Thyolo/Mwanza annual project technical report submitted to Technical Consultative Committee (TCC): from January 2007 to December 2007

RESERVED FOR PROJECT LOGO/HEADING COUNTRYAIOTF: MATAWI Proiect Na[Le: THYOTO/MWANZA Year:1996 Launching yearz 1997 From: JANUARY,2007..To: ...DECEMBER, 2007 ...(Month/Year) ( Month/Year)Period:Re (circleone) 1 2 3 4 5 6 7 8 9 10 llf this report:Proiect vear Date submitted: 31 MARCH ,2009 NGDO partner: SSI/TEA ORIGINAL : English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) rO! Fcr ayDEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC To APOC Management by 31 July for September TCC pl/ For Tor -b IR llr- AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I I ! I I I Brt4 csa coP FO ,+ B:tu I 0, aun 2t)tlfl WHO/APOC, 24 November 2004 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: MATAWI NOTF Chairman Name: Dr S. Kabuluzi Signature Date :vtr f -=.5\ (- NGDO Representative Name: Mr Frank Mwafulirwa.... Signature: &-*A Date: m\qS\qg This report has been prepared by Name : Laston Sitima Designation : National Coordinator Signature : ... Date i$ iq I lqs I 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 I I I lt Table of contents DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION I : BACKGROLI\D INFORMATION........ 1.1. GpNpRar- rNFoRMATroN................ 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. PopularroN V VI 8 9 t0 l0 t0 t2 13 SECTION 2 : TMPLEMENTATION OF CDTI............... 2.1. TruplrNp oF ACTrvrrrES .............. 15 l5 2.2. ADVocAcY...... 17 2.3. MoetltzertoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT zusK coMMuNtlgs 17 2.4. CouuuNrry rNVoLVEMENT............ .................18 2.5. Capactry BUTLDTNG ....... l9 .,,..,.222.6. TReanrapNrs 2.6.1. Treatmentfigures........... .......22 2.6.2 What are the causes of absenteeism?............. ............24 2.6.3 llhat are the reasonsfor refusals? ................ .. .........24 2.6.4 Briefly describe all known andverified serious adverse events (SAE| that....24 2.6.5. Trend of treatment achievement from CDTI project inception to the current year26 2,7. ORDERING, SToRAGE AND DELIVERY oF IVERMECTIN 2.8. CoNaNaLNrry sELF-MoNrroRrNGAND STAKEHoLDERSMppTtNc 2.9. SuppRvrsroN............... 2.9. 1 . Provide aJlow chart of supervision hierarclry. 2.9.2. What were the main issues identified during supervision? 2.9.3. Vf/as a supervision checklist used? ......... 27 28 28 28 28 29 ll'hat were the outcomes at each level of CDTI implementation supervision? 29 Was feedback given to the person or groups supervised? .............29 How was the feedback used to improve the overall performance of the project? 29 SECTION 3: SUPPORT TO CDTI 30 3.1. EeurpupNr 2.9.4 2.9. s 2.9.6, 3.2. FrunNcraL coNTRTBUTToNS oF THE pARTNERS AND coMMUNrrrES3.3. OrueR FoRMS oF coMMlrNrry suppoRT.... 3.4. ExppNoITuRE PER ACTIvITY ....,..30 .......3 1 .......3 I .,..,.,32 SECTION 4: SUSTAINABILITY OF CDTI.. 33 4.1. INreRNal; TNDEpENDENT pARTrcrpAToRy MoNIToRING; EvaLuRrroN....................33 4.1.1 l[/as Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhichare applicable)............ ........33 4.1.2. What were the recommendations? ...........33 4.1.3. How hqve they been implemented?.............. ..............34 4.2. SusratNaellrry oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy AT ...............34 Yn 3)......... ...........34 llt WHO/APOC, 24 November 2004 4.2.1. 4.2.2. 4.2.3 4.2.4. Planning at oll relevant levels Funds........ Tr ans p o rt (re p I ace me nt and mainte nance) Other resources... 34 34 34 34 35 35 35 35 35 35 4.3. IurpcnauoN............... 4.3.L lvermectin delivery mechanisms 4.3.2. Training 4.3.3. Joint supervision ond monitoringwith other programs. 4.3.4. Release offunds for project activities4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. 4.3.7. Describe others issues considered in the integration of CDTL 4.4. OppnarroNAl RESEARCH.. 4.4.1 . Summarize in not more than one half of a page the operational research undertaken in the project areawithin the reporting period........ ..................36 4.4.2. How were the results applied in the project? ............. ..................36 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AI\D OPPORTI.INITIES....... 36 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........37 35 35 36 lv WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund U ltimate Treatment Goal World Health Organization I WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Treatment (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesoftryper 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) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 24 November 2004 sf C\ o .o o o z$ c.l o c- FOLLOW UP ON TCG 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 TCC 25 Note that: 1. The issues raised in the TCC25 Report were responded to in e-mails dated 26 November, 2007 and 18 December,2007 sent to APOC to the attention of the Director. 2. The responses to recommendations in TCC23 report were addressed in a letter dated 23 April, 2007 to the attention of the Director 8 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 24 November 2004 Executive Summary Prepare an Executive summary of the report in not more than one page. The Onchocerciosis Control Progromme in Molowi hos been corrying out lvermectin distribution under Thyolo/Mwonzo projecl since 1997 ofler the lounch of Communily Directed Treotment wilh lvermectin ( CDTI ). However, mectizon distribution hos beengoing on since 1991 ond 1993 in Thyolo ond Mwonzo respectively using CBTI opprooch. Thyolo ond Mwonzo districts ore in their eleventh yeor of implementotion under the CDTI Project. The districts ore under the Post - APOC Sustoinobilily phose. The people of the two dislricts move in certoin seosons of the yeor. The two districts shore on lnlernotionol boundory with Mozombique. During the roiny seoson, the people of the two districts move to Mozombique to cultivote. These people hove formlonds in Mozombique where they grow different crops for their livelihood. They stoy there from plonting period till they horvest their produce. ln oddition, during lhe dry seoson, lhe people of Thyolo move to the bonks of Shire river to cultivote off seoson crops such os moize. ln the 2002 distribution yeor, o totol of 666,040 persons were treoted out of the populotion of 800,535 people representing o treotment coveroge of 83.2%. All the 672 villoges ( inclusive l2 Estotes ) torgeted were treoted representing o 100% Geogrophicol coveroge. The Ultimote Treolment Goolwos 664,444 people. The progromme continued to corry oul troinings. Troining covered heolth workers direclly involved in CDTI oclivities ond the CDDs. During the reporting yeor, o totol of 279 Heolth Workers ond 1,397 CDDs were troined. Despile thot o tolol of 1,397 CDDs were troined during the reporting yeor, o totol of 3,835 CDDs were involved representing i CDD lo o populotion of 209 people. The most notoble chollenge thot the project foced wos little funding of APOC Trusl funds to the project, however, this did not offect the octivities of the project. Project octivities were funded from Sector Wide Approoch (SWAP) ond funding from the Governmenl os indicoted in the District lmplementotion Plon (DlP) of porticulor districts. 9 WHO/APOC, 24 November 2004 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Onchocerciosis Control octivities hove been going on in the two districts ofThyolo ond Mwonzo tor more thon 5 yeors uno6r the CDTI ond the two dislrictsore under the post - APOC Sustoinobility phose. Ihyolo ond Mwonzo lies olmost IOO kilometres oport on the southeosl ondsouthwestern borders with Mozombique in the Southern Region of Molowi.Thyolo is o more densely populoted district thon Mwonzo ond is very hilly ondwith difficult terroin. Accessibility is therefore good during the dry seoson. Thenumerous riverine systems moke il fovouroble foi the breeding ofonchocerciosis vectors, Blockfly. However, the Neno port of Mwonzo hos similortopogrophicol ond climotic feotures os those of Thyolo ( Refer lo Fig. I on poge4 - Mop of Southern Region of Molowi ) Thyolo district is mostly dominoled. by Lomwe people. These constitute o highpercentoge thon ony other tribe in the districi. Mwonzo is dominoted by theNgoni people. People in these two districts proctice motrilineol type of morrioge whereby themon stoys of the womon's home villoge. Most of the people in the two districts depend on Agriculture ond smoll scolebusinesses for their livelihood. ln the Southern Region of Molowi, i.e. including Thyolo ond Mwonzo Districts, themoin roiny seoson losts from November through Morch. Additionol light roinusuotty fotts between Moy ond Jury. The peok foiming ,"oronL.J;;1, )ury onoends in April. Thyolo is in the highlonds, so roins com6 ony time ot 1,e yeor. Theclimote in Thyolo is fovouroble for teo plontotions thus why the pierence otlorge teo estotes. Administrotively, Molowi is divided into three regions with twenty-eight districts.The locol community is moinly o villoge set upirriir, totto*, o common clononcestry ond /or o similor culturol grouping. The villoge is heoded by otroditionol chief who moy hove severol ossistonts or odvisors moinly elders of hisclon' ln some oreos severol house-holds belonging to one villoge ioulo oescottered over severol kilometres. severol villoges"con be grouped togelherunder one Group villoge Heodmon (GVH). Tie highest ronked ruler is theTroditionol Authority commonly colled the T.A. *hose outhority .or"r, ogeogrophic zone in o district. The TA is o very powerfur ond' respectedtroditionol ruler'. ln the moiority of the tribes there is genoer equolity in theinheritonce of heodship (chieftoincy). The country's populotion is currenlyeslimoted more rhon ro miilion with most of it in the southern Region. on heolth core system, Molowiunderwent o decenlrolizotion process, thereforethe regionol heolth offices were obolished. The District Heottrr officers reportdirect to the Ministry of Heolth Heodquorters. Al district level, lhere is one districthospitol which is heoded by o District Heolth officer ( DHo ). From the District l0 WHO/APOC, 24 November 2004 Hospilol, there is either o heolth centre or o Rurol Hospitol. Then Heolth posts follow the Heolth Centre/Rurol Hospitol. Communities occess medicol treotment of eoch heolth focility free of chorge. Mwonzo districl hos l4 heolth focilities including the district hospitol whilst in Thyolo, there ore 22 heolth focilities with l2 Estote clinics. Out of o totol number of 1,084 heolth workers, 780 were involved in CDTI representing 72%. There wos no 100% heolth workers involvement becouse by the end of lhe yeor (2007) new stoff hod been employed who hove not yet been lroined, however, we ore plonning to troin the newly employed stoff before the 2008 mectizon distribution. Fig. I : Map of Southem Region of Malawi E EI]ZA + hTAHGOCHI Mozambi zambique E HIHGA CHEU CHI ll WHO/APOC, 24 November 2004 Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area BI Number of health staff involved in CDTI Bz Percentage Br=Bzl Br *100 Thyolo 822 518 63% Mwanza 262 262 100% Total 1,084 780 72o/o 1.1.2. Partnership The NOTF Molowi comprises of the Ministry of Heqlth ( MOH ) ond other portners : the Sight Sovers lnternotionol (SSl), Teo Estotes Associotion of Molowi, the World Heolth Orgonizotion ( WHO ). SSI wos token on boord ofter the winding up of octivities of the lnternotionol Eye Foundotion in Molowi. The NOTF portners ore involved in vorious CDTI octivities. The SSI Country Representotive porticipotes in the plonning of CDTI octivities, supervision, ottending NOTF Meetings. For the post l0 yeors, the teo estotes in Thyolo districl hove octively corried out treotments on their estoblishments. Mectizon distribution on the Teo Estotes is corried out by volunteers who ore troined by the Estote Clinic Heolth personnel ossisted by the District Onchocerciosis Coordinotor. t2 WHO/APOC, 24 November 2004 +c..l C) -o E 0) o z s C.l Q o ca E t+A le -._ E Gt'- .)9 -0?O lc) o,t -qr^ EWAli suE =ea. >! o.raE *)0I Y9L-Y aoQE .ofi^-0 H- E .LE = Ioo -s6 Esr: v.$ =eEi-- -v- -o= a L-T; Ts g,+ i N-rL . ''EE = __0.jh viocl >r (rE 5! .= >e G t (l)IH L =choa)E de fE S3=o=()e: 'isE = e!oEo e oa Ea :d'E(l))00 9^.rd ;aEE EEA9ooe! e(,,E3 t.? H e'Iorci € x !'s q S>;!=6tq, € 2y,; -ed-()-rE9OO0 OrO(g y ?- -6tYr t-b E'E *e E:r = i!= F .-\, -E €Y"3 EEE tr U= cr;itc,E! r5oq)6 ---o-t- € Ee^, ee ! -i" t, .= a= !! = .ha u; .i+iL>)(Ba!otr _LZ5 Gt rr \A!-\JY(EZ..E ,l 9=Esi (rr o (, (n C) .b o 0.) a C)oL v) C) o n.) -41/ 9a (JH bv(! C) d(! ! o9 '=o :(.)vc) o-o(B aq d9z .33 L c0 :a Ea d z L tsr' * o z I .l C) L() oo t- o a. C)L() bo L C) o() .F (l) € 0 a (.) o (n c/) 6d B d uq) \) $ > q) \)\ o -o o : qJ B sB Rr '5 QLh\ *P $b'\b$S -tA:\ .: ca qO' $H cq) .ts s! -ts8 qr( Su iaUPSs:u >.x s,: =()rPs3 s-6(lr sEps o> ^,$ *L3\\Px= -o: s00 '=L5p s9 $-s.Y \iS :hn(Js .:'= ild l\! q > \ v t -.: L C) o. bo t- o a.oL c) ho L -o o L (.) C)L c) C) L 0.) I() c! o) c! c)o L q,)L o 0) lZ a ! o o (d (t) C) oU c.ir o.ll -ol6llFI E o fl6 Jc oE N F F gE .= :; = !!v cn @ o\ tn $ \o .f(n t =t =\o\o + il .oiE -qrO .= oN ; ).g -{ EooHF 33 cO ta) C\ + \o c! ooN\i oo in(f)ia o6 o91 , c)g Ei'=e6&E.Er: >.! o o *{:'t=6' N: oo o\ cn N c.l oo tr- rn o\r- \06t ra Fr 'EgE :t E tr .= !:,?9rEo E'=gsi lr)(a) oo^ co o\ cO |r) oo \oia ?a tr-t I g >: ctN 3.v 6€) F + il (r) C) (€ cn r! CB() F c.l +t \l \o ra) N 6l r.-\o .e3 E9 €E_ E-E PL- c! >r €)ErE N \o\o N$ 6N (r) q) AI u)(,) I Lq) z 'EgE :v6 tr.=1-?oE oF: 2 ra)co + t\o!+ cttr 9') uv- .-Llu !.- .E:E? = O.gi.E *cr 9' _f9-L !A-^ cotr)(-.ld \o c.l ooot \o oo ia ?aia € ah?a)d .x.! e .EE:ngB E I'F () o F (g N (! B Fl t'r t'r * a N C) E o o z $6l O o $ o o o o o0qr (! .o) o C) 'a L (.) o (€ () o -o(! a C)Lo (* o (! L ,o Lo (n I o a SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current yeat indicating when the key activities were implemented by the month they began and the month they ended. l5 WHO/APOC, 24 November 2004 vc.l () .o o Z st a.l Q o o \o U) o o() I N 4a\)Qq) h' 4 > L q)\ t \)a q) s Ld C) C)F o o C)(! oL c/)(n oL(n C) _o <h C) o (H o() 0.) E F a.;; ot -ol(€l FI 0 () a *oEE U !() o - () -o E 0) o 0) o o0-E+ 1iE >.(! a >. d L U) AI EE Q E() o (,) o o -o oo hoaE 1nE(!: a- b0 o rl c .t) .n q)(J o a6 EE Q o ADE ,E IPE (J o bI cl F EE I bo () -o E 0) o-oa .He (B: o oo ijEc!=N= oor-9a EE o Q b0 bo E',-e !.E C) >. I L at) o o F N 60 Fl t'r F< 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. During the year, one major advocacy activity was carried out at National level. The Secretary for Health held an advocacy meeting with District Assembly officials. During the meeting, journalists from different media houses both print and electronic including the Television Malawi were invited. Both activities brought awareness to the community since onchocerciasis was featured in local media both print and electronic including Television Malawi. The meeting provided opportunify for many of the participants to understand the issues of Onchocerciasis. As a program the advocacy meeting was successful and we hope to build on the experience to continue to advocate for the participation ofother stakeholders. At district level, advocacy was targeted to influential leaders depending on the level. Meetings were held in churches, villahe headman headquarters for this purpose. 2.3. Mobilization, sensitlzation and health education of at rlsk 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 communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. In addition to the information provided on advocacy, districts took charge of disseminating messages about Onchocerciasis. The Community structures were actively involved in the mobilization of the public. More emphasis was put on the need to participate during ivermectin distribution which was planned to take place within 2 months only. Drama and meetings including onchocerciasis open days were used to disseminate information. These meetings were being conducted by different personnel at different levels such as the community, health center e.t.c. IEC materials such as posters, leaflets were used in sensitization. Health education sessions were also carried out in Out Patient Departments (OPDs) of health facilities. With the intensive mobilization and Health Education, this has assisted to maintain a higher treatment coverage that has been realized since 2004. For a successful mobilization to be realized, there is a need to involve influential leaders such as village headmen, politicians. In 2008, we are planning to use Ministry of health education band during the distribution period to increase awareness. l7 WHO/APOC, 24 November 2004 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please odd more rows if necessary) During health education meetings, more female members attended the meetings than men. This is also the same in any activity. The participation of female members was more than male members. As of now, no monetary incentives have so far been provided to the CDDs by the communify Attrition of cDDs is not a major problem, however, attrition of CDDs comes about due to transfers of CDDs to other areas for employment and marriage District Number of comm unities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Number of communities with female CDDs Percentage Brr= B * 100 Total no. communities in the entire project area B{ Number with community members as supervisors B{ Percentage Bo= BJ B. *100 Male CDDs Br Female CDDs B8 Total Be= Br*[* Thyolo 404 +12 Estates 0 0 1,603 1,352 2,955 350 84% Mwanza 256 0 0 400 480 880 148 5'7 8% Total 672 0 0 2,003 1,832 3,835 498 '74% l8 WHO/APOC, 24 November 2003 2.5. Gapacity buildlng - Describe the adequacy of available knowledgeable manpower at all levels. Knowledgeable manpower is adequate at all levels. This applies at National, District, Health Centre/Post and at community levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lvtowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). The situation is remedied by recruiting and training adequate staff in different cadres at all levels. Currently the Ministry of Health is employing more HSAs to reduce the HSAs to population ratio. t9 WHO/APOC, 24 November 2003 c.) c.l E() -o E() z $N (, 0. o oo o a € o N o t o !p .E o *It o t I a. d €s s E o i U q. 6 ,i + ir =v € + F- : o\ o\ co 00 co O c.l r- o\(a €\o 6 \o C) cl O aI o oE z U ?F @ .+ c- i o\F- in ri\o I a) o \o : : !- --d s,iqv }S =v + sl \o raN N in o o q) .=6!rF lLqJl ,oE LGq)L z ULF $ $ at\ q) () €) \o rtl o\6 I U C cF U (, + I q t o\ : N F-\o : e.tN : + tN 6r ! iot o 6l L!! 92I= E>- zE €)I Q o\N .+ oo =r-! o\ € () () q) $ Q E.'i ?F-d a 00 NN (ft t\N 6 (,) G (q 00 9 0 o o z QYF la a o >' F (! N d j t'r t'r t- \o6 I o () \v a %q)() q: \ q)\ t ! q) 4 5 o (n C) 0) F IJQ(H o 0 o (.) 0)L 0)!H C) oo cdLF fi1 ot <l _ol(€t FI Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) During the reporting year, NOTF in coordination with APOC conducted training on Data Management in July, 2007. This training drew participants from all the CDTI districts. The training was conducted in August, 2007. DHOs, DEHOs and DOCs and District HMIS coordinators were participants from the districts. In addition to this training, NOTF in coordination with APOC conducted training on Financial Management in August, 2007. The training was attended by District Accountants, District Oncho Coordinators and Accounting personnel from the Ministry of Health Headquarters. During the same reporting period, NOTF Secretariat conducted training on resource mobilization. The training was conducted in May,2007. The training was attended by DOCs, DHOs and other district Environmental Health Officers. This training was a follow up after the National Coordinator attended training on resource mobilization in Ouagadougou, Burkina Faso in September, 2006. This training was funded by the Ministry of Health. Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifo) Program management x How to conduct Health education x x x x Management of SAEs CSM SHM x x x x Data collection x x x x Data analysis x x x Report writing x x x x Drug distribution x x x x 2t WHO/APOC, 24 November 2003 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographicalcoverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. 22 WHO/APOC, 24 November 2004 $ ON Eo -o C) z =lN O o co(...l ba L xI E $\ sQ 0o \ON U/E .vU d\93d{t 9d .gl '5es\a-!r .='ar tBa't.s* -.SYEETH Ss .r U S -=1! tseS{'EE- c)a'tIU\kfs0)E_ o-o! .e€ S ,SEP..s'pd .; $ r"$\E+X \ !q/E E SF at I R 'Ii' =t ; : 8ixll E B-x Et c r JL .Yl ar q 'l ".Sl=+ E SS5l E : -iEot o. .Y Y\Br S E! Bl r s ssq=l* { 8E :t = i tp -81 . *' .sStrl ta E \o =I E B TSzn- .! itqaaJu !' 6\ 'X os , Iti$ su x. -{S\I sS: ts s !s\ -q)< \ !*I ql s9a i s$ 9 S Er(u u qrt .- s S=y h l\='FrrttSD s 9!\o F- I-:o\ \ aS (.) L G, 9o() 'a LG(.)!c)(q _.CpP()d(.) .= 'd^ LV H2,() rtrid HA FJ U>0)2 t- a ; .=q.) LV ='- -aEdE(, ^()(J€ o'E E ot c(l) ol =-O *l t6 *l 8 * El ,, o- dlE + !l !A alcOl X fr)l o olol dj !flJ ol ;l E =l 8" ;stl .! <l a cl '89l oo :'l= gl U EI = :EI H EIF9t .1 Ht - 9l v ,,t ; =t E .,t -tls Elr ilE9l rr Ll Ul L 9l td Pl b el E(HI J el = r.-l () ol p. ol tr ol-rl O rl ! ult()l o- c)l c ()l= -ol _ -ol _ -ol ::trl 6J trl cd trl=5lo =lb =ltrzl? zl? zl< 6l o)l$ LIol BI ol sl -clAI(dl LIbrl ol o)l oll sl CdI ,rl ul JI 0)Iol LI()l -cl od cl =lal EI ol :l €l tsl =lEI 5t rr.l r\ 4q)() q) q L q) t q) s $ JZlr) (€ 0 oL (n r '')J o (r', >' ant! a C) (.) LF r-l o-r I -ol 631FI C) d C) bo!!^0s oo oF C) (d C) bI) L() oo do- -C o-(! L o0 C) o o (d H 0) o0(dL 0) o O,^ Eo\ C) a.(dLo F A€E3#es* o.iilt = O *eHeE -oq o ,QO o! o o z O lrl ts<\a Ao vobE E3:r -oz.n N c.) F- : q- *e LC^-o9 0 9! tr Eh}9E2d E s t-- v}N \o o. o ll {ix a !o =ooo cg^O!\o(l Sr9- ooEOF o\+ € 5\+ @ o.t 00 o a_bEU trho = o!z caN \o oo o\+ + rd\o\o :o?6: =Qo 4.9b' F'J o oo oi <t \o + !+ <fq .+\o\o .9 '3: xoi. EE1E -3.g o.:oE oF o{ <l' \o 6l oo C.l rd oo c.) oo (r) obo C) C) o() ll r ^,4 .9o ^6^iI 9p\ooa- do o\ \o6\ o\ ts8.-E.: f,i! .8 5 go* ==-! AO (! o c.l +c) <t(i t() cl N F-\o :o d o.= t ,p.D FU oa.l : 'o :.dVg \o(\ c.l F-\o >9, pI o= i df :! g f e -3qt.9^ € E $B E- o>-6 (! 6) N +g +d tfo \o N c{F-\o o o F dN d 2 r.l t'r t'r lt 2J 2.6.2 What are the causes of absenteeism? a. Chronic illness - the person could be registered during the census update however due to chronic illness the person is hospitalized during the treatment b. Unplanned emigration - the person could be registered during the census update however, it could be found out that the person has emigrated to Mozambique or other districts during the treatment c. Deaths also contributed to absenteeism d. Laying off of workers particularly in tea estates-the workers could be registered during census update however it was found that the workers are laid off during distribution 2.6.3 What are the reasons for refusals? Religion - there are some religious sects which do not allow their followers to take drugs Sometimes people are afraid of the side effects if the side effects are over emphasized during health education Rumors and misconceptions 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 I 24 WHO/APOC, 24 November 2004 \t (\ () E() z t6t U ra) N q) \ \qJ .a ! I\ q t( -:\ 4a u\) h q: p o * ! q)q q) 5 L()o b0 L (.) c) oo L E 0)LL ooo (B an E,] a U) c) o()(a Lo E € an o L oa(H U)oo (-) cb; 0)I -ol(dl FI 6) E09 O7 royo <I CP - ooq;dlFOc'.= tr ! cgiJooo == EgEd El oo I a.2 C^ g{o =9L.) 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() o(, lL *- !i li r-1 o ^00P E.}t- oo\<e- o q $ ? lr) n\o\o n F-(n v? \o \o \o\o o O g= :'u E q sf, oq (r) n\o\o n I.*r) ,r? \o 9\o\o O li aoo-q q; Hg =E>F>O@ \o\o F-r- c{ Ns co oo c-)$ o\ c* ca \oO$ ao ca$ 6lr*\o c-lr-\o NF-\o NF- E] =od q.= EE9. <,e A' -v \o\o o\o\o o\o\o \o\o O\o\o \o\o \o\o N Ir-\o c..lF-\o c.lF-\o e.lt'-\o bo6 =qtL IEIt oE >':EE.E<:d E :T E€ EO I \o O\o\o \o\o \o\o \o\o \o\o O\o\o (t.l r-\o c-lF-\o NF- c.lr-\o & trl t-- o\ o\ oo o\ o\ o\ o\ o\ N cl c.l (\ c\l * c.l (\ (\ Fr a.l 0a c.l <f c-l o -o E a) zt c.l U \o N -O 5 E -9 I C) a0 c€l-q) I() rltvF D cl -EB'b -\:o -t\ESER9dtrl.4) :$r5USet>.-= :.=0PRT -L s-63t!o)SrE =N.2v IEi- €c) =9,.nvL- q!l or(Jlool .='f IEa. I .geltr'Elo.Eltsol ',r()1atlU:I Eq:lLLIo(€l& g, .,1!|clltEl IEEI ;6(,1 E q)(-)I .+IAEilE2 -ol a. !o0: !v9br- !-LP:priCF =(!D;2.strofgtr0) l--FiEcE -o)9q-E e.i or1 ';()l 0 =l dHeFl Fi 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH NT wHotr UNICEFtr NGDOtr Other (please specif,,): Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH N/ wHotr t,NICEFtr NGDON Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities - Mectizan tablets are ordered by the NOTF Secretariat from Merck. Estimation of total tablets requirement is done basing on the total population and how many tablets are remaining from the previous distribution, the difference is the request that goes to Merck. After the mectizan has been received at the National Office, it is taken to Blantyre DHO Pharmacy where all the districts make their orders from. The order should be within their allocation based on the population the district is to treat during that particular year. When their allocation is approved, the district collects the drugs from Blantyre Pharmacy. From the district, Mectizan is delivered to health facilities which are closer to the communities. Health Surveillance Assistants who are direct supervisors of the CDDs collect Mectizan from the Health Facilities and the CDDs collect the mectizan from these Health Surveillance Assistants who are based in the communities . Other CDDs who are close to the Health facilities collect Mectizan directly from the Health facilify. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? After distribution, the CDDs deliver the remaining tablets to the Health Surveillance Assistants who in turn delivers it to the Health Centres they report. The districts collect the remaining tablets from the Health Centres. When the district has collected att the remaining tablets in the district, it delivers the tablets to Blantyre DHO pharmacy which is serving as a regional pharmacy for safe keeping. District Number of Mectizano tablets Requested Received Used Lost Wasted Expired Remaining Thyolo 1,800,000 1,768,500 1,221,627 867 0 0 546,006 Mwanza 691,203 69t,203 465,307 2,710 2,000 0 221,186 TOTAL 2,491,203 2,459,703 1,686,934 3,577 2,000 0 767,192 27 WHO/APOC, 24 November 2004 List and briefly describe the activities under ivermectin delivery that are being canied out by health care personnel in the project area. The Health Care personnel carry out the following activities under Mectizan delivery : Collection of the drug from the collection point Mobilization of communities Reporting on the drug usage and persons treated Supervision of Mectizan distribution Census update Collection of remaining Ivermectin tablets from the CDDs after treatment 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? 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. Supervislon 2.9.1. Provide a flow chart of supervision hierarchy. National Level + District + Health Centre + CDD 2.9.2. What were the main issues identified during supervision? The main issues that were identified during the supervision are:l. Failure by some Health Workers to calculate for CDTI related data e.g. Therapeutic coverage. 2. Inaccurate recording by some CDDs in the recording notebooks.3. Some mectizan stock records were not updated by the CDDs4. Inadequate supervision from the District to CDD levels 5. Lack of commitment by some CDDs and Health workers6. Non availability of CDDs in some villages l. 2. 3. 4. 5. 6. District Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) Ilvqlo Mwanza 404 + 12Tea estates 2s6 0 0 416 256 TOTAL 672 0 672 28 WHO/APOC, 24 November 2004 2.9.3. Was a supervision checklist used? The checklist was used during the supervision 2.9.4. What were the outcomes at each level of CDTI implementation supervision? The supervision managed to correct some issues identified immediately thereby improving the implementation of CDTI. For example CDDs were taught on how to do correct recording in the notebooks 2.9.5. Was feedback given to the person or groups supervised? Feedback was given after the supervision. 2.9.6. How was the feedback used to improve the overall performance of the project? Feedback assisted to identify the existing gaps in the performance of the CDTI program 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 drop outs . This has also assisted because the program has maintained high therapeutic coverage. 29 WHO/APOC, 24 November 2004 SECTION 3: Support to GDTI 3.{. Equlpment 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, CNFI: Currently non-functional but irreparable). How does the project intend to maintain and replace existing equipment and other materials? The project maintains and replaces existing equipment and other materials in different ways. The project uses government resources and other donor funds which have been pooled together in what is known as Sector Wide Approach (SWAP). SWAP funds are not meant for a specific purpose, but rather the funds are used for different purposes, therefore the project's equipment is not excluded when maintaining or replacing equipment of other programs. This is applicable at all levels i.e. at Headquarters and district levels. Every year, each program is requested to submit its budget. The budget includes activities in the lield and procurement. So each program indicates its requirements in terms of capital equipment. The equipment is purchased after the approval of the national budget. Source Type of equipment APOC MOH DISTRICT NGDO Others No Condrtron No Condrtron No Conditron No Condruon No Condrtron l. Vehicle I IF 2. Motor cycle(s) 8 5F 2WO I CNFI 4 3F, I wo 3. Computer(s) J IF 2 CNF 4 F 4. Printer(s) J 3F 4 F 5. Photocopier (s) I CNFR 6. Fax Machine(s) I CNFI 2 2F 7. Others a) Public address system I F b) c) 30 WHO/APOC, 24 November 2004 Contributor Year 2005 ('provrde the pernd') Year 2006 ('provde the period') Year 2007 ('provde the perrcd') TOTAL Cash Budgeted (US$) TOTAL Cash released (us$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash released (US$) MOH (Central) I 1,1 54 I 1,154 3t,131 3 l,l3 l MOH (District) 86,s69 86,569 89,242 89,242 13s,222 135,'751 LocalNGDO(s) ( if any) NGDO partner(s) Others a) b) Communities In kind In krnd In krnd In kind In kind In kind APOC Trust Fund 79,799-budgeted 28,404 - approved 28,404 7,000 - -) released TOTAL 3.2. Financial contributions of the partnens and communities Table l3: Financial contributions by all partners for the last three years - If there are problems with release of counterpart funds, how were they addressed? So far there have not been any problems in the release of counterpart funding. All the funds requests made to the basket fund (SWAP) are honored. Central level funds were being used for both projects. In2006, the NGDO partner released USD82 for both projects, however some of their contributions are not always in cash but in kind. 3.3. Other forms of communlty support Describe (indicate forms of in-kind contributions of communities if any) Identification of a suitable CDD Collection of drugs Community awareness during census, distribution periods Mobilisation of other community members Distribution of drugs 3l WHO/APOC, 24 November 2004 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the cunent United Nations exchange rate to local currency. Indicate exchange rate used here_l USD: MKl40_ 32 WHO/APOC, 24 November 2004 Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities Traiq4g_o_l CDDs Training of health staff at all levels SUpqyts,ilr&Cosr q4d distribution Internal monitoring of CDTI activities Advocacy visits to health and political aulhoqillgg IEC materials Su_mm.ary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g compulers, printers etc) Evaluation 450.5 2,142.8 3,833 5,054 1,936 0 550 0 25.2 5,000 121,455 35 MOH MOH MOH, APOC MOH, APOC MOH MOH MOH MOH MOH MOH Mon MOH TOTAL 138,339 Total number of persons treated 666,040 Table l4: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. Internall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Reduction of CDD to population ratio JJ WHO/APOC, 24 November 2004 4.1.3. How have they been implemented? The recommendation will be implemented this year with training of additional CDDs 4.2. $ustalnability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainabilify plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The planning at all levels follows the planning cycle. The community participates in providing information to the Health Centres, District Hospital. The Government financial year starts from July to June. Before July, government ministries, departments and programs are requested to submit their plans and budgets for the year, During the planning cycle, all plans are drawn up including activities of Onchocerciasis Control Programme. At the district level, their plans and budgets are consolidated in one document known as the DIP which is submitted to Ministry headquarters. 4.2.2. Funds The activities of Onchocerciasis Control Programme are integrated into the District Implementation Plan ( DIP ). This ensures that the activities of the Onchocerciasis Control programme are funded from the district Other Recurrent Transaction (ORT) under SWAP. ORT funds under SWAP come in a basket form for different health related activities. Onchocerciasis activities are expected to get an allocation and when planned activities are ready for implementation. At National level, each year each program including onchocerciasis, submits its annual budget for inclusion in the Ministry annual budget. when the budgets have been approved by the parliament, funds are spent through what is known as ORT under SWAP in the ministry. 4.2.3 Transport(replacementandmaintenance) The activities of Onchocerciasis Control Program are integrated into the District Implementation Plan ( DIP ). This ensures that the activities of the program are getting funds from the district ORT. Transport at district level is managed in a pool , each program is given preference according to the work plan on that particular day. Maintenance is carried when due. At National level, each program manages its own transport, however, when the vehicle is due for service, it is treated as any other government vehicle. The MoH pays for it. 34 WHO/APOC, 24 November 2004 4.2.4. Other resources Through integration with other programs in the District Implementation Plan ( DIP ). 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin deliverymechanisms Mectizan is taken as any other drug. When the DHO is dispatching other drugs to the Health Facilities in the peripheral, Mectizan is included in the transportation. 4.3.2. Training There is a plan to develop an integrated training package which will allow health workers to be developed incrementally. 4.3.3. Joint supervision and monitoring with other programs Using an integrated checklist which includes Onchocerciasis activities 4.3.4. Release of funds for project activities All districts in Malawi develop a DIP for sourcing funding from the Central level. In the DIP all health related activities are included. Each activity is budgeted for. When the plans have been approved, funding is made available to the districts on monthly basis. When district has been funded in a particular month, the DHMT sits down and plan for activities to be funded and carried out during that month depending on the level of funding during that month. Therefore, since onchocerciasis control is one of the programmes included in the DIP, funds are released to the activities for onchocerciasis control. 4.3.5. Is CDTI included in the PHC budget? Yes 4.3.6. Describe other health programmes that are using the CDTr structure and how this was achieved. What have been the achievements? Malaria control program is using CDTI structure especially during the net retreatment week. The program uses the CDDs that are used for ivermectin distribution for this purpose 35 WHO/APOC, 24 November 2004 4.3.7. Describe others issues considered in the integration of CDTI. Other issues considered in the integration of CDTI is the implementation of other NTD such as Schistosomiasis, STH, LF including trachoma using the CDTI structures 4.4. Operational 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. No Operational Research was undertaken during the reportin g year. However, a research was conducted in 2006 and no feedback meetings have been held till to date because the funds which were meant for this activity have not been released from APOC. 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the and weaknesses of CDTI - List the challenges and indicate how they were addressed. One of the challenges that the project faced was little funding of APOC Trust funds to the project, however, this did not affect the activities of the project. Project activities were funded from Sector wide Approach (swAP) funding and funding from the Government as indicated in the District Implementation Plan (DIP). Strengths l. Integration of CDTI activities into the normal government operations 2. Ability of the government to co-fund CDTI activities at central and district levels Challenges 1. Dropping out of CDDs 2. Employment of new HSAs who will require training Opportunities l. Availability of HSAs at communiry level 2. Availability of SWAP funds 3. Availability of NGDO partner Weaknesses Transferring of experienced staff particularly HSAs 36 WHO/APOC, 24 November 2004 SEGTION 6: Unique features of the prolecUother matters The most notable unique feature is the presence of a cadre of Health Workers known as Health Surveillance Assistants. These Health workers are based in the community. They supervise the CDDs activities in the communities. The HSAs carry out any health related activity in the communities they are based. These are government employees. Another unique feature of the project is Estate Distribution. Thyolo and Mulanje District have got estates. To ensure that estate workers are protected from onchocerciasis since they are always out in the tea fields, distribution was introduced on the tea estates. The estate health workers conduct the distribution. In 2006, the estate distribution period was harmonised the with community distribution period. Estate distribution and community distribution are taking place at the same period. 37 WHO/APOC, 24 November 2004