Ruvuma focus CDTI annual project technical report submitted to Technical Consultative Committee (TCC): December 1st 2002 to November 30th, 2003

RESERVED FOR PROJECT LOGO/HEADII,{G I I I I ORIGINAL : 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 3L Julv for September TCC meeting 'llr i r t.!rn.g, -1. * lL c It '-,( t 1v trcc$vfi ,irel -- ^),)fn) lc€ .f.t itli DI t) Fs AFRICAN PROGRAMME FOR oNcHocERCrASrS CONTROL (APOC For lnicri,nction To, .L iL r{o COUNTRY/NOTF : Tanzania Pro.iect Name: CDTI Ruvuma focus Approval year: 1997 Launching year: 1998 Reporting Period: From: Decembeii" iooi ro: x@E (Month/Year) ( Month/Year) Proiectyearof thisreport: (circleone) I 2 3 (4) 5 6 7 8 9 10 Date submitted: January 2005 NGDO partner: S ight Saver's International NECU n r FFV 7005 ,ffvL Dtt 1 WHO/APOC,24 N I I L l- j., i rF RI',Itr_RUUUI,IH TX,/RX NO. 5658 P01 f ,J. r rnt I rI ANNUAL PROJECT TECHF{ICAL REPORT TO TECHNICALCONSULTATIVECOMMITTEE,('fCC,) E}{DORSEMENT please confirm you have read this report by siguing in the appropriate space' OFFICERS to sigE the rePort: Country: Tanzania National Coordinator Narne: Dr.Grace saguti Signature Date 3a [l )ocS ZOnal OnChO COOrdinatof Name: Dr. Datrisl l"lalcl(clo. signatwe' ..r\N., I I I I , I I I I i I i I I t ) I I I I I I i I : I i I ) I i It i I ( Date \ 1,,*'t\ "._.. I;JNSL MESTiIAL EFFtl... YtfDO Rvyrwuorrtoti+'c Nlqrrre' Mr. Pius Mabuba *li'r#-f Signature Date 'I'IXS fBporl llas l-rr.:sn proprrreJ L1. N-nrc : Dr- Wede Kahuka Designation : Proiect Coordiuator / signature:.M.. Dato -.3o'. I "..-,kg&*,..=-. ii 31/01 '08 09:86 FHX ND. : ?sEarq?El-ain WHO/APQC. 74 NovettrLe, 2004 I I i I I I I I t I ! I I I I I i I I I : I t I I I I Table of contents ACRONYMS 4 DEFINITIONS 5 FOLLOW UP ON TCC RECOMMENDATIONS 6 EXECUTIVE SIIMMARY 8 SECTION 1: BACKGROLIND INFORMATION....... ......................9 GBxeRaI- INFoRMATIoN PopularroN Apvocacy. MosLzarloN, SENSITzATIoN AND ITEALTH EDUCATIoN oF AT RISK coMMUNITTs 15 Cotr,rtvrutNtry INvoLVEMENT......... Cepecny BUILDING.. TRlamreNTS.............. ORppRtNG, sroRAGE AND DELTvERy oF TvERMECTIN ............... CotvlltrNrry sELF-MoNIToRING axo S rarpHoLDERS MBBrn-tc SuppRvtstoN ............... SECTION 3: SUPPORT TO CDTI 28 1.1. t.2. 2.2. 2.3. 2.4. 2.5. 2.6. 2.1. 2.8. 2.9. 3.1 3.2 J.J 3.4 .9 13 15 .,.,.. l7 ...... 17 ......21 ......26 .,.,..21 ,,.,.,27 EquretlmNr FneNcrar coNTRTBUTIoNS oF T[rE pARTNERS AND coMMUNTTIES Orsrn FoRMS oF coMMUNrry suppoRT ............. E>cnNotrur-B pER AcTrvrry ............. .28 .30 .30 .3t ...3l ,.,32 ...32 ,.. JJ ...33 SECTION 4: SUSTAINABILITY OF CDTI....... ..........31 4.1. INreRNar-; TNDEpENDENT pARTrcrpAToRy MoNrroRrNc; EveruerloN.... 4.2. Susrarualrl-rTy oFPROJECTS: PLAN AND SET TARGETS (VraNOerORy AT Yn 3) 4.3 INtgcRattoN 4.4. OprnerroNAl RESEARCH SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTI.JNITIES .....34 SECTION 6: UIIIIQUE FEATURES oF THE PROJECT/OTHER MATTERS...........34 3 IL WHO/APOC, 24 November 2OO4 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 Objective Annual Training Objecti ve Community-Based Organization Communi ty-Directed Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitorin g Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Govemmental 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 Natrons Children's Fund Ultimate Treatment Goal World Health Organization I 4 WHO/APOC, 24 November 200,4 i: Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (i i) Eligible population: calculated as 84Vo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Obiective (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 Treltment Gqal (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 of the 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 CDTL (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention prograrnme), 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. L 5 WHO/APOC, 24 November 200,4 .i- O N Eo -o o o z -tN U o tr< o A B U [. l!SPXu:sUi\< qd elI] *su Stg U t\ e pF HS U H n< s €rbs R s =c<"s\^, s EsEd.s Uo\ r.l sF5Qt\<t-()O n<E t\ Eil 5 sqss <Fi \ p-9 --E'4 E.. gE r.l;*E sg. E;83!.s SclEa=;sEE:;rE* bod bE Fx E!ts -O 6.)!'o r^a t Yj i;>c)Ois6E.eaP EE€ FEES aztD qa FisStrETU< H giEEHEEErEEIEES rE " i s FEiB$f E\ bE$ .t F* S $.s?( s ra r- \oF- \o Ti 0) U) <n oL I U lu t Oo -o O c0 o - ; o e o -o .F o U)o I I -d POo o!z["o:IXF; AI2-EltJ e =E =ZOE(r3 urEEE )<(r8(reL9l- -EOEtri :, is .o€ = *:o s.=J PfrJ ;;orHL 5= L, t L L vOO c.l rq) .o o z d ol O A \J B t-- a qqp\)q) q- v) > o qJ \\ B q) U.,\l\) 5 E:"9-c€ oirr<EErg; . q.;; :! 9 o k E EE A O A_LLcgllo(! -c:?o-co.ly"U.-H> ,=SHEPEiXrs = g I t H 18 g E Eo= I o YoqN;.F oO=^€.nir^:ei9 3EsEE5=;;r gEg;EggiEIgEEE 3aa*gEguEEtgEaeElu F-F- cot- I i," t_ l. I- t. Executive Summary The Ruvuma Project is made up of two endemic distncts of Ruvuma Region, Songea and Mbinga as well as one neigbouring district of Innga 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. With the exception of a small area along Lake Nyasa (altitude approximately 100 m above sea level) most of the project area lies between 500 and 1,600 m above sea level. Ruvuma Focus CDTI Project has a total number of L64 communities in all the three districts. The total population is 338,278. In this distribution cycle, we were able to treat228,974. Ivermectin mass distribution was instituted in The Ruvuma Focus in October 1992 funded by RBF up to 1995. IMA provided bridge funding in 1996 while SSI provided bridge funding for the year 1997. Year I APOC funding started in October 1998 with the new concept of CDTI. We are now implementing the 4th year of APOC Funding. In all our villages there is a stable government structure allowing CDTI to be implemented using this structure. In some villages, community members have two or more homes one being located in the main village while another is located in the fields. We managed to train 150 RHW and 383 CDD'S including those added in supplementary REA survey in Mbinga and Songea Districts. One advantage to the CDTI strategy is that the government has used our registers in designing registers for the National Census. In all our respective districts the district councils have set budgets for CDTI activities. Songea district has budgeted US $ 1.900, Mbinga has budgeted US $ 9,000 and Ludewa has budgeted US $ 300. Also the Songea and Mbinga District councils conducted REA survey in communities, which reported to have cases of onchocerciasis. A total number of 12 villages have been identified to be meso endemic and have been added into the programme. The APOC management conducted the.5th year evaluation to our focus project. This was carried out from 20th October,2003 to 6s November, 2003. The results of the evaluation are not yet out. 8 WHO/APOC, 24 November 2004 bf- l L! SEGTION {: Background information 1.1. General information Ruvuma Focus The Ruvuma CDTI project is composed of three adjoining drstricts of Songea and Mbinga in Ruvuma Region and Ludewa in Iringa Region. It is often referred to as the Ruvuma Focus. The three districts have a total population of 789,165 inhabitants (according to the2002 census) with l7 administrative divisions, 75 wards and296 villages. Songea District Songea is one of the 4 districts which make up Ruvuma Region and is the main town in the region. It houses all the regional administrative functions. The district has 2 hospitals, one is owned by the government and the Roman Catholic Church owns the other. It has 7 health centers, 53 dispensaries and 3 village health posts (VFIP). It covers a total area of 34,193km3, The total population of the district is 323,957. This gives a population density of approximately 8.9 people Km2 The district is about 1,000 km from Dar es Salaam, serviced by an all-weather tarmac highway. The nearest railway station is at Makambako in Iringa Region, 301 km from Songea town. Currently the town is not linked to the national airline network. There are occasional air characters into the town. Administratively, Songea district has been divided into two districts of Namtumbo and Songea. Namtumbo has 3 divisions (Namtumbo, Mkongo and Lusewa) while Songea District has 3 (Madaba, Ruvuma and Mhukuru) ,22 wards, and 128 villages. Namtumbo borders with Selou Game reserve to the east, Tunduru district and a neighboring country-Mozambique (Northern Province) to the south-east, Songea district to the west and north. Songea district is bounded by Mbinga to the west, Namtumbo to the east, Mozambique to the south and Njombe and Ludewa to the north and north-west. Mbinga District: Mbinga district is the second project area in the Ruvuma Focus. The district has 4 hospitals one is owned by the government and the rest by NGOs. It has 5 health centers,4g dispensaries and 71 village health posts (VFIP). It covers a total area of 18,778 km2 . The total population of the district is 337,288. The administrative offices for Mbinga district are in Mbinga town; which is 100 kms from the regional headquarters in Songea. The road is partly tarmac (i.e. 20 kms from Songea) and the rest is gravel with permanent bridges. The main means of overland travel outside the district are through Songea. The second alternative is by boat from Mbamba Bay to Itungi Port, Kyela district in Mbeya Region. Administratively, Mbinga district has 6 divisions (Mbuji, Mbinga Mjini, Rahekei, Namswea, Mpepo and Ruhuhu),37 wards, and 184 villages. Mbinga borders with Ludewa district (Iringa Region) to the north, Songea district to the east and Mozambique's Northern Province (neighboring country) to the south. On the western side it borders with a neighbouring country-Malawi (Lake Nyasa) 9 WHO/APOC, 24 Novemb er 20[,4 Ludelva District: Ludewa district is also withrn Ruvuma Onchocerciasis Focus, but administratively is part of Iringa region where there are 6 districts. The district has 3 hospitals one owned by the govemment. There are 6 health centers, trvo of which are owned by the Roman Catholic Church and about 40 dispensanes and 76-village health post. It covers a total area of 2,072 km2. The total population of the distnct is 128,520. The district is administered from Ludelva torvnship, whrch is accessible along a windy all weather gravel road. Its location makes it a relatively remote site even from its regional headquarters at Iringa. The main means of travel to and from the district are by road or by boat from Lake Nyasa from Lupingu to Itungi Port, Kyela district in Mbeya Region. The district is divided into 5 divisions ( Mlangali, Liganga, Mawengi, Masasi and Mwambao),22 wards and 78 villages. Ludewa borders with the districts of Songea in the east, Mbinga and Kyela in the north-west, Njombe and Makete in the north and Malawi (Lake Nyasa) in the west. The main ethnic groups in the project area include the Wangoni, Wamatengo, Wabena, Wamanda, Wapangwa and other migrants. Despite some minor differences in their socio- cultural characteristics, these tribes mix without tension. Peasant farming forms the mainstay of income generating activities in the three districts where crops such as maize, banana, beans, rice, cassava and potatoes are grown as staple foods while tobacco, tea and, to a lesser extent, timber are cash crops. There is also small scale fishing along the rivers and lakes. Border as rvell as highway trade is also existent in the project area. I I L l0 WHO/APOC, 24 November 2004 Table l: Number of health staff involved in CDTI (Please add ntore rows if necessary) District/LGA Nunrber of health staff involved in CDTI activities. Total Number of health statf in the entire project area Br Nunrber of health staff involved in CDTI Br Percentage Br=Bzl Br *100 Songea 435 58 13 Mbrnga 2'71 27 l0 Ludewa 337 30 9 Total 1,043 115 32 1.7.2. Partnership 1. VILI,AGES: In this cycle villages has been performing the following: Selection of CDDs o Collection of drugs from health facility o Support CDDs (both materially and financially) o Communities have decided on the period of distribution, mode but not timing in most cases. o Sensitize community members o Monitor treatment . Census update o Submission of report to first line health facility 2. FIRST LINE HEALTH FACILITIES: The role of the first line health facility remained the same, and these included the following: o Collection of Mectizan from the District o Sensitization and mobilization of communities o Training of CDDs o Supervision of distribution and monitoring of CDDs . Report writing O HSAM 11 WHOiAPOC, 24 Novemb er 20[,4 t 3. DISTRICT In this cycle as usual, the Council Health Management Team (CHMT) was responsible for o planning . Training of health facility staff o Payment of the salary of workers o Mectizan procurement from the Region o Monitoring and supervision of health facilities o Maintenance of equipment . In Songea and Mbinga, the Districts conducted REA and identified fourteen more communities that needed treatment, twelve of which were meso and two hyper. 4. REGIONAL HEALTH MANAGEMENT TEAM The roles of the RHMT were: o Training o Supervision and monitoring . Request and disbursement of funds o Collection and submission of Report to the National level o Advocacy o Payment of the salary of workers o Procurement of Mectizan o Printing of reporting forms . Supply of Mectizan to districts 5. MINISTRY OF HEALTH The national level: o Produced IEC materials o Payment of salaries to workers o Submit requisition for Mectizan through Medical Stores Department o Monitoring and supervision o Advocacy 6, SIGHT SAYERS INTERNATIONAL In the current year, the supporting NGDO o Managed and disbursed funds o Funded annual review meeting r Maintenance of capital equipment o Provision of travel cost to the project staff o Support Capacity Building o Provided IEC materials and support transport/material equipments o Provided in-kind financial support o Participated in training and supervision o Advocacy o Provided capital equipment (replaced one motor cycle for Mbinga District) 7. APOC o In the current cycle, APOC has provided funds and technical assistance. t2 WHO/APOC, 24 November 20CI4 l= .f, oN L o .o o z .f, cl c JJr ots ca 0q) ,rq) +r o o) oz 0)lro o o U) 9) o 0) ak o (! ao o o -o an 0)lro o o t<oq-r H o) o >t tr 0)li G) IA s "[ "i -s Y '=Nho,!Fd-.tsrE q.A[ = .:e I E ;h : q IFGqEio> *OFi>.it<'r\ A' trE$r)'rLf-Eq)F :.iIr=:--tvpu1.1 \--! ",=9cE{P-- ^ALJ: b ;*1V *'v€A$CF-E = 6eiS o. F$Et9 \luH- :SP-.CK:i .;i qJ>dX = <ot* ) YoEFr .2 9= O'O' E< e O)i i ci ':';t=^ :o 59s?^ J 'i-.-9! S u '5 cCL 'i* a E u;Xa,qQv.io) St T EE .!! a €:E!: E Ci trt,! E ErocH 3 ESL\\-u\) c) K.-$u -c : 'IT Z E? :!)-A(U€ali! n ts$-s E E c!Ii : ;3sx (! Gtsif-EEL Es , IEPE ,E Sr*;s 3 s;Nh-.Fq) :s H, :E -8 9' = t6$1 't 3t .\Y Ei cl ot'T o *?r-i >' ; o) -$E E g* =h ) >.clE A I\s)<-tEv tr A (J s Y^ ,a r'C) el E *S\6C)8r>\).La:6)t'x o o l'7SE E 5E-iT Po PEE.tu-v^tY 3 =EEtB H <-eBilil aPt 9.s I5P IrH Q o q o q\)U\) Vj > L p o t B \) v) a. --.i 'tr O oo P oH o b0 'i t<o o =O! (.)lr 0) li 0) 0) Gq) , G Iq) La e)L (l) q) & .t) .F <g o (g A. ! C! -.4L{Do'E fltrrE= - IE -tio.xor.iA:. si Elr GllFFI q q q) Eor z ooLL os(hr' [: t' L t- I F €JF EtrcE =:\\J .t t--v} CO o..l oo N oo .+ \o o\$- o\ra 00 F- .l € ca .a ao F-el € ra m + il b .0) .= O.N .;:< tri rfl $ t--v} CAN @ a.l @$ \o o\$" o\tr) . eErvrLL'=e6ts8.=5; >rE o oJ -l--.-lrr i''i : o' -sf, \f, c1 cn\o \o\ovl @ ca s\o \o" o\ ca .+ tui !+ N 6 E:C] ;e cE ?oU tr'-Aa \oc\ I-r\o Nrt \o" o\ (\ co co^ o\ v rO\\o o\ I q,) >: oNq., c! q) oF + il \o caN \n ca t+\o .eEE'F E E-tro:Y9E Ei-c!6JE >) q)FtrEO N N 00@ c.t \n c.l (A rA t)q) OI cn U)q) 9 Lq) z I E:q) ;e d tr .= :.1?0,,8 o=trilr '- OA 00 co (a .-G E9 .9gE =E:.-aE 3g E,Haistr. r--\nq caN co oo @ct r- cfl crr Nlr) ooN ra\or- oi €f- .!r()9 .if.* tsqEc 5{ ilHEr95Et s od8* $Ec-tri. Cll6z d b0 tr -o (! B c) € aJ Fl H o Er It -J N Eo -o o o z sN o0i o B $ bo L. O x(g a o F0) o€ -c 0) 2t-JJ (! odA- :Y >, O'r=co I o-r ()9oc)tr tio.o c <t) <! g) ()e()- zi sQ =l-oodO d-)lr Lrti() oo o> =.ox()v o9 6BEcEB 'c or oo(€ >x6S ='o,9 c)Ya cooaoc ts() HLr o'Z6i O c-lBrGI?aE>,9c B6 i, cl(g= -LOQ -C lJr *Q)tr-c U) I o tr E oU >. V)q \J() \,) L q t* \)\ \ 4 \) a. Lr o 9)F o C) (.) d 9) cn (.) l-r(s () $<o .h o o (H o o) 0) E F c.it 6)l -l -ol(nt FI q)q) I c! o (l) c) E,. N z F E-rz r-'1!rari Fl0rlria : al z o Er L) F1(h I L t- t- t v) (h -=trE U L{) ,o 0.) o z Lo .o o o z L C) -o C) o z b!_EA V)- Lo ,! o (J o C) -oo o o ro -oo O o U) OI k o.=?=trH (J ro -oo o o C) .o o orl L o -oo o o E" -q u)' o -o E 0,) o.o(h o -o E o ao(n o -o C) o. C)(n c) D (n U) q) U e:o.= EE Q ro -o o o.o U) o3 o o.o U) L C) -o o o. 6)(h 00_trtlitr cl= o .o o a.o(n L() -o o o.. C)(n r 0) -o o o. 0)(n bx L3 o.=EEo' o -o o o-q) U) a) -o E o o.o(n o ,.o o o U) H.c Ptr CE: bo a q b0 a a bo VUD -o) s= Etroo =9a o cL= EEQ a oO bo bo Eo -q li. tr 6: (, Fl I tr o n -o a E cd z * Rl 0) oo a U) cU bo p A (! B d)! J Fl Fr oH 2.2. Advocacy The following Policy/Decision were mobilized Regional Level District Irvel Community level Divisional level Ward level Village level Sub village level 8 43 L9 62 r51 900 The reason for mobilization and sensitization : Enhance further project acceptance thus creating sustainability The goal was achieved. Problems encountered Poor attendance as the majority of the meetings were done during farming season Absenteism due to rgnorance and refusal. Suggestion to improve advocacy Community rnvolvement when planning for these meetings 2.3. Mobilization, sensitization and health education of at risk communities We still have two radio stations in Songea where our focus project offices are located. We continued to use these services to disseminate various CDTI massages. The Ludewa District Coordinator has been provided with a landline telephone that has made communication to this remote district much better compared to previous years. The telephone system in Ludewa uses solar power which functions during daytime only.l. More trainings and increase the number of training days to 3; 2. Frequent monitoring & supervision using prepared CDTI check list3. Improved quality and availability of training materials.4' Training of RHW who subsequently train CDD'S should be strengthened and if possible a training manual uniform for all CDTI Projects in the country should be developed.5. Strengthen stakeholders meetings and community-self monitoring activities.6. Dissemination of CDTI posters and leaflets, which has been produced recently. The following type of materials were prepared to be used for training Health Staff and CDD'S l. Handouts explaining disease & Ivermectin benefit and use; 2. Treatment forms; 3. Dosage forms; 15 WHO/APOC, 24 Novemb er 2004 4. Ledger books for Mectizan distribution, storage, & inventory; 5. CDTI summary forms; 6. Measuring sticks for height of people; 1. Translated and disseminated MDP dosage posters into Kiswahili 8. Weekly CDTI progress report forms. 9. Posters and leaflets developed by the Ministry of Health. t6 WHO/APOC, 24 November 20f,4 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please acld ntore rows if necesscut,) In Ruvuma Region as a whole the ratio of females attending public meetings is higher than men. Females are more active in communual work parlicipation than men. When it comes to leadership, most women do not come out to seek elections in the village government. This leads to men domination on matters perlaining to leadership. There is a considerable involvement of women in CDTI activities as evidenced by a good proportion of selected female CDD's. 2.5. Gapacitylbuilding - Describe the adequacy of available knowledgeable manpower at all levels. Apart from the Ludewa district where the staff is not stable, the other two district of Songea and Mbinga have stable staff. The frequent change of staff in Ludewa has made it difficult to maintain good trainings to FLHF workers. In the other districts the trainings are consistent and regular. There is immediate replacement of the district or FLFIF worker once transferred to another area as evidenced in Ludewa district. The replaced staff are trained immediately on CDTI and are followed up frequently in order to asses their performance. District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with fenrale CDDs 'fotal no. conrnrunities in the entire project area BI Nunrber with community members as supervisors Bs Percentage Bo= BJ B, *IOO Male CDDs Br l'enrale CDDs Br Total Bq= Br*Bn Nunrber of communities with female CDDs Bro Percentage Brr= Br/BI*100 SONGEA 106 106 100 604 401 l,005 106 100 MBINGA 23 23 100 183 181 364 23 100 LUDEWA 35 35 100 201 176 377 35 100 t64 164 100 988 758 t,746 164 100 Total L II t7 WHO/APOC, 24 November 2003 l- U) Q o Z .-6 lll, --d U ir z! a< c?) 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I90'q)L 'aq Lq)AL. xq) L,) -c (g :!)6-Fkltr(gloEl ool -t €31cr>{ *) -ol 9Xolr (tl :6 riO oE -t!Eqo= .r6 .(€6lo\?F c.t O\l ol .ol cllFI lr)N 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer\ MOH{ WHO I-INICEF NGDO Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH { WHO tr I.]NICEF tr NGDO f] Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities Table 3: Mectizan@ Inventory (Please add ntore rows if necessary) We received additional 77,000 Mectizan tablets from IMA as we were expecting shortage from field reports. State activities under ivermectin delivery that are being carried out by health care personnel in the project area. 1. Mectizan is receivedfrom the district pharmacy by issue voucher and is entered in the FLHF pharrnacy ledger. CDD's collect their mectizanfrom FLHF in-charge by signing an issue voucher. Table 10: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? Mectizan@ and distribution data are returned back to the Health facility by CDD'S once the distribution is over. From here Mectizan@ is either re-allocated to other villages or sent back to the district pharmacy for re-allocation to other Health Facility. 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@ I , I Region Number of Mectizant tablets Requested Received Used Lost Waste Expired Ruvuma 622,OOO 699,000 522.913 7,867 6,960 0 TOTAL 622,N0 699,000 522,9t3 7,867 6,960 0 State/DistricU LGA Number of Mectizan" tablets Requested Received Used Lost Wasted Expired Remaining Ruvuma 622,N0 699,000 522,913 7,867 6,960 0 TOTAL 622,N0 699,000 522,913 7,861 6,960 0 26 WHO/APOC, 24 November 2OM 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 Project coordinator makes follorv up to the national office. . The Project coordinator collects the drug from the zonal medical stores department and enter the received drug to the regional pharmacy. o Distnct Coordinators makes orders to the project coordinator and distnbute the drug to the health facilities according to their requisitions. o FLHW distribute information to sub-village leaders and CDD'S about the arrival of mectizan. o They come for collection and distribution o This is followed by Supportive supervision during distribution. Any other comments NONE 2.8. GommuniQl self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, When? I't and 2nd week of November Table 1l: 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. Has increased a sense of ownership to the programme. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. RMO Iringa J JRMO Ruvuma PC J DMO Songeaf DMO Mbinga J DOM Ludewa| District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Songea r28 7 7 Mbinga 93 4 4 Ludewa 76 J 3 TOTAL 297 14 t4 27 WHO/APOC, 24 November 2OO4 District Oncho. Coord J DOT'S J FLHW'S J CDD'S J Communrty 2,9.2. What were the main issues identified during supervision? Discrepancy in record keeping. In adequate CDD motivation. Relatively high refusal rate. 2.9.3. Was a supervision checklist used? Yes, a check list is always used 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Levels concerned always gave appositive 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? 14 villages were able to conduct CSM SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Conditron No. Condition No. Condition No. Condition No. Condition 1. Vehicle 2 One functio nal 2. Motor cycle(s) 7 6 functio nal 3. Computer(s) I Functi onal 4. Printer(s) 1 Functi 28 WHO/APOC, 24 November 2ffi4 t: onal 5. Photocopier (s) Functi onal 6. Fax Machine(s) Not functio nal 7. Others a) b) c) t *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 existing equipment is maintained through the normal process in the Region. Repairs and services are carried out using funds from the hospital. At the moment the region has not planned for replacement of the present vehicle as it is still in good working condition. In Songea and Mbinga districts we have adequate man power. The staff have not changed since we started the programme. They are highly knowledgeable and competent. In Ludewa district the picture is different. The staff have been changing almost every year. We have therefore, been re-training new staff to replace those transferred other parts in the country. Sight Savers International has played an important role in providing funds for conducting these trainings. 29 WHO/APOC, 24 November 2004 Contributor Year | ('protide the period') Year 2 ('provide rhe period') Year 3 ('provide rhe period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) 31,399 3 r,399 31,399 31,399 31,399 3r 399 MOH (District/LGA) Local NGDO(s) ( if any) 19,000 r 8,000 r7,000 15,000 t'7,799 18,860 NGDO partner(s) 0thers a) b) Communities APOC Trust Fund TOTAL 53,263 36,t59.7 32,537 2'7,603.5 31,369 20,u0 t03,662 85,558.7 80,936 74,002.5 80,240 71,259 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all paftners forthe last three years If there are problems with release of counterpart funds, how were they addressed? We had no serious problem with release of funds from SSI and MOH. There was a deficit of US$ 4,933 which was not released by APOC in year 200212003. Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The type of support provided by the villages varies in each village. Some villages provide incentives to CDD's during distribution. The incentives are in form of money, food and exemption from communal work.In Mbinga district fifteen villages has replaced worn out registers and are providing notebooks and pen to CDD's for recording data. Sometimes they provide bicycles to CDD's when they go to collect Mectizan from nearest health facility. t I I IL 30 WHO/APOC, 24 Novemb er 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 current United Nations exchange rate to local currency. Indictate exchange rate used here lUS$ = TSH.l,000/= Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTION 4: Sustainability of GDTI lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) ./ Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners None ^/ ri None _Year I Participatory Independent monitoring 3l WHO/APOC,24 November2O}4 4.1. ) Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities 800 7,000 MOH SSI Traini ng qf CDDs 5,000 APOC Training of health staff at all levels 4,000 APOC Supervising CDDs and distribution 3,000 SSI Internal monitori !g of CDTI activities 2,000 APOC Advocac visits to health and itical authorities 1,500 APOC IEC materials 8,000 SSI S n forms for treatment Vehicles/ Motorc ycles/ bicycles maintenance 897 10,000 APOC APOC com ters nters etc Others 3,000 APOC TOTAL 45,197 MOH,SSI& APOC Total number ofpersons treated 225,674 tOffice Lr Mi d Term Sustainability Evaluation 5'h year Sustainability Evaluation Internal Monrtoring by NOTF Other Evaluation by other paftners 4.1.2 What were the recommendations? Recommendations Training sessions for CDDs and Health personnel should be increased and periods should be longer. Community education on key issues like programme ownership, community responsibility, reporting of side effects and census should be stressed during CDD training. An update of community census before the next round of treatment should be carried out. APOC should consider possibility of extending period of project funding for at least two more years to enable project sustainability, much emphasis being on health education and IEC materials development. r 4.1.3 How have they been implemented? Targeted training to CDD's and Health personnel have been increased and the training period also increased to 3 days for CDD and 4 days for Health personnel. Community Self-Monitoring has begun in 4 villages in Mbinga, 7 villages in Songea and 3 villages in Ludewa. Updating of census is being carried out before each distribution. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the oroiect evaluated durins the reoortins neriod? Was a sustainability plan written?_ When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms oft 4.2.1. Planning at all relevant levels Planning at district level has been implemented and CDTI activities have specific line item in the Comprehensive Council Health Budgets. In this year Mbinga has set aside 4,000US$, Songea 1,900 US$, and Ludewa 1,200 US$. Transport facilities are intergrated in the Health t L 32 WHO/APOC, 24 Novembet 2004 D system in each district so that when CDTI activitres are to be implemented , it is the transpoft manager who allocates vehicles to be used for the activity. 4.2.2. Funds 4.2.3 Transport (replacement and maintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration Ivermectin delivery is done through MSD up to the project level. District Onchocerciasis Control Coordinators collects the drug from the Regional Pharmacy and delivers to the District Pharmacy. From the district pharmacy the drug is transported to the FLfm where the CDD's collects it for distribution. From the district pharmacy to the FLIIF, the drug is transported through the existing PHC structure during supervision and monitoring. Only targeted training was conducted to CDD's in the added villages identified by REA results in Songea and Mbinga. In Ludewa training was done to 10 villages which had a low treatment coverage. As mentioned above the CHMT is involved in supervision and monitoring in all the 3 districts. The District Onchoceciasis Coordinator is a member of this team and always goes for supervision routes. The release of funds from the districts is smooth. All funds allocated for CDTI activities in Songea and Mbinga were released. Ludewa district released only 600US$ out of l,2OO All the districts have included CDTI in the PHC budget. we have two programmes using the GDTI structure. The structure is not identical but has many components similar to CDTI. For example , registration, census taking, using measuring sticks to determine dosage and conducting advocacy. These projects are Lymphatic Filariasis and rrachoma Control Programme. a l. 4.4. Operational research 33 WHO/APOC, 24 Novemb er 2004 4.4,1. Sumntarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research have been carried out throughout the treatment period. 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. In the process of the implementation of CDTI within the Ruvuma CDTI focus the achievement e has been recorded over the five-year period. However, a number of challenges and constraints were equally encountered. The challenges and constrains are listed below. Challenges and Constraints: ./ Change of leadership in Ludewa made CDTI implementation very difficult in this area because the project had to train staff constantly ./ The involvement of Ludewa, which is in a different region from the other Districts in the project posed serious problem of supervision and coordination. The policies of the different regions differed. ,/ The wearing out of capital equipment as the project aged was another source of constraint. The vehicle is old and maintenance cost has increased tremendously. ,/ With the exception of Mbinga District, the other District made very minimal contribution to the implementation of CDTI. This also applied to the Regional authorities. The regions did not feel obliged to commit any resources to the implementation of the Programme since they could not claim ownership of the Programme in strict sense of the word ,/ We also had to contend with the sudden imposition of tax on the drug, contrary to the Memorandum of Understanding (MoU), which stipulate duty free condition for Mectizan. This stalled the clearance of the drug for nine months at the Port and led to a disruption in the distribution of Mectizan in year 2002. ./ One of the biggest challenges we have had in the project was the loss of the project laptop, last year. The laptop was lost with all the records and data concerning the implementation of the Programme. We also appreciate that the stolen Laptop computer was replaced by APOC, for which we are very grateful. However, despite these challenges and constraints, CDTI has been successfully implemented in all the areas and communities identified under REMO for mass treatment with Mectizan. List the challenges and indicate how they were addressed. SEGTION 6: Unique features of the proiecUother matters I 34 WHO/APOC, 24 November 200,4 The frequent change of distnct oncho staff in Ludewa, makes CDTI implementation difficult in that area. Quite a number of villages in the project area are inaccessible leading to limited supervision in these areas. Implementatron of CDTI in Ludewa district which is in Iringa Region is difficult as the district fall under different government leadership compared to Mbinga and Songea distncts. t- t) I L t 35 WHO/APOC, 24 November 2004 -