ai THE UNITED REPUBLIC OF TANZANIA (inq[udi4_g e-mail address ) ORIGTNAL : Enslisli ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 3l Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) Proiect Narne: MOROGORO CDTICOUNTRY/NOTF: TANZANIA Approval year: 2002 From: JANUARY 2013 To: DECEMBER 2013riod: ( Month/Year)(Month/Yerar) Re ortin (circleone) I 2 3 4 5678 (9) l0 11 12 13 APOCProiectimrrlementationvearreport: (circleone) l2 3 4 5 6 78(!)10 APOC funding year 1l t2 t3 Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - GlaxoSmithKline(GSK) - Morogoro District (MDC) and Mvomero District Councils(MvDC) - Sightsavers - 1059 Communities Date submitted: WHO/APOC, 14 September 2009 I I I I I I I I I I I I I I I Launching vear: 2003 I a, I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: TANZANIA National Coordinator Name: Dr. Upendo Mwingira Signature: ... Date Zonal Oncho Coordinator Name: : Dr. Godfrey J.B. Mtey Signature: .. Date NGDO Representative Name: Mr. Gosbert Katunzi Signature: Date This report has been prepared by Name : Dr. Deborah Kabudi Designation : Project Coordinator Signature Date 20th June 2Ol4 I ll WHO/APOC, 14 September 2009 Table of contents ACRONYMS v DEFINITIONS... ...... vII FOLLOW UP ON TCC RECOMMENDATIONS... I EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION..... 1.1. GENpRaITNFoRN4A'noN............. 1.1 .1 Description of the proiect (bricJlyl . .. 1.1.2. Partncrsltip 1.2. Popu1erroN............... SECTION 2: IMPLEMENTATION OF CDTI 2.1. TltrapLtNe oF AcT'tvtnES ............ ....... l0 2.2. ADVocACy .....................l2 2.3. MoeILIzeTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMN,IUNITIES I3 2.4. Covvulrry INVoLVEN4ENT.......... ...................... 14 2.5. CRpacrrv BUrLDINc... ..... 15 2.6. TRearvpNrs.............. .....17 2.6.1. Treatment figures .......... ....... Erreur ! Signet non ddfini. 2.6.2 llhat are the causes of absenteeism? .......... ..................... I9 2.6.3 What are the reasonsfor refusals?................. .................. l9 2.6.4 Briefly describe all knov,n and verified serious adverse events (SAEs) that ....... l9 2.6.5. Trend of trealment achievement from CDTI project inception to the current year 2l 2.7. ORDERTNG, sroRAGE AND DELIVERY oF IVERMECTIN ...........22 2.8. CovrrauNrry sELF-MoNIToRING AND STAKEHoLDERS Mperruc ............23 2.9. SuppRvtstoN ............... ......................23 2.9.1. Provide aJlov, chart of supervision hierarchy. ............ 23 2.9.2. What were the main issues identified during supervision? . Erreur ! Signet non diJinL 2.9.3. Was a supervision checklist used? ......... Erueur ! Signet non ddJini. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Erueur ! Signet non ddJini. 2.9.5. Was feedback given to the person or groups supervised?... Erreur ! Signet non diJini. 2.9.6. How u,as the feedback used to improve the overall performance of the project'? Erreur ! Signet non ddfini. ., I 4 I ....,...,.9 ........10 t SECTION 3: SUPPORT TO CDTI 3.1 3.2 J.J 3.4 25 25 26 3l 3l 3l 3l EqureveNr Fn.IRNCIeL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES. Orsen FoRMS oF coMMUNITy suPPoRT ............... ExpeNotruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI 4.1. INrenNar-; INDEIENDENT PARTICIPAToRY MoNIToRINc; Evnl-uRrtoN lll WHO/APOC, 14 September 2009 1.1.1 Has the project ever been evaluated/monitored? (fick any of the follov,ing v,hich are applicable) ... ....... ............ 31 4.1.2. I4/hat v'ere the recommendations? .................. 31 1.1.3. Hov, hove they been implemented? ............. ... . ......... 31 4.2. SusrerNaetLrry oF rRoJECTS: nLAN AND sET TARGETS (MANDAToRv AT................ 3l Yn 3) ....... 31 1.2.1. Planning at all relevant levels... ..... .... 32 1.2.2. Funds... ... . ... ...... 32 1.2.3 Transport (replacement and maintenance) ...... 32 1.2.J Other resow'ces ....... ..32 1.2.5. To v,hat extent has the plan been implernented..... ..... ............... 32 4.3. INr-ecRnttoN ............... .....................32 1-3.1. Ivermeclin delit'ery mechanisntr'.......... . ......... 32 1.3.2 Truining.... ......32 1.3.3 .loinl supervision and moniloringvt,ilh olher progt"am.t.. .. ... .32 1 3. J Relcase of .funds .for project activities .. . 3 3 1.3 5 l.g ('DT'l included in the PHC budget? ............ ... ..33 1.3.6. De.scribe other healthprogrammes that arc u,sing lhc ('DT1 structtlre ctrtd hotr this v'as ochieved. What have been the achieventenls'/......... .............. 33 1.3.7. Describe others issues considered in the integration of CDTI. ... . ... . 33 4.4. OpeurroNAL RESEARCH ..... 36 1.1.1. Sunmtarize in nol more than one half of a page lhe operational researclt undertaken in the project area within the reporting period. ........ 36 4.4.2. How were lhe results applied in the project?.... ............. 36 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... 36 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........36 u lv WHO/APOC, 14 September 2009 a Acronyms APOC ATO ATrO CBO CCHP CDD CDDs CDTI CHMT CSM DNTDco DOT FLHF FLHW IANET LF LGA LLINs M&E MDP MOH MSD NGDO NGO NNTDco NOTF NTDs PHC REMO RHMT RNTDco SAE SHM African Programme for Onchocerciasis Control Annual Treatment Obj ectir,e Annual Training Objective Community-Based Organization Comprehensive Council Health Plan Community-Directed Di stributor Community Drug Distributer Community-Directed Treatment rvith lvernrectin Council I-lealth Managemnt Team Community Self-Monitoring District Neglected Tropical Disease Coordinator Distrct Oncho Team Front Line Health Facility Front Line Health Workers Integrated approach to NTD Elimination inTanzania Lymphatic filariasis Local Government Area Longlasting Insectisides Treated Nets Monitoring and Evaluation Mectizan Donation Programme Ministry of Health Medical Stores Department Non-Governmental Development Organization Non- Governmental Or gan izatio n National Neglected Tropical Disease Coordinator National Onchocerciasis Task Force NTD Neglected Tropical Diseases Primary health care Rapid Epidemiological Mapping of Onchocerciasis Regional Health Management Team Regional Neglected Tropical Disease Coordinator Severe Adverse Event Stakeholders meeting v WHO/APOC, 14 September 2009 STH TCC TO'I TV iINICEF iJS AID UTG WIIO Soil Transmited Healmith Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Television United Nations Children's Fund United States Agency for International Devclopment Ultimate Treatment Goal \\rorld Health Organization VI WHO/APOC, 14 September 2009 a Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84oh of the total population in meso/hyper- endemic communities in the project area. (ii) (iii) Annual'kpatncnt lbicsttrg: (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 rvithin 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) Therapeqtic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage) (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vll WHO/APOC, 14 September 2009 a FOLLOW UP ON TCC RECOMMENDATIONS Using the table belorv. fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 37th 1 Number of Recommendulio tt itr llte Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Rerrort related 198 a Correcl the .figures in tohle 4 on llte lotql number of CDDs (nmles 600 + 634 : 12-14 hut the .figure provided is 1271 wltile for fenrules 653 + 646: 1299 but thefigure provided ri 1262). Ultimotely it is ttot cleor which ri the correcl position in the implenrcnting communities There was calculation error. The total number of CDDs....... a Ensure lhot tlte information for 2012 in tsble 9 is consistent with the information in the otlter tables (for instance the total number of villages treated is 1052 yet table 7 reports that 1045 communities were treated). There was typing error the community treated w4s........ a Tsble 10 indicates tlrat lhere were no drugs in stock yet the 20Il report indicated that 617,972 drugs remained). The team sltould exploin how these drugs were used The team should explain what happened to these drugs since for lhis reporting year more than 700,000 drugs are The remained drugs were sent to another district where there was a shortage. WHO/APOC, 14 September 2009 reporled remained to ltave Include infornrution on lhe oulcomes of internal monitoring (secliort 4.1.1. - 3) have been cottsislently blottk. a AII Evaluation was already done in our Project area i.e a)Year I Participatory Independent monitoring b) Mid Term Sustainability Evaluation c) 5 year Sustainabilitl, Evaluation reloled Ensure lhut all communities tre covered during treotmenl. h is ttol clear wlty ly' villages in Morogoro Rural did not receive treatment in the currenl report period a The communities rvere not treated because they are situated in hard to reach area and during the distribution the bridge was washed away with rain so no communication. The communities were treated this Address the reasons for refusals, which include people who have no signs and symptoms refusing to take treatment and the persistent association of Ivermectin with contraception. People tends to recall the past incidence so they are still remembering minor side effect they got when taking drug for the first time and those with no sign fear to get minor effects when they see people who reacted. Address the 63% of the villages (669) currently not achieving the 80% t lt e rape utic coverage. a In those communities infection is very high therefore there is tendency of people refusing to take the drugs regularly. (Please add more rou,s if necessary) 2 WHO/APOC, I4 September 2009 a . Executive Summary Morogoro Rural CDTI Project is in the 9th year of CDTI implementation and is covering two districls namely Mvomero District and Morogoro District council.out of six districts in Morogoro region. The two districts are decentrahzed with separate government funding for CDTI, using lt, o*n Comprehensive Council Health Plan (CCHP) and support from APOC fund. The pioject is now in the six year for the implementation of integrated NTDs activities in Oncho and non Oncho endemic areas. In Nov 2013 APOC management sent a team to conducl Phase la Epodemiological llyaluation in our project. The exercise was conducted in 20 villages whereby 8 (40%) r,illages rvere found rvith positive cases rvith prer,alence ranging from 0.3Y" in Mkamba villa[e b 33j%o in Bwakira Juu village. Morogoro rural district registered the highest number of five (5) villages with positive cases rihile Kilombero districl registered three (3) and none in Mvomero and Kilindi districts. In tolal 3.348 persons were examined and 169 (5%) were found positive with microlllaria. 27 persons had onchoccrciasis nodules after palpation. ln this repo(ing year. the project had fbcused mainll' on the lbllowing components: - training- rnonitoring, sensilization, mobilization. Comrnunitl' Self Monitoring (CSM) in 294 communities and Stakeholders meeting (SHM) 510 communities. The project trained and retrained 2,533 CDDs, 133 FLHWs, 57 CHM'| members and 7 ToTs. Sensitization and mobilization meetings were conducted in the entire project area with more focus paid to places where there is new leadership. In Morogoro CDTI Project, Onchocerciasis is found in 1059 communities which are both hyper urd *.ro endemic. The population living in those areas is 372,727 people out of this Zge,qlS people were treated achieving the therapeutic coverage of 79.5%. The geographical coveragewui tOOX whereby the UTG was 313,091 and ATO was 305,637 respectively. The CDD per population ratio ranged between 1:100 and l: 120. The Project received total number of 1,379,000 Mectizan tablets for the treatment of Onchoceiciasis and Lymphatic Filariasis in oncho and non oncho endemic areas, out of that, 7,267,520 Mectizan tablets were used in the treatment plans to the targeted areas as mentioned above. The remained tablets were collected and stored in the district pharmacy or store. Challenges and how they were solved: - Submission of the implementation reports in different formats this increases the workload to project coordinators and other staffs. How to replace worn-out of capital equiprnent and office equipment. J WHO/APOC, 14 September 2009 SECTION I: BACKGROUND INFORMATION 1.1. Generalinformation I. MOROGORO DISTRICT Area: Morogoro District Council has an area of 11,925 Sq.ktr.which is about llYo of the total area of Morogoro Region. 'fhe Council is located between latitudes 8 and 10 degrees North -East of Morogoro Region and South of the Equator between longitudes 32 and 38 degrees east. Bagamoyo District is situated to the East, while Rufiji is to the South East, Ulanga and Kilombero to the West and Mvomero District to the North. Administration structurcs Cultures Main cultures are:- - Traditional dances, - Use of traditionalmedicine, - Conduction of church sessions over the hills 4 S/no Divisions \\/ards Pop/ward No. of villages No. of sub- villages 1 Ngerengere Ngcrengere Kidugalo Mkulazi Matuli Tununguo 13709 n260 5824 5950 8780 7 8 4 J 4 l8 53 l1 10 t7 2 Mikesc Mkambarani Mikese Gwata 8667 12089 10012 4 7 2 t9 l8 t6 J Mkuyuni Kiroka Tegetero Kinole Mkuyuni 24141 7422 13967 215t2 5 5 5 7 34 t6 24 4t 4 Matombo Kisemu Lundi Mtombozi Tawa Kibungo juu Kibogwa Konde 91 11 I 1353 9870 tt936 6869 9155 65t2 6 4 7 6 5 5 J 13 t6 z) 47 19 28 il 5 Mvuha Mvuha Selembala Kolero Kasanga Bungu l 3095 581 1 10000 s839 52t3 6 5 6 8 J 55 24 35 18 t9 6 Bwakira Bwakira chini Bwakira juu Singisa Mngazi Kisaki t3016 6326 12799 9508 14273 4 3 6 4 J 32 2l JJ l5 t4 Total 6 29 304019 146 787 WHO/APOC, 14 September 2009 Languages Main languages spoken includes:- - Kiswahili as a National Language - Local languages ie. Luguru. Kwere. Kikutu and Masai. Weather: Due to availability of both mountains and lorvlands, the clirnatic condition of Morogoro varies within the districts. Thus, there are two rainy seasons. The "short rains'' season usually occurs from November to December rvhilc the "long rains" scason occurs from March to May. The annual rain totals are between 800 mm in lowland areas to 2200 mm in mountainous areas. Tlie dry' season normally commences from June to October. Physical Features: The districl can be divided inlo three -eeographical zones a) Mountainous/ Highland zonc This covers the Uluguru Mounlains u,ith an altitude of 1200- 2000 r-nctcrs abor''e sea level and rvitlr clay type of soil. 'fhis zone covers about 25oh of the dislricl area, and is densely populaled. The zone is suitable for the production of maize. beans and horticulture products particularly Mediterranean types of fruits. Cash crops like cardamom and coffee are also grown. b) Semi Mountainous/ Lowland zone This zone covers a great part of the Morogoro South. It occupies 20o/o of the total area of the district with an altitude of 800-1200 meters above sea Ievel and it has loamy type of soil. The zone is suitable for the production of maize, cassava, sorghum as staple food crops while cotton, sunflower, simsim and sisal are grown as cash crops. c) Savannazone The zone covers 55%o of the district with an altitude of 600-800 meters above sea level, with loamy type of soil. Paddy, maize and cassava are grown for both food and cash crops. fuce cane, cotton and sisal are cash crops. Selous Game Reserve is also in this zone. The district has got big rivers and valleys. Rivers included Ruvu. Ngerengere. Mvuha, Mtombozi, Mbezi, Kasanga and MgetaKafa. d) Human Resource For Health The Council Health Management Team (CHMT) has only 7 members out of 8, whereby there is no District Dental Officer. Also there are l6 other staffs for administrative purposes. The Council has eight Health Centres which comprises of 137 staffs from various health cadres. Out of 203 required staff only 737 are available, Hence there is a shortage of 66 staffs in the level ofhealth centre especially professional staffs. At dispensary level there are 161 health staffs from various health cadres, whereby out of 420 required staffs, only 161 are available. Therefore at dispensary level there is a shortage of 259 skilled staffs. 2. MVOMERO: AREA: Mvomero district is located between 8-10'S and28-37'E in centraleast Tanzania. The district has an area of 7 ,325 Sq. km., which is about 14o/o of the total area of Morogoro Region. 5 BORDERS WHO/APOC, l4 September 2009 To northern part Mvomero is bordered by Handeni and Kilindi districts of Tanga Region. To the East there is Morogoro District. Bagamoyo District forms the Norlh eastern part and Kilosa District is situated at the u,est. CLIMATE The altitude ranges fronr 300-2300 above sea level. The mean monthly temperature is26C. Temperature ranges bctrvecn l8 o C and 30o rnrn and rainfall ranges between 600 to 2000m. Rainfall patterns are of tu'o seasons narnelt'Iong rains and shoft rains seasons. Their rnain activities are:- - Subsister.tcr'Iani.]i11g - Business - Livestock keeping PHYSICAL FEATURES Geographicaly the District lics ott thc lollorving thrce ecologicaI zones:- I) HIGHLAND AND MOUNTAINS ZONE l-he zone occupies about25%o of the districl area exlending on Nguu Mountain ranges. This zone lies rvitlrin altitude ol 1,200 -2.000. Main Occupations in this zone are agriculture, horticulture and ntargiual livestock keeping. Therclbrc. thc zonc is ver]' potential for grorving food crops, cash crops, spices. fi'uits and vegetables. 2) MIOMBO WOODLAND ZONE The zone occupies about20%o of the district area rvith lorv flat lowland physicalfeatures. The zone lies within the altitude of 600-l200rn above the sea level. Average rainfall is 600-1200mm. Most people within this zone engage themselves in agriculturel livestock and some employed in the National parks and forestry. This is the best zone for agricultural production and livestock grazing. 3) SAVANNAH RrVER BASIN LINE This zone extends alongside great rivers of Mkata, Wami, Mgeta, Mlali, Divue, Diburuma, Mkindo, Mburumi etc. The zone is potential for irrigation, dry season cultivation, production of paddy, sugarcane, cotton, vegetables and fishing Cultures Main cultures are:- - Traditional dances, - Use of traditional medicine, - Conduction of church sessions over the hills Languages Main languages include:- - Kiswahili as a National Language - Local languages ie. Luguru,Zigua, Nguu, Kaguru and Masai. ADMINISTRATION Mvomero District has been divided into 4 Division23 Wards and ll5 Villages as shown in thetable bellow:- No. DIVISION WARDS VILLAGES HAMLETS I Mvomero 1 34 154 2 Turiani 5 29 158 3 Mgeta 7 25 156 4 Mlali 4 27 109 Total 4 23 l15 577 a. HUMAN RESOURCES FOR HEALTH: 6 WHO/APOC, 14 September 2009 Mvomero District Council has a total of 625 staffs (75%) out of 858 needed employees. The department is facing a problem of inadequate skilled health staffs. The gap is budgeted in PE every year. All employees' personnel information is kept in HRHIS Data base. b. TRANSPORT & COMMUNICATION Roads/Railways The district has a total road network of 1,164 kms which are Regional Roads and 334 kms feeder roads. All trunk roads are tarmac, but the rest are rough which become nearly impossible during rainy seasons. Electricity This is found in3 (75%) out of 4 divisional headquarters. Tclephones/Fax/Radio call services & e - mail Mobile phone services covers 3 (85%) di'u'isional headquarters out of 4. Radio call scrvices 15%. Internet & fax sen,ices arc available at Turiani Hospital. Mtibrva Sugar lrstate. Mkindo Iranners 1'raining Centre and Mzumbe Universitl'. c. DISTRICT ECONOMY Mvomero District econom)' has no exceplion: It also depends heavill,on Agriculture. ntainll' from crop production. Major crops being, maize, paddy, cassava and sorghum as food crops and cash crops produced are sugarcane, coffee, cotton and sisal. More than 80% of adult population in Mvomero earns money for living through agriculture though mainly at subsistence production. d. POPULATION: The2002 population and housing is the fourth since independence. The previous censuses were carried out in 1967,1978, 1988 and20l2. The human population ts320,291(Projection from the 2012 censes) of which males are 164,352 and females 155,939 and 65,058 households average household size of 5 persons, average growth rate of 2.6oh. Table 1 : Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage B.=Brl B' *100 MVOMERO 62s 322 51.5 MOROGORO RURAL 298 193 64.7 Total 923 515 55.7 This data is after integration 1,1,2, Partnership Ministry of Health and Social Welfare: Provides strategies and guidelines in approaching any planned activity. The Ministry also provides financial and technical support through supervision and internal monitoring during implementation of program activities. 7 WHO/APOC, 14 September 2009 Sight savers: Sight savers is supporting the program through financial and technical support, with new project IANET. The funding received from Sight savers is used in advocacy and community sensitization, training of FLHW about community self-monitoring, conducting CMS. Whereas in terms of technical support. Sight savers is supporting capacity building and project monitoring. District Councils: Both Morogoro and Mvomero district councils are providing human resources and technical support to the project. The districts provide support through supporting supervision and monitoring. The project is also being integrated into district plans to ensure sustainability. Community: The communities in the project areas are the critical supporters of the project implementation. They are supporling in providing human resources such as CDDs, collection of drugs from FLHF. support supen,ision to CDDs and self M&E. The community also has the crucial role of motivating CDDs through provision of incentives although same areas arc not doing it. Working Relationship There is good cooperation benveen district councils. Sight Saver and communities in implementation of CDTI activities. District council's plays a big role in paying salaries, allowances, supporting Supervision and Monitoring and also pays other in-kind costs. Communities select CDDs whose duties is to collect Mectizans from the nearest FLHF and distributes them to the people in the community, also they discuss problem facing during MDA through community self-monitoring (CSM). 8 WHO/APOC, 14 September 2009 a.l Lo -o E o o- 0)a 'f j o o :i q) oo0)- v(u\OA C.: \J 6.9()6 LF CC q5 o.- 0)=(* (,) Oa()o -.o'- E(9 =$i Zia c2 . t-.1 cJ rr(-,, \-/ oHo) b R! -d -\o .=6J.o i()(g= li-1 () < F L6e 'iAo, ?,e_C Arj['] '; . 'E 8, 3(gd:r L{-(gE+ E '= -o 'FL- €d acd; g I 9H .g \VL FV aa=EQ ;)-* trv '(r) ox0) 5 ! iof =9E ;:Eo(! .2 B 6'e0) Et s i't, -5 t.) H^-! 6) L<E boy o =s; EE;_ OO trtr.NFHI-= o-.o= ,9 q)aa F-!L - LU ;i!)9 *.2 a .€OFA;^ rai?OX- c) .H <d I-.] a'9 - r,\ / \ H5 I F! \-.r cd .E E: ol Q9U\9-H2 Ae cd 9i--u*oo^H*rr r\ c).v u)VVeH- o\ a. CJ 0)9. cr') () otr (h L{o c =l I3 l-.,1 oQ (h th o o 611 = c..t (d 7 C)oLL5(g;- 0) a/ a U) a)I\ 'ts I4 q) C) o -o C) .o(d 0) (n cd 0) (H o C)o l.< Ch o a zqr z =l I(/)(.)/ o l<o o. oo t< a.o! o bI) L< 0) o 0) H a. 0) t< € U) U) 0)o (d ch(d s Q a) c' i a- q) U e) U 1)\ qJ -c c :\ :.J F=.:i :- =\-i) !\ L.\B$p -t >' qJ: sq) uq)is "tB$x L.\qrJ \qr %U$B S\j 3s 'E$ =3s* E-5(Jh\n -9P*t{h ^. a) :s\3\ a_P\\s U= -a: =bo{Bso Iqr. dE- dqo I\ ild t\B\q) o L() or oo L o o. 0) t<() oo o L o o o li oLr (.) fro () q) fr c( (, 0) tr q) L c) C) j4 (n fr (s o. o a. a(.) EoU oil 0)t -ol(dl FI N q q) uq) oo N\ ta)\o ca v co t--$ o\ ?a ?a F o)E = a)- E FU \n c\.1 c- r-(\l\6lF- ?t) r- 00 ra(\ c! -oo .= o-N e\qi rs . UE i E6.=;-: >.! o q/ - r^tlU Na: 'EgE ?.U o-L -'-O.a + IIs ca o. oq r- C\O .i- c{ $A\o \o co oo ca tr- oo c.) N aeq tr) t-- s \o(\l I q) >.= ON3.v 6qJ + il \o N o\ rac.) c.)\f, O C-lN r-r-N tr- o\ rf, .eEE9q)= (?E Ei-cg()E >r 0)Hg -O N 4)q) ux G ah 0) () o frq) z 4 (J 'EgE j€c 9orU 33Y ='-Qa cn c.l o\+ ca (\l\o ra rd o) og6t -.- .! -,= tr :{ .d = o.:X *cr 9'vu--F AE q o\c{ O c{ co o\ $ ca ?a =.I o& tr.l z o o/.o o74trlH z/. ,.] 3 F !1 q)CJ .9s qr Ecic5'; aE -; o il a'l F a SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, tirneline of actit,ities.for ureas treated in cm'renl ),ear.indicating when the key activities were implemented by the monlh the1, [s*., and the month they ended. 10 WHO/APOC, 14 September 2009
N L C) ,o Eo z -1- a.l U o o- o :E > (r.l EE &iEE H E .9> .= = = = o 'J'-at' EVcf = =P; 9 € ELr a 3 i - a -- = c.l-q L. o - b Er ? 5 c iiva uA u'i o () -E 6i,,?)," * Scou i:Ep= b =L:- dE cZ; i -cCjF-'<JLr.OEA a5 o-3I .s E3,= reEz{ d, -o9i s=tJF n E -l oEp_9 -oorb -,!tg; = e ,C 2'-ls? 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C)(s qr o() () E F ..i r o-,l -ol(dt FI a P o o cr! U =a.l L GJ -f, (..l L(c b!_ a- (\ co 5 al oO U) a0 cl! *o U s (\ L =(\ (l e0 a- $ N .t cl (! 0) C! tt) ah q) U c)- *oEs U () -ooca o^ l-, c! L() _o oca o^(, ar 60;E a- N o.o a N o.oa b! cqLF o c)e EOEtr o U a.l o-() a c.l o-q) a hoCE a!: Oc.l 60 c.l bo irtrc!=Ni &troo =9a *oEE (-) c.l o.o a co (\ o()a hoEE o! a- gr!<X c-t o.l oo J o L q) & trl 2 o z /ad oOl d,)A= zd F] F 3 o\ N O -o E c) q) U) : Q o c- o ca (s o € - !t- Od -6F- .= o- CJF 3oC,Er -YA alu", .-a -0) =^eC -H =oF-! F VA().; a- ) LI :F UF 6; ^ vI .rH ao) .P0.)(! w cg(,Lbo }L VUo Uo-c )to0) 6d !2(.)-d'v 9H -cgva! oo >, .x .r€ *ir H !/ coH t CH F '=o9 :ouE-L'hqJO-O b. o.,u s -oE'(d(UY g\ ^6Lnti \-U ,r .r Veo '-d\?o .H FE6 HcoNxl -'8 Eb,s Fi;z q)vr, q HVS t--():E 6H :I ! ! L U\tv;r.i\6v --e '5.= N4'Eo=qJ'O \ cn '\E8 3.? t Eca.=>r^.FS EE X tsnrH=Xvi6Hol)3 L 6) NSuXerOtr'=3*FX a s}jo:o=h\. IS g€ $ ^.s.= (g oo iYL\6)iF' sX.= ER SSE B" r,:- Q OO a<\q C, tr! +)- tr- ,; (_) -F- .I'o -:c() O EEE Li-Ca -oE op -2 P 0.) c3m- cor^ -^9 .rt , ts N9o !,F eL! w,: )t a) Ur- .^ * U .)v .r ! - ,P;PqE-d L i -. U (JU(J- d -e0)! -.YA^> !v .- U>?L2No. '/)9 -rt - v H -0)cB ,. i-l'-c o.lqrcgeN .E ar -.r\ Y fiJFr '\6ri!i oE!.) .Rdo)- = trE !N!.:\-\u\ 5 6€Sorhf!-( .-a sPoo aiC-C iv9 A U H.IYo(!; =.N o..r t$.; .N e >HA: ()= u)dovn U o) tr,^ELH .= o-i ! ii * k<-!i- -a -U 'r U) u (6\L-r FU-U :sYcaS/ E!v-2\oE2 l6-i 8,f'6UdY*bE p,,9 s > E.!Oau:o.l .\#L- = J o=P U)E-V ) I = b0:\ cL i v )sH-ruu€ xs"t,'= o\,\!-\)(.1roqr.= E (d -S-Ho.r ELa-!- iE 5 H -:i-E*€ E .S or'5 E a E Sit B'S=€z Hs > 6 9!A d h^! I<- X(.) o <{rYU)bO oor srF6HJ!o?cr -o 9E U::C'd vFLH -LJ- P\vLu CtY) ,.vcJ Euv)trcro o o'*olo a tAc)gA-1!_c\ o+ u-,a c-c) ^-A .-a) P t) c3 ='Ud!utspvE o''€dJ= c) Lee .-(j- CJ ^ ;i (UA-4vP .=0?o -UL !u97 -rn o'- .4r6 PcJr- oE 9 LLT! (,) Ud:Y36Y _.E L 0.., E'6 .q H5*'E -E H-.c .EHTv.-'^oc YL-o trEEo- s-u E uS=E!UHH.Fs o.osi Ets.,\Y F:- O ! 6r i u 'E:9- ?$ - >.(JH Soss u']Nc l9S E;E ='v0.)ho;= tr tr .= u o';\'5 E:r ^=tr-v:L!i a8 E;SfiEi.gU ?E E EbE.e>.E *t: u:F- E P ml+ Ots':: 3 3I a g's ! : ^'.i E LE f,E E g .. L 6) tr c Itr o5 - o tr oNP>.'5! _ S 2. .= ts dj O ls! H U) E E.S U E) r -xod!,vH!-F(l* LVA!_B s Z-5.quH\X boq'= .iv-cI.r- o u ()'i: otqt)va 'i str€€= oP!t\O. F'- ar) c) (, 9n o () q) cl 0) d cl N q) c)(n cq N =Z (f) 6l "lri ri '] & - o\\o (r) o\ oo ra6 rn F] rc ri Fl FU Fra c.)\n @\o 6l z ri .f, ca o ok o0 ol< o ok C) o =a c! F N L o -o E() o-() a <J U o o- o I s U o I LtrO()a d L!C)o: .v .*Eo2 =2?.U6 -(,fiVLCcdco 'Ecoc CJ9.; .U)(d = En LU;,!! '.= tsO co: Eu.= ;i6^,* L v -a d -a(Jriv = Oc* u: '=ra u - t-.1wL-^ -^Lrl *^- L n) .- \J ao:::()(Jrvl_ @Li -F a rnq:u:L.iv3!g g r .-v!arv ,n B oi';6-r*Q ruaXo9rE s H.g'oul 9'-BEd'5E 2- E >''fi C 'E Ro 6.;d"!orc..rE ElY H=lOe<-rCiraaO+< (d () ii ae B'EF E IT EE 9* E 5 ,-66a2E o >A Oo (! /i- C !-h(FI t AZ cit- 5 n H'-; o- aptr,^(r_c o9cieEP"()otj!; ),t) cr< v.- -o:-oc() r^.dPA-) ci € 3'E rn -P c X ()fl a u.I <JL/ E :r C QeeEi{* i\.r i-q H Hsa=o (.)o/!HU-.F '*5 o O';' ii t?F H o 99- diY .= -E r.i ,^\ u):i.,e'FLia .=;i tr qLl boY.- gr r d#Eq:E;; >l-:1E?o.ro*-odFiHP'aO-EHO.O tr .-\ o ra E Qo.Y=Q a.r c'J 9 -o:Eh;sEa 7U::EIStr'rr.=.= EO- E'E r #.E E9-vakH v E-= o (d Q3 E 5 *.! Efl 3f E q g tll o (.) rrt E ra -: qO Ev :.o r!o.-I@troo z? ll * o o! I L o o\ o. \c o. o\ :.9 3 : EEi = E!Uzii o. N$ o{ oia o o -c):> 69 oZa.= a(J o! z E + EA ll tr (! F N O @(\ ?o(.)rf) al ta 9-c!OE^; '9O laUo 6 z >o !"3. >0)ooF tro =E EO oE o= ze ll * ca Ea EA o o0 G tro o 0. s la Erer *'a o a . =\-26=l> -o tr: h 23i.7, \o al\o o\rao ?oc -'.: L oE'EEt -5o:SEgU .o c t'3 'oE= + \o al o\ln J od tr.l z o o& o 4A z& oF -:\ >. qq\)Iq) 4: \. q)\o \ uq q) 5 F aU() :o c)(!Ea. o)(.) o(B '- c) li= trtr $t o-,l r ?il NFI o at) C) (d o o () 0) U) o oa \6 C) (gC Pl< 6- C)O C)- l-Pc-(siN ^A .^ 0) -da Av >.9 at4 ^C)-o. C,_ .; (! X6) o; 'o€()c .od -u5JaOcd a* ol'C)o co ,a oooF -voQ dcu za -o .n (dE&o -lE -=d(,)(g -C)PLi(gN 0)dto0 (! Hi!ii; ,=? *) t-o(\<6 z6 2.5. Capacity building Adequocy of available knowledgeable monpower al all levels. o The project has greatly benefited from the trainings conducted for different cadres at all levels of project implementation as these have been the key persons in advocacy and community mobilization and sensitization. There trained FLHFs most of them have CDTI Implementation knorvledge for more than 6 years, CDDs most of them are CDDs since inception of the project in2004. A well experienced Regional coordinator and 2 District coordinalors are adequate to carry CDTI and NTD activities. The project get support from RHMTs and CHMTs at regional and District levels respectively to ensure proper implementation CDTI and integrated NTDs activities. We went further by also including in our rvork plan for this year to conduct training for prirnary school health teachers and communify developrnent officers residing or u'orking ,'i,ithin the project area to make it more objective. lVhere frequenl tronsfers of trained staff occur, state tthot the project is doing, or intends to do, to remedy the situation. Normally training is done to the in charge of FLHF on hou, 1o carry CDTI activities. I-le/she trains his/her colleagues and delegate power to thern so that, in case of transfer CDTI activities will continue as normal. 15 WHO/APOC, 14 September 2009 c\ C\ oo c..l NN a.) ?alia(.l s a.l -t al {: qv rJ zv q) a (J q) z ?11 c.)! ooN t) ra rn c.l c) 0) c) \o Lro< =cll\, c -- + '(, 2.v $ .f, =f, r- r- U)L o) .aaFF l[r G) o0) .Gl t- ci oJ l- z (JF $ r- G) o q) C) o\ (.)+q e E.t + \o c..l\o co o\\o \o rO ?o ia .I 6 6) cEL =5 3? E:- zE q) a) UF N\o o\\o ?a)(-) o o q) 6' ql \oo\ o(n c.) co $ oo\o o\ riq U'z Eil+ al \o o\ rf) al C! o ah FI 3eq)0) a$ o q)E z UF c.th @ or rl (.) o o& tq o z (J & \Jt d,) zil Fl l-r F< tro q) q) s N o -o Eo o a \i- o- o \o hO o a € o o I E i. o B o bo t o * o t o\ qi aB: o -:\ qq\)Qq) q: T\ 3\ E \)q gq) 5 o (d C) ()q F o(-)(* o a() 0) 0)l< _()qi E C) d bo (d t<F .iir 6.)l _oldlFI \ E ; Trainees Type of train ing CDDs Other Communitv r.nernbers eg Cornmunity supervisors Health Workers (frontline health faci lities) MOH staff or Other Political Leaders Othcrs(specifi') Program managel.nent Horv to conduct Health education Managenrcnt of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Table 6: Type of training undertaken (Tick the boxe,s v,here specific training u,as carried out during the reporting period) Any other comments:Nil t7 WHO/APOC, 14 September 2009 ON L() -otr o o-oa : O t-) o oo ! c{\ I =e.\ 3 Ca ':\ .tv\ , ! .\ii=63< oYo ':\ a,'.\r:e. ur !:E ii +tr* a.:s (d:p oih sir) ! S .=>\ F-.36E: el: ot!=iI=()o-oE +\qAC>y,gv() s 'sd.E ; 8..! ': p sE X a. Eqr .: i '=s(! h iJ'ot 9 S 'iE' =l ; : k!x -o = I i!l c s ;LHl* F Srgl .E s Et orl 5- .! ?rEl ,* S b solo S \: 8l u s €s ,16 i S:EtE ! !.:rl = i: tY .gl = s, .sstrl o d \r 5t ; P :szt? i It\E O6$tJs' s\ '= il * t-N:\ ov! uf -i. *$I it3 rss si = \ar-%Y \l t*Y S :Y .q E .ss -C T d\I S Ss(v u uli!J E *sFrrttS? P HS o\ \ aS (!() L o() 'a L cJ^(J LA :=Oe u.- '= LV () rrt rd. -!t U>0)? t- ch .=oc! s6F Ea;^ d) o.: oq )tr ot tr() ot =! -l E5 xl 8 * Bl.eo- bltr ! slfi A aIC,d ol() ol(J oll .r Oltr ql 6 -l n,: Fl s xl t .= <l a ol Ibo 3l= El U; .:l 3 Pl* .- at F gtv E EI* ;IE .Y Hl - ol q ^l L .\l L6 519 HIE = (Hl= el Io. ol tr ol-O rl 5 rl'-o- C)l c ol=(€ trl <g trl=!-t!rtkb =lo =1trF zlt- zl< x E c) (d oL 6) o oq(Hl o1 -l6)l -ol EI)l zt (.) L C)bo !d^6S ><Joo oF o)(!L() oo(! L 0,) o c) (d o-. -.c o\ (c L oo oo arl c) L() b0dr 0) C)(),^ C) a.(d 0) t- 6)l hddlLI C)l a :ldl ol -clo.l(gl t<l o0 ol C)I o0 rl trl cdl ,rl EI C)I oldl bl -clil trt =tan EI ol :l €l ,al JI EI ol r.rl lrlt ,=o "aa4a-7 3 a 60;* g5E€€H:; 7 oiI o>ooOL O Dq q E 9e2n; O h.(J s.9 ". ..-e<dl6 coo 6 !o € E: si =EPo9zi,E" cl o] r-\o c.l r-t be -, -. u,taiaefA ZG o\ oo \o c.t o \o$ rn N EE,E ,? 2E,E=E =$a.l c-r- $ aN F- o CU g o ll * '5u =boo d^ A-9o\ oo -EaF r-r- \o c- F-r- a =T €-69tso!rd = E9z o! \o c- .{- r- t-- =J:\o c.) ?n o\ o\ at =ts-eE 3..*"<F 5 c.l oo\ \o oo- c.t .f, F- aa\o r,o (.) ao ^..d- :1 0cxk< ^ ts€ Sioio ')ha Oa9 EEo r-r- oo oi o\ C.l\o oo F- o\ ?o s-^ €r- t+) U) C) b0d ao q oU ll +dd (d .9o -m i:9e\ooi- Eo('1 oO E.9 _- L.L O Vo c Mg.l .o = d-EF C= a =E>'AO o ca c.t .<t \o c.l\o o\ roo =oE 6.2 lEo E (d.: < 9PFIJ ca c.l \o a.l\o o\ia -oE:E 3 &.9 - c oQo >E o * E*f *E Ea = c >.= - tr 6tr E> E 9 ca c.)v \o c.l\o o\ r.o .9< ;q H o&I! 2 o z o& oOlU<d,) ^=z& j F 3 44 a)U a) q + \ q) r* t U q) 4sq) c. .5Z r./) L = a,(n C) tid (6 o -l o H ./) -o rh rI] (n .o u)- oY :cd c! c) o)Lrf- F<r< .. ' t-\l orl eFlNFI 2.6.2 What are the causes of absenteeism? Rural-urban migration, and this is mainly due to poverty of indigenous which threat their lives. hence tend to move to town in search for better life, in return this results to absenteeism Varieties of economic activities such as mining activities which to an extent promote employment opportunities and for those case individuals have to move temporally to places nearby, leaving behind their settlements Nomadic pastoralism in some societies for they tend to have temporally settlements. 2.6.3 What are the reasons for refusals? Due to side effect of drugs to some community member in hyper endemic area Misconception among communily nrember that the drug are causing impotence. infertility and why are gir,'en free of charge. Ignorance for some of the community mcmbers who have no sign and symptoms think that they are healthill, therefore there is no need to swallorv drugs 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. . Parasitolo-qist trained? o Existence of microscope'? 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 t9 WHO/APOC, 14 September 2009 n O o.l (J ,o E 6J o-(,) a v U o o- o :E > N q) \) U a) .a s\q)q aa Q q.) ? \ q) ;.. e)q q) a_\- o lr() o. bo f o a.otr o bo lr ()lrk oo o (B U) r! a ct) C) o C)aL() E d U) Lr C) c/)(H o (r) o c/)(t O #r ,l -ol(dl FI o E0e -c2*o; L3;or== L " croCrl- I e (6::6oo A-) -=9X^, Li-.] o u a.9 AC o. cI) oa o- ,o qD ^ r'..a a q;c/- o.2EA o E q=(d40()A=-L-G -u99 -.o €.= A H-EE z d € - I 9P'E; =.o.b of;EEtg o o. U) Av ;X() -x ho=q) =E o. HbdG ^c, =(J .N*98so>; z o()b0c 6.r =oo>6 x 0)a () bo * z a o\ c-'l q) -o E 0) o- C)a <. U q I c..l U) ?) Q 0) oo () a F = q) q) U) G q) L UD U) 0)(t) o\ ?a) (n 0)L6 c)ql l- q) l- F D c) q) CE(J q) U)6q) e U 9= !.: 63 0) a.I ei1 6l :9 Arq)9 C)0) T= .ge q) l- 0) UX o(dL0) trHlotltrcl o -Yl oot .EHC) -olcq o)eootr(g9b cs5 o)L!(-(s Ectr()q)C trE ,4)rr) ,aal-\o6i o\l()l -ol(dl FI (J cO tr bk '- >:/(, "lr-\o o 09 t vl o. o, ce o\ o.o ll + c;r i, O ^ IJJ !:\e -a al oo r.- co @ al v v@ o. o\ F- r-r- i-i L il o;o ad)O d^ ='2 d .) a_ Fo F- a- r- .1 O oo .i- co a1 oo oo vl r- r- a- Ii.,: ! 5:la -O2"ta o- $\ F- Nn € C] I oo .c) 'i-a.l $ o) r- a.1 \o o) oor- .J t ooN oa- € 00 N n\c) o\(-n ca o\N EI =uE U.= aCu i9-D' -EO N o\ c\ \c) r-2 N 'a ..l a- c.l oo o) <- co N o\ c.l ; a.l o. co\ o\ a.t t r-. c.l r- r- N c.t LAo *3 L^= S'Y o )o . .os€='EEr ' a 3e o \o o\ o\o(\ \oc.t .rt co- oo(\ ca) :f\odl r- ca ca r-I.-\\o$ ao o\\oq \o ao $ \o co t-t ..lF- o.ir- ca o\ can oor- c.) (.) bo(g 0) o() ll + ti o ^bo(, !d-F 6X o o\ OO O o\o\ EO:<o.oo=E= EGIL.- H'O:9UEOori c c.l o\ O O O OO O o\o\ OO kl qo o' A EsSE tr tr= il =c>L706 \o oo(\ co r- @ r- oo r* oo co o\ co o c.l o\ O frl Eo d o.= jai' FL' \o :f, @N@ t-too tr-€ r-@ o'oo O o\r) o\o 6n cd =b .!dts-i " Q 9 a oE ). --i ^ - 6 .^ i\i E u 9i EO oo \o$ ooa.l oo F- oo t-- oo r-. @ o\ @ o\ o\ O <l' & rr.l c.tO a.t t O ..1 ON \oO N r-O C.l oo N o\oO c{ O ol N al o(\ c.t c.l 2.7. Ordering, storage and delivery of Ivermectin Mectizan@ ordered/applied for by - @lease tick the appropriate ansu,er) MoH ./ tr WHO tr UNICEF N Other (plcase specify) Mcctizan@ delivered by - @lease tick lhe appropriate ansv'er)MOH{tr WHOtr UNICEFtr Please a NGDO tr NGDO T Other (please specify) describe how Mectizan@ is ordered and how it gets to the communities Mcctizan tablels arc ordered after conducting census in the affected community and gelling the total population of the project. We calculate the number of tablets require b1'rnultiplying the ATO times 2.2then we get total number of required tablets. The Regional ofl-ice rcquest Mectizan and Albendazolelo NTDs Secretariat. The request is sent to Mectizan@ Expert Committee for approval. Mectizan@ arrives in countrl' through the same channel and is cleared by Medical Store Department (MSD) rvhich sends the inlbrmation to the Nl'Ds Secretariat. The NTDs Secretariat within thc Ministry sends the distribution list to MSD. MSD delivering of drugs up to the District level . The District authority distributes drugs to the FLHF by following requesl sent to them by FLHF staff. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Mectizan thereafter the CDD or any selected community member comes to the FLHF to collect Mectizan@ ready for distribution to other Community members. Mectizan ordered/received for this reporting year has change compared to the previous three years because of integration between Onchocerciasis and Lymphatic Filariasis and decentralization were by district(Councils have given full mandate-where by drugs are sent straight to districts)Region remain with supervisory role) Table l0: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining lvermectin tablets collected and where are they kept? The remaining Ivermectin tablets are collected into bottles and taken back to the nearest health facilities and then they transported to the district pharmacy waiting for next distribution or distraction if they are expired. List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. . Advocacy and sensitization to community members and political leaders in the area of jurisdictions. . Training to CDD's . Supervision during drugs distribution. . Data collection and report writing State /District ILGA Number of Mectizan@ tubl.tt In stock from previous year Requested Received Used Lost Wasted Expired Remaining MVOMERO 120,000 720,000 625,220 132 94,648 MOROGORO RURAL 6s9,000 659,000 642,300 146 16,554 TOTAL l,379,ooo 1,379,000 1,267,520 278 ltl,202 22 WHO/APOC, l4 September 2009 Any other comments Note that the Mectizrnn trbl.tt above are used in Oncho and none Oncho areas 2.8. Communitl'self-monitoringand StakeholdcrsMeeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so. When'7 Table 1 1: Cornmunitl, self-rnonitoring and Stakeholders Mccling (..{tld rov.s i/'nceded) 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. Increases community ownership hence sustainability can be achieved in the project and Solving the problems in the next treatment cycle if identified and maintain successes 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy COMMUNITY District/ LGA Total # of communities/villages in the entire project area No of Conrmuuities that carried out sell- monitoring (CSM) No of Cornmunities that conducted stakeholders meeting (SHI\[) MVOMERO MOROGORO RURAL 433 626 234 276 212 232 TOTAL 1059 510 444 NOTF/ N NTD SECRETARIET RHMT/ RNTD / RNTD SECRETARIET CHMT/ DNTD/ DNTD SECRETARIET FLITW CDD 23 WHO/APOC, 14 September 2009 Level 2.9.2Main issues identified 2.9.3 Supervision check list used Yes/1.{o 2.9.4 What were the outcome of CDTI implementation supen'ise 2.9.5 Was feedback given to the supervise d Yes/l'{o 2.9.6 How was feedback used in improving the overall performance of the project DISl-RICl' a) Incorporate of CDTI/NTD activities in CCHP b)Cornrnitted DOTs c)Some District budget small amounl of funds Yes Problerns and Successes Identified Yes -Council continue to put CDTI/NTDs activities in CCHP -More commitment of DOTs -lmprove performancc o1' the implementation. a)Maintained High therapeutic coverage b)Due to shortage of staff supervision of CDDs are mainly done in nearby communities Yes Problerns and Successes Identified Yes Maintained hi gh therapeutic coverage -FLHFs supervise CDDs& to involve pr. School teachers to do supervision to CDDs COMMUNITY a)Distribution period was carried out during rainy season when most of the community members are at farming hence many absent seem b)Full involvement of community leaders Yes Problems and Successes Identified Yes - Distribution to be done per community Need hence high therapeutic coverage c)Increase ownership and sustainability of the project. d)Improvement of filling of treatment registers 'r' []F 24 WHO/APOC, l4 September 2009 . SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add ntore rotrs i.f 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? - Maintenance of motorcycles are being done using funds from council (CCHP) and partner (Sightsaver) supports the project to maintain office equipment - The project has requested replacement of existing equipment from APOC Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtron No Condrtron No Condrtrtu l\ () Condrtron No Corrdrtrorr 1. Vehicle 1 CNFR 2. Motor cycle(s) 5 CNFR I CNFR 3. Cornputer(s) 1 F 4. Printer(s) 1 F wo F 5. Photocopier (s) I CNFR 6. Fax Machine(s) 1 F 7. Others a)Laptop 1 Wo b)Biycles 77 F c)Scaner 2 F d) LCD projector I CNFR 25 WHO/APOC, 14 September 2009 3.2. Financial contributions of the partners and communities Fill tables 13a, 13b and 13c If there are problems with release of counterpart lunds. horv werc they addressed? Additional comments 26 WHO/APOC, 14 September 2009 o. al L o -o E o o- 0)a =O o c- o > O c @ \o. 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Collect Mectizan from the nearest FLHF . CDDs are being excepted fiom community development work in the drug distribution period in same area of the project . Make a follow up to other community members to encouraging them to swallow Mectizan 3.4. Expenditure per activig, lndicate in table 13. the amount expended during the reporling period fbr each activitl, listed Write the amount expended in US dollars using the current United Nalions exchange rate to local currency. Indicate exchange rate used here USS1600 Any comments or explanations? . SECTION 4: Sustainability of CDTI 4.1. Internal; independentparticipatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) {-y"ar I Participatory Independent monitoring Mid Term Sustainability Evaluation { 5 year Sustainability Evaluation _{_ Internal Monitoring by NOTF { Other Evaluation by other partners 4.1.2. What were the recommendations? The project are sustainable because the council are contributing through CCHP for some CDTI activities. 4.1.3. How have they been implemented? 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Wastheprojectevaluatedduringthereportingperiod?N/A I Was a sustainability plan written? N/A 31 WHO/APOC, l4 September 2009 When was the sustainability plan submitted? N/A What arrangemenls have been made to sustain CDTI after APOC funding ceases in terms o1': 4.2.1. Planning at all relcvant levels CDTI activities are already incorporated into CCHP, and the plan is bottom up plan which is based on the priority of the community themselves. 4.2.2. Funds The district council has alreadl, started releasing funds for implemcntatiotl of N'l-Ds activities. In this reporting 1,ear nrost the activities were conducted using LGA funds. 4.2.3 Transport (rcplacement and maintenance) Maintenance ol-motorcl,cles arc bcing done using funds from council (CCI1p1. t'hc projecl has rcqucsted placentent olcxisting equiprncttt frorn APOC 4.2.4. Othcr resources The pro.iect mainly depends on the support from APOC/USAID, Sight savers, Council and Communities to Implement NTDs activities. To rvhat extent has the plan been implemented The Project had been evaluated in year six of implementing CDTI activities, since then Action Plan was developed in year three evaluation and have been incorporated into CCHP and planned activities are funded. a 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 Ivermectin delivery is within governmental system using the existence structure. Mectizan drugs are being delivered to FLHF in Oncho and Non Oncho endemic areas through normal channel together with other essential drugs/drug kit and vaccines. The FLHF in charge and his/her subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect Mectizan ready to distribute to the community members. The same CDD are also responsible on distribute Mectizan and Albendazole for Lymphatic Filariasis Elimination Training The project conducted training to CDDs and FLHFs staffs as there were new staffs in oncho and non Oncho endemic areas, where the project is implementing integrated NTDs activities. 4.2.5 4.3.2 Joint supervision and monitoring with other programs Supervision and Monitoring of CDTI activities are integrated within PHC system. Therefore at Region and District level supervision is done jointly by a team using the developed checklist. 4.3.3. 32 WHO/APOC, 14 September 2009 4.3.4 4.3.6 Release of funds for project activities Funds are released through normal channel according to budget line item even though disbursement of funds sometimes it takes a long time. The project is mainly depending on APOC and Council. 4.3.5. Is CDTI included in the PHC budget? YES Ir IS Describe other health programs that are using the CDTI structure and hon' this n'as achieved. What have been the achievements? . Filltables l4 and 15 and provide describe other programs that are using the CD]'l structure and how this was achieved. What have bcen the achievetnents? . For each intervention listed in table 15, explain u,hat u'ere the roles played b1'the CDDs (census. mobilization, distribution. data collection. storage^ collection of drugs. referral of SAEs, etc. ...)? a Explain rvhat are the combinations of interventions co-irnplemented? Hou,were the interventions implemented? (At the satne time?) 1.3.7. Describe others issues considered in thc integration of CDTI l JJ WHO/APOC, 14 September 2009 o\ C\ L() -o Eo o a .it Oc o- o q) (, q) o L 4) z F (r) caq \o o\ c.l @\o\o c.] oo$ 6)({ {)h tr)N c{ c-(r) N(\ c-)(r) tr) c..l I 6 2 N o\ ca \o$ n r-- c\N 6) q) o!L o L c) q) z 6 F r- ca\o tr) ca $ c.l \c oc$ a) olL \o N N\o t-- Nrn N q) a @\o C. ca$ aa $. aa ca o.l L)c .o o> -otr z F c-l ca(r) N $Otr) ce cq troq ol\o N o' \o () (! z r- C.l (r) 6 oo :.u -Q=EE =trZo (,) (g c)& o\tr) @ tr) {)() b!L6F o\ ra) ooO ta) oa 6.9 ^O t-E-2A-z C) q) & N N 0) q) EO CE F. N N -?' =.s9\ >,k -os (9.Q s.i e)i ES () ./) .,(H 5 (d --qtx aEEu);ad)ot-{EOtrEH.C r-)A > ovH-€ c)t) sts t(s --( ="EE u ).i-)@r-EOtr t; h-(SEie e0 >.Lr<o o=95 0)a>= a o trc) :N5€ !() OE a (F o bs E(E PN oa a q< oc) ^U .=Nq(g ;: 'Ed .24ntr a o o 9a'i7 ai a (H 0.) E()d o 9P'E oc!(o a .9 (d <6 EE '=() =o-+: o. -aC a a a a a c)!3q --) OFe cn U)(n C)F C)o_Oo -ql-o= (-, o o Aa Sv)Qd LiL5d Fl t{= th 6J o U) o U) o Avt rJ<F0 l< oo (u k Cd (d z ol-r oo(t lid (d z o l-r H (d z. Cg tr o o(g L<F th o(U l-<(d (d U 6 (+r EEta. $ cn q a) \L hq) + . q.) q q)\ q) S \) a) .{ q o a)\q) a) co ts o {-a c{ .{-) q) >r q) F I o U tt-l q) C! Fr to\ N Lo E 0) o- a t (, o o. o n ca q q) a_ aq) + q q) L. a) -a q) q) q q ! q) \q) q) Qo = ch 0) I o 0) q) o l-l q)(, () L oL (!c! \ \ \ \ \ \ \ oo q) oo oz =Otru 2 \ \ \ \ \ q,) q) o. q)o \ \ \ 2= \ \ \ \ \ \ O- b,n= q cg E.9 \ \ \ \ I* 9.U o E.9 Oo \ \ \ \ Xq) TEq9q) cr= ql \ \ \ oo '= z. da q) \ \ \ \ \ \ q) 0) cg \ \ \ \ \ \ \ o () 0,) o q) F ()E0.)= |-L 0)o a o q() :N5€ .E3 l-l cd a (H o =s2 eN oa a (so() .:N!cd 'E c) .96OE a q- o 9a '=z -H oi a (.) E C) oo r(d 6-' d ,J. O a .tl\() aO) =o-i: o_ a a a a o o q) F a a .s oL C)9-(,o o= L.,, o a q cd l< cd o a. '] a a cd E oa o o oa F Fa o oo d !(d (n z oL o o (0 L d 63 z o cd z (d o o(n F a o(d (d (c O o o)p.(n U)L C) e0ir.\) L \ N\)q s *t U () Lr +)o +)a t-.,tU o0 a) a CO t,( o0 o L< O. Lr() +) rii r-l q) GF t4.4. 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. NONE 1.4.2. How rvere the results applied in the project? N/A . SECTION 5: Strengths, weaknesses, challenges, and opportunities STRENGHS . Availability of local Radios, TV and nervspapers helped to disserninate infbrmation to tltc community. . Council Ilealth Management Team (CI'lMl') and FLHI" staffs are lull1, n1ru.e of the implementation of NTDs activities. o Contribution from the councils is increasing each year . Policy makers are aware and willing to participate in the implementation of NTDs activilies. WEAKNESS . Delay of report submission at all levels. o Shortage of staffs at the FLHF levels that restrict the CDTI health staffs working with CDTI due to work overload. . Inadequate incentive from the community to their own CCDs. . Community members do fear side effects of Mectizans which are still seen in hyper endemic area CHALLENGES o Submission of the implementation reports in different formats as required by partners (APOC, Sight savers and NTD). This increases the workload to project coordinators and other staffs. o How to replace worn-out of capital equipment and office equipment. OPPORTUNITIES o NTDs activities are incorporated in the CCHP in all oncho endemic districts. o CDTI approach is now used in the implementation of integrated NTDs activities o CHMT members in both districts have knowledge on the CDTI approach o Political stability ensure ownership and sustainability a SECTION 6: Unique features of the project/other matters: NONEa 36 WHO/APOC, l4 September 2009 It a