RESERVED FOR PROJECT LOGO/IIEADING I I I I I I I I ORIGINAL : English hF5 For .\) ,' 'fo: +s$ (L),4* , For lnformotlon ( (, l'1 ,4 ti t) f tj. l it ,ft r d t, c-g t{lo+/or. , CO Y/|.[OTF: Proiect Name: EXTENSION DISTRICTS . MULANJE Approval year: 1999 Laulching year: 2000 PO ERIOD: FROM: APRIL, 2004TO: MARCH, 2005 ear Month/Year Proiec t yea r of this report: (circleone) I 2 3 4 678910 Date submitted: NGDO partner: 1 I Jull- tnnq WIIO/APOC, 24 Nor,,ember 200.1 aIf +l : I 't ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: k Country MALAWI National Coordinator Name: DHO Signature: (n yc?o'lf"^;:'9 (- Date Zonal Oncho Coordinator Name: DOC Signature: '- a3,l pi 0l 4 Date:4?.).rL.f.r,'.: _ N:ji{ Cooril^o\t,@ Name: NATIONAL CORD Signature: .1.&tiptt. . .!.x.it!{n. . Date: ,l+ l9r TOR This report has been prepared by Name : Lp.M. JUMMA Designation: AEHO .ffi Iqai',s Signature WHO/APOC. 2.1 November 200.1 I Date .. a .A 11
Table of contents ACRONYMS DEFINITIONS .......... FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY .......... SECTION I : BACKGROUND INFORMATION........ 1.1. GpNeRal rNFoRMATroN.............,........... 1.1.1 Description of the project (brteJly) 1.1.2. Partnership 1.2. PopuLerroN SECTION 2: IMPLEMENTATION OF CDTI 2.1. TtupLrue oF ACTrvtrrES ..............2.2. ADVoCACY v VI 1 8 2.3. MoetLIzertoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT zusK coutvtuNtrles l22.4. CoMMtTNITy rNVoLVEMENT.............. ...............i.42.5. CRpecny BUTLDTNG ...................... 152.6. TRrerNasNrs................ ................. 172.6.1. Treatmentfigures............. .....172.6.2 Llhat are the causes of absenteeism?........... .............. tg2.6.3 What are the reasonsfor refusals? ............ ... ...............1g2-6.4 Brtefly describe all known and verified serious adverse events (SAEs) that.... l9 2 6.5. Trend of treatntent achievementfrom CDTI project inception to the current year2l2.7. ORDEzuNG, sroRAGE AND DELIVERy oF IVERMECTIN........, ..................222.8. CouuLrNlry sELF-MoNITozuNG AND STAKEHoLDERS MeerrNc ...........222.9. SupenvrsroN............... .................232.9.1. Provide aflow chart of supervisionhierarchy. .........232.9.2 LV'hat were the main issues identified durtng supervision? ......... . .............232.9.3. ll'as a supervision checklist used? ......... ............ . ....232-9.4. Ll/hqt were the outcomes at each level of CDTI implementatiort supentision? 232.9.5. Ll/as feedback given to the person or groups supervised? .. ........232.9.6. How was thefeedbackused to improve the overall performance of the project? ZJ SECTION 3: SUPPORT TO CDTI..... 23 3.1. EqurrurNr 3.2- FrNeNcter- coNTzuBUTroNS oF THE pARTNERS AND coMMUNrrrES3.3. OrHsR FoRMS oF coMMUNrry suppoRT 3.4. ExpgNotruRr pERACTIVITy ............... SECTION 4: SUSTAINABILITY OF CDTI.. 4.1 INTCRNEI; INDEPENDENT PARTICIPATORY MONITORING; EVNLUETION.........,..........25 4 1.1 Was Monitoring/evaluatrcn carried out during the reportutg periocl? (tick any o.f the.follov,irug which are applicable) ..... ....................25 4 1.2 ll/hat v,ere the recontntendations'? .. ...25 4 1 3 Ho.pv haye they been implernented'?...... .. ... .. .254.2. SusrnrN,qeu-rry oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy AT ...... .. .....26 ........................ 9 ........................9 ..,,.,...,.............. 9 ...................... I 0 ...... ............... I 1 ...................... I I ..... .. . . .. . .. .... .. .. I I ...................... t2 ......23 ......24 ,.,,..24 ......24 ,( lll WHO/APOC, 24 November 2004 Yn 3)......... ...........26 4.2.1 . Planning at all relevant levels . . .............26 4.2.2. Funds .. . ...........26 4.2.3 Transport (replacement and maintenance) ................26 4.2.4. Other resources... ..................26 4.2.5. To what extent has the plan been tmplemented ......... ...................26 4.3. INrpcRerroN ............... .................26 4.3.1. Ivermectin delivery mechanisms .. ..........26 4.3.2. Training . ..26 4.3.3. Joint superttision and monitoring with other programs..... ...........26 4.3.4. Release offunds for project activities ......26 4.3.5. Is CDTI included in the PHC budget? .....26 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. .................26 4.3.7. Describe others issues considered in the tntegration of CDTI .....26 4.4. OpsnarroNAL RESEARCH.. ..................26 4.4. I . Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. .......27 4.4.2. How were the results applied in the project? ............. ..................27 SECTION 5: STRENGTHS, WEAKNESSES, CIIALLENGES, AND OPPORTTINITIES........ ..27 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........27 1V WHO/APOC. 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Arurual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization WHO/APOC. 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemrc communities within the project area (based on REMO and census taking). (ii) Elierble 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 OTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the pro.;ect should be expected to reach the UTG at the end of the 3'd year ofthe project). (") Therapeutic coverage: number of people treated in a given year over the total population (thrs should be expressed as a percentage). (vi) Geographtcal coverage: number of communitres treated rn a given year over the total number of mesoftryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (usrng the same systems, training, supervision and personnel) in order to maximise cost- effecttveness and empower corrrrnunities to solve more of their health problems. This does not include activities or interventions camed out by community drstrrbutors outside of CDTI. (vrii) Sustainabrlity: CDTI acttvittes ln an area are sustainable when they continue to function effectively for the foreseeable future, with hrgh treatment coverage, integrated into the available healthcare service, with strong communlty ownershrp, using resources mobilised by the communrty and the goverrrment. (ix) Communitlz self-monitorins (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any communlty- based health intervention programme), with a view to ensunng that the prograrnme is being executed in the way intended. It encourages the community to take full responsrbilrty of ivermectin distribution and make appropriate modifications when necessary. VI WHO/APOC. 24 Novenrber 2004 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 (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 WHO/APOC, 24 Novernber 2004 Executive Summary Prepare an Executive summary of the report in not more than one page. 1. 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. EXECUTIVE SI.IMMARY Mulanje District has a total number of 584 villages with a total population of 441,734. Treatment is supposed to cover 369 villages with a population of 357,294 so our annual treatment objective is 357,294 with an ultimate treatment Goal of 83%. During2004 we had a Therapeutic coverage of 65oh. Part of Mulanje district borders with Mozambique some of the communities go to Mozambique for cultivation and other activities and this partly affects numbers of the people registered and treated. Some of the communities work in Tea Estates on seasonal basis this also affects registration and distribution. In Mulanje total number of Health Workers in the geographical project area is 210 but 107 have been trained between 2000 and2004. There are only 1560 CDDs in 285 villages and these were trained between 2000 afiZOO4. The ratio of CDD to population is I CDD per 235 people. The dropout rate for the CDD is currently at 5.8o/o. There are several challenges faced in the programme and several ways are tried out to overcome them. o Increased number of CDD dropout. Effort is made by communities to replace CDDs. o There is movement of people along the village bordering with Mozambique which affects registration and distribution. However effort is made by timing distribution to a period when there is a minimal migration. . A bigger population from the villages is employed in Tea Estates on seasonal basis which also affect both distribution and registration. However different distribution time and strategy is set in the Tea Estates. Ho"vever there has been continuous monitoring and supervision with top up funds provided by MOH and DHOs Office, Mulanje. 8 WHO/APOC, 2.1 November 200-1 SEGTION'l : Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads...) Administration structure 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. The District is in the Southem Region of Malawi. It is bordered by Phalombe and Zomba districts in the North. Thyolo and Chiradzulu districts in the west and the People's Republic of Mozambique in the East and South. Mulanje is approximately 85 KM east of Blantyre and 415 KM south of Lilongwe the capital city the district is accessed either by a tarmac road passing through Thyolo District Extending up to the boarder with Mozambique or Midima earth road passing through Chiradzulu District. Mulanje has a total land area of 2056 square I<M(2.2% of total land Malawi). The district has the highest mountain in Malawi and Central Africa called Mulanje Mountain with of 3001 metres above see level called Sapitwa as the highest peak. Because of the mountain there are two topographical district natural regions: 1. Hilly zone. This covers the area surrounding Mulanje Mountain, most of the south, central, northwest and eastern parts of the district with undulating land and lots of rivers and streams flowing down the mountain 2. The plain zone-covering parts of southwest, west and North western areas the district lying at an altitude about 600 metres above sea level. Mulanje has a tropical climate with two main seasons wet and dry season. November to April is wet season while May to October is dry season. The weather conditions are influenced by the mountain. The district has a total population of 441,734 people with a diverse cultural background due influence of various tribes converging in the district. Most families follow the matrineal system of marriage where by land is acquired through marriage and a man resides in the wife's village with the children belonging to the wife's village and clan. 89o/o are Christians, 50% Moslems. Chichewa is the main spoken language (approx. 53%) Nyanja (approx. 33.62%) Lomwe (approx. 10.26%) and Yawo (approx. 2.3%) Most of the administrative offices are located at the Boma as a central point headed by the Chief Executive also known as the District Commissioner who is also the secretary of the District Assembly The District Assembly is composed of all ward councillors, 6 Traditional leaders and members of parlianient. 9 WHO/APOC, 24 Novernber 2004 The major sources of income in the district are employment in the Tea Estate and small scale businesses. The settlement pattern is dominantly rural with semi-urban at the Boma. There are 39 health facilities in the district, that is, 14 estates, 15 government,4 CHAM, 5 private and I N.G.D.O. The means of communication include Radio, Telephone, Cell phone, intemet and telefax. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage Bs=Bzl Br *100 MULANJE 210 210 100 Total 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), 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 parlners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. 1. 1.2 PARTNERSHIP The major partners in the project implementation are community, MOH staff at National, District, Health Centre and community level. Currently there are no NGDOs after Thandizani Moyo (responsible for Estate t{ealth programme) phased out in 2002. 10 WI IO/APOCI. 2-i Novcmber 200{ t o] () -o Eo o z$ c\t (J o o --h () Lo (.) o oa q< C)L o() L a. O o. o. o o -o(! e=(,)n .EQ oa -c ;(! l-(,) cu .o- 0)F o .. r o..l c,2 (J-' -.cr) !a C) (H o oL o- (.) hrr 0) o a F ai bo(! L o x E E oo C) q C) a o o q.) O C) oo E o L() o oo a ()()L -oA()), o' oo9.trl C)oL oq ! o o c oQ I I I I I I I I I Ia a Oo o (64.. ooLL ^(D6> l+ q) 0) c-.E o L C) o. oot PE d)c)LE(.)cd *() oo -q E, c0()S I c.,e-E oq<oo 'd o.rL (-) ILL or? L() hE o)= oj <!; a:.632 Uq) ':\\ s U :\q) () B\) -o o (J t- D :6- E.:oE ii(J tla) \o o\N + ll rq) -19o ,= aN = -F.gE> E ! ot <l o\Nr- ta) c.) o :''l r.:f, x *E i;;EEE'FNa o\tr)\oC\\o ;!6tr.=:?"Ugsi coso\N I o l*o ON o.= c! c) F +* il o\\o co .= a) € a_tr o :''l9E Ei! tcotr >iOF!= N o\ta) I ah c) of, G U)o c.) Ll 0)t -al z 'EgE :r5 h ?oUgsi aa Cgtr 9.) v?- .I L TY -s9 -=;96 5 ().AX Pqr 9' -vU-LrA-a $ o\ c-.1r-la) co :q,,e ,YE q) tscle5'; aH;< g c! aFl F irl z J D =a a)q) - atr 3sO ES .E E:tu =xF!I ;SO. X'xO rl-Eo. -.t .-'rl y . ()l sN sIQJ fts o L C) o. bo L O a.oL o oo ! o LoE 0) q) o li >. c) H 0) o q) cl Iq) q) q) o vo L o (o o. a. -o c)s I oa o eF -I oLq) d ! C)L(! a d o- -o t cd {je ;6 |"nbOrrl g cdtr() L - (-)EC) 6 -a .=(€ d :o)otrFtr()(d =q!FU .o- .oaH v19 = .Y6 a!Y E.r! ^-nv.-YO. -o'EqacB Q AaHF'- .UL --9 J: co2.oo qrq/:e a ';10 dLH = o'= 6 . Q.Y^(JP-WL 6 ;i re3 lpE6;L=(.) v)c-' a-l!l*d o-O c)F bo?= O-.l E-Y C J*A6 y E;j jzFU-H L (q+i U! sorB* .L*6 = a o,l!? :Y F O rl HdL'ho ='= t, u/ aVLH !LU9 o>EL>odoJ->> -EulaF ,?Hd)v'*' Mobilization of communities Training Census/Update District/LGA Startingmonth Completion month Starting month Completion month Starting month Completion month APRIL DECEMBER MAY DECEMBER APRIL JLTNE Drt Starti monl MAY 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. The DHO assisted in funding planning meeting and provision of fuel for transport for supervision. Estate managers assisted in mobilisation of Tea Estate workers to take Mectizan. The constraints faced were: 1. some estate workers demanded money as payment for drug distribution 2. limited funding from MOH and hence some activities could not be conducted on time The above difficulties stated can be eased if: 1. there is constant consultations and dialogue between the Estate Managers and drug distributors 2. maximise the use of limited funds available 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and./or other local systems to disseminate information Mobilization and health education of communities including women and minorities Response of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. The local system which is used to disseminate information is through local community meetings and through theater/drama performances. The response has been encouraging. Drugs were delivered in good time to Health centres and communities. t2 WHO/APOC, 24 November 2004 CDTI PROJECT ANNUAL WORKPLAN FOR MULANJE TARGET MAY JUN JULY AUG SEPT OCT NOV DEC 1.To train CDDs and Village heads from new villages 1271 CDDs and 84 village heads X X 2.To conduct planning meetings with CDDs and HSAs in readiness for Mectizan distribution I x 3.To mobilize and sensitize the community on Mectizan distribution t6 x x X 4.To order Mectizan from BI 600000 X 5.To collect and distribute Mectizan 600000 x X 6.To supervise CDDs in the area 1 560 X X x X x 7.To request TV,V, deck All items purchased X 8.To conduct stakeholders meeting r6 x x 9.To conduct review meeting on Mectizan distribution t6 X 13 WHO/APOC. 24 Novcmbcr 2004 6l r6) -o C) o z$ o.t Oo oE $ oi o E q) d a 0) a ah O a E bo C)p 0) H aq) aa F -o \J '\ -qJgt ,6A\w UO\trs sEo{!>h >i^.\ .;Ltrs \8oE n" UtrH:Ytl () ia:: N.958 P F--HUNOI -!\ =P\lN e^\id -* ql'o!4S.s =()qJ()E E .U t()- H-= <l E ": $l'e -8e i S 3 * d-Y ='Fd E N; Xbe u n ='E q qo .H - u qJ r) e E={()Otr.Y \-t t+r! +t Q'J aQ cU.- g tfo O.N o ()o,l'56qi -.c.ih o='*Ei()Y H P 6.E Av*9dr s"ooElQ€ E E 5!v!.r'tr g'A H.EHiBOOH ts = 9 >,d or 9.;-oJ3 = />ru-HoeU;F'O.-En H>i>A t.-/'- 4 : o't 9ii *H^_@o ^ o *'ii 0) .. () -.- A O -tr-N=a-6oitXX)fo .- U.H b 6 t'^'E U'tr I :€wLr\9*H!-;YPP =.4lixr--74u \ - *- \ vt: (,rrrrr od =0H6 E+ ri3atrbo =6ZF o ll * cq eE! € e o o\ o Ec* E EEEzz, € F 9-6Otr^ n O o o q U z o € \o @ o\ o\\o >o uh OG tro Eq oE @= ze il* co ra ca UD o o z E >,2 e t'= a a , = L.?6=1' -o tr= h ZUE- ?qdj.: L q tr'EE 6 - = o: i.:E:o .v H- o z 6 € gJ J .9 a H z ,.1) z oFr i\ N 4 qj U a) o\ p o q) V2$ AJ a_v F L.]O 0) fl . .\E=o.=E=on go'6 EH #o L'=)=EEtrE -Ori(r: <rl . orlrElr cdlNFI 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). o Those who are kained have adequate knowledge. . Those who are trained on the job have low knowledge. . And those not trained lack knowledge. 15 WHO/APOC, 24 November 2003 q) G a U o z iU l 'U \rqv l: =v r) o\ t'.- \o \c)ta q) C) o o\ m ra?rFU coN 0 o .1 'q'FF 0r: oq) .c) Lc! z : !1 '(, *,iqv av ru o o o\(,F tr-N q) ct qG oq .aPtr:- 7; E,'l?F-d ,r&,U U = oo C\ 6 \o N q) o \o F € 6 a 0 Fl 3e90) EF o z ",,dE,''r +F'(j pd U (,LF F- N \o co (\ q) o s N J o e = F] t'r 3 o.l o 'o E o z t(\ L.,o o f s a { o\ a { I .E o a- o \ o\ s a G ! o ts ,r ts = -\ 4q\) U 4: l* q) o .: q U () E o a- E F o O +< o a o c.) C)L . (.) FI () c0 bi) LF ,ii1 oJl -l F] r- a.l N Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilihes) MOH staff or Other Political Leaders Village heads Program management How to conduct Health education x x X Management of SAEs CSM SHM Data collection x x Data analysis Report writrng x X Drug distrrbution x x x Table 6: Type of training undertaken (Tick the boxes where specific tratning was 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. t1 WHO/APOC. 24 November 2003 s e.l (.) -o o o z$ e.l U oA o > oo E6 ll-\ q s tr-ll' $" bO s 3 F o't3is .as oot A1 taJ { .=B}:$s:s.x so .r x' AE Ti o$ \iB\r}B .S '$nE \.u P'S\\ E!! '=.Et\\:s'Q Ir u ES 3 'iui tsB ib .l Y'uE lrs s.: S {'.8 u d--\ s\) s s\ E \Uf Es .i iY M od s-Q\ 'a oQ E $E *N. .* $s' Iu r G.a: ar s s! : sr \ t* _u I !.,tB t's E9Lr da.e st .^.\ SSrF\ t\ ='il ilso oiLt\S ri F Cd c) L(t Oo kq() ad okd o E() 0) Ik 0) o. oa() €() d ^, c)xl !Il o, xl s *l o 9l .dl -0)l qEl Iot o-El .*bt o ol ko+q LI Jol tr *l 3 ol d -ol - Ht d 3l o zl?- OIOI -t t0)xl > El I cdl '- ,tsl6()I : oloOI trot 5 o.l d tslE rl 'ol = -ol 9l 2l a. 63() fi Po(D '=U(aH OJHC)6i PP Odo.= a! Sa(D rrl4E& t d! I> (-) -'a Ia00)= .=otr(, d6trc€ co;i() .9EA)tr ot CC) OI E € -l Eb xl 3 -r tl6 !2lPo- dlEb 9l b! !l atv ^alC; 0)l o)tri b.0.r -Gl ilalVH-l ^Hat ^bo 3l= .= Ul 6> El I = ,l tsc El t*o trl o id Yl oJ vl ^JHI -o- oltr ULI Jo- olc '63 trl dHte a-taF Zlt- O x () () k () p o o(H k 0) -o z a() bJ lro oo d o I cd! bI o(-) bI q)I li() bI 0 o (_) H _o F o =\r U) a1q) Uq) h a\ q) o "E q) v1(J qJ 5 JZq cd cn cd 0)L(c rFl F.l oi. a '(, >. .o 6 El a 'If {) 0) liF r-1 d) I -l 0) C) O cd(,F \oa\ () p (.) bo (J\ oo oF () H 0) bo H() o o -1- dL bo o 0) o 0) H o bo k 0) oo 9.eP^\ (J o- cdp 0) F A'g EE#ss*o<r'U= o iHEsE dg o- o o o o -o E z O I fr.lE4\ t/) AO b9!ccO o\F- d t-- o6 EZEE--o .o;E d trEb}4F2" EE mr- F- o (! aopr o lt * oa\o o '50 ,d)od =o ooEOF \o \o H o 6_ E8E EbE = o.-z + O C\ ='oE6: B:Oi sFF(J \oo\N ! ;,d = c, F.E5--c i o 6 - q€ oF s c.] t-r ao b0 a q 0) E oU ll + ^rxH! o bo o oo da a.6 bo oot'l o\ O ! u o - L = [j ! -3 5 SH =tr>-z6 o\\o aO ! dUa e 6,: i 9-o' -t:o \o \o6d-td G o= i n, eJ-^= -4aE9Ad i o ^\ --6 E S3 E v>o \o FJo\ ,l t-r F lt 2.6.2 What are the causes of absenteeism? o Some people were taken as tenants to some parts of the country. o Some people are always busy with their business across border. 2.6.3 What are the reasons for refusals? For religious belief. Some are not interested to take the drug for reasons known to them selves. 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 ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report a 19 WI-IO/APOC, 24 Nor ember 2004 v O6l () E C) o z <-(-.l O oA o 3 o c..l AJ \ q) *t o'\q) B\q)4 ,+ -:\ a q 6qj (..) q) q + L q)\ o \ q) A) s AJ a*\- E .F 0)A bo li q 0) *i 0) bo $i 0)F) Oo 63 a rrl a a 0) 0) 0)alr() E q o l-.() a(H o a() a Cd(, cbr drl -lot(gl FI () -E=o.o9 -c2rO'l uoyo <.E E ;103 P6J6oi,f-e o!rEF9rl.]55 o ().9 e^ e=6h O @ o.-.eY(H9 o: @9 ^ 6:c)C)-c tr&3d qi;o-O 2E C o c c= 6@C)OOE.he O tr o vo-c+ atsd;i .x-o 0J xLJ (!-cC: CN t.9 99iiEE€53;_i.:q)?<Ao-OjjZ O E o- F a C)=u p !o6d O =oN= Y!2o a> x O I o 0)b0e =g)20 xo CN () bo * <n O O O C)bor,r d ^Y L'^'F ()X '1 ></eo O \o @ o\ co co o\ co oo o\ € o d a.o P. l I o hl tl il ri o ^bo(J€+ r Qo\ o \o n e'l \o \o .o \o c.) co ll {_ r-1 d ti o\ o5o ,b0od ec, ooEoF o\ n aa C.l o\ \o .c) o\\o ri E ,o od ,oOEp_q -oz9,o a. \o o\ "1 (-- $ tr- € -i .tO ca C-.1 ri =oEb> =F!E 6.gli9s'FU o\O\o a.l o\ t--o '+ !d o\ c.1 GAo +3 S I o l- - .os€= E14 ' a 39 o o\ \o c.l6 O d ca m o\ ci co $ o\ a\I (r- @obo CB a o tr Eo() o !i li l.l o ^bou(^ r Ua\ o 6\ .l rc <f o\6 6\OO oild- 6-rr f ts u 9 ar.i'.r Oeri c.l rc o\$ o\€ o\O rJ.) oi9'! e 5 #9 >oti $ \o\o \o a EoE 6.> !:= o rPD \o aa o\\o o\\o \o ood = -rd.:?.. b e, " a: o:+ o= t-'- -.=-Eo 2783.P ' ! trF EO oo l-l o\\o o\\o o.\\o o\\o d. r! r- o\ @o\ o\ o\ o\ Ooo c] OO(\ No C\ OON $ ON OO c\l \o O(\ t--Oo cl €OO c! o\OON o ON $ e.l Eo -o C) o z c.l O op.{o B N ah G o d e) q) o! d q) <.) Fp 6l d () q) U) c! q) o0 o q) o C!q) d Oq) o q) () F D 0) c) O q) a d 6) a p s.\) 9-s estr..9\ =nrQq 6) :. Pd .=L 9.t E OA '= c) Fro.> ii .o &U o, cgl =.olool .e utt.l ! !-)oll o!utr6 oo +rE 9=ae t<E r;9\oi c.i o\l(JI ^ldtr-lr 'l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)MOHX WHOtr TINICEF! Other (please speciff): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH x WHO t] UNICEF tr NGDOtr NGDO Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities MOH Hqrs. By DHO to District by DOC/HC staff to HC by CDD to Community Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? Collection is done by H.S.A to DOC and is kept at the Pharmacy. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Any other comments 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Table 1 l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 132,383 State/District/ LGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remaining MULANJE 700,000 700,000 564,964 0 2,653 0 TOTAL DrstricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSNf) No of Comrnunities that conducted stakeholders meetlng (SHIVD 369 0 TOTAL 369 22 WHO/APOC. 24 November 2004 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Supewision 2.9.1. Provide a flow chart of supervision hierarchy. Hq to DHO to H/C to CDD[community] 2.9.2. What were the main issues identified during supervision? - Some H.S.As still fail to calculate on percentages which result in late submission of reports. 9.3. Was a supervision checklist used? yes. 2.9.4. 2.9.5. 2.9.6. What were the outcomes at each level of CDTI implementation supervision? - The problems were identified and rectified on the spot. Was feedback given to the person or groups supervised? Yes. How was the feedback used to improve the overall performance of the project? - Feedback was incorporated in plans and contribute to alterations in schedules and plans. SEGTION 3: Support to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows if necessar.y) *Condihon of the WO:Wrrtten off,) equipment (F:Functional, CNFR:Currently norr-functional but repairable, How does the project intend to maintain and replace existing equipment and other materials? Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO Others No Condrtion No Condrtion No. Condttron No Condrtron No Condrtron 1. Vehicle 0 0 2. Motor cycle(s) 2 CNFR 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) 0 0 6. Fax Machine(s) 0 0 7. Others a) b) c) 23 WHO/APOC. 24 November 2004 Contributor Year I ('provide the period') Year 2 ('provide the period') Year 3 ('provide the penod') TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central * Provincial/State) MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) Others a) b) Communities APOC Trust Fund TOTAL 3,2. Financial contributions of the partners and eommunities Table l3: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Human resource ie the communities assist in drug collection and distribution 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. Indicate exchange rate used here 24 WHO/APO('. 24 Novcmber 2004 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 GDT! 4.1. lnternall independent participatory monitoringl Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What *'ere the recommendations? 4.1.3. Hon, have they been implemented? Aqlivity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of gomqq!rly_ Mobilization and health education of communities Training of CDDs Training of health staff at all levels S qP,ery-tl il&9 DDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 200 285 380 ll0 460 185 DHO DHO DHO DHO DHO DHO TOTAL Total number of rsons treated 81,'9 WI-{OiAPOC. 24 Novcmber 2004 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period ? 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 of: 4.2.1. Planning at all relevant levels Incorporation of CDTI with other activities. 4.2.2. Funds To tap funds from DHO and possible donors. 4.2.3 Transport(replacementandmaintenance) Though the DHO tunds [ORT]. 4.2.4. Other resources DHO and possible donors. 4.2.5. To what extent has the plan been implemented Provision of funds for planning meetings, m,/bike maintenance fuel and manpower. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Collection of drug from Bt. DHO pharmacy to the district and IVCs. 4.3.2. Training. Joint supervision and monitoring with other programs Is incorporated into supervisory visits to FVfacilities. Release of funds for project activities Is planned that funds will be released through the DHO. Is CDTI included in the PHC budget? Yes in DIP. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? None at present. Describe others issues considered in the integration of CDTI. A well developed supervisory checklist . The use of same leadership structure, Min.of Health staff and health infrastructure 4.3.3. 4.3.4. 4.3.5. 4.3.6. 4.3.7. t 4.4. Operational research 26 WHO/APOC. 2.1 Novembcr 2004 4.4.1. 4.4.2. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challengcsr and opportunities List the strengths and weaknesses of CDTI implementation process. Strengths: Managed to reach 100% geographical coverage. Integration of CDTI services with other programs. Provision of transport and fuel by DHO. Weaknesses: Increased no. of CDD dropout. Late submission of reports. List the challenges and indicate how they were addressed. Challenges: Late funding. Some H.S.As still fail to calculate on percentages. A lot ofrefusals and absentees. Solutions: Timely funding. On job training. Intensification of IEC through tvtalks and drama goups in the community SEGTION 6: matters Unique features of the proiecUother :t 2l WHO/APOC, 24 November 2004 ,ft:i a' a a I( a