Ruvuma CDTI focus annual project technical report submitted to Technical Consultative Committee (TCC): from December 1st 2004 to November 30th 2005

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH -"-! I I I ffi I COUNTRY/I.{OTF : Tanzania Proiect Name: CDTI Ruvuma focus Approval vearz 1997 Launchins vear: 1998 Reportins Period From: December l't 2004 To: November 30th 2005(Month/Year) ( Month/Year) Proiectvearofthisreoort: (circleone) I 2 3 4 5 (6) 7 8 9 10 Date submitted: 29 January 2006 NGDO partner: Sight Savers International OzuGINAL : English 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 For lrilcrrnotlon T.>, L, i -..- - \,u..\ LLx t' @,v AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) !;tr r,l r'H''"r r,r\i"r I 24 2004 -_1L€)- ..,#3*# ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in th appropriate space. OFFICERS to sign the report: ei Country: Tanzania National Coordinator Name: Dr.Grace Saguti Signature: .. Date 5 Zanal Oncho Coordinator Name: Dr. Landolin Wella. signature ,YfuY,/fumfl"4 c,[ !/t)r,o2.zo ,rr:f r[,r.r.1il ME',DIeAL oFFltl?r "-'' lvllM! \fGDO Representative Name: Mr. Pius Mabuba f. p' ,,*rature Date: .. o s- o2*2Po L This report has been prepared by Name : Dr. Wade Kabuka Designation : Project Coordinator ll WHO/APOC, 24 November 2004 Table of contents ACRONYMS VI FOLLOW UP ON TCC RECOMMENDATIONS 8 EXECUTIVE SUMMARY............. .....ERROR! BOOKMARK NOT DEFINED SECTION 1: BACKGROUND INFORIVIATION........ ...................9 SECTION 2: IMPLEMENTATION OF CDTI...ERROR! BOOKMARK NOT DEFINED. 2.1. Trunrne oF ACTrvrrrES .............. .... Ennon! Booxlranx Nor DEFTNED. 2.2. Aovocecv... ........ t2 2.3. MosLzerloN, sENSrrrzATroN AND HEALTH EDUCATToN oF AT RISK coMMuNrrrss 14 2.4. CouurtxrryrNVoLVEMENT............ ................. 15 2.5 Cepecrty BUTLDTNG .. 15 2.6. TRBeruBNrs. 18 2.6.1. Treatmentfigures............. ....................... 18 2.6.2 ll/hat are the causes of absenteeism?..................8rror! Bookmark not deftned 2.6.3 What are the reasons for refusals?......................8rror! Bookmark not defined.2.6.4 Briefly describe all lorcwn and verified serious adverse events (SAEs) that Error! Bookmark not deJined. 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year2l 2.7. ORDnRTNG, sroRAGE AND DELIVERv oF IVERMECTIN 2.8. Coutvttxlry sELF-MoNIToRTNG aNo STaTBHoLDERS MBBrrNc....... 23 2.9. SupBRvrsroN................ 2.9.1. Provide aflow chart of supervision hierarchy... l.l. GBNBner rNFoRMATroN......................... 1.1.1 Description of the project (briefly) 1 .1.2. Partnership 1.2. PopurerroN ;;;;;i ;;;; ;;;; )*i ilnil. ::::': ::::::'! ::! *"1; .................24 .................25 .................25 .,..,.26 ......27 2.9.2. What were the main issues identified during supervision? .............................. 25 2.9.3. Ll'as a supervision checklist used? .......... 25 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 25 2.9.5. llas feedback given to the person or groups supervised? ............. 252.9.6. How was thefeedbackused to improve the overall performance of the project? 25 SECTION 3: SUPPORT TO CDTI ..........26 3.1 3.2 3.3 3.4 EqumurNr...... FTNaNcIaT CoNTRIBUTIoNS oF THE PARTNERS AND CoMMTINITIES OrHeR FoRMs oF coMMUNrry suppoRT ExpsNorruRE PER AcTrvrry 27 .......27 SECTION 4: SUSTAINABILITY OF CDTI.. ............28 4.1. INrenNar; INDErENDENT pARTrcIpAToRy MoNIToRTNG; EvetuertoN.................... 28 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowing which are applicable)............ ........ 28 4.1.2. What were the recommendations? .......... 28 tv WHO/APOC, 24 November 2004 4.1.3. How have they been implemented? ..... 4.2. SusrerNesrI.rry oF rRoJECTS: rLAN AND sET TARGETS (MANDAToRY AT...... Yn3) 4.3 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.3.1 4.3.2 Planning at all relevant levels Funds..... Transport (replacement and maintenance) Other resources '9 4.2.5. To what extent has the plan been implemented.......... INrpcneuoN ................ . Ivermectin delivery mechanisms '. Training................ 4.3.3. Joint supervision and monitoring with other progroms deJined. 4.3.4. Release offunds for project activities .................Error! Bookmark not deJined"4.3.5. Is CDTI included in the PHC budget? ................Eruor! Bookmark not dejined 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. lI/hat have been the achievements?......Eruor! Bookmark not detined" 4.3.7. Describe others issues considered in the integration of CDTI. Error! Bookmark not deftned. 4.4. OpsRArroNAL RESEARCH ...................30 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. ...... 30 4.4.2. How were the results applied in the project? .............. .................. 3l SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND oPPORTUNITIES..... .............32 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........32 v WHO/APOC, 24 November 2004 29 ...... 28 ...29 ...29 29 .Error! Bookmark not deftned Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I-JNICEF 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 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 vl 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) Annual Treatment Objective: (ATO): the estimated number of persons living rn meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Gopl (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) Geographical coverase: number of communities treated in a given year over the total number of meso/tryper-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 corlmunities 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 govemment. (ix) Communiw 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, 24 November 2004 FOLLOW UP ON TCC RECOMMENDATIONS TCC recommendations were dealt in the re-submission report sent to APOC as it was directed by TCC 21.The re-submission report was accepted. Executive Summary The report .ou... a period of 12 months starting from l't December 2004 to 30th November, 2005. Year 6 of the project saw many activities being implemented by the district council using funds from the councils and Sight Saver's International all being directed at strengthening sustainability of the program by involving leaders at district level who are the policy makers and warrant holders. We held a project review meeting organized by SSI which aimed at preparing project action plans for each district. The treatment cycle of this reporting period started in May 2005 and lasted in October 2005 where by a total of 213,81I people were treated in 1,064 communities. The total population in Hyper and Meso endemic communities is 297 ,686 people. The geographical coverage for the reporting year is 100% whereby the therapeutic coverage is7l.8oh. The UTG is248,132 and ATO is 250,056. MectizanrM tablets arrived in the country on time and the Ruvuma CDTI project office in Songea received the drug on time. There was no delay from the MSD in Dar Es Salaam. The project received 817,500 (3mg) Mectizan@ tablets to be distributed to hyper and meso endemic communities in the project. The drug was distributed in all three endemic districts and the district authority by using health existing system sent the drugs to all FLHF in hyper and meso endemic communities.646,948 tablets were used and 4,881 lost. We have a balance of 165,671(3mg) tablets stored in the district Pharmacies. The expiring date for the tablets is March, 2007. Since the 5th year evaluation in OctoberA.lovember, 2003 we have received no funds from APOC trust fund. CDTI activities have been implemented mainly using funds from the District Councils and Sight Saver's International. By using SSI funds the project managed to conduct re-training to 185 FLHW in all three endemic districts who also conducted re-retraining of CDDs. Total of 1,945 CDDs of which 854 male CDDs and 1,091 female CDDs, were re-trained between May and July, 2005. Larger communities in Mbinga District split up forming 5 new villages thus making a total number of 29 villages in Mbinga district. For the whole project we have a total number of 170 villages which form 1,064 communities. The major challenges are: -To ensure that all CDTI activities in Comprehensive Council Heath Plans are funded and fund released accordingly in -all three endemic districts. - Songea district has been divided into two districts forming new one called Natumbo district, therefore there is a need to conduct advocacy, mobilization and sensitization to policy makers so that they incorporate CDTI activities in there plan and select District Onchocerciasis Coordinator to run day to day CDTI activities. 8 WHO/APOC, 24 November 2004 SECTION 1: Background information '1.1. General information The location of the Ruvuma Focus CDTI Project remains the same that is - southem part of the country sharing borders with The Republics of Mozambique and Malawi to the south and west respectively. It borders Mtwara and Lindi Regions to the east while Iringa and Morogoro Regions forms a border to the north and northeast. Project is made up of two endemic districts of Ruvuma Region (Songea and Mbinga), as well as one neighbouring district of Iringa region (Ludewa). It covers approximately an area of 64,333 sq. km of which 1,006 sq. km are inland water bodies from Lake Nyasa. Ruvuma CDTI Focus project lies between latitudes 10 degrees south and I 1.5 degrees south and longitudes 33 degrees east and 38 degrees east. Most of the project area lies between 500 and 1,600 m above sea level. The project area has a tropical climate characterized by two distinct seasons, notably wet and dry seasons. Temperafures are also modified by the seasonal variations so that the area becomes hot (average temperature is 27 degrees Celsius) during the dry season and cold during the wet season (average temperature is 14 degrees Celsius). The dry season lasts from June to November/December and the wet one December to April/May. The peak of the rainy season is from March to May. Miyombo woodlands mainly form the natural vegetation although in Mbinga district artificial forestation has replaced the natural one. The two distinct seasons have a very important implication when conducting CDTI trainings and subsequent distribution followed by data collection. This implies that all these activities have to be carried out between June and December each distribution cycle. The road network in the project area varies considerably. Communication from the project centre to the districts is quite accessible. The main problem is communication from the districts to the villages where most roads are seasonal. The Ruvuma Focus project has 1,064 meso and hyper endemic communities. Many communities keep on splitting forming new communities mainly due to increase in number of people and in search for new farming land. We therefore expect increase in the number of hyper and meso endemic communities. Ivermectin mass distribution started as a vertical programme in 1992 funded jointly by the Government of Tanzania and River Blindness Foundation of USA up to 1995. From 1996 to 1997 Inter Church Medical Assistance and Sight Saver's International provided bridging fund to the project. Year I APOC funding started in October 1998 with the new concept of CDTI. Our communities vary in size depending on the number of people living in the area. Each community is headed by the village chairperson (selected by the community members) assisted by the village executive officer (appointed by the district executive officer). The next administrative level is the Ward, which is headed by The Ward Executive Officer also appointed by The District Executive Director. The Ward Executive Officer heads several villages in his/her catchment area. Almost all villages in Ruvuma CDTI Focus Project have a number of village health workers and these are people who have been trained in a number of simple health interventions by Ministry of Health trainers. All villages utilize these people in collecting, distributing, and data collection during Mectizan@ distribution. These village health workers are not ministry of health employees; they are recruited by the community to perform simple health tasks in the village and are motivated by the community. Motivation to these people usually is in the form of financial assistance during distribution or exemption on communal work. 9 WHO/APOC, 24 November 2004 Table 1 : Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of heelth steff in the entire project aree B1 Number of health steff involved in CDTI Bz Percentage Br=Brl Br *100 Songea 341 64 t8.7 Mbinga 314 96 30.5 Ludewa 3t9 25 8 Total 974 185 18.9 1.2 Partnership There is strong partnership in the prograrnrne, SSI, NOCP support supervision, train project staff and provide fund CDD's. Districts Council fuel motorcycles during supervision, during planning project staffs are supported by district. Community members are willing to take ivermectin and some motivate CDD's by exempting them in communal work. 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period. add more rows neces, Source Yeer Nationel census 2002 other, specify: CDD UTG = calculated as the maximum number of people to be lreated annually in meso/hyper endemic areas within the proiect area, ultimately to be reached when the project has reachedfull geographic coverage (normally lhe project should be expected to reach the UTG at the end of the 3'o year of the project). 10 WHO/APOC, 24 November 2004 Number of communities/villaqes in Population of CDTI Districts/ LGAs in the entire project area Total population in the entire project area Meso- endemic zone in the project area A1 Az Hype r- ende mic zone in the proje ct area Total in meso/h yper- endemi c zone A;= Aft Az Meso- endemic zone in the project area Aa Hyper- endemic zone in the project area A5 Total in meso/hyper -endemic zone .{6=Ay'A5 Ultimate treatment Goal (urG) Songea 333,055 1 9 1 331 522 32,003 153,701 185,704 155,992 Mbinga 438,780 173 193 366 7,765 45,965 53,730 41,910 Ludewa 132,290 8l 95 176 15,444 42,808 58,252 51,628 TOTAL 904,125 445 619 1,064 55,212 242,474 297,686 249,530 If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. - We use term community to define sub village which is the lowest level of administration in the govemment structure in Tanzania. It is headed by a sub village chairperson elected democratically by all community members. The size of the village population may vary from 400 - 1,000 people. Is there any other information of interest about the population in the project area? If so, include it here. None of interest l1 WHO/APOC, 24 November 2004 o ta trq) a o =trr+otrts U !o .o o o z k(.)p E C) z Ho! () o z P-e 1ntr k(.) -oo o o E() ! o o k 0)p o() ! L U) a( Lr a o *E EE Q Eop o o E C)p o oo ts(.) -oo oo Eo -=i, r: E C)! c) oo(/) Hop E(.) o() U) H(.) -o (.) A(.) U) q) ctE an an q)I o g: o.6EEo Q Hq) ! tr(.) oo U) ko -o Eq) o c) a H 6) -o o (.) a P. 9E 6: q) ! G) ooa o -o () a() a k(.) ! Eoq c) a EI GILt. o o.6EEo Q Eo! c)q q) CN Eo! C) o.oa E(.)p (.) aoa S= !E 6: bo q oo q o0 aQ) ii= -aEooE< CJz o.6EE q) ao0 q bo q bo) P- ftr 6= a- IJ o L ar, o ,.o E a .B z € CB C) oo oa cB oo .o z (6 ' q)! Fl Fl F F a.t c.l c)F q) zsN U o H B c-.1 aN aN rn Io(\l C't Jl- v tr(gh ,ri!€,^ a8>Hi RN HXE L * u 'J.( -8 ='B 6 Ll oJ!^nFa bry X ()!! Ht o H ff =*,E;.E h'E #;8 35.3aEc{ o:E E tg r!F.ritieQoqa.=-9-o<ti Y E q dng B €^950rPo3 E 1<e B; qr< c tr q € g s E EE EEEB€!E=E,D,AO - $-O cr (D ii =_ i/(llaOIiOe -.=co>,(, .E-r 6€ p"5oEE:E.Eg .E E E ' 7=$EHE:"So t'' E.9!ir- o o s 0$ '- H gi IEI -:.6JtoA:if.q-bE(-)t!.o Q ra oEE3=inF tr E * tE FgE c6) Oqllllll\JE ?\ q 3() .S a4 > p q)L o \ q)q qJg t<d a)h () !! o C) o 63oL at) doL((, o Lr € a o) o CBqr o C) q) F ".ito.r I .oldtFI aa() C,) 6l 4) q) - 6l z t'r F zritaa rij Pr =2 :(\l z o 3 U ria Advocacy This period the project managed to conduct advocacy to all policy makers at all level that is from Region up to Village level. At Regional level advocacy was conducted during the PHC meeting. In this meeting all Departmental and Political leaders are members where the Region Commissioner is the Chairperson. The advocacy at District level was done at Councilors meetings. The village leaders including sub-village leaders were also sensitized; this was done after advocacy meetings at Ward and district level. The reason for mobilization and sensitization: The advocacy meetings were undertaken before dishibution of Mectizan@ drugs starts aiming at creation of more awareness for those who are familiar with CDTI and for others who is there first time to attend these meeting. Advocacy also aimed to build and maintain the sense of ownership to the community leaders and members. Through this advocacy meeting, the Region and Districts managed to incorporate CDTI activities in their Comprehensive Health Plans and funds were release. Problems encountered No constraints were being faced, as majority of policy makers/community leaders were the same people but this year we held a national elections for both Councilors, Member of Parliament. A great change has been made in the leadership at district level. Almost all previous Councilors have been replaced by new ones there we a aiming to conduct targeted mobilization and sensitization in levels where there is a change in leadership.. Suggestion to improve advocacy All policy makers should be invited to attend advocacy meetings at all level and there is a need to request the District Executive Directors to finance these meetings. l3 WHO/APOC, 24 November 2003 2.3. Mobilization, sensltization and health educatlon of at risk communities o The local radio station in the project continued to be used in disseminating CDTI information to targeted groups as it was done in the previous year. The country wide radio station was used to disseminate information on CDTI activities nationally. t We involved leaders at all levels in the districts in conducting mobilizationto targeted communities. o The response was much better in Ludewa and Mbinga districts compared to Songea district as shown by coverage rates. Mobilization and health education of communities including women and minorities r Schoolteachers, student, women who come at OPD and Clinic to seek medical advise including woman CDDs are the ones who are mobilize and advised to give health education to other woman and minorities. Response of target communities/villages o The response of target population was good. Accomplishments of the project in this year are- o The project managed to conduct CDTI activities depending on Government funds o Community members gain sense of project ownership as they participated well in conducting CDTI activities. o Most of the communities know the important of taking drugs every year. t Low CDDs attrition rate of CDDs o CDDs are willingly to continue to distribute Mectizan@ voluntarily. Suggestion of way to improve mobilization and sensitization of target communities - a Mobilization and sensitization meetings should be conduct every year prior to Mectizan@ distribution cycle starts. o Health education should be done continuous to remind the community their responsibility. i To strengthen Community self Monitoring and Stakeholders meetings in all affected communities t4 WHO/APOC, 24 November 2003 2.4. Gommunifir lnvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Although leadership at village level is still dominated by men, females are more active in communal work participation than men. This is evidenced by having a good number of female CDD' S participating in ivermectin distribution. 2.5. GapaciQr building - Describe the adequacy of available knowledgeable manpower at all levels. In Ludewa district the Oncho Team has been appointed. This has solved the problem of frequent change of staff in the district. The coverage in the district has rised as a result of this change. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. We normally train the FLHF in charge on how to conduct CDTI activities but we insist him / her to train also her / his collogues and delegate power to sub ordinate staff in case there will be a transfer so that CDTI activities will not be affected. District Number of heelth steff involved in CDTI ectivities. Number of communities/villeges with community members es supervisors Number of CDDs end the communities involved Number of communities /villages with female CDD's Totel Number of heelth staff in the entire project lree ti Number of heelth steff involved in CDTI It Percentege lr. = B: tlr I00 Total no. communiti es in the entire project erea lt, Number with community members ts supervisors I]. Percentege llu: lls,' 13. r,,,u Male CDDs li- Female CDD'S lJ. Total li,r-= ll--flls Number of communiti es with female CDDs lJ,, Percent rge lll llr,, li I I (!(, SONGEA 341 64 18.7 s22 522 100 602 7t0 r,3t2 522 100% MBINGA 331 96 29 366 366 100 r02 212 314 366 l00o/o LUDEWA 319 25 8 176 176 100 150 t69 319 176 100% Total 991 185 r8.6 1,064 1,064 100 E54 1,091 1,945 1,064 1000A t5 WHO/APOC, 24 November 2004 () cl o oU o q)E z - ",j 6' .: i. zv $ co 6l : (\l <f c.l _1 * o\ €(.)t \o =6r N o\ () q) q) Y t = ?!F(J o $ * c.) o\ ao t) € o O q) .=G cl Fr 0): o6) ,q) r- Gl crl- z : o -: +F 9.F *.: is *d a-l a.l al ar e q) q) U o N al rc 6) -E) GL =g 3ElE<l zil ot(,l I .i E,?+F-d &'u Uz cO @ c.l c.l c..l \o a.t e.l (.) € cli i o q) q) \v o\ rrI ?F t\o mN c{ r- !q) c\t 6t 0 o I O q)E z - .? Ei'r+F-d q t \o \o r- ca \o ct (aN (.) q) qJ o (, \Q ta \o ra (J? N \o \oi () Fl sl zoa z tq >r! o F.l I t'r 3 ooN k c) -o o o zs6l (J oA o Ji B \o gb o a o\ o b s{ \: o 5 bo\ o\ IF o \ o\q os B \' !-' s =I (^' 4 U1q) q) b V) oL p o \ q) U) q) E o (! () o a. 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E fi*?EESz gci oi I o. o o qElt<>v) AO o vobs -otrco zd \o!f, @{ c.lcaco e.l\o €^ ao o\N 6l al : e- s E:i E E['€E rft$@ r- N o\ co co F- C\ o\ o\s ll aiEo =o0O G^ sgrooEOF o^o EEE = osz -EeE PE CEY < g4'FL) .9 .,H * " FEE€.?.g o:OE d gz't oF oo oi\o oo t-- n C\lIr- a rr c.lin\o o\ c.l co o\ $ o\Nc\ c\$ €(a N o\ o\ (.l(a) c.t co (n .f c! cn o\ @$ \o ra to6t $ r-(n @ aa r-. eO r.} c-l\ N @\a \oa\o r- o\ol il >9., E =.o=:6 g);EE*I E E3H5 o>-6 .9oib0 ^ G^EUSb0a- Ue ?E -_ # =!'fi=Es!z6 o -Ee6 o.=486 ==ot gFFqJ U) c) oO o c.l6t(a) \o\o e.) \o r-- =\o o.lNtar \o\o c.l \o Itr t\o C\C\ta \o\o c.t \o I-r t\o .3s ;q r!() zoa (, z FA z B rI] o D Fl Fl 3 oF Ludewa district was able to conduct CSM and SHM in three villages while Mbinga conducted CSM and SHM in two villages. Songea district did not conduct this activity due to lack of funds. It is very encouraging to note that all districts have included budgets for CSM and SHM in their Comprehensive Council Health Plan (CCHP's). The number of absentees has further dropped compared to the last distribution. This has been attributed by the intensive advocacy carried out by each district. Also the number of refusals is much lower compared to last year. In case the project has no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report ./ 20 WHO/APOC, 24 November 2004 $ o c.lko -otr (.) o z$ a.t do oE N a) s. q) "s o' Lq) .o Lq)q * -:. 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F- o\N o o0 co c) oO I Ti H rI ti ooS- - O6\< B-o oo o o =oq $e $s,[Oel.l o oo o r.l qoO'E Ep'I o Y=dtEg zoa N co cn .f $\o *\o ta :o do.a =E-E d.=<.sf Fv c! c.i ao t+\o $\o 3 -; o !=.= 6 I;3 *e irtrotsO=oiiti tr !2E co o a.l ca cO s\o g E -i r- o\ o\ @ o\ o\ o\ o\ o\ at N c.l c.l c.l o.l \t c{ a..t \o a^l F-o e.l @ c.l o\oo a.t N sa c.l E 0)! E c) o z$N A o F c) a0 GLq) oIg t'r GI ti 6l o 0)E o C' 6l c)tr a0 U) q) at) c..l c-l e .lS \q)L s.q) q)s a?) Bq,) s qri c)L 6l I c) otra oL q) 0) Lr € L(! C) ul6lEI trlol (Bl ol >l -ol c) 00 Lr c) oI (o U) C) C)L.F orr()l -ol(€l FI 6l c) >. q) L I q) c) C) Iq) oL F n Q q) o) q) I 6l Q) Gq) o q) L3 ra \o N a{(a €!C al I 6l c)L cl () o) L q) L .o F D q) q) cr-e)0 E.= a)s ed OiU 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH{ WHO UNICEF NGDO Other (please specifo): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOII { wHotr UNICEF! NGDOtr Other (please specifr) Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan retirement by filling in the ordering forms and sending them to the National Onchocerciasis Control Task Force in the Ministry of Health. o The NOTF Secretariat went through the Re - Application Forms, approved them and then send it to Mectizan@ Donation Programme (MDP) . The MDP scrutinizethe Form and send the drug to the Ministry of Health through the Government Clearing and Forwarding Agent inTanzania. (Medical Store Department- MSD) o The MSD notify the NOFT Secretariat on arrival of Mectizan@ who then informs the Project Coordinator also. o The Project Coordinator collects the drug from the zonal Medical Stores Department and enters the received drug to the Regional Pharmacy. o District Coordinators makes orders from the Project Coordinator and distribute the drug through the normal channel of the Government system to the health facilities according to their requisitions. o FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan@ . They come for collection and distribution to the community member in the entire area Table 3: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining Ivermectin tablets collected and where are they kept? The remaining tablets were collected from the communities and returned back to FLHF then the DOT'S or CHMT members collected them and bring them to the district pharmacy where they are stored. Region Number of Mectizan@ tablets Requested Received Used Lost Waste Expired Ruvuma 8 17,500 817,500 646,948 4,881 0 NIL TOTAL 817,500 817,500 646,948 4,881 0 NIL 23 WHO/APOC, 24 November 2004 List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. Activities performed by Health personnel in handling Mectizan@ o Supervise census update in his/trer catchments area. o Mectizan ordering by filling in the forms and sending them to the District Onchocerciasis Coordinator. o Makes follow up to the District Office. o FLHW inform the sub-village leaders and CDD's about the arrival of mectizan. o Organize and attend mobilization and sensitization meeting to the community members o They come for collection and distribution to the community members in their area o Conduct supportive supervision during Mectizan@ drug distribution to CDD's. o Data collection and report writing and send it to District Oncho Coordinator o Conduct feedback meeting with community members. Any other comments NONE 2.8. Gommunltlrself-monitoring and Stakeholderu illeeting Has any training (of trainers) for community self-monitoring been done in the project area? YES If so, When? Community Self-monitoring was conducted in Ludewa and Mbinga districts after the distribution cycle which was done in October, 2005. 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: Ludewa district was able to conduct CSM and SHM in three villages while Mbinga conducted CSM and SHM in two villages. Songea district did not conduct this activity due to lack of funds. It is very encouraging to note that all districts have included budgets for CSM and SHM in their Comprehensive Council Health Plan (CCHP's). Maintaining the coverage rate of above 70%o in Ludewa and Mbinga districts shows that CSM and SHM have good impact on the results. DistricU LGA Total # of villages in the entire project area No of village that carried out self monitorins (CSM) No of villages that conducted stakeholders meeting (SHM) Soqgeq It4blnga Ludewa r06 29 35 0 2 3 0 2 3 TOTAL 170 3 5 24 WHO/APOC, 24 November 2004 2.9. Supewlsion 2.9.1. Provide a flow chart of supervision hierarchy. NOTF J RMO Iringa J JRMO Ruvuma DMO SongeaJ PC J DMO Mbinga J DOM LudewaJ District Oncho. Coord I DOT'S J FLHW'S J CDD'S J Community 2.9.2. What were the main issues identified during supervision? Worn out of Registers. In adequate CDD motivation. Lack of IEC material Improper recording in treatment registers in villages where the CDD was new Few staff at FLHF 2.9.3. Was a supervision checklist used? Yes, APOC developed check list is always used 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Levels concerned gave a positive answer to improve their performance during the next distribution. 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? o Ludewa District Executive Director has replaced the worn out registers in 74 sub villages. o Community members were encouraged to provide incentives during distribution. r The approved 70 bicycles from APOC will greatly motivate the FLFH staff o The District Executive Directors of Songea and Mbinga promised to release funds in the next financial year to purchase registers 25 WHO/APOC, 24 November 2004 SECTION 3: Support to CDTI 3.{. Equlpment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO:Written ofO. How does the project intend to maintain and replace existing equipment and other materials? The existing equipment is maintained through the normal process in the Region. Repairs and services are carried out using funds from the hospital and from the NGDO partner- Sight Saver's Intemational. SSI has provided the project with a new S/TV MITSUBISHI - Pajero to be used for both eye care and onchocerciasis activities. The man power situation in all the three districts is now stable. They have been highly trained in CDTI activity implementation. The DOC for Ludewa has taken his position after graduating in post graduate diploma in medicine thus strengthening the oncho staff in the district Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 2 IF lCNFR 2. Motor cycle(s) 7 5F 2CNFR 3. Lap top Computer I F 4. Printer I F 5. Photocopier I CNFR 6. Fax Machine I wo 7. Others a) b) c) 26 WHO/APOC, 24 November 2004 Contributor Year I (2003') Year 2 2004) Year 3 (2005') TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) MOH (Central * ProvinciaVState) 31,399 -11 ,.199 31,399 -r 1.399 31,399 -31.--199 MOH (DistricVLGA) t't,'199 18,860 15,000 12,000 t1,373 8,000 Local NGDO(s) ( if any) NGDO partner(s) r0,000 8,1 00 9,000 6,000 22,700 10,900 Others a) b) Communities APOC Trust Fund 31,369 20,440 0 0 0 0 TOTAL 88,936 81,202.5 90,567 78,799 65,472 50,299 3.2. Financial contributions of the partneru and communitlei 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? The project has not received funds from counterparts for two year now. The project is mainly depending on NGDO partner and Council. - Additional comments: Letters of Agreement between MoH and APOC was received and it indicate that the period covered is from I't November, 2005 to 3l't October, 2006. We are thankful to APOC Management for this support and funds will be used to implement CDTI activities in 2006. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) o The CDDs are exempted from the public works especial during distribution. o Community leaders and CDDs collect Mectizan from the nearest of the FLHF o If there is any work in that particular village which involve payment CDDs are given priority therefore act as some sort of support to them (eg. Distribution of Vitamin A supplementation) 3.4. Expenditure per actlvifur lndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here lUS$: TSH.1,000/: 27 WHO/APOC, 24 November 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainability of CDTI 4.1. Internall Independent partlcipatory monltorlng; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) None Year I Participatory Independent monitoring None mid Term Sustainability Evaluation None 5 year Sustainability Evaluation None Internal Monitoring by NOTF None Other Evaluation by other partners None Year 1 Participatory Independent monitoring 4.1.2. \ilhat were the recommendations? NONE 4.1.3. How have they been implemented? NONE Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of gqlqry!ry Mobilization and health education of communities CDDs health staff at all levels CDDs and distribution 500 MOH 4,000 SSI 4 , 500 COUNCIL/S SI 2,112 Council 1,200 Council/SSI 0 COUNCIL SSI SSI 0 0 Summary (reporting) forms for treatrlent Vehicles/ Motorcycles/ bicycles maintenance O ffi c_e lqu rp rngnt _( 9. & collqputers, printers etO Others 900 4,200 900 TOTAL 18,312 MOH,SSI& COUNCILS Total number of persons treated 213,811 28 WHO/APOC, 24 November 2004 of Monitolinga4d Evaluation CDTIof activities to andhealth authorities IEC materials