Thyolo/Mwanza annual project technical report to Technical Consultative Committee (TCC): from January 2008 to December 2008

ICOUNTRYAIOTF: MATAWI Proiect Name: THYOTO/MWANZA Approval year: 1 996 Launchins vearz 1997 From: JANUARY,2008..To: ...DECEMBER, 2008...(Month/Year) ( Month/Year)Reportins?eriod: Proiectvearofthisreport: (circleone) | 2 3 4 5 6 7 8 9 l0lll2 Date submitted: 27 JANUARY, 2009 NGDO partner: SSI & TEA ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) -qq \9 ,8 (xqf=As tlT 4 a-t t 1 0 I FEV, 2(i(,9 APOC/DIR RECU & ()[4- oF 24 November 2004 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 NOTF Chairman Name: Dr S. Kabuluzi Signature: .. I lDate Date (, NGDO Representative Name: Mr Frank Mwafulirwa Signature: Date: Q6 This report has been prepared by Name : Laston sitima...... Designation:National Oncho Coordinator Signature : I I : I I I I I I I I I : I ! I I I I I : I I I I I I : I I I I I I I I \ rb:pr 4,,l ewr ll I WHO/APOC, 24 November 2004 Table of contents v DEFINITIONS VI FOLLOW IJP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY ......... SECTION I : BACKGROLIND INFORMATION........ l.l. GpNpRar- rNFoRMATroN.......... 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. PopuLarrou SECTION 2: IMPLEMENTATION OF CDTI 2.1. TrueLrNr oF ACTrvrrrES .............. 2.2. Aovocacy......... 2.3 . Mostl-rzattoN, sENSITIZATIoN AND HEALTH EDUCATToN oF AT RrsK coMMtrurrrss . . 9 2.4. CouulrNtrY rNvoLVEMENT...... 2.5. CRpecny BUTLDING 2.6. Tn-earueNrs......................... 2.6.1. Treatmentfigures.......... 2.6.2 What are the causes of absenteeism?............. ............182.6.3 llhat are the reasons for refusalsz ................ ............ t82.6.4 Briefly describe all known and verified serious adverse events (SAE) that..,. l8 2.6.5. Trend of treatment achievement from CDTI project inception to the current year202.7. ORopRtNc, sroRAGE AND DELTvERy oF TvERMECTTN ..21 2.8. CouuLnqrry sELF-MoNIToRTNG AND STAKEHoLDERS Meprruc . 22 2.9. SupeRvrsroN ................. 22 I 2 3 aJj 5 6 7 7 9 t2 l3 l6 t6 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3.3. Orupn FoRMS oF coMMUNrry suppoRT 3.4. ExpeuorruRE pER AcTrvrry Provide aflow chart of supervision hierarchy. ..........22 What were the main issues identified during supervision? .........,.22 Was a supervision checklist used? ......... ....................23 What were the outcomes at each level of CDTI implementation supervision? 23 Wasfeedback given to the person or groups supervised? .............23 How was the feedback used to improve the overall performance of the project? 23 SECTION 3: SUPPORT TO CDTI 3.1. EqurueNr 243.2. FrueNcral coNTRTBUTToNS oF THE pARTNERS AND coMMUNITIES 25 25 25 SECTION 4: SUSTAINABILITY OF CDTI.. 26 4.1. INreRNar-; TNDEpENDENT pARTrcrpAToRy MoNTToRING; Eve1uar1oN....................26 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)............ ........26 4.1.2. What were the recommendations? ...........26 4.1.3. How hqve they been implentented?.............. .......,......27 4.2. susraNasrlrry oF pRoJECTS: pLAN AND sET TARGETS (MANDAToRy AT ...............27 27Yn 3)................ I ll WHO/APOC, 24 November 2004 4.2.1 . Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport (replacement and maintenance) ....... 4.2.4. Otherresources... 4.3. INrecnauoN.............. .,,,..27 ,,..,.27 ,,.. ,. 27 ,,,.,.28 ......28 ,,..,.28 ,,,...28 ....,,28 .,..,.28 ......28 ,..,29 ....29 4.3.1. 4.3,2. 4.3,3. 4.3.4. 4.3.5. Ivermect in de I ivery me chan i s ms Training.... Joint supervision and monitoringwith other programs Releqse offunds for project activities Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. llhat have been the achievements? ............. ..................28 4.3.7. Describe others issues consideredinthe integrationof CDTI........................29 4.4. OppnauoNAl RESEARCH......... 29 4.4. I . Summarize in not more than one half of a page the operational research undertaken in the project areawithin the reporting period........ 4.4,2. How were the results applied in the project? ............. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, Ai\D OPPORTI.II\ITIES ....... 29 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........30 tv WHO/APOC, 24 November 2004 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-Based Organ ization Commun ity-Directed Distributor Community-Directed Treatment with Ivermectin Commun ity 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 \ 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 84%o of the total population in mesoftryper- endemic communities in the project area. (iii) Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/tryper-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 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 ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geosraphical coverase: 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) Inteeration: 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, inte$ated 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. VI WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOM]UIENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 27 It should be noted that TCC 27 accepted the llth year ThyololMwanza project report and the above issues were suggestions put forward for improvement of the project. The detailed response to the issues raised in TCC 27 report was sent to APOC in a letter dated 18th November, 2008 reference NOCP/CHSU/49i08. T Number of Recommendation in the Repoil TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCAAPOC MGT USE ONLY t87 To carry out CSM This will be addressed in the 2009 implementation year Too many residual tablets NOCP office has ensured that orders of mectizan are according to the district population and use ofthe right calculation (80% of total pop.-MSD formula ) to determine the number oftablets required. It should be appreciated that the tablets remaining after 2008 MDA are less than in 2007. Address census issues This will be addressed in the 2009 implementation year. The project will ensure that each village has conducted census thoughly NOTF Malawi and APOC management to facilitate in-country review of technical reports by Technical Review Committee Collaboration with APOC will be ensured for the implementation of this recommendation WHO/APOC, 24 November 2004 Executive Summaqy Prepare an Executive summary of the report in not more than one page. The Onchocerciasis Control Programme in Malawi has been carrying out Ivermectin distribution under Thyolo/I\4wanza project since 1997 after the launch of Community Directed Treatment with Ivermectin ( CDTI ). Horvever, mectizan distribution has been going on since 1991 and 1993 in Thyolo and Mwanza districts respectively using CBTI approach. Ln2002, the Government of Malawi divided Mwanza district into two districts of Mwanza and Neno. ln 2007, Neno then started to operate as an independent district from Mwanza. This means then that the Thyolo/I4wanza project consists three districts of Thyolo, Mwanza and Neno. However, the geographical area remains the same. Thyolo, Neno and Mwanza districts are in their twelfth year of implementation under the CDTI Project. The people of the three districts move in certain seasons of the year. The three districts share an international boundary with Mozambique. During the rainy season (November - March ), the people of the three districts who are along the border move to Mozambique to cultivate. These people have farmlands in Mozambique where they grow different crops for their livelihood. They stay there from planting period till they harvest their produce. In addition, during the dry season, the people of Thyolo who are along the border with Chikwawa district move to the banks of Shire river to cultivate off season crops such as maize. In the 2008 distribution year, a total of 699,678 persons were treated out of the population of 843,847 people representing treatment coverage of 82.9%. All the 672 villages (inclusive of 12 Estates ) targeted were treated representing al00%o Geographical coverage. The Ultimate Treatment Goal was 708,832 people. It should be noted that in 2008 implementation year, there is an increase in number of refusals and absentees comparedto2007. This has come about because of Neno district. It should be noted that Neno is a new district and the staff particularly at district level are inexperienced in CDTI, therefore they could not effectively carry out sensitization and advocacy at community level, thereby affecting number of people taking the drug. The programme continued to carry out trainings. Training covered the CDDs and health workers directly involved in CDTI activities. During the reportingyear, a total of 944 Health Workers and 1,374 CDDs were trained. Despite that a total of 1,374 CDDs were trained during the reporting year, a total of 3,845 CDDs were involved during the distribution representing I CDD to a population of 219 people. During the reportingyear, the project notably faced two challenges. The first challenge was the sharing of financial and material resources between Mwanza and Neno districts. This challenge was addressed by holding meetings of the Management Teams from both districts and also discussions in the NOTF Meetings on how to share the resources. The second challenge was that there were some delays in starting the 2008 Mass Drug Administration (MDA) since Lymphatic filariasis (LF) started to be co-implemented with onchocerciasis. The health workers and the CDDs were to be oriented on LF before the start of the implementation. However, this did not affect the finishing period for the 2008 MDA. 2 WHO/APOC, 24 November 2004 \ SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Onchocerciasis Control activities have been going on in the two districts of Thyolo and Mwanza for more than l0 years under the CDTI, however in 2002, the Govemment of Malawi divided Mwanza district into two districts of Mwanza and Neno. In 2007, Neno then started to operate as an independent district from Mwanza. This means then that the ThyoloAvlwanza project constitutes three districts of Thyolo, Mwanza and Neno. However, the geographical area remains the same. Thyolo and Mwanza/Neno lies almost 100 kilometres apart on the southeast and southwestern borders with Mozambique in the Southern Region of Malawi. Thyolo is a more densely populated district than Mwanza and is very hilly and with difficult terrain. Accessibility is therefore good during the dry season. The numerous riverine systems make it favourable for the breeding of Onchocerciasis vectors, Blackfly. Neno has similar topographical and climatic features as those of Thyolo ( Refer to Fig. I on Page 4 - Map of Southern Region of Malawi). Thyolo district is mostly dominated by Lomwe people. These constitute a high percentage than any other tribe in the district. Mwanza and Neno districts are dominated by the Ngoni people. People in these three districts practice matrilineal type of marriage whereby the man stays at the woman's home village. Most of the people in the three districts depend on Agriculture and small scale businesses for their livelihood. In the Southern Region of Malawi, i.e. including Thyolo, Mwanza and Neno Districts, the main rainy season lasts from November through March. Additional light rain usually falls between May and July. The climate in Thyolo is favourable for tea plantations thus why the presence of large tea estates. Administratively, Malawi is divided into three regions ( South, Centre and North) with twenty-eight districts. The local community is mainly a village set up which follows a common clan ancestry and /or a similar cultural grouping. The village is headed by a Village Headman who may have several assistants or advisors mainly elders of his clan. In some areas several households belonging to one village could be scattered over several kilometres. Several villages can be grouped together under one Group Village Headman (GVH). The highest ranked ruler is the Traditional Authority commonly called the T.A. whose authority covers a geographic zone in a district encompassing several GVHs. The TA is a very powerful and respected traditional ruler. In the majority of the tribes there is gender equality in the inheritance of headship (chieftaincy). According to the 2008 Population and Housing Census, the country's population is currently estimated to more than l3 million with most of it in the Southem Region. On health care system, Malawi underwent a decentralization process, therefore the regional health offices were abolished and this led to the creation of Health Zones (five Zones; the southern and central regions have 2 zones each while I is in the Northern region). The Zonal Officer is the in charge of the Health Zone which is comprised of several district hospitals whose in charges are District Health Officers ( DHOs ). Despite the creation of Health Zones, the DHOs report direct to the Ministry of Health J WHO/APOC, 24 November 2004 Headquarters. At district level, there is one dishict hospital which is headed by a DHO as earlier indicated. From the District Hospital, there is either a health centre or a Rural Hospital. Then Health posts follow the Health Centre/Rural Hospital. Communities access medical treatment at each health facility free of charge. Regarding health facilities, Mwanza district has 4 health facilities including the district hospital, Neno district has l0 health facilities, however, the district hospital is under construction whilst in Thyolo, there are 26health facilities including the district hospital and 12 Estate clinics. In 2008 implementation year, all the 824 health workers who are directly or indirectly involved in CDTI area were involved in CDTI representing 100% involvement. The health workers who are involved in CDTI according to Malawi are the Clinical Officers, Medical Assistants, Nurses and Health Surveillance Assistants (HSAs). Fig. I : Map of Southern Region of Malawi showing CDTI districts t]EDZA ti hIAHGOCHI Mozambi zambique E 4 H!NGA HEU hrtBA CHI WHO/APOC, 24 November 2004 Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District Number of health staff involved in CDTI rctivities. Total Number of health strff in the entire project area Br Number of herlth staff involved in CDTI Br Percentage B"=Br/ B, rl00 Neno 84 84 t00% Mwanza 96 96 100% Thyolo 644 644 t00% Total 824 824 l00o/o 1.1.2. Partnership The NOTF Malawi comprises of the Ministry of Health ( MOH ) and other partners such as the Sight Savers International (SSD, Tea Estates Association of Malawi, the World Health Organization ( WHO ). The NOTF partners are involved in various CDTI activities. The SSI Country Representative participates in the planning of CDTI activities, supervision, advocacy and mobilization, attending NOTF Meetings. In 2008, SSI funded community leaders mobilization meetings in all the CDTI districts and training of CDDs in Neno district. For the past l0 years, the tea estates in Thyolo district have actively carried out treatments on their establishments. Mectizan distribution on the Tea Estates is carried out by volunteers who are trained by the Estate Clinic Health personnel assisted by the District Onchocerciasis Coordi nator. 5 \ WHO/APOC, 24 November 2004 st N () .o () o z s e.l O o o. o c)E: Gl'- =tolc) tEsu =!>E aqtOE boo(!6 oo&.ElEootr !'l Gt E.bvE 6)E =E *;;SarH >;E =0.niloo(l)E ED>e G(DIE IU)OC) .;S i0or-6to= =()e.- CL lF)r_ o cto60gE.E -0u) ;oEEEA e9E \oaq, .- ct 'IoctE10; 61,::E G>= =G€]> s3 -Ege rF9OOeO e?-GYyEE= --op'= €5A* =H-cJ> G .=(,9 €Yc o6=gE; l6lhDo.ca (E =c)>il 9P c)(l) ,,1:! u0AF Eura a) 'fgH alo tr G! rr 1 zqrE Etr:iocl \o d(D L(n oo .? a. o (: o o rE o a o (ll lr) o tr q o B lr) F q, bo(g o tr oo c) an(.) U)troo (B () C) 'o () bod L o oo o o bo U) (.)k(! o (rr H GI c) o C)o ar) o)oL o .h L(l) o S\ a.\ -Ee i, \ s$ ; )!s 6tir trU.: '--r :B E O6> q ns{ s o o.9 o *L !N3 epss .=ss €tS I sc € 3,FS E fEb .F :NF A Eqrl o Os.x -tr '53E ; 2\s- c=EEo a !? iYo '^ H *= E Ei\ o ild G, rr*S axE s5P U tr o z an(u q T\ q)L -x q) F5 q) 'oo 0) a. bo tr oa() 0) ootr li)E o lro 't,() (€()k c) cn x C) q) o c, c)L Io oL q)L o (.) tr JZ(r) L (o tr o d oa ! (! (n() ! E tr oO oit orl -ol(Bl FI E o a-fl6 - =c oE aN aF s \) o'L g b, L q)\ \) o' a q) o F\ ,q) c p N (J q) o'\ q) q) q) \)I q) .o o 5 AJ B S ciq)\ q) \) : i q)\ t q)\q)$ \4q) F D :6- :E6 .= ir -Y = !q9 + 6l \o o\ C\ Nr- oo c'l\f, \f,|r) N(aa € F- + il llE -tDo .= qN r -?.gE> EF 8€ @Nlr) s C\ q oo F-\o co c.i$\o tr-t6 ?al!+ € o!{ . g< tL':e6 *EisrE E E'F.N= c-\o F-\o cn ca \lr)q o\ c.lc\ 6l o\ ra !f, ?a) o o G o Fr 'EgS 9t E E.=1i?a.rEo E'=gsi oo ta)$^ cn |r) oo(r) c.i F-- o.t sl cn $ inia .+ o\(aia I o -o ON 8.eEE -El!€) oF +* il oo co oo a C) (€ a tr.l (n C)F (r.l +s $ (\l t--\o .eEE9EEEo!{9E trL! c!oE >or+E N s oo oo ra) \o a (\t !r,q) a0 s at) 4) E tr cl t=l ht olsl EI E9U ^9t Etr .= 1!,1?o.rUo E'=83EE* .f( \o ra)CO !+\o = c!tr9o9= .-LLY -e:E? = 6.9 _E 3e e' -A-A @ c\ ra) + c.l q ra) @ t-.\o ca ce$\o F-$ € ra!f, a g aJ9c! .-LO)f;E:x o}? = .g .I" -eo' b.= E o () z (! N (! 2, o F j t'r t'r SEGTION 2: lmplementation of GDTI 2.1. Tlmeline of activities Fill in table 3, timeline of activities for areas treated in curuent year, indicating when the key activities were implemented by the month they began and the month they ended. 7 WHO/APOC, 24 November 2004 =o C.l Eo! E c) o z $6l o o. o A o thtq)a a E o o.5 EE Q rt) -o E C) o.oo o ,o E 6) o 6) o () -oo oo S--e .tJ E c: aE L G, c(d xd o E L eh E AT L o o E o a) o A o(J o!o oo ()5o oo F()Do C)o En= i. El 6= aE bI) E 6)! E{) o-oa a oo = o GIEe 3h ah q) L) o a6 EE Q 6! C)tr *. (.) tra E'r .FE ct= o. d q) tr UTE E clLH o 3E L) () 3 o ,.o Eo o.()a ruc 3',o .iJ E d= otra o. C) U) >l(, th(l) E E o() o tr o clN ! ots2 Eo o a) o Eo Q (.) c (l) tra E Eo E o0 E 6! o o. o. x6 2 I L ah c otrit) z (, Ntr(, 3o EF @ -:. oBV) v2q)() q) b v2ioL q) L o t B q) V2 B A) S tr .!o >\ tt) E o o) tr Eo GIoL v)(\l o GI o € o{t) o C,(t o otr o)c F c.ir ol -ol(dl FI 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. During the year, two major advocacy activities were carried out at National level. The Minister for Health held a Press conference with members of the press. During the Press conference, journalists from different media houses both print and electronic including the Television Malawi were invited. Directors of departments from the Ministry of health were present during the Press conference. The National level also involved the Health Education band from the Ministry to assist in the sensitization and health education. The band went out to the CDTI districts and made performances at different venues. During the performances the messages of onchocerciasis and Lymphatic filariasis were disseminated and the masses were encouraged to take ivermectin and albendazole during the year's Mass Drug Administration (MDA ). Both activities brought awareness to the community since onchocerciasis was featured in local media both print and electronic including Television Malawi. The meetings provided opportunity for many of the participants to understand the issues of Onchocerciasis and Lymphatic filariasis. As a program, the two activities were successful and we hope to build on the experience to continue to advocate for the participation of other stakeholders. At district level, advocacy was targeted to influential leaders depending on the level. Meetings were held at District Assembly headquarters, in churches, village headman headquarters for this purpose. 2.3. Mobllization, sensltizatlon and health cducatlon of at rlsk communltlcs Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensithation of the targetcommunities. In addition to the information provided on advocacy, districts took charge of disseminating messages about Onchocerciasis. The Community structures were actively involved in the mobilization of the public. More emphasis was put on the need to participate during the 2008 MDA which included mectizan and albendazole, 9 WHO/APOC, 24 November 2004 Drama and meetings were.used to disseminate information. These meetings were being conducted by different personnel at different levels such as the community, health center e.t.c. IEC materials such as posters, Ieaflets were used in sensitization. Ilealth education sessions were also carried out in Out Patient Departments (OPDs) of health facilities. With the intensive mobilization and Health Education, this has assisted to maintain a higher treatment coverage that has been realized since 2004. For a successful mobilization to be realized, there is a need to involve influential leaders such as village headmen, politicians. Also use different and attractive ways of bringing awareness to the communities. In 2009, we are planning to continue using the health education band to assist in increasing awareness. I. l0 WHO/APOC, 24 November 2004 2.4. Gommunity lnvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: r - Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrition a problem for the project? [f yes, how is it addressed? - Other issues During health education meetings including the health education band performances, more female members attended the meetings than male members. This is also the same in most of the activities. As of now, no monetary incentives have so far been provided to the CDDs by the community. Attrition of CDDs is not a major problem, howeyer, in smaller cases attrition of CDDs comes about due to transfers of CDDs to other areas for employment and marriage. District Numbcr of communities/villegcs with community mcmbcrs ls supcrvisors Numbcr of CDDg end the communitics involved Number of communities /villrgcs with fcmrle CDDs Totel no. communities in thc cntirc project erce B. Numbcr with community mcmbers rs supcrvisors B. Pcrccntagc Bo= BJ B. .100 Malc CDDs Bz Fcmelc CDDs Br Totel Bc= BzfBr Numbcr of communitics with fcmrle CDDs Brn Perccntege Brl= Bro/B.rl00 Neno 138 0 0 222 288 510 132 95.7o,'o Mwanza ll8 0 0 165 199 364 lt2 9s% Thyolo 416 0 0 1,302 1,669 2,971 376 90.40/o Total 672 0 0 1,689 2.156 3,845 620 92.3o/o *{ 4,1 WHO/APOC, 24 November 2003 2.5. Gapaclty bulldlng - Describe the adequacy of available knowledgeable manpower at all levels. Knowledgeable manpower is adequate at all levels. This applies at National, District, Health Centre/Post and at community levels. The ministry is continuing to employ Health Surveillance Assistants (HSAs) to meet the target of I HSA to serve a population of 11000 people. The increase in number of HSAs enhanced supervision of CDDs since the HSAs are based at community level and they are the supervisors of the CDDs. - 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 fuscribe ts what tneasures were talren to ensure adequate CDTI implementationwhere not enaugh knowledgeable manpower was ovailable or if staff are frequently transferred during the course of tlw campaign). Usually the transfers that occur in the Ministry of Health are replacement transfers. When a member of staff has been transferred, a replacement is done. fn case when the replacement is coming from the non-oncho area, the district makes arrangement to orient the staffon CDTI. This applies at all levels; district, health centre and communify(HSAs) levels. *r 42 WHO/APOC, 24 November 2003 dlz 2 6 .= +Fv-: $,5 |r) o o\t o6l =\oto +\o co o o oo o tF.(.I tin t") o GI Eo 6ltr .A o e(J c LoE z Q ?F o o\ t\o c") o ra !o!c o\ F. o\ o o I I -o o\ (.)sq = td*: '9 Iu! \o ta! B co 6l co o c.) cn ra t ra ('t o ot-q) .=G6HLi lk :U ,1ho9tr9 r- qlt! z U o F \o coc.) ! ra) o o E a, I e s Us( Qi = E&3 \oF- \oF\ o @cO o\ F \o o € c.t 6 cl6F. !\o\o E'o -E =6E! Eg IE E!- 2E i)o (J?F \o F- o\ t6l\o ra o\t-- ! € o\ trt) E a) a) I s dsq Ui* E&3 € oo o\ r- o o 6o in\o (r)! o E qt E 6t 0 .A I 0 n c o! z (-)?F o\ € d Nc cl o o Fo o (.) z Fl F o E-( 0 o 1) -oo\ oo coo (\l o ,o E(, o ztN O o o.\o ca \ \ d) T o a €: € os € $ E a G o p\ E o +\ o -\ BV) V2q) ag b v2) o\ q)\I E B q) ri a) s tro Gt tr o) Eq) a E FA(J oIo I tr c)L .o)E E o -q (!l ho tr .E F ,iir ol -ol c6l F<l Table 6: Type of training undertaken (Tick the boxes where specrfic training was carried out during the reporting period) During the reportinEyear, NOTF secretariat organized an orientation meeting of District team members. The meeting was organized against the background that most of the Distict team members particularly at district headquarters were new in the district. This haining drew participants from all the CDTI districts. The training was conducted in May, 2008. DHOs, District Environmental Health Officers (DEHOs) and District Onchocerciasis Coordinators (DOCs) were participants to the orientation meeting. In addition to this training, NOTF secretariat organized a working session for Technicat Annual Report writin$. This training was organized against the background that there were some gaps noted in report writing. The training was conducted in February, 2008 and was attended by DOCs and their Assistants. During the same reporting period, NOTF Secretariat also conducted training on determination of coordinates. The training was conducted in September, 2008. The training was attended by DOCs and Health Surveillance Assistants (HSAs). This training was conducted to enable the districts finalize determining coordinates of the villages whose coordinates were not yet determined. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(specifo) Program management * * * How to conduct Health education * * * Management ofSAEs * CSM SHM * Data collection * * Data analysis t * Report writing * * Drug distribution * * *r 4+ WHO/APOC, 24 November 2003 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving l00Yo 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. E T .( 4 5 wHo/APoc, 24 November 2oo4 s 6l o -o Eo o zt e{ (.) o A. o > \s \ $\I .E $ 60 ,t!rtF{ ()JCIvt G!\HS6E .91 's$ i$ €5s .E'at iilt! '=.s! (, 6Sql H Ei .eIs5E$EiEo€I!itEFi EBSEH:RBf $ *gX a E! € F ES or I A EE' :t; ! si EIE!irEt S RS .EI H I S': ;IE $ IS EIE E EIEE b6 arUE- 'O\:: ss ,, BBTt s$\ S€t EEr rbU T Su .E E F}E "tr d\H 3 Sr!) E tsF I rr !3 q sE olol -l crxl > EIE El8 -elEol c)OI tr BIE :ln €lE ,td zl< GIo cl oo 'g o. 9 .E o 1I)& >r! !(l) rE trop 6 G! U) .9 tr ol trol = -l Exl I Bl.ciiltrgl 6sl !olc 9Je st b =l o.>t x Bl< Pl 6 '=l a) =l E Elb Hl u .-t .o EI E ol cDt _ Et s =t oZIE- (g It) d o() 'a o ru .g B U' .9 .=tr aE Eoo o tso1'tr o) ILoo ot Hol a,dlE xl I ol .=9l oocItrg:E o.rl - BE EIE(rl 3ot o. rl O 313trt d =t bzft- 6l d)l dl cllLI a)l >t olol ctlol -clol(dI a0 ol olbll olcldl ,.>l =l(l)lol(rlI LI c:)l -cl bd trl el =lol EI ol :l el (Bt =lEILI ol tr.l o TS V) v2q) o A) =oL a)Lo s t5 q) V) Bq) s J4 ah GI th GI C) CI (q tr (, Jl .9 (n ! >t .o ar', rq a .E tr(ll tr o) E d ID F e-'f orl -oldlFI o 6 o o0!B^gE o() oF o (dL o ood C) oo GIC,A to\ clL 00 ooo 0) GI !) bI) RlL C) ao(), Eo\ !.) o.(d 0) F : e€E cH{?IEtZ HE & o O O o c rrl €< u c/, AO o o o o8bg3trEgAA >qt c.t rI ol o c.t ol $t.- €d 6N ra o\ EE'EE o \(\.t lat mtq c.l 6\o \o tro GI ooF. a his o 'Eo500oq, E9ooEOF s\o o € s c; oo \oo\ c1 m @ sq cr € o o --E8E EEE , o"sz oo c-(\l N o\ (\I coa r.. oo\oq r) ca aF\0" o\ o\\o aEE$ =o6l\o o\ ooC\l Nt- oo c..l$- s No € €ot-- a .E .,HE. EHF€.?.gB.9E E E - ET oo6l t+ 6lr}q r) € r-\orI +\o t.-t6(.l!a (r, o o0(rl U)o tr E Eo(J cc t_ a o lt A 6i$^ HiE8E() so soo so soo a ts.9 .^ u.E ii! .T E PHE E= O =E'i!AO o oo @ \o s FIF.\o =o? 6.2 EE$ €c.t @ \o$ clF.\o >9.' 3q o= - o E E EE€- 00c.) € \o.+ t\lF-\o o E .2 o otro z c,Ntr(d Io F Ft l'( oF il I2.6.2 What are the causes of absenteeism? a. Unplanned emigration - the person was registered during the census update however, it was found out that the person has emigrated to Mozambique or other districts during the treatment b. Deaths also contributed to absenteeism c. Laying off of workers particularly in tea estates-the workers registered during census update however it was found that the workers were laid off during distribution 2.6.3 What are the reasons for refusals? Religion - there are some religious sects which do not allow their followers to take drugs Sometimes people are afraid of the side effects if the side effects are over emphasized during health education Rumors and misconceptions about mectizan. Some people think that mectizan is a birth control pill, resulting in refusals No proper sensitization to the masses. Due to inexperience of staff in CDTI particularly Neno district, people were not properly sensitized as a result the project experienced many refusals 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 2. aJ. 4. 2{ /7 WHO/APOC, 24 November 2004 D =l' N o () z t+N Q o0. o qo \ h \) AJ \q) \ q * -:. 4p U\) q: o q)L ";l9B \)q q) s o L() o- bo Loo(l)L C) bo E ok (.) oo d .t7 r! a (h o o C) an L c) E cq (h L() o(H o an C)(h CB(-) cbr o,l -.oldlFI () -E*o99 -EE b4 c2 3 p.8E.= c e(€:icgoi, =.- di= E6 =!EEC rrt 5'6 ot .9 EA 9E cqb =9(J O- o- (H !i o3 ^ d.9 uO.E trd?d *S3-o.9E5 o E c= dooOO Eq:,8 o v ot e d=:Y o IJ d-.cG: S;irs o o- xa t=o -x H()=o :E O. LlooGl E !.1 N= EE;A: $ o S.s =bO?o xo U) obo * a o o0g $s -o O o\ N$ v? lr) t-*tr) r-\o$ 9 tr-( -q t-.\o n\o oo rn +@ ta) a co6 C-l oO F-d o\ o : o.oA] rt i itrl E] o ^9p tl Oo:< B-o cl o\ o\ 6i$ v? lal c.i F- rn \\o sf 9t-.lr) n c-\o n\o oo ,r') s € \ -q ca @ 6t o \ @ o\ ll * I! tl f.l o =DOA d-sbs oo .qoF q ta) 9ta) ca @ 6is ra) r-tf, oo o<; ca € t-$ \oia \ I-r ,r? € ra) n ca oo o.! co € q C.l € ti ! ,o od .o o59-- =5ab o. o\ o\ CO oo r- .tq tn oo $ oo c.l c.l ooN$ ootn c.l \n(.) c.t i.l N t--\o o r--N crtc!\a) co c.l co rar- O o\!+ 6l co c.t\oin \o\o$ in \o o$o\i\o\o € r-.\o ol o\\o r.,l =od o.= lQo )On'FU' a- o\ +N$ oo oo '/l co ca$ r- co =l:N!t$ F-\ot .f oo\o O\ot N ooo I-t sr ln r--\o oiF-$ talia €\o ra N c.l oo\d\o\o c-t rl.) c- ca cr $vs !+\o\o c! co oo odar- L ^rd-:1o _ E EE -!!'5 O ?o c .o .! € =.E r{ - a r o oo .f, o\ ra) \o o\ e.I c-l cn|r) c- ral co co( \o caq ca$ ra) r- coo v1 ra) ia) $\o c-t \.d\o r c.l C-lq r-.r-(a $C\h + €\o o\\oo o\\o c.lola) t-- c.) r= lr} colrl ao oo r-sl €" ca!+ oo (.) bI) <d () E O Il + ri ri ri o ^d)I Pa - qo\ <. >e q t 09 ( n\o\o nr- ra ,a? \o 9\o\o oo o O oO c'- E'^ ,, r loU 9-r.jEI (laEl q $ oq ra) n\o\o n r-.in ,a? \o \o \o\o oo o oa o ti aoo::3* u 5 goE tr E= U >Oa \o\o c-c-N c..l$ c-) oo co =1' o\r- ca \o $ € ca$ Nt--\o c-l c-\o c\c-\o C-lc-\o c\t--\o frl :o do= ,loE' F9 \o\o \o\o \o\o \o \o\o O\o\o o\o\o 6t r--\o c.lt--\o Nt-r\o c.lt'-\o Nr-\o d)(! =q:8, E-Err 9E >;; _ =.= tr {.= Ir € = E E€ co o \o\o \o\o \o\o \o\o o\o\o o\o\o O\o\o c\ c-\o (\l r-\o C\r-\o c.lr-\o 6l c-.\o & E] a- o\ o\ 00 o\ o\ o\ o\ o\ a.l N N c.l c.) N soo ot iaooN \oo C-l r-o c.T ooo N o\ooN tO N () ! (.) o z + c.t -aL., s St \ \ qh G I 6lI o u0 GL.q) q) t'r cl t- o 6l o 4) c) at) GI oL UD <h (l) .a) GIq) Lr GI q) o o'L q) L E(J t'r c) q) 6l c) q)0 c! c) Fr e €\qJ s.q) \\)iis :.sE\!$i7B oqJ rt1 o ct5g CL-o()0() EE. .ge l-l e -q)Ll€UX O(BL(D :-lH6t9el 6a)| ool -cxe -olcgo ! OI)Ed9b g5 r-E rE(\l EEEI C)q)E!r F(! .9 ,r1 F\o e.i o\l C)l -olcdlFI 2.7. Orderlng, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH Nl/ wriotr uNrcilrtr Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH N/ wHotr tINICEFtr NGDOtr Other (please specifu): Please describe how Mectizan@ is ordered and how it gets to the communities - Mectizan tablets are ordered by the NOTF Secretariat from Merck. Estimation of total tablets requirement is done basing on the total population and how many tablets were remaining from the previous distribution, the difference is the request that goes to Merck. After the mectizan has been received at the National Office, it is taken to Blantyre DHO Pharmacy where all the districts make their orders from. The order should be within their allocation based on the population the district is to treat during that particular year. When their allocation is approved, the districts collect the drugs from Blantyre Pharmacy. From the district, Mectizan is delivered to health facilities which are closer to the communities. Health Surveillance Assistants who are direct supervisors of the CDDs collect Mectizan from the Health Facilities and the CDDs collect the mectizan from these Health Surveillance Assistants who are based in the communities . Other CDDs who are close to the Health facilities collect Mectizan directly from the Health facility. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? After distribution, the CDDs deliver the remaining tablets to the Health Surveillance Assistants who in turn deliver them to the Health Centres they report. The districts collect the remaining tablets from the Health Centres. When the district has collected all the remaining tablets in the district, the tablets are kept at district pharmacy for safe keeping to be used during the following distribution year. NGDOtr District Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Neno 340,686 340,686 327,125 0 1,412 0 12,t49 Mwanza 265,s00 265,500 234,964 l,l l3 0 0 29,423 Thyolo 1,48 I ,006 r ,481,006 1,467,197 758 0 0 13,051 TOTAL 2,087,192 2,087,192 2,029,296 1,871 1,412 0 54,623 2r 2o WHO/APOC, 24 November 2004 List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The Health Care personnel carry out the following activities under Mectizan delivery : Collection of the drug from the collection point Advocacy and mobilization of communities Reporting on the drug usage and persons treated Supervision of Mectizan distribution Census update Collection of remaining Ivermectin tablets from the CDDs after treatment 2.8. Gommunity self-monitoring and $takeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so, When? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Stakeholders meetings have assisted in increased commitment to supporting CDTI activities at different levels and this will assist in mobilization for the 2009 MDA. 2.9. Supervision 4.9.1. 2.9.1.Provide a flow chart of supervision hierarchy National Level + District + Health Centre + CDD 2.9.2. What were the main issues identified during supervision? The main issues that were identified during the supervision are: 1. Failure by some Health Workers to calculate for CDTI related data e.g. Therapeutic coverage. 2. No proper recording in the registers by some CDDs3. Some CDDs did not provide a column for albendazol since albendazol is being co-implemented with mectizan since 2008 4. Some CDDs were not using measuring sticks to determine dosage 5. Inadequate supervision from the District to CDD levels6. Inadequate mectizan to some CDDs 2f 2-l wHo/APoc,24November 2oo4 l. 2. 3. 4. 5. 6. District Total # of communities/vil lages in the entire ploject area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) Neno Mwanza Thyolo 138 1lq 416 0 0 0 r38 ll8 416 TOTAL 672 0 672 2.9.3. Was a supervision checklist used? The checklist was used during the supervision 2.9.4. What were the outcomes at each level of CDTI implementation supervision? The supervision managed to correct some issues identified immediately thereby improving the implementation of CDTI. For example CDDs were taught to provide a column for albendazol in the village registers 2.9.5. Was feedback given to the person or groups supervised? Feedback was given after the supervision. 2.9.6. How was the feedback used to improve the overall performance of the project? Feedback assisted to identify the existing gaps in the performance of the CDTI program and thereafter came up with remedial measures such as training the CDDs on providing column for albendazole and the need to use measuring sticks in dose determination. This has also assisted because the program has maintained high therapeutic coverage. .{ 22 WHO/APOC, 24 November 2004 SEGTION 3: Support to GDTI 3.{. Equlpment Table 12: Status of equipment (Please add more rows if 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? The project maintains and replaces existing equipment and other materials in different ways. The project uses government resources and other donor funds which have been pooled together in what is known as Sector Wide Approach (SWAP). SWAP funds are not meant for a specific purpose, but rather the funds are used for different purposes, therefore the project's equipment is not excluded when maintaining or replacing equipment of other programs. This is applicable at all levels i.e. at Headquarters and district levels. Every year, each program is requested to submit its budget. The budget includes activities in the field and procurement. So each program indicates its requirements in terms of capital equipment. The equipment is purchased after the approval of the national budget. Source Type of equipment APOC MOH DISTRICT NGDO Others No, Condrtron No Condrtion No. Condition No. Conditon No. Condition l. Vehicle I 1F I wo 2. Motor cycle(s) l0 7F 2WO I CNFI 39 32F,7 CNFR 3. Computer(s) J IF 2 CNF 5 F 4. Printer(s) J 3F 5 F 5. Photocopier (s) 1 CNFR J F 6. Fax Machine(s) I CNFI 2 F 7. Others a) Public address system I F b)bicycles 20 F c)Scanner I F .2{ % WHO/APOC, 24 November 2004 Contributor Year 2006 ('provde the pernd') Year 2007 ('provide lhe period') Yeer 2008 ('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) I 1,1 54 l 1.154 3 l,l 3l 3 l,l3l Under Extension Under Extension MOH (District) 89,242 89,242 135,222 135,751 135,851 I 35,85 I LocalNGDO(s) ( if any) NGDO partner(s)-SSl 5,555 5,555 Others a) b) Communities In krnd In kind ln kind In kind APOC Trust Fund 7,000 - + released 20,906 37,657 TOTAL 100,396 107,396 173,353 173,8E2 162.312 179,063 !.2. Financlal contributions of the pailnert and communities Table l3: Financial contributions by all partners for the last three years Note that salaries contribute a lot to the MOH contribution - If there are problems with release of counterpart funds, how were they addressed? So far there have not been any problems in the release of counterpart funding. All the funds requests made to the basket fund (SWAP) are honored. Central level funds were being used for both projects. In 2008, the NGDO partner (SSI) provided funding for advocacy meetings of community leaders in all the CDTI districts and also provided funding for training of CDDs in Neno district, however some of their contributions are not always in cash but in kind. 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) Identification of a suitable CDD Collection of drugs Community awareness during distribution periods Mobilisation of other community members Distribution of drugs 3.4. Expendlture per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here_l USD: MKl40_ -+f 2+ wHo/APoc, 24 November 2oo4 Activity Expenditure (s us) Source(s) of funding Drug delivery from NOTF HQ area to central collection of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring o_f CDTI activities 44ygj!9yf E!s_ to- h e a lth a n d p o I i t i c a I gUqglqg! IEC materials S umm ary (r_e_p grti q g) _fgJgls for tre atm ent Veh !q!q_q{ Motorcycles/ bicyc les m a i ntenance 9&q eqripr.rt (e.g coqputers, pri Others nters etc 1,990.7 MOH 4,007 MOH & SSI MOH&APOC&SSI MOH & APOq MOH 7,808.1 10,5 88.1 4,568 1,035.7 2,230.1 800 s95.9 5,634.2 2,228.7 MOH MOH MOH MOH MOH MOH MOH TOTAL 41,486.5 Total number of persons treated 699,678 Table l4: Indicate how much the project spent for each activity listed below during the reporting period SECTION 4: Sustainability of GDTI 4.1. lnterna!; 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 Partici patory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. l. What were the recommendations? CDDs should ensure that a column for albendazole is included in the Registers The DOC/FISAs should ensure that CDDs are given both mectizan and albendazole 2. )F 25 WHO/APOC, 24 November 2004 How have they been implemented? The recommendations will be implemented during the 2009 MDA. The issues identified during the internal monitoring by the NOTF will be highlighted during the planning meetings in preparation for the2009 MDA. 4.2. Eustainability of proieets: plan and set targcts (mandatory at Yr 3) Was the project evaluated during the reporting During the report year, APoc carried out an activity on monitoring of ivermectin treatment coverage. This activity was carried out in Mwanza representing the Thyolo/Mwanza project. This activity was carried out to compare what is reported against the real situation on the ground. Was a sustainability plan written? When was the sustainability plan submitted? What anangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The planning at all levels follows the planning cycle. The Government financial year starts from July to June. Before July, government ministries, departments and programs are requested to submit their plans and budgets for the year. During the planning cycle, all plans are drawn up including activities of Onchocerciasis Control Programme. At the district level, their plans and budgets are consolidated in one document known as the DIP which is submitted to Ministry headquarters. 4.2,2. Funds The activities of Onchocerciasis Control Programme are integrated into the District Implementation Plan ( DIP ). This ensures that the activities of the Onchocerciasis Control programme are funded from the district Other Recurrent Transaction (ORT) under SWAP. ORT funds under SWAP come in a basket form for different health related activities. Onchocerciasis activities are expected to get an allocation and are funded when planned activities are ready for implementation. At National level, each year, each program including onchocerciasis, submits its annual budget for inclusion in the Ministry annual budget. When the budgets have been approved by the parliament, funds are spent through what is known as oRT under SWAP in the Ministrv. 4.2.3 Transport(replacementand maintenance) Transport at district level is managed in a pool , each program is given preference according to the work plan on that particular day. Maintenance is carried when due. At National level, each program manages its own transport, however, when the vehicle is due for service, it is treated as any other government vehicle. The MOH pays for the maintenance. 4.1.3. a -w 26 WHO/APOC, 24 November 2004 4.2.4. Other resources Through integration with other programs in the District Implementation Plan ( DIP ) 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 Mectizan is taken as any other drug. When the DHO is dispatching other drugs to the Health Facilities in the peripheral, Mectizan is included in the transportation. 4.3.2. Training During the eight weeks training of HSAs, they go through different topics and CDTI is amongst the topics they are trained on. 4.3.3. Joint supervision and monitoring with other programs Using an integrated checklist which includes Onchocerciasis activities 4.3.4. Release of funds for project activities All districts in Malawi develop a DIP for sourcing funding from the Central level. In the DIP all health related activities are included. Each activity is budgeted for. When the plans have been approved, funding is made available to the districts on monthly basis. When district has been funded in a particular month, the DHMT sits down and plan for activities to be funded and canied out during that month depending on the level of funding during that month. Therefore, since onchocerciasis control is one of the programmes included in the DIP, funds are released to the activities for onchocerciasis control. 4.3.5. Is CDTI included in the PHC budgetr Yes 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Malaria control program is using CDTI structure especially during the net retreatment week. The program uses the CDDs that are used for ivermectin distribution for this purpose. LF is another health program that is using CDTI structure. CDDs are used for distribution of albendazol in addition to the mectizan they have been distributing over the years. 2{ 27 wHo/APoc, 24 November 2oo4 Describe others issues considered in the integration of CDTI. Other issues considered in the integration of CDTI is the implementation of other NTD such as Schistosomiasis, STH, Primary Eye Care (PEC) using the CDTI structures. 4.4. Operational research 4.3.7. 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 was undertaken during the reportingyear. However, dissemination meeting was carried out for a research that was conducted in 2006. During the feedback meeting all stakeholders were invited. The program has submitted to APOC a survey protocol on prevalence of onchocercciasis. The survey is proposed to be conducted in 2009. The findings of the survey will indicate the impact of the MDA that has been going on since 1997. 4.4.2. How were the results applied in the project? All stakeholders including the districts took note of the findings and recommendations. A plan of action was drawn and the responsible paftner to ensure the implementation of a particular recommendation. SEGTION 5: Strengths, weaknesses, challengcsr and opportunities List the and weaknesses of CDTI im entation Strengths l. Integration of CDTI activities into the normal government operations 2. Ability of the government to co-fund CDTI activities at central and district levels 3. Uninterrupted MDA since 1997 4. High therapeutic coverage of more than 80% Challenges l. Dropping out of CDDs 2. Employment of new HSAs who will require training 3, To maintain the high therapeutic coverage Opportunities l Availability of HSAs at community level 2. Availability of SWAP funds 3. Availability of NGDO pafiner Weaknesses Transferring of experienced staff particularly HSAs .,ry 2g WHOiAPOC, 24 November 2004 - List the challenges and indicate how they were addressed. The project notably faced two challenges. The first challenge was the sharing of financial and material resources between Mwanza and Neno districts. As indicated earlier on that Mwanza and Neno were one district and the 2008 approved budget did not include Neno, however, Neno was part of Mwanza in the approved budget. Therefore, there was a need to share the resources between the two districts. This challenge was addressed by holding meetings of the Management Teams from both districts and also discussions in the NOTF Meetings on how to share the resources. The second challenge was that there were some delays in starting the 2008 MDA since LF started to be co-implemented with onchocerciasis. In 2004, NOTF Malawi resolved that the MDA should be conducted during the months of July-September and mop-up be conducted in October, since they are dry months and the CDDs are not busy in their field. The 2008 MDA started in August. The delays came about because the health workers and the CDDs were to be oriented on LF before the start of the implementation. However, this did not affect the finishing period for the MDA. SEGTION 6: Unique features of the proiecUother matters The most notable unique feature is the presence of a cadre of Health Workers known as Health Surveillance Assistants rvho are government employees. These Health workers are based in the community. They supervise the CDDs activities in the communities. The HSAs carry out any health related activity in the communities they are based. Another unique feature of the project is Estate Distribution. Thyolo and Mulanje District have got estates. To ensure that estate workers are protected from onchocerciasis since they are always out in the tea fields, distribution was introduced on the tea estates. The estate health workers conduct the distribution. In 2006, the estate distribution period was harmonised the with community distribution period. Estate distribution and community distribution is conducted at the same period. 2r Z9 WHO/APOC, 24 November 2004