Morogoro CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January 2010 to December 2010

I I THE UNITED REPUBLIC OF TANZANIA i4_cludlUg p-mail address) APOCfundinsyear: (circleonc) I 2 3 4 5 (6) 7 8 9 l0 ll 12 13 APOC Pro tim lementation circle one 123 4 5 78910111213 - _-__--__-_--_-,_ -_ _ J ORIGINAL : Enslish # * tl I I r rt: Date submitted: aI i I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FO SUBMTSSION: To APOC Management by 3l January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ( qI g I -_.__.! I COUNTRYTNOTF : TANZANIA Proiect Name: MOROGORO CDTI Approval year: 2002 Launching year: 2003 From: JANUARY 2010 To: DECBMBER 2010(Month/Year) ( Month/Year)Beporting Period: Partners: - Ministrl'of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sightsavers (SS) - 893 Communities 0 7 FE\/, 20ll APOC/DlR RECU LE E E6ra- F WHO/APOC, l4 September 2009 I I I I I I I I I I I I t_ \ N \ANNUAL PROJECT IBCTTXICAL REPORT {o TECHNICAL CONSULTATIVE COMMITTEE (TCC) i ENDORI$ Please confirm you hav. ..uA appropriztte sPace. EMENT this report by signing in the OFFICERS to s;ign the report: Country: TANZANIA National Coordinator lrlame: Dr. Nkun Mwakyusa Siignature loIe ftrDate Zonal Oncho Coordinafo r Name: Dr. Frida T. Mokiti Signature: fl- oa t^ (, Date: .. ...:.t \. L{ I ( NGDO Representattve Name. I)r. I m Kabole Signatule Date. This report has been prepared by Nam': . Dr. Deborah Kabudi Des,ignation : Project Coordinator Signafure 6("J* 3s a-ol I Country Director, SIGHTSAVERS INTERNATIONAL - TCO P. O. BOX 2513 : .DAR5S SALAAM TANZANIA I)ate lll WHO/APOC, l4 SePtember 2009 t( I Table of contents ACRONYMS V DEFTNITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS.. EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION.... 1.1. GeNERaITNFoRN{ATIoN............. I .1 I De.tcription o./ tha project (brie./11') 1.1.2 Partnership 1.2. PopuurnoN............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1. Tttrrpt-rNe oF ACTIVITIES ............ .......... 8 2.2. ADVocAC\ ..... l0 2.3. MogILIzn.rIoN. SENSITIZA,I.IoN AND HEALfI{ EDUCATION OIT AT RISK COMI\,IIJNITII.S IO 2.4. CoulauNtry INVoLVENIENT......... .......l2 2.5. Cnpacrry BIJILDING... . 13 2.6. TRearpreNTS.............. ..... 15 2.6.1. Treatme nt figure.t I 5 2.6.2 What are lhe causes oJ ahsenteeism'?. . . .. .. . .. 17 2.6.3 LVhat are the reasons.for refusals?....... .. . .. 17 2.6.4 BrieJly describe all knoy,n andverified serious adverse events (SAEs) thal .... .. l7 2.6.5. Trend of treatment achieyernentfrom CDTI project inception to thc current )tear l9 2.7. ORopRtNc, sroRAGE AND DELIVERy oF TvERNIECTIN .... . ..20 2.8. CovvuNrry sELF-N,ToNIToRING nNo STRTSHoLDERS MpertNc ............21 2.9. SuppRvrsroN ............... ......................21 2.9.1. Provide aflov'chart o.f supervision hierurchy'. . .... .......21 2.9.2. l(hat were the ntain issues identified dw'ing supervision? . Erreur ! Signet non ddJitti. 2,9.3. LV'as a supervision checklist used? Erreur ! Signet non ddfini. 2.9.4. What were the outcomes at each levcl o.f CDTI implemenlation supervision? Erreur ! Signet non ddJini. 2.9.5. LVas.feedback given lo lhe person or groups supervised?... Erreur ! Signet non ddfitti. 2 9.6. How'v'a.E the feedback usad to irnprovc the overall performance of the project? Erreur ! Signet non ddfini. SECTION 3: SUPPORT TO CDTI..... 3.1. Equrnvenr 3.2. FmnNclel coNTRIBUTIoNS oF THE pARTNERS AND coN4MLfNITIES 3 .3 . Oruen FoRMS oF coMN,tuNITy suppoRT ............... 3.4. ExpeNorruRE PER AcrrvrrY SECTION 4: SUSTAINABILITY OF CDTI........ 4.1. lNrenxnr-; INDEeENDENTpARTICTpAToRy MoNrroRrNc; EvnI-uatroN I 3 4 4 4 6 7 8 lll WHO/APOC, l4 September 2009 23 23 24 28 28 4.1.1 Has the project eyer been evaluated/monitored? (fick any of the following which are opplicabte) . . .. ...-. -.28 4. 1.2. What were the recommendations? . .- 28 4.1.3. How have they been implemented? ............. . ..28 4.2. SusrarNRgtLrry oF nRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT................ 28 Yn 3) .......28 4.2.1. Planning at all relevant levels... .. 29 4.2.2. Funds........ ...... ..... 29 4.2.3 Transport (replacement and maintenance) ........ 29 4.2.4. Other resources ....... 29 4.2.5. To what extent has the plan been implemented......... ... .. .. ... 29 4.3. INrpcRnrroN............... ..... .... . .....29 4.3.1. Ivermectin delivery mechanism.t....... ... ..... .. ... 29 4.3.2. Training.... .... 29 4.3.3. Joint supervision and ntonitoringwilh other progranls. ... 30 1.3.4. Ilelease of.fiutds.fot" projcct ttctit'itie.v .. . 30 4.3.5. Is CDTI inclttded in tha PI\C'buclget'? . . . ... . 30 4 3 6. Dc.gcribe other hcctlth progranunes that ure using the CDTI structure ortd hov, this v,as achiet'etl. trl/hat have been the achicvements'/ . .. . 30 4.3.7. Describc others i.ssue.s considered in thc intcgration o/'C'DTI. .. .. 30 4.4. Opene'rroNAL RESEARCH .....34 4 4.1. Suntmarize in nol rnore than onc hull of a pagc the oparationol rescorc'h undertaken in thc proiect areo v,ilhin the reporling period. . 3'l 4.4.2. I[ow v'ere tlte results applicd in tlte prrlect?. 31 SECTION 5: STRENGTHS, WEAKNESSES, CI{ALLENGES, AND OPPORTUNITIES.......... ......34 SECTION 6: UNIQUE FEATURES OF THE PRO.IECT/OTHER MATTERS...........34 IV WHO/APOC, l4 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SIIM TCC TOT LINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Obj ective Community-Based Organization Community-D irected 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 rneeting Technical Consultatil'e Cornmittee (APOC scicntiflc advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization WHO/APOC, l4 September 2009 Definitions (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 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat rvith iverrnectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximurn nuntber ol people to be treated annually in meso/hyper endentic areas u,ithin the project area, ultimately to be reached when the project has reached lull geographic coverage (nornrally' the project should be expected to reach the UTG at the end o[ the 3'd l,ear ol the project). (v) ThCtapru!q!qveraee number of people treated in a given )/ear ovcr the total population (this should be expressed as a percentage) (vi) Geographical coverage: number of cornrnunities treated in a given year over the total nutnber of meso/hyper-endemic comrnunities as identified bl, REMO in tlie project area (this should be expressed as a percentage). (vii) lntegration: delivering additional health interventions (i.e. vitarnin A supplenlents. albendazole for LF, screening for cataract. etc.) through CDTI (using the same systems, training, supervision and personne[) iu order to maxintise cost- effectiveness and ernpower cornmunities to solve more of their health problems. 'f his does not include activities or interventions carried out by cornrnunity distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when the1, continue to futtction effectively for the foreseeable future, rvith high treatment coverage. integrated into the available healthcare service, 'uvith strong community orvnership. using resources mobilised by the community and the governmcnt. (ix) Comrnunity self-monitoring (CSM): 'fhe process by rvhich the cornmuniry is empowered to oversee and monitor the performance of CDTI (or anl,community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. [t encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vt WHO/APOC, l4 September 2009 FOLLOW UP ON TGG RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 30th I IYumber of Recomnrcndatiou in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report related a Address posl TCC reco nutrcndatio tts e-rltaustively In this report past TCC recornnrendatious rvas addressed exhaustivelv o Colculale tlte cosl per lrealme,tl, CDD populalion ralio artd nrul: fenule CDD rulio Cost per treattnent : 1:US$ 4 CDDs per pop: 1:100 Male:Female ratio -l:1 a Use the new reporling formil This report is written in the format . Provide informaliott ott:- evuluatiott The project have been evaluated but not on the sustainabiliry. This year we expect that Sustainabiliry evaluation will be conducted. supporl Community rnetnbers collect drugs from the FLHF or provide bicycle to CDDs to go to the FLHF to collect drugs outconte of advococl, Creation of more awareness, to build and maintain the sense of ownership to the community leaders and members. As a result Region and Districts has included NTDs activities in their CCHP. At WHO/APOC, l4 September 2009 community level there is fully participation of community member in the implementation of CDTI activities. Few communities exempt CDDs to participate in development work during drug distribution period Attrition occurs in rare occasions, like death or marriage lor a female CDD Outcotne of s uperv is io rt Problems and Successes was identified Proiecl rclaled a Ittiliate in-counlrl' irtlcr-secto ral collahoraliort lo enltance tesource mohilization, inlegralion and suslainabilily The project has integrated rvith other NDTs Prograrnrne hence rve collaborate in resource rnobilization. a Tro't all ltealth stuff ort CDTI All 152 FLHW in Oncho endemic area were training in this reporting period o Trairt ntore CDDs 2434 CDDs was trained a Retrain all irrvolved in CDTI on record keeping Training emphasized mainly on sensitization of Community members, drug distribution, monitoring and supervision, data collection and report writing. i 2 (Please add more rov,s if necessarl') WHO/APOC, l4 September 2009 Executive Summary Morogoro CDTI Project operates in two districts namely Morogoro Rural and Mvomero out of six districts in Morogoro region. The project is now in the sixth year of implementation of CDTI activities and second year for the implementation of integrated NTDs activities in Oncho and non Oncho endemic areas. Onchocerciasis is found in 893 communities which are Hyper and Meso endemic and the total population is 356,469. Drug administration extended from May to December 2010 whereby total of 286,032 people were treated using Mectizan drug and Therapeutic coverage is 80.Zoh. The geographical coverage was 100% whereby UTG is 299,789 and ATO is299,434. In this reporting year, the project managed to accomplish the following activities; training of 152 FLHW, training of 2434 CDDs, sensitization of Community members, drug distribution, monitoring and supervision, collection and cornpilation of treatment data and report writing. The CDD per population ratio ranged betrveen l:100 and l:120. Tlre project received a total of 1,176,260 Mectizan tablets for treatment of Onchocerciasis and [-1'mplratic Filariasis in oncho and non oncho endemic areas and 765.875 Mectizan tablets u,ere used to treat people living in oncho endemic areas. Challenges and hot, thel, ryere overcome: - CDDs demanding to be paid during training and not motivated to u,ork on voluntary basis. . 'fo encourage colnmunity and district councils to provide incentive the CI)Ds - FLHF staff arc overloaded rvith rvork due to shoftage of health staffs making rhern less efficierrt in CDI-l activities. . The Government to look a rnearls of employing more l{ealth staff and to post thcm in the FLHF - Other programmes who comes with diflerent approach by providing payment to Village Ilealth Workers and CDDs to implernent their activities. . To emphasize CDTI Philosophy during training of CDDs and to conduct sensitization meeting rvith community members. - Submitting irnplementation repo(s in different format as required by paftners ( APOC. SSI ancl NTD). This increases the workload to project coordinators and other staff. o Waiting for a consolidate fbrrnat rvhich rvill cater for all paftners 3 WHO/APOC, l4 Seprember 2009 SECTION 1: Background information 1.1. General information 1.1.1 GeographicalLocation Morogoro Rural and Mvomero districts rvhere CDTI activities are being impletnented are found in Morogoro Region rvhich is one of the 2l regions in Tanzania Mainland. It is an inland area lying torvards the East and Southern boarder of Tanzania Mainland. The region lies between latitudes 5o 58" and l0"0"SouthoftheEquatorandbetweenlongitudes35"25" and38o30"eastofGreenwich. Ithas a total area of 73,039 sq km rvhich is 8.2'/" of Tanzania. According to the 2002 population and human seftlement census, the region had an estimated population of about [,759,805 people rvith a groMh rate of 2.6%o annually. The trvo districts lie betu,een latitude 8n and l0o south of Equator attd betrveen longitude 37o and 38o East of Greenrvich. The region is inhabited by Luguru. Kaguru. Ku'ere and Masai tribes. These cotnrnunities consist of indigenous and nornadic population. the u.rountainous areas beirtg Inuclt tnore densell,popLrlated thart the lorv land. The )'oung people keep on n-rigratiug to look for ertrployrnent itt towtls and to areas or neighboring regions w,lrere there are nervll,drscovered rnines. Tlte main occupatiott of the cclrtrrnullitv is fanning of foods aud cash crops, catlle herding. small scale fishing and timbering. Several rivers and tributaries originatrng tiorn the rnourttaius cut across Morogoro region. Major rivers include Kilombero. Ruaha. Lurvengu, Ruvu. Wami, Ngerengere, Mkondoa and Mkindo. 'l-ltere are about 143 rivers, rvhich lbmr r,ery large plains in the lorvlands consisting of fertile alluvial soils. Due to tfte climatic inlluence of the ludian Ocean, the Eastern Arch Mountans have unique plant and animal life. Although environmental degradation has affected the area for many years, there are still different species of fauna and flora. This is particularly true itt the case of the Udzungrva and Uluguru Mountains. Topography The two districts are divided into three geographical zoues:- (a) Mourrtainous or Highland Zone (25%) This zone covers the Uluguru Mountains located at an altitude of 1200 - 2000 m. above sea level rvith the clay type of soils. The zone is suitable for the production of tnaize, beans and horticultural parlicularly Mediterranean types of fruits. (b) Semi-Mountainous/Lorv Land Zone (20o/") This zone covers most of the Southeni part of Morogoro/Mvomero districts, at an altitude of 800 - l2OO m above sea levelwith sarrdy clay loam type of soils. The zone is suitable for the production of maize, cassava and sorghum as staple food crops. (c) Savannah Zone (55%) This zone is located at the altitude of 600 - 800 rneters above sea level; with same clal' loamy type of soils. The zone is suitable for padd1,, rnaize and cassava, for both food and cash crops: and also suitable for sugarcane, conon and sisal as cash crops. Part of South East of the zone falls under Selous National Park, further the district has big valleys and numerous fast running rivers such as Mgeta, Ruvu and Waml-Luhindo. 4 WHO/APOC, l4 September 2009 Climate The region enjoys two rain seasons - the short rains, which normally starts in October and ends in January and the long rains which commence in Mid-February and end in May. The annual rainfall ranges between 600 mm in the Savannah areas up to 1600 mm in the mountainous areas. . The temperature ranges between 20oc up to 28oc. Population According to the 2002 national population census, Morogoro Rural district has a population of 263,910 rvith an average household size of 4.7 where as Mvomero district has a total population of 260,525 with an average household size of 4.5. Major tribes are Luguru, Kutu, Zigua and Kwere; minor ones are Kaguru, Sukuma and Masai. Their main activities are:- - Subsistence farming - Business - Livestock keeping Cultures Main cultures are:- - l-raditional ngonras, (dances). - Use of traditional rnedicir-re. - Conduction of church sessions over the hills Languages Main languages include:- - Kisrvahili as a National Language - Local languages ie. I-uguru. Ku,ere, Kikutu and Masai Communication The total road netrvork in the district is I168 knr categories:- The roads are divided into the lbllou,ing - National truck roads - Regional roads - District roads - Village feeder roads 188 km (tarrnac) 343 km 295 km 3 42 km (40Yo are passable throughout the year and 60%o seasonal). Most of the road network is passable during the dr1, season, but some feeder-roads to the villages are impassable during the rainy season. Administrative Structure Administratively the trvo districts are divided into l0 (ten) divisions,42 rvards and 233 registered villages. They also constitute 3 parliamentary electoral constituencies. Health System The Morogoro Focus CDTI Project area is constituted by 3 hospitals. One owned by the Governtnent, one (l) by Parastatal organization and the I (one) by Voluntary Agency. There are ten (10) Rural Health Centers; nine(9) being Govemment owned and one (1) belonging to Parastatal organization and 105 dispensaries of which J2 are owned by the Government, l6 by Religious agency, l3 by Parastatal organizations and four (4) by individual/private organizations. 5 WHO/APOC, l4 September 2009 Table I : Number of health staff involved in CDTI (Please add more rows i,f necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area BI Number of health staff involved in CDTI B2 Percentage g.=3r7 S, * 100 MVOMERO 195 70 3 5.8 MOROGORO RURAL t96 79 400 Total 391 149 38 1.1.2. Partncrship N{inistr1, of Health and Social Wclfarc: Provides strategies and guidelines in approachiug an)' planr-red activit)'. 'l'he N4inistry also providc lirancial and technical support tltrough supen'ision and intenral monitorirlg during inrplcnrentation of prograrn actir ities 2. Sightsavcrs: Sightsavers is supporling the program tlrough llnancial and technical support. The funding received from Sightsavers International are used in advocacy and cornmunitv sensitization, project offlce renovation and equipmenls. rvhereas in terms ol technical support Sightsal'ers International is supporting capacity building and pro.iect monitoring. 3. District Councils: Both Morogoro and Mvomero district councils are providing human resources and technical support to the project. The districts provide support through supporting supervision and monitoring. The project is also being integrated into district plans to ensure sustainability. 4. Community: 'fhe communities in the project areas are the critical supporters of the project implementation. They are supporting in providing human resources such as CDDs, collection of drugs from FLHF, support supervision to CDDs and self M&8. The community also has the crucial role of motivating CDDs through provision of incentives. Working Relationship There is good cooperation between district councils, SSI and communities in implementation of CDTI activities. District council's plays a big role in paying salaries, allowances, supporting Supervision and Monitoring and also pays other in-kind costs. Communities select CDDs whose duties is to collect Mectizan fiom the nearest FLHF and distributes them to the people in the community, also they discuss problem facing during MDA (CSM) 6 WHO/APOC, l4 September 2009 t-- o\ c.l o -o E{J o-oa w O U o. o lL] zc z q.)! 0_) (J -o O i a o-. CO(JL Cd o c-) e! o.() o (d o. o o. o o -o a(JL CJ (H o o (d tr .oI L c_) d 0)L() (n o a.) oo(.) - @^ - t-.] H @.9()d l-Fd e5A.-()ao.d(H A) Oa oo -.o'- ZA . t--.1ej rr E9 .= -d 0)E lid 6e =o-,Ap9,;f' c.)'E b0(cd L_ ua ./ trr H= Ecn(dP (./) hYotr GC ch tn :Q OB -- o9 -.ceO .-? ! o.,r t -^^U rd E= ootr>co eaa c-AAo'I -c ncafoF0, ,- d L--.1 ! -,_\ r\ ==l].](J .E E^: o.l €l<vH a-1 dE F.n tr .l.Y o.6VV!H t< 0)/ (-)() o.tn do o a L 0) o a. OJ o -O^dlJ or l--.,1 -o \J(6 0) c! cd -o o-/ 2 ;o) 0)+(.) (( (,ts A- .e3 L d zq< ., o z I I I I 0) -. 'o o ti 0) bo P U 0)L 0-) oo L 0) o o o 'a ! O. 0) k ,o a Cf) 0) cd v)(d a U au o'\ a) q) >\\) () U\ o : i\ :! 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O a(g o a a>. o) (nP > ) -qJ.== .t=t L =:1 uSo- U= ar =O I'ibo-.: arY0-r \-oi F.-0J-: O c OL':=oa -LN E 6.E<L- '=o(d0 ;..' u ',] o qrvl_(Ju1'A I -c x't- ) ? c9A B (d.=! e(s--d U VLP LHLUBOLC']^ l.r.H WsE_vep a) J *1E-. :'o l- o-li cJ >.tr P i'- Lu oG oe\ 0) LIC) :}J- (J L\*A,J '=Y)P o (g o jj n-"1 r'O2 <:"5=c.l > LU -JaN!9 Y.* ., .dM,: o o :s-2 F Fq... c o. oo o p s a aq c)L 0)6 ..E(.) Od(9tr ^;^l- .-t- .UE C) I .E(eo OIJ C)(J e() - )j..= cd cd; a -= oot dbo; iq.=-u LP (E0)arootrta()L-L: -otr() . a) e6 Ar,-= -di E"a B .= 'n hrc '5P()(g o(F-C ^eqL n9rs>.i - bPtr.= H(J(Ua- -6'=tr sr =: oatritok 53;8hY" '5 c.r -C R19! ='r:6ALcu:vd.aL!-Yp .P: 3q;.j3! L, *-C trt - -oS Yo b::=: dS.^'=Eotrl(ci-:=.==!CdSX A-c. tro.N\r'EdErrp .!'art-l.=Fv(Ju; E (g X(! ()rrE.-?Euo>ft8-:; = q s,- =triOc+(JO{sSe,::S,gO'0.)-| cg + q cd ^.s.= 0.l or H5 oP!--iaL-="-!-Lqa(S(-)_OUl-O5 s-s < > } S\r:-aaaaaq\J _cn o F! 0) 6) 'E (J= LL)C 'oE o)o E. P()cs -c LL OOJU 'E-O -d(cNl.o a*)'1 aP= ",C(J Q=-d (!trcd or5PCo-'o^a d=^ P.=L .9U,c il' () c)cd-c N(-)P.- !c)=CdU oJ- C Ld)L!-U ^o>€ orgt ra3 coc UE9Ndt +j 6J .=Ntr e= .(oJ'= atn= -\or ; '/iL F l-.io) - r)>:v a(u!0J- E:9U9' oJx2oolfo(u0.)- =!.o>9r r E'6 JHPcnA- bOY Cc:\cd -o- ?fi'uZ'= Ed!:o s"E90()H.:E9Fe:€ I ,'€.rU sB-bE-;944 =o)o9)>! 9d4 < 10; 5o.Y.bO o\ N 0) -o Eo o.q) a v O o. o c.l oin (!o'=c "o=38,dd F >_=(g = .;'- E = 3 qP 9 : L (!.= tnvi;-!ao -i Fx =LE)^H(-)O O t-J'I aE 'u U; € .L 'd.Y:(!ooo-)L-o-C0)dE a- 6oi .E .(c ;LL;dLcr .= i: >1u n c.= ootr = (J= cCJ.Ce.|.1 o'; =I 6 7- r3E E E.9 a . I u :__..1 -ve E =P 'JcJE dOqP;\4 e h," Ed , ;E e9caq-9aoro?o -9oor(.)(-) .= o'-o =-q6CJtr cd -olj (gqoro- € E *d .'- >- i 8ci cE .o .- -'9(J.-.+ E 9i,eUE ? tsi-c; ^=(E(!.-'-5 ), 6 E= qa 9 9J9=lrn > E - - *o-doc - -L! a^:.i9 - e -9 L ,r30 :.'i;E; .; F=:9Jro g6 P A::.F E E9 ;tx t--: EeF E [;tsLIIa) L- =\, u 0-) O'.= ; tr q,1 u'! uid ^ tri - - il9 I E,:E3.=)^^.ElJ.H .p _o U o 9.! o.r ug9; 3a7,EeP = o:.Y c) rr6J HA tr= cJ - -E ?:r-"igEE 9R E E 5E E? Yi-.j g'[ c-r o'r oE !y as f E sE fi fr:3:x gI E H: e EE xrtr '- (J.= o u:il I+ :9ue:3;E(! '<.C o-)-=tr t=; -Z9P& [BE i u* I(H a 4) O.XS-Y'-c .9.Io6EF€3.:'E E a:: E aC (d = (J c.: -e ^ v d L O oO- d!v_.rp.iaVUeE!r=EE'=g H E E 5 3^:E x = H 3osiB;b=.EEEE-:3 F;i]il q 3tj. v- H Errrr o O -:\ U) a) a)() a) q > o;* L o \\ q U a) \- F t-.1(J () o d o. o f o- cl)q) E oU v; drl -l!ldtFI aJ tr o E o 2 o .s .: trt E E o o $ $i o o! o Lo [{ q 6 o, o\o\ ha EH Ev <o F= ri9-tAEU z= :.! 3 :.E EXi =eXE E-tr =E.:-zg> N cl -f !@ 00 ( F + EA ll ca 61 N N at t \l cl o\o \c) $ N o tr E -e A(, L e E z H U I z FA 3-(O q r\ o\(\\o clal o oo G oILe 0. ll + ca Ea @ oo \o =l- co t-- $ r -J \o s -)o\ € aaqo6 >q)ooG t=e Eo oE o'E -oE za E >,= t i'a a o - =r-2I E: T Zaca ;.:.! i, ='=H: SEgB eEeo o&El o o& o (J? d) ^=z& E oF J L .2 a 2.5. Capacity building Adequacy of available knowledgeable manpower at all levels. The project has greatly benefited from the trainings conducted for different cadres at all levels of project implementation as these have been the key persons in advocacy and cornmunity mobilization and sensitization. We went further by also including in our work plan for the next year to conduct training for primary school health teachers and community development officers residing or working within the project area to make it more objective. lVlterefrequent transfers of trained staffoccttr, state what the project is doirtg, or intends lo do, to remedy the situatiott. Normally training is done to the in charge of FLI IF on how to carry CDTI activities. He/she trains his/her colleagues and delegate power to them so that, in case of transfer CDl'l activities will continue as normal. l3 WHO/APOC, 14 September 2009 o.O(\ !o -o E0 aa -t (, o s o -t. $ oo o s €: o\ o { B 6 o U +- q ! F-.i :-o rizv (\l(\ tr- r- o\$ .+(') =cl lr) ! o\ cll t rnv(.l qJ q) a) c,) -o o\ q) a) Q o z ?1a r) .1. N N c\ N @ o\\o $ c.l C\ 1t ,q U (.) dll U o.i +Fr-, = .U Fq) (.l -l c.l a.l c-.1 c.l = o o q) (J o\ q ql .Aq9rF 6J' oq) . o,) L6 z o\ f- r-\o c\ al al a{ rf) a.lU\e< Uz dilvE,T + -u t\ o\o c.t (rr o\r- al rn C) o o o U.- !jj H8 tr.-- ZE q) c) QF (\(a <-E.''l + -u ro (J d+.q U{.. w s O $ o\ o\ r-\o e.l U) O O F] a)- (.)q) !, !u q) z o E) 2. o o a)(rl r)4d) ^=>d J t-r t- q,) () C) q) o\ J U1 V) q) Q c) U) i oL q) s_ o ! ! q !q) o* o (g () C) o. E F (_) (H o cf)() () () li 0)h () (! bo (dlrF ,iit ol -l -olcdlFI Trainees Type of training CDDs Other Community members e.g Communiq' supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifo) Program management Ho'rv to conduct Health education Managerrrent of SAEs CSN,{ SHM Data collection Data analy'sis Report writing Others (specifo) Table 6: Type of training undertaken ffck the boxei where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures In this year treatment, was done in 893 endemic commuuities and the project managed to treat a total oi 286,032 people and attained the therapeutic coverage of 80.2o/o. The geographical coverage was 100%. There is people who still refusing to take the drug and some were absent duringtrug distribution. We are planning to intensifo, sensitization and mobiliz-ation in area where number of refusal and absentees is found to be high. l5 WHOiAPOC, 14 September 2009 o. ON Lo -o Eo o-oa : Q o o. Oa c!L! I \ 0oI bo \r't \ L I)t v! J\U= G\5! .o 'i. ^'\i\4.o-n! o)-.= r-l -v! *tr\ E! U o.ic!d>!UU: .'\ aF-UE: 0Jg: .r -iJ = ='; ioica-:!3 .s Ft "E\.\ .= 's ii L\\H a- EUY :\ ':S(! t\ =,-OI E S 'iEol ! \J q\ -l o <] s:xl -o : l;\!l e S :i"9l or ! '!u(ql : : ..\s El 3 S tt;l E .s YiEt S \I PI h * SS +t = \ % eol E ! !,-IJ*GV El = .3 I\!l _ A '-vql d 6 \r;l 6 l *sZl? i lt\c b^U!S .O\:i ss u\il * E]i r!3. ._o tt :'J \ !s! -o!s \s -\-\-9 I \ Ssu!3y .e i'ig -c I da.q 3 S:co u ut 'h .s S :\/ F- F\='Frrrr:D s pi ^EF! o\ \ a: ?lel t0) xl .> EI E Eltr -l tql E oloOI tr tsl E <*l 9.tolr: El= rl c zl< C)! O 0) 'a L o- O ; z- rl.]c -o -o (-) .E () =a a 0) E E o(.) o E() ! C) I! C) o. o(r) C) Eqr o o -o E oF olOI -l 'ol o)lPld C)LP q() b{ * .9 .: E oo o () -o z () L () 0) 'a L 0_, .c =.= a .9 .= =E E a(J .9 E(J -o () I! C) o. oa() E oo o o- o o. (n oF OI =lx sl 0Jt d)! ; o. 0)o o 0) ,o z IIII (J ct 0.) bo Lw^ 6S oo oF (J Cd 0) oo(!r 0) o o E .) /^- .- \" o-v(! L ho o 0) o 0-) () bo dL() o(.) O,^ "= \o o o-d OJ t-p a>o HPY;9ETU v! a 9> a o iiEEEH-}o,J oie o' o O o o -o E z Dq htr oul = -<Zoa ^ : . .- ..JJ-P:, o;-- o:, 6=-:Fr-r> ==*uJ - = --c o 6 6 F- r/.) SoUf = L a' i, (\ a\\o a..l oo c\ ?a) r-! LCDU ^ 9- -9;E i C -L>6=tru2J:1 D; N Vt o (d o. o O. AA\o to =boo6 A!, oo -EOF aq @ O oo al O a a 2TE:o =-b9 ...l c.l N c- ao^ altl \o @(-I dtr=au-o E 3 " X.' @ oo a..l \o$ $ v rOt o\ o\ ar ! ,2o l;i -Y! Si.iu _o 6€=; Od)rr o oo al oi oo <. € \d\o o\\ot- \o rA c.t tt) G) o(-) ll ddo\o G9o -ME.F !vo;oZ 6o O :o -3 5 SHc c= u =c>-z6 o r- $ \o ?a) o\6 Au? u.z c(6:. .,r' 9r -oFU rr s \o $ ?a) o\ co 6_ + c io^o zrE H -E d ts"5-<g 9aJ L= 9 : d t::> oo o.- r- $ \o s rO o\6 E< Eqo\ od u.l z. o z OJo<odd>od EO Fl F oF i U1 U) AJ(_) V): I\ a)\ \ a)V) q) U & an k a cC(.) l<(d (c r f') J o t< a ! .o (n tr.l a (! 0) () tiF r*l 6)l -tol(dt FI a aa a 2.6.2 What are the causes of absenteeism? Implementation of drug distribution was done during rain session and people were alriady engaged in the farming activities and therefore fear for side effect of drugs. Movement of people especially young ones who are businessman. 2.6.3 What are the reasons for refusals? Ignorance for some of the community members who have no sign and symptoms think that they are healthily therefore there is no need to swallow drugs 2.6.4 Briefly describe all known and veri{ied serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information rvhen available. . Parasitologisttrained'? o Existcnce ol nricroscope'.' . In case the project did not have anv cases of serious adverse ct'eltts (SAE) dr"rring this reporting period, please tick in the box. No SAE, case to report l7 WHO/APOC, l4 September 2009 o\ O c.l L -o E o o-oa $ U o o. o oo \) B q) Lq) -a \q) V) {: () -E.=o998," o;o ac= L 'Mocrn -- Uc.= c e (gi:GO@ a)r x 5.=LL] o o O- cO9O qS ^ J,.Y Uo_c tr .J4\ ida;o-oa.aa. 6400 n 5 ,r,G o o.9 C^ 9 oJl (J O- C v6EL' o;=- : L (e .r :"-d o;LJ 6.CG: E] I z AV € - I S!! U EH-v o +PYc\J->' *apPa E o o- E a tr-o _vq':cu o=() l-)66<A rc =0) .N -ft Oo-- o> B z o 0)ooc d.; -ho2A x() a o oo + a -:\. 944 a)Qq) ? \ q) O \ -F q) V) \J o* o .I 0) bo .F o o.()p () bo L ! 0) li! o o atll a U) o () q) a! C) Cd a o ti() a(H o (n() Cf)(! O <idr 6rl -ol(dl F] () oo P Eo )O O v] r-\o '.q o\ oo + o\ vl o, n o\ cO a.o O. I ilr ,,i r! ti o _oorl 6 ^ts oo\ < >r -o o c.l @ c: o\ @ o\ oo c.l v o. s € vl ll * ri .;O =ooO 6^ i-uo\i: >-OO -c9F r-\o co r- c- q oo n @ c.l O co !.1 .o .o a=9- a' o o \os\ : (\ n € 6l (.l co v ol $ o) t- a.l \o o) € t-. a.l \f, .o' € al G] "na doa = ts.u] .ot -o' -ic \o c.l o\ c.l c- oo (-.l $ a\ \o r- c.l o\ oo o)$ oo(\ (-.1 CI $ n o. o\ a.l qq o -i::L^= jYio:'o6 o 6E< =Q O o; o- O\oq \o c.l \o $ 6 coN $ dI c- rt. c- F-, $ o.\o .f- \o o oo o o(J ll + kI ki E] q ^oo() 6^ F o6\ -o I o\ co=o-oo=6- 9!- il * Pii 9Cue oviOakl c] o o\ O Ii oa?bEbE F, C2 a : El b 706 ooN oo r- oo r- € r- co o\ € Et ?u d o.= EEgr 99 F\J <- €(\ € c- oo r- € r- ca o. € OIJd =q__,6q>::oo>.3 aE +u-^-- s'E =b E* e 7 3 Q4 tro oo <f, oo(\ @ r- € r- @ c- @ m cO & rl] r- o\ coo\ o\o\ o\ N o N N (\ OOo.l $ N o c\ c.l c-OO c\ ooO N o\ C! N o\O N L(-) -o E o o a $ (, o o. o f o. -O I o 9 / -C) I q) bo ELiol x/!9 *9 U rtaL\J .IF s.) s\ \L:,\?t '\ -E\!9;=c(!-\trL vaqE ts: ord: \is3 3q) t!o! 5cqft C.e33! ) .=obo !=+ic) LrG).2 .4:rF vl- a- En0 ,v ) ,0)vh€avxr-trdoiHLA iUN !lCqd =l C,)o'tl = ,\lc) -Yl .) 0J ol .-IA .EHi?-or q:8,e -9bL !_lr6TErYjitF (H cg iJ a EdE 04)g c)LE9 lj 'd Cr3 'o)Q)U;-E .L\O!6i o'1 ';(-)l o -t{Jl qr Fl 0i 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtleose tick the appropriate answer) MOH ./ f] WHO tr UNICEF tr Other (please specify) NGDO tr Other (please specify) Please describe hou,Mectizan@ is orde and hou'it gets to the communities . Mectizan tablets are ordered afte conducting census in the affected community and getting the total population of the project. We calculate the nurnber of tablets require by multiplying the ATO tirnes 2 then rve get total nurnber of required tablets. The Mectizan@ delivered by - @lease tick t MoH ./ fl wHo tr Regional ofllce request Mectizan sent to Mectizan@ Expert Comm - How are the remaining ivermectin ! The rernaining Ivermectin tablets are collect! facilities and then they transported to the dist if they are expired. List and briefly describe the activities by health care personnel in the projec] . Advocacy and sensitization to c! jurisdictions. ' Training to CDD's NGDO tr appropriate ansv,er) UNICEF E Albendazole to NTDs Secretariat. Tlie request is for approval. Mectizan@ arrives in country lablets collected and where are they kept? d into bottles and taken back to the nearest health rict pharmacy, waiting for next distribution or distruction under ivermectin delivery that are being carried out area. mrnunity members and political leaders in the area of through the same channel and is by Medical Store Department (MSD) rvhich handles over to the NTDs Se at. The NTDs Secretariat within the Ministrv of Health and social Welfare are responsible for delivering of drugs up to the District level . The District authority distributes drugs to the FLHF by following request sent to thern by IrLHF stafl. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Me thereafter the CDD or any selected cornnrunity member comes to the FLHF to lect Mectizan@ ready for distribution to other Community members. Mectizan compared to the previous three ered/received for this reporting year has change and Lymphatic Filariasis and because of integration between Onchocerciasis lization rvere by district(Councils have given full mandate-where by drugs are supervisory role) straight to districts)Region remain with Table l0: Mectizan@ Inventory (Please more rows if necessary) Number of Mectizant tab lets Requested Received Used Lost Waste d Expired Remai ning State /District tLGA lrr stocl< frorn prcvious t,ear Used LF area36,760 750,000 5 5 5,500 398,4ss MVOMERO 7 10,000 546,000 367420 Used LF area MOROGORO RURAL 3 8,000 I,101,500 165,8757 4,7 60 1,460,000TOTAL 20 WHO/APOC, l4 September 2009 . Supervision during drugs distribution. . Data collection and report writing Any other comments . None 2.8. Gommunity self-monitoring and stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so. When? In each distribution cycle ToT training had been conducted Table 1 l: Cornmunity self-monitoring and Stakeholders Meeting (.4dd rows if needecl) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or horv they would be utilized during the next treatment cycle. . Increases community ownership hence sustainability can be achieved in the project . Solving the problems in the next treatment cycle if identified and maintain successes 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchl'. NOTF + I CHMT/DMO ------} I Districti LGA Total # of comr.ntrtr ities/r'i I lages in the entire project area No of Cornutunities that carried out sell' nronitoring (CSN! No of Conrntunities tltat conducted stakeholders meetitrg (SHM) IvIVOMERO MOROGORO RURAL 457 436 101 101 98 87 TOTAL 893 202 l8s RHMT/ RMO RNTD/ PC DNTDi DOT FLFTW 2l WHO/APOC, l4 September 2009 Level 2.9.2 Main issues identified 2.9.3 Supervision check list used Yes/No 2.9.4 W[rat rvere the outdome of CDTI implenrlentation sunervtseI 2.9.5 Was feedback given to the supervise d Yes/l.,lo 2.9.6 Horv rvas feedback used in improving the overall performance of the project DISTRIC-I- a) Incorporate of CDTI/NTD activities in CCHP b)Cornrnittcd DOTs c)Some District budget small amount of funds Yes Probler.frs and Succes$es Identified Yes FLHF a)Maintained High therapeutic coverage b)Due to shortage of staf f supervision of CDDs are mainly done in nearby communities Yes Problcims and S ucce bses Identified Yes COMMLTNITY a)Distribution period was carried out during rainy season when most of the community members are at farming hence many absent seem b)Full involvement of community leaders Yes Probfems and Succfsses ldentified Yes CDD COMMUNITY -Council continue to put CDTI/NTDs activities in CCHP -More commitment ol DOTs -Maintain high geographical and Tlierapeutic coverage -lmprove perfortnance ol tlie implcmentation. Maintained high therapeutic coverage -FLHFs supervise CDDs& to involve pr. School teachers to do supervision to CDDs - Distribution to be done pe; community Need hence high therapeutic coverage c)lncrease orvnership and sustainability of the project. d)lmprovement of filling of treatment registers 22 WHO/APOC, l4 September 2009 SEGTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipment (Pleose add more rov's if necessary) *Condition of the equipment (F:Functional. CNFR: Currentlv non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? - Maintenance of rnotorcycles are being done using funds from council (CCHP) and partner (Sightsaver) suppofts the project to maintain office equipment - The project has requested placement of existing equipment frorn APOC Source -l-ype of equiptuent APOC MOH DISTRICT/ LGA NGDO Others No Condrtton No Condrtron No Condrtron No Condrtron No Condrtron 1. Vehicle 1 CNFR 2. Motor cycle(s) 5 F 1 CNFR 3. Cornputer(s) I F 4. Printer(s) I F I CNFR 5. Photocopier (s) I CNFR 6. Fax Machine(s) I F 7. Others a)Laptop I wo b)Biycles F- c) 23 WHO/APOC, l4 September 2009 3.2. Financial contributions of the partners and communities Fill tables 13a, l3b and l3c If there are problems rvith release of rpart funds, horv rvere they addressed? 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Other forms of community upport Describe (indicate forms of in-kind contributiotrs ot'communities if any) . Collect Mectizan from the nearest FLHF . CDDs are being excepted from comn'funity development rvork in the drug distribution period . Make a follorv up to other communit{ members to encouraging them to srvallorv Mectizan 3.4. Expenditure per activity Indicate in table 13. the amount expende(l during the reporting period fbr each activiti' listed Write the amount expended in US dollar$ using the current United Nations exchange rate to local currency. tndicate exchange rate u$ed here US$l'150 Any comments or explanations? +,SEGTION 4: Sustainabili Of GDTI 4.1. tnternall independent partifipatory monitoring; Evaluation 4.1.1 Has thc project cvcl' be rvhich arc applicable) q'aluatctl/monitorctl ? ('f ick ant ol' thc lollon ing "ri {-I.ar I Participatory Independent monitoring {- Mid Term Sustainabitity Evaluation year Sustainability Evaluation Monitoring by NOTF Other Evaluation by other partners 4.1.2. What rvere the recommend tions? 4.1.3. How have they been imPle,lr"ntear I 4.2. SustainabilitY of Proiects: Yr 3) Was the project evaluated during the report ffr" and set targets (mandatory at ng period? N/A Was a sustainability plan written? N/A 28 WHO/APOC, l4 September 2009 When was the sustainability plan submitted? N/A What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels CDTI activities are already incorporated into CCHP, and the plan is bottom up plan which is based on the priority of the community themselves. 4.2.2 Funds The district council has already started releasing {unds for implementation of NTDs activities. In this reporting year most the activities \vere conducted using LGA funds. 4.2.3 Transport (replacement and maintenance) Maintenance ol motorcycles are being done using funds from council (CCHP) and paftner (Sightsaver) supports the project to r-naintain offlce equiprnent. The project has recluested placerneut o{-exrsting equipnrent fronr APOC ,1.2.4 Other resources Thc project rnainly depends on the support frorn APOC/USAID. Sightsavers. Cor,rncil and Cornmunities to hnplement NTDs activities. 4.2.5. To rvhat extent has the plan been implemented The Project had been evaluated in year three of implementing CD'tl activities, since then Action Plan was developed and have been incorporated into CCHP and plamred activities are Iunded. 4.3. lntegration Outline the extent of integration of CDTI into the PI-IC structure and the plans lbr cornplete integration: 4.3.1 Ivermectin delivery mechanisms Ivermectin delivery is within Government system using the existence structure. Mectizan drugs are being delivered to FLHF in Oncho endemic areas through normal channel together with other essential drugs/drug kit and vaccines. The FLHF in charge and his/her subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect Mectizan ready to distribute to the community members. The same CDD are also responsible on distribute Mectizan and Albendazole for Lymphatic Fi lariasis Elimination 4.3.2 Training The project conducted refreshertraining to CDDs and FLHF's staff as there rvere no new staff in oncho endemic areas. Training was also conducted in none oncho areas where the project is implementing integrated NTDs activities. 29 WHO/APOC, l4 September 2009 4.3.3. 4.3.4. 4.3.5. Joint supervision and monitgring with other programs Supervision and Monitoring o{CDTI activities are integrated within PHC system. Therefore at Region and Distrigt level supervision is done jointly by a team using the developed checklist. Release of funds for project {ctivities Funds are released through nofrnal channel according to budget line item even though disbursement of funds bometimes it takes a long time. The project is mainly depending on APOC and Couhcil. Is CDTI included in the PHQ budget? YES IT IS 4.3.6. Dcscribe other health progr mmes that are using the CDTI structure and hou' this rvas achieved. What h been the achievements? . Filltables 14 and 15 and pro de descrrbe other programnres that are usrng tlre CDTI structure and how this was chreved. What have been the achtevernetrts? a For eacl.r rnterventton lrsted n table 15, explarn what were the roles ltlayed by the CDDs (census, mobiltzatron, distn utron, data collectior-r, storage, collectrorr of drtrgs, referral of SAEs, etc ...)? . a a Explain what are the combt How were the interventiort atrons of interverrttons co-irn plentented? rnrplernented? (at the sante tirne?)1S 4.3.7. Dcscribe others issues consi[ered in the integration of CDTI 30 WHO/APOC, 14 September 2009 a D9 tD s o I tD tD t, \) 86 i+ (, o ID A)F1 A)o a -lr-i F0o o tD 7 pD F-t o 7 p) p0 Ft TD o o I 7 FDH .) o Fl o V)iFrr 0 ur) o a U) o pJ a +- o),: HFI o)rd AP. o o^ *o *t:'Oo o F-' o 0)a a o-lOutd T.o a a a a o9< UO rD:. JoF = o) a. a o=I 3=j oOJ^ -OQ '-urD OJ rD f a =92+ o -1. 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