I .5 DC-P C u_____ I i RESERVED FOR PROJECT LOGO/TIEADING I I I I I I I I I a r COUNTRY/NOTF: Mataûi Proiect Name: Chiradzulu District Approval vear: 2000 Launching vear: 2004 Reporti s Period: From: November 2004 To: December 2004 nth/Year Month/Y Proiect vear of this report: (circleone) @2 3 4 5 6 78910 Date su bmitted : 7'n February 2005 NGDO partner: ORIGINAL: English FT,\^t',f ,To: ,. tor Informoilon ç* fu«,làTh TO, Nfi flÀ\)2 "" L r--, \ /iô-| i (ôÈ I'Jt -1,,' Ç,(I' I I JUIL. ?n05 û,p;l,i i t i |l ] WHO/APOC, 24 November 2004 1- ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTBE (TCC) DEADLINE FOR SUBMISSION: To APoc Management by 3l Januarv for March rcc meeting To APoc Management by 3l Julv for september TCC meeting \ AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t I I t E WHO/APOC. 24 November 2004 I I I i I I I ! I I : I i I I I : ! i I I ! i I I I I I : I i I 11 ta ,l 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 District Health Officer Name: E:0... lyl{.p..r-t4t=t. n -W'Signature: ..... IY Date: ...1 o3 District Oncho Coordinator Nam.' . . .A :Ç ,. . ..2§-n*+.ç.e Signature: -q{L Date: lfl.9r.i f.ocs-. National Coordinator Name: . t û1nN. . . .hI mn . Signature: . Date: ... tf. J.f. I 0ÿ This report has been prepared by Name : Austin c. zgambo Designation : DOC Signature : ..... -.%.b Date :).1. "5. . . \}\ ù' oq lll lr+ WHO/APOC, 24 November 2004 I Table of contents ACRONYMS.... VI EXECUTIVE SUMMARY DEFINITIONS 3.1 3.2 J.J 3.4 vII FOLLO\ry UP ON TCC RECOMMENDATIONS I 2 3 J 3 5 6 8 SECTION 1: BACKGROUND INFORIVIATION 1.1. I I 1.2. 2.5. CRpncrryBUrLDrNG..... 2.6. TRpnrH,reNTS................ 2.6.1. Treatmentfigures. GENeRnl tNFoRMATtoN............. I Description of the project (briefly). 2. Partnership Popu1nrroN............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1 TrveLrNp oF ACTIvtlES .......8 2.2. Aovocecy ...................... l0 2.3. MogtutzarroN, sENStlzATIoN AND HEALTH EDUCATIoN oF AT RlsK coMMuNtrtes l0 2.4 CovvuNlrY TNVoLVEMENT t2 .,,..14 ..... l6 ..... 16 2.6.2 What are the causes of absenteeism? .......... ................. 18 2.6.3 ÿl'hal are the reasons for refusals?.............. ................. 182.6.1 BrieJly desuibe all known and verified serious adverse events (SAEs) that ... l8 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curuent year20 2.7. ORoeRlNc, sroRAcE AND DELIvERy oF IVERMECTTN ...........21 2.8. CorrarvruNrry sELF-MoNrroRINc nNo SrnrceHoLDERS MeprtNc ............21 2.9. SupeRvlsroN ............... ......................22 2.9.1. Provide aflov,chart of supervision hierarchy. ............22 2.9.2. ÿl'hat were the main issues identified during supervision? ..............................22 2.9.3. Was a supervision checklist used? .............22 2.9.4. lV'hat u,ere the outcomes at each level of CDTI implementation supervision? 22 2.9.5. Was feedback given to the person or groups supervised?................ ................ 222.9.6. How was the.feedback used to improve the overall performance of the project? 23 SECTION 3: SUPPORT TO CDTI EqurrnaeNr FtNeNctnl coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES OrHen FoRMS oF coMMUNrry suppoRT ............... ExppNorruRE PER ACTIvtrY 23 23 24 24 24 26 ISECTION 4: SUSTAINABILITY OF CDTI....... 4.1. INrpRNlr-; TNDEpENDENT pARTrcrpAToRy MoNrroRrNc; Evn1unrroN....................26 1.1.1 Wcts Moniloring/evalualion carried out during the reporting period? (lick any o/ the.follov,ing which are applicable)... ....... ............ 26 1.1 .2. What v,ere the recommendations'? .............. 26 1.1.3. Hoy, have thcy been implemented? ............. ................. 26 4.2. Susra,rNeetLITv oF rRoJECTS: rLAN AND sET TARGETS (vaNoeroRy AT...... ..........27 Yn 3) .......27 IV WHO/APOC, 24 November 2004 4.2.1, 4.2.2 4.2.3 4.2.4 4.2.5 Planning at all relevant levels.. Funds....... Transport (replacement and maintenance) .. .. Other resources To what extent has the plan been implemented ..27 ..27 ..27 .. 27 .. 27 ..27 .. 27 ..27 , 4.3. INrecRnrroN.............. 4.3.1. Ivermectin deltvery mechanisms. 4.3.2. Troining.... 4.3.3. Joint supervision and monitoring with other programs........... ...... 271.3.4. Release offunds for project activities ........ 284.3.5. Is CDTI included in the PHC budget? .............. ...........2g1.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. LVhat have been the achievements?............. .................... 2g4.3.7. Describe others issues considered in the integration of GDTI... .. ... . ...... ..2g 4.4. OpennrroNAL RESEARCH .....2g 4.4. I. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ........ 2g4.4.2. How were the results applied in the project?............. ....................2g SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPP0RTUNITIES.... ................... 28 SECTION 6: UNIQUE FEATURES oF THE PROJECT/OTHER MATTERS...........29 V WHO/APOC. 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with lvermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organi zation 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 a VI WHO/APOC. 24 November 2004 l Definitions (ii) (i ii) (iv) (v) (vi) (vii) (viii) (ix) (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. Annual rreatment objective: (ATo): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectinln agiven year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people tobe treated annually in meso/hyper endemic areas within the projàct area, ultimately to be reached when the project has reached full geograjhi. .or".ug"(normally the project should be expected to reach the UTG at the end of the 3=d year ofthe project). TherQpeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Ceographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identifià by REMO in the project area (this should be expressed as a percentage). lntegration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using ïh" .u." 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 cômmunity distributors outside of CDTI. §ustainability: CDTI activities in an area are sustainable when they continue tofunction effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community o*n".shÏp, using resources mobilised by the community and the government. community selÊmonitoring (cSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any "or*rnity_based health intervention programme), with a view to ensuring that the prog.urr" is being executed in the way intended. It encourages the coinmunity io àt" frll responsibility of ivermectin distribution and make appropriate modifications when necessary. vll WHO/APOC, 24 November 2004 t FOLLOW UP ON TGG RECOTITIENDATIONS 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 ntore roy,s if necessary) a Number of Recommendation in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 24 November 2004 Executive Summary l. Background on treatment and population data Chiradzulu is one of the extension Districts. Unlike other extension districts it started implementing the CDTI project last year, 2004.\t has at the moment a total of 328 villages in the CDTI area. Treatment has already reached 100% geographical coverage but with a 55o/o therapeutic coverage. The total population is 135,499 and72,654 people have so far been treated in 2004. 2. Background on population movements Most of the people in the CDTI area do their business in the bordering district Blanÿre and others also move to the northern region during rainy season where they work as tenants in tobacco fields. 3. Training data 856 CDDs have been trained and already 27 have dropped. A total of 77 health workers (TOTs, HSAs) have been trained. 40 leaders were also trained. The ratio of a CDD to population is at 1: 158 but the coordinator is suggesting a ratio of I : 80 so that if one CDD drops, the impact is not felt much. 4, Challenges and how they were overcome. a Some people including some local leaders were telling their subjects not to receive the drug because it wasn't publicised on the radio. The coordinator went to the concerned leaders and explained to them the importance of the programme to them and their subjects, Some cooperated while others were not sure. Some cDDs were in the fore front discouraging people not to take the drug because of its side effects. The HSAs and the District Task Force cleared the misconceptions during supervision. t 3 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location Chiradzulu district is one of the thirteen districts in the Southern region of Malaûi. It shares boundaries with the following districts: Phalombe to the East, Mulanje to the Northeast, Zomba to the North, Thyolo to the South and Blantyre to the West. The district covers approximately 767km2. This represents approximately 2.4 % of the Southem region and 0.8% of Malaûi. Topography Chiradzulu district lies partly on the Phalombe-Thuchira plain to the East. The rest of the district is punctuated by highlands and hills. The topography of Chiradzulu can be divided into two distinct categories namely Phalombe-Thuchira and the Shire highlands. The plain is found to the East of the district covering Milepa, Namitambo and Nkalo. The highlands and hills are found in the Northern part of the district (either isolated or as a chain of hills) including Chiradzulu Mountain, Mbombwe and Nsoni hills. Climate The district experiences a warm tropicalclimate with mean temperatures ranging from l6'C - 28'C. In exceptional instances temperatures rise as high as 32'C. The lowest temperatures are experienced in June and July while the highest temperatures are registered between the months of October and November. Two climatic conditions may be distinguished in Chiradzulu. These are hot and cool conditions. Chiradzulu district has two pronounced seasons: dry and wet seasons. The rainy season starts in November and ends in April. Population There are777 villages intotal inthedistrictwithaprojectedpopulation of 276,478 from 1998 National census [National Statistics Office - 2004]. The district has a population density of 381 per km'. o The current birthrate is 38.6 per 1000. . The current fertility rate is 6.1 o The current growth rate is 1.0 % o Marriage is by living, legal and traditional arrangements. There 328 villages and a population of 133,074 in the project area rvhich is 48% of the entire district. Cultures The people of Chiradzulu district have maintained their traditions in almost all aspects of their culture. For example, local institutions such as chieftaincy are rvell recognised and so are Itraditional dances. Sometimes people pray to ancestral spirits in times of stress such as drought. They still maintain the family institution. They also practice different rituals such as circumcision for both boys and girls. Language Chichewa is the main language spoken by people in Chiradzulu district. Chiyao and Chilomwe are second most spoken languages Communication system The main means of transport is by road while communication is by phone, land route and mail. Administration structure There are six (6) Traditional Authorities, three (3) sub-Traditional Authorities, seventy nine(79) Group village headmen and six hundred and ninety eight (698) village headmen/women in the district. These provide a link between the Central Government and rural communites in the implementation of development activities using the local government structures. Health system & health care delivery Ministry of Health and Population (MoHP) is the main provider of the health services in the district. All the health services in the district are coordinated by the District Health Office (DHO). The DHO reports directly to MoHP headquarters and vice-versa. There is I district hospital. 6 health centers under MoHP, 2 health centers under both MoHp and LoG, lhospital and lhealth centre under CHAM and 3 private owned health clinics. Out of these, Nguludi mission hospital, Nkalo, Namitambo, and Providence Industrial Mission (pIM) health centres are under the project area. 4 WHO/APOC, 24 Novemb er 2004 Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area Br Number of health staffinvolved in CDTI B, Percentage B.=8,/ B, *100 Namitambo Health Centre 30 t7 57 Nkalo Health Centre 25 9 36 PIM Mission Health Centre 23 t2 52 Total 78 38 49 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaUinternational), communities, local organizations, etc.l The project is at the moment fully implemented by the Ministry of Health. However, there are some NGOs like World Vision International that are involved indirectly. They provide bicycles to some Health Surveillance Assistants to implement their (WVI) activities and in so doing, the HSAs use the same bicycles when they go for Onchocerciasis activities. The District Task Force has already proposed in the 200512006 budget to mobilize the community including NGOs, local leaders and others to help in the implementation of the programme. 5 WHO/APOC, 24 Novernber 2004 tf, C.l Lo ,.o E C) o z l+ c.l U o 1.U§ o'\\§ §) à\q) I §) q) .§ o ù §B È.i '\ÙL§\ vè '§b\.\§ §q) *t\ :s %Ô'p§§§) Ld(.) () o t-< o(n !O o 9=z o -Oad r-t()Q 63 0) (ü (ü a2Ë(,h8 -c)(,) _OCü U)Ë9z .e8 L§dEû ,: z +i .. cr) o l< c)q èo ti q C)L{ (.) âo l-r o () 0.) 'a trq C) ! (n a C)o U)(§ t.: § l>..- l-= ùt§ ! §§ vsi §ô§\§È P§ ^.ù*Y :rà§\Y\ ë_p\È ^vtN: §ôo §ÿ §9ù- .§ .: §§ ù:! -:= ilù t\§\§) \o z'ȧ ȧ ùrv §)! §q, è*tùè §) s_ §) ȧ ù -§§) o l<() èo tr a 0)L 0) ào L{ ! C) (d otr oL cü >.q) *<o C) q) cË q) q) tr q) () (l) JI Ch s< o o, o «J ao E oQ Àr orl -ol(dt FI tr o !-fl G - =c oÈ aN I F t J, aF D : ô_ =86 .=!-Y = qs(, =f,\oÿ C\ s\o .t N + ils ,(, -(uô .= CLN ÉE -t .-Ëè EF 3Ë o\ Ot+ ra) cî OtOt+ ta) cî , .-Ë §È'I* cg *E T s r 'J.dEp'N= B GI È 'Ëgs *t k FTe§si o\ o\$ (a) cl O, o\ .+ tr) cô oo ô.1 c1 U)(l) âa çn Q) CJ r-lê)l ^ol I q) ON q,).= ciq) F o .g qr HOq)! Eo:!9E f OE >) c) N I ts:(r *È:çis ?o?Ë"4 +_ il i oo N aa æN ca æ N c1 clr §,)o9= .- L rr9.- _g- -:: ir Id = e.:j O.-, a'oo:I !A-af'-94 o\ o\q L^ aa o\ o\$^ c.) :oe Ëqic5'; ÈE ,-< Ë 6 âr f; NpË() Hr= '=a Uâ '] 3 3 s a.l L(.) -o Eo o z§(\ OoÀ s > o) +Cü L>'o-o c)EE€OcdLC)È,8(u>. È - - §E'() HV cleG) t) d IHq)(! '1, cnEo À -È I o .É èo -'-.-a .'d, ü) G) .t -*EULo) .Ê. ê)rÀvË"9 à 'rE li +ioo -éa =50ECütsooôÊ v €)(dtc)3ti ü)(l)>. I =-o:1 .É nr +r2 1t)sLHUo E(ü(Jii^ (JVÈL€ Go)dE ËÜÈ .=kI EeHrh9rE io é)!-r5 kEôG)9$ E.:decnJoO rl(r) * LËr'OaÊ --=ôà, .=! 0)rrtr EÈE b+lv^H-*ô'ao2o .Ft -!-ULEEHL(ËÉq)-(B !^à !He).Éx UVË =Èâ0 trÈItslv 0:oH e)êrLy:§LGpy -H! ô-. - v u?0rfbl) ;,'3 4., § l- : ;:'- l-l Ili f- P t-- SEGTTON 2: lmplementation of CDTI 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 endà. 8 WHO/APOC, 24 November 2004 x C\ (,) -o () oz *dt ôt o o- \J .rj (§(l)OLrH(1)(§ '>rth * ut)r< 0) c.!I >6È r'Po(1)=É 8üC)olr FËa)o.) ^o)PâF.èO Uèu) >.=9-a)5 s8.o-()È EE. .E eh € Ëâ (l)(hX0) 0) !-o)\v>C)!i;> e l*.I Xot ÈP u) t':-!cdalÉ oç -= XC§(Ir r= o.l ,2à € Ëc,la E&'e de§ g8 .-o â) \v ! ôI) ., )É Ïj9t prv !' .Ë gb -o -.q<o :: .2 e5" =aa .9 ' aYE.É' 9ç§>'=YrÉ.- L iLPç/ .E H gfE r-. Àr5 ep-8 h tPX()o5 v >r^Vr\VU -tJ-c Y=Ée,;c.lc§eüôo"aiÉvt or E ôI) -i 'EË'ô § F=EË raE3e Ë sg .^ o !).= i!E B .b!-,?,e EEg8.Ë ; E §cho'-a)-è0.9Ô: .= s ë s..! ,=.= e (, §EË 8IS 'L>9- L9>Pts €o cE6 * è{l oE o.ëE ËËEIr ÈEe o.l.É 7 o'= =vÀvt! l.j \<<È riF 5 ZF O. an q) () I -:\ 4q§)u§) q > \ ùt\ §a lJ § fr ox 0)Lr li o C) o 0)lr C) 63 C)Ld o tr k a o o qi o o F ôr rl -ol FI o\ o (n l.q) ra tsF I (,) .o 9+ ZX .Ësÿt cÉ= a' q) -o 9sÀooO7) C.l tr at) èx L o =-HE (J H 0) -o 9< ZX .ËsËE c: u)- L 0) -oos L, a.l ê) cl È ah cÀ (l) U o EÉ Q L(l) -o 9ç zè( .È'e1i É c!= L(I) .oô$ .)x L,) c{ èo «l ,i3 o EE U () E9r zx ào -E () -ô E9*Ê.ooc)U] C\ rê) .EÈ G= oor-9à EÉ oQ L() -o E9x zdi àoÊE cI a- L 0) -oôs U Ô.I rà I (, tr an o r ! N! 6ü O t] - 3 2.2. Advocacy The people were first sensitized through the District Assembly members in order to gain support during the implementation period. Then people were sensitized again in their respective villages by using Health Surveillance Assistants (HSAs). 2.3. tlobilization, sensitization and health education of at risk communities The project had the following weaknesses/constraints o Mobilisation was not enough using the DHo's vote being in its first year. The project did not approve the funds for mobilization o The villagers in the project area had expectations to hear from local radios about the introduction of the new project o People still do not understand the concept of volunteerism. They associate it with monetary issues despite being clearly told during village meetings where selections are done. Ways to improve mobilization of the target communities. ' conduct a press conference so that the local media can publicise the importance of taking mectizan because many people believe that if they hear news from a radio, its easy to follow. D l0 WHO/APOC, 24 November 2004
ooô.t r(!)s (1) oz :fô{ t,o ê< i<o c.t t)() E! cl!oÉ1)Ë(rl crtov, v, ov, E à0 trl o§() L§, v) rt) ( u^) Fo() Éo ,É B V,bo q) o E a tr Eoo o .q ç{o t)Lo .ÔEÈo E o «l eçr o É € cÉÊ. o t<«rî q tl.)ÈEg'a d(, rO -_ tÀ >E oo.!€ tss ^o(ÉT oQ. Xo ôr) ii a<d§o. ,,, o € Iod EIo «tN E Èr GI C) oo(l) Gl v, «lP cÉq) (l) .Ég(H o ar) o ts (l) th doo! o an çr, oè0.iÉI vz Etr év) -vEË CÉ tI9Ë ,=o3.8 -ÉP+j .= ci=(l)f, :E .E J6 ElÉr(1)EÉ o!?é)ÉE() ôq< qàQL+'9EÉ*ôFE: o9 d- boEE .Q) t) E3()= .. I U o iI o.rUPçi X .r{0)!{ÉE =+o()r 8Ê 'gH 'Ë lvl!, -9Éd EË!i r.i3BEàOE5zE eêrr ,iE Éa o§o 6t oI È r!§- c'l c"rÈ- É E.E Ë È EEâz â'i o{ c{ o+ c.l o o o 1' 6a O o z É +À IÉ d êF E æ \c, oô Êa 2qnôEA o r\ § 'f Êq r) 61à ÿ 'lt Êe >o 6'=orË9 àorr, É Elo 5É Ëo oEçâ o= zo o ll * ÉEe EE oèo 6l o aJ ê ô Ëakr bi!'rÊ =Ë b Zeeq Êa ..! Ë 5;ËEl -fo9EEgEÊ e:'F æ ol æN "l o L H o b â a NE(! E(J c!!i ti -\ô§ u;§q) §) V1: I\ p ȧ §)à ù Ê-v F oQ o +r&tr:o.=trÉL^o.; -&o'5 -t-!- ii û. c) E'= =!EÉtrE Ori(r: .1_ | . orl\t 5ld§t \t§Ii§t § § É '.+ e.lIà.\It! ca o(,) rn V' () o HIü H* .Li oEÈpi olî -§ fqeEbE .tsU «l> üd3a .;,.; HsO '+jëErgPèo uo a)§ .- (l) €.ËEp.'u) vl d) ô.tDv g B8E E.E fi-ÈE.HOÉa9. E§T a ào t^- .-tr: eÈ.E ËÀE- p.g = Eü E''= oiË€ .g9pé [ *È e e.E :98:9x -E e,§Ë.8 È,àa'E c! gg E tË 'F e o.)c!oEËàE ,E: Ë;8€ âU BU§ }lx-uoilo E.(Ë.=oo> 'E< ô. at)âoO oI E!â c)apâ>UH oÊ'Eî) LCü di q.) o.Z .PË .E q)É9 ts <.1ÉlE oq) :Ë.Âo foÉ o^ 5()ôtrô.: o*oc)>.tr ô< o 2.5. Gapacltyr bulldlng - Descrübe the adequacy of available knowledgeable mmpower at all levels. Where frequent transfers of nained staffoccur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to aesciità is what *i^*r, *rrc taken to e_rts_lre adequate CDTI imptementatton where not etnugh knowledgeable manpower was available or if staffare frequently transferred during the ciurse of the"campaign). New staff are still coming to the dishict and some are shifted from one area to another as such, the district has planned to train this staff (in CDTI area). t4 V/HO/APOC, 24 November 2003 §ur E i.9 È d.rt trÈ qr- \o rô æ o \o æ v, tal æ o \o r') æ l s1LË E hââU tEo L !DEIË z 3sFU 11\o\ô -i (1 v,\o I Ec t) E9 s I :al rnl 'l t"d i 0tr o +(, §ui tc *ü o\ o\ o o\ o\ o o eo .=àt! tr r. f-((l): 9q)êo E.Ë r. 6l .)hE- lt z () oE t< c1 e.l ôê{ §Ét6 ét) E a) I 4e s UÈ. §ü Êe5 oo4.. : oo F- æt-- o ar- E ô) aé :=dgË EE Eg Ëâtr>- 2E É)o (J o t< ooÈ- æt- E(, E a) .9EI s soo ü§o( ()§ E,\Y \Ô \o : O \o o o cl Oô o FI8eu6) 'Ëcü'a a o z o e t< N oN (J È .) a â N* 'toÈlJ '=6 UO FI H o Fi Éoé o I (J s §oùo clooN o ,o Êo oZ rJ. N doô. oE p § o§ §( .5 § § :È § § ë'§ t'§ §oʧ o§ È riʧ(l È §§ ::r§ d§ p È È :. e\) U t)§§ hIp §)l. o § ù§ §)t4§ §)§ o s oÉgÀ É F o U(+{ o th o o É o t< .oE ! o d à0É dkF ür ,I 5l(dl FI Table 6: Type of training undertaken (Tick the boxes where specific training was caruied out during the reporting period) NB: Some local leaders were briefed not trained on programme management and ownership 2.6. Treatments 2.6.1. Treatment figures Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specif,) Program management { How to conduct Health education { Management of SAEs CSM { { i SHM { { Data collection Data analysis { Report writing { Others (specify) t6 WHO/APOC, 24 November 2003 $ ôl 0) .o o) o z .rt(\ (J o- J. §ô§\ùàI\§ §s L s§ èo \/È\J:FÈ ùJ§ v§ Cd\93 .\i§6S(.) 's9's \f §,§ €§s .= e§+§Èt.s§ 6.=§E§Th §.§ .) qJ § .=.à: F-<.6ȧ 9l:()§'§LÈÈ oo-§§ÈÈ ÈÀ§!a§tI .S '§ôE ! !:iË .§ ü'§ : § §\>< \ §ù .: - ':§ cÉ t\ È.*ot I S 'iè ol - !r q\ -l (I) È §:{xl§ È P x'çl e § :LHl o = '!q, ElÉ § §§ijt x § ˧' orl â .! YtsEr § §§Hlb § §'srlË § §§rl 3 X §Y3l tr §' .ss trl E E s s, =l Ë § Èsztt- i Ètè §§§'§\ .: ss ,, -. Ù\il § ȧ!\ § ::l§. -&+:' §-: I §§À ʧ§ §§È §§\-9u § §sr, § §'= .v § 'ÈE H § §§ 'i§SrV § t\='FrrrrSD § 9§ .o t\ !-: o\ \ È: t-- d(") L Po 0.) 'a .L6ô 0)LC)Glép!()é o).= 'Aô LV 6) rrl ifü ^'= -o P - Iô0.lË .:()trEëôË(B ts66.e C)P otr )E ot tr() ol =! -l E3 xl Ii Tl ,,() .:t .-o- (iltr ! !t -3r sr -l tr il o)xl I Fl Psl.! <l â 9l :o .El:sl'= .Ël 3el ,;- =l c--t - Jt L -l È FtL g^il^ lt9EtvUl !- El8IË 8I E . I i , tPHIJHIÈolo- oltr -lo ç150)lo- olC -ôl _ -ol -Éld trl(g =lô =lozl? zlt- ÔIol -l orxl > EI E§l§ o.rl =oI 6)ol Éol .=ol ad ElÊ rl -qlE =l Ézl< 0) 9 C)êo L 0) oo 63o- '=§ L èo oo 0.) L c) ôo tr C) o o o^ .- \o C) o. C) t- u)l 0Jl è0 CÉILlÛ)l àlol Ël .el -clo.l(dt l-r I H G)l ôd olÉl(dt ,rl 0)lol cdlLI 0Jl -<l -J Ét =l Ëi ol ol rl €l)t )t EI fr" I o: L o èo !v^q)S o o F GP =H9 B6€* âÈËHsÉ9q: oaoô-OL o () oÈo -o E z Ë?Eo AO o b.s -ôEco zd coO o\ cî o. o\ Ço LÉ--o3 9.EE Etrl:89Ë5Ë- ç9 c.) c.) +II o!o =ôoo (d^ f9o\()oEOF Q a-bFü Ebs5 o.-z tso d o.=)-Éo < 9PF9 E rHCd qE = o PdÉ€ -â.g vOO E 92!ë EEF 9s ra) 9s sf \O- ôlF- t .o- c.lt-- §F- æ oô § r-. od æ o. s al o.§ cl >9.,8ç o= :: o ".È c êA+ ê'* >r -- =,^-9Ë = ü= E! E d)v L € E§ q€ o.-o tl =ou.ts ü!3 5 Sfr =É>-AÔo Ë .9oêàI) - cda 60lJ uoo ?ud o.: iP-o' -Èo ao O O O ooôl oêN æN co c.']ô oo N cô coôl cô <)t TY Ll-. N9!o§'É '=ûUâ Fl t-i tr §44§) c)§) q L§L \ §)q ù À- .j .ÿ(h lr cO ct)(d() L< J C)È ü) E -o cn IJ] a () E (ü() t<F Ër orl -t.ol(dl FI 2.6.2 2.6.3 2.6.4 What are the causes of absenteeism? . Negligence on the part of the community o Traveling to other areas for different reasons o funerals What are the reasons for refusals? o Misconceptions surrounding the drug o V/ish of the community members Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table t; itre requiredinformation 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 18 WHO/APOC, 24 November 2004 ÿ ô.1 L(!) -o (.) o z sôI IJ o\ §) §) \ù -§ \ L)q tF r'\§q ?) §)U \- qà \ L ! § §)q§§) LL\- o Êr(l) O. ooÉ tr o o. 0)Lr() ôo *r () t-rL c)o o (d a IJ] a V) 0) 0) C)û)ko a o ! 0) l1)qi o aoa(d U #r orlÈl _ôl(6l FI C) _E<ôo)9 -EE b<.E Ë ;P3c.= c{+ (Ei:§cro É o-=gEÉ rr.l ü'Ü o c,r .9 C^oÈ!.1 èo =o 0)-(H :i a9^ d.9 ü().E trd9d (Èi;q)- o.9tc o É Ê= 6üOô(JOE,te o '^a> vû8, «l=:Y ()â Hëqg dÉ-9sD.È = 5_o.= (J #gEËË o o- (/) rl '1, 0)I(§() o. o.(n q) .ÿ, c0 E o. >' N OJ 2 (Jôôc 6.< = ôI) ?o o oo 0) IJ 0.) IJ o x 0.)(n * U) (l) ô0 P Ës - ></Jo O o (B Ào a op i-I.- oo\ <:>! -ô o V? N oo ll r IJ] E] t o eO =ào()daô-!rod qo\ oôtoF .+ ti -o ,o ôd xP E^ /-i o- § \O- ô..1r- L) ioE ü.U =:o .l .o .o' FL' $r- od æ aq e hàicxL = o tLG 'lôa o< o o\ o\$ c.) () à0 C) U ll * kS Ei L) o a P- a- oô\ -o o ti ÇO o = Yÿo 2Aô ooô{ kl =e6 o.= ) o_a' FU oo c\ èOd =q!->.. à; ev à: È:i + oïj >'- aa?ôaF Ê U 9T, EO oo coN a-ô. 00o\ o\ o, o. O N O c.l c.t N ôl § a\ N \o N r-O ôt æ N o\ ôt O O ô.t \f, oôt L o) -o Eo zçC\ Q À1 \J ôi I ü2 I o .l *.§) .9 GI c) q) â0 6lL c) I rltvF D GI 1E§- .Àb§ëY!\E '§ 'E È9ùÉ\(l) :u15!)§er>'È= :.iûô§c'rF§.9 =ù'=-ekdD ê)ù!E\È&.2 ovf,I 6l q)5E2 Èel0)()l(Jol .= 'il IEÀI .9ole.à I IaLt rol -()l†Iuxl El q:lHLI odtÈ8..r e|Clltral 9C)ril ÈtrÉl Gôgl Ë>6,1 d)q)ot6È1 E : bË ôi:+r a..) L l. ô rar çÉ ü rr!vvLU5dl:Ëb EÊ,rÉC)+.9Ëq)L-9 -Lücq 6) ()u?Èù\otrêi o'l ';(.)l .ôEl §Fl È 2.7. Ordering, storage and delively of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH I WHO N UNICEF N NGDO tr Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH I WHO N UNICEF E NGDO N Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan is ordered by the District Oncho Coordinator from the manufacturers through The National Oncho Coordinator. Then The National Coordinator delivers the drugs to Central Medical Stores. The DOCC gets the drugs from CMS to District pharmacy. From District pharmacy, the Health Surveillance Assistants through The Health Centre/facility Incharge orders the drugs. The CDDs gets the drugs from the HSAs at a Health Centre/facility. Table l0: Mectizan@ Inventory (Please add more rows if necessary) Number of Mectizan tablets How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets have been delivered to Blantyre DHO pharmacy following the directive from the Director of Preventive Health Services. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Any other comments 2.8. GommuniQl self-monitoring and Stakeholders tleeting Has any training (of trainers) for community self-monitoring been done in the project area? NO If so, When? Table 1 I : Community self-monitoring and Stakeholders Meeting (Add rows i.f needed) Remain 299,21I 299,211 Wasted ExpiredReceived Used Lost State/District/ LGA Requested 0 4,682 0490,000 490,000 I 86,107Chiradzulu District 4,682 0490,000 I 86,107 0 TOTAL 490,000 No of Communities that conducted stakeho lders meeting (SHM) No of Comrnunities that carried out self monitoring (CSM) Total # of communities/vi I lages in the entire project area Districÿ LGA 2l WHO/APOC, 24 November 2004 TOTAL 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. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? Mainly it was failure to record properly: o the names of households during census by CDDs since some were not used to writing . recording of figures on the appropriate space by CDDs 2.9.3. Was a supervision checklist used? YES 2.9.4. What were the outcomes at each level of CDTI implementation supervision? CDDs improved in recording 2.9.5. Was feedback given to the person or groups supervised? District Onchocerciasis Task Force Health Centre Staff Health Surveillance Assistants CDDs 22 WHO/APOC, 24 November 2004 YES, it was on spot feedback 2.9.6. How was the feedback used to improve the overall performance of the project? SEGTION 3: Support to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR:Currently non-functional but repairable, WO:Written off). NB: The equipment on the MOH side is used for different programmes Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No Condrtion No. Condition No Conditron No. Condition l. Vehicle 0 5 F 2. Motor cycle(s) 2 F 7 F 3. Computer(s) I F 2 F 4. Printer(s) 1 F 2 F 5. Photocopier (s) 0 I F 6. Fax Machine(s) 0 I F 7. Others a) b) c) 23 WHO/APOC, 24 November 2004 aHow does the project intend to maintain and replace existing equipment and other materials? The government uses what is called Other Recurrent Transaction (ORT) funds for various activities. It will be the same source of funding which will be used for repairing this equipment. 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years NB: The conversion rate used is US $ I : MK100 If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Mobilisation of fellow community members self means of transport during mectizan distribution a a Contributor Year I ('provide the period') Year 2 ('provde 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 + Provincial/State) MOH (District/LGA) 0.00 29,992.90 8.497.68 Local NGDO(s) ( if any) NGDO partner(s) Others a) b) Communities APOC Trust Fund 2 r .560.00 16.661.99 4 r. r30.82 TOTAL 2 r.560.00 46.654.89 49.628.50 3.4. Expenditure per activity 24 WHOiAPOC, 24 November 2004 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- a ) 25 WHO/APOC, 24 November 2004 aTable 14: Indicate how much the project spent for each activity listed below during the reporting period NB: Some of the contributions are difficult to quantify SEGTION 4: Sustainability of CDTI 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 Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. rilhat were the recommendations? 4.1.3. How have they been implemented? a a a Expenditure (s us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 2,092.90 4,327.30 3,403 . I g 1,533.57 257.00 1,352.50 38.s0 540.00 9,950 DHO APOC APOC APOC, DHO DHO APOC APOC DHO APOC, DHO TOTAL 23,494.25 Total number of persons treated 72,654 26 WHO/APOC, 24 November 2004 Activity 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Wastheprojectevaluatedduringthereportingperiod? Was a sustainability plan written? YES IN A FORM OF DISTRICT IMPLEMENTATION PLAN When was the sustainability plan submitted? IN JANUARY 2005 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels PLANNING ALREADY INVOLVES EVERYBODY. WHEN DEVELOPING DISTRICT IMPLEMENTATION PLAN, ALL PROGRAMME COORDTNATORS ARE TNVOLVED. 4.2.2. Funds THE DHO THROUGH MINISTRY OF HEALTH WILL BE RESPONSIBLE FOR FUNDING THE PROGRAMME AS IT IS DONE WITH OTHER PROGRAMMES THAT ARE IMPLEMENTED IN THE DISTRICT 4.2.3 Transport (replacement and maintenance) THE DHO IS ALREADY SUPPORTING THE PROGRAMME. IT GIVES FUEL WHENEVER THERE IS NEED, OTHER VEHTCLES AND MOTORCYCLES OTHER THAN THE ONCHO ONES ARE USED FOR THE PROGRAMME. FIELD WORKERS (HSAs) ARE ALREADY USTNG BICYCLES V/HICH ARE SUPPLIED BY OTHER DONORS INCLUDING THE DHO FOR THE IMPLEMENTATION OF THE PROGRAMME. 4.2.4, Other resources 4.2.5. To what extent has the plan been implemented IT IS FULLY IMPLEMENTATED AS EXPLAINED ABOVE 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 WHEN DELIVERING IVERMECTIN TO HEALTH CENTRES, THE VEHICLE CARRYING THE DRUGS IS ALSO ALLOCATED TO SOME OTHER DUTIES 4.3.2. Training Joint supervision and monitoring with other programs THERE ARE A LOT OF PROGRAMMES RUNNING IN THE, DISTRICT SUCH AS MCH/EPI, IDSR. MALARIA, etc. THE COORDINATORS OF I a a ) 4.3.3. 27 WHO/APOC, 24 Novernber 2004 Ç THESE PROGRAMMES ARE COORDINATED SUCH THAT WHEN THEY GO FOR SUPERVISION FOR THETR PROGRAMMES, THEY INTEGRATE WITH ONCHO PROGRAMME. 4.3.4. Release of funds for project activities Is CDTI included in the PHC budget? YES AS IT IS SHOWN IN THE DIP FOR THE DISTRICT Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Describe others issues considered in the integration of cDTI. 4.4. Operat:onal researcha 4.3.4. 4.3.6. 4.3.7. 4.4.1. 4.4.2. summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. How were the results applied in the project? SEGTION 5: strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of cDTI implementation process. . Publicity was not enough during the introduction of Oncho programme due to lack of funds to fully sensitise the community o The distribution coincided with the registration of government Targeted Input Programme (TIP) so those who were left out of the TIP programme refused to take the drug List the challenges and indicate how they were addressed. Some people including some local leaders were telling their subjects not to receive the drug because it wasn't publicised on the radio some cDDs were in the fore front discouraging people not to take the drug because of its side effects a a D a a WAY FORWARI) The major way forward is that we have planned/budgeted for a mobilisation campaign where we expect to clarify on several issues for the success of the programme National coordinator to put some adverts on the radio and TV in order to publicise the programme a 28 WHO/APOC, 24 November 2004 ISEGTION 6: matters Unique features of the proiecUother a â a a 29 WHO/APOC, 24 November 2004