CDTI Extension-Chikwawa annual project technical report submitted to Technical Consultative Committee (TCC): January 2009 to December 2009

RESERVED FOR PROJECT LOGO/IIEADING OzuGINAL:English Proiect Name: EXTENSION - CHIKWAWA Fc,r Actiqa -[o t -rc[3O C lo.i'r 8s YTD rt y'.,l,rtr,l1:.i,: : rrrii .! : .tlr For ffirnadon Tor Ltr;. Lou."! L<r'-.' r' - CO YAIOTF: MALAWI Approval year: 1999 Launc year: 2000 REPORTIN G PERIOD FROM: JAN 2009 TO: DEC 2009 ea Month/Year Proiect vear of this report: (circleone) I 2 3 4 5 6 7 8 9 (10) Date submittetl: iOm DECEMBER 2OO9 NGDO DArtner: SIGHT SAVERS & WHO 0 8 FtV, 20?0 APOC/DIR RECU LE wHO/Apoc, 46 January 200g f' I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATI\TE COMMITTEE (TCC) DEADITINE FOR SUBMISSION: To APOC Management by 3l Januarv for March TCC meeting To APOC Management by 31 JulY for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) wHo/APoC, 46 January 2008ll 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: MALAWI. DHO DEHO Name: Dr M. MBEWE Signature: . Date: ..4.ft Name: T KAJOMBO Signature H rkg [o, I Qoto Date National Coordinator Name: L A Signature: allqtlrq Date: ...?1 I.qDI This report has been prepared by Name : MKUKUMILA V Designation: DOC Signature : .J &-*o.*:fq Date . ?? l i?t .hqp lll wHo/APoC, 4s January 2008 ITable of contents ACRONYMS ..................... w DEFINITIONS ......... vII FOLLOW UP ON TCC RECOMMEI\DATIONS I EXECUTIVE SUMMARY ........2 SECTION I: BACKGROUND INFORMATION I.I. GBNBRAI-INFORMATION 1 .1 . 1 Description of the project (briefly) 1.1.2. Partnership 1.2. PopuLenoN SECTION 2: IMPLEMENTATION OF CDTI........ 2,1. TIMELTNE OF ACTIVITIES .............. 2.2. ADVOCACY 2,3. MOSILIZETION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES 2.4. CoMNaLrMrY INVoLVEMENT............ .'....'....'.....10 2.5. Cepectrv BUILDING .."...........'......11 2.6. TRBernanNrs................ '.'..........'... 13 2.6.1. Treatmentfigures........... """13 2.6.2 What are the causes of absenteeism?.......'..... ".""""' 15 2.6.3 What are the reasons for refusals? .-...'.......... """""" 15 2.6.4 BrieJty describe all known and verified serious adverse events (SAEs) that---- I5 2.6.5. Trend of treatment achievement from CDTI project inception to the current year l7 2.7, ORDEzuNG, STORAGE AND DELIVERY OF IVERMECTIN'........ '....'............. 18 2.8. COUUUNITY SELF-MONITORING AND STAKEHOLDERS MEETING ....... .. I9 2.9. Supenr,rstoN............... ......'.....'."" 19 2.g. t. Provide aJlow chart of supervision hierarchy. "" ""' 19 2.g.2. lVhat were the main issues identified during supervision? ..."""" ' ' 19 2.g.3. llas a supervision checklist used?......... "' """""""" 19 2.g.4. l[/hat were the outcomes at each level of CDTI implementation supervision? ]9 2.g.5. l|/as feedback given to the person or groups supervised? "" """" 19 2 . g . 6. How was the feedback used to intprove the overall performance of the proj ect? 20 SECTION 3: SUPPORT TO CDTI 20 .....,,,.20 Ennon! BOOXITaNX NOT DEFINED. 3.3. OIUPN FORMS OF COMMUNITY SUPPORT 3.4. ExpeNolrunr PER ACTIvITY ............... SECTION 4: SUSTAINABILITY OF CDTI 4.1. INtenNeL; INDEPENDENT PARTICIPATORY MONITORING; EvALUATION ....................22 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the fotlowing which are applicable) .......... . """" 22 4.1.2. Watweretherecommendations? """""'23 4.1.3. How have they been implemented? ..-......-.... """"""" 23 3 J 3 4 5 7 7 9 9 3.1. EqutnueNr 3,2. FINENCIEL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES ''..,.,,........21 ,''.,......,....21 ................22 lv WHO/APOC, 46 January 2008 4.2. SUST4NeeILITY OF PROJECTS: PLAN AND SET TARGETS (veNoerORY AT ...............23 Yn 3)......... ...........23 4.2. t. Planning at all relevant levels .......-........- 23 4.2.2. Funds........ ..........23 4.2.3 Transport (replacement and maintenance) ................23 4.2.4. Other resources... ................" 23 4.2.5. To what extent has the plan been implemented ........- '................'.23 4.3. INrecnetoN ..............23 4.3.1. Ivermectin delivery mechanisms ............' 23 4.3.2. Training..... ...-.....23 4.3.3. Joint supervision and monitoring with other programs..... ...'.......23 4.3.4. Release offundsfor project activities '.....24 4.3.5. Is CDTI included in the PHC budget? .....24 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. . .. ... ......24 4.3.7. Describe others issues considered in the integration of CDTL .....24 4.4. OpBnerroNAL RESEARCH.. ..................24 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..... .....................24 4.4.2. How were the results applied in the project? ............. .................. 24 SECTION 5: STRENGTHS, WEAKNESSES, CIIALLENGES' AND OPPORTUNITIES 24 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........25 WHO/APOC, 4m January 2008 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 Conhol Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Govemmental 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 vl WHO/APOC, 4ft January 2008 Definitions Totpl population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objecfive: (ATO): the estimated number of persons living in meso/h1per-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 wrthin the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expicted to reach the UTG at the end of the 3'd year ofthe project). (v) TheraDeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemrc communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) lnteqration: 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, rntegrated rnto 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 communtty ts empowered to oversee and monitor the performance of CDTI (or any communlty- based health rntervention programme), with a view to ensuring that the prograuxne is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (i) vll WHO/APOC, 4s January 2008 FOLLOW UP ON TCG REGOM]UIENDATIONS Using the table below, filI 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) I Number of Recommendation in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 4s January 2008 Executive Summary Prepare an Executive summary of the report in not more than one page. Chikwawa is one of the districts implementing CDTI in the extension phase since 2000. The district has 128 villages and these are headed by village headmen. The district has a population of 438,395 (NSO- 2008) but the impact area for Onchocerciasis has a population of I 05, 317 people (census update). People that were treated in 2009 arc 86,129 out of 105, 3 l7 representing 8l .8% but the district's ultimate treatment goal was 88, 466 people. The population for the district is mostly comprised of the Sena and Mang'anja ethnic $oups. They earn their living through farming and they practice winter cropping and this affects treatment coverage since a good number move temporarily to their farms during this period. The district has a total of 764 CDDs bringing the CDD/population ratio of l:138 and I 18 health workers who are directly involved in CDTI. Review meetings with health workers and CDDs were conducted in order to achieve this treatment coverage of 81.8%. The challenge that was experienced was late starting of Mass Drug Administration due to late arrival of albendazole however intensive supervision assisted in solving this. 2 WHO/APOC, 4th January 2008 SEGTION 1: Background information 1.1. General information l.l.l Description of the project (briefly) Chikwawa is one of the districts in the southem region of Malawi. The temperanlres are always hot reaching a maximum of 42 degrees Celsius and minimum of 20 degrees in cold months. It shares boundaries with Blantyre, Mwanza, Thyolo, Nsanje and an external boundary with Mozambique. Chikwawa together with Nsanje are called lower Shire because the river Shire passes through them at its lowest level. The Mang'anja and Sena are the main tribes in Chikwawa with the Lomwe in minority. People grow maize, sorghum and millet as their staple food, cotton as a cash crop and they also rare goats, cattle and pigs in large number. They also practice winter cropping on top of normal growing season. The district has one tarmac road and several weather roads which are a problem in wet seasons. Most places are connected with telephone facilities and health facilities are also provided with radio message facilities The district is headed by the District commissioner and supported by sector heads such as the District Health Officer heading the Health sector. The district health office has four sections which are Clinical, Preventive, Nursing and Administration. There are three hospitals (the district hospital, Mission hospital and Rural hospital),17 health centers and 39 heath posts but the impact area has 7 health facilities and these are Mfera, Maperera, Makhuwira, Gola, Gaga, Chithumba and Chang'ambika. According to REMO survey that was conducted in 1997, onchocerciasis is prevalent in two zones of the district and these are East bank zone and Changoima zone. The east bank zone is hyper - endemic zone to onchocerciasis with 73 villages and has three health centers while Changoima zone is Meso - endemic with 55 communities and four health centers. There are a total of I 18 health workers directly involved in onchocerciasis programme and all these were involved in CDTI during the reporting year. Tabte 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 projcct area Bl Number of health staff involved in CDTI B2 Percen tage Br=Bz/ Br *100 CHIKWAWA I t8 118 100, Total lt8 I l8 100% 3 WHO/APOC, 4s January 2008 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 partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in project implementation are Ministry of Health, Sight savers international (SSD, W.H.O and the community. These partners are involved in planning, supervision and implementation of CDTI activities. 4 WHO/APOC, 4m January 2008 €o N >\(| G! :f o B olrot o € o tt)qr (o o (d oo 'a lia() <n a. a o a 0)! o +i o o Cd tr Lr(.) o cl C)k a) a oo 'a l-.g c) qr o G) l-r c) (! (t) li(.)E & C) t) H Ci b0d l-ro o o a(.) a o 0.) 0) 0)bo lio oo L C) q) bo U) c) lid ^c)(!H H(g d 0) a oo o. ch oo li oa Lro o a. c.) So(tA ()fr p c) (n oA (H C)Oo Oao;:h56'r6(6oz -9? :oEa .i z ;i* q c a) \ a) \) q) o q) a .o o q) s s r8 d'dSLha.is .Y k-oi o'\r\<J$9 -t -r te qO' $: Bq) .sss\i* s r\ vF\ s!$o $BsP 6 .rs -5-s -EP bs9 0rP.rSts 6 a!r ;S'e .ET= P!==3* ts sE IqrP- o *\ ets4. bo\g c'h,: .trb=' E -s: =\E\sn -!t^.sx^ ()N6, o 'r L '=r69 HEp Aqrl o)IN €3$ H\F. (;gS u)s8. a *= bx\ o il-t (g r:'S 6x8 sbP 5 o q)\ o B -; 'tr C) bo tr o C)E c) bo 'tr = E o 0) cn C)Lr q) ti 0) l< C) o cqq) 6t () 0) e) c) C) .51a k cC o a p. d a() O c.ir o.,l -ol cBlFI c o a-I .E -fc otr aN aF tr} IFE Er E 8.3 \o\o$@ oo \o\ot66 + il rc)Ltr -oo .= aN 5 t'Eoo!F 8€ r- c.l ro r- (?) rao N\o o\ ra -. Gl , 9; E i'=! dB.E.Er; >'!c)()* . E F.g N\o o\\n \o o\\o(n$ \o o\\oln$ o o c(l a '= -. 6tE:e) ^Et5 hFisgsi a6l I q) oN 8.2 -o 6o oF + il @N .e3 ;o- = -. 6t 9E;i-ctOE >ae+E N ra t-- (f) r- ra ra an(l) ol cll q) c) I o c) -o z 'EgB :ed ?oE oX! 2 lr}ra) Gtr9 ^ ,. L .-Lrr de:'i? = 6.11X *er 9'v9-tF o.i: a r-- c.t \r1 r- ra r.) !'l o cJ .9s qr ;trEc5; ?g ,eGt -\Ll-(J5Ar.l F B B M A U Fl F oF @o N r c! d $() o B \o ;(! €(n C) c) bod d E 0) (B o o o B ali C)a 0) bo a C! -o E 0) L o o bo -o t) d o (! a qr o (.) C) o o a 0)bo d SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicattng when the key activities were implemented by the month they began and the month they ended. A 7 No ACTIVITY STARTING MONTH ENDING MONTH 1 Census Update May 2009 June 2009 2 Collection of mectizan from Blantyre July 2009 July 2009 3 Distribution of Mectizan Sept 2009 October 2009 4 Conduct review and Planning meetings with HSAs July 2009 August 2009 5 Conducting review and Planning meetings with CDDs July 2009 August 2009 6 Advocacy with traditional leaders July 2009 August 2009 7 Procure July 2009 October 2009 8 sion of mectizan distribution August 2009 October 2009 9 distribution November 2009 November 2009 l0 CDD feedback meetings December 2009 December 2009 WHO/APOC, 4s January 2008 €N 6l d s O o @ a () E o() I q %q) Qq) .S L qJ\.U \ B q)q q) E L(! c) () Ht< o (.) 0) (n 0)t- a(! 0)Hd() H € a C) o(! q< o otr 0) F ".i ro)l -ol(dl FI ah Lq)t a o +E FE oQ d tr.lo r!Ugl o u0-tr-- 1iE d: aE tr ! L at) AI L o €) o o L) & tuo oFO bneE TE cl: p0 z rI]F o.tn& Ch IA q) G a q) q)tq)I o E o {) o(-) 2 60- .=elitr c= d;E 2 ut 6l F o FE oI rI]o rrlO rrlA& AD CE !E d: a- trl7f, EEc(=Nr -otrooEroa =9o Q & s.l cn 11 FO o ODCF ?E d: ch- J () F] q) l- .t) a B B x i! O J F F 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 iifficulties/constraints being faced and suggesfions on how to improve advocacy' - 5 Traditiona! Authorities (T/As) and 128 village heads were mobilized to take lead in mobilizing their subiects to swallow mectizan. This activity was made possible with funds from Ministry of Health Gentral office. During the meetings it was agreed that messages should be sent to those that goes for winter cropping to come and swallow drugs first and proceed with their cultivation' 2.3. Mobilization, sensitization and health education of at risk communities Public meetings in all the 128 villages were conducted by the HSAs in the presence of the CDDs. The response from the community was very good and they mainly appreciated- the-. addition/ inclusion of albendazoli for treating LF for they were already very familiar on its impact on intestinal worms. - A lot of women and minorities are taking part in CDTI activities' Involvement of traditional leaders every year would greatly assist in improving mobilization and sensiti zationof the target communities and these are village headmen' church Leaders,Politician and village Health committee Members. 9 WHO/APOC, 4m JanuarY 2008 a.l 0)! tr 0) oz t e.I Uo0. IE ts tiotr E0) '--o) -Cou)T€€9>-LdH ,!Hts 'tiA6 o,t5--^'cE x< E 9..XH!dE,HH c)=oE8EH tr.- -otrAH _6-9 0', Edpae EEE9EE(€--EE A"E!.E o)EeEgHEc€otr^ .r .i I .Ic @ adaE:$,Ed _-c()xboj( =rLF €;s *-r,trt >' -6)=s6q:!*LP =-o q F! =thdQE o L-.1 EooL) oH.c:qE .__bO ootr L-.-Ltso >o rE8qtrtr +J=kCF=L =Eov(co> "0..r9o -.c tri. _uw 9aoHtr(n -()Oa "q-i o ar etr>() rr.i -otr=ooEtroiiHEF. - 'H Ol)6o9 LHAb3.,-o trE5do) PYo(i9L< aOQ 9A i; (! *t= I H3 6E E E E':f E E E ;3 3(, IJFJ O A. se Ee =-9tril =o r!3aqu! =6ZF o il i' ica' 15 o o0I Eo o s .l ra € s .! ra € E.g t i EEEZ?, o\ 6 oF 2-caE;i Or, U O E tr o o E= 6:' U D z t*-s F-E @r N €r- d o\ .E- e >o 9Pd Er Eo EEE9 o!l o= -oEEEao ze o ili c0 cQ la oo cq troI ca farrl'= a o T Ei i jo:= ZeEo la ?ed :itt i -19:! E;5 @ N @ at ,] o E E(J 6 F o q Uq) ? v L p = q) 4 q) tu! F IJ(, 0) fl€E:o.=Etr o'n -*o'6 -LL(6 fl() E.Z )1CH EELilO r-rfJ: $t .rlrEloi gl 2.5. Gapaci$r 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 lonwledgeable manpower was available or if staff are frequently transferred during the course of the campaign). Whenever a health worker is on posting from the project area, immediate replacement is made and on job training is conducted if that staff is not trained in CDTI. 1l WHO/APOC, 24 November 2003 c{ o .o E 0) o z$ at (J o ho o o a! G o o t *s\: !! iq \Q i.u ct !o l-q \M *i >s -- s *o F- $\o F- F-\t\oUo< rll v LU: . ir tv t\o : F- st : F- o 6t 0 Q o (,) z (,LF a- * F- *\o s € : q)q q) o s \Jq dll\J 6 -: fL\,9 tv o E0 o s O q) .1 'q' dfr q)l oc) ,o LG o)L z (,)F € a Uq U = ErQE.?+FVrT € ao co o\ : ru o \o o 3! u6t 92!x tr ':- zE (,) QLF € (\ € 6 ".1 U U ?rr Q o,i+F'6 a< e c! q -] 9q) q) z UF J 3 Fr s o o o o\ t L .2 -\ r\ Vlq c)U 4 L o 4 5 o (.) Eq) o. E F n(-) o 2 O O () L .c) ! C) bo E c!3 LF .ii1 drl -.ol(!l FI Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments More issues were being tackled during the review meetings with H/w and CDDs, 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. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management How to conduct Health education x x x Management of SAEs x x x CSM SHM Data collection x x x Data analysis x x Report writrng x x x Others (specifu) 13 WHO/APOC, 24 November 2003 @OoN r GI d $() oA B $ $ 8\!t t $. EO .:l rh- \v\rHS;- 's>)(Jvtt(!P9rd.iTBs.sv-\as 3o\.'iESsE $"S .PE*t.sSe.ssUE PC!Eag !sEESq i€E E!xss €r!oq9H .E '$+Ir\.!; $ sR!2 \ E\, =lE F E*il: : HH rl e E IfElt s s+ !l [ .l ]SEl: S iSo.l (J s Fs'.stslt i Ei sl = S :R trl .S E tr. ^tP i $: .i 130. $sS Q\ 'i o-sl t s\B SEt $$ r $'a .ts -6ss st: s{\-bH E iES PI -tr r d\H S SS!, * EsFrrttS? P FS6\ \ aC (n(.) li c, €o c) 'a cdH(.) HO)Rlt 9P()do.= 'AA LV () r'l =&c>, 4p >c) -,r q a.i L .ts c)trE datrciEE OiJ3=tr OI trC) ot =! -l H6 xl 3 * Bl ga 6t trF TIgA ol Col ; 9j a) otOl o o{.r Ol -lE stE -t,xl - ;-l P xl > zl .I <l a -ol I9l oo 3l= 9l Ugl= EIE ulAet .; =t c et vq.rl - il L orl = -t - Ft a -t Hot= =tA otooI .: HI Y 6I trts18 8IE 3I€ c*l = .*l * cgl qol a. ol tr olJpl O ul 2 ul(0)l o- ()l c ol= .ol _ -ol _ -ol :Els Els EIE3lb 3lo =lqzl? zl? zl< al ol sLI 0)I BI :l 3l -cl o.tdl s o)I 5 EI ,rl EI Et!l(l)l -cl $ al EIol olpl fl :Jl EI olEl -\ $4 qj Qq) .S \ q)L o t q)q Bq)g .Y a 'F a doH(! d ;oJ Eth >' -o a rr.l (/) (n C) (! o F r-f -l -.ol(dl FI () (B () bo(r^bs oo oF (.) (B H 0) bo filko o(-) 3a a:,(! b0 o() o(!k() bo CB q) oO o,: ()q(! ! 0) F h A€E E HgriE tz tE e o crat<| (/)2z oEb95trEBa9zd \oo\ \o o\ Ee'et l-- r-. o (n o o< oo ll rdd o o\ o 'Eo ,h0o6 E9 .88F \o 09 € o\ € @ H Eer o\N @ o\N \o @ H EoE 6.> =EoE= C)j9ts' F'.J \o$@@ \o <t € @ .='d * - EFb.=€:o.:oE E q.- oF F- r-- U)q) bo(d 5 a C) E EI o ll d Oo '=dEssaii 9o\boa- 6o o\ o\ E.9 .- r.i U!3 5 S*F t= o =Q>uAO o €6l @ a.t ?a =62 =QoEHO < 9*'FU €(\ @ a.t \Oa : o! b 9);EE*E - = ag.9A € E $B E- ot*6 @ e.l @(\ E< =B Y O< rl tr o i.r 2.6.2 What are the causes of absenteeism? -Migration of people from the district to other districts during distribution period for employment, business and marriages -Winter cropping caused some people to temporarily transfer to their gardens. 2.6.3 What are the reasons for refusals? - Cultural beliefs and Church Law 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. No serious adverse effects were observed but swelling and itching. l5 WHO/APOC, 24 November 2004 s oN o .o E 0) z d o.l (J o \o U \ q) Lq) ^a -q)q) IF qq q)(.) a) q: L. q)\ O .E ! 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(.) c) '= q 0) Fp 0) q) c!o E A 0) ah 6t OJ B\\q)\ s.q) cl:9t e.= 9;: 63 oa!s HC) OL a:o(.)()q) EE.o o.t .o) ,0) r) H odlr() =rlH (gt0,, tl nd)l >(6l c)ol E>lqJ !l6o !bO eb 615g€!E E'Ctrc)q)c l-Fl1 i6 '0) ": i\o ..i o\l a)l -ol(nl FI 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtleasetr tick the appropriate answer) TNIICEF ! NGDO trMoH./ wHo Other (please speciff): Mectizan@ delivered by - Qtlease tick the appropriate an"rwer){uorn wHotr r.DrrcEil NGDC Other (please specifu) 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 dnecessary) NOTE: The remaining tablets (2714) went to non Onchoerciasis area for treatment of Lymphatic filariasis. How are the remaining ivermectin tablets collected and where are they kept? They are collected through the HSAs and are kept in the district pharmacy. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. MDA supervision Reporting on drug usage. Collection of drugs. Any other comments StateiDistrict/ LGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remaining CHIKWAWA 243693 243693 240100 879 0 0 2714 TOTAL 243693 243693 240100 879 0 0 27 t4 18 WHO/APOC, 24 November 2004 2.8. GommuniQr self-monitoring and Stakeholderc Meeting Has any training (of trainers) for community self-monitoring been done in the project area? NO Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9r. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. DHO to DOC to TOT to H.S.A. to CDDs. 2.9.2. What were the main issues identified during supervision? Incomplete CDD registers. Less supervision by HSAs. Since new registers were distributed this year so most of them were not completely lined. 2.9.3. Was a supervision checklist used? YES 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Encouragement to all implementers. On job haining of the gaps identified. 2.9.5. Was feedback given to the person or groups supervised? YES DishicU 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) CHIKWAWA 128 0 128 TOTAL 128 0 128 l9 WHO/APOC, 46 January 2008 2.9.6. How was the feedback used to improve the overall performance of the project? It assisted the district to identifu the existing gaps in the performance of the CDTI programme and thereafter came up with remedial Measures such as conducting on the job training of old CDDs. SEGTION 3r Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written of0. How does the project intend to maintain and replace existing equipment and other materials? By using Ministry of Health resources through the District Health Officer and also the DHO to maintain the non functioning printers and computers. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Conditi on No. Condition No. Conditi No. Condrtion No. Conditron l. Vehicle 0 N/A 7 F 0 0 2. Motor cycle(s) 2 lF& I CNF R 9 F 0 0 3. Computer(s) I F 2 CNF 0 0 4. Printer(s) 1 F 2 CNF 0 0 5. Photocopier (s) 0 N/A I F 0 0 6. Fax Machine(s) 0 N/A I F 0 0 7. Others a) bicycles 38 F 182 F b) c) 20 WHO/APOC, 46 January 2008 3.2. Financial contributions of the partners and communities 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? NO Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) - The distribution of mectizan by CDDs to community. - Collection of mectizan from the HSAs. 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. The exchange rate is l4l . Contributor Year I (2007) Yeer (2008) Year 3 Q009) TOTAL Cash Budgeted (us$) TOTAL Cash Released rus$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central * ProvinciaYstate) 79842 79842 116158.69 l r6rs8.69 MOH (District/LGA) 2292 2292 6,1u{l 6l()8 14.2b,l 14,263 Local NGDO($ ( if any) NGDO partner(s) 886 886 Others a) b) Communities APOC Trust Fund 70 70 8-4q I "1.,126 10..195 ti,.t I 7 TOTAL 2362 2362 95327 91262 r 509r6.69 r38938.69 21 WHO/APOC, 4n January 2008 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? For summary forms for treatment $282 was for purchase oftonner and $14 for purchase ofpapers. SEGTION 4: Sustainability of CDTI 4.1. !nternal; independent participatory monitoring; Evaluation 4.1,1 Was Monitoring/evaluafion carried out during the reporting period? (tick any of the following which are applicable) NO Year I Participatory Independent monitoring NO Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Activity Expenditure (s) Source(s) of fundine Drug delivery from NOTF HQ area to central collection point of gq4lqunity t879 MOH Distribution of mectizan Mobilization and health education of communities Review and Plannilg mee_tings with CDDs Training of health staff at all levels (review meetings) Supervising CDDs and distribution 284 688 1420 52r 1362 MOH wHo APOC APOC APOC Internal mo:ritoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment 1901 1922 270 298 MOH MOH APOC MOH Vehicles/ Motorcycles/ bicycles maintenance Office e. printers etc) Others (Purchase of registers) 681 l 606 MOH APOC + MOH TOTAL 12,832 Total number of persons treated 86129 NO 22 WHO/APOC, 4s January 2008 YES Internal Monitoring by NOTF NO Other Evaluation by other parlners 4.1.2. What were the recommendations? o To provide column for albendazole. o Intensive supervision of MDA. 4.1.3. How have they been implemented? Through meetings with HSAs and visit to CDDs. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?-No- Was a sustainability plan written? YES- When was the sustainability plan submitted?-YEs- What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. Planning at all relevant levels Including CDTI activities in DIP. Funds DHO to be releasing funds from as indicated in the DIP. Transport (replacement and maintenance) DHO vehicles to be used as in other programmes. Other resources DHO to be supporting and to encourage community to support as well. To what extent has the plan been implemented This year purchase of additional registers (350) and rrainining of HSAs and CDDs and supervision were topped by DHO using the DIP. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms It is delivered with other Primary Health Care materials. 4.3.2. Training Incorporated into other Primary Health Care training programmes Joint supervision and monitoring with other programs When supervising other Primary Health Care programmes the CDTI is 23 WHO/APOC, 46 JanuarY 2008 4.3.3. ,l also Incorporated within the supervision schedule. 4.3.4. Release of funds for project activities Integration with existing Primary Health Care budget. 4.3.5. Is CDTI included in the PHC budgetz YES. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The project is intergrating with Lymphatic Filariasis Control programme and is using CDTI strategy and Malaria control programme through the use of ITNs and CDDs at community level. 4.3.7. Describe others issues considered in the integration of CDTI. The use of same leadership structure, Min.of Health staff and health infrastructure 4.4. Operationa! 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. NO 4.4.2. How were the results applied in the project? SEGTTON 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. STRENGTHS: Ability to conduct distribution in all 128 villages of the district thus 100% Geographical coverage and 81.8% therapeutic coverage CDDs are taking an initiative of distributing Mectizan Drugs Inte$ation of CDTI in normal government system. Whilst treating Onchocerciasis at the same time eliminating Lymphatic filariasis. WEAKNESSES o Transfers of fUworkers. o Late start of MDA 24 WHO/APOC, 4s January 2008 I r, SOLUTIONS - On job training of lUWorkers. - Intensivesupervision. SEGTION 6: Unique features of the proiecUother matters Presence of HSAs at community level. 25 wHo/APoC, 4n January 2008 Ia It D