phase lV-Uganda 8 July 2009 oal h(t tr GI cl(l -oq d o0 I o v)d o.I Oo z + qr$\$ S\) E E 0OH o$tr-*83$Ee H !Ef E.-Eg a f !,s € fr E g*a>rfi!E € ::IfZ fi E E i()=ds6E b '3's:EpEE IEs' E-, E F T $ ErlE ; E $S El :E ss El,, l r ,' B Btrsl q &s$ E1f E s till$ g B i s E$ ;la'€'$'s s SS EIE g 3 3 + *s -\ (t B4 %q)\)q) S 91 oL q) ta o rY! ! q) Fi s U l( ch rr GI ah c0 c) cl (C tr ot\ o l-. t, rd >t .o(a rq a 'o GI o tr (! o) F C-f orl -ol(€I FI h e€EEEE*sr'* E E€HE=E z z z z z z z €B2z z z z z z z z o8bs -otrc0 ,.ozd Ee-fg il o5o5 hI)o d^sbs ooFOF Ee' tso .d O.Z286ll= ot uFF{9 € *$E o StsFf €.eo.:oE = - 6€ -o H5F co @ \o F- o\c-. oo oot- ooo o6 F-O -i: o.l f7) $ c?) r-o r oq\ +\o ++ @o o\ <iN t € €r-o \o f-\o!+ lrl co \o € oo o *\o ,o- o\ o caF- orn co o\$6l \0 car+ \o \o o\ e(a\o t--C\6l o\ rat o\ € o\ + \o cA rr) cn oo(a ooc\ cos rr) .+(a t- i,,)\o o\ (a raia t-\o F- I e :Bs * $ -Y.: tr AA EEg;E o>*6 d '3 e" E$sAo6- o :B €EgE3 E'5 !z6 is$ oo oo o oo o o oo a c- F\r.- oo\ (n c.l CO o\a ra(*I (\l o\6 € cr c-t\ oo\ c.tN(r) o\ € ra Ng\ € €F- c\cr oo\ ciN o\6 (7) No\ € .9<Eq (rl B ti c () (,) (B cls v oxo E(lxo FI F o F{ o Rl 0. oA o I a d d 2.6.2 What are the causes of absenteeism? The causes of absenteeism were: People had moved to several placesfor work and some students in boarding secondary schools were not available to receive treatmenl In some of lhe conflict districts the communities were not stable. 2.6.3 What are the reasons for refusals? After the dhappearance of the symptoms of Onchocerciasis, some people percetve that they ore already cured ond they don't see the needfor continuing with ivermectin treatmenl a I 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. There were no serious adverse events reported in 2009. 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 | $Jganda Onchocerciasis Control Programme June 30 09 o\O oc o E 6! bI) o o. o(-) o a(! oL C)oo -qod o GI!cd a0 \o o) 13\ q) o' L\) "as B L ,x .tT B %v) q) (.) s) c1 =oL a)I\ o t q) (t q) U o li()a bo tr oq o t< o ho Lr EEo E ooo (B a/,H a crt tr G) C)() ta o R, th o C)(h +r o (A o(r, GIU qidr ol -ol(tl t-l :Ht =>c -EE 5<.E E S.H E8.9 ? EEE o.9E3 9C 310 oa o o eY(H !ao:i3sa 57i d6.= L)()-C tril9d *S3-o.@ro C) c c= doooOE,Ee o(H.= o '"i -c, C()'=.ll =d€-r& d €-S'*.$ $fiEEg @ Eo o Ex v) OF B -i ho+oEF. *)oog, I I I E* Eg $ o o!0e =o0>b x(,)(/) o b0 * 4a o (\l 6t c c! c.l(l 'ocd bo I o d 0r IAO z r- s B $ S \ a) Ss ES\lS ss s% €\s%EEt!rSa' €.8 .-.3TI =a)S,S\ts ES S\5E <E .-i o. ris bP!(q)\5Q)- ss *s 'Es €N *E\- r;S' q)$SPss .sE T:S SE s.h\q)$elhBS rSE 3$ SB sP!q) q=bI SESBSs =s);.s NF t: 6, o) q)LL o c) ;H .9.d !{ p.Es,r- .E 8E '= c) frtq;- rr.Ofr Hrbh?h;i5El ! ,dltt :.EI EEAI O(l)el '= - \l vEallic)*rl a >(Dq)bo : -EU -96)t6l> O rOlEEC)rhgE F5d D EE.ge(1){.,tsE .9 .oB IE-.< 5gF ; l-,. oil '; .-! cI t,UEI .EoiFl Er -o6\ obo6l (.) oO oFD o\c- \or- oo @r- r-F- oo ooo r-r\ oor\ c\c- 6 o€ tro (g o.o P{ Irui r-i trl !d o ^ bI)!rEc -lU6\ o o\c- \C)F- oo oor- r-c- o€ ooo r-c- oor- F-f- € o\r- oolL .. E]rI] frl o '.i o ,o0od^3bs ooEOF o\r- \or- oo €r- c-t\ o@ O€ r-r- @r- c-t\ @ ooo Fl E ,. c) o6 .o o .lJ €6EEzE o co -f oo$r.| C\r- oo oic\ir) @iAr- c\ oo r.| t\oo o\ \o o\Ot ca\o \o eA aad cA\o colrlr\ c.i\n\o c- or- o =f*^ r\ f- € C{ o\ @ ra(a) C.I co o\o oo c-a \o A Eo?6.2 €E$ c.l cn c\6t\o \o o\od co\o -: e.E -S'Eoboea.g,q<.E9 ,'=ots ' a 89& EE r- (n rala) s ctr C\Ir\iat GI$o o o\\a o\N 6o\o $o r- c\\o o\ o\q \o$\o $o\ s^ \o\o\o r-o c- €\o ooia c.l €oc- if16l o\(\lr- otatr- oi cAr- c.t c.t h ri\or- bo ot)(t c) tr tr E O o6 ll rEI ei H o9 S-Fo6\ -o o oo oo oo oo oo o oo oo oo oo oo oo EO=qap= se E85k Oeld oo oo oo oo oo oo oo o Oo oo oo oo f.l aoo'5E.E FEAE=EEE>K oor\\o o\o\\o 6lr\ cot+ r- \o\of- o\ oor- t € o\ co oo rr|\o oo r\F-a €r\ oo C{ Or oo ri EoE6.Z EEs oor-\o o\o\o c.lt\ c.l$t- \o\ot- o\ ooF- $ oo o\ cf) oo rat\o € r\ c- € oor- oo c! o\6 s =oISeisE'E.E€'E'-iSeEqg =Etrco 8 ac\\o o\ cr\\o 6lF- ca+f- \o\of- o\ oo c- $ € o\ ca oo irl\o oo r\r\ € oo F- oo c{o\ € & rI] 6 o\ o\ o\o\ o\ oo (\l o N (\I OoN coaoN too6l Oo(\l \oo (\l t- o6l oooo(\.l o\ooN 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) uon .,fl wion uirircilrtr Mectizan@ delivered by - Qilease tick the appropriate answer)MoHE wHo/ u uxrcBr ! NGDOtr Other (please specifu): _Order by Ministry of Health_ NGDO Other (please specifu): wHo Please describe how Mectizan@ is ordered and how it gets to the communities National Onchocerciasis Control Programme of Ministry of Health orders Mectizan. It is cleared and delivered to NOTF slores wilh the assistance of Wortd Heatth Organizalion(lyHO). From NOTF stores, the districts collect the drug and deliver it to the district medical inventories where the health sub-districts collect the drug. The /irst line heatth facilities collect the drug from the health subdistrict and stored at this leeel Then the communities collect the drug from the tirst line heahh facilities. Sometimes, the health workets and community sapervisors of CDDs deliver the drug to the communities when they visit the communiticsfor support supentision Table 10: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets are collected hy districts and treatmenL The high level of wastage in Kibaale has superviston and reasonsfor it addressed. caniedforwardfor the next round of to be investigated during support List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities carried out by health personnel include: t Delivery of ivermectinfrom the cenlre up to the lirst line health facilities where the communitics collect the drug at the time of distribution o Supervision of the CDDs during mass treatment o Compilation of reports on treatments and accountability of ivermectin usage - Any other comments | $Jganda Onchocerciasis Control Programme June 30 09 State/Dis trict/LG A Number of Mectizan@ tabletJ Number in stock Requested Received Used Used/Perso n treated Lost Wasted Expired Remaining Adjumani 2,248 456,500 458,748 379,251 132,407 44 0 2,453 Amuru 4,680 315,500 320,190 314,81 I 107,345 0 0 0 4,508 Gulu 355 292,0N 292,355 288,520 90,050 0 865 0 2,970 Kibaale 0 779,000 779,000 719,954 144,564 0 950 0 58,096 Moyo 481 473,500 473,ggl 350,633 120,909 0 857 0 1,491 Oyam 2,836 46,500 49,336 46,940 15,804 0 26 0 2,370 TOTAL 10,600 2J53,000 2,373,600 2,2g4,ggg 611,078 0 2,69E 0 7l,E8E 2,8. Gommunity self-monltoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? lf so, When? None hos been conducted 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. Community self-monitoring and stakeholders meetings were not carried out in 2009. However, in 2010 it has been included in the budget that has just been submitted to APOC managemenl. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Flg 7t Organization of health seruices in Uganda (the chain of command) 2.9.2. What were the main issues identified during supervision? The main issues identified during supervision included: Of Health Other line ministriesDevelopment Partners Referral Hospitals District Health Oflice District Hospital HSD HC IV Health Centre III Health Cenhe II Communities t9 NOCP-Phase IV-Uganda 25 January 2010 Minifv c Limited funds restricted the districts from regular support supervision. However, with USAID funding for NTDs districts will improve on conducting CDTI supervision in an integrated manner wilh other health services. The Carter Center regularly supervises the districts it is supporting. o Retrieval of treatment data and timely accountability of ivermeclin was still an issue in some districts. o Involvement of health workers in supervkion was inadequate due to small numbers of health workers at the health units o A few individuols refused treatment due to misinformation most of these were youths. o Use of integrated NTD registers still a problem in some of the districts. There is ongoing dialogue among stokeholders to embrace integration and to have a common stand and strive to achieve the elimination of some NTDs especially onchocerciasis. 2.9.3. Was a supervision checklist used? o Supervision check list was used. An integrated checklist for integrated control of neglected tropical diseases is being usedfor integrated supentision. 2-9.4. what were the outcomes at each level of GDTI imprementation supervision? o The districts promised to contribule some funds for CDTI activities. However, somc of these promises are notfuffilled o Parish and community supervisorc given more roles in overseeing treatment data comp i latio n in co mm un itie s. 2.9.5. Was feedback given to the person or groups supervised? o Feedbacks are usaallyftrst given to District Health offrcers who in turn bring to the attention of his District Health ream about a problem identiJted o Laterfeedbach can also be given to the groups supervised with recommendations to be addressed to tmprove the implementation of CDTI acttvtties. 2.9-6. How was the feedback used to improve the overall performance of the project? . Record keeping has improved at all levels. o Submission of treatment data improved in some of the districts. 20 NOCP-Phase IV-Uganda 25 January 2010 SEGTION 3: Support to GDTI 3,{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? The equipment provided by APOC and NGDOs to the districts is maintained by the districts. The equipment at the center is maintained by the Ministry of Health while that one belonging to NGDOs is maintained by lhe respective NGDOs. As regards replacement of equipment, especially vehicles, donors will be approached lor assistance where necessory. Nearly all the vehicles used by programmes in the Ministry of Health are donated and it ts unlikely that Onchocerciasis control programme will be exceptional. 3,2. Financial contributions of the partners and communities Table_l3.: Financial contributions by all partners for the last three years Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Conditi on No Conditi on No. Conditi on No. Conditr on l. Vehicle 2 F 2 Vehicle 2 CNFR 6 F 2. Motor cycle(s) F 5 F 3. Computer(s) F 4. Printer(s) F 5. Photocopier (s) F 6. Fax Machine(s) F 7. Others a) b) c) Contributor Ycrr I ('provide the oeriod 2007') Yc* 2 ('provide the period in 2008') Yctr 3 ('provide the period tn 2009) TOTAL CASH Budgeted rus$) TOTAL CASH Released russ) TOTAL CASH Budgeted rus$) TOTAL CASH Released russ) TOTAL CASH Budgeted rus$) TOTAL CASH Released rus$) MOH (Cenhal +District/LGA) 58,795 32299 44,642 33,300 44,642 33,300 MOH- district 12,717 I 1,300 14,543 t0,E42 14,543 10,842 Local NGDO(s) ( if any) NGDO partner(s) TCC 51,193 51,r93 479,624 479,624 Others a) Sight savers International b) usArD-RTr 35,979 35,979 25,000 25,000 2t NOCP-Phase IV-Uganda 25 January 2010 APOC Trust Fund 291,M8 223,331 31,645 19,056 TOTAL 362,560 266.930 146,357 131Jr4 595,454 sfifi22 - If there are problems with release of counterpart funds, how were they addressed? The prohlem with release of counterpartfunds is due to lack of adequatefunds at all levels. The districts receive Primary Health Care (PHC) grantfrom the centerfor implementation of primary heatth activities. 50% of PHC fund is for purchase of drugs and about 25% is for salaries. What the districts receive is usually less than what they requested which makes it difJicultlor the districts to implement the planned activities effectively. The districts are always encouraged to integrate their activittcs, which they have done satisfoctorily, such as integrated support supervision where CDTI has beneJited Contributions mtry increase with time since most of the phase 4 districts affected by the aftermath of contlict are picking up in terms of developmenl, thus raising lhe revenue base of the individual districts. Additional comments 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) c Distribulion of ivermectin by the CDDs o Collection of ivermectinfrom the nearest central point by the CDDs or village leaders . Community mobilizationfor ivermeclin treatment by CDDs and thevillage leaders at community level 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here-lUS$:2050 UGSHS Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ areato central collection point of community 2,800 TCC Mobilization and health education of communities 2,581 TCC Training of CDDs 17,724 APOCI TCC Training of health staff at all levels 987 APOC Supervising CDDs and distribution lnternal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treafinent VehicleV MotorcycleV bicycles maintenance Office Equipment (e.g computers, printers etc) 22 NOCP-Phase lV-Uganda 25 January 2010 Others TOTAL 24,094 Total number of persons treated 611,078 - Any comments or explanations? The Jigures in table 14 only include government contribution towards CDTI activities. It does not include salaries of Ministry of health staff and contributionsfrom NGDO partner. SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation { _Internal Monitoring by NOTF _{ _Other Evaluation by other partners 4.1.2, What were the recommendations? o Harmonization of activities among various stakeholders. o Training mare CDDs where the number of CDDs werefew o The districls encouraged to always include CDTI in their health plans and budget and release funds for CDTI activittes 4.1.3. How have they been implemented? o Use of integrated register, integrated support supervision and planning at all levels. o More CDDs were trained in all the districts o Districts including CDTI in thetr health plans although thefunds releasedfor CDTI is still inadequate due to low revenue collection base. 4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? When was the sustainability plan submitted? 23 NOCP-Phase lV-Uganda 25 January 2010 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Advocacy to the district health services will continue to ensure that Onchocerciasis and olher neglected tropical diseases control are integrated in the overall health plan each year. It should be apprecialed that health sector planning (annual and strategic), is an important activity, which has the blessing of the district/sub county councils and legally spells out what the health sector intends to do, in the stated period This will provide an entry point for CDTI programme integration. The CDTI activities will be in the districts', health sub districts', sub counties' and parishhillage (where they exist) health plans. This kind of arrangement will continue even when supportlrom partners cease. 4.2.2. Funds NOTF now under the umbrella of NTD will continue seehing political and technical supportfor CDTIfrom political and technical managers in the districts to include it in their health plans. Politicians will particularly be made to appreciote that atthough Onchocerciosis does not kill, it has serious social economic impact on comtnunities because of its associoted debilitating complications lo solicit for their support. It wilt also be emphasized that the drug (mectiztn) will always be availahlefor as long as it is neededfree of charge, the contributions which other partnerc are mthing and what is eryected from the districts to suslain CDTI activities. . 4.2.3 Transport (replacement and maintenance) The districts have continued to use transport in an integrated manner and meeting costfor repair of the motorcycles. However, replacement of the motorcycles by the health services may nol befeasible as neorly 100% of motor vehicles at all levels are donorfunded. Most programmes in tlte district have beneJitedfrom integration policy because planning, implementation of activities are all done together, including use of logistics. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented With support from NGDO partners and a grant from USAID for integrated control of neglected tropical diseases, integrated training manuals, supentisory check lists and IEC materials have been developed Advocacy meetings on integrated control of neglected tropical dkeases were conducted during the reporting period. NTD has supported the use of local FM radios ond this has played a very big role in social mobiliution as IEC materials like posters may not reach all the offected communities. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. 4.3.3. Ivermectin delivery mechanisms Training Joint supervision and monitoring with other programs Release of funds for project activities4.3.4. 24 NOCP-Phase lV-Uganda 25 January 2010 4.3.5. Is CDTI included in the PHC budgetr 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? 4.3.7. Describe others issues considered in the integration of CDTI. Delivery of ivermectin has to a large erteil been integrated within the PHC structure. When the district ofJicials come to Kampala for any other issues (as long as they have vehicles) they normally take ivermectin. However, NOTF or the NGDO parlner may take the drug if offtcers from the secretariat happen to be going to the district that requires From the district to the peripheral health units, delivery of ivermectin is fully integrated with delivery of other essential drugs. Although there are mnny community interventions that use llte Mass Drug Administration (MDA) strategy of disease control, none is integrated with delivery of ivermectin. This is mainly because the interventions tahe place at dffirent periods. A number of challenges are being faced with integrated control of neglected tropicol diseases, which include the following: RTI supports training of two CDDs and provides integrated registerc to the two trained CDDs. An average of I CDDs had been trained tn CDTI areas and this had reduced the workload of CDDs and demandfor incenttves. This had olso increased treatment coverage. The chollenge is that among the I CDDs already in place, whom do you include for training ond whom do you leave out in the RTI arrangemenl The second challenge is on reporting. RTI is interesled in treatment coverage while in CDTI, quite a lot of information is needed This implies exlra resoarces might be needed to collect the required information needed for CDTI reporting. Who will meet the cost of collecting aA this tnformation tor CDTI reporting formnt in fuure? There arc many programmes modeled on the CDTI structure. Promtnent among them is the Home Management of Fever Strategt, distribution of ivermectin and Albendazole forlhe control of lymphatic Filariasis, distribution of Praziquantel for the control of Schistosomiasis ond to some extent Directly Observed Treatmcnt for control of tuberculosis. All the above programmes have been regislered varying degrees of success. Distributors of ivermectin are generally involved in many other health and developmental interventions. Also involved in the interventions are community memben and health staff, Their involvement in the interventions is however, haphazard with no clear guiding principle of participation. It cannot be concluded that the add-on interventions enhanced performance of CDDS. However, it was noted that the interventions were offering incentives to CDDS. It has also been observed that where CDDS are made to distribute ivermectin with albendazole, many people turn up as albendazole is a ncrowd puller, 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operalional research was conducted in phase 4 districts. 25 NOCP-Phase tV-Uganda 25 January 2010 Strengths o The CDTI programme has built a strong structure, which has been exploited by olher community, based interventions. There is now evidence from several studies that when CDTI is co-implemented with other health interventions, especially those perceived by communities as their priorities, ivermectin lreatment coverage increases, This is an opportunity to exploitfor sustainability of CDTI o Uganda is one of the Jirct track countries to receive funding from USAID grant for integrated control of neglected tropical diseases and phase four districts are benefiting from these funds, where ivermectin distribution is integrated with Albendazole to control Soil Transmitted Helminth infections and Lymphotic Filariasis and Pra4iquantel for Schistosomiasis controL Weaknesses o The health workers are few and mostly involved wilh curative services, leaving no time for public health inten:entions, which makes support supervision dfficult. o Although there is now adequate linancial support from partners, there are tinancial resources contributed hy the districts health services for suslainability when externalfunding comes lo and end. Opportunities o Currently there are many interventions, which are using CDTI as a vehicle to deliver other community interventions. These in turn come with many opportuntties in form of incentives. These interventions provide avenues for integrating with CDTI, which creales an opportunity for CDDs to get incentives. However, this might be detrimental to sastainability of CDTI as the sustainability of these prugtammes is questionable. Threats While other community intententions provide opportunitiesfor CDTI, they can also be threats if not well harnessed. Because some intententions come with incenttves, the distributors of ivermectin are likely to abandon CDTI for the above intementions. There is no set lime when ivermectin will be stopped. This mtkes advocacy dilftcult especially among the young community members who have no experience wilh signs and symptoms of Onchocerciasis. SEGTION 6: Unique features of the projecUother matters Vector elimination was achieved about 4 years ago in Mpamba Nkusifocus in Kibaale district and no vectors have been seen tn thefocus since then. However, surveillance activities are still ongoing in thefocus. It is only Kibaale district where the vector is Simulium neavei, but the rest of the districts in phase 4 the vector species is S. damnosum, afactor attribuled to the ecologt of the respecttve vector. a 26 NOCP-Phase IV-Uganda 25 January 2Ql0