Tunduru CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

I UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE a q rl I i & i I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting (9 AFRTCAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I ORIGINAL : Enslish COUNTRY/NOTF : TANZANIA Proiect Name: TUNDURU CDTI Approval year:2004 Launching vear: 2005 Reporting Period: From: JANUARY 2011 To: DECEMBER 20ll (Month/Year) ( Month/Year) APOCProiectimplementationyearreport: (circleone) 1 2 3 4 5 6 (7) 8 9 10 11 12 13 Date submitted: JAN 2012 Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sight Savers International - 536 communities WHO/APOC 14 September 2009 I ! I I I : I I : I i I I I I I I a, ! ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: TANZANIA National Coordinator Name: Dr. Upendo Mwingira Signature: Date: Zonal Oncho Coordinator Name: Dr. Daniel Malekela Signature: ..... Date: NGDO Representative Name: Dr. Ibrahim Kabore Signature: ..... Date: This report has been prepared by Name : Mr. Nurdin K. Malloya Designation : Project Coordinator Signature : ..... Date I ii WHO/APOC 14 September 2009 EXECUTIVE SUMMARY The report covers a period of 12 months starting from I't January, 20ll to 31't December, 2011. Year 7 of the project saw many activities being implemented by integrating with other Programme such Trachoma, Lymphatic Filariasis, Soil Transmitted Helminthiasis (STH) and Schistosomiasis since the country has embamarked on the move of NTDs control. These activities were implemented by using funds from APOCruSAID and Council all being directed at creating sustainability of the program by involving leaders at district level who are the policy makers and warrant holders. The treatment cycle of this reporting period started in July 201I and lasted in December 2011 in 536 communities which are Hyper and Meso endemic. The total population living in those communities is 124,085 people; where by a total of 102,148 people were treated. The ATO was 104,231 and UTG was 108,402. The Project attained 82o/o therapeutic coverage and 100% geographical coverage for this reporting year. In this period 1,080 CDDs, 70 RHWs and 38 CHMT & HMT members were trained and re-trained on the implementation of CDTI activities together with NTDs activities and how to administer medicine by intervals. The training was done in September 2011. Also the project conducted sensitization meetings at various levels, that is at district 23 people were sensitized, Ward level 54 people and at community level 602 leaders were sensitized. The CDD ratio is 1 :1 15 people. Mectizan@ tablets arrived early enough at project office in April and June 2011 and we received 1,319,000 tablets (3mg) Mectizan@ tablets for treatment in Oncho and None Q.fTDs) areas. 300,000 Mectizan@ tablets were sent to hyper and meso oncho endemic areas in the district whereby 247 ,925 tablets were used and 432 lost. 5 7,722 Mectizan@ tablets which remained were sent to non Oncho communities for treating other NTDs. The medicines are norrnally delivered in all communities by using existing health system through Front Line Health Facilities. The expiring date for the tablets is July 2013 The project received a total amount of Tshs. 27,648,000.00, from APOC/USAID for the implementing various NTDs activities using CDTI method. Also the District Council released Tshs. 16,392,760/: for the same, while SSI released nothing for CDTI activities. The major Challenges and how they were overcome: . To ensure that all CDTI and NTDs activities are incoperated in Comprehensive Council Heath Plans and funded and funds released timely. . The influx of people from outside the district prospecting for gemstone. . Writing more than one report while reporting on one thing implemented on the same time, it gives us more confusions. There is a need to consolidate reporting format to have one for all CDTI/ NTDs. . Medicines was distributed during dry season,most of young man moved from our country to neibouring gemstone country Mozambique .This led to more abscentism. WHO/APOC l4 September 2009 SEGTION 1: Background informatio 1.1. General information 1.1.1 Description of the project (briefly) Tunduru district is located far south of Tanzania between 10'15 and 11.45 south of equator and longitudes 36"30 and 38o East of Greenwich. It borders with Namtumbo district to west -in Ruvuma Region, Liwale and Nachingwea to the north in Lindi Region. Masasi district(Nanyumbu district) in Mtwara Region to East. In south there is the Ruvuma River which forms a physical Intemational boundary with peoples Republic of Mozambique. Tunduru district covers a total land area of 18,778 Sq km out of which 413 square kilometers(2.2%) are covers by water bodies leaving the area of 18,365 Sq km the land. The district has a total of 148 villages which forms 942 sub villages out of these 66 villages which have 536 communities are found in Oncho endemic areas. Tunduru district situated between 200 and 500 meters above sea level. There are three ecological zones namely:- l. MATEMANGA ZONE: This covers the north - west part of Tunduru and includes almost all of Matemanga division. This part falls under Selous Game reserve, it's a zone where by big rivers such as Muhuwesi, Nampungu and Mbarang'andu "Luwegu river" starts at the rolling hills. 2. SOUTHERN TUNDURU ZONE: This zone covers the whole of the Southern part of Tunduru District including the divisions of Lukumbule, Nalasi, Namasakata, Nampungu and West Mlingoti ward. It is a zone characterized by rolling hills, dominated by miombo woodland. 3' NAKAPANYA ZONE: This small zone located eastern part of Tunduru district bordering to Masasi district (Nanyumbu district). It covers Nakapanya division and East Mlingoti ward. It has Rock Mountains and miombo woodland. CLIMATE: The temperature ranges between 20"C up to 30"C Dry season: June - November Rain season: December - Mav Farming season: o Preparation: August - October o Planting and weeding: November - April o Harvest: May to July (Food crops) o Harvest Cashew nuts November to December (Cash crop) Tunduru District has been distributing Mectizan for several years since 1994 using bridge funds donated by River blindness Foundation I.M.A, CSSC and Sight Savers International. The main task was to train 2 CDDs in each village, sensitize the local village leaders thus to facilitate the Mectizan distribution to villages concerned. The project commenced with l7 villages increasing yearly to 34 villages in 2001. WHO/APOC 14 September 2009 - In 2002 REA study were conducted to the remaining 3 divisions of Namasakata, Nampungu and Lukumbule. A total number of 32 new villages were found to be meso and hyper endemic thus making a total number of 66 villages in the Project. - On 26th January 2005 - Launching of the Tunduru CDTI Project was carried out. The NOTF member (MoH), NGDO - SSI representative and The Regional Team and other CDTI project staffs participated in the event. District Govemment leaders I.E. District Commissioner, District Administrative secretary, DED and other departmental Heads - CMT members participated and contribute in Launching activity, also Urban residents participated especially drummer groups. The CDTI project now has 66 villages with 536 Sub villages/communities' - Table 1: Number of health staff involved in CDTI (Please add more rows if : necessary). District/LGA Number of health staff involved in CDTI activities. Total Number of health stafl in the entire project area Br Number of health staff involved in CDTI Bz Percentage BfBzlBr *100 Tunduru 483 108 22% 1.1.2. Partnership The project is implementing its 7th year of mass Mectizan distribution with a lot of difficulties due to insufficient support to CDTI project, capital equipments such as motor vehicle and motorbikes has grounded some times due to breakdown which needs a major repair of engine and other necessary parts. We had a promise from APOC to have a new capital equipments such as vehicle,desktop computer etc,very bad luck we have not yet received these capital equipments. Lack of reliatle means of transport to reach peripheral oncho endemic areas is a major problem which affects efficiency of the project implementation. The District Council has been giving us a support, but not enough for efficiency' The community is generally willing to take Mectizan and in some colrlmunities CDDs are I well motivated both in kind by exemption from Communial work. 4 WHO/APOC 14 September 2009 ta\a 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period.(Please add more rows if necessary)eqs l ssa. CDTI Districts/ LGAs in the entire project area Total population in the entire project area Number of communities/villages in Population of Meso-endemic zone in the project area At Hyper-endemic zone in the project area A2 Total in meso/hyper- endemic zone Aj: Af [, Meso-endemic zone in the project area A.r Hyper- endemic zone in the project area A5 Total in meso/hyper- endemic zone A6: A.1+ [, Ultimate treatment Goal (uTG) Tunduru 309,617 190 346 536 48,709 75,376 124,095 108,402 * Source: Nationel census other, speciry: CDD sYear : 2002 aTG = calculated as the maximum number ofpeople to be treated annually in meso/hyper endemic areas t)ithin the project area, ultimarely to be reached when the ptoiect has rcachedfull geographic cowrage (normally the project ihould be expected to reach the iTG ar the ena oTini s;o y"o, o7 the project). If you are usitrg the ter"m communi8 or village, defitre what constitut€s th€ comDrunity or yillage. This will help understatrd the prolile of th€proj€ct area. - we use telm corDmunity to define sub village which is the lowest levet ofadministration in the govemment structwe in Tarzania. It is headed by a sub village chairpe$on elected deEocratically by all community members. A village is maie up ftom several sub villages. The size ofthe village population may vary from 400 - 3,OOO people. Is there rny other iDformation of interest about the population in the project area? If so, irclrde it here. Tunduru dist ct has recendy been invaded by people outside the district looking for gemstone mining. This inversion leads to populatioo fluctuation leading to unstable census in sub villages where mining takes place.Fan enough ow neibouring counia Mozambique now has a lot of Gemstone which the residents tends to move now and then WHO/APOC l4 September 2009 SECTION 2: lmplementation of GDTI 2.1. Timetine of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. t 6 WHO/APOC 14 September2009 tara Table 3: Timeline of activities for the areas treated in the current year (Please add more rows if necessary) - Comments Implementation of CDTI l) 1080 CDD'S were trained in September up to October 2011 2) 70 and 38 CHMT & HMT members were trained in September 2011 3) Sensitization meetings conducted at various levels: - District level 23 people sensitized in July- 2011 - Ward level 54 people sensitized in September- 2011 - village and subvillage leaders 602 sensitizedin September-2011 4) Supportive supervision and data collection was done in Decemb er 2011 -January 201 2 following Mectizan distribution . Districtll-GA Mobilization of communities Training Census/Update Drug distribution Supervision Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completio n month Starting month Completion month Tunduru July September September October October November November Decembe r December lan2012 TOTAL WHO/APOC 14 September 2009 2.2. Advocacy We conducted advocacy meetings to Primary Health Care Committee and Council Management Team members (Heads of Department) in order to sensitize them on the philosophy of CDTI. This advocacy was conducted in July2O11, and the Council supported funds for the activity (Basket fund) as a partner. The outcome was the increase of fund allocation for the implementation of CDTI activities in the districts. The reason for mobilization and sensitization: ' Most of the departmental heads in the district are new appointed Council Management Team members, Divisional Secretaries, Ward Executive Officers and Village Executive Officer has . been transferred to non endemic areas. In this set up there was a need to conduct Mobilization & Health education to the new officials so that CDTI continues to be supported by the council Problems encountered Lack of reliable means of transport (Motor vehicle) to visit communities. The project vehicle needs a major repair. Suggestion to improve advocacy All policy makers should be invited to attend advocacy meetings at all level and there is a need to request the Tunduru District Executive Director to facilitate these meetings. The following table shows the number of policy/decision makers advocated at different level per each district. DISTRICT DISTRICT LEVEL WARD LEVEL VILLAGE LEVEL Tunduru 23 54 148 Total 23 54 148 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 t Leaflets and T-Shirts carrying various CDTI massages were not available to sensitize communities in our district. t We involved community leaders at all levels in the district in conducting mobilization to targeted communities. - Mobilization and health education of communities including vtomen and minorities t Health education was provided to women, teachers, school children and female CDD's to assist in mobilizing the community prior to Mectizan distribution. WHO/APOC, 14 September 2009 a- Response of target communities/villages i The response of targeted population was good as evidenced by high treatment coverage rate from 8l .77% of last year- 2010 up to 82%o for the year 2O1l . - Accomplishments o The project managed to conduct CDTI activities depending on funds provided by Councils and APOC . Community ownership of the Programme is still maintained amongst community members but we have to conduct HSAM following transfers of various community leaders which brought changes to most village leaders. a CDDs are willingly to continue to distribute Mectizan@ voluntarily. Few among them they demand to be paid more as incentives. - Suggest ways to improve mobilization and sensitization of target communities - a Mobilization and sensitization meetings should be conducted every year prior to Mectizan@ distribution cycle. I Health education should be done continuous to remind the community their responsibilities. t Inclusion of primary school teachers in mobilization should be part of CDTI activities. t To strengthen Community self Monitoring and Stakeholders meetings in all affected communities. i Provisional of T-shirts to CDDs and community leaders would motivate them. Availability of Oncho pamphlets would increase awareness to the Community members. 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: a Attendance offemale members of the community at health education meetings -Female members at community health education meetings are good. i In general, how do you rate the participation offemale members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). -We rate them by head counting(attendance,participation in the discussions the number of female is bigger than male) t Incentives provided by communitiesfor the CDDs -Excemption of communial work,and recorginition. District/LGA Number of com munities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no, communities in the entire project area B, Number with community members as supervisors B. Percentage Be= B./ B, *100 Male CDDs B" Female CDDs B" Total Bq= B,*B* Number of communities with female CDDs B'n Percentage Brr= B,r/B"* 100 Tunduru 536 663 100% 54t 539 I 080 536 t00% Total s36 663 100"h 541 s39 l 080 536 100"h WHO/APOC 14 September 2009 a Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? - In Tunduru to be a CDD carries a pride in the community. This has led to low number of attrition in the whole project. a Other issaes In some areas CDDs demands payment when they conduct MDAs for more than one drug such as Mectizan@ for Oncho and Zithromax for Trachoma. 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. So far the staff at all levels are stable and competent in executing CDTI activities. There is no shortage of staff in all health facilities where CDTI is implemented. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enoagh knowledgeable manpower was available or d staff are frequently transferued during the course of the campaign). We have increased the number of FLHF staff from one to two in one Health Facility during training session. l0 WHO/APOC 14 SeptemberZ}}9 , tr.a Table 5: Training at the different levels of CDTI implementation (Please add more rows if necessary) New,,,Refr'.Ifdelailnotavailable,provdethecorrespondtngtotalon$,Mok,'u@ ll District/LGA Number of Districts/LGAs staff trained Number of Health center/post staff trained Number of other trainers of trainees ( TOTs) Number of CDDs trained ATrO cr Nev C, Refr Total Cr: Cz+ CsC: ATrO C. New Cd Relr Cz Total Cr= C6+ C7 ATrO C. Nets Cn ReJr C,, Total Crz= Cro* C, ATrO Crr New C,, Refr C,s Total Crr= Cr.* C, Tunduru 23 07 t6 23 70 13 57 70 5 0 5 5 1080 24 1 056 1 080 TOTAL 23 07 t6 23 70 13 57 70 5 0 5 5 1080 24 1056 1080 7o Achievement 100 %o Achievement 100 7o Achievement 100 %o Achievement 100 WHO/APOC, 14 September 2009 Trainees Type of trainine CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management { ./ { How to conduct Health education Management ofSAEs CSM { ^/ { { ^/ SHM { ^/ { Data collection { { ./ Data analysis Report writine Others (speciff) Primary school teachers Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) - Any other comments 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100% geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. N/A 12 WHO/APOC, 14 September 2009 Table 7: Treatment and SAEs by district/LGA in all areas at risk (Please add more rows if necessary) .tra District /LGA Communities/Villages Population Number of persons who refused the treatment Numb er of absent ees Number of communities with < 80% therapeutic coYerage Number of SAEs Number of serious adverse events (SAEs) refened to the health post/hospital Total # of communities/ villages in the meso/hyper- endemic areas Dr Annual Treatment Objective D2 Number of communities/ villages treated Dr Geographical coverage (%) Dr= D/ Dr*100 Total population of the mesoftryper- endemic areas D. Annual Treatmen t Objective De Number of persons treated D, Therapeutic coverage (%) Ds: D7l D5* 100 Tunduru 536 536 536 100 t24,085 104,231 102,148 82Y. 472 4,3 l5 35 05 0 TOTAL 536 536 536 100 124,085 104,231 102,148 82' 472 4,315 35 05 0 Formula for computins therapeutic and eeosraohical coveraee Therapeutic coverage rate : Number ofpeople treated x 100(%) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate : Number ofcommunities/villaees teated x 100("/"') Total number ofmeso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate = Number ofpeople treated x 100("/.) Annual Treatment Objective 7o UTG achieved = Number ofpeople treated x 100 Total number ofpeople to be heated itr meso/h)?er-endemic areas within the project ares (UTc) ATO = The estittutetl nu bet ofpeople living in,rqso/hrpet-ddehicoreas that aCDTI project ,|qb toteatfith ivme.t ltuagitenlear, (nonnollt the ptujlct should b. ex?ect.d to ..zah th? UTc at th. .nd of th. lt r.ot of thc ptoj.d). l3 WHO/APOC 14 September 2009 2.6.2 What are the causes of absenteeism? - Different activities conducted by community members leads some of them to be absent when MDAs is being conducted. Those activities are such as i.e. farming, hunting, fishing and mining. Also Tunduru district has the cross boarder issue as it boarder with Mozambique. 2.6.3 What are the reasons for refusals? - Disappearance of sing and symptoms in human body make some of them to think that they are already cured from Oncho therefore their no need to continue taking medicine. Moreover there is still sense of ignorance and misconception regarding the drug among of community members. 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. o Parasitologist trained? N/A . Existence of microscope? N/A . 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 l4 V/HO/APOC, l4 September 2009 ra Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (Please add more rows if necessary) SAI+ Age Sex Village of origin Date Mectizan was taken Date I't symptom S appeared Symptoms Health status before taking Mectizan Date of admission health facility ln Date of dismissal from health facility Results of tests (thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involveme nt or not N o N E * Serial number of the patient 15 WHO/APOC, 14 September 2009 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9: Treatments and coverage by calendar year for the entire project area. (PleaseJill in the required data) Please indicate the UTG for the project area: 108,402 (use this figure as the denominator in all UTG coverage calculations.) YEAR CommunitiesA/illages Population Total # of commun ities/v illag es in the meso/hyper- endemic areas Er Annual Treatment Objective Er Number of communitie s/villages treated E. Geographi cal coverage (%) Er: E3l Er*100 ATO coverage (o/o) Es: E3l E2*100 Total population of the meso/hyper- endemic areas Et Annual Treatment Objective Et Number of persons treated E" Therapeutic coverage (%) Eg: E8/ E6*100 ATO coverage (%) Ero: Er/ Er*100 UTG Coverage (%) t991 I 998 t999 2000 200 I 2002 2003 2004 2005 525 525 525 l00Yo l00Yo l 05,857 88,920 74,094 70o/o 83o/o 81y;. 2006 530 530 530 100% l00o/o r18,531 99,566 83,740 7t% 84% 89% 2007 531 531 53r 100% 100% 120,714 99,232 93,516 77% 94.Yo 94.v, 2008 536 536 536 t000 l00Yo t24,506 r03,957 100,828 8t% 97% 97Yo 2009 s36 536 536 100% 100% 125,449 107,980 102,554 820 95% 95Yo 2010 536 s36 536 100% 100% 128,400 110,424 105,004 81.77% 95% 95v, 2011 536 s36 536 r00% 100% r24,085 t04,231 102,148 82% 96% 98% WHO/APOC 14 September 2009 rt L6 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) ,/ MOH WHO tr UNICEFI NGDO Other (please specify): E Mectizan@ delivered by - Qtlease tick the appropriate answer) ./ MOH tr WHO tr UNICEFI NGDC Other (please specify): NIMR I Please describe how Mectizan@ is ordered and how it gets to the communities . The district sends to the NTDs secretariat Ministry of Health and Social Welfare the .total population r of the district obtained by census which are conducted by CDDs . The NTDs secretariat Ministry of Health and Social Welfare, fills the Re - Application Forms as a country request and then send them to Mectizan@ Donation Programme (MDP) o The MDP scrutinize the Form and send the drug to the NTDs secretariat Ministry of Health and Social Welfare, through the Government Clearing and Forwarding Agent in Tanzania. (Medical Store Department- MSD) o The MSD notiff the Ministry of Health and Social Welfare on arrival of Mectizan@, then the NTDs Secretariat prepare the distribution list according to total population per districts and send it to MSD. o MSD is responsible from transportation of drug from central store to Zonal store where Project Coordinator comes and collects the drug bring the consignment in the District Pharmacy. . The the drugs are being sent Health Facility through existing health systems. o FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan@ . They come for collection and distribution to the community member in the entire area Table 10: Mectizan@ Inventory (Please add more rows if necessary) State /District /LGA Number of Mectizant tablets In stock from previous year Requested Received Used Lost Waste d Expired Remaining TUNDUR U 0 300,000 300,000 247,925 432 Nil Nil 51,722 TOTAL 0 300,000 300,000 247,925 432 Nit Nil 51,722 sent to Non Oncho areas How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets were collected from the communities and returned back to FLHF by CDD's and then the DOT'S or CHMT members collects them and bring back to the district pharmacy whereby they were reallocated to other FLHFs for NTD implementation. Reallocated to other FLHFs for NTD implementation in the whole district. o List and briefly describe the octivities under ivermectin delivery thot ore being carried out by health care personnel in the project areo. Activities performed by Health personnel in handling Mectizan@ o Supervise census update in hislher catchments area. o Mectizan ordering by filling in the forms and sending them to the District Onchocerciasis Coordinator. . Makes follow up to the District Ofhce. . FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan. ll WHO/APOC, 14 September2D}9 o Organize and attend mobilization and sensitization meeting to the community members . Conduct supportive supervision during Mectizan@ drug distribution to CDD's. o Data collection and report writing and send it to District Oncho Coordinator . Conduct feedback meeting with community members. . Any other comments NONE 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? NO. If so, When? NA Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) DistricU LGA Total # of communitiesivillages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meetins (SHIO Tunduru 536 0 2 TOTAL 536 0 2 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. No community self-monitoring done during the reporting year because of lack of financial resources. 2.9. Superwision 2.9.1. Provide a flow chart of supervision hierarchy. Ministry of Health and Social Welfare (NTDs Secretariat) J Regional Administrative Secretary (RMO) J DISTzuCT EXECUTIVE DIRECTOR J DITRICT MEDICAL OFFICER J DNTDC J DOTS J FLHW's J CDD'S J Community 18 WHO/APOC 14 September 2009 2.9.2. What were the main issues identified during supervision? o In adequate CDD motivation due to increase of work as we are now integrated and use the same CDDs. . Inadequate NTDs IEC material . Improper recording in treatment registers in villages where the CDD are new esp in Non Oncho areas . Work load to FLHF staff 2.9.3. Was a supervision checklist used? . Yes. Integrated supervision check list at the DMOs office were used. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? ' Levels concerned gave a positive answer to improve their performance during the next distribution. 2.9.5. Was feedback given to the person or groups supervised? . Yes. 2.9.6. How was the feedback used to improve the overall performance of the project? . The majority of community leaders provide incentives to CDD's Community members were encouraged to provide incentives during distribution. The District replaced registers in communities that are in need. SEGTION 3: Support to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtion No Condihon No. Condrtron No. Condrtion No. Condition 1. Vehicle 1 CNFR 0 0 0 2. Motor cycle(s) I F 0 2 CNFR 0 3. Computer(s) I F 0 I F 0 4. Printer(s) I F 0 0 0 5. Photocopier (s) I F 0 0 0 6. Fax Machine(s) I F 0 0 0 7. Others 0 a) Internet I F b) c) *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 existing equipment is maintained through the normal system in the district through Central Procurement Unit. Repairs and services are carried out using funds from the Council. t9 WHO/APOC l4 September 2009 3.2. Financial contributions of the partners and communities . Fill tables l3a, 13b and 13c . If there are problems with releose of counterpartfunds, how were they addressed? There was no problem in the release of counterpart funds. The project received Tshs 27,648,000.00 (US$18,429) from APOC Management and Tshs. 72,388,500.00 (US$ 48,259) from Council for the implementation of specific NTDs activities. Our NGDO partner this time disbursed their funds to the Central office. o Additional comments : Due to inadequate financial support to our CDTI project it leads to difficulties in implementation of various activities i.e motor vehicle grounded due to lack of funds for proper service and maintenance 20 WHO/APOC 14 September 2009 Table 13a: Financial contributions by all partners for the last three years ta TUNDURU CDTI PROJECT TANZANIA CURRENCY: US$. Calendar YEAR being reported (specify the year) 2011 GOVERNMEN'I contribution OTHER paftners' disbursement Budgeted Amounts disbursed at the following levels National Regional District Total lo disbursed NGDOs LocalNGDOs Communi ties Others APOCTrust FundBUDGET LINE l. Mobilization, advocacy, sensitization et heqlth education _ 1.1- Mobilization -_ 1.2. Sensitization 1.3. Advocacy_ _ 1.4". He-alth-education Sub-total I 1,333 2,000 1,333 4,666 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 "0. 0 0 I """ 0 0 0 0 ",q 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,93Q _. 1,86.1 1,333 0_ 4,530 !!-T*raining 2. 1 ."-Tra-ining/retraining of CDDs _ !.2. Training/retraining of Health workers Sub-total ll lll. S u pervisi on, m onito ri n g, Eval u ation 9,385 6,533 15,918 0 0 0 0 0 0 6,666 0 6,666 6,606 0 6,666 71 "0" 42 0 0 0 0 0 0 0 0 0 0 0 0 1,q30.""_ 3,546 q:076 _ 9.1_.-Supervision 9*.2._Monitoring _ 3.3. _Evaluation Sub-total lll 3,400 3,000 3,000 9,400 0 0 0 0 0 0 0 0 1,33_3 1,333 1,qes 4,261 1,3"33 1,333 1,595 4,261 39 44 53 45 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 960 " 3,333 "106 4,699 lV. lvermectin distribution and management o!*ggy-e I e a dv e r s e e yen fs 4.1 . _lvermectin dlstribution --1".2, M?Iqgement of Severe adverse events Sub-total lV 2,666 133 2,799 0 0 0 0 0 0 0 0 0 0 0 0 0 0. 0 0 0 0 0 0 0 0 0 0 0 0 0 1,124 _0 1,124 !.A3[d" ! ti o" 1L7 I exp enses 5.1_, -S_qlertgs_ _ __5_.2. Equipm_gnt Sub-total V 36,666 3,333 39,999 0 0 0 0 0 0 36,666 669 37,332 190 33 96 "-0 0 0 0 0 0 0 0 0 0 0 0 0"". 0 0 GRAND TOTAL 72,782 0 0 48,259 48,259 66 0 0 0 0 18,429 2t WHO/APOC, 14 September 2009 Table 13 b : Financial contributionr all partners fbr the ast three TUNDURU CDTI PROJECT TANZANIA CURRENCY TSHS. Calendar YEAR beinq reported (specify the year)2010 GOVERNMENT contribution OTHER partners' disbursement Budgeted Amounts disbursed at the following levels National Reqional District Total to disburse d NGDOs LocalNGDOs Commun ities Others APOCTrust Fund BUDGET LINE l. Mobilization, advocacy, sensitization et hsdtn education 1.1- It/obilization __1.2- Sglgitilation *1.-9 Advsgqcv. --!.i, !le-al_t[ educationSub-total I 1,000,000 1,000,000 500,000 2,500,000 0 0 0 0 0 0 0" 0_" 1,000,000 1,0_00,000 - q00,009 2.so0:6do 100" 0 0 100 0 o 0 0 0 0 0 0 o 0 0 0 1,925,000 1,925,000 U.r-lllnlqs. -_?J, JqiQing/re_training of CDDs 2-2. Ugjlfng/f etrainin g of Health workers s_t@-_!ofr!_lr lll, Superuision, monitoring, Evaluation 15,000,000 5,000,000 20,000,000 0 0 0 0 0 0 __6_,000,000 31900!000 9,500,000 0 "Q,O_0qL0q-o _ 3_,500,000 -9,500,000 0 4o _0. 0. 40 0 -o o 0 0 0 0 0 0 0 o o 0 0 0 0 3,679,000 5,000,000 8,679,000 o -3,1-.-$up__ervision - _9.?.!Y!-o_n!lering __9_-ll. Ev-aluation Sub-total lll 3,500,000= 0 0 3.500.000= 0 0 0 0 0 0 0 0 2,610,000 0 ""9 2,610,000 2,p1_qpqq 9"" " .-0 2,610,000 75 0 _0"" 75 0 o' o o 0 0 0 0 0 0 0 0 0 0 0 0 2,000,000 0 0 2,000,000 lV. lvermectin distribution and n3-qagg!?gqt""of severe adverse ev-ents *4. 1 . lvermectin distribution 3r?, M4?gement of Severe adverse events Sub-total lV 4,000,000 200,000 4.200.000 0 0 0 0 0 0 r,6oo,ooo 0 1.600.000 r,ooo,ooo _0 1,600,000 40 q 40 0 0 o 0 o o 0 0 o 0 0 0 1 ,4i o,ooo 0 1 ,410,000 )1: A!-! itj o ! ?! _expenses _ _ 5.1 . _Salaries 5.2. Equipment Sub-total V 52,000,000 3,000,000= 55,000,000= 52,000,000 0 52,000,000 0 0 0 0 1,000,000 1.000.000 sz,ooo,oo .p. 1,000,000 53,000,00 0 100 ,3"3" 96 0 o" 0 0 0 0 0 0 0 0 0 0 0 0 0 GRAND TOTAL 85,200,000 52,000,000 0 14,710,000 69,210,00 0 14,014,000 WHO/APOC 14 September 2009 ra'r 22 ta I ) Table l3c: Financiall contri rutions by all partners for the rast three years (continued TUNDURU CDTI PROJECT TANZANIA CURRENCY TSHS. Calendar YEAR being reported (specify the year)200i GOVERNMENT contribution OTHER partners' disbursement Budgeted Amounts disbursed at the following levels lo disbursed NGDOs LocalNGDOs Communitie S Others APOC TrustFund BUDGET LINE Re gio National nal District Total l. M obil izati on, advocacy, sensitization et health education 1.1. Mobilization _ 1_.2. Sensitization 1-3. Advocacy 1.4. Health education Sub-total I 2,500,000-- 1,500,000= 4.000.000= 0 0 0 0 0 0 0 0 0 0_ 0 0"" _.0 "0 "-o' 6,450,000 o 6,45o,OOO 0 o 0 0 0 o 0 0 0 5,000,000 5,000,000 l o,ooo,ooo u. Training 2.1- _Training/retraining of CDDs 2.2. T raininglretraining of Health workers $ubaotalll ll l. Su pervision, monito ri ng, Evaluation 14,000,000 2,500,000= 16,500,000 0 0 0 0 0 0 14,000,000 0 14,OOO,d0o 14,000,000 0 14,OOO;OOO 100 0 340,000 1,57b,000 1,910,000 0 0 0 0 0 0 0 0 0 0 1,410,000 1,410,000 3.1- Supervision _ 3.2_. Monitoring _-3.3. Evaluation Sub-total lll 1,500,000= 0 0 1,500,000= 0 0 0 0 0 0 0 0 5'10,000= 0 0 510,000= !l0",Q99= 0 0 5't0,000= 34 ". 0 0 34 " 800,000- 2,00_0,000 0 2,800.000 0q" 0 "o 0 0 0 0 0 0 0 0 1,590,000 0 0 1,59O,OOOtv. tvermecun cl,stnbutton ancl management of severe adverse 9_Y94ts 4.1 . lvermectin distribution 4.2. Management of Severe adverse eygntq Sub-total lV 850,000= 150,000= 1,000.000= 0 0 0 0 0 0 s5o,ooo: 0 850,000= 850,000=- 0 8-50,000= irio 0 5?0,qgo 0 52o.OO0 0 0 0 1,080,000 0 1.O80,ObO 0 0 0 1,000,000 0 t.ooo.ooo V. A-d d iti o n aI expenses -5_.1. Salari_es 5.?. Equipment Sub-total V 40,000,000 1,Obo,0oo= 41,000,000 40,000,000= 0 40,000,000= 0 0 0 0 1,000,000: 1,000,000= +olbbb,ooo 1,OOO,O_OO= 41,000,000 100 100 100 0- 0 0 0 0 0 0 0 0 0 0 o 0 0 0 GRAND TOTAL 64,000,000 40,000,000 0 16,360,000 56,00,00 11,680.00 0 1,080,000 0 14.000.00 23 WHO/APOC 14 September 2009 3.3. Other forms of community support . Describe (indicate forms of in-kind contributions of communities tf any) . The CDDs are exempted from the public/Communial works especial during distribution. . Community leaders and CDDs collect Mectizan from the nearest of the FLHF o If there is any work in that particular village which involve payment CDDs are given priority therefore act as some sort of support to them (eg. Zithromax distribution, albendazole and distribution of ITN Nets) . Willingness to prepare Mectizan measuring sticks. 3.4. Expenditure per activity ' . Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to Iocal currency. Indicate exchange rate used here USD$ 1 : Tshs. 1.500/: . Any comments or explanations? YES; inadequate funds to CDTI projects. SEGTION 4: Sustainability of GDTI 4.1. Internall independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) '/ Year 3 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? . The project was advised to carry out operational research on the Why CDD attrition rate in Tunduru is low compared to other Oncho endemic areas o District Council have to make sure that CDTI activities are incorporated into CCHP and funds for implementing those activities are timely released 24 WHO/APOC, 14 September 2009 4't'3' "": oil'. ,fi.HT.ill"tT:'J:ilsal ror operational research to Apoc, but very unfortunate the NTD Program came to overlap the CDTI activities since 2009. In this reporting year the District has released US dollars 13,125 for the implementation of CDTIA..ITDs. 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? YES When was the sustainability plan submitted? 200912009 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels o At community level they plan on how to collect Mectizan@ from the nearest health facility and distribute to the community members. . FLHF order Mectizan@ from the District Oncho Coordinator and inform community members on arrival of the drug, also conduct HSAM and perform supervision, monitoring, data collection and report writing. . The DOC performs spot check supervision, monitoring, data collection and report writing. Also participate in planning of CDTI activities at district level as a co-opted member of CHMT and attend Project annual review meetings. . The Project Coordinator compile report form district, prepares Technical APOC annual report, Mectizan@ retirement and Re-application, supportive supervision to district and attend various CDTI meetings. 4.2.2. Funds . As in the previous year the district council allocated funds for implementing CDTIA,ITD activities. It is encouraging to note that money allocated for CDTIAITD activities is increasing. .t 4.2.3 Transport (replacement and maintenance) o APOC management did not replaced all capital equipment in the six year of the implementation of CDTI activities. More worse the motor vehicle is not running now (lts grounded) 4.2.3. Other resources: o We only depend on support of District Council. 4.2.5. To what extent has the plan been implemented 25 WHO/APOC 14 September 2009 a 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin deliverymechanisms . The Mectizan@ drug is transported through the existing PHC systems. 4.3.2. Training . CDTI structure is being applied in many projects in our District Trachoma Control Programme is using the same structure in Tunduru 4.3.3. Joint supervision and monitoring with other programs . . The District Onchocerciasis Coordinator is a co-opted member of CHMT team at district level and always they conduct routine supervision as a team. 4.3.4. Release of funds for project activities o In this reporting year the council has contributed US dollars 13,125 for the implementation of CDTI/\ITDs activities. 4.3.5. Is CDTI included in the PHC budgetz o CDTI activities and NTD activities are executed under the directive of DMO who is the in charge of all matters pertaining to Health in the district, therefore all plans including CDTI goes through hislher office then are tabled in CHMT. The districts have included CDTI in the CCHP budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . Fill tables l4 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? . Explain what are the combinations of interventions co-implemented? . How were the interventions implemented? (at the same time?) 4.3.7. Describe others issues considered in the integration of CDTI. 26 WHO/APOC 14 September 2009 ra . I Table 14 : Co-implementatiDl LO r uon Type of control Type of intervention Roles played by CDDs (erplain in bullet points) Num dist ber of ricts Number of communities Number of CDDs involved Number of persons targeted Number of persons reached Targeted Reached Target ed Reache d Male s Fema les Total Males Females Total Males Females Total Onchocerciasi s control o Ivermectin distribution . Census taking o Ivermectin distribution o Reffering SAE cases ifany. 1 I s36 536 54r 539 1,080 rll,206 120,474 231,680 101 ,682 1 10,156 2l 1,838 Lymphatic filariasis o Distribution of Ivermectin and Albendazole o Census taking o Ivermectin and Albendazole distribution 1 1 942 942 942 942 1,884 117,206 120,474 231,680 l0l,6g2 110,156 21 1,838 Schistosomias S o Distribution of praziquantel . School teachers distributing Praziquantel 1 1 t4s t29 63 66 r29 26,671 27,452 54,741 22,496 24,789 43,959 STH o Distribution of Albendazole . Census taking . Albendazole distribution I 1 942 942 942 942 1,884 lll,206 120,474 23 1,690 l0l,6g2 I 10,156 211,839 Malaria control o Distribution of LLINs N o N E Malaria control o Home management of malaria 1 I z0 20 1l 9 20 7720 10117 t7827 3860 5059 8919 Malnutrition Vitamin A supplementati on Distribution done by VHWs and RHWs 1 I 148 Villag CS 148 Villag es 3t2 323 635 ')?')')2, 24,170 47,393 21,843 22,734 44,577 Trachoma o Distribution of Zithromax N o D R U G Cataracts o 1 I 15 t4 29 Others (specify) a NB: the interventions listed in the table are just few examples 27 WHO/APOC 14 September 2009 * In table above unable to separate male and female targeted & rcached population as in most of the Iaw data's were not separated -Trachoma control. * Commrmities in other plogramme stand for villages while in onchocerchiasis endemic area is sub-villages. * Separation ofthe CDDs in gender is only done in onchocerchiasis while other programme not able to find. * Distribution ofpr zequentel were implemerted to or y l29Primary Schools out of 145 Primary schools in the District whereby 54,741 pfunary school pupils were eligible.TREATED: Primary school pupils arc 43,959 =80'/" WHO/APOC 14 September 2009 'l ' t!t rt 28 fA , .l .a ; I Counrty... ...TANZANIA CDTI PROJECT TLINDURU Table 15: Other programmes using CDI structure (tick as appropriate) EAR 2011 Type of control Type of intervention Involvement of communities in Planning SHM Implementation Monitoring CSM Reporting Provision of resources activities period mode selection of implementer s collection of commodit ies storage of commodit ies distribu tion supervis ion In kind financi al Onchocerciasis control o Ivermectin distribution Distributi on. Oct-Dec Mass distributi on community CDDs CDDs CDDs FLHWs Community CDDs/FLH Ws Lymphatic filariasis o Distribution of Ivermectin and Albendazole -do- -do- -do- community CDDs CDDs CDDs FLHWs Community CDDS/FLH Ws Schistosomiasis o Distribution of Praziquantel Distributi on October Mass distributi on Head teachers School Health Teachers School Health Teachers School Health Teachers FLHWs/ Head Teachers DMO/DEO FLHWs/He alrh Teachers STH o Distribution of Albendazole Distributi on Oct - Dec Mass distributi on Community CDDs CDDs CDDs FLHWs Community CDDs/FLH Ws Malaria control Distribution of LLINs Registrati on/Distrib ution Continu ous Selective pregnant mothers and under five children FLHWs and Community. Communit y/FLHWs LGAs/FL HWs Commu nity/FL HWs. NGDO/ CHMT DMO Community/ FLHWs Malaria control o Mass distribution of ITN Registrati on/Distrib ution Continu ous Mass distributi on Community Communit y/FLHWs Communit y/FLHWs Commu nity/FL HWs NGDO/ CHMT DMO DMFP/DM o Malnutrition o Vitamin A supplementation Distributi on JuneiDe cember Mass distributi on Community/F LHWs FLHWs FLHWs Commu nity/FL HWs CHMT DMO FLHWs/DC CO Trachoma a Cataracts a Others (specifo) a a NB: the interventions listed in the table are justfew exqmples 29 WHO/APOC 14 September 2009 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. NONE 4.4.2. How were the results applied in the project? NONE SEGTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. SEGTION 6: Unique features of the proiect/other a STRENGTH WEAKNESSES The project has prominent Partner (Council ) who supports the implementation of CDTI activities Late disbursement of funds from Council for implementation of CDTI activities CDTI activities are incorporated in the CCHP Council are providing limited funds to implement CDTI activities Community acceptance to take/swallow the drug Mectizan and albendazole for implementation of CDTIA{TD activities Some of the community members mn away during Mectizan distribution searching for Germ stone. Willingness of CDDs to continue to work without being paid salary only allowances. Low education in data collection and reporting and some of them still demand to be paid Key project staff are committed to work in the proiect In adequate funds to conduct frequency follow up visits to the community level working facilities are available facilitated by Council Brake down of traveling facilities Motor vehicle lcycle affects implementation of CDTI activities CHALLENGES SOLUTION To ensure that all CDTI and NTDs activities are incorporated in Comprehensive Council Heath Plans and funded and funds released timely. HSAM to be conducted to Policy makers and liaise with budget team at district levels to ensure that NTDs activities are incorporated in CCHP and funds released on time The influx of people from outside the district prospecting for gemstone (Mining activities). To update census prior MDA and the patner to set aside fund to conduct census. Writing more than one report while reporting on one thing implemented on the same time, it gives us more confusions. There is a need to APOC and other programme partner to merge reporting format to have one which incomorate all partners' needs. l I matters: Availability of gemstone nearby areas (Mozambique) fluctuate human sencus 30 WHO/APOC, 14 September 2009