t RESERVED FOR PROJECT LOGO/HEADING t I ORIGINAL : English Proiect Name: EXTENSION - CHIKWAWA COUNTRY/IIOTF: MALAWI Approval,year: 1999 Launching year: 2000 REPORTING PERIOD FROM: JAN 2007 TO (Month/Year) DEC 20007 ( Month/Year) Proiectvearofthisreport: (circleone) I 2 3 4 5 6 7 (8) 9 10 Date submitted: 26't'H FEBRUARY 2008 NGDO partner: SIGHT SAVERS & WHO o i (cc t+ rV '8tM 4SA(oP vD r!-- kt+{ tsro ' _r-f Ci -LI Kk0,, h+ lMnA 'VT.Wr.r,., 1 n A\if ?-f}fiB wHo/APoC. 4'h January 2008 I ANNUAL 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 AFRICANIPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ll wHo/APoC, 4th January 2008 t I I I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: MALAWI. National Coordinator Name: MKWANDA. '{\ sisnut"t"' Date: ... i j v3\ t DHO Name: Dr M. MBEWE J Designation : . !-. Signature : . . Y'J)'[-1.',tr.r. .r. , I .i. . Date . ii':,.1.'.-. L i Signature: ...1+U{ Date: H )..1.'l l..a.l.q.( This report has been prepared by Name : MKUKUMILA V. 1 l'r.t [ -.-,,- ,'t {-, . . .-J.- r- I I I t lll WHO/APOC, 4s January 2008 FOLLOW UP ON TCC RECOMMENDATIONS EXECUTTVE SUMMARY .............. SECTION 1: BACKGROUND INFORMATION 1.1. GENrRel INFoRMATIoN ............... 1.1.1 Desuiption of the project (briefly) . 1 .1.2. Partnership 1.2. Popu1erroN................ SECTION 2: IMPLEMENTATION OF CDTI........ Table of contents EeurpunNr FrNaNcreL coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES...... OTTTTR FoRMs oF CoMMUNITY SUPPoRT ExpeNoIlurc PER ACTIVITY VI I 2 3 TnraBrrNp oF ACTIVITIES .............. ......................7 Aovocecv ...................9 MoeTLzeTIoN, SENSITIzATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITITS..9 Couutxrrv rNVoLVEMENT.............. ............... l0 Cepecnv BUrLDrNG ...................... 1I TReeru8Nrs................ ................. 13 6.1. Treatmentfigures............. .....13 6.2 What are the causes of absenteeism?........... ..............15 6.3 What are the reasons for refusals? ................ ............ 156.4 BrieJly describe all ltnown and verified serious adverse events (SAEs) that.... l5 6. 5. Trend of treatment achievement from CDTI proj ect inception to the current year I 7 ORDERING, SToRAGE AND DELIVERY oF IVERMECTIN .......... 18 Couutxrv sELF-MoNrroRrNG AND STAKEHoLDERS MEETING ........... 19 SupeRvrsroN............... .................. 19 9.1. Provide aflow chart ofsupervision hierarchy. .......... 19 9.2. lV'hat were the main issues identified during supervision? ....................... .....19 9.3. l[las a supervision checklist used?......... ....................19 9.4. lV'hat were the outcomes at each level of CDTI implementation supervision? l9 9.5. ll/as feedback given to the person or groups supervised? ............. I99.6. How was thefeedback used to improve the overall performance of the project? t9 SECTION 3: SUPPORT TO CDTI.. 20 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2 2 2 2 2 2.7. 2.8. 2.9. 2 2 2, 2 2, 2 3.1 3.2 3.3 3.4 20 21 21 2t SECTION 4: SUSTAINABILITY OF CDTI 22 4.1. INrrRreL; NDErENDENT pARTrcrpAToRy MoNrroRrNG; EvALUATroN....................22 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowing which are applicable) ............ ........22 4.1.2. What were the recommendations? ...........23 4.1.3. How have they been implemented? ...... ....... ..............23 4.2. SusraJNesILITy oF rRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT ...............23 Yn 3)......... ...........23 4.2.1. Planning at all relevant levels ................. 23 4.2.2. Funds........ ..........23 IV WHO/APOC, 4s January 2008 4.2.3 Transport (replacement and maintenance) ................23 4.2.4. Other resources... ..................23 4.2.5. To what extent has the plan been implemented ......... ...................23 4.3. INrecRerroN ..............23 4.3.1. Ivermectin delivery mechanisms ..............23 4.3.2. Training.... ..........23 4.3.3. Joint supervision and monitoring with other programs..... ...........23 4.3.4. Release offunds for project activities ......234.3.5. Is CDTI included in the PHC budget? .....23 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. ..................24 4.3.7. Describe others issues considered in the integration of CDTI. .....24 4.4. OpEnerroNAL RESEARCH.. ..................24 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period........ ..................24 4.4.2. How were the results applied in the project? ............. .. ..............24 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTT]NITIES....... 24 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTIIER MATTERS ...........24 v WHO/APOC, 46 January 2008 \Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermecfin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental Organ ization 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 vt WHO/APOC, 46 January 2008
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 84%o of the total population in meso/h1per- 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 with ivermectin in a glven year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geopraphical coverage: number of communities treated in a given year over the total number of mesolhyper-endemrc communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) InteEration: 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 corlmunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (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) Community self-monitorine (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, 4'h January 2008
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 if necessary) Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 4th January 2008I
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. 2. Background on population movements. 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. Chikwawa is one of the districts implementing CDTI in the extension phase since 2000. The district has 128 villages and these are headed by village headmen. The district has a population of 450, 609 but the impact area for Onchocerciasis has a population of 100, 306 people. People that were treated in2007 are 82241out of 100, 306 representing 82%o however the district's ultimate treatment goal is 83254. The population for the district is mostly comprised of the Sena and Mang'anja ethnic groups. They earn their living through farming and they practice winter cropping and this affects treafrnent coverage since a good number move temporarily to their farms during this period. The district has a total of 647 CDDs bring the CDD/population ratio of 1:155 and 61 health workers who are directly involved in CDTI. Review meetings with health workers and CDDs were conducted in order to achieve this treatrnent coverage of 82o/o. Most of the challenges met were in adequate coordination amongst supervisors and lack of handover and this was solved by holding frequent meetings and full involvement of the assistant Onchocerciasis coordinator. 2 WHO/APOC, 46 January 2008 SEGTION'l= Background information 1.1, General information 1.1.1 Description of the project @riefly) Chikwawa is one of the districts in the southern region of Malawi. The temperatures are always hot reaching a maximum of 42 degrees Celsius and minimum of 20 degrees in cold months. It shares boundaries with Blantyre,Mwanza, Thyolo, Nsanje and an external boundary with Mozambique. Chikwawa together with Nsanje are called lower Shire because the river Shire passes through them at its lowest level. The Mang'anja and Sean are the main tribes in Chikwawa with the Lomwe in minority. People grow maize, sorghum and millet as their staple food, cotton as a cash crop and they also rare goats, cattle and pigs in large number. They also practice winter cropping on top of normal growing season. The district has one tarmac road and several weather roads which are a problem in wet seasons. Most places are connected with telephone facilities and health facilities are also provided with radio message facilities The district is headed by the District commissioner and supported by sector heads such as the District Health Officer heading the Health sector. The district health office has four sections which are Clinical, Preventive, Nursing and Administration. There are three hospitals (the district hospital, Mission hospital and Rural hospital),17 health centers and 39 heath posts. According to REMO, onchocerciasis is prevalent in two zones of the district and these are East bank zone and Changoima zone. The east bank zone is hyper - endemic zone to onchocerciasis with 73 villages and has three health centers while Changoima zone is Meso - endemic with 66 communities and four health centers. There are a total of 55 health workers directly involved in onchocerciasis programme. Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health steff involved in CDTI ectivities. Total Numbcr of health staff in the cntire project erea Br Number of health steff involved in CDTI B2 Percentagc Br=Bzl Br *1(X) CHIKWAWA 6l 61 l00o/" Total 6l 6l 100% 3 WHO/APOC, 4m January 2008 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaVinternational), communities, local organizations, etc. ] Describe overall working relationship among parbrers, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in project implementation are Ministry of Health, and W.H.O These parbrers are involved in planning, supervision and implementation of CDTI activities. 4 WHO/APOC, 4n January 2008 oo c.l c, $ oA E > oo li o I(+r o o ti= oLr 0) d u)F(.)E 0. o B a F oi o0 CI I'ro I tr E oo o) ta C) a oo (B B C) oE C) oo CI Fro tr oo tr 0) (l) ho rn =(D L<d ox +i ,h o 0) o. ct) 0)oli U) lr 0) o c) Pa(dA 0) r\ (€ o (o (n o9 :C)9O O-9E ?o(,E a>7 o9? ::oEa d z ii lt cn o € o !()g bI) ! o 0)L C) bI) tr 1' 0.) o C) 'a ka o) l-r € .t) (n C)o d C')(d 5 ci Qq) p' a. q) sq) q) "a o a) B su ci'BaUL :a.:s!ii .Y q- ci o' \G$9 .SA -S q) %o' 9: $q) .t3 EI :!trr$< U! $q, o-shUO(l sP $'rr clis9TPsi*B6l\ ".l: -o(l*U.:lxp< st ^. qJ *\pa- a. q,t\i -a: =L Sbo '-L ilv s8$- .s .Y ci E' N$CIU :bos= ildetH(J\s q p p o t N o tr C)& oo L oe(,) Lr() oo L € o l-r o C) (ll o)lr o)L(d >. 0.) lr() o) > GIq)L cl q) q) Lq o)L q) o tr vo tr (B o d ao E (d a o E () oir o)l -ol(dl FI E o a-flt! -tc oE aN a rF rat (l)tr() (;) € o o(nqi c, C)Lr(!l oo 'a lra G) tr o (d)ooa c) ) o .o cl rh olro +r o o (n E € Lo o >. CI o)t< C) rn Cd 0.)Lr(!l Lr Cd C) 0F=E6i -= ij -: = 8u $rarc..l co@ + il .oiE -oo .= aN E €'EootsF 3fl \o ca O o :''l r.:f :tE.=5; >.t o o \ *aE9- N= trr\o(\l c! ra) o o 6l a o Fr 'EeS ^9! Etr.= :?oEo E'=gsi o\caooo^$ I o -q ON 3.2 -trdq) t- + il € c.i .eEE9 *EEo!!9E !ie(!(t)E >ro +rE N c.tr- tr at(D at 6l ah c) tr oq) o Lq)E z E9Ugt Hq .= !:??.6 oYL >'-tr (.)rr) Gltr9oo= .FL$9.- d!:,:iaY? = 6.31E 3g P'F o.! cL \o c.) !'l o cJ .9s cr EsicE; ?g -< I6 R-r E ts M =+r(J Fl F Fr I ooO c.l L(g (, .{- IJ o o. E > ; d (B o c) bod (o €o (d o tt) o B o(h lr c.)q q) bo .t) (€ p €o lio obo p a G o tt) qr o oo o a c) 00 cn ASEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in curuent year, indicating when the key activities were implemented by the month they began and the month they ended. 7 No ACTIVITY STARTING MONTH ENDING MONTH I Census Update Jaly 2007 July 2007 2 Collection of mectizan from Blantyre August 2007 August 2007 3 Distribution of Mectizan August 2007 Septmber 2007 4 Conduct review and Planning meetings with HSAs Jnly 2007 August 2007 5 Conducting review and Planning meetings with CDDs July 2007 August 2007 6 Initial Training (drama shows) September 2007 September 2007 7 Procure stationary June 2007 June 2007 8 Supervision of mectizan distribution August 2007 September 2007 9 Compiling distribution report October 2007 October 2007 WHO/APOC, 4th January 2008 t@ cl E CB $ U o o. o B @ (n o o() I -. -' V24q)() q) oL q)L \ q)q q) 5 L{ Cd o) >' o E (-) o q) (d 0)li t/)(B c)L ctt C) lr € a c) od(H o 0)tr (.) F c.ir ol -ol cdlFI o eh L 6)q U) o 3EI & r!o oFO ADiE 1iE .lD o L an AD L n o o () a oU c tI] la oF() a0 .E tiE 6!: Fa o 0) GI q) tt) o)I o o C) o U J P-c ItE 6= J D at GIL3 o EE Q Eq 2 rI]F o-tacza lr) h!EE iiE #E d rI] ta zt!F o. trla -6) 6l=N- trq)a 3E O & rI] ca oFU P= ?tre9 a- J (J F] q) L an B =g EO F] F F It 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. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communitieVvillages - Accomplishments - - A lot of women and minorities are taking part in CDTI activities. - Suggest ways to improve mobilization and sensitizationof the target communities. - By using influential leaders in the socities such as village headmen, church Leaders ,Politician and Village Health Committee Members. 9 WHO/APOC, 46 January 2008 ca N q) -otr 0) o z!t e.l Oo o. o (, .o PH!trtr u.idE=if '= tr bI)ts99!tstr-e O.I9gb0= c)4VF viF!i €HgOO(.) e LLpE -- E eg Hk! -J(l) *88 trotr >r$) O! Ed * r*EE;iH(dngs5(B= >'o.I o) e{i_Ctr tr'POOrc=t(!HqsE:8 EdAHi6trbF boE ts =!r(!9ro *-a Ei d o QE ts,He EL-5s I iE6!E HIJd C'^O E €Hr.€'Scd'n C 2 -XcBoEE rnOOw- o .Y.='EL i\tr >\i, X()CHtr r-.36+t .8EEE H EE dH; EE9€ 50: Eqsee,Et e ar e Ec > ()- '_.F F L9€F-6)E=:YPsHXHCLrO8;8E !E^- 3 e5.E5 iti tl).=EeEE -oiAcB9* -- H I d ! E E XERo--:ovc oQHS oE.Esuz6 = o.,tr \-/IJFJ O I oo +I te o u0 6l o c o. E.E * ;EEE -g '=v a9tr6 =o := r!3BtraD zi s O.l.. o\t-- at e.l 6 oF 9o ETflu U I o o Et €9 a.= L) c oE lt z r-$\o F-S €+6l 6s a.l o\ o, o\ o, >o u0 I'r >o)ooE5o Eo EO otr o=EE zo oo ll r lQla pe o UD 6l 0 o Fr o la Faee iE{l o o ta ?o6 EE.E H -=o:g EE 5 @ N @c.l rl a B X O d F ?\(^' q qi k S o\ q)L q) %N q) a- !_ F n Q 0) -tE=o.=EtrLAo'n -*o'6 EH a- go --= -- ,= =ELHEEOrf(r: $t . crlrEl6t fll 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 tssue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lvtowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). ll WHO/APOC, 24 November 2003 ,o -: +rrl:J: E: o<v ir =v F-+ : F- * : o c! 0 n U q,) z Q ? F-+\o tro It) l) s $,iqv cll I is =v 0 () .=GdL LIr c): oq) *9 L6l(JL z QLF () c) €) \o U U E.'r?F-u' 0< : : q) =6(!t 4)q -o9 E:- >3 oq) QF A €) o o s = o.i+ : d\J \o ts G 0q rI9e9() Zc o Q)E z (.) \o (J tl a x Q Fl t'{ F o () it) \v c.l N o -o o o z <l' c.l O o c\ \ \ s LI a(-)\ ;d 6ir o 6h I a € o s o s o bo .E o 3. o €B G o stb : i 4q q) Q q: U\ !J * R qJq U 5 o C) E 0) o F o O(! o t) C) (.) oL 0.) cO oo LF .iir o-,l -oldtFI Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments Some issues were being done during the review meetings 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of taining CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education 647 55 6t Management of SAEs 55 6l CSM SHM Data collection 647 55 61 Data analysis 647 55 6t Report writing 647 55 6l Others (specifu) l3 WHO/APOC, 24 November 2003 @e.l cd s U o o. o B $ \' Eo a\U I\I E Y!o ;h\v\kal- {r ,gi/ l!(!t 9qES Pou&$ai 3oP.n ess .E.a.incoiPlthE.sSe.sHUEI(!SG3IsF'ir6s\' 'o'sEI i.Et E\F6Ear\s -.Eb\bx:ou9(D -t ,s9 .c .= s-6; E i$E l- s\lD \ a$ ^,8 F ST =tI r is ^t bt\ 'ol lJ i trtq)l -- - gcrElf, s s+ !l E i .ESEt: s is ol C) = Jr'sEIE I E!ge s :FEIE ' ;:zll: i: Meu a- Q\:: ss,' E. EE :i $:t s$\ Sa .3 tss sE = \.s\-qr E i$rrsyf -c il d\H S SS!, E ESF rr tr!? P PS o\ \ aS c! c)Ld ,O C) 'a <oH G)H(D6d p! o(.) .= 'AA L (L) rYl d =& E-o .i9 >G) ?ta Iao= H .= c)CE!.i d6trdFE6 '.=HEtr or tr0) ol E € -l EE xl I * El gA tnl I-h 9l 6it el ! - ald3r ede 8l -l F 'El 6 -l ",5l; El* :li9l oo El= El U EI = :EI E EItr:t 5t E :t:Jl a trl o :l i8I.E EI t' E E8lH 8lE 8lE ,*l 'j <*l # ql !.>olo. oltr ol- rl O rl E rl'(l)l o- C)l c ol= -ol _ -ol - -ol ::trld trlRt trl= =1b =lo =1trZlt- Zl? Zl< alol bo cdltrl ol BI el cdlol -cloldl Ed ol(Dl brl ol trl sl (Dt oldttrl C)l -tr19l hd trl JI ol EI ol 3l €l .ol rl EI ol fri I :. 4qq) c)q) b v q) L t\l 4 q) ea )1a L< d an(d() l-rd d (5 El o Lr a E >.p t, rrl a E GI C) (B oLrF r-1 ol 5t(dl FI C)(! (l) o0(B^ L ^-oX o O oF C) clH() bo clL() oo R^ a- GI bo o(.) o dh obodko oo(,) - (I)A(gk() F ! 3EE :9 9< as'E -B.E Ue;t E E H* E HE;z Ht e 9 lrl24 >, (n zz eo EO o! E3 zd o\ \o o\ ts.^ -3= s H,ei E E['€g t-- t--\o (B o o< o tl r!x a o 'Eo ,bo odOEin.{) oo 'troF s c.l@ s o.l @ o a- EEE Eb9 z s a.lN @ $ c.tN@ =od o.= } i5.5- -EO <f c.l @ .t c.l @ .= -. d d oYi o ts€ EF €:o-:oE = - U€ oF \o co \o ch o oo(B a 0.) O ll + a'd-6\ 6 .9oFM -oF sa d; e o OO tsu.^E.= U! # = _E"H =E>-ro o @ct @ c.t tso 6 0.= =Co:=o < EP'FU ooc.a @ N >9., gtsEEE.H e E$'i;" .- EE EE €a.t @ el 9< t;q '-!o\ B BV E()< Fl t'r oF 2.6.2 What are the causes of absenteeism? -Migration of people from the district to other districts during distribution period for employment, business and marriages -Winter cropping caused some people to temporarily transfer to their gardens. 2.6.3 What are the reasons for refusals? - Cultural beliefs and Church Law 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. 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 l5 WHO/APOC, 24 November 2004 \ a t N o -o o o z$N oA B \o q) \ q) o' LqJ "s <3\q)q * r\ q qj Uq) S a oL q)\ o t q)q q) U o Lr C)o bI) L o C) Fr C) bo k o E)o(.) o d th E] a (n o o C) U)lr(.) !(€ at o Lo(h qi a 0)t) (-) cidr()l -oldtFI =EpEE a4tF '- bo c)qJtr 9 €oo tr d=@i))aEE Eloo o o.9E39Catr 6E o aOr :5 a3^ d.9 uo-c tr&3d (Hi;(,- o qE c, o E c= cBoooOE,Ie ;o VqEP o'===E tr f,'6o x-Ee E € - I o0N gEE€g o o o =,U) ?;69) =o=oPE xxo-l-.lood E* sg s oboc =bo\Lao x(.) a c) bo * a q) bI) rlt (! ^F bs -o (-) \o @ o\ cn @ s co @ @t'. cd o\ o d o.o o Ii ri trl tsl o ^bo9Eati Oo:d'.>J -o o o\ c-l C.Ir- \o o\ o\ -oo\ n @ € tr- 6 o\ ll + Ll l{ H o\ o 'Eo 500od =o oo .EoF \o 5\ e.l \o o\ o\ COFr ai@ H ,o 66L9OE 4q =o =6zi A oo o\ co e.l co o\ F-$ cr F- $NN00 ld EoE 6.2 E 6.sr<86 c{ t-- €+$ 6(.io €$ t-. r- s ot € G@ : bE - = odSEo)-. .oS€= Elc - a r"q o aO o\F- co $ o\ c- o\ o\ o\ @ F- @ C) bo(l o o(-) o fil r{ il li o ^bo!-rEata Oo: -o o \o Fr o\ @ c.l 6\6t € a.bo= E.t g 8,it Oold ^\ 6\ r-. 6\ e qo oit!!bEbE tr tr= ii =Eib>Oa $F- \oo\ @e.l @c.l ti io? 6.2 E E.9T<86 tF- @e.l €N €cl 60d =6ti s IE]t o= x':E.= tr< -rd E E E BEE EE oo $ r-. €N ooc{ @N & rI] r- o\ o\ @ o\ o\ o\o\ e.l c.l N at e.l $ N Oc.l \o e.l r- N 6 e'l o\ e.l e.l a N x L 6t (, $ (J o o. > trr (n o 6t () 6lo o a0 GtL 0) oq) (J F 6l tr L o 6l o q) q) ra) 6l o)L a0 an (l) ar2 GIq)fr 6l I o) ofrq 0) L €IFp o) c) GI I q) U) Go F( s'B\\p Br\)L$s *. .=FFi\i\)6g 0)q){.)tl o 6l5g E+)o9C)c) EE. .ge atr -o -0) l-l eUH od -L(D trEl6) ?ilH6l 6)ol r3lcl c)+. 0OtrcB9b g6 I-Evtr lH c0OaEEtrtie)c,LHHE .9)ultr \o ..i o,l a)l -ol(ttl FI a2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH E wHo N INICEF N NGDO Other (please specift) Mectizan@ delivered by - Qtlease tick the appropriate answer)r/uoril wHofl rrNrcEil NGDC Other (please speciff) Please describe how Mectizan@ is ordered and how it gets to the communities MOH Hqrs. By DHO to District by DOC/HC staff to HC by CDD to Community. Table l0: Mectizan@ Inventory (Please add more rows if necessary) NOTE: We used 24422 tablets from the previous year How are the remaining ivermectin tablets collected and where are they kept? They are collected through the HSAs and are kept in the district pharmacy. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. From district coordinator to health center to CDDs and through the same channel to the district pharmacist Any other comments State/District/ LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining CHIKWAWA 310,718 310,7r8 230,707 830 0 0 79,r81 TOTAL 310,718 310,718 230,707 830 0 0 79,181 l8 WHO/APOC, 24 November 2004 I tr a2.8. Gommunity selGmonitoring and Stakeholdens Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Table I l: 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. 2.9. Supewision 2.9.1. Provide a flow chart of supervision hierarchy DHO tO DOC tO TOT tO H.S.A. tO CDDS. 2.9.2. What were the main issues identified during supervision? CDDs failing to update other information on treatment book and dropout of CDDs 2.9.3. Was a supervision checklist used? YES 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Encouragement to all implementers. 2.9.5. Was feedback given to the person or groups supervised? YES 2.9.6. How was the feedback used to improve the overall performance of the project? It assisted the district to identifu the existing gaps in the performance of the CDTI programme and thereafter came up with remedial Measures such as conducting on the job training of old CDDs and Local training of new CDDs to replace the dropped out . DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) CHIKWAWA 128 0 128 TOTAL 128 0 128 t9 WHO/APOC, 4th January 2008 aSEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Cunently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? By using Ministry of Health resources through the District Health Officer. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Conditron No. Condition No. Condihon No. Condition No. Condition l. Vehicle 0 N/A 7 F 0 0 0 2. Motor cycle(s) 2 lF&1 CNFR 9 F 0 0 0 3. Computer(s) I F 2 F 0 0 0 4. Printer(s) 1 F 2 F 0 0 0 5. Photocopier (s) 0 N/A I F 0 0 0 6. Fax Machine(s) 0 N/A I F 0 0 0 7. Others a) b) c) 20 WHO/APOC, 4'h January 2008 l\i a 3.2. Financia! contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? NO Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) - The distribution of mectizan by CDDs to community. - Collection of mectizan from the HSAs. 3.4. Expenditure per activiQl 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. Indictate exchange rate used here Contributor Year I ('provide the period') Yctr 2 ('provide the period') Year 3 ('provide the period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) MOH (Central * ProvinciaVState) MOH (DistricULGA) 321,000 303400 Local NGDO(s) ( if any) NGDO partner(s) Others a) b) Communities APOC Trust Fund 219200 TOTAL 522600 2t WHO/APOC, 46 January 2008 t{ Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTION 4: Sustainability of GDT! 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) NO Year I Participatory Independent monitoring NO Mid Term Sustainability Evaluation NO 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners Activitv Expenditure (MK) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community 5000 MOH Distribution of mectizan Mobilization and health education of communities Review and CDDs _Iielljlgq_flq_elt-h qtaff ut aU lqrg-b-Gqytqy'ngqt O _ Supervising CDDs and distribution Internal poqr-toryg 9f CDT! ag!iv.$gs_ _ visits to health and authorities IEC materials Summary (reporting) forms for treatrnent Vehicles/ Motorcycles/ bicycles mai{94pc,q . Offi ceEqgjp4gnt(_ejg-goml{qrlrpnllejrrtc)__ Others 1 1300 98000 200000 uoH wHo + MOH WHO + MOH 120000 wHo 88000 MOH TOTAL 522300 Total number of persons treated 82241 NO NO 22 WHO/APOC, 4m January 2008 + ?\ I t 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?_No_ Was a sustainability plan written? NO_ When was the sustainability plan submitted?_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.s. Planning at all relevant levels Including CDTI activities in DIP. Funds DHO to be releasing funds from as indicated in the DIP. Transport (replacement and maintenance) DHO vehicles to be used as in other programmes. Other resources DHO to be supporting and to encourage community to support as well. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms It is delivered with other Primary Health Care materials. 4.3.2. Training Incorporated into other Primary Health Care training programmes. 4.3.3. Joint supervision and monitoring with other programs When supervising other Primary Health Care programmes the CDTI is also Incorporated within the supervision schedule. 4.3.4. Release offunds for project activities Integration with existing Primary Health Care budget. 4.3.5. Is CDTI included in the PHC budgetr YES. 23 WHO/APOC, 46 January 2008 D4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? DERMATOLOGY. The staff from this department was oriented on Onchocerciasis. The achievements noted so far are that the dermatologist Is able to trace onchocerciasis cases from out-patient department. The department is assisting in the distribution of mectizan to Out- patients. 4.3.7. Describe others issues considered in the integration of CDTI. The use of same leadership structure, Min.of Health staff and health infrastructure 4.4. Opetational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. STRENGTHS: Ability to conduct distribution in all 139 villages of the district thus 100% Geographical coverage and 82.%o therapeutic coverage CDDs are taking an initiative of distributing Mectizan Drugs Integration of CDTI in normal government system. WEAKNESSES No coordination between the coordinator and CDTI supervisors. No handover since the coordinator went on posting. SOLUTIONS - All supervisors to take part in CDTI activities. - Assistant coordinator to take part or be involved in all CDTI activities. SECTIOil 6: Unique features of the proiecUother matters Presence of HSAs at community level. 24 WHO/APOC, 4s January 2008