-1 ,'} / THE UNITED REPUBLIC OF TANZANIA ula r,t io: v -, acJ 4 $i( ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meetingc$D CoP AH For lri,o;,. on gtu To APOC Management by 3L Julv for September TCC meeting o AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) To, \ A, AA Proiect Name: CDTI Morogoro Focus COUNTRY/ITIOTF: Tanzania Launching year: 2003 Approval year: 2002 From: l't November 2005 To: 31't October 2006(Month/Year) ( Utqq!!/Yg4.)Reporting Period Proiect year of this report: (circle one) I 2 45678910 Date submitted: NGDO partner: SSI 1 1 \lrll i1iti6 WHO/APOC, 24 November 2004 tANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to the re Country: Tanzania National Coordinator Name: Dr. Grace Saguti. Signature Date Zonal Oncho Coordinator Name: Dr. M.M. Z. Massi. . . . . .. Signature Date NGDO Representative Name: Mr. Pius Mabuba.. Signature Date This report has been prepared by Name : Dr. N. C. Kanyika Designation : Project Coordinator Signature Date WHO/APOC, 24 November 2004 Table of contents ACRONYMS..... v FOLLOW UP ON TCC RECOMMEI\DATIONS 7 EXECUTIVE SUMMARY 8 SECTION I: BACKGROUND INFORMATION l.l. GsNpRar-rNFoRMATroN.......................... 1.1.1 Description of the project (briefly) . 1.1.2. Partnership 1.2. Popu1eroN................ SECTION 2: IMPLEMENTATION OF CDTI TIMELINE oF ACTIVITIES ADVoCACY MoBILIZATIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES .... CouNlu,ltry INVoLVEMENT ............ 2.5. CepacrrvBUrLDrNG..... 2.6. 2, 2, 2, 2, 2, 2.7. 2.8. 2.9. 2.1. 2.2. 2.3. 2.4. 3.1. 3.2. 5.5. 3.4. TRparupNrs ................. 6.1. Treatmentfigures............ 6.2 What are the causes of absenteeism?.............. 6.3 What are the reasons for refusals? ..6.4 Briefly describe all lcnown and verified serious adverse events (SAEs) that... 6.5. Trend of treatment achievementfrom CDTI project inception to the current year ORDERING, SToRAGE AND DELIVERY OF IVERMECTIN CovuuNnY SELF-MONITORING AND STAKEHOLDERS MPPTTT.TC SupgnvlstoN ....... 20 22 22 22 24 25 25 26 26 26 26 26 26 26 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. Provide aflow chart of supervision hierarchy. What were the main issues identified during supervision?............ Was o supervision checklist used?.......... What were the outcomes at each level of CDTI implementation supervision?..... Was feedback given to the person or groups supervised? How was the feedback used to improve the overall performance of the project? Eeurpupur FmaNcIaL CoNTRIBUTIoNS oF THE PARTNERS AND COMMUNITIES...... OrusR FORMS oF coMMUNrry suppoRT ................. EXPENDITURE PER ACTIVITY Planning at all relevant levels........ Funds Transport (replace ment and maintenance)....... Other resources ............ To what extent has the plan been implemented SECTION 4: SUSTAINABILITY OF CDTI ........29 4.1. INTERNAL; INDEPENDENT pARTICIpAToRy MONIToRTNG; EvaLuanoN................. ............29 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the foll ow in g w hich are appl icab le).............4.1.2. kVhat were the recommendations? .. 4.1.3. How have theybeenimplemented?.................. 4.2. SusraNasrI-lTy oF PRoJECTS: PLAN AND sET TARGETS (MANDAToRY AT Yn 3)..... 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. 29 29 29 29 29 29 29 29 30 30 lll WHO/APOC, 24 November 2004 .Erreur ! Signet non diJini. ...... I I 9 12 t4 4.3. 4, 4. 4. 4, 4, 4, 30 30 30 30 30 30 INTEGRATroN................ 3.1. Ivermectindeliverymechanisms 3.2. Training..... 3.3. Joint supervision and monitoringwith other programs 3.4. Release of funds for project activities.....3.5. Is CDTI included in the PHC budget?....... 3.6. Describe other health programmes that are using the CDTI structure and how this was achieyed. Wat have been the achievements? .......... ......................30 4.3.7. Describe others issues considered in the integration of CDTI.................................... 30 4.4. OppnerroNALRESEARCH.. ..........31 1.4.1. Summarize in not more than one half of a page the operational research undertaken in the project areawithin the reporting period...... ..................31 4.4.2. How were the results applied in the project? ................ ........ 3l SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES........ 32 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ......32 lv WHO/APOC, 24 November 2004 Acronyms APOC African Programme for Onchocerciasis Control ATO AnnualTreatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization MTUHA(HMIS) Mfumo wa Taarifa za Uendeshaji wa Hudumaza Afya(Health Management Information System. IMCI Integrated Management of Childhood Illness MCH Maternal Child Health TANESCO Tanzania Electric Supply Company CEDHA Center for Educational Development in Health Arusha REMO Rapid Epidemiological Mapping of Onchocerciasis WHO/APOC, 24 November 2004 Definitions Total population: the total population living in mesoflryper-endemic communities within the project area (based on REMO and census taking). Elieible population: calculated as 84%o of the total population in meso/hyper-endemic communities in the project area. Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/lryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) lntegration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilit-y: 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 govemment. (ix) Communitv self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (i) (ii) (iii) (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 ofthe 3'o year ofthe project). vl WHO/APOC, 24 November 2004 FOLLOW UP ON TCG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 7 Number of Recommen dalion in lhe Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY l. Include more information on programme history and background, as well as achievements in the Executive Summary. Information on the project background, activities conducted, challenges and the way forward have been well summarized in the executive summary of this report as requested. ll. Use ten divisions as unit of reporting to allow for more detailed assessment of activities, so that support could be directed where needed. The district has a total population of 524,495 inhabitants, of which the pretreatment census 260,960 persons are living in meso and hypemdemic areas. During the reporting period a total of 175,746 persons received treatment. Administratively, the project area is divided into 10 divisions, 33 Wards, 146 villages and 826 sub-villages hereby referred as treatment units. lll. Indicate clearly which months of the years the CDTI activities refer to. The implemented CDTI activities have been summarized on table 3 in page 15 below. tv, Make special effort to involve women. Community mobilization was strengthened to raise women attendance during the Annual Mectizan launching day using the influential regional leaders (where the Regional Commissioner, Regional Medical Officer and District Commissioner actively participated in the mobilization and sensitization campaign). Drama groups were also involved in the campaigns. v Correct data error. Correction of data enor The Annual Treatment Objective :96.50/o. vt. Aim at 1007o geographical coverage & a higher therapeutic coverage during the next cycle. At the moment, all the 828 sub villages already confirmed to be Oncho endemic have already been treated therefore attaining a 100% geographic coverage and an overall chemotherapeutic coverage of 7 5 .3o/o from 67%o of the previous cycle. This was also complemented with REMO refinement where the neighboring villages to the project .uea were surveyed for Oncho endemicity. Those found meso or hyper endemic will be included in the list during the next treatment cycle. vlI. Improve on HSAM. IEC materials with Oncho messages were produced to increase knowledge of communities about Onchocerciasis. Training and retraining of FLHF staff and CDDs were canied out before the distribution cycle. WHO/APOC, 24 November 2004 Executive Summary Morogoro CDTI Project is in its second year of implementation. The project has a total of l0 divisions, 33 Wards, 146 villages, 828 sub villages with a total population of 524,495 people out of which 260,960 inhabitants are living in Oncho hyper and meso endemic areas. During this cycle, a total of 828 communities (sub villages) with a population of 524,495 received ivermectin treatment therefore attaining a chemotherapeutic coverage of 75.3Yo. During the reporting period a total of 154 FLHF workers, 32 CHMTs, 5 TOTs and 1,668 CDDs were trained and retrained about Oncho disease, its public health importance and treatment. The CDD ratio to population ranged from l:150 tol :200. In addition to this, other activities conducted during this ivermectin distribution cycle were pre- treatment census, community mobilization and sensitization, Mectizan distribution, monitoring and supervision and collection and compilation of treatment data for report writing. During the implementation period, the project also recorded a number of successes and challenges. These were:- o Delays in release of funds by donors resulting in failure to timely implementation of the project activities. . Community Directed Distributors do not get frequent training which they regard as motivation. As a result, this has resulted in dropouts, demand for transport and other allowances as some of them serve bid areas depending on the population dispersal o Distribution of Mectizan became difficult in schools especially during the reporting period because the individual scholars' sub village cannot be known easily. o LonB distances covered by a single CDD have resulted in low chemotherapeutic coverage in some communities. . High refusal rate resulting to low chemotherapeutic coverage. o Lack of support to CDDs by some village leaders during Mectizan distribution. o Conflicting interests between CDTI and other community based programmes which provide incentives to their supporters . CDD dropouts partly due to lack of motivation. The following recommendations are made to address the above mentioned challenges:- - Timely release of funds to allow the project to implement its activities according to its work plan. - Frequent training of CDDs as means of motivating them - Select more than two CDDs in sub villages with higher population density in order to maintain the recommended CDD number to population ratio. - Strengthen community mobilization and sensitization to reduce the number of refusals and increase chemotherapeutic coverage. - To motivate CDDs whenever possible. 8 WHO/APOC, 24 November 2004 SEGTION {: Background information '1.'1. General information 1.1.1 GeographicalLocation Morogoro Region is one of the 2l regions in Tanzania Mainland. It is an inland area lying towards the East and Southern boarder of Tanzania Mainland. The region lies between latitudes 5o 58" and l0o 0" South of the Equator and between longitudes 35" 25" and 38o 30" east of Greenwich. It has a total area of 73039 sq km which is 8.2Yo of Tanzania. According to the 2002 population and human settlement census, the region had an estimated population of about 1,759,805 people with a growth rate of 2.6Yo annually. The region is inhabited by Luguru, Kaguru, Kwere and Masai tribes. These communities consist of indigenous and nomadic population; the mountainous areas being much more densely populated than the low land. The young people keep on migrating to look for employment in towns and to areas or neighboring regions where there are newly discovered mines. The main occupation of the community is farming of foods and cash crops, cattle herding, small scale fishing and timbering. Several rivers and tributaries originating from the mountains cut across Morogoro region. Major rivers include Kilombero, Ruaha, Luwengu, Ruw, Wami, Ngerengere, Mkondoa and Mkindo. There are about 143 rivers, which form very large plains in the lowlands consisting of fertile alluvial soils. Due to the climatic influence of the Indian Ocean, the Eastern Arch Mountans have unique plant and animal life. Although environmental degradation has affected the area for many years, there are still different species of fauna and flora. This is particularly true in the case of the Udzungwa and Uluguru Mountains. The Morogoro CDTI focus covers the districts of Morogoro Rural and Mvomero. The later being a newly created district carved out of the previous Morogoro Rural district in NIay 2002. The two districts lie between latitude 8o and l0o south of Equator and between longitude 37' and 38o East of Greenwich. Topography The two districts are divided into three geographical zones:- (a) Mountainous or Highland Zone (25%) This zone covers the Uluguru Mountains located at an altitude of 1200 - 2000 m, above sea level with the clay type of soils. The zone is suitable for the production of maize, beans and horticulturalparticularly Mediterranean types of fruits. (b) Semi-Mountainous/Low Land Zone (20Yo) This zone covers most of the Southern part of Morogoro/Mvomero districts , at an altitude of 800 - 1200 m above sea level with sandy clay loam type of soils. The zone is suitable for the production of maize, cassava and sorghum as staple food crops. (c) SavannahZone (55%) This zone is located at the altitude of 600 - 800 meters above sea level; with same clay loamy type of soils. The zone is suitable for paddy, maize and cassava, for both food and cash crops; and also suitable for sugarcane, cotton and sisal as cash crops. Part of South East of the zone falls under Selous National Park, further the district has big valleys and numerous fast running rivers such as Mgeta, Ruvu and Wami-Luhindo. Climate The region enjoys two rain seasons - the short rains, which normally starts in October and ends in January and the long rains which commence in Mid-February and end in May. The annual rainfall ranges between 600 mm in the Savannah areas up to 1600 mm in the mountainous areas. . The temperature ranges between 20oc up to 28oc. 9 WHO/APOC, 24 November 2004 Population According to the 2002 national population census, Morogoro Rural district has a population of 263,970 with an average household size of 4.7 where as Mvomero district has a total population of 26-,525 with an average household size of 4.5, Majortribes are Luguru, Kutu, Zigua and Kwere; minor ones are Kaguru, Sukuma and Masai. Their main activities are:- - Subsistence farming - Business - Livestock keeping Cultures Main cultures are:- - Traditional ngomas, (dances), - Use of traditionalmedicine, - Conduction of church sessions over the hills Languages Main languages include:- - Kiswahili as a National Language - Local languages ie. Luguru, Kwere, Kikutu and Masai Communication The total road network in the district is 1168 km. The roads are divided into the following categories:- - National truck roads - 188 km (tarmac) - Regional roads - 343 km - District roads - 295 km - Village feeder roads - 342 km (40% are passable throughout the year and 60Yo seasonal). Most of the road network is passable during the dry season, but some feeder-roads to the villages are impassable during the rainy season. Administrative Structure Administratively the two districts are divided into l0 (ten) divisions, 42 wards and 207 registered villages. They also constitute 3 parliamentary electoral constituencies. Health System The Morogoro Focus CDTI Project area is constituted by 3 hospitals. One owned by the Government, one (1) by Parastatal organization and the I (one) by Voluntary Agency. There are eight (8) Rural Health Centers; five (5) being Government owned and three (3) belonging to Parastatal organization and eighty (80) dispensaries of which 56 are owned by the Government, twelve (12) by NGO's, ten (10) by Parastatal organizations and two (2) by ind ividual/private organ izations. There are also (59) fifty nine village health Posts of which 50 (fifty) are owned by the Government and 9 (nine) by NGO's. 4 WHO/APOC, 24 November 2004 l0 WHO/APOC, 24 November 2004 Table l: Number of health staff involved in CDTI 1.1.2. Partnership The Project involves the following partners in its implementation at all levels from region to community. Ministry of Health, NGDO's like Sight Savers International, APOC, District Council and Community. Working Relationship l. M.O.H.- Provides strategies and guidelines in approaching any planned activity. Provides financial support to the project. Supportive supervision and internal monitoring during implementation 2 S.S.I Provision of funds for different activities like advocacy, sensitization, mobilization of the community. Provide building capacity to implementers. Provide funds for renovation of the project office, furniture etc. Monitoring of project activities and expenditure periodically District Council:+Provision of human resources and non human resources to ensure sustainability of the project. - Provision of supportive supervision and monitoring. Community:- As owners of the project - Collection of Mectizan from nearby FLHFs. - Selection of Community Directed Distributors (CDDs) - Provision supportive supervision to CDDs - Self-monitoring and evaluation of themselves and the CDDs. - Is supposed to motivate and provide incentives to CDDs ---+ + + + ---+ + J 4. District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Bz Percentage Br=B/ Br *100 Morogoro Rural 153 96 63.00 Mvomero 152 96 63. 15 Total 305 192 62.9 ll WHO/APOC, 24 November 2004 <. N 0)! C) o zs c.l (-) o o N aiL 0) o o ot) +i 0)L Cd o C) 'a (.) o d a. o a. C) !(d th 0)H 0) (r o o F L C) o d o o a niok(t o c) 'a l< a. C) (H o C) rE lia 0.) Cd u)! C) o 0 F (, oo L o C) (t) o a oo Cd o rE o C)bo(€ Lo oo L(.) P (.) ho (r) o (* \o (\ L d C) c)(.) ah o(J o a L 0) cr,(.) o ,o(n 6-) .o(EA PHoo € c-' e> d; iiE oc) €o(*tr oo 6)P()(q =da\)o+ Po ac) Fa d zE* 6 C) E o L 0)a 00 L o 0) o bI) L ! (.) o 'o oo 'a La C) l< € at) ct) (.) o(! ad V) . T\ L t -.1o (.) bo f o.(.) L o bo t< o L C) oL C)L CB (.) li c) (.) 0) CE (, q) o q) o Ia L (n o Cd o (! (h C) E o() e..ir ol -oldtFI E o g G fr oE N F \\) () q)\ B oq) L. I \) q) a)L q) .a a) J \)\ \) '=\ --i. 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CB 0) C) F (.)l ol sldttl o o g tr +a o6 tF o o E o E F =N F a(, lF o E o !Ifl G{. c o EIc E IIN z o IF(, ul o (h t-q) C,) o EE U \o oN tr.l zf, \o N rI] zD Eor 1:Jtr(!: ONJ & o. \o c{ -l & L ah OI ao 2sDO;r 6l B-Ao - c.l bnEE liE a- o.l J &A \ooo c.l J & C) CB U) ah o(J o o9 aEEEoU \o N rl.] zf \oo c.l rI] zD b!_ 1itr \o (\ J & o. \o c.l J dA AT cllL t'r o! aaEEoU O oZ ro<o =iO2 e.r O c( ro<o 2 ..t a0ET 1|Jtr a- & F] la g.l(-) y? OX & E] ca 2 rl.] ox E'G=Nr oolrC')a o o9 EEo Q \o oN mr!f! \o c.l o rr.ltu 1rtr c.l d E] H oo(\ q.l IJ rl o ah o obo o o z o c) o z Fl H t'r 2.2. Advocacy At the regional level, l0 policy makers, 38 decision makers at district level and 828 supervisors were mobilized. The reason of undertaking the advocacy to familiarize the policy and decision makers with CDTI philosophy. Difficulties faced were fund constraints, few people attending meetings, the activity was conducted during rain season and most of our roads are not passable during this season. Suggestions on how to improve advocacy is to continue sensitization and improve IEC materials. 2.3. Mobilization, sensitization and health education of at risk communities In addition to the advocacy seminar for policy and decision makers, at the community level, an event of annual Mectizan launching was organized where facilitators were drawn from the regional and district levels. The event was entertained by local drama group and primary school children. The main messages delivered were the knowledge about Oncho, its transmission, its quencequences, treatment and the safety of the drug (Mectizan). During the Mectizan distribution, we have also managed to use the local medias like radios, magazines, brochures and leaflets to disseminate information on CDTI and encourage communities to turn up for Mectizan swallowing. As a result, drug compliance was high, as there was an improved awareness about the disease and its treatment in most communities. t4 WHO/APOC, 24 November 2004
cooON o -o o o z + c.l Qo0. o \o I Ebo -.(6try?p'E v)6r q.Ex(Xt'E ^9.2EOPq,C)9r;6 E ::= rE(!E ,E P.: ! oo x_tr th L C).He>a)2 .E €E! - vF a,o !oU € =>>,svtro .^a3,trr HS)o h.9 5 E tsE E E EEs a ,sg eb;o ;.: !/H a = -Y o--r= cqC,7EEI. UE E 9t g8tr a tr c---H; E .E g "bolu#() ->.E Fo B E-E,EE. 3I = tr- q-< -=i HH oP50 oU b;'E(J A c C'l3 3 " A':b:€ u6 I .E U = bbE oieQ .F.i : .EEt eE -lfoiB' o-E EE"o'6 9 q 0r€.9 H= ,i[i- h ,n7 aEAd FX 90 -6zr tr6E E QE E 'Eoru.rEHU; *; E;.: g Y€ H!=oco0Po=2-C(l)() a E.H e'E oE c - (l)'= 'F dH2rriL e 5 9 ',=-i _ dr_* orr= F () ,-A__E .! rd o 5 = jCE re: so€.=3=9 9<iE-c -vL^OF'-68..i(E.-EEE *E-pE *& i ; s = tg =s g= - o" EEEHEE.E:b59.E.UEER()'.= 7 ().=E':F9E >,;'E: iQ € EE; E SEb E H H€.E5 i€<EO0v>od aaaaa at) 0) U F U sP LPOcE;o.9 xO .LI EEt- (t flY!E.E =q;=EtrEEo,q(,Y +l . o)ltbl r (glNFI o 6l e o UD c! oO E z ll * b0 q o oo oo oo e 2o =vEo eI Oo OE z @@ N c,cl6 o E o c! (, o z + rL la F +6F @@ 6 a0@ 2o O r1 N CDo N tto6 ca Q 0 ct z Noo N + @ >o 0'= Ui ?n z il* Ead ce 0 oo6 o oo soo oo -l o+EL 't E.a o >- .o.= L ==ez ? E @@o N -f @6t@ 6g'gC: -EE=G50x! e o.1i E5 e @@ N @6t6 I o bI) !o2 o o d F 2.5. Gapacity building With regard to capacity building /strengthening training was organized and conducted for different project staff at different levels of project implementation. These were:- o Project Coordinator attended training on writing skills. This training was organized by NOTF (Ministry of Health - Tanzania) and funded by APOC. The training was conducted at the TANESCO Conference Hall in Morogoro Municipal. . The Ministry of Health organized and conducted a training on project management for TOTs at the CEDHA in Arusha, Tanzania. o At the project level, all the FLHF workers, Ward Executive Officers (WEO), Village Executive Officers (VEO), sub-village leaders and CDDs were trained on the CDTI philosophy. Generally speaking, the project has greatly benefited from the trainings conducted for different cadres at different levels of project implementation as these have been the key persons in advocacy and community mobilization and sensitization. We have also included in our work plan for the next year to conduct training for primary school health teachers and community development officers residing or working within the project area. Currently, frequent transfers of the staff working within the project area were not observed. But since these are the government employees and may be transferred at any time, the project has taken precautional measures to overcome this whenever it happens by training 2 -3 staff in each health facility in both districts. t7 WHO/APOC, 24 November 2003 q) G 0 a (J o () z 2 o .= +Fv.+ T.!qv ir =v s @F- $\oF- o.t sf, oo oo \o F-F- € €\o\o o =ra € GI 6 q) () {) \c?=FU oF-F- \t€€ rc ra\o q q) .l'o' cH r.F9v og{ Lcg ola z Lv = .U U is =v + N t c.l co t o €) !) q) U N N = 0 q) o€oc) dL3; !i: q) z E.'? +F-d po U* q) q) q) \o UF C! o O J 9oO() o o z E,r?F'd \.) U 0< z F- : -- \o F-r- \o \o $ ra N GI ett) e Q) q) o I \Y UF F-F- F-F- tin j q = o o oo o o z o o o (.) o z Fl 3 Fr o N c) .o () o z +N o0. o @ bo a o\ o G I € o bo p a : qq sa \) .b 4 U t q)q qJ n- 6l 0) 0) a F U o o q) o oL .0) 0) cl u0 c! F ral orl eldttl = Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Trainees Type of training CDD's Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci tu) Program management ./ How to conduct Health education Managemen t ofSAEs { CSM SHM Data collection Data analysis { ,V Report writing ,v Any other comments Training for political and religious leaders is envisaged ideal as they play a very pivotal role in mobilizing and sensitizing the community. This could not be conducted during the reporting period due to lack offunds. a 19 WHO/APOC, 24 November 2003 2.6, Treatments 2.6.1. Treatmentfigures At the moment, all the 828 sub villages already confirmed to be Oncho endemic have already been treated therefore attaining al00%o geographic coverage and an overall chemotherapeutic coverage of75.3o/ofrom 67%o of the previous cycle. However, there are doubts that some of the adjoining villages to the project area that may be Oncho endemic. To confirm their endemicity and eligibility for inclusion REMO refinement in l6 villages were examined to complet and the report has been prepared to the higher authorities. The project is waiting for feedback from the NOTFA.IOCP for the list of additional villages to be third year treatment plan. Table 7 below shows in summary the treatment figures for the Morogoro CDTI Project for the second year of its implementation. 20 WHO/APOC, 24 November 2004 +c.l q) ! () o z$N -aL' o o. o I c.I q){ s\ S q) 00\ AJ E{$\ Io U 00 .it\\q,{(,!FU La,u (l OsLUs.s(Ji .os\q's,*;$s oot .E€\ --U 2'rd D9LE isE$s o.aaE EiE t.sYP: o^so.:d -b€ E 3.E'5tr;\ \ : $*;-a. IE FSE i''l *rqr Y 38p : s.Es s Fie ;':iq s ssU \ Ebfr .: iro s 99xt*='5 S S'raE { ;e - P !=c a t\E S. .S;io i tss E$i s: M qJQ!. :Pt !:E$sP\S .r :.8cr iPs *si \\i =tE SS .s 'tr3E is$ U:s s.i r\F% il [E rr Uts x'n\ \)\ x ! 0) (B() q) o oo0 o H()p z Eo C) o cd oF -o o\ olol -t lo)xt > EI E El8 ,l= Olool Eot E ol id tslgpl ' rlE trt c zl< (d(.)Ld (,) C) 'a a 0) :(J z r! >. .o C) rE c)! tn Cd q 0.) 5t = xl 5 El.g(6l Eql 0)El 'r, -ltol 0.)bd .rdl 6 -t o->l > at <()l o 'E-l a 'El Ifl tr trl q- =t oEI3q ol tr ul 3ol c -ol - ql d =l oZlt- (n 6.) o 0) 'a r o. 0) B o 0.) oo o C) 0,) IHo oOl aol o) -t Exl -!l.-9l oodl c 0)l .- olEIE ol .= el E el =ol +Ll Iol o- .ol - trl (d =t ozt? 0) (6L() bo L\9o 9-- oo oF 0) (o k() oodLo o() d,A()\o -qva.(d ! bO oo \J () c) 60 cd 0,) oo <.r G '5 o\jv o o. 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Mainly due to misconceptions and myths build against Mectizan that the drug is used secretly for family planning purposes. o Inefficiency in drug distribution by CDDs attributed to the lack of motivation. 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. No SAEs occurred during this period 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 { 22 WHO/APOC, 24 November 2004 I $ ON o -o c) o z $N o. > c.l c.l \) \ q) o' Lq) .a \qJq * -:\ sq 4q) Uq) q 1 UL q) +3 B a) Fi q) E E o 0)a bI) 1i o a. 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N o\ oo Ll ^.= .^ . . oE6 tr boo ^-d= = F= Uttr>Ez6-o \o ca) € o.l oo l-l :oE b.z aEo < g4FU O c.l c.l o + e.l -o^ J.yyoS o-o ts5€'9 *O4.r_ -'- O .=,it O=.,o Eco \o$ €(\@ F- o\ o\ oo o\ o\ o\ o\ o\ o o.l N c.l oN co N $O N oN o N r- oN 6 c.l o\OON N s oN o! C) z$N Q o -) $(..l -aa ! c! -(.) (J q) EO c{t-q) o o t'r) =CE L ! CE \^L i YI xO)BE .h q,)SEA.eu.h .\d 6l$eJo'sL eSU0 iriNZt-\.i -qJi9ko) o :.| t) -s{=:A_-i o\;l!lE8l .-tt -l o;l?UIH.-l !LlEaloloLtl..iltrElFo$lHcl.<fla€elQxKl Eq:dlLI I "EEI €h';EhI Uo:l lr E-l ool tieH.ivl --lu =attH-ol o.2$9L-oi:!t(.)L!e€ o e rlrrrEY - =(dp-a v v;- l rIeEsFECB .d)<Jln.r= .-v\o.ENo\lJ 0.)l .h €-uFI F. 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH il WHO E UNICEF E Other (please speciff): NGDO E Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH U WHO E UNICEF N NGDO E Other (please speciff): Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan@ is ordered by the MOH using the formula of total population x 2.2. When the drugs arrive at the port of entry the same ministry cleared them and transfer to Medical Store Department whereby Project Coordinators collect them for their respective districts to the district pharmacy then District Councils distribute them to health facilities whereby FLTIW inform the communities about the arrival of Mectizan@ for collection and swallowing. Table l0: Mectizan@ Inventory (Please add more rows if necessary) 8000 tablets were used in Morogoro Hospital. - How are the remaining ivermectin tablets collected and where are they kept? The remaining Ivermectin tablets are collected into bottles and taken back to the District pharmacy to be stored for next distribution. Activities performed by Health care personnel in the project area:- l. Completion of Mectizan ordering forms by FLHF workers and forwarding them to the project office via their respective DOTs. 2. Making follow-up of Mectizan arrival at the MOH Headquarters in Dar es Salaam 3. Collection of Mectizan from MSD by Project Coordinator 4. Distribution of Mectizan to Health facilities according to requisition forms. 5. FLHW disseminate information to sub-village leaders and CDDs about the arrival of Mectizan. 6. Delivery of Mectizan to CDDs / community leaders 8. Supportive Supervision. - Any other comments - No 2.E. Gommunity self-monitoring and Stakeholders Meeting Training (of trainers) for community self-monitoring has not been done in the project area during the reporting period. However, this has been scheduled to be implemented after receiving the second installment of funds from APOC. Training of the Community Self Monitoring (CSM) is planned to take place as one of the activities to be implemented in the third year. state/District/LGA Number of Mectizano tablets Reouested Received Used Lost Wastcd Expired Remeinine 489443 Mvomero 345566 345566 280613 3 109 Nil 61,834 Morogoro 342053 342053 283868 I 150 Nil 58,1 85 TOTAL 687619 687619 5644E1 4459 NIL 1200r9 25 WHO/APOC, 24 November 2004 Comm and Stakeholders 2.9, Supervision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2 Main issues identifted during supervision Improper recording system in sub village treatment registers Inadequate support of CDDs by the community 2.9.3. Use of a supervision checklist - During supervision checklist was always used whenever supervisory visits were made. 2.9.4 Outcomes of supervision at each level of CDTI implementation - Increased awareness among communities - Reduced number of refusal rate and absenteeism. - Ensured adequacy of mectizan supply at the FLHF and community level. 2.9.s Feedback given to the person or groups supervised Feedback meeting currently is not yet given to the communities but is planned when we receive the second installment from APOC. 2.9.6. How was the feedback used to improve the overall performance of the project? This is planned to be done as the project has just completed its treatment cycle recently. No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) DistricV LGA Total # of communities/villages in the entire project area NONE NONE NONE NONE Mvomero 386 442 TOTAL 828 COMMUNITY RMO DMOPC DOTs FLHWs CDDs 26 WHO/APOC, 24 November 2004 SEGTION 3: Support to GDTI 3.'1. Equipment Table l2: 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 project conducts regular maintenance of vehicle and motorcycles. Source Type of equipment APOC MOH DISTRICT/L GA NGDO Others No Condrtron No. Conditron No Condrtton No Conditron No Condrtion l. Vehicle I F 2. Motor cycle(s) 5 F 3. Computer(s) 2 F 4. Printer(s) I F 5. Photocopier (s) 1 F 6. Fax Machine(s) I CNFR 7. Others a) Office chairs 9 F b) Office tables J F c) Computer table I F d) Photocopier table I F 27 WHO/APOC, 24 November 2004 Contributor Year I ('provide the period') Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) MOH (District/LGA) 3424.65 3424.65 Local NGDO(s) ( if any) NGDO partner(s) 19740.088 21740.881 34000 18,652 Others a) b) Communities APOC Trust Fund 140613 72000 89254 40000 TOTAL 163777.738 97165.531 123254 58652 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Not well investigated yet. 3.4. Expenditure per activity Table 14: Indicate how much the project spent for each activity listed below during the reporting period Source(s) ofBxpenditure ($ GOVT Not costed SSI APOC SSI GOVT GOVT 12,348.30 15,302.00 7,567 .00 487.50 500.00 Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities litical authoritiesvisits to health and CDTI activities CDDs and distribution of atstaff levelall STrai of healtht!g Trq14{,g of c_P*Qs_ 28 WHO/APOC, 24 November 2004 IEC materials Su_mm-ary (leport!4g) forms lor treatment Vehicles/ Motorcycles/ bicycles maintenance Q{nqg Eqylpmqlt (e,.g cgmp-uters, print-ers g,!c)__ Others 7,000 44.00 1000.00 187.50 SSI GOVERNMENT APOC APOC TOTAL 36,217.70 Total number of persons treated 238,423 Any comments or explanations? No SEGTION 4: Sustainability of GDTI 4.t1. lnternal; independent participatory monitoringl 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. 4.1.3. Recommendations on faults in filling treatment registers. registers. Implementation status on Correction offaults. 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? NO When was the sustainability plan Not Arrangements have been made to sustain CDTI after APOC funding ceases in terms of:- a4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 29 WHO/APOC, 24 November 2004 4.2.4 4.2.5. Other resources To what extent has the plan been implemented A sustainability meeting workshop has already been planned where all the stakeholders will be invited to attend. During the workshop all these aspects will be discussed and it is expected that the workshop will develop strategies that will sustain CDTI after APOC funding comes to an end. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: . Combined supervision - Supervision of CDTI activities was done along with supervision of other health intervention programmes in the project area e.g. MTUHA, MCH clinics, IMCI etc. . Use of Oncho vehicle in other health issues - The project vehicle was used in the supervision and activities mentioned above. Consequently, the project also used other government vehicles in project activities e.g. collection of IEC materials from Dar es Salaam. . Plans to integrate Onchocerciasis with eye care activities - These are underway and discussions with the in charges of the eye care services have already started.. r Use same CDDs in other community health activities - CDDs are already involved in other health interventions in the project area e.g. distribution of mosquito nets for prevention of malaria, MCH Clinics, weighing of pregnant mothers and children under five years of age. ' Oncho activities to appear in CCHP - The two district councils have already started to incorporate some of the CDTI activities in the Comprehensive Council Health Plans (CCFIP) budgets. Activities like monitoring and supervision, fuel and maintenance of motor cycles have been included in the CCHP.. 4.3.1. Ivermectin delivery mechanisms The delivery of ivermectin is within the government system whereby it is taken together with other kits of drug from District Pharmacy to health facilities within the project area. 4.3.2. Integrated Training Currently there is no integrated training as each community based programme has its own plans in this specific activity. Based on the gravity and cost effectiveness of this approach, we are planning to establish a platform with other health intervention programmes and discuss on the need to introduce integrated training 4.3.3 Joint superuision and monitoring with other programs Joint supervision and monitoring is being practiced as indicated in bullet I & 2 above. 4.3.4. Release of funds for project activities During the implementation of the project activities in the second year, the two district councils released funds for supporting supervision and fuel for motorcycles. 4.3.5. Is CDTI included in the PHC budget? CDTI activities were included in the PHC budget in year one. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Not in this project area. Describe others issues considered in the integration of CDTI. - Vitamin A supplementation activities 4.3.7. 30 WHO/APOC, 24 November 2004 Lymphatic filariasis Eye care activities. 4.4. Operational research 4.4.1. Summarize operational research undertaken in the project area within the reporting period. No operational research was undertaken during the reporting period 4.4.2. How were the results applied in the project? N/A 3l WHO/APOC, 24 November 2004 SEGTION 5: Strengths, weaknesses, challengesr and opportunities SEGTION 6: Unique features of the proiecUother matters Other lssues: Due to delayed funds which were not reimbursed for the whole of last year, we were not able to complete CDTI activities in time. Strengths Weaknesses Challenges Opportunities Drug compliance is now high compared to year one. Late transfer of funds from donors Dropouts of CDDs Community awareness on CDTI philosophy is now improving. poor documentation and Conflicting implementation of calendar year between different donors Sit with donors and agree on calendar years. Monitoring and supervision is strengthened. low chemotherapeutic coverage. Late transfer of funds. Late preparation and submission of financial reports to donors Inadequate funds Improve on timely preparation ans submission of financial reports to donors High rate of refusals Strengthen community health education about Oncho. 32 WHO/APOC, 24 November 2004