CDTI Ruvuma focus annual project technical report submitted to Technical Consultative Committee (TCC): from December 1st 2003 to November 30th, 2004

RESERVED FOR PROJECT LOGO/HEADING COUNTRY/NOTF : Tanzania Proiect Name: CDTI Ruvuma focus Approval vearz L997 Launchins year: 1998 Reportins Period: From: December L't 2003 To: November 30th ,2004(Month/Year) ( Month/Year) Proiect vear of this report: (circleone) 1 2 3 4 (5) 6 7 8 9 10 Date submitted: January 2005 NGDO partner: Sight Saver's International ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TBCHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting Dx r- l(.tJ o / L(: /tt ,G", -L L AFRICANPROGRAMME FOR oNCHOCERCTASTS CONTROL (APOC) (TP 4$ E, c F,' -E rt; Bfsj-1 bilfrcu fI l{ rru ?005 APU(/DIT I |,r i*.'r** 8. {E. Ur .9$ ) WHO/APOC, 24 November 2004 ' // rRtll" +u.fr_tt r< I , t I i i i I ! ! i I : ! 1 I ! I ! ! I ! ! I I i I I I I I I I I I I ! i i tIIj ! I I I I ANNUALPROJECTTECHI'{ICALREPoRT TECHNICALCONSLILTATIVE,COMMITTEH,(rc(j} EI{DORSEMENT please confirm you have read this report by signing in the approprlate sPace' OFFICERS to si the ort: Counfty: Tanzania National Coordinator Nanre: Dr.Grace Saguti Signature: .. Date ,,w, :)-P i. Zonal Oncho Coordinator Name: Dr. Daniel Malekela. signature, . :S/. #,':i-I3H:_fi'Eii,i< 1'r I fi (Lf'L.rl-! -EaJ,-'Irr ra\(:l I r.a.rl v v ] {ur^,-. t-+-_ rri,-- Irrf ah, r}r,r Signarure Date This report has been prepared by Name : Dr. Wade Kabuka DesignatrOn : rroJcuL Cvtltli*atsr Signature : Date 30. | .z-pod ll WIIO/APOC. 24 Novenfier 2004 31./01 ' 0b 09: S9 FAI zssa22lsoooojlzot '0s 0e'u^ur,., uTJ# *o. 5658 P02 F I I 1 I i I I i t ! t I I I I I I ! ! I I I i I I ANNUAL PROJECT TBCHNICAL 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.Grace Saguti Signature Date:.....S9.1iJ 05 Zonal Oncho Coordinator Name: Dr. Daniel Malekela. Signature Date NGDO Representative Name: Mr. Pius Mabuba Signature Date: .... This report has been prepared by Name : Dr. Wade Kabuka Designation : Project Coordinator Signature : . Date 2 WHO/APOC, 24 Novemb er 2OO4 Table of contents ACRONYMS 4 FOLLOW T]P ON TCC RECOMMENDATIONS.. .......6 SECTION L: BACKGROLIND INFORMATION....... .....................8 1.1. r.2. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 3.1. 3.2. 3.3. GrNenar TNFoRMATToN PopuLeuoN Apvocecv.. Monu,zauoN, SENSITzATIoN AND TmALTH EDUCATIoN oF AT RrsK coMMUNTTIES t4 CorwnrmrY TNVoLVEMENT . Capecrrv BUTLDTNG Ononnnqc, sroRAGE AND DELTvERv oF TvERMECTIN ComvrtrNny sELF-MoNrroRING exo S rexruoLDERS MEET[.rG... SuppRvrsroN.. EeuplvmNr FnqeNcmr coNTRTBUTIoNS oF TrrE pARTNERS AND coMMUNITIES Orrmn FoRMS oF coMMUMTy suppoRT............. 4.L. INrenNaU TNDEIENDENTpARTTcTpAToRy MoMToRINc; EveruerroN.... 4.2. SusrerNauI-rry oF rRoJECTS: ILAN AND sET TARGETS (uaNoeroRy AT Yn 3) 4.3. INrrcneuoN.............. 4.4. OpBnerIoNAL RESEARCH. ..8 t2 t4 15 r6 24 25 25 19 SECTION 3: SLIPPORT TO CDTI........ ......27 27 28 28 3.4. E>enxorrrlRr PER ACTrvrrY .,...,.,...28 SECTION 4: SUSTAINABILITY OF CDTI ................30 30 3t 3t 3L 32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AI{DOPPORTLINTTIES ......................33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 3 WHO/APOC, 24 November 2OO4 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Community-Directed Di stributor 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 4 WHO/APOC, 24 November 2004 Definitions (i) Total 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 84Vo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) 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 progralnme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. 5 WHO/APOC, 24 Novemb er 2OO4 FOLLOW UP ON TGG REGOMMENDATIONS TCC 18 recommendations have been addressed in the resubmission of the 4ft Technical report. 6 WHO/APOC, 24 November 2004 Executive Summary The report covers a period of 12 months starting from l't December 2OOO3 to 30ft November 2004. Only Mbinga and Songea districts were able to implement CDTI activities in Year 5. Ludewa district has not completed Mectizan distribution due to absence of District Oncho Team members. All the two members were selected to go for further studies in colleges within the country. Replacement has been planned to be done in December, 2004 after getting funds for training from Sight Saver's International. We still have not received the 5tn Year evaluation report conducted from 20th October,2003 to 6th November 14,2003. Few activities has been conducted in the current year due to financial constraints. In Songea district only targeted training was carried out to 30 Rural Health Workers who had been transferred to meso and Hyper endemic areas. No training for CDD'S was done. In Mbinga district Trainings were done in the following areas: All the two districts have fully incorporated CDTI activities in their Comprehensive Council Health Plans and form part of a routine supervision in the districts. Sight Savers International provided funds to conduct a study to asses knowledge of Rural Health Workers on the CDTI Concept and to determine their competence in Training CDD'S. Mectizan tablets arrived in the country on time and the Ruvuma CDTI project office in Songea received the drug on time. There was no delay from the MSD in Dar Es Salaam. The drug has been distributed to all districts and the District Onchocerciasis Coordinators has already sent the medicine to all hyper and meso endemic communities. In Ludewa district there has been a change to the Onchocerciasis staff. All the team members for onchocerciasis in the district have been selected for further training in colleges within the country. We have applied funds from Sight Saver's International to train new staff to fill the gap. SSI has responded to our request and they are making ,urangement to transfer the money needed. We have not received any funds from APOC since the project was evaluated in its 5'h Year in November,2003. We hope that the post APOC sustainability budgets prepared and submitted to APOC management in November,2003 will be approved and released. 7 WHO/APOC, 24 November 2004 SECTION'l: Background information 1.1. General information The Ruvuma Focus CDTI Project is situated on the southwest part of Tanzania, and lies between latitudes 10 degrees south and 11.5 degrees south and longitudes 33 degrees east and 38 degrees east. It shares borders with The Republic of Malawi and Mozambique to the west and south respectively. It borders Mtwara and Lindi Regions to the east while Iringa and Morogoro Regions forms a border to the north and northeast. The Ruvuma Project is made up of two endemic districts of Ruvuma Region, Songea and Mbinga as well as one neigbouring district of Iringa region, Ludewa. It covers approximately an area of 64,333 sq. km of which 1,006 sq. km are inland water bodies from lake Nyasa. With the exception of a small area along lake Nyasa (altitude approximately 100 m above sea level) most of the project area lies between 500 and 1,600 m above sea level. The project area has a tropical climate charactenzed by two distinct seasons, notably wet and dry seasons. Temperatures are also modified by the seasonal variations so that the area becomes hot (average temperature is 27 degrees Celsius) during the dry season and cold during the wet season (average temperature is 14 degrees Celsius). The dry season lasts from June to November/December and the wet one December to AprilAvlay. The peak of the rainy season is from March to May. Miyombo woodlands mainly form the natural vegetation although in Mbinga district artificial forestation is now taking shape. The drainage pattern of the area is mainly two fold. Permanent rivers of Hanga, Lutukira (these two rivers join to form river Ruhuhu) and Rwekeye drains into lake Nyasa. River Ruvuma, Luegu and Ruhuji drain into the Indian Ocean. In between you have many seasonal rivers draining into these two drainage partten. Major food crops grown in this area are maize, rice and potatoes. Legumes such as beans and soya are also cultivated in large quantity. Cash crops cultivated include tobacco and coffee. Economically the area is quite well-of although the wealth so generated is not equally distributed among the people, giving a wide range between the poor, who forms the majority, and the few effluent group. The road network in the project area varies considerably. Seasonal roads that are only passable during the dry season-an important factor during ivermectin distribution, serve Ludewa and Mbinga districts. Feeder roads going to meso and hyper endemic communities in all districts are only passable during the dry season. Songea district is served by a tarmac road, which passes in the oncho area and therefore offers easy transportation to those communities situated along this road. Songea town, situated l,000km southwest of Dar- Es- Salaam port, served by all weather tarnac road, is the administrative headquarters of the Ruvuma CDTI Focus Project. Ivermectin mass distribution was instituted in The Ruvuma Focus in October 1992 funded by RBF up to 1995. IMA provided bridge funding in 1996 while SSI provided bridge funding for the year l997.During all this time the project was being implemented using mobile teams to distribute the medicine. Year I APOC funding started in October 1998 with the new concept of CDTL The updated census conducted by distributors before this distribution indicates that there are 287 ,349 people in 164 endemic communities in Ruvuma CDTI Focus Project. We received a total amount of 40,000 US $ from APOC for implementation of CDTI activities in Ruvuma. We also received 509,000 (3mg) Mectizan@ tablets to be distributed to 164 communities in the project. We had an old stock of 266,500 (3mg) Mectizan@ which was added to the new stock giving a total number of 469,000 (3mg) Mectizan@ tablets. So far 8 WHO/APOC, 24 Novemb er 2004 158106 (3 mg) Mectizan@ tablets has been distributed to 45,173 people in Ludewa District, ll62L8 Mectizan @ tablets to 33,205 people in Mbinga District and 425145 (3mg) Mectizan@ to 12L,47 opeople in Songea District. In the Ruvuma CDTI Focus Project the village structure is basically the same as is found in other parts of the country. A village chairperson assisted by the village executive officer heads it. The community members elect the village chairperson whereas The District Executive Director appoints the village executive officer. The size of each community vary; some are large with population up to 5000 people and others are small with population of 500 or less. The government system at village level is well organized with established village government offices, which are easily accessible in terms of bureaucracy, giving easy entry point into the community. The next administrative level is the Ward, which is headed by The Ward Executive Director also appointed by The District Executive Director. The Ward Executive Director heads several villages in his/trer catchment area. Traditional Leadership was abolished in the early 1960's though they still hold some power in the community; they are not recognized in the country's constitution and have no political powers. Almost all villages in Ruvuma CDTI Focus Project have a number of village health workers and these are people who have been trained in a number of simple health interventions by Ministry of Health trainers. All villages utilize these people in collecting, distributing, and data collection during Mectizan@ distribution. These village health workers are not ministry of health employees; they are recruited by the community to perform simple health tasks in the village and are motivated by community. 9 WHO/APOC, 24 November 2004 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 Br Percentage Br=Bzl Br *1(X) Songea 435 58 13 Mbinga 271 27 l0 Ludewa 337 30 9 Total 1,043 1r5 32 1.1.2 Partnership 1. WLI,AGES: In this cycle villages has been performing the following: Selection of CDDs o Collection of drugs from health facility . Support CDDs (both materially and financially) o Communities have decided on the period of distribution, mode but not timing in most cases. o Sensitize community members o Monitor treatment . Census update o Submission of report to first line health facility 2. FIRST LINE HEALTH FACILITIES, The role of the first line health facility remained the same, and these included the following: o Collection of Mectizan from the District o Sensitization and mobilization of communities . Supervision of distribution and monitoring of CDDs o Report writing o HSAM 3. DISTRICT In this cycle as usual, the Council Health Management Team (CHMT) was responsible for o Planning for CDTI activities o Training of health facility staff o Payment of the salary of workers o Mectizan procurement from the Region o Monitoring and supervision of health facilities o Maintenance of equipment 4. REGIONAL HEALTH MANAGEMENT TEAM 10 WHO/APOC, 24 November 2004 The roles of the RHMT were: o Supervision and monitoring o Collection and submission of Report to the National level o Advocacy o Payment of the salary of workers o Printing of reporting forms . Supply of Mectizan to districts 5. MINISTRY OF HEALTH The national level: o Payment of salaries to workers o Monitoring and supervision o Advocacy 6. SIGHT SAVERS INTERNATIONAL In the current year, the supporting NGDO Provided funds to conduct assessment on the training needs to Rural Health Workers and CDD'S 7. APOC In the current cycle, APOC has provided technical assistance only to our project.a 11 WHO/APOC, 24 November 2004 so N Ho -o C) o z .+ N U o n{ B N I l* oE trt!o)'-Gl -q 9= €l.r € =>E E.gU. EE E -9 00 E: 1io q)1 EU .EE F.E E = 0E- 9E E$ EE .E€ 9 .:!HU L-9! L- ..rEPo--s 5$ 3 = 5cs .A- . L;i Y .9>L =rh'U.-- E Er frtr cE> 6,H-- H-wtr ocg Io-9= 9 AE H !vE EE E. .e E€ .gI E=c)HA-ira5*'9tr .crrva) -E €: Ei EEa EE $+g r9! rta o >EO =oA I 9O :i = igT EF EE= H -3)ctlrEE Er,E .=E F;E EE 3*f E : er9> E E E:g E o ,ha ., .E r5 U qr.E .9 h E'E-UEE f3 8E E I ; H g<fl a F3€, E ^-9,* 1= .hl-l I q) \) \) o q) q) aU!\) '9X Bq) .sF I3 .!' $s$v B! U ''Uq) }JE :q-\o' \)h eq) .i qr -S ^s .E! >h IJvp h.- B! o\) '= -s \o \JP \)o }N oula \)9F. _.s 'S* \pr.xPP <i ;='$B EE .\5t'p uI -S q) s.! =.e tR"s6 -: oo:* B\ *q)\)> =pi\{q lt E t\ S' \l\ U ! q t< c) t0 q) E^ ;R cgz €) a_ U) q > T \) a t -.io Loa oo tr P oa C) Lr o bo tr tr) tr o 1,q) (s ol-. 0) t-< Cd >to trq) P C) B cl,q) li cl Iq) , q) tr o q) tr }1(n 'tr d o (! O.oa !tr(! .h o tr tr tr oU oit o.ll -ol cdlFI E otr aa o -3c oE IN! F 4q) Q v 6l c) F .9F =q.!E f,9 O\nC\ N@ r- ca\o" cav oi\oq \o o\t(a F* €N + ilE ig -oo .= oN E i'.: € Eg o\nol N@ r- ca\o- c.)$ N\o -l: \o o\t(.i f- €N 9E =o)tIEs, ffEE - - Fq ca \n \n$q r- ca o\ cas F-t (a(a6l +ro o c! 9c FH Eq) o'= EEiE €e a.a o\$q ca N o\ \O" \n H\o\n r- € Nt ra N + I .c)itr;()O .= aN E €.: '? EE \o ca C.l \n ca t\o € .E,H9' € E._trG):!if H6)tr >: q)Ftr -O N €6 N \nN (a(A Qo OI cg ahq) I Lq) z I .e.gEO' € ?.tr=c)6)i L .a .= .? c,zt N @ ca (a ;F .9gE =EE.EE 3g i'ts ai5 El. \o- o\ c\l ea Nq o\ ca c.) co co -l: O eo (a(a !a^ o\g\ F- octEc)lL --tr9699.r.-{a -.9 ots !{HEdo'rU Q,-.l a od€ 9rEEHA(E6Z (s bo -o\3a (d Bo! J Fl 3 Fr ,+ ! N !(.) -o o z$ c.I ri oA o > ca +joo 'a L<a li o o)s 'tr cn € bo () 0:)qiq{(t U) an c\I e.l !(n o ootro 'tr 0)a xo >' A.O. =c/) (! N oo oo (g L) cr) q) F .A o oU h BL) L') \J \) .b q: oL q) o ts q)q \) & L(g C) >' tr 0) H o o tr '(,o (d c)H ar)(n(.) li 0) Lro IA C) o(g(rr o otr o tr F c.ir ol -ol(dt FI (t,q) I o q) o Et N z o Er Fz riEra rc F] =a : N z Ei(-) ri(a Q Lq) a q) e oQ C) -o c) o z r C) -o o o z E 0) .o o z H.q !.E CE: op o o Ho -oo oo E 0) ,oo o , .A o( L ti .9- -9:o.= EEQ !o o o E C) -oIo o Hop o o Eo+ 1itr cc= o -o o o.o(h O .o tr o a. C) U) 0) ,o oq o U) q) c! q an at q)(.) €=g: o.= EEQ (.) ,o o a) U) Eo .o Eo o.o U) q) .o tr 6) a.o U) P^. .ri tr d: o -o o o v) k C) -o 0) o. 0) CN o -o E(.) o U) o( cctr Fr EE(J H(.) -o C) o. C) v) H C) -o o (.) U) ! 0) -o E o a(.) U) E'--e .P tr cl= oo o0 a o o0 CH ora r(D s= Etr !r9e o 9: EEU o oO q o0 o bo Er+!.E c6= Fr FI I L tt n -o dz € c) bo o U) bo -o a cB 3 C)! J Fl Fr Er 2.2. Advocacy The following Policy/Decision were mobilized: Regional Level District kvel Community level: Divisional level Ward level Village level Sub village level The reason for mobilization and sensitization : Targeted mobilization and sensitization in levels where there has been change in leadership. The goal was achieved. Problems encountered Poor attendance cased by bad timing. This was noted especially in sub-village meetings. Suggestion to improve advocacy We have advised the FLFIF workers to involve CDD's in preparing these meetings 2.3. Mobilization, sensitization and health education of at risk communities The project area has one local radio station used for broadcasting our CDTI activities. We also has another country wide radio station which we use in disseminating various information on CDTI activities. Various leaders at all levels in the district are mobilized in CDTI and we use them to disseminate CDTI philosophy to communities. Methods used to mobilize these targeted groups are as follows: o Classroom discussions especially for teachers. o Focus group discussions o School teachers. The response is usually good as indicated by raise in coverage treatment in this cycle. Weaknesses 1. Money demand fro participants 2. lack of incentives during these sessions leads to poor attendance. Ways to improve mobilization of the target communities: 1. Repeated mobilization. 2. Conduct CSM sessions to as many villages as possible 3. Convince the district authorities(fund holders) to allocate more funds for mobilization. 4 3 2 7 34 t37 T4 WHO/APOC, 24 November 2003 ca N k(.) -o (.) z{N U o0. oH B \n C) JZEXoY€ 5 rn- cd(g!2 =s to 4<n-Es >'EFSO€Eotro -oo '-trlie trt .i0)>E?O S YrHb to8tr (q'E o.lF > ;E HQ+j-E sFd'* n .b 3ul.J< O - -.1 i '-l:O-Ps btrotrtr-\z E -E8t €(A(HhooYPe :3E E caOO '-tr)$8E Hca.l tr 0_6 -E c'J .9cbE 9p3E<na.o trlp} I .tsa(tlP9.-(l)t-.i-. H a:b ,NEFO) aH -l<-(g0j): e utEs€ .9:tEE X=J"lSsoY o ho^*e - g /\ - .H .;r \./ -l! E l< rr €EEIi? s"t - R ?r(!lio(.) L99F L U,\ Oc:ic) .--E-ao:J H ()o't c 4d ^ o,c6c"tr'.5 0 hHd.TU JO.(!ij -.rdH =J (J.= OdE E * -cdOEii O. rO A. a 6J 9: '= €d E&E-q 9 8e:'! oo 5Ez ll * : e BO cg oI , o,)q so so so so E.E * c EEEz e'i \oo N r)(.i t\o 6 6) E E q) -q)!r>H=cEy U o o z + r,l.F rnoo -: .+\o to r-r- co \otr: 4)o E;^o i:-rIr \J ot € \o c- oo r- 0 U q) c! 2 to\o c.)@ o ol @ @ o\ >g n'5 ;D l. cEX >q Efr !o tr6i EE9>: o= zc) il\ q) EO G' qJ q) o 3 >,s p B'l o I E EE I EeET \o caN |r)ta {\o t EEi g - 5 ellg E8 5 \oo co c.t (o g F U E9 = .=a (!.F 0'5 E(! ct C) o L €) z | ^i' () a0 cl q) q) (.) o o\ c.lCA =ts tri:Ei ETEO z z.= €ra F-N ca r) 3h fl I ETEh2E LE = o+'= .Y!='= a hCOt F-c.l r- cal co ca .+ J L o IJ]oz (/) z ta B s1 a J F h L)q \)() \) *- q p t \3 Uq \,) q, F aU o o (n A. o tr(! O. cAo E oU +t o-ll -ol(dl FI fl E o E o a: o .5 ItE- 3 E E o o 1N 2.5. GapaciQr building - Describe the adequacy of available knowledgeable manpower at all levels. Apart from the Ludewa district where the staff is not stable, the other two district of Songea and Mbinga have stable staff. The frequent change of staff in Ludewa has made it difficult to maintain good trainings to FLIIF workers. In the other districts the trainings are consistent and regular. There is immediate replacement of the district or FLFIF worker once transferred to another area as evidenced in Ludewa district. The replaced staff are trained immediately on CDTI and are followed up frequently in order to asses their performance. t6 WHO/APOC, 24 November 2003 Eq) L IA U o L e) z (.) +: Q U ir zv I () c! F a< O c.l c.) c\l c.) o o O O mra (f) ra (a ro q) q) 6) () s?=F.U o ta) Oo ol o co tt)trq) .=G cg FrLh, Lr<c)' -i U)oc) trr9 LGIOl li az dll 9 io ! *i &v tu (.) c-) O O t !+ F*ta q) C) () I sI o Fr co ol c-.1 t\ Eq) al 6i tro:- EE Egtr> z$. q) I (J + Q Q U I(JcqF A< > = O c.t C\l r-N t'-(.l t-- t-- t\o rr(a i- t t-r+ o) o c) 9 Be(JF F-\o olco \ocf) ra(a fH 6, t) t) J\ -?r90) E.s o Lq) z E,r3 $ Uz ra) c.) c{ o\ $ : N c.l 0\(A r+(.) la o c) o I s U?F |r) O $ o\(f) Fl (, L 0 a H zo v) o Z ta B rrl n tl FI F o Fr caoo c.t Lo .otr o o z$CI 0. B r- 60 a S a .J ! + 5 o OO\ o * o S\ s s Gth s z; !q v2p\)\) *- q o q) L t S \J U'2 !U o- o (g q) o tr F Uqr o cA (.) q) oH(.) (j; C) bo tr(! HF ,iir 6)l -oldtFI Table 6: Type of training undertaken (Tick the boxes where speciftc training was canied out during the reporting period) We included the training of teachers in CMS and SHM so that they could help in villages which do not have a health facility. They have proved to be very effective in preparing repots on CMS and SHM. 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 ^/ ^i { Management of SAEs ^/ .i CSM ^/ { { ./SHM { { { { { Data collection { ^/ Data analysis { ^/ Report writing { { { Others (specify) 18 WHO/APOC, 24 November 2003 c.) ON Ho -o 0) zs c.l o B o\ tr c) o il th cg th o& il tl. o q) o q) o il I U) il rh o o c! 00 0)LFi BYilo Or= ,i ll!q)r-. A0t,nE Vc) l,_e vcE ,,9 \Jo. c!IF,Itol.l oJ (r)q)L a0 q) clq) tr E-,, \o N ofl E o Eg t! oLF I(o 6i E€ Ng\ € F- a.lg\ t- = o\ o\|ag\\c 2E QA eg 0tt) > o E E tt \co\ it €la s \o \a;\o \oF = F r) o\\c F. 6N a & t ! g\t6 r\ €ll E\o\o ro \c $ g\g\t-d) ra € ra \cN N U) !c \o € rl\o € \o cl N@ cl\oio! 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Ordering, storage and deliyery of ivermectin Mectizan@ ordered/applied for by - @lease tick the appropriale answer)MOH{ WHO I.]NICEF NGDO Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer) MOH { WHO N I.JNICEF ! NGDOtr Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities Table 3: Mectizan@ Inventory (Please addmore rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? Mectizan@ and distribution data are returned back to the Health facility by CDD'S once the distribution is over. From here Mectizan@ is either re-allocated to other villages or sent back to the district pharmacy for re-allocation to other Health Facility. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Activities performed by Health personnel in handling Mectizan@ o Mectizan retirement by filling in the ordering forms and sending them to the National Onchocerciasis Control Task force in the Ministry of Health. o The Project coordinator makes follow up to the national office. o The Project coordinator collects the drug from the zonal medical stores department and enter the received drug to the regional pharmacy. o District Coordinators makes orders to the project coordinator and distribute the drug to the health facilities according to their requisitions. o FLHW distribute information to sub-village leaders and CDD'S about the arrival of mectizan. . They come for collection and distribution o This is followed by Supportive supervision during distribution. Any other comments NONE Region Number of Mectizant tablets Requested Received Used Lost Waste Expired Ruvuma 470,522 509,000 699,469 3,000 0 0 TOTAL 470j22 509,000 699,469 3,000 0 0 24 WHO/APOC, 24 Novemb er 2004 2.8. Gommuni$r self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? NO If so, When? Table 11: 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. Except in Ludewa, performance in the other districts has increased, especially on proper data recording. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. RMO kinga I JRMO Ruvuma PC DMO Songea[ J DMO Mbinga I District Oncho. Coord I DOT'S J FLIfW's J CDD'S I Community DOM Ludewa| 2.9.2. What were the main issues identified during supervision? Worn out of Registers. In adequate CDD motivation. Increase in drop out of CDD's District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meeting (SHM) Songea r28 3 3 Mbinga 93 6 5 Ludewa 76 0 0 TOTAL 297 9 8 25 WHO/APOC, 24 Novemb er 2004 2.9.3. Was a supervision checklist used? Yes, a check list is always used 2.9.4. 2.9.5. Was feedback given to the person or groups supervised? Yes. 2.9.6. What were the outcomes at each level of CDTI implementation supervision? lrvels concerned always gave appositive answer to improve their performance during the next distribution. How was the feedback used to improve the overall performance of the project? Solved the problem of CDD drop out and in all districts the District Executive Director promised to replace the worn out registers. 26 WHO/APOC, 24 November 2004 SEGTION 3: Support to CDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) xCondition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? The existing equipment is maintained through the normal process in the Region. Repairs and services are carried out using funds from the hospital. At the moment the region has not planned for replacement of the present vehicle as it is still in good working condition. In Songea and Mbinga districts we have adequate man power. The staff have not changed since we started the programme. They are highly knowledgeable and competent. In Ludewa district the picture is different. The staff have been changing almost every year. We have therefore, been re-training new staff to replace those transferred other parts in the country. Sight Savers International has played an important role in providing funds for conducting these trainings. APOC MOH DISTRICT/ LGA NGDO Others Type of equipment Source No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 2 One functio nal 2. Motor cycle(s) 7 5 functio nal 3. Computer(s) I Functi onal 4. Printer(s) 1 Functi onal 5. Photocopier (s) Functi onal 6. Fax Machine(s) Not functio nal 7. Others a) b) c) IIII 27 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years - If there are problems with release of counterpart funds, how were they addressed? We had no serious problem with release of funds from SSI and MOH. All the districts released all funds budgeted for CDTI. Additional comments NONE 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) There was inadequate support provided by community members to CDD's. Some villages provide incentives to CDD's during distribution. The incentives are in form of money' food and exemption from communal work. Mbinga district council is leading in the focus for allocating a good amount of funds for CDTI activities as a whole. Contributor Year I ('provide the period') Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) MOH (Central + Provincial/State) 31,399 31,J99 31,399 31 399 31,399 3lJe9 MOH (District/LGA) 17,000 15,000 t7,799 r8,860 15,000 12,000 Local NGDO(s) ( if any) NGDO partner(s) 8,000 7,200 10,000 8,100 9,000 6,000 Others a) b) Communities APOC Trust Fund 32,537 27,603.5 3t,369 20,440 0 0 TOTAL 88,936 81,202.5 90,567 78,799 53,399 49,399 3,4. Expenditure per actiyity 28 WHO/APOC, 24 Novemb er 2004 Indicate in table t4,the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here lUS$ = TSH.1,000/= Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community 500 MOH Mobilization and health education of communities 4,000 SSI Training of CDDs 6,000 APOC Training of health staff at all levels 3,000 APOC Supervising CDDs and distribution 1,000 SSI Internal monitoring of CDTI activities 0 APOC Advocacy visits to health and political authorities 0 APOC IEC materials 0 SSI Summary (reporting) forms for treatment 600 APOC Vehicles/ Motorcycles/ bicycles maintenance 2,000 SSI Office Equipment (e.g computers, printers etc) 900 Others TOTAL 18,000 MOH,SSI& APOC Total number of persons treated 199,848 29 WHO/APOC, 24 November 2OO4 SEGTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) {-Year 1 Participatory Independent monitoring None Mid Term Sustainability Evaluation { 5 year Sustainability Evaluation { Internal Monitoring by NOTF None Other Evaluation by other partners _Year I Participatory Independent monitoring Mid Term Sustainabi lity Evaluation 5th year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Recommendations Training sessions for CDDs and Health personnel should be increased and periods should be longer. Community education on key issues like programme ownership, community responsibility, reporting of side effects and census should be stressed during CDD training. An update of community census before the next round of treatment should be carried out. APOC should consider possibility of extending period of project funding for at least two more years to enable project sustainability, much emphasis being on health education and IEC materials development. 4.1.3. How have they been implemented? Targeted training to CDD's and Health personnel have been increased and the training period also increased to 3 days for CDD and 4 days for Health personnel. Community Self-Monitoring has begun in 4 villages in Mbinga,T vlllages in Songea and 3 villages in Ludewa. Updating of census is being carried out before each distribution. 30 WHO/APOC, 24 November 2004 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?YES Was a sustainability plan written?YES When was the sustainability plan submitted? December,z0}4. What alrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1., Planning at all relevant levels All district councils are allocating funds for implementing CDTI activities. However the allocation varies from one council to another. Mbinga District is leading and allocated US $ 9,000 in the current year. 4.2.2. Funds 4.2.3 4.2.4. Transport (replacement and maintenance) No plans available for transport replacement yet Other resources 4.2.5. To what extent has the plan been implemented The plan has not been approved yet 4,3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: Ivermectin delivery is done through MSD up to the project level. District Onchocerciasis Control Coordinators collects the drug from the Regional Pharmacy and delivers to the District Pharmacy. From the district pharmacy the drug is transported to the FLttr where the CDD's collects it for distribution. From the district pharmacy to the FLItr, the drug is transpofted through the existing PHC structure during supervision and monitoring. Only targeted training was conducted to CDD's in the added villages identified by REA results in Songea and Mbinga. In Ludewa training was done to 10 villages which had a low treatment coverage. As mentioned above the CHMT is involved in supervision and monitoring in all the 3 districts. The District Onchoceciasis Coordinator is a member of this team and always goes for supervision routes. 31 WHO/APOC, 24 Novemb er 2004 The release of funds from the districts is smooth. All funds allocated for CDTI activities in Songea and Mbinga were released. Ludewa district released only 600US$ out of 1,200 All the districts have included CDTI in the PHC budget. We have two programmes using the CDTI structure. The structure is not identical but has many components similar to CDTI. For example , registration, census taking, using measuring sticks to determine dosage and conducting advocacy. These projects are Lymphatic Filariasis and Trachoma Control Programme. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research have been carried out throughout the treatment period. 4.4.2. How were the results applied in the project? 32 WHO/APOC, 24 November 2004 SEGTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. In the process of the implementation of CDTI within the Ruvuma CDTI focus the achievement e has been recorded over the five-year period. However, a number of challenges and constraints were equally encountered. The challenges and constrains are listed below. List the challenges and indicate how they were addressed. STRENGTH WEAKNESSES CHALLENGES SOLU'TION Stable staff in Mbinga and Songea districts Unstable staff Ludewa ln Create good working conditions in Ludewa Create stable staff in Ludewa Availability of communication network inMbinga and Songea Poor condition of roads in the Project How to reach inacssesible villages Districts to improve road conditions Primary school teachers used in mobilizations CDD's demanding payments during distribution Strengthen SHM CSM& Advocacy to village/sub-village leaders to motivate the CDD's 33 WHO/APOC, 24 November 2004 SEGTION 6: Unique features of the proiecUother matters The frequent change of district oncho staff in Ludewa, makes CDTI implementation difficult in that area. Quite a number of villages in the project area are inaccessible leading to limited supervision in these areas. Implementation of CDTI in Ludewa district which is in Iringa Region is difficult as the district fall under different government leadership compared to Mbinga and Songea districts \ 34 WHO/APOC, 24 Novemb er 2004