RESERVED FOR PROJECT LOGO/HEADING I I COUNTRY/NOTF:UGANDA Proiect Name - PHASE 2 Approval year:1996 Reportins Period (Month/Year): January to December 2009 Proiectvearofthisreport: (circleone) I 2 3 4 5 6 7 8 9 10 Date submitted: stn February 2010 NGDO partner: TCC SSI NTD -5o ORIGINAL :English AA YBC trvfI 15rlt(Sli c0r t? tfia +lFo I r,?y.rrt# .)i'r i-t r,, tt i '- l)tp{: 'r e. Ao, AP/t I wHo/APoc, 25n october 2005 Launching vear:1996 IANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAIIPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) u wHo/APoc, 25s october 2oo5 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: UGANDA National Coordinator Name: Tom Lakwo (Acting) Signature: SS"{ Date: .1.:t I Ac ro NGDO Partner Name: .. \A' h. rr{ }\rj sF:1!?) \/ r0 This report has been prepared by Name : Dr. Andrew Byamungu Designatior,,sn*.. [ng..t]Lal ] Signature Date Signature : Date t_.._.. llt wHo/APoc, 256 october 2oo5 Table of contents ACRONYMS VI DEFINITIONS VII FOLLOW UP ON TCC RECOMMENDATIONS 1 EXECATIVE SAMMARY 2 SECTION I: BACKGROAND INFORMATION 3 1.1. GpNr,nq.L INFoRMATIoN............... 1.1.1 Description of the project (briefly) . 1.1.2. Partnership 1.2. Popu1arroN................ SECTION 2: IMPLEMENTATION OF CDTI 10 2.I. TTTT,TPI-INB OF ACTIVITIES 2.2. ADVOCACY 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3,3. OTgpRFORMS OF COMMUMTY SUPPORT 3.4. Expr,NoIrURE PER ACTIVITY 3 3 6 8 .10 .t4 2.3. MoeLIzarroN, SENSITIZATION AND HEALTH EDUCATIoN oF AT RISK coMMuNtrrcs 14 2.4. CoMMu'rrryINvoLvEMENT............ ................. 16 2.5, CapacrrYBUILDING, 2.6.2 V[hat are the causes of absenteeism?............. ............25 2.6.3 Vlrhat are the reasonsfor refusals? ................ ............25 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that....25 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year27 2.7. ORDEBJNG, STORAGE AND DELIVERY OF IVERMECTIN .,.......28 2.8. CounauNtry sELF-MoNIToRINGAND STAKEHoLDERS MEETING ...........29 2.9 SuppRvtsroN.......... 29 Provide a/low chart of supervision hierarclry. ..........29 l{hat were the main issues identified during supervision? ......,....29 7[/os a supervision checklist usedT ......... ....................30 What were the outcomes at each level of CDTI implementation supervision? 30 Wos feedback given to the person or groups supervised? .............30 How was the feedback used to improve the overall performance of the proiect? 30 SECTION 3: SUPPORT TO CDTI 30 3.1. Equrrvevr ........... 3 1 ........... 3 I ...........32 .....,.,...32 3.2. FnvaNCTaI- CONTRIBUTIONS OF THE PARTNERS AND COMMTINITIES SECTION 4: SUSTAINABILITY OF CDTI 33 4.1. IurrRNaI-; INDEnENDENT PARTICIPAToRY MoNIToRING; EvALUATION.................... 33 4. t.1 Was Monitoring/evaluation catied out during the reporting period? (tick any of thefollowingwhichare applicable)............ .......33 4.1.2. Vfhat were the recommendations? .........'.34 4.1.3. How have they been implemented?.............. ...........-..i4 4.2. SusTATABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT......... .......34 Yn 3)......... .-....---.34 tv WHO/APOC, 25n October 2005 4.2.1. Planning at all relevant levels .............."'34 4.2.2. Funds........ ...'....-.34 4.2.3 Transport (replacement and maintenance) ........8rror! Bookmark not deftned. 4.2.4. Other resources... ...'......Error! Bookmark not defined. 4.2.5. To what extent has the plan been implemented..............-.. 4.3. lurecRarroN............... 4.3.1. Ivermectin delivery mechanisms 4.3.2. Training.... 4.i.3. Joint supervision and monitoringwith other programs..... 4.3.4. Release offunds for project activities4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. .......'.".....'.35 4.i.7. Describe others issues considered in the integration of CDTI. .....35 4.4. OpBnaTIONAL RESEARCH . .....36 4.4.1. Summarize in not more than one half of a page the operational reseorch undertaken in the project oreawithin the reporting period........ ..................36 4.4.2. How were the results applied in the project? ............. ..................36 SECTION 5: STRENGTHS, WEATNE^S,SES, CHALLENGES, AND OPPORTUNITIES 36 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS 37 35 35 35 i5 35 35 i5 v WHO/APOC, 25s October 2005 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINTCEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization vl wHo/APoC, 25n october 2005 Definitions (i) Total population: the total population living in mesolhyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84oh of the total population in mesofttyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesolhyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be explctld 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). (ri) 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 CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) 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. vll WHO/APoC, 25ft october 2005 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows tf necessary) I Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCAAPOC MGT USE ONLY WHO/APOC, 25s October 2005 Executive Summary Prepare an Executive summary of the report in not more than one page. 1. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. This report covers the period of January to December 2009 for Phose II districts, which include Mbale, Sironko, Kabale, Bushenyi, Kyenioio, Kabarole, Kamwenge and Manafwa and Bududa. Manafwa was curvedfrom Mbale in 2006 and Bududa was cut from Manafwa in 2007. The number of communities tn phase II districts is 1,457 with a total population of 696,566 people. The UTG in this project is 594,944 people during the reporting period with therapeutic coverage of 82% and geographic coverage of ru|%. These districts sturted implementing CDTI acttvities with financial support from APOC in 1998. The districts were evaluated for sustainabilily in June 2003 after Jive years of APOC funding and thereafter, they developed sustainability plans, which they have, been implementing using resources from the district health services and the partner NGDO. These districts are in the llth year of CDTI implementation. lVith funding from all partners, all phose II districts have slarted implementing semi-annual treatment with ivermectin plus vector control/elimination in an elfoil tu eliminate onchocerciasis in these districts. These districts are targeted for onchocerciasis elimination because the foci are believed to be isolated and therefore, feasible for elimination. Encouraging results are being obtainedfrom the elimination policy both in semi-annual treatment and vector elimination. Some of the foci are waiting for a guideline to be tn place in orderfor intervention to be halted, 2. Background on population movements. The populotions in phase II districts ore stable and homogeneous. Issues of population fluctuations are not reported in lhese districts. 3. Training data - CDDS, health workers, Total population (community) per CDD trained. A total of 34,175 CDDs were targeted for training and 31,488 were trained, giving 92.1% achievement. The total population in the project area was 696,015 giving a ratio of o4e CDD per 22 people (apprortmakly 5 hoase holds per CDD to treat). A total of 266-health workers were targeted for training and 266 were trained giving 100-% achievement. Also a lotal of 2,685 TOTs were trained during the period under review. 4. Challenges and how they were overcome. The main challenge has been inadequate counterfunding by the health services. Advocacy to political leaders and policy makers has been intensiJied and it will continue to ensure that CDTI continues to be included in the overall district health plans and funds budgeted and released for CDTI activilies. Where onchocerciosis control is inlegrated with other NTDs, CDDS are overwhelmed by a lot of information, administration of many drugs, use of dffirent dose poles, and recording in the integrated regbter. This has resulted in poor data and increased demand for incentives. Effort hss been made to intensify training of CDDs in the various NIDs, bringing on board Health assistonts and Village Health teams as CDDs and supervisors at various levels in the communily. There is also a problem of inability to tuA exactly when treatment with ivermectin will stop hence making advocacy quite dfficult. llith the recommendations of llganda Onchocerciasis Elimination Committee (UOEC) the Ministry of Healtlt and NOTF/I,{TD are working on a national guideline to give direclion in halting intervention in some of the areas where elimination has been achieved. 2 WHO/APOC, 256 October 2005 SEGTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads. . .) Administration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staffinvolved in CDTI activities. Phase II CDTI districts are located in western Uganda (Bushenyi, Kabale, Kabarole, Kamwenge and Kyenjojo) and Eastern Uganda (Mbale, Sironko and Manafwa). The populations in these districts are homogeneous and stable. The districts in Eastern Uganda and Kabale in ll/estern llganda are highlands with dfficult terrain, which makes it dfficult to reach the communities especially during the rainy season. The main activity in phase II districts is subsistence farming. Administratively Uganda is organized under local where the political head of the district is the Local council chairperson (LCS). Under the LC 5 chairperson, there are LC4 at county level, LC 3 at suh-county level, and LC2 at parish level and LCI al village leveL Communication systems The road networks in all phase 1I districts are typical of Ugandan rouds. The roads from the Capital City are all tarmac roods. However all roads from the District Health Offtce to onchocerciosis endemic areas are all murram roads. In onchocerciasts endemic areas however, all the districts are served by village roads which are somctimes impassable during rainy seasons, especially the district of Kabale and the Elgon region districts that are characterized by highlands. In most parts of the phase 2 districts, it is possible to access the networks of at least one of the three commonesl wireless telephone systems. All dislricts are well served witlt telecommunication networks Organlzation of the Health Seruices Since 1997, Ugandan government adopted reforms, which include decentralizalion of services from the centq to lhe lower levels of governance. Most of the central government functions have been decentrolized to the districts in whot is popularly known as the decentralization policy. Decentralization takes services and resources nearet to the people, eases decision-making, improves accountability and creates a sense of ownership. At the district, actual implementation of health care is further decentralized to the health sub- district level and lower level health centers. 3 WHO/APOC, 256 October 2005 Health indicators Infant mortality rate is about 100/1000 live births, child mortality is 16/1000, totalfertility rate is Thooman, 323 populations per nurse, Ide expectancy is 52 years for females and 50 years foe males. 50% of population lives within 10 km of health unit although most health unils are understaffed. Health care financing Povefi eradication Action plan (PEAP) in place: reduce pover$t, Universal Primary and Secondary education, Primary Health Care,Improve communications and debt relieli, Central governmenl budgetfor health is about I5%. Estimated per capita on health is U^S$ 30-40. The health budget is overwhelmed by the i major killer diseases (Malaria, HIV/AIDs and TB). The PHC grant, more oflen, does not meet the health needs of districts. The biggest challenge of implementing the minimum health care package is under funding - with only 30% of the package funded. Attempts have and are being made to have sdditional funds for the sector but these efforts have been constrained, by macro economic concerns and the rigid sector ceilings. Government has therefore resorted to prioritization ond integrated implementation of certain areas of the pockage. The areas of special focus for integrated systems are human resources for heolth, health infrastructure development and provision of essential medicines and supplies. 4 WHO/APOC, 25n October 2005 Organization of health services in Uganda (the chain of command) 5 Development Partners Ministry Of Health Other line ministries Referral Hospitals District Health Office District Hospital HSD HCTV Health Centre III Health Centre II Communities wHo/APoC, 25m october 2005 DistricULGA Number of health staff involved in CDTI rctivitics. Totel Number of health steff in thc entire project arer Br Numbcr of hcalth stelf involvcd in CDTI Bt Percentage *100 Bushenyi 50 28 56 Kabale 31 13 42 Kabarole 22 15 68 Kamwenge 25 15 60 Kyenjojo 186 40 22 Manafwa 10 5 50 Mbale 33 t4 42 Sironko 19 12 63 Bududa 18 10 56 TOTAL 192 119 62 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nati onal/international), communities, local or ganization s, etc.] The NGDO portner in phase 2 district is the Carter Center assisting all the districts. Semi-annual treatment is ongoing in Kabale, Mbale, Sironko, Bududa, Manafwa and Kamwenge. The rest of the remaining districts in this phase are under annual treatment. Other partners include the Ministry of Health, the District Health Services and the affected communities, which play a leading role in the organization and exccution of CDTI activities. Of recent NTD control started also providing some support to Kyenjojo, Kabarole and Kamwenge. Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. The partners work closely in advocacy, monitoring and supervision, planning and review of the progress of the projecl For instance, regional and dktricts advocacy meetings are conductediointly by MOH and NGDOs. Since 2007 the programme for control of Neglected Tropical Diseases has come on board. It integrotes control of live NTDs whose major control strategJ/ is mass drug chemotherapy. Mass drug administration is implemented through an integrated, flexible, community toilored health care package, which aims at minimizing implementation costs, maximizing performance, enhancing coverage and promoting sustainability. The overall out come is reduction of the burden of NTDs which will improve the quality of lde of NTD victims subsequently leading to reduction of 6 WHO/APOC, 25n October 2005 poverty and accelerating lhe attainment of Millennium Development Goals (MDG$. In order to streamline the coordinalion of NTD activities all Programme Managers and NGDO partners meet on a regular basis and before any major activily is conducted. Government hos also appoinled a counterpart to the Programme Monager NTD to ensare that activities are timely done and get further integrated within child health days. - State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Mobilization of the districts is ongoing and it has been strengthened by semi-annual treatment witlt ivermectin, where reosons and needfor semi-annual treatment and the roles of all partners were explained. The district authorities appreciated the goal of elimination of oncltocerciasis in their districts and pledged political and technical support in attainment of tltis goal. 7 WHO/APOC, 256 October 2005 c{ !)p o o o ol Q .b o(,) o.(a C) C) 3< o U7 Lq) o a oQ I I I I _l rn () o dq .9 4..()9'- 8.8a/ I I I I I ,,lo 1, o L() o- oo -()tr> E€6; a) -!(.)(G Elc.l b0 -q EN oEEE €E()+ic)o 'd c.rE9 e3 p(D .o -c 6 ?r') 2H 6.)Fou cd; oE <nABs d U'- L I \) -e + p $ q) .a o so B s $q) h u a) '5 \ I { p .9 C'. tU *'d s\b.s$ia\ -dihdY\EE .S crr -$ .o+ ss- vs\ xtr s\/ .o\ op *sd's\Bbx .o3\ssEU sk-tsqi .s gd H eS :38 .si .Y b *.S * E $8 * I'^' N L.X(Jsl- : bo-P *=;. u 5t' ll$set it\BXb Ps V1 o\ q) Lo .x q) 4B a)\. <i L o)a bo tr Eo o" C)L o o0tr k E o L o c) CBo r< C)L(g h() t< C) C) B cqoL 6l Ia oLE q)L c) C) tr J at l. ctl tr o d aa o9. tr(q =Eo5rr'!gE iE= -FrEcxt?C\I .olNSI .(!1FFI z € * o\ |rl \o .{ \o cO r-ta) rf, co (a c.l \o O(-- aod ca .+ .f o\ + o\talF : a- .= :; = uv cO *o(\ !+ !f, oo^ c..l (n(a) \o^ rr) N r- oo\o c.i cO + ll .(l)tlg -oo .= aN E -a.e9\ cootF. g3trtr ta) r.) ra) \o c\ c\l oo oo \o c\ o\ oo\o c.t .+ o\ o\ crt o\ o\c* eO\o oo co +r+ .f,o o\ ci cO st\o rr) inr- c-l oo @ o(l.) 1A \o o\\o , .: EL'=e6&8.E6; >,! o (9 -E6Eg rn oo ca crl O $ c.l o\ oo oo oo C.l o\ oo cA o\o\ c- oiin ao o\ r{ c.) $ \o lr) cA sf\o oo\o co ao ra) r+ \n oo F-$\o cl o A{ Si str.= *?crEo tr'=gsx. oo t-- c.l oo € N o oo O ra) € oO rar cO Olrlt^ \o Oo co C\l ota) r- o c.t o\ c\ € <f ti) (30ON 3,eEI E -o -tr(t() oF + lt \o $ oo cO cos cO\n cn€ $N ooo\ o\ ctl .+ oo TA+ .eEE'-3 ;.-tr o :''l9E ! rle6!OE >r q)+rE N o\ c-) O cO tal co oo$ cor- +o c\lo\ + o\ c'1 ra)O ca .Dq) bI 6, t,q) o C, o L 0)E z .9E9U :E h tr-=ti?qrE **l ca c.l @ oo rat o o C.l \o lat ol ra) ctr9oo= .-Ltt9.- de:i? r 6.9L E 3g E'H EE A \n ra, la) \d c\t c.l a oo \o N o\ oo\o o cO o\t o\ oi c.t o\o\ .l co\o 6 co =tl\l .+ o\ tr- ca rf,\o(rl (nt- ca oo oo ola) la) o \o o\\o C) (Bs(!l M o oL Cd .o c0 v (.) o0 c) B E(O v o 'a o >rV C) cds (€ .EI (g o -V o a (g .o €) ca Fl FroF E ri .9s cr faV- 5T IHFi (J'E E'S x G) rr') E o N Lo3 so o e.l p. 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La a Lra q) 6l U) U) C)U Eo aa trts U a 0)a aoa a()a aoa a.q)a ooa a 0)a o c)(r) 0. c)a EOat ?E a- o li o L<(g z oL(c oL(n z ot<(n otr(! a oLd z o (B c) (B a! tC t-{ o =tr*oEE oU ao(n &()a a()a ooa &oa o.oa o.oa aoa &()a AF ?tr 6: o.oa o.()a a(l) a o.() U) a.o U) a. C)o o. oa a G)a 0. C) V) oqt ;C) o.:5E6l=Ni -oEooH(Jz o EE o Q bo h0 tra bo L0. bI)) bo ho oI) EO-Ei 1itr d: a- >r >, olr l- o GI z ) >tl- >. >tl- (, Fl I L U) a >. o U) o I(dp CB M 0,) oL cdo CBV C)bo C) (s v o 'a (l) >. M () ((l .o z (o ,E (B (0 A oJItro ,i a cl E ca Fl Er oH 2.2, Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. There was sensitization of political leaders and decision makers in alt the districts of phase 2 in preparation for semi-annual treatment and vector control/elimination. The political leaders ond decision makers at all levels were positive about the new developments of eliminating onchocerciasis ond pledged their support in order to achieve this goal. The biggest challenge facing advocacy in community mobilization is lack of appropriate information packaging targeting the ever growing cohort of young people who have no experience with onchocerciasis. The messages have been notoriously similar over the years and people are tired of listening to the some message day in ond day out. The way forwardis to have new innovations targeting key sections of the populations. Pufling in place an IEC policy drawn by experts is critical at this stage as we pushfor disease elimination 2.3, Mobilization, sensitization and hearth education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information Types of IEC materials used Mobilization and health education of communities including women and minorities Response of target communitieVvillages Accomplishments Suggest ways to improve mobilization and sensitizationof the target communities. The CDDs, community supervisors and health workers sensitized communities about CDTI activities. Other meons of sensitization include addressing community gatherings. Messages are also passed to the people through places of worship. Videos Jilms-shows anddrama groups, The videos shows were crowd puller and many people including h,omen, men and the youlh attended in large numbers. This gave an opportunity to disseminote health education messages on CDTI ond other neglected tropical diseases. The use of IEC materials has also continued but the curuent IEC materials need updating since the symptoms of oncltocerciasis have disappeared in most districts with the exception of Pader and Kilgum-. During CHDs Plus, the MOH uses local radios to air out messages in local languages. These messages are integrated and control of onchocerciasis featuresprominently. NTD also sponsored radio talk shows where political and technical leaders do live discussions with community members who are gtven time to telephone the stations. In Carter Center supported districts, heatth education r,s carried out by community supervisors. The developed materials however, ore still characterized by depicting signs and symptoms of onchocerciasis. In a situation where such symploms have significantty reduced (such as in phase I districls) new innovations need to be put in place. During the year, no KAP studies were conducted. However NTD did coverage veriJicatton surveys. 14 WHO/APOC, 256 October 2005
co N !) -o E C) o z$N O 0r o Jr \o 'o b0 6t ,44 =-9tr6 =o o ! z ll * caq oi I!0 qa I o Pr oo o O o OO o o ae E.E I E EEE \o sr @ co c.l =f ca ta) c-too sl-C\ € o\ o\ Nsf r- ra = I o ! ,z le + I tr d oF corf oo^ co co oo tr) rr) c{co olo\ +o\ ea + O C\ eo sf,q sf o oo rr) t6i (a tr 9qE= or-(4, $tN o\ o\ rl^i!f, .+ f- o\ a-l ooF- n" at \o o\ €latol c\t +\ola) ia rn ia la AU o oa 2 ca r-.N N t-alr) N rat co r)r- oo t c.t\o \o o\ rOo in&\o N \o o \o (a ??)(r) \o o >o a'= dX >0Br5?, E9 'EE95E o z ll r tllla le o b0 sa q c o Oo O oO oo oO oo oo tr Eeirl'i c .Z -=EE* \o $ oo ao or <r c.l\at cooo + C.T a o\ o\ (..lt F-rflt E i c:g.E H -EE!.i65oX E E€.i \o .+ oo c.l 6l+ car, cooo *c{ ooo\ o\ c.l* r*ia .rf >t q) U)) EA c) (€ 'o(d v C) oL(n -od v () o0tr() Btr cd M o 'a C)hv -9(l, ,o (o ,E CB C6 oJItroL O (Bt € o Fl F oF -\ 11 q U2q)(.)g \.- h l a\ q) L ,;Ss)SE\\\ls) rr$J rd =q) ra f! .: HUEE *= !s=s.;sElo sESE $iJ BEr\C0ol\Y l;lE€I()Ft s Ei?v\3 _ :i B\s s s:g $*EE is$s {.$E5 U AA E s $t 3 s$rE s - 8E iR: $ E-EE E : EE: cEorSg^(3s p a\ s s .a.s N.s E S '\ .rs E+ $EllESI r..€ B 3Ebs:u sssBLE\.s TTST HE$.8 *.EHH = it Ei LF\\o ssi.s B E EE sI iisii EEtE$ E S \E : 8 rs ig . SS i *sEts Comment on: - Attendance of female members of the community at health education meetings Attendance offemale memhers during health education meetings is satisfaclory. - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (affendance, participation in the discussion etc). Female members attend in good numbers and also participate in discussions ond selection of CDDs includingfemale CDDs. As shown in table 4,48% of the CDDs werefemales in phase two CDTI project. - lncentives provided by communities for the CDDs The CDDs are not provided with cash incentives but somelimes the community members remunetate them in-kind. - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Attrition of CDDs leas not a major issue during the reporting period although CDDs dropout in some communities was due to migration or moving to urban cenlersfor jobs. These were replaced and trained on the job by community supervisors. Overall, the ratio of persons per CDD in phase two districts was about 22 persons per CDD. This is important because it reduces the workload of CDDs and the demandfor incentives. - Other issues Although many CDDs were trained in phase two districts with a ratio of 22 percons per CDD during the reporting period, there is a need to carry out o census to know how many CDDs are still active. 18 WHO/APOC, 24 November 2003 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - 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 implementationwhere not enough knowledgeable nnnpower was qvailabte or if staffare frequently tansferued during the course of the compaign). 19 WHO/APOC, 24 November 2003 t- o o, o. ah o ahr- d) .vri B aa c{ o -o c) z$N O o.{ \ns 4 GI \iUq) \ o\ S)\o .N S q)b rtss o (u trq) C) o. t \ F Qq< o(a C) o c) r< .oH \, (.) (B ho (s IYF ,ri1 ol .ol(Bl FI I:IJt il d C c *, a< e ea!+ oo ca (n o a.) oo car- ca oo co!+N ooa\n oc! cil r/) cn a.l oo !f, o\ cn sf l--- a-\o c! c.l c!F- N \o c- c- (nN cn cO\f, o\ '+ r.- c-c\ c.l \o\o\o o oo h t+ oo!+ \o o\ q U o () z ?F s a( t nil F:U r+ : l.+ : rf, \o \oo l\O\o :_ \o\o :. oo!+ : oo r+N \o o\ :. \o o\ c{oo :- c\ 00 e.| z 0 c) ciL o Fr F(,) o o Oo() 6tl-q) € tr I U n 0F $ i -tr coN t-- aaN \o\o6t '--l \o\oGl GIq) o oE z ts c, 0 o F. IId d F (. q t 0 (, F1 0() q a o C) z ts G U) ?F o (){ tJ A x o U) o lc) (s .o CB \Z o a c)X M o (B -o =a ro .o !o EA \n ra) ooo ra) ca v l N E()4 o € c.i Oo o. o c-l qi ok oo G) (n t<bo C) tr Lr € E(.) o -o Cd bo C) -o ot) (d >to P .ts (d F aU >.I o o\, CI v, v)iCBc)}E OH6 '= >r hdxd) 6(d >.9 'E9 =Htro E o-r oe(riO oe o96) *:E o .oa rr')nd68UE 9E OQeo .9'o(,c) >obso. u05o) .r, c Table 6: Type of training undertaken (fick the boxes where spectfic trainingwas corried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100%o geographical coverage and a minimum of 65% therapbutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. 100% geographic coverage and a minimum of 65% therapeutic coverage is being achieved in phose 2 districts. Note that some bigger communities have been splint into new and smaller communities. This does not mean thal geographical coverage has not been 100%. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifo) Program management How to conduct Health education Management ofSAEs CSM SHM Data collection Data analysis Report writing Others (specify) 22 WHO/APOC, 24 November 2003 oo C-l () .o o c) 5 N L.) o or\o > co c! z -l z ts] z N il o\F\ N ooT\ c.lo\r\ oo o\c\ ootr-aoo 6tooo z N\o oo N 6to oo oto oo c.loo caoo oo cooo cooo Lo ,6 E z o o ,o Ea z oo c.l o\ vc\ \f \o \oorf, c!o oo c-) N c.)r\ o\ an c{ .+ rar oi\f, !f,\ot\ N oo6lo c\ lcNo\n <>o (n oo o ,o(! oo No\ c.)!+ Ic)\n o\d co cf) lnv c.) \o N($^ oo N\o !+ !a \t oo cf)c\ \o o\ .+ 6t ooo c\ I's o500od B'g So ovEOFo aoEt= d3 8< o -'E .g 6s1;= E' H€ e FES d9 E .- 9- 5 9E I!r-! o tr6r3Ea. (traE! N6 .a oooo ca Epog !a€gt -tr9 E50{95 l'+ oo !f,o l-f!+ 6 C\ !n\a\o ,ri c{ r\ oo\o c.l cA o\ ta, \o c\t \o co r\\a\f ca lh c\t ,.i\o r\ c-) O c.) ra) f- co .Jl oo rf, o\ o cg A o a o. o. 6 o F- ,9bU ar FH €-?o a >..'E OJtrtro c-)!+ \o c.l ao oo \o c.l lo\ oo\o o c.) lov o\ o\ ao o\ o\c! ca\o oo ce vt+ r+o o\Fi a.) v\o tat (a) r\ r.) oo oo o^\a !n c\t o |.a Oo oo oo oo O o oo c.) c-l \f, oo eo o\ c.l tf o\ N \f, c-oN N:f coiat oo o\ o\oN r\oN 6t!+ c.)h ooo\ o\ c.l oo cn N c\t c\v ca!n ooo\ o\ c.l ca oo t+ c\.t o oE z oo oo ao o oa afl oo $(\t ca oo !+ crl -EsrE 9.4 €E$ oUd^gr a (,) o .i 3t:5 sgqE g oo oIt 6 F )9,i, .9r h ti .= s 6! 5 bt O Ege-€o's tr g .9< 5 .ti2 v-A< og o r< Q 16, .IJ .o a o (u\, (t) ov i Fi oF] \ \l ":q) QqJ S Rp o s tB q)h se$. -v cr) tr CB (r)(o G) r< Cg G (, n o tr t/, 1' X .o U)H cr) (g tro E (v 0) F C\l a.rl .ol(Bl FI N op o 4 c.l () o t, s! a B E s bo a Eo .s\qJ *g Bq, N{ o o'E}}'s =s .q€ co] rl\ .ss ,SH:rsNIUS sE' tI oS €\StsSU .S 's'ti.t \.S$ sR\ Eq)E ES H Ao' : sF :r PXs :T" c 'Ra, s tR .l Yrs E!E s'€Y \:! E.: .$ :F d \uH *S! TE Oa$\rE .Q\:: ss : u\tRts' ;a) * s$; bd3 rs s !s \ SI s f IE S$E UA.B S: u sri s;Srlr Fr='r nEP PE\ ag \\ qJ S -\\ !\ - -\ss Eb sp .L E sss s itE H SSE 5l+ N E SEt ,Ys*T HE i $$$$* R EESH * :ss I. F sSEi * SEES E isir E s,$ $ E t E $EEBS .i{xi* *BV\-VLt s s L.s.s L$iiEE .S \e€..s S ss $$$g$Eiii$ -\'t: s t rib4!bE .9 S'ts;:S $FSNNEI E P.s * s e I :S€EEEi Ss E * ! ! + 'iiisssss *EESSSS !f c.l oF nl() H oo 'a t<a (.) -q , 3 C)L rd o g tr C) I r<() o. >. o0 o) E .E .o C) d ^r 6)ot s -l c.rxl P *l o 9l -8lE tsl I9l a8ttOl r ol 0) <-l ! ol ELI 59l tr *,4 - trt d =l oZlt- olol -t ,xl > EI Egls ol : ol c)OI trol i5ol i6 rlE Ll '3lE trt c3l dzl< C)L cd Po o) 'a tch G)bE 9Poc).= 'AA LV o i,i =&H>, =-oP U k6a)= L .= c)trE t6tid EU)o.9(J aro'E Jtr ol E(.) ol ='o -l EF i8b El.go. irt tr E- el EA alc,ol ; 0).l d) =l P -gl *x I El s -t Hat A9t .- \t d frl ry glEEI t '=l 6);I! EI E =l C tsl (HEt.g El o8lE 8l Etrl 3 (rl =ol i1 ol E rl O pl iJ()lo- ()lEfl= fla =16 3lEzl? zl? ll .o o .9 C)(l oFp s (.) 6J 6) bo$a 9E oo oF o Cd li C) o0 c,k(l) o do- t9\ (t o0 o c)o O L c, ood (l) oo (),A P^\ ()p. dk G) tr il 2.6.2 What are the causes of absenteeism? The causes of absenteeism were: People had moved to Kampala for work and some students in boarding secondary schools were not available to receive treatment. Some may migrate to prospectfor gold inforest and others across borders for business and may not be available during treatment period 2.6.3 What are the reasons for refusals? Some people perceive that they are already cured after the disappearance of the s symptoms of onchocerciasis and do not see the needfor continuing with ivermectin treatment, There is a needfor continued health education on the needfor long-term treatment if onchocerciasis is to be eliminated in phase two districts. This can be pursued through the radio talk shows that are sponsored by NTD control programme, to ensure lhat the affected populations are properly sensitized. 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 serious adverse events have been recorded. 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 25 WHO/APOC, 24 November 2004 ! oN c) -o Eo o z\t c{ d \o C.l q) !\\) o' Lq) "a L _q)q {+ :\ q 4q) Uq) S U2 l L \)\ o t q) $q) 5 o L C)a o0 li ooOL C) oo Lr) ok oo o (ll (n H V) a C) C) o ah o E(0 (h o o(n o an c) .l)$(.) &ir o,l -ol CBIFI c) EEEt>L395 <.EE ;P8c.= tr JdJ6()0 E dEoa?#g; o o.2EA 9C9q0)9oa q9-oq-Q q3 ^ d.9 uo-c tr&94 =d+rUq)-o-4E3 c) tr tr= dooc)O E,.: ,E '; o v oEt' AT U Pu (!-trq: d €.9 9p.s7 =-O.= oggErs o A >\(n --=c)r; ho=o:E O. Lloo(i H34 .st .sE;8: $ ot{c6,J = ol) ao x() U) C) bI) * 4a cl o -oo o L.] 5 c.l o. c) cl C) F(D 6l Lo c{ o o ao cll c- c\l tt) 0) an CE c)L cl e \\q) SEi a)\!s,us :.= FNi\iq)53 6)q) -sF!tl o -clEE Evo9(.)() Ei .9 sr atrrr()f- C) LleUh o(B -li c) :. E.EI E5t> .Blc)ol ,.s xoslcl 61r hI)EG!9bE> dxg; eE(Hd EEtrc)()ctts l-{ cl -.9 v) r:\o '.. e.i o'l ol -ol cdlFI o L €() F q) 0) c3 c.) o .A cllq) Cr () bI) r't d ^tr bs Q ra <+\o o\\o o\c- \oo\ o6 c{a € ooo 00 o ir i triH H o$^ ? tU o\ € \n € €r- oo\ c{o\ aoo o\ r-oo \o€ tr)€ Go\ 6 ll r lr1 li o :1=O =oood *bi:>OOEOF \ot* cot-- €r- rnr- F-(t- !+t-- cor- c.la- OH- €€tr- rco€€€cn \o\o \ot- ti € ,o o6 .oOE9atsE z# A c-o o^ c.l\o ot co o\ oo N cr) oo c-N co o\(\l =f,c- co c.lr- ca\o <f ci c'l\o € co sl ca o\ cn ca\o c- c.)@ co \o c.l oo ca o\\o =fs + --!+co co O\dl-o\ o\ a.l ra)$lnQcoca- .+ .+ O\O\ t'- O\O^ \O^ .'I c.looooO\!+coai- a tot"q=^R €:R I{ =o? u.z E=o < sF liv co oo\o. * 01 c.l tr} o\ € + rn cn o o\ N * o\ oo+ r- + o cl coo|r) F-F. oo co -l ci c.l a.l$ tr) $ c.l++ .+s\ c\l++ o\N oodF- rf, tr- o\ oot .+ o\ tr- oo(a tro d oA rr} \o o\\o b AH _ E EK -S'ts o )o .o 6E<'=tdr-=-ot:' 6. 8sE EE \o 00\o" \o r+ c.l co o{tr) tr- + \.)\o c"f \o o\$ c.t\o -i o\ <. a-l c\l o\ o\o ooo c.)6$ €ola) oo ooq o cl \nr- N alia) N c..l ro" oo|r) la) o\s rr)r-r.) (n oq(r) \o\o ll r El lll ri o ^oo9 g<er oo\< >v o oO o oo o qo\ o\ \$ o\ oo c.Jr- o\ nr- o\ oo oo oo EO= gr $s,!()ord oo oo oo oo o qo\ o\ \+ o\ oo c!tt- o\ -t rr o\ ao o oo ,rl qo o'i a bEFEE E= 8IEQ!z3- +o € o\ r- 6 o\o otrr =t t- s (-. ao rt tr-co o\\o * €+ ra) otola) €\a$ l{ =od o.= -Co!=o} ij5Fq, +o €\6 F- € o\o or-$ o\o$ r-o$ cno .+ .+ 00o r oos N rn €la) .+ 6 c) bI)(, o a E oO bI)d =qtE g E Er*.9 E b;; _ =.E c{'!31i: tr'- o t: € e E q€ = EtrEO o o .+ a o\ t'- 6 o\o o c--$ o\o+ F-- s coo sf, O q 6 €t c.l oor .+ d r! c- o\ 01 € o\ o\ 6 o\ o\ oOO C.l oocl (\ooN cooo(\ !+ooN r oN \oo C.l r-ao c.l €ooN o\o (\l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by * Qtlease tick the appropriate answer) MOH ff WHON UNICEF! NGDOtr Other (please specify): MINISTRY OF HEALTH Mectizan@ delivered by - Qtlease ttck the appropriate answer) MOH tr WHOtr TINICEFtr NGDOtr Other (please speciff): WHO Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan is cleared by the World Health Organization (IVHO) country of/ice from the port of entry and delivered to NOTF stores. From NOTF stores, the districts collect lhe drug and deliver it to the district medical inventories where the heollh sub-districts collect the drug. The Jirst line health facilities collect the drug from the health sub-district and stored at this level. Then the communities collect the drug from the lirst line health facilities. Sometimes, the supervisors of CDDs deliver the drug to the communities when they visit lhe communities for support supervision. Mectizan k not incorporated in the National Medical Stores (NMS) inventory because NMS charge handling and storage fees, which the Ministry of health pays to NMS. Sometimes when there are delays in payment of handling and slorage charges by tlte Ministry of Health, the NMS does nol release the consignment of the drugs. NOTF thougltt that delayed release of Mectizan would mean that the communities would not get treatment at their preferred time, which would negatively affect coverage. Table l0: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? The remaining ivermectin tablels are carriedforwardfor the nert round of treatment if they are not expired. Tlte tablets are tltrown in pit latrines if they expired at the end of distribution. State/Dis trictlLG A Number of Mectizant tablets Number in stock Requested Received Used Used/Perso n treated Lost Wasted Expire d Remainin ob Bushenyi 29,890 547,500 576,390 540,397 203,273 l5l 0 35,842 Kabale 3,1 55 126,500 129,655 125,6t3 42,115 0 0 0 4,042 Kabarole 00 76,500 76,500 67,774 24,196 0 340 0 8,386 Kamwenge 1,403 192,000 193,403 189, I 57 63,775 0 1,508 0 2,738 Kyenjojo 00 I 53,000 153,000 130,458 50,823 0 649 4,496 17,397 Mbale 932 209,500 2r0,432 198,824 70,707 0 r63 0 11,445 Manafira 00 186,000 186,000 184,706 62,375 0 t6 0 1,278 Sironko 2,081 375,000 377,081 360,776 124,190 0 272 0 16,033 Bududa 00 718,000 718,000 709,300 254,880 0 45 0 8,655 TOTAL 36,461 2,584,000 2,620,461 2.507.005 896,334 0 3,144 4,496 105,816 28 WHO/APOC, 24 November 2004 List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Delivery of ivermectin from the centre up to the tirst line health facilities where the communities collect the drug at tlte time of distribution Supervision of the CDDs during mass treatment Compilation of reports on treatments and accountability of ivermectin usage and forward to them to tlte high levels. - Any other comments The number of persons treated quoted in the inventory is excess of the total number treated in the project area. This excess is inclusive of visitors. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Early 2005 Table l1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Community self-monitoring and stakeholders nrcetings were not carried out. The district health serttices claim that tltese activities needfunds to be implemented, the fund, which the districts do not have. In order to revive these important activities, APOC managemenl should allocote funds for these activities, altltough their sustainability is questionable after APOCfunding has come to an end In the recent budget submitted to APOC management, this activity was included and hopefully it will be implemented once approved 2.9. Supervision 2.9.1. Provide a flow chart of supcrvision hierarchy. 2.9.2. What were the main issues idcntified during supervision? Tlte moin issues identified during supervision include Little funds are released by the districts for support supervision. However, the districts claim that they do CDTI supervision in integrated support supervision. The Carter Center and RTI are now giving districts funds for support supervision. DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meetins (SHfi{) TOTAL a 29 WHO/APOC, 256 October 2005 a Involvement of health workers in supervision was inadequate due to small numbers of health workers at the health units who are already overburdened by curative health services. 2.9.3. Was a supervision checklist used? Supervision check list was used. An integratetl checklist for integrated control of neglected tropical diseases has been developed developed. A standard check list was used during support supervision. The check list highlights the following areas; planning, budgeting, release of funds, HSAM, training, community registration and register up date, aclual MDA duta comptlation, reporting and phermacovigilance. After the support supervision visit, reports were written and shared with the programme manager and commissioner National Disease Control. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? After each support supervision visit a debrieting meeting was carried out with the district health services n anogers. The challenges encountered during activity implementalion were discussed und the way forward agreed upon. With current support of the districts from USAID for integrated control of neglected tropical diseases including onchocerciasis, the districts claim they don't have funds to support progtams, which are already odequately ef,ernally funded. However, they promtsed political and technical support. Advocacy will be continucd to ensure that districts budget and relesse funds for CDTI and other neglected tropical diseases. 2.9.5. Was feedback given to the person or groups supervised? A feedback is normtlly given to the groups supervised with recommendations to be tddressed to improve the implemenlation of CDTI activities. 2.9.6. How was the feedback used to improve the overall performance of the . project? Districts promised to budget and release funds for CDTI and other neglected tropical diseases. SEGTION 3: Support to GDTI 30 WHO/APOC, 25s October 2005 3.{, Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO:Written off) How does the project intend to maintain and replace existing equipment and other materials? The equipments provided by APOC and NGDOs to the districts are maintained by the districts. The equipment at the center is maintained by the Ministry of Heallh while that one belonging to NGDOs is maintained by the respective NGDOs. As regards replacement of equipment, especially vehicles, donors will be approached for assistance where necessary. Nearly all the vehicles used by programs in the Ministry of Health are donated and it is unlikely that onchocerciasis control program will be exceplional. 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condifion No Con ditro n No. Con dltio n No. Condrti No Condin on 1. Vehicle NIL NIL NIL NIL NIL 2. Motor cycle(s) t4 F NIL NIL NIL NIL 3. Computer(s) 7 F NIL NIL NIL NIL 4. Printer(s) 7 F NIL NIL NIL NIL 5. Photocopier (s) NIL NIL NIL NIL 6. Fax Machine(s) NIL NIL NIL NIL 7. Others Contributor Year I ('provide the period'2007) Ycar 2 ('provide the period 2008') Year 3 ('provide the oeriod 2009') TOTAL CASH Budgeted (US$) TOTAL CASII Released (US$) TOTAL CASH Budgeted (US$) TOTAL CASH Released (US$) TOTAL CASH Budgeted (us$) TOTAL CASH Released (us$) MOH (Central * Provincial/State) 10,8 I 0 00 25,043 23,022 I 1,340 4,050 Salaries 2,650 2,650 2,650 2,650 2,650 2,650 MOH (District/LGA) 76,000 1,500 76,000 7.650 49,950 49,950 Local NGDO(s) ( if any) NGDO partner(s) 157,428 t57,428 100,934 100,934 Others a) b) APOC Trust Fund 66,449 66,449 8,369 8,369 5,482 5,482 TOTAL 155,909 70,599 269,490 l99,tL9 170,356 153,066 3l WHO/APOC, 25e October 2005 on - If there are problems with release of counterpart funds, how were they addressed? The problent with release of counterpart funds by the government is due to lack of adequate funds at all levels. The districts receive Primary Health Care (PHC) grantfrom the center for implementation of primary heallh activities. 50% of PHC fund is for purchase of drugs and about 25% isfor salaries. lYhat the districts receive is usual less than what they requested which makes it dfficult for the districts to implement the planned activities odequately. The districts are alwoys encouraged to integrate their activities, which they have done satisfactorily, such as integrated support supervision where CDTI has benelited. Elfort is still being made to advocate to all districts through a combined voice under NTD to ensure that districts give support to core CDTI activities. - Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here_l USD:2050 UGX 32 WHO/APOC, 25th October 2005 Table 14: lndicate how much the project spent for each activity listed below during the reporting period. - Any comments or explanations? The ligures presented in table 14 above are only government contributions towards the listed CDTI activities. It does not include NGDOsJigures and salaries paid by government to civil servants involved in CDTI. SECTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation In.ernal Monitoring by NOTF Other Evaluation by other partners Activity Expenditure ($ us) Source(s) of fundinq Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities of CDDs s Supervising CPDI eqd d tqqrqqqg!! CDTI activities 44yggegy r!q{s to health and political authorities IEC materials 33,482 APOC + TCC 00 54,850 TCC 00 00 00 Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance qffigg Eqglpq"q! @.e Others etc) TOTAL 88,332 Total number of persons treated 484,753 JJ WHO/APOC, 256 October 2005 4.1.2. What were the recommendations? None of the above activities was implemented during the reporting period 4.1.3. How have they been implemented? Not applicable 4.1.3. How have they been implemented? 4.2. Sustainability of profects: 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 submitted? 2004 What arrangements have been made to sustain CDTI after APOC funding ce{Nes in terms of: 4.2.1. Planning at all relevant lcvels It should be appreciated that heolth sector planning (annual and strategic), is an important activity, which has lhe blessing of the district/sub county councils and legally spells out what the health sector intends to do, in the stated period This will provide an entry point for CDTI programme integrotion. The CDTI activities will be in the districts', health sub districts', sub counties' and parish/village (where they exist) health plans. Advocacy to the district health services will continue to ensure that onchocerciasis continues to be integrated in the overall health plan each year. 4.2.2. Funds NOTF now incorporated under NTD rvill continue seeking political and technical support for CDTI from the district political and technical managers. Politicians will particularly be made to appreciate thot olthough onchocerciasis does not kill, it has serious social economic impact on comnrunities because of its associated debilitating complications. It will also be emphasized that the drug (mectizan) will always be available for as long as it is needed free of charge and the need for long-term treatment. 4.2.3 Transport(replacementand maintenance) The districts have continued to use transport in an integrated manner and meeting the cost for repair of the motorcycles. However, replacement of the motorcycles by the health services may not be feasible as nearly 100% of motor vehicles at all levels are donor funded 4.2.4. Other resources Control of onchocerciasis should be considered along with other vector borne diseases such that the tesources, activities and supporl supervision services are combined Efforts will be made where it is operationally possible to integrate controUelimination of Neglected Tropical Diseases. Advocacy and healtlt educution will be integrated in the integrated control of Neglected Tropical Diseases which is getting funding from USAID through Research Triangle International (RTI) and Scltistosomiasis Control Initiative (SCI. 34 wHo/APoC, 25n October 2005 4.2.5. To what extent has the plan been implemented With support from (ISAID for integrated control of neglected tropical diseases, integrated training monuals, supervisory check lists and IEC materials were developed Advocacy meetings planned were successfully executed. Similarlyractivities planned in an integrated manner were equally done with the involvement of all programme heads and their staff. However, there were specijic vertical prograntmes that could only be caruied by each individual progromme, for instance, ntoppirtg for disease like trachoma 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.L. Ivermectindeliverymechanisms 4.3.2. Training 4.3.3. Joint supervision and monitoring with other programs 4.3.4. Release of funds for project activities 4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health progrtmrrr€s that are using the CDTI structure and how this was achieved. What hirve been the achievements? 4.3.7. Describe others issues considered in the integration of CDTI. Delivery of ivermectin has to a large erteil been tntegrated within the PHC slructura When the district of/icials come to Kompala for any other issues (as long as they have vehicles) they normally take ivermectin. Iirom the district to the peripheral health units, delivery of ivermectin is fully integrated with delivery of other essential drugs. With the support of USAID through RTI, Albendazole is being integrated with ivermectin distribution. There is ako co-implementatiotr of ivermectin distribution with HMM; ITN distribution and vitamin A supplements to children aged less tltan /ive years in phase 2 districts. lllith integration in place there is consideration for a joint application for LF and onchocerciasis, but the modalities are still being discussed to ensure that it will not alfect activities in the semi-annual districts. Training of tvermectirt and albendazole distribution was integrated in all the districts of phase two and there was joint supervision. Bollt The carter Center and RTI released funds for training and supervision. With the new initiative of control of neglected tropical diseases, there is a need for all partners lo hormonize the implementation of the activities in order to avoid duplication offunding. CDTI is included in the PHC budget but due o inadequatefunding of all health services at the district level, little money is allocoled for CDTI.A number of programmes are using CDTI structure e.g, lymphatic Jilariasis and schistosmiasis and wornt control are using CDTI struclures. Schistosomiasis and worm 35 WHO/APOC, 25e October 2005 control uses both school-based and community direcled approaches. Where the prevalence of schistosmiasis among school children i:s more than 5096 all community members ore ireated and this is when CDTI structures are used to reach non-school going children and adulls. Other programmes using CDTI structures include home management of malaria. All lhe above programmes have regislered varying degrees of success. Other challenges associated with integration are slowly and surely being ironed out among the various stakeholders, some of which included numher of CDDs, treatment in schools versus community and retrievat of data. Progrumme managers regularly meet wilh other partners in an effort to improve tmplementation andtind ways of bridging gaps. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the projcct area within the reporting period. No operational research wos undertaken during lhe period under review. 4.4.2. How werc the results applied in the proiect? Not applicable SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths o CDTI being usecl as an enlry point for other interventions. The CDDs are becoming more contntittetl because of intrinsic incentives from other interventions heing added on and social motivation. These are somc of the examplesfrom CDDs: . Mon! CDDs have been trained with a ratio of about 22 persons per CDD. This reduces the workload of tlte CDDs Weaknesses o The healtlt workers are few and mostly involved with curative services, leaving no timefor pubtic health interventions, which makes support supervision dfficult. o New initiatives such as integrated control of neglected tropical diseases coming with lots of trtoney and the district health services do not see the need for contributions. This could be detrimental to sustainability. Opportunities o Currently therc are many inlerventions, whtch are using CDTI as a vehicle to deliver other community interventions. These in turn come with many opportunities in form of intrinsic and extrinsic incentives to the CDDs. However, this mtght be detrimental to sustainability of CDTI as the sustainability of these proghrammes is questionable. Threats Community mentbers perceptions that they are already cured due to the disappearance of the symptonts of onchocerciasis and refuse to take ivermectin a List the challenges and indicate how they were addressed 36 WHO/APOC, 25s October 2005 The main challenge has been inadequate counterfunding by the health services. Advocacy to political and policy makers has been intensiJied and will continue to ensure that CDTI is continues to be included tn the overall district health plans SEGTION 6: Unique features of the proiect/other matters Vector elimination in Itwara Focus covering Kabarole and Kyenjojo districts was achieved in 1997. There is need for certiticotion of vector elimination in this focus. Ivermectin treatment has continued in these districts up to date. In the last Uganda Onchocerciasis Elimination meeting, a recommendation was made to stop treatmenl in this focus. However, the Ministry of Heattlt view is that there should be a clear guideline put in place before such a decision can be made. The vector elimination activities that also started in 2007 in Kashoya-Kitomifocus (Ibanda, Bushenyi and Kamwenge dislricts) are progressing very well with sattsfoctory results. For over 6 months notry, no adult Jly has been caught in the six catching sites in the focus. Similarly, crab infestations hove reduced to zero through out mosl of the focus, and in the last assessment conducted in December 2009,out of the 5,988 fresh water crabs caught from 72 sites, only 3 (0.05%) were carrying immature stages of S. neavei. These ore very strong indications that elimination campaign in this focus is progressing very well. In Mt Elgon focus covering Mbale, Sironko, Manafwa and Bududa districts,elimination of the vector fly was achieved by the end of 2008. For over twelve months now no adult fly or positive crab has been encountered in this focus. A recommendation was also made by the UOEC to stop treatment in this focus. It is onticipated that once the guideline is in place, treatment may be halted in this focus. ll/ith lhe semi-annual treatment, continued high ivermeclin lrealment covcroge and satisfactory progress in veclor eliminalion, elimination of onchocerciasis in phose two districts is likely to be achieved in the near future. 37 WHO/APOC, 25h October 2005