Kilosa Focus CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January 2009 to December 2009

THE LTNITED REPUBLIC OF TANZANIA IVIIMSTRY OF HEALTH AND SOCIAL WELFARE ffi I i I t Ïlz Fa latomrlon To-DiR ORIGINAL : English RECU LE APOC/DtR I 0 iif 2$i0 I COUNTRYÆ{OTF : TANZANIA Proiect Name: KILOSA FOCUS CDTI PROJECT Approval year: 2000 Launc s Year: SEPTEMBER 2001 Renorti Period: JANUARY 2009 To: DECEMBER 2009 (Month/Year) (Month/Year) Proiectyearofthisreport: (circleone)l 2 3 4567(8) 9 10 Date submitted: JANUARY 2010 NGDO partner: SIGHT SAVERS INTERNATIONAL I I o: 'Lil,r Ao WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by for March TCC meeting To APOC Management by for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) a 2 WHO/APOC, 24 November 2004 ANIYUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATI\'E 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. NKI-INDWE MWAKYU SA Signature: Date: . Regional Medical Officer Name: Dr. FRIDA MOKITI Signature: Date: . NGDO Representative Name: DR. IBRAHIM KABOLE Signature: Date: . This report has been prepared by Name: ROSEMARY NGURUWE Designation: PRoJECT cooRDINAToR Signature: Date JANUARY 2010 3 WHO/APOC, 24 November 2004 i I Table of contents ACRONYMS DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS. EXECUTIVB SUMMARY... EqunuENr FTNaNcnT CoNTzuBUTIONS OF THE PARTNERS AND COMMUNITIES OTTmn FoRMS oF CoMMUNITY SUPPoRT ExpBNoTTuRE PER ACTIVITY 6 7 8 9 SBCTION I : BACKGROTII\D INFORMATION..... l.l. GpNpRaLINFoRMATIoN................ l.l.l Description of the project (briefly) ........ 1.1.2 Partnership I 2. Population SBCTION 2: IMPLEMENTATION OF CDTI......... .................136 2.1. TrvpLrNp oF AcTIvtrtES .............. ................. 136 2.2. Aovocaci- .............. 136 2.3. MOSILIZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK CON'IN4UNITIES t41 2.4. ColrvuNtrv INVoLVEMENT.............. -........... 158 2.5. Capacrrv BUILDING ...................169 2.6. TRrarusNrs................ ...............22 2.6.1. Treatmentfigures........... 2.6.2 What are the couses of absenteeism?.............. 2.6.3 What are the reasons for refusals? ................ 2.6.4 Brie/ly describe all known andverified serious adverse events (SAEr) that....... 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year.... 2.7. ORDERING, STORAGE AND DELIVERY OF IVERMECTIN......... .................226 2.8. ColrnauNrry sELF-MoNITozuNG nNo Sra«psoLDERS MBprrNc .........227 2.9. SuppRvrsroN ............... ...............239 2.9.1. Provide aJlow chart of supervision hierarchy. . ...238 2.9.2. Vf/hat were the main issues identified during supervision? 2.9.3. lÿ'as a supervision checklist used? ......... 2.9.4. What were the outcomes at each level of CDTI implementation supervision? .... 2.9.5. Was feedback given to the person or groups supervised? 2.9.6. How was the feedback used to improve the overall pedormance of the project? SECTION 3: SUPPORT TO CDTI..... 2s30 ..30 262 273 274 3.1. 3.2. 3.3. 3.4. SECTION 4: SUSTAINABILITY OF CDTI... ..........28s 4.1. INrenNnl-; TNDEeENDENT pARTrcrpAToRy MoNIToRTNG; EvaruattoN..................285 4.1.1 lÿ'as Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) ............ 4.1.2. ÿ[rhat were the recommendations? 4.1.3. How hqve they been implemented? 4.2. SusrarNeslLrry oF eRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT .............285 Yn 3) ......... 4.2.1. Planning at all relevant levels 4.2.2. Funds........ 4 WHO/APOC, 24 November 2004 4.2.3 Transport (replacementondmaintenance) 4.2.4. Otherresources... 4.2.5. To what extent has the plon been implemented.............. 4.3. INrpcRarroN...... ..........36 4.3,1. IveRvecTnl DELIVERY MECTIANISMS...................... EnNTUR ! SIGNET NON DEFIM.6 4.3.2. Training 4.3.3. Joint supervision and monitoringwith other progroms..... 4.i.4. Release offunds for project activities 4.3.5. Is CDTI included in the PHC budget? 4.i.6. Describe other health programmes that are using the CDTI structure and how this was achieved. lÿ'hot have been the achievements? ............. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. OpenauoNAL RESEARCH.. .. . ............37 4.4.1 Summarize in not more than one half of a page the operational research undertaken in the project orea within the reporting period 4.4.2 How v,ere the results applied in the project? ............... SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTT]NITIES ....... 297 SECTION 6: UNIQUE FEATIIRBS OF THE PROJECTiOTHER MATTBRS .........318 5 WHO/APOC, 24 November 2004 t Acronymes NLFEP National LymphaticFilariasis Elimination Programme APOC African Programme for Onchocerciasis Control ATO AnnualTreatment Objective ATrO AnnualTraining Objective CDD Community-Directed Distributor CDTI Communiÿ-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring MDA Mass Drug Administration MOHSW Ministry of Health and Social Welfare NGDO Non-GovernmentalDevelopmentOrganization CHMT Council Health Management Team NOTF National Onchocerciasis Task Force HOD SHM TCC TOT UTG wHo IEC SSI DC DED LFEP KDC CCHP DPLO NTDs SAE MSD HQ STH I{eads of Depaftment Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Ultimate Treatment Goal World Health Organization Information, Education and Communication Sight Savers International District Commissioner District Executive Director Lymphatic Filariasis Elimination Programme Kilosa District Council Council Comprehensive Health Plan District Planning Officer Neglected Tropical Diseases Severe Adverse Events Medical Store Department Head Quarter Soil Transmitted Helminthes 6 WHO/APOC, 24 November 2004 I IDefÏnitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living rn meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatmçnt GqêI(IJT]G] 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) Geosraphical 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) Integration: 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 CDTL (viii) Sustainabilit-v: 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-monitorins (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 fuIl responsibility of ivermectin distribution and make appropriate modifications when necessary. 7 WHO/APOC, 24 November 2004 RECOMMANDATION NO: in the report TCC RECOMMANDATION ACTION TAKEN BY THE PROJECT FOR TCC/APOC MANAGENT USE ONLY 218 TCC accepted the rePort with the following recommendations and suggestions for improving project implementation: Proiect related: (i) Ensure lhat report is endorsed by relevant partners This report has been endorsed by relevant partners as advised (iù list of Auonyms should always be updated and exPlained The list of acronyms rvas uPdate (iiü Provide conJirmation that ralio of male lo female trained CDDs is 1:I The project insists to the community to consider gender balance when selecting CDDs that is r.vhy the male to female CDD ratio is l:l (iv) Provide information on lhe rcason for consislenl underutilization of APOC approval funds and recommendation on There are not funds from APOC which were not utilized bY project. Atl funds were spent according to budget line item. Proiect related:(D ÀPOC and NGDO should ensure early release of funds The project received funds from both APOC and NGDO on time (ii)Train more CDDs to reduce CDD work load: Communiÿ members ratio The project intend to increase the number of CDDs bY sensitizing community on the importance of reducing workload to CDDs by adding number of CDDs in areas where one CDD serves more than 200 people (iii)Produce more IEC materials and intensify communtÿ mobilization in order to reduce absentees and refusals The project received posters and T-shirts from National office, this has helped to enlighten community member on the importance of community to participate in CDTI activities. (iv)APOC need to consider lhe replacemenl of old capital equipment and provide addilional motorcycle for the project We would like to thank APOC management for providing new motor vehicle to the project. Waiting for motor cycle. (iii)Conduct Communi$t Self Monitoring GSA and StakeHolders Meeting(SHM) to improve communigt involvemenl and supemision in lhe remaining communities The project has already trained FLHF staff on how to conduct CSM and SHM. The FLHF staff will carry this activity in area where they serve. FOLLOW UP ON TCC RBCOMMENDATIONS Using the table below, filI in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 29 I a 8 WHO/APOC, 24 November 2004 IExecutive Summary Kilosa CDTI Project is now in the year eight of implementation of CDTI activities. The project was launched in 2001 and it is divided into five zone constituencies, namely Gairo, Kilosa, Mikumi, Magubike and Magole. This report provides information on financial & technical reports of activities conducted in the period of January to December,2009. The project managed to conduct and to accomplish the following:- re-training of 2138 CDDs and74 FLHF staff advocacy to political leader; 52 councilors and 32 (CHMTs & Heads of department), sensitization and social mobilization to endemic communities (875 Ward Development Committee members were sensitized), service and repair of project equipment, drugs distribution to all health facilities, launching of drug swallowing (Mectizan day), supervision and monitoring of CDTI activities, data collection, and report writing. The project also conducted its annual review meeting where by participants were informed on the implementation of CDTI activities which are now integrated with other NTDs/Co implementation. Kilosa CDTI Project has 970 affected communities with a total population of 482,954 people, out of them 389,243 people were treated with the therapeutic coverage of 80.6%. The Ultimate Treatment Goal (UTG) is 405,681 whereby the Annual Treatment Object (ATO) is 386,363 Geographical coverage was maintained at 100%. The Project received a total amount of l, 095,500 Mectizan drugs from Merck & Co. for both CDTI and non CDTI areas, and 886,218 tablets were used in oncho endemic areas. In this reporting year, the Project received funds amounting Tshs. 61,059,529 from difference sources. These are: APOC Tshs 26, 901,680, Sight Savers International (SSI) contributed 17, 536,549 and Council 16, 621,300. The major challenges are: o Lack of Integrated reporting format and IEC materials for NTDs o Few number of CDDs especially females. 9 WHO/APOC. 24 November 2004 SECTION 1: Background information 1.1. Generalinformation 1.1.1 Description of the project (briefly) Kilosa Focus CDTI projèct is situated in Kilosa District that is one of the six Districts in Morogoro Region, locatêd in east Central of Tanzania. It is 300km West of Dar-es-salaam, and is-bounaà Uy latitudes 5'55'and 7.53 South and longitude 36'31'and 37'30 east. The total surface area of Kilosa district is 14,245 sq km, which is 20o of total surface area of Morogoro Region. Average length §orth -South) 180 Km. Average width (East-West) 80km. The topography varies significantly within the District. The Central and Southern flood plains of Wami, lrrtkata and Ruaha rivers stand at 400m above sea level, while the cultivation steppe in the north around Gairo riches 1100m. The highest palts of the district are found in the Ukaguru, Rubeho and Vidunda mountains, which form almost continuous north-south ,nor-ntuinr, range long the Western side of the District and reach an elevation of 2200m. Flood plains ,or. "oÀprisei both flat and undulating ptains extending from the foothills in the west. Àttitrd" is typicàlly 550m. The plains are dissects by many rivers, principally the Wami and Ruaha systeÂs. The central plains are subject to seasonal flooding. The mountain ranges running ilorth-South are part ôf Eastern Arc system and comprise pre-Cambrian metamorphic rock covered by coarse soil. With altitudes up to 2200m Drainage of the District's main rivers is to the east. The area provides most of the headwaters of the Wami river of National significance. The southern part of the District drains into the Great Ruaha River. Kilosa District's rainfall is fairly tropical region and is largely bi- modal with 'short rains' in November/ January and 'long rains' in MarchAvlay with a peak in April. The average annual rainfall varies from yearto year and between ecological zones.l000m- l400mm is common in the southern flood plains whilst Gairo in the north averages 800-ll00mm. However, the mountains forest u."ui "un receive up to 1600mm annually. The lO-year mean for Kilosa (1982-91) is 1040.3mm, with 82 rainy days per year. All over the district, the dry period extends from June to October. The average annual temperature is typically 25'C in Kilosa town with extremes in March (30'C) and July (19'C). The vegetation is characterized by both tropicaland Mediterranean type, depending largely on altitude. Typically though it consists of Miyombo Woodland with grass and shrubs. There are 83,l1ha. fÔi t l% of the total forested area) of catchments forest whilst these come under thejurisdiction of central Government, 24,651ta (0.3%) of productive, protected reserve are the iesponsibility of the district Council. A further l69ha of softwood plantations have beén developed. Kilosa District is administratively divided into 9 divisions, which in turn are subdivided into 37 wards, and 161 registered villages. Kilosa town is the district headquarters and is located 96km West of Morogoro town. Agriculture is by far the most important activity in Kilosa, accounting for approximately 80o of household income. Cash crops include; Sisal (dormant), Cotton, Sugar cane, Coconuts, Onions, Coffee, Semsim, Castor seed and Tobacco Food crops include; Maize, Paddy, Beans, Cassava, Millet, Bananas. Kilosa District road network comprises 3565 Kilometers. t a l0 WHO/APOC, 24 November 2004 District 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 B2 Percentage B::BzlBr*100 KILOSA 350 l14 33% Total 3s0 114 33'/, Table l.Number of health staff involved in CDTI 1.1.2 Partnership Kilosa CDTI Project implements CDTI activities under the support of Endemic Communities, Kilosa District Council (KDC), Ministry of Health and Social Welfare (MOHSW), APOC, and Sight Savers International (SSD. The District council provides salary to staff, namely PC, DOTs, Project driver and FLHF workers. It also supports the project with transpoft when conducting HSAM, Supervision, Planning and Monitoring. The Ministry of Health and Social Welfare provides technical support for the implementation of CDTI activities in the project. The SSI as NGDO partner provides funds for training of FLHF staff and CDDs, Support advocacy meeting to political leaders including ward development committees, Supervision and monitoring. SSI also provides funds for facilitating launching of Mectizan distribution, and also provides office fumiture and supplies. Community members are encouraged to collect Mectizan from the nearest Health Post/faciliÿ and distribute to other members within the community, Mobilize others, also motivate CDDs by for example exempting them from communalwork in the village. il WHO/APOC, 24 November 2004 c..l o o o zç ô.t O o o c.t C) (§ .9 a.Ê. o z d C) ()e t- c) -o0)É èo .<(!^. =û>(È l- -ô5 c'.(,(É a9) .=-o E .Cr -o'Fli =(l) (É_éH bn ijÊ-6 Ë9o)9ÉÀ 6)9 -cE 7(g à; '= c)LL5(.) 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The reason for Advocacy to policy/decision markers is to create awareness among the new comers in the area, educate them and to remind them their roles and responsibilities in the coming cycle and CDTI in general' ' The outcome: Raised therapèutic coverage, reduced refusal rate and also increased ownership of the Project. . The project faced prôblems of funds for sensitization/advocacy and also this year (200-9) we had eleôtions for the lower level community (hamlet) and village leaders, so we conducted advocacy only to village executive officers (VEO) 2.3. Mobilization, sensitization and health education of at risk communities Information Provided include: Information on the use of media to disseminate information: The approach used to disseminate information was community dialogue and health education session. Severalmeetings were conducted in Villages and Wards regarding implementation of CDTI activities to combat Onchocerciasis and other NTDs' The project emphasized on the importance of swallowing Mectizan@ drugs during MDA "*..ôir"r. Community members themselves should make sure that any eligible person is swallowing the drugs. Other means of delivering the messages to the community include local Radio stations whereby spots with Onchocerciasis messages are aired, churches and mosque by including Onchoceiciàsis messages when religious leaders are addressing their congregations. on Mectizan day, (i.e, Launching of treatment), we provided Mectizan to all members available on thai day including District Commissioner, District Executive Director, heads of departments, other community leaders available and some villagers. The main objective was to sensitize community members on the importance of taking the drug and remind them that time for taking the drug has reached. Posters were also used as a display on open place to clariÿ on Mectizan drug and the importance of communiÿ members to participate in CDTI activities. Result of mobilization efforts: Many people participated in CDTI activities. Sornl tom-unity members were well sensitized to the extent of assisting with convincing others to take drugs. A number of people have been inquiring from CDDs as to when will the drugs be distributed when the drugs arrive a bit late compared to the date they had agreed upon. Response of target communities: As a result of sufficient health education provided many communities accepted CDTI as the main approach to control Onchocerciasis and other health problem in their areas, also they demand for Mectizan when it has not reached to communities. a t4 WHO/APOC, 24 November 2003 aSuggestion for improving mobilization of target communities: o To integrate supervision with district officials and all stakeholders to emphasize on the issues of ownership and sustainability of the project. o To increase number of communiÿ meetings and sensitization prior to Mectizan distribution. o To commemorate Mectizan day at each level, and produce and distribute IEC materials with massages on communiÿ participation in CDTI activities. o To convene more meetings to Govemment leaders, Religious leaders and Councilors. 2.4. Communityinvolvement Table 4: Communities participation in the CDTI (Please add more row.s if necessary) Comment on: Attendance offemale members of the communiÿ at health education meetings Women are care givers of underfive normally participate in Health education session in all Reproductive and Child Health Clinics R(CH). Health education on Onchocerciasis control is also given at RCH clinics including the need for community participation in CDTI activities. Other female communiÿ members receive the messages through public meeting and there is an increase of number of women attending public meetings compared to previous year for both urban and rural areas. In general, how do you rate the participotion offemale members of the communiÿ meetings when CDTI issues are being discussed (attendance, pafiicipation in the discussion etc) The participation of female members in the community meetings when CDTI issues are being discussed was high, due to the fact that women/females are now empowered to take chance of being leaders by 50% as men. Females can always raise their concerns and the do also contribute to discussions. The participation of female members actually increases year after year. Incentives provided by communities for the CDDs o Excluding CDDs from participating in any communal work for the whole month of Mectizan distribution. o Providing some cash during the month of distribution o CDDs are being involved in other Programme activities, which provide incentives like Malaria programme. o During farming session some community members do help CDDs in their fields. trict Number of communities/Sub vilhges with community members as supervisors Number of CDDs and the communities involved Number of communities /Sub villages with female CDDs Totâl no. communities in thc entire project arca Br Number with community members as supervisors Perce ntagc B. Be= B5/ B. *100 Male CDDs B7 Female CDDs Br Total Be= Br+f,t Number of communities with female CDDs Bro Percentage Brt= B,JB1* 100 KILOSA DISTRICT 970 970 t00 1069 I 069 2138 970 100 Total 970 970 100 1069 1069 2138 910 100 l5 WHO/APOC, 24 November 2004 Other issues 2.5. Capacify building Training and Education The project affolded to retrain 74 FLHFs and 2,138 CDDs in all CDTI areas. CDDs have then been involved in distributing Mectizan where they also insisted to the community on the importance of taking Mectizan for l5 consecutive years. Type of materials develops for use in Training health staff and cDDs ln inis year training was conducted in integrated manner, as we are now going to NTDs co- implementation. During training we used both Oncho manuals and NTDs developed manuals to èxplain NTDs cycle and how to treat and prevent by using appropriate medicines. - 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 enough knowledgeable manpower was available or if staffs arefrequenlly transferred during the course of the campatgn). In our project we usually train head of health faciliÿ to be the in charge of CDTI activities, in their locaiities, therefore after we direct him or her to train all subordinates on how to implement CDTI activities so that activity will not be affected even when she/he is not around. All community leaders are responsiblefor mobilizing community members and the district makes sure that all leaders are aware of CDTI Implementation. Sometimes in areas where there is no health facility or when there is no knowledgeable manpower we use the nearby health facility worker to train and supervise CDTI implementation in.that area. Moreôver, when it happens that there is transfer of project staff, the Council in collaboration with NGDO takes reiponsibility to train the new in charge of that particular health facility. t l6 WHO/APOC, 24 November 2004 6Jê .- + l-v 1 È.qv æ(1 êt æ(.) èl æ(7) ôl æ(t) êl 6t q) o G Oââ Q q) z L] æ(.) êl æ(.) êl a) tr() r[) a- 00 o O o .=G6É< o: o q,) .e) LC! olL z ê< F Ô:{ Fv: àv Fr æ o () il) ê\ ,:t ô -1 + r_ .yu Ér- r- ÿ + §t- È- q) =d8È l§ ËE E rsl zË 6)q)l ?F +È- +c- ru E 1l) o s è q à (irÿ a, + <fs <t =l ++ tî+ 6l 00 J I,e9() ;!! q)E z J L \tç És (J J â ct) -.]ÿ FI t'r oF É a)E() () \c N () -ô o o z§ ô.1 Q (_, ùU§) 4 l. §)t È ! §)q §) o s o H c) t-*FâQqr o (h (.) o o.)È< .c)I E (l) (B Table 6: Type of training undertaken (fick the boxei where specific troining was caruied out during the reporting period) Any other comments: o More funds allocation specific for Community self Monitoring, hence leads to sustainability of the Programme o There should be more other partners to support on Community Self Monitoring because this is the foundation of sustainabiliÿ of the programme because it needs a lot of money. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (speciÿ) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis VEOs Report Project coordinator Others (speciÿ) Supervision on Mectizan swallowing a Council Health management Team District officials (DED & DC) a 18 WHO/APOC, l0 April 2003 ô.1 o- OoÀ o, ùèo§\! U (/ §\ èo èo ;.à \\JÈF-ùbË(üP 9q˧ POU .* .sY\L o. ù::9 ='§!- §s .= èo{: .E §SP >.aQI .sÈ I !Ëi §u '" s6 .e .ës E §§5 s.§ L\-() :§ -s§ bÙ -.ÉÈ\ -\ȧUÙ\@ =!!P ':'§ÊLU\Ù - § §.'s .= '§u iË hSqfl È*§§ÈI FEbE tllr 6t § % Ë5 E§XI §iT" o-l 3.Y uE §§È0) UȧO. '= §\ts §§§ - = RVU §.§'SË §è.: = §§§§ §i Eô § §ÈF .s §t M\:.i§è i .s s§ §È§I§ù§ È.È .\! §È §'ù v L.ê§3si§^§ E-%r§ù§:lÙ .§'t \I §Èq, Ùl .s{ÈS ril§ PP S =§§ o C)>XËç6).Y Ë9) E()(1)oÊoËë()a L: ,vËP <z CÉI(§ Io C) v -L0)ËÊ !PO-0.t .! 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(! €.˧kb!{^ ,s\EI' .2ù^.§ôÈ(É\(.)AA§i'E Éo ÿe §a(üÈ o€è 29b (.)H () \ÉtÉ'di§ (ü o-ô s E '--. -§ O.= à. -ê-U\ bo^v r-À-ÊrF erO.a \cj ô,i C)() 't o(§ oJeeEL(d '=o E.h -(B 6)Hé oe9Lü€ 6ag o= 9O- tt)88 o.(:)() -c 9) qr ÔO OLü'9oôotrÉ -o?o)v ()G) -cP}E bouoÉa(d9,3:- §3 o;§Ezôoà .= .9 =o88. 9= 3(vé =6>, :: .9 ^ÊY'a§;g E .ka é i§Jc)C)E -§ =- ÉÈJ-Ls-o () o§'- > o%J50)-. .§ u)i v -§E:îÈbE,;: tâ 09;üthE§ 8o.'Y 3U = ()(_ s., .H E o§:'!:p ô âȧ >.'È gs .9 !.1 oo§&<HSFrl]àrà ôraaa 6 ..i st a.l L() -ô tro o z sf ô.1 O o c.l U) o 03 o o oo F 0û Lo CÜ E o C) c) an(! q1 c) an .+ i.jo (§ oo o Ë< € F D() o (Ë o E (.)(â(d oÀ È\ §,)L §.p §§ § § §J Ê. ql G c') c) '= :l- :l- FE;oeor gI o-o ÉLo(§ 'E9 èàlo. 302 '= (!Eo --o:o -èou(Ë LE9oaÈa ÉE o.^ oÊ E()(,E GL E9tslr3ôr!oll o .!l ËFtq) t- '':\At ci () d) F 9à< -oQ o\ t- \o \ot.. o\ôl co o\ o\ oo o\\o +æ \o o\ oi oo \oq o\ 6\ rf oo -à o ^ oI)9 §.; - Oô\ <' >e -ô o \o c- +F- \o r-È- 5\ oo ^\o\ o\ æ \oo\ ô.1 È- æ t-- s o\ \oo\ \o o\ 6\+ c.i æ o =à0od3b oo .EoF 6 6\ \o \oê\ n æ\o o\ r;rr \o J Èr -o ^\!? È- \o r- o æ \o oô E ,o o6 .o o.!j9-- io ZÉ o a ONq ôl c.l rr æ(\\o(\ (\ \oÿ c\l tj cl tr a.l r- r- c1 N ô.1 æ c.i oo c1 <f e.l oi æ Ëo d o ,: cd=iÿs' FU o\ Èi t-- o\\o oi co \o r- F- ôt o\ oê + c- o\q mÈ- !+ F-ô È- cô sf od o\ I I : ,p -io -: o.E§ i o ào .ô ôE< =L ' É Beo É= o F- o\r- st §s + oo o\ ri c.lÉ oo\l .d .+§ \ocl \o <t ÿ n æ\os oo c-l{F-+ çq a.l æ\t g rI: o _èoÿ i:aâ <" >v -o o \ê 6\ \o \o s ê\ \o Eo=qàD:6- §a i BS §E;; (,0* \o s o \oê\ \oô\ ê\ s \c '* o.E 3- E E $Etr tr= ù = Ei!>oô <t o\ § o\ s o\ ç o\ É o\ t-o\ Èro\ l'-o\ -) 2ad o.= -ÉoE=oi üF l- t-) sf o\ + o\ sr) o\ * o\ s o\ c*o\ o c- o\ F-o\ () ôo(É o Q I (Ë oF è06 = ,pl.Eg8€ *6 'i - 8.9 ; T Eë = EÉEO a s o\ s o\ <l o\ § o\ É o\ F*o\ F-o\ Èro\ ON \oo N È- ô.1 û ô.1 o\ O a.l & rl] c..lo(\ cl c.l § N 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH (./) wHo ( ) UITICEF ( ) Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH (ü wHo ( ) uNrcEF ( ) NGDo o NGDO ( ) Please describe how Mectizan@ is ordered and how it gets to the communities yearly Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project and requests drugs by filling in the ordering forms ànd sànd rhem to the N9TF in thè Ministry of Health & Social Welfare. We calculate the number of tablets require by multiplying the ATO times 2.2 then we get total number of required tablets. But in this distribution year we received the drugs direct from MSD HQ whereby the distribution list was done at the Ministry of Health and Social Welfare. When the drugs arrive at the district pharmacy, the District authority distributed drugs to the FLHF by follàwing request sent to them by FLHF staff. After getting Mectizan the FLHF staff infôrms the Village authority on the arrival of Mectizan thereafter the CDD or any selected community m-ember come up to the FLHF to collect Mectizan@ ready for distribution to other Community members. Mectizan@ In lease add more roÿÿs nece, Activities under ivermectin delivery that are being carried out by health personnel in the project area are: îo inform communities that Mectizan is already at the facility for them to collect To collect the remaining Ivermectin tablets and bring them to store in the district Pharmacy for next treatment cYcle Issuing Mectizan to community according to their needs FLHF staffs are involved in monitoring and supervision on Mectizan distribution. When they attend Patients at OPD, they provide health Education on the importance of taking Mectizan during the distribution period. 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring had been done in the proiect area? NO Number of Mectizan tablets BalanceUsed Lost/wasteReceivedRequested State/District/LGA 00 KILOSA PHARMACY 209,28201,438,926 886,2181,095,500 FROM MECK 209,282886,218 01,438,9261,095,500TOTAL 22 WHO/APOC, 24 November 2004 If so, ll/hen? Not applicable Table 1l: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) Describe how the results of the community self- mon'toring and stokeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Achievements : o In some community they put Onchocerciasis control as agenda in every community meeting during time of distribution. o In areas whereby CSM was done there is an increase in therapeutic coverage . Decrease of drop out yearly, also number of refusal decreases o Community members and government leaders are both committed in CDTI activities 2.9. Supervision 2.9.1. A flow chart of supervision hierarchy NOTF Nationallevel Regionallevel level Health Facilities level Districÿ LGA Total # of communities/villages in the entire project area No. of Communities that carried out self monitoring (CSfvD No. of Communities that conducted stakeholders meeting (SHfvD KILOSA 970 62 970 TOTAL 970 62 970 R.M.O DMO, PG DOT RHWs MUNITIESGDDs 23 WHO/APOC, 24 November 2004 Level 2.9.2Main issues identified 2.9.3 Supervi sion check list used YesÆ.{o 2.9.4 What were the outcome of CDTI implementation supervised 2.9.s Was feedbac k given to the supervis ed YesÆ',lo 2.9.6 How was feedback used in improving the overall performance ofthe project DISTRICT Funds from Council was not released on time. Yes -Good relationship between Community and FLHFS -lmproved performance in CDTI implementation -Create commitment and confidence among CDDs, village leaders, -Problems identified and solved early (during period of Mectizan distribution) -CDTI activities are in cooperated in the health care system Yes Feedback is very important because it helps community members to realize that they have to work hard for their own benefit instead of waiting for the high level. Feedback was also given to the community members on meetings, which involve allCDTI implementers/stake holders in the area visited. FLFtr Lack oftransport for supporting supervision. Yes - CDTI activities are integrated with other programs like malaria control, Trachoma, Lymphatic Filariasis. - Increase morality of work to implementers Yes Feedback was given to the people supervised and community by using normal public meetings of the Villages and other community gathering. When conducting supervision you also include extension workers. COMMUMTY Some communities are not giving incentives to CDDs Yes Community know their responsibility and own the project Yes Public meetings with both community leaders & other community members. Table 12. Below show how supervision is done at each level of CDTI implementation a 24 WHO/APOC, 24 November 2004 SECTION 3: Support to CDTI 3.1. 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 project received new motor vehicle from APOC Trust funds and we would like to thank APOC for this move hoping that other capital equipment will be replaced. CDTI activities are already integrated into the health system; the project capital equipment will be serviced through PHC system. a a Source Type of Equipment APOC MOH District NGDO 0thers No Condition N o Conditi on No Condi tion No Cond ition No Con ditio n l. Vehicle 2 lwo, lF 0 0 I wo 0 2. Motor cycle 4 2 F,2WO 2 F 3. Computers a) desk top I wo b) Lap top I WO 4. Printers I F 5. Fax Machines I wo 6. Others a) Photocopy machine I F b) Air conditioner I F c) Office Furniture 8 F 25 WHO/APOC, 24 November 2004 vôl q) E 0.) o z\t C.l Oô o ô] æ r\oær- !()û -(§(É 0)(,q -oôa -d,- ÿ o o æ §o \o ô.1 cf) L(n c) >. 0)()6!0)+ '= ./) Èo treOL(.) .O H.h(§ c) 6)= o.(o vO P':- ijo o(d U .§EOE (É lJr tr. cll rl ..i *l c.; Èl t a , -g(§ d_) .6 -S* -='d3 o O \Ôr. N æq t'-ôl æ o" r fz s <f o. ôl t \o- \ê F. r L o 0)q -(!cd ()€46.6 a? &? O o o^ \o æ r-. v \o r^ n \ê æ r 0)(!(J .6 3* - )cho) O O cl \o æ\ Eÿ € r râç ç (.) o1 -6(i o€ê -oia?&) € c.lI c{ O\ € f; \o d ,y €cl \o d \oç 1ô o\d - !.1(!à)Ë lpeE- 3aÊoD €\Ô N €N F} =<>É c.l ..) æ æ æ <f, v] r- E lu q\o ô1+ € æ\ê ra 3,a oû _CË(! ()€âé6cn?&) N <f æ æ +ôl F- ç c- + \o" I æ ! .Eli é q ca Qn n c.l ç o\ æ N\ê E c)ËË€âx ôo(,? z) Êa ôl =læ s" r-æ od o\ \orl ôrôr d) J(c oV] r tr- §l.- æç\o cÊÈ- L('Ç r!E! O^ < qê 5+3 -É, ô,\i oôl ô1 9 o' .o- r- \o d \ ô{q ô.1 \o ôiæ a- + \o o\ 6 Èl o^ É -g"aÔED ô'.d 9 æ !q o^ s r dq d \o\o ôl qç æêt ôl æ L oQ a oà Lo 1i (ü t-.1 Av L() E(! o l-.1 2o o L ah o rtl o o Àr! tliJ z (§ -ô o ar) o o C) E) frr (t) r<F O oÀ Fl F< o Fr a aComments: None 3.3. Other forms of community support - Provision of transport to CDDs or any community member to go to nearby health facility for drugs collection. Some communities prepare drama group to Mobilize and sensitize community members prior to drug distribution and during distribution. Some of communities support CDDs by excluding them from communiÿ development work. 3.4. Expenditure per activify Indicated in table 14, the amount expended during the reporting period for each activity listed. Current United Nations exchange rate to local currency was US$ I : TSHS 1,300. Table l4: Indicate how much the project spent for each activity listed below during the reporting period a a a Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of commun Mobilization and health education of communities Training of CDDs J1'qlni_ng-_qf b_"Cltl, s!?ffgt ?_ll lgyelq ising CDDs and distribution Intemal m_on itori n g_ 9IçDff activities Advocacy visits to health andpolitical IEC materials authorities sqq@t treatment Vehicleÿ Motocycles/ bicycles mainte_nance Office e. Others 1,921_ 4,546 17,376 4,629 2,825 0 1,538 0 0 1,154 0 K_Dç- NLFEP KDC &, APOC APOC SSI & KDC Nil .§SI NIL Nil SSI & KDC NIL TOTAL 33,989 Total number of persons treated 389,,243 27 WHO/APOC, 24 November 2004 Lap top. printers etc) SECTION 4: SUSTAINABILITY OF CDTI 4.1. Internal; independentparticipatorymonitoring; Evaluation 4.L.1 Was Monitoring/evaluation carried out during the reporting period? (Tick where applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners What were the recommendations? NA 4.1.2 How have they been implemented? NA 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No llhat arrangements have been made to sustain CDTI after APOCfunding ceases in terms ofr 4.2.L. Planning at all relevant levels CDTI activities aie incorporated in the CCHP, and community is empowered to make their plans according to their priority. 4.2.2. Funds District council has been encouraged to release funds budgeted for carrying out CDTI activities and the contribution is increasingly yearly. Communities are encouraged to take their full responsibilities in CDTI activities. 4.2.3 Transport(replacementand maintenance) The project thanks APOC for vehicle provided recently. We still have problems with motorcycles. District council is responsible for service and repair of the vehicle as CDTI activities are already incorporated CCHP. 4.2.4. Other resources The Project depends on Government, Council and NGDO (SSI) which is committed to continue its support to the project. 4.2,5. To what extent has the plan been implemented In this year the implementation of CDTI activities has followed the Sustainability Plan developed after the mid- evaluation of project. a a a 28 WHO/APOC, 24 November 2004 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Ivermectin is delivered through the existing Health system from NationalHQ to project levelthrough MSD. 4.3.2 Training Training had been integrated with NTDs. We trained CDDs on all five NTDs (Oncho, LFEP, Stchisomiasis, SoilTransmitted Helminthes (STH) and Trachoma). To Some extent the project started to co implement with Vitamin A and ITNs distribution as pilot in one Ward. 4.3.3. Joint supervision and monitoring with other programs CDTI activities are incorporated in the district supervision matrix using the existing Onchocerciasis checklist. 4.3.4 Release of funds Funds from council are not released on time this cause delay in the implementation of activities. 4.3.5. Is CDTI included in the CCHP budget? Yes, and some of CDTI activities are being financed by Council 4.3.6. Describe other health programs that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is being used in Malaria Control by distributing Insecticide Treated Nets (ITNs), Vitamin A supplementation and now co-implementation of the frve NTDs (Oncho, LF, Trachoma, Schistosomiasis and STH. 4.3.7. Describe others issues considered in the integration of CDTI. The district still looking at how they can use CDTI in identification of TB patient and distribution of TB drugs to Patient by using community at house hold level. 4.4. Operational research No any operation research done SECTION 5: Strengths, weaknesses, challenges, and opportunities STRENGTH AI\D WEAKNESS STRENGTHS: o Integration of Oncho activities with other programs ( NTDs Implementation) a I 29 WHO/APOC, 24 November 2004 a All Policy makers at all level participated well in the implementation of MDA activities. . Kilosa District Council increase their allocation to NTDs activities o Active participation of CHMTs, Counciland community leaders to ensure the campaign was successful. o CDTI activities are incorporated in the CCHP o CDDs are willing to volunteer in NTDs WEAKNESSES: o Late arrival of medicine from MSD to project area o Integrated Registers came late thus could not be used during the MDA exercise. o Distribution of drug during rainy season o Negative attitude of some community members on mass drugs administration questioning why it is given free why not Malaria drugs? o Late release of funds from Partners CHALLBNGES: o Lack of Integrated reporting format and IEC materials for NTDs o Need to increase number of CDDs especially females. o CDTI activities to continue to appear in the CCHP and funds are allocated and released in time o Lack of transport to FLHFs. OPPORTIJNITIES o Availability of funds (basket fund) for implementing CDTI activities o Integration of CDTI activities with other NTDs programme o Availability of knowledgeable CHMT members and FLHF staff on CDTI coordination o Political stability ensure ownership and sustainability o The project have a prominent NGDO (SSI) Major achievement of the Project during the Year - The project managed to reduce number of people refusing to take Mectizan. - Advôcaty meetings were conducted targeting all representative from political parties on NTDs implementation. - Conducted Project's Annual Review Meeting and Mectizan day where all major partners were invited to participate. TYPE OF ASSISTAI\CE REQTIIRED 1. Government: o A timely release of funds that have been budgeted in the Council Plan to continue supporting CDTI activities as it has been done before. o Increase funds allocated by Council to CDTI activities a 2. APOC Management: t a 30 WHO/APOC, 24 November 2004 APOC management is requested to replace other remained capital equipment as per memorandum of understanding. New capital equipment will enable the project to conduct CDTI activities as schedule and thus maintain the recommended Therapeutic coverage. 3. Sight Savers International Continue with their support to the project. SECTION 6: Unique features of the project/other matters NONE a t 3l WHO/APOC, 24 November 2004