Phase 1 CDTI annual project technical report to technical consultative committee (TCC): Jan 2007 through Dec 2007

RESERVED FOR PROJECT LOGO/IIEADING MINISTRY OF HEALTH , a ORIGINAL : English '-l a Cs!It 1w bi c> 60P A*€ 8fo ici i;b-=::;ilon Tor COUNTRY/NOTF: UGANDA Prqiect Namez PHASE 1 CDTI Anproval yearz 1997 Launchins vearz 1997 Reportine Period Month/Year)z JAN 2007 THROUGH DEC 2007 Proiect year of this report (Circle Oue) 1234s678e (1) Date submitted: IULY 2008 NGDO partner: THE CARTER CENTER AND SIGHT SAVERS INTERNATIONAL t 3 c JUIL 200$ i WHO/APOC, 25m October2005 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 AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) a a I I I I ll wHoiAPoc, 25n october 2oo5 rANNUAL 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: _aGANDA National Coordinator Name: Dr. Richard Ndyomugyenyi Signature Date NGDO partnerlZonal Oncho Coordinator Name: Signature Date This report has been prepared by Name: Dr. R. Ndyomugyenyi Designation : NOCPCoordinator Signature Date lll wHo/APoc, 256 october 2oo5 1.1. GeNeRAr.rNFoRMATIoN............. 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. Popu1nrroN............... SECTION 2: IMPLEMENTATION OF CDTI....... .......9 4 4 6 7 a 2.1. TIupt tNp oF ACTIVITIES .............. 2.2. Aovocacv ..........t2 2.3. MoerLIzetIoN, sENSTTIZATToN AND HEALTH EDUCATIoN oF AT RISK coMMtxtrms 12 2.4. CotrauuNIryDn/oLvEMENT......... ..... 13 ..................... 9 2.5. CapecnvBUILDING 2.6. TnrnrunNTs.............. 2.6. L Treatment figures ........... 15 17 t7 2.6.2 What are the causes of absenteeism? .......... ....'............20 2.6.3 What are the reasons for refusals?................ ...........-... 202.6.4 Brie/ty desuibe all lcnown andverified serious adverse events (SAEr) that...20 2.6.5. Trend of treatment achievement from CDTI project tnception to the curuent year22 2.7. ORoeRtNc, sroRAGE AND DELIVERY oF IVERMECTIN 24 2.8. Covltxtry sELF-MoNIToRING eNo SrarrHoLDERS MrerINc....... 24 2.9. SuppRvIsroN ........26 2.9.1. Provide aflow chart of supervision hierarchy. ............26 2.9.2. What were the main issues identified during supervision?................ .............. 26 2.9.3. Was a supervision checHist used? ....'.-....-.27 2.9.4. What were the outcomes at each level of CDTI implementatton supervision? 27 2.9.5. Was feedback given to the person or groups supervised?... Erreur ! Signet non ddlinL 2.9.6. How was the feedback used to improve the overall performance of the project? 27 SECTION 3: SUPPORT TO CDTI -.............27 a 3.1. 3.2. 3.3. 3.4. EqurueNT....... FmaNcw. coNTRIBUTIoNS oF THE PARTNERS AND coMMLINITIES OrseR FoRMS oF coMMUNITY suPPoRT............ ExpeNprtuRE PER ACTIVITY 27 28 28 29 SECTION 4: SUSTAINABILITY OF CDTI....... ...........29 4.1. INrenNar,; INDEIENDENT IARTICIPAToRY MoNIToRINc; EveluenoN 29 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)............ ...........29 4.1.2. What were the recommendations? ............. 30 4.1.3. How have they been implemented? ............. .................30 4.2. SusreNAeILITy oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT................ 30 lv WHO/APOC, 25e October 2005 4.2.1. Planning at all relevant \eve\s........... 30 4.2.2. 4.2.3 4.2.4. 4.2.5. Funds........ Transport (r eplacement and maintenance) ...... Other resources.. To what extent has the plan been implemented ......... i0 .........30 .........30 .........30 ......... 3 I ! 31 4.3.1. Ivermectin delivery mechanisms................ .................. 3I 4.3.2. Training.... .............. iI 4.3.3. Joint superviston and monitoring with other programs.... ............. 31 4.3.4. Release offunds for project activities ........ 3I4.i.5. Is CDTI included in the PHC budget? .............. ........... 31 4.3.6. Describe other health progrommes that are using the CDTI structure and how this was achieved, Wat have been the achievements?............. .................... 31 4.3.7. Describe others issues considered in the integration of CDTI. ..,.. 31 4.4. OpenarIoNAL RESEARCH .........32 4.4.1. Summartze in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project?......, SECTION 5: STRENGTHS, WEAKNESSES, CIIALLENGES, AND0PPORTUNITrES....... ................ 32 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........33 32 32 V WHO/APOC, 25ft October 2005 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-D irected Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Govemmental 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 I vl WHO/APOC, 256 October 2005 Definitions (D Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (iD 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 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 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) Geoeraphical 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) Communi8 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. vii WHO/APOC, 256 October 2005 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session TWENTY SIXTH SEESION (Please add more rows if necessary) 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY I The project needs to provide details of Jinancial support from NGDOs Provided in thes rcport 2 More informalion on semi- annual treatment and plans for elimination is needed, as well as the effect of inlegration of NTDs on this proiect Provided in thes report 3 Overview of utilization of Mectizun tablets needs to be imp rov ed, w ith accu r ate data and information on how many tublets are remaining at the end of distribution Provided in the report 4 Executive Summary WHO/APOC, 25ft October 2005 tPrepare an Executive summary of the report in not more than one page. l. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. 2, Background on population movements 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. This report covers the period of January to December 2007 for phase I districts (Hoima, Masindi, Bulisa Kasese and Kisoro districts). Bulisa is a new district, which was created from Masindi districl The total number of communities in the project areo wos 406 with a total population of 283,385 people. The NGDO partner in Kasese and Kisoro is The Carter Center QCC) while the NGDO partner in Hoima, Masindi and Bulisa is Sight Savers International (SSI. These distric* started implementing CDTI activities with ftnancial support from APOC in 1997. The districts were evaluated for sustainability in June 2002 after five years of APOC funding and judged to be making progress towards sustainability. Thereofter, the districts developed sustainability plans, which they have been implementing using local resources supplemented with those ones from the NGDOs partners. These districts are in the llth year of CDTI implementation and all started semi-annual treatment with ivermectin in 2007 except in Kosese, to eliminate onchocerciasis in those areas. Onchocerciasis foci in these districts are isolated and elimination is thought to be leasible except in Kasese disttict where the focus extends to DRC and elimination therefore not feasible. Treatment coverage Geographic and therapeutic coverage in phase I districts have remained high with 100% geographic coverage in each district The therapeutic coverage values for the tirst round of ivermectin treatment in April 2007 was 70%, 81%, 79% and 78% in Kisoro, Hoima, Bullisa and Masindi, respectively. The coverage values for the second round were 7396, 83%, 82% and 76% in Kisoro, Hoima, Bullisa and Masindi, respectively. Treatment coverage in Kasese was 84%. The annuol treatment objective in the project area for semi-onnual treatment districts was 161,659 people ond 157,105 and 159,804 were treated in round one and two, respectively, giving ATO coverage of 97% and 99%. Training A total of 1,367 CDDs were newly trained while 1,296 received refresher training giving a total of 2,663 CDDs trained in the reporting period 2,663 CDDs were targetedfor training and 2,663 were trained giving an achievement of 100%. The total population in the project area wos 313,836 people, giving a ratio of 118 persons per CDD (approximately 17 households per CDD). A total of 356 health workers were targetedfor training and all were trained giving 100% achievement. Those who were newly trained were 193 and 163 r eceiv e d refr e s h e r t raining. 2 WHO/APOC, 25ft October 2005 Integration CDTI activities are being integrated with other health services especially, support supervision and monitoring using the same motor vehicles and other logistics and Mass drug administration. The interventions being co-implemented with CDTI in phase one districts include schistosomiasis, Home management of malaria, Soil transmitted helminth infections and vitamin A supplements to under-Jives. SWOT analysis Strength c The CDTI programme has built a strong structure, which has been exploited by other community, based interventions. The structure includes trained drug distributors, community supervisors and health worhers. All phase one districts are also beneJiting from USAID grant for integrated control of neglected tropical diseases where ivermectin distribution is being integrated with albendazole to control soil transmitted helminth $fH infections and Praziquantel for schistosomiasis control. Schistosiomiasis is co-endemic with onchocerciasis only in Bullisa and Hoima districts while STH is co-endemic with onchocerciasis in all the districts of phase l. Weaknesses o There is no set time when ivermectin will be stopped This makes advocacy diffrcult especially among the young community members who have no experience with signs and symptoms of onchocerciaisis. Opportunities o Currently there are many interventions, which are using CDTI as a vehicle to deliver other community interventions. These in turn come with many opportunities in form of intrinsic incentives These interventions provide avenues for integrating with CDTI and the CDDs getting intrinsic incentives from those other programmes, especially those, which are perceived by community members as priorities, like malariu Threats o lYhile other community interventions provide opportunitiesfor CDTI, they can ako be threats if not well harnessed Because some interventions come with incentives, the distributors of ivermectin are likely to abandon CDTI for the above interventions. Challenges Although Creation of new districts decentralizes services nearer to the people, it has challenges. There are increased administrative costs to the CDTI. For instance, the district coordinator of the new district together with his/her team needs training on CDTI. Secondly, the new coordinator needs transport (motorcycle) to facilitate him in supervision and monitoring of CDTI activities in the communities. Conclusion CDTI activities have continued with good coverage in the distric* implementing semi- annual treatment and annual treatment. This has been boosted withJinancial supportfrom The Cater Center, Sight Savers International and the integrated control of neglected tropical diseases with supportfrom aSAID through RTI. J WHO/APOC, 25e October 2005 SECTION'l: Background information ,/1.1. General lnformation 1.1.1 Description of the project (briefly) - Geographical location, topography, climate - Population: activities,cultures,language - Communication systems (roads...) - Administrationstructure - Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). - Number of health staff in project area and number of health staff involved in CDTI activities. Phase I CDTI distric* are located in western Uganda (Hoima, Masind, Bullisa and Kasese) and Kisoro in southwestern Uganda Kisoro and Kasese districts are highland areos. The main activity in phase I districts is subsistence farming. The road network is generally good in all the districts. However, the road networkfrom the district headquarters to onchocerciasis endemic areos is poor especially in Kisoro ond Kasese districts where the roads become impassible especially during the rainy season. Organization of the Health Services The Ministry of Health has two Directorates namely, Clinical and Curative, and Planning. All the neglected tropical diseases fall under the directorate of clinical and curative. Since 1997, Ugandan government adopted decentralization policy. The ministry of Health provides policy, guidelines, standards and supervision. Decentralization takes services and resources nearer to the people, eases decision-making, improves accountability and creates a sense of ownership. At the district, octual implementation of health care is further decentralized to the health sub-district level and lower level health centers. Wllage health committees are set up and depending on the size of the village, there are 9-15 village health team members. Most of the village health team mcmberc are the distributors of ivermectin. Health indicators Infant mortality rate is about 100/1000 live births, child mortahty is 16/1000, totalfertility rate is 7/woman,323 populations per nurse,life expectancy is 52 yearsforfemales and 50 yearsfor males. 50% of population lives within I0 km of health unit although most health un its a r e un d e r s t affe d. Healthlinancing Poverty eliminotion Action plan (PEAP) in place: reduce povergt, Universal Primary ond Secondary education, Primary Health Care,Improve communications and debt relief, Central governmentfor health is about I5%. Estimated per capita on health is U.S$ 30-40 and only US$ is provided. The heolth budget is overwhelmed by the 3 major killer diseoses (Maloria, HIV/AIDs and TB). 4 WHO/APOC, 25tr October 2005 Organlzatlon ol heatth servlces in ltganda (the chaln of command) YV 5 Development Partners Ministry Of Health Other line minishies Referral Hospitals District Health Office District Hospital HS Health Centre III Health Centre II Communities (Health Centre 1) WHO/APOC, 256 October 2005 TI Table Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of heelth staff involvcd in CDTI rctivities. Total Number of herlth strll in thc entire project rree Br Number of health staffinvolved in CDTI Bt Pcrcentage Br=Bzl Bt *100 Hoima 80 24 30 Kasese 464 162 35 Masindi 20 l0 50 Kisoro 27 t4 50 Bullisa t0 6 60 Total 601 192 32 1.1.2. Partnership Indicate the parhrers involved in project implementation at all levels [MoH, NGDOs(nationaVintemational), communities, local organizations, etc.] Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Implementation of phase I CDTI project is in partnership wilh NGDOs namely, The Carter Center assisting in Kasese and Kisoro and Sight Savers International (SSl assisting in Hoima, Masindi and Bullisa districts. A total of 408 communities are involved in CDTI in the Proiect ore& The communities have continued playing their leading role in organization and execution of CDTI activities, The partners work closely in advocacy, monitoring and supervision, planning and review of the performance of the project. 6 WHO/APOC, 25ft October 2005 r- ra)oo c..l Lop o o € ra) N d A o 'l o(l) 'a lra 0) ({-i o 0) (ti olrg os .13 (d!t)k 0)E)q (.) u) F oi o0(d >#r{UoFl >rv EPJHHtr Ccl9-OE(., 9'5 o2g3 .EdB9 O(r()oHs BE ooEErHdE9 'o a) o)Ebo:(d6 - 'r,'5E o(d -(l) ,\k .ts(ttr<> E6.tr(dLiLob0oo a(Dtr bI) oCE ,U,(D .r €b bo'=tr= tiQ gb(Eo o; l-r 0)HH I I I I .h o G)aU) do LJt e lr(D o I I I I +. Iol ol €R'9ft (d €l ol ,tl €lcl(dlHI €l o9 EV)lrBvo E= t.EU)ts Atz&1.. .e8LKE5(! 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SE .o qfe' Beg sEE sio ssE \ECg EqJE .E*& .ts o 1!S € ErE 'et € Ei €S-B Ssbt\ ,E $EE brtr k.s .9 iE!6 *<tr .Y\E ES .E ..8 & -E EEE i.\ - qr\.A :.8 o '3'i s $s ,9 ds @ SEGTION 2: lmplementation of GDTI 2.1. Timellne of actlvltles Fill in table 3 , timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 9 WHO/APOC, 25ft October 2005 Eo ot(l) o a o 0)e o.= EE U az oz o z o z En.?E v)- >. >' h >.a o E L rh E OI L a o o q) g oQ oz o z o z z .Hs?E 6= o o () o oo o I 6l e ah a2 Eq)(, o EEQ ao cn q ru V) q oq) a()a EOE& 1iE rh- a()a q o(A a.()(h ao(n u! E 6llrtr o EE Q o. c)a g o u) r()a a C) u) .He 6: aoa q() v) o(l) v) aoo r: vaD r(l) .E .E s= EEoolr9ta o (l)? o.=EEo- U o0 b0 b0 oo P. an: >. a >, I Fl I L v) d H o E U) G, ol<o ./) u c,t/) pa Fl tr t''r o ot lrlI)p o o o ol O oq > q) Lq) (r._ o' \\ oUq) Va q) L\ .\A B vtq) \)q) \- ra: o\p o N B a) F; s) e. 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La La q) GEQ at) U) E 6) U o E o (l) o(J Eo d z oL(6 z oLd A ok R! o d h0EE 1i E d:(n- oL(g z C)L 16 Eo oL(d to GI ur E El clLH o o rU E oI o (d E c) H o (d o (d () (d 2 EOtrE 1iE d= oLd A () d C)L G, oL G, z o H fH v4, r€) .E'E s= EEoo =(,2 o EEI p(u frr €() trr p orr p(l)fr !(u tri .Hs *,E 6= aE tr GI d(U tr(, (6 dGI (, Fl I L o a cB o €tr v)d ot)()(n (U V oLo v,g CO(n EA Fl Fr otr E o o t(l) e (a rnooNlr o)p o o o N d oA > d tr c) E E o c) L(l)E l- =t I Ei 6l a xq) o ar) 6lq) e o tr i: tr cl ro q) tr sl e an CE E(l)! 6l E\Sq)Q) Ett 9 vr' 6)YEs8* +jts >Q)tsic€I =s)crs +i5 c)qa+. q)8E .l >. E'r .rE 9q)fr{r t\ 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. There is political and technical will to control neglected tropical diseases and eliminate some of them where possible. For this teoson, H.E. The President of the Republic of Uganda represented by the second Deputy Prime Minister, launched the elimination of onchocerciasis in Uganda in Januory 2007. W ogencies, The Carter Center, SSI, district offtcials and APOC management attended the Launching. There has been sensitization of political leaders in the districts of Kisoro, Masindi, Bullisa and Hoima on the new policy of semi-annual treatment with ivermectin. Elforts have been made to devolve some of onchocerciasis control functions to the new district of Buliisa, which was creoted from Masindi district in 2006. The districts have pledged to support elimination of onchocerciasis through semi-annual treatment and promised political, technical and Jinancial support in order to achieve the objective of elimination of onchocercias is in thos e districts. 2.3, Mobillzatlon, sensltlzatlon and health education of at rlsk communltles Provide information on: - The use of media and/or other local systems to disseminate information - Types of IEC materials used - 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. The CDDs, communigt supervisors and health workers sensitized communities about CDTI activities, Other means of mobilization and sensitization include addressing community gatherings such as markets and messages on CDTI passed on to the people through places of worship, video tilm shows and drama groups. The response of the target communities has been good ond the turn up of eligible population for heatth education has been satistactory. IEC campaign is a continuous engagement that peaks when ivermectin is about to be distributed IEC campaign is facilitated by posters, which show the symptoms of onchocerciasis. However, as the symptoms of onchocerciask disappear among the adults, the youth may not perceive onchocerciasis os a serious health problem and become less compliant due to poor knowledge of the symptoms or clinical picture of onchocerciasis. There is an urgent need to revise the current IEC materials to suit the current situation of onchocerciasis in the communities, in the light of the disoppearance of signs and symptoms of the disease. Many people in rural villages have radios. It might be worthwhile having radio jingles although this is expensive and most women do not listen to the radios due to their heavy schedule of work. t2 WHO/APOC, 25ft October 2005 2.4. CommunlQr lnvolvement There is generally high community involvement in CDTI activities e.g. community members selecting their own CDDs and the CDDs and village leaders collecting ivermectin from the nearest health facilities at the time of distribution. Due to few health workers to provide training and support supervision to the CDDs, many community members (retired civil servants and school drop out) have been trained as community supervisors. This has improved CDTI activities in phase one districts, especially in training, community mo b ilization, mo nito rin g and s up e rvis io n. Table 4: Communities participation in the CDTI (Please add more rows if necessary) NI: No information on CDDs by gender Comment on: - Attendance of female members of the community at health education meetings Participation of females is adequate as evidenced by community meetings where women attend the meetings in large numbers. The NOTF po@ of having two community supervisors (one male and one female) per community has ensured that women are not left oul As shown in table 4, from the districts where the number of CDDs by gender was available, 38% of the CDDs were females and all the communities have at least one female CDD. Mobilization witl continue to ensure that more women participate in CDTI activities. - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Female's participation during community meetings when CDTI issues are being discussed is high and their decisions are respected. - Incentives provided by communities for the CDDs CDDs have continued to ask for incentives although this does not stop them from pedorming their duties as CDDs. Among the things they are requesting are T-shirts, boots and bags to carry medicine and registers as they move in the communities distributing ivermectin from house to house. These are genuine demands, which partners should consider providing because it is a one off supply, which will motivate the CDDs to workfor many more years. However, despite the demandfor incentives, the CDDs have continued to perform their work. District/LGA Number of communities/villages with community members as supervisors Number ofCDDs Number of communities /villages with female CDDs Total no. communities in thc entirc projcct area B. Number with community membcrs as supervisors B( Percentage Br= BJ B. *100 Male CDDs Bz Female CDDs Br Total Be= B?+Bs Number of communities with female CDDs Bt Percentage Brr= Br/Br* l00yoHoima 140 140 l00%o NI NI 486 140 Masindi 60 60 100% 197 162 359 60 l00o/o Kasese I J 1 1 3 1 t00% 538 24t 779 I aJ 1 1000/" Kisoro 45 45 100% 598 238 836 45 l00o/o Bullisa 30 30 l00Yo 134 69 203 30 100, Total 406 406 l00o/o 1467 710 2,663 406 100, 13 WHO/APOC, 24 November 2003 - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Attrition rate of CDDs is generally low in phase one districts and this is not considered as an issue. Other issues t4 WHO/APOC, 25ft October 2005 2.5. Gapaci$l building - Describe the adequacy of available knowledgeable manpower at all levels. Training of health workers and CDDs on CDTI was carried out, with financial support from the Cater Center QCC) and Sight Savers International (SSI) and USAID through RTI, which is supporting integrated control of neglected tropical diseases. A total of 2663 CDDs were trained (Table 5). Overall, there was a ratio of 118 persons per CDD (approximatety 17 households per CDD in 2007. This has reduced the workload of CDDs and the demandfor incentive. The health workers are generally knowledgeable on CDTI at all levels. However, the health workers are few and overburden by curative services at the health facilities and this makes them unable to provide adequate support supervision for all community based health programmes including CDTI. For this reoson, community supervisors have been appointed to assist in supervision of CDDs. The community supervisors have continued to work without payment although they are agitating for incentives. Some of them were provided bicycles by APOC and this hos been an incentive for them to continue doing their work os community supervisors. A total of 554 community supervisors were trained during the reporting period in phase one districts (Toble 5). - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementationwhere not enough lvtowledgeable manpower wos available or if staff are frequently transferued during the course of the campaign). There were nofrequent transfers in phase I districts during the reporting period a 15 WHO/APOC, 25ft October 2005 c.too c.l Lo -o E(D o z .t N () o Or o +{ > \o ll oo€ 'S .s :s €\ s.st .,r$s *r 13sB ss rFr '={ sp se S .s' .* SiEsU'$r .EEt o!S: *ri I l''.. h.EH € sY E $,sd3o"96,s gtt oF s5\,l S 'riEc.3G.ESF ESrqr lt.Sr)-!t atx E'F .'ESEo . T.T s,3t i Hs g [.} 'Eah-. ,I g *S Esis ETN S; SY P €t$tt&ts s o t E P 6 a € o tt o s :i o * P\o o a .o s E B 9 t\ t F it + -\eB% U2 a)uq) S U2l o\ q) T\ o ts q) 4B s) s o d () () a F aO o U) o) o tr(,) Lr -oqi .d (D P(E a0 dLF .iit o-rl -ol'd FI I U il oF +.o'q i * \o oo$ r.) c.l la) eo ol o\trt'- rn c{ stal N o\!f c.l o\ ra rn \o cn 00 t'.la) C-l o\ cr rn $ cooN o\ oo r-.\ot) ('l\o\o cl \o o\N 1'q) E GIL o o e(.) o frq) z Fd \o00v o\F-r- o\ratco \ocr)6 c.)c-.1 ('l\o\o ol sQc o (l) 6) I o\ S.iqv o-:+ 'U io *ol Frr- c-lo r- t- ca co t-. ro ca o N c{ \o @r- oo c.l co c.l r+ ia l.a OI ol ra GItl o ahtrq) ,1Gttlfi!bLfro: 90oq) *!9 r- cloLE- z IF r-t-. r-c.) co c.l \oo cq !l,ol,o cc q) q) (l) I r€ c\ IrL I a o t< + U o*.q dit o(.) o\ c.l c.l NtaN $ cn oo o\ o N c-.1 ol c.l$ ool c.l c-l o $ \o fa\o (a o\ \oin r.)o -E dL TE!svzD 3E E> 2E oI (J o F orr) c.l caN c..lN Nsf o \oia(.l o Eo 6J e) s c\ ti+.q $-9 E,r?F-(5 z co c.t o o z tl cn z z co tl z ol ol GI GIcl .A ch I FI3z9(t) LH;'e aij L oE z (,F co o ca ca c.l ct (J S .9 q2 a cl .E o oooq C,V 'otr d a oLo0 M dq =lq Fl F o3 o q) (l) I -oo\ 19 a Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifu) Table 6: Type of training undertaken Qick the boxes where specific trainingwas carried out during the reporting period) Any other comments 2.6. Treatments 2.6,1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project is achieving 100% geographical coverage and therapeutic coverage is now stable and over 70% in all phase I districts. With supportfrom The Carter Center and the Ministry of Health, all phase 1 districts started implementing semi-annual treatment with ivermectin with a goal of eliminating onchocerciasis in those districts. As shown in Table 7, treatment coveragefor both rounds of treatment in 2007 was high. t7 WHO/APOC, 24 November 2003 inoo c.l L o)p o o o E c{ (J opr o @ d c,)\) L a) s Eq) B T E B sol691 .3 8J xlE $I EIE EITI$ El fl$ El€iar o0 r-lI Rl .81 .EdEl * E €l Et$n $. E €l$$ S. $ Hl $t t f flE ss E E El $ ss s f El i sE F S EI E : A€E E fiiEEE E z z z z z z O r') €< ,v) Ao z z z z z z bs!trco 3Dzd z z z z z z E;r#c E['6E z z z z z z tr o cl aa o Or il rix\oo\ (J 'Eo ,hDC)d s.bqro F()F r o.lH caloo€ rN oo \of- r- :f,oo <alO c.tr- F- rN o\ (\If\€ o\ef-€ ! ,*9 od L ,q)()E 9oHtr EAAE a < a.l\a r\ oo O\qo^\o o\ €oo r c.l\o olr- O\f\ f- HO co c.t (n F-c*t- o\ rNt c.l\o ol\\ *Ol ol ol < e.lOco €o\\o# \o tr- .Ih&\ N i;"f fr a tso d o.=5trlil E E.S < gP'FU oo r- oo o\\o co ca rn oo o\ c.l -t: sol rn r- e 6 o\la(\l G69 *8 -^*6S'.i c) hoo (gE<'= ' a 8go cxo -6 o\ \oo ola)q o$ Nf-$ ra o co $ 01\ool \o(a € ?a (., oo hI) GI u,o c tr ts oO ll * a 8 Eo., io0 .CL F EO 4066(J o sOo soo sOo soo soo so - qB _8 E Sfrtr e= ii = E's 15 a4o o o .+ o\o c.| \a$ c.) \oe = tso ct O.=zEAE E.g < gf' o!+ o\o ca \n$ Ocn \o !C :3€ * t eEcfiE" . 8E E E o$ \o ca \.|.+ oco \o $ .E<gq E< d E o rd v)(l a C)t, o C'') ad M o o U) u cl v) EA Fl tr oF t n S viq) Uq) \- U't > L q) L -x B q) F5vq) E JZ cn Lr (d (r)(d o (d (B tr Fl o k v) t >.s v) r! a E d tro E (g 0.)kF r-t orl -ol'ct FI ta) o c.l L(;)p o oo ol oo Oi{ o rri > o\ u Eb E clq E$ c, Oo *,! E E{ !i s 's s\i,*$s .SsooiEj .si .stsEiq,S EE tE :$lJllSE .S 'B ii "E s$C. Eq)F ETfl ts': RHE X\S:L E Ei .c Fis \sF -{:b 3-BS :E d \rss s*i EtE! U qr s- Qla 'i 6o : $\ EB$ r s$\ SsT EEr ist sfiE .i.P 's sa,s siJl rErt\ t-=' rr ttSP PS\ .s F D (d oL(! oo 'E a o B U) € C)Ld o o troIo o. >t o(n C) ; o) (d ^,oot € -l oxlf !I .IJEl -c,EIE!l I9l a 3ts6l pol(u ol 3 ol EHl =3l trtrl Gi 5t Ezt? olOI -l oxt > EI Edl '=rg6 sl EoI(Dol trol l=Ol ilr :lt _8tE EI E zl< (g c)L Cg Po G) 'a tok6)*h-3 €€oo.= 'AA f.v o iri €a .: .B' € U -(n :1:o= .Eotr-o d t)trd F6Fc) oij(.) 'E)E ot tro ot ='O -l EI xl B -r tt E. €I E>, gl6(r !l 'OA alc,6 g)Jos -El * =l o-tr >t x s Els .= +jl u)i EI Ec Elqo tsl oEIH 9l bvtA = ql =o. oltrO r-l Io- oltr: st - 'Gr trl (n b .=l oF Zll- I () 0) o(d F s o (d (!) b0!0^ 9Eoo oF o €6tr o)b0(€ (l) oo (d .i/^ ro .)i rog\. E 9\- G! h0 oo(5 2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasons for refusals? 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 20 WHO/APOC, 24 Novemb er 2004 n $ooN kostr() o zs c.l (J oA o !S qr\ 0o s$ c) d !o €\ql (.)(J S !J !.rEtsr '_H $ E..! s3 ,t .s o'u $6' "QaSUS! e(l x-Ss< Lq) V) * e a4 14q) uq) q- 14t oT\ a):\ N\l a) $q) QJ o l<(uA b0 tr f og(l)k(l) b0 tr Lrt .o (l) E C) C) o CdE U)H a a do o c)alro .t,(! v2 o o(n(+{ o oo U)(B O <iir 0)l -ol(ltl FI c.l =Ep€ E <.E E \a ;PoB €€ EGtoi, 6 s= X E.EILIoo (H o or .9E89C EBO 90. a a(1)rqE oP -7E Eq)-c tr&9d il *E 8 -o.9E6 o c tr= E€TE o!:'a >,v a-d9' o'l :j 5E I !S'6O H -H,.8 t d €.999'EEE€.U8iH-8E> 0 Eo a E a trE .LE Hol+q):H Ad h.. s H9) .N -6 rDb-^ EE E (H o (l) ooc6'H -oO >5 x()a (l) b0 * 4a o0 .- c! 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" u€ -o H6H colat ct NN ot o o\\ cr c.l ca$\o" cnNN (n a € t-. c.r ol$tr){$ o.l \o € o\ ra)\o N € o\tr- c.l $sc! c.lF- c.'l oo o\\o^ $r-N € rat co t co \o!f @ co cn 0q) on cl o c) tr E oo e lL ** rd lll ti p$-t tc sao so soo soo so soa soo soo soo saa saa ':8" e Ess,Ik OE Ei soo \oo\oo soo soo so 1Oo\oo soo soa soo soo soa E] a() uE $r 'tr E=;iSEiE>o6 c.lr- ca C\l c- c.t c.tr- co sr- ao tr- co \o c-ci c\l € co ol@ co coa co @ oo c.t \oat Ei Ec)E 5.22EEiE8 Ntr- ca (.t t'- co m r-. co .+ t-- c.l $F- co \0 tr- co N6(Y) N € co cn oo co € € co \oat+ o0d =q; * [E .g : t.e EaEEE H6 8 o Eotr c-'l r-- a.t ol c- co c.tr- co $ r-. c.) $r- c.) \0t'- c.t o.l oo co N oo co c.) oo ca 6 oo co \0ot r- o\ o\ oo o\ o\ o\o\ o\ oooN oo c! c.laoN coooC\ tooN rr1oo(\t \0ooN r-oo(\l r.)oo c-lk c,so o o ra) c.l O o o< s C\IN I b0 cgL(l,) o()(, H 6l L o G E o Eq) €) U' 6l €)fr b0|I U) E (l) eh U2g o cl I clI 6 o\to _l G(l) L GI I(D oLa (9 L €(J Fr o q) GII E tr q) .A clo tr e\ €\!JL tt Srq) L2\)ps a. :.i6NFR.L18 sq)q) EF{r t\ o> 6lEg5ctg*. o99q) EEE. .ge EE -q) -ont5Uh lLod -L c)rri >,EHIHEI6al q)()1 4H()pt c{ o)eh0trd9b 85LE rE C! vv) .6E EC)flE FT GJIu) r:\o e.i o\l ol .ol cBlFI (a ooN kop o q o ra) c.l t, A o B cnN t: q) q) 0o G lS >.14' Et a) \ .S U\ti a) s\q) o OO () S () l\ v, q)s >. .s' U\Li LqJ B t4 S v,q.r s(J AJ * s' 0o IS tr-l,,- o q) \ 60 la|l nr (J q) q) €p B *r ta) SJ () r a) rA a)sFr Et) L\) s \) lrql E S (.) L E \)aq.l ?)$E q) !o CI p Sa a \p s i q) AJE It lr .'\ q) sa \ S S(Jq) vj (,)q) Eq) s = q) q!qlf B tl .,! sq) aa \ ra & 2.7. Ordering, storage and dellvery of lvemectln Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH r'N WHO N UNICEF'N Other (please specify): _Order by Ministry of Health Mectizan@ delivered by - Qtlease tick the appropriate answer)MOHtr WHO/ U I'NICEF tr NGDOD NGDO Other (please speciff): _WH ,o Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan is cleared and delivered to NOTF stores with the assistance of World Health Organization (lltHo). From NOTF stores, the districts collect the drug and deliver it to the district medical inventories where the health sub-districts collect the drug. The Jirst line health tacilities collect the drug from the health sub-district and stored at this level Then the communities collect the drug from the lirst line health facilities. Sometimes, the health workers and community supervisors of CDDs deliver the drug to the communities when they visit the communitiesfor support supervision Table 10: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? The remaining tablets are collected by districts and carriedforwardfor the next round of treatment - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities carried out by health personnel include: o Deliver! of ivermectin trom the center up to the Jirst line health facitities where the communities collect the drug at the time of distribution o Supervision of the CDDs during moss treatment c Community mobilization and sensitization o Compilation of reports on treatments and accountabihty of ivermectin usage and forward them to the center - Any other comments 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring was done in the project area? 0 0 1,019 646 I State/Distric IlLGA Number of Mectizan@ tablets Number in stock Requested Received Used Used/P erson treated Lost Wasted Expired Remaining Hoima 0 400,000 400,000 400,000 2.7 0 0 0 Masindi and Bullisa 0 220,000 220,000 220,000 2.1 0 0 0 Kasese 745 257,000 257,745 257,745 1.6 0 15 0 Kisoro 3,312 139,641 143,927 142,953 3l',0 0 328 0 TOTAL 4,057 1,016,641 1,021,672 1.020,698 2-:5 0 343 0 24 WHO/APOC, 24 November 2004 DishicULGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) TOTAL If so, When? Table I 1: 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. Community self-monitoring and stakeholders meetings were not carried oul The district health services claim that these activities need funds to be implemented, the funds, which the districts do not have. APOC management and other partners should consider supporting these important activities although the sustainability after external funding has ceased is questionable. 25 WHO/APOC, 25ft October 2005 : 2.9. Supervislon 2.9.1. Provide a flow chart of supervision hierarchy. Organlzalion ol health aervlcea ln llganda (the chain of command) 2.9.2. What were the main issues identified during supervision? The main issues identified during supervision include: Little funds were released by the distric* for support supervision. The districts are conducting CDTI supervision in an integrated manner with other health services. Development Partners Ministry Of Health Other line ministries Referral Hospitals District Health Office District Hospital HSD HC TV Health Centre III Health Centre II Village Health Team (HCI) there is no physical structure at this sorsCommunity supervi level. Communities (Kinship clusters) a 26 WHO/APOC, 25ft October 2005 r f I However, this integrated supervision may not be focused thus leaving out some key activities un s up e rv is e d o Accountabitily of ivermectin was properly done in all the districts. o Involvement of health workers in supervision was inadequate due to small numbers of health workers at the health units o 2.9.3. Was a supervision checklist used? An integrated checktist for integrated control of neglected tropical diseases was used 2.9.4. What were the outcomes at each level of CDTI implementation supervision? o A feedback is normally given to the groups supervised with recommendations to be addressed to improve the implementation of CDTI activities. 2.9.6. How was the feedback used to improve the overall performance of the project? Accountability of ivermectin has improved in all the districts. SEGTION 3: Support to GDTI 3.'t. 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 off). How does the project intend to maintain and replace existing equipment and other materials? The equipment provided by APOC and NGDOs to the districts are supposed to be maintiinid by tie districts but very few do it, The Minktry of Heakh while maintains the equipment at the center, that one betonging to NGDOs is maintained by the respective ttebOs. As regards replacement of equipment, especially vehicles, donors will be approachedfor assistance where necessary. Nearly all the vehicles used by programmes in 27 WHO/APOC, 256 October 2005 Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Conditi on No. Conditi on No. Conditi on No. Conditi on 1. Vehicle I F 2. Motor cycle(s) 5 CNFR 4 F 3. Computer(s) 4. Printer(s) 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) b) c) the Ministry of Health are donated and it is unlikely that onchocerciasis control programme will be the exceptional 3.2. Financlal contrlbutions of the partners and communlties 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 problem with release of counterpartfunds is due to lack of adequatefunds at all levels. The distric* receive Primary Health Care @HC) grantfromthe centerfor implementation of primary health activities. 50% of PHCfund isfor purchase of drugs and about 25% is for salaries. What the distric* receive is usual less than what they requested which makes it diffrcultfor the districts to implement the planned activities effectively. The districts are always encouraged to integrate their activities, which thqt have done satisfactorily, such as integrated support supervision where CDTI has somehow beneftted. Additional comments APOCfunds do not include capital equipment, which was purchased by WHO because information on how much WHO paidfor those equipments was not availed to NOTF. The rest of APOCfunds were usedfor training health workers, monitoring and supervision. 3.3. Other forms of communlty support Describe (indicate forms of in-kind contributions of communities if any) c Distribution of ivermectin by the CDDs o Collection of ivermectinfrom the nearest central point by the CDDs or village leaders o Community mobilizationfor ivermectin treatment by CDDs and the village leaders, Contributor Yer,r I ('provide the period 2005') Year 2 ('provide the period in 2006') Year 3 ('provide the period in 2007') TOTAL CASH Budgeted (US$) TOTAL CASII Released (US$) TOTAL CASH Budgeted rus$) TOTAL CASH Released rus$) TOTAL CASH Budgeted (US$) TOTAL CASH Released (us$) MOH (Central +District/LGA) MOH) 28,459 17,879 25,288 18,654 19,251 12,379 Local NGDO(s) ( if any) NGDO partner(s) 11,773 I 1 t773 3,026 3,026 22,025 22,025 Others a) b) APOC Trust Fund 0 15,308 159 TOTAL 40,232 29,652 28,314 36,988 41,276 34,563 28 WHO/APOC, 256 October 2005 3.4. Expendlture per activlQr - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here Table 14: Indicate how much the project spent for each activity listed below during the reporting period. - Any comments or exPlanations? The ligures in table 14 only include government contribution towards CDTI activities. It doei nit include salaries of Ministry of heatth staff and contributionsfrom NGDO partner. SECTION 4: SustainabilitY of GDTI 4.t1. lnternal; independent parttcipatory monitoring; Evaluation 4,1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation .r' _Internal Monitoring by NOTF Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of 1,314 500 542 Districts Mobilization and health education of communities of CDDs Districts Districts T of health staff at all levels CDDs and distribution 580 550 Districts Districts I4SrneL Eg!ito"!g*o J q P!{ rylf .yiti-e s Advocac visits to health and tical authorities 588 MOH IEC materials forms for treatment Yehicles/ es maintenance 974 Districts Office e etc Others TOTAL 5,048 Total number of persons treated 255,730 29 WHO/APOC, 256 October 2005 Activity community Other Evaluation by other partners 4,1.2. What were the recommendations? o Training more CDDs where the number of CDDs werefew o The districts encouraged to include CDTI in their health plans ond budget and rclease funds for CDTI activities 4.1.3. How have they been implemented? o More CDDs were trained in all the districts o Distric* including CDTI in their health plans although thefunds releasedfor CDTI activities is still inadequate due to low revenue collection base. 4.2. Sustalnabllity of proJects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting Was a sustainability plan written? NO When was the sustainability plan submitted? 2003 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1, Planning at all relevant levels Advocacy to the district health services will continue to ensure that onchocerciasis continues to be integrated in the overall health plan each year.It should be appreciated that health sector planning (annual and strategic), is an importafi activity, which has the blessing of the district/sub county councils and legally spells out what the health sector intends to do, in the stated period This will provide an entry point for CDTI programme integration. The CDTI activities will be in the districts', health sub districts', sub counties' and parish/village (where they exht) health plans. 4.2.2. Funds NOTF will continue seeking for polilical and technical support of CDTI from the district political and technical managers. Politicians will particularly be made to appreciate that although onchocerciasis does not kill, it has serious social economic impact on communities because of its associated debilitating complications. It will also be emphasized that the drug (mectizan) will always be available for as long as it is needed free of charge and the needfor long-term treatment. 4.2.3 Transport (replacement and maintenance) The districts have continued to use transport in an integrated manner ond some districts are meeting costfor repair of the motorcycles. However, replacement of the motorcycles by the health services may not befeasible as nearly 100% of motorvehicles at all levels are donorfunded 4,2.4. Other resources Elforts will be made where it is operationally possible to integrate controUelimination of Neglected Tropical Diseases. Advocacy and health education will be integrated in the 30 WHO/APOC, 25ft October 2005 integrated control of Neglected Tropical Diseases, which is getting funding from USAID through Research Triangle International (RTI). NGDO partners such as The Carter Center and Sight Savers International are continuing to support CDTI activities in various districts. 4.2,5. To what extent has the plan been implemented lltith support from NGDO partners and a grant from USAID for integrated control of neglected tropical diseases, integrated training manuals, supervisory check lists and IEC materials were developed Advocacy meetings wilh the district leaders were conducted in an integrated manner in 2007. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms 4.3.2. Training 4.3.3. Joint superuision and monitoring with other programs 4.3.4. Release of funds for project activities 4.3.5. Is CDTI included in the PHC budgetr 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 CDTI. Delivery of ivermectin has to a large extent been integrated within the PHC structure. lYhen the district officials come to Kampala for any other issues (as long as they have vehicles) they normally take ivermectin. However, NOTF or the NGDO partner may be forced to take the drug if oflicers from the secretariat happen to be going to the district that requires the drug, or the district is about to start distribufing ivermectin and yet they have not had the "opportunily" to come to Kampala. From the district to the peripheral health units, delivery of ivermectin is fully integrated with delivery of other essential drugs. There is integrated control of neglected tropical diseuses in phase one districts. These include schisto, onchocerciasis and soil transmitted helminth infections. In addition to neglected tropical diseases, home management of malaria and vitamin A supplements are being co-implemented with CDTI in phase one districts. The safety of co-administration of various drugs is not known e.g. ivermectin and Prazuiquantel Pharmco-vigilance data is being compiled, as integrated control of neglected tropical diseases is under way. Integrated support supervision tor neglected tropical diseases was conducted, Spot checks were also conductedfor CDTI activities in particular. Although there are adequate human resources for co-implementation of CDTI with other health interventions, ftnancial resources allocated to control of neglected tropical diseases remain inadequate due to the low national tox base and high demandfor many competing 31 I0[/HO/APOC, 256 October 2005 thealth priorities in the country. The government needs to mobilize more resources for integrated control of health interventions. Partners like APOC and WHO should continue with advocacy to policy makers to ensure that the government budgets and releases funds for neglected tropical diseases. 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. There b)as no operattonal research conducted in phase one districts. 4.4.2, How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. Strengths Communities are still willing to take ivermectin due perceived beneJits. Some of these statements illustrate this : A CDD from floima district: "The people like to take the drug as demonstrated by those whom I don'tlind in the homes and they lookfor mefrom my home to take it. The desire is now high. I don't think the people will refuse the drug because they still like it We never retarn the drug. We only return empty tins". Men in a FGD in Hoima district: "lYe have the desire to take the drug for a long time because the Jly is still in existence and if it bites a person with falaria then it also bites you, you can also be re-infected The village members are ako willing to take the drug before the drug anives. Also when it arrives, people respond posilively towards swollowing of the drug". Weaknessess o The project heavily depends on externalfunding. Will elimination of the disease in the project area be achieved before external funding comes to an end? If this is not achieved, then sustainability will be questionable. Opportunities o Currently there are many interventions, which are using CDTI as a vehicle to deliver other communigt interventions. These in turn come with many opportunities in lorm of intrinsic incentives. These interventions provide avenues for integrating with CDTI which gives an opportunityfor CDDs getting incentives Threats o While other communigt interventions provide opportunitiesfor CDTI, they can also be threats if not well harnessed. Because some interventions come with incentives, the distributors of ivermectin could obandon CDTI for those interventions with incentives. 32 WHO/APOC, 25ft October 2005 SEGTION 6: Unique features of the prolecUother matters Phase 1 districts were the lirst districts in lJganda to start CDTI with tinancial support from APOC and other partners. Since then, treatment coverage has improved steadily and now stable at more than 70%. This needs to be maintained through continued community mobilization and sensitization on the need for long-term treatment until elimination of the disease is achieved. The current funding for integrated neglected tropical diseases and the new initiative of elimination of onchocerciasis in these districts through semi-annual treatment with ivermectin has boosted CDTI activities in these distric*. Feasibility studies for vector elimination in Hoima district are hoped to start soon and vector elimination activities will commence late 2008 or early 2009. ) 33 WHO/APOC, 25s October 2005