Thyolo Mwanza-Neno annual project technical report submitted to Technical Consultative Committee: January 2010 to December 2010

I I ! I IRESERVED FOR PROJECT LOGO/IIEADING (including e-mail address) OzuGINAL :Enelish 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) COUNTRY/NOTF: MALAWI Proiect Name: Thyolo Mwanza-Neno Approval yearz 1996 Launching vear: 1997 From: January 2010 To: Dec 2010(Month/Year) ( Month/Year)Reportins Period APocfundinevear: I2 3 4 5 6 7 8I l0 (11) l2 13 APOCProiectimplementationvearrenort: I 2 3 4 5 6 7 8 9 l0 ll 12 13 (14) Date submitted Partners: - Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mcctizan Donation Program (ilIDP) - World Ilcalth Organization (WIIO) - Sight Savers International (SSI) - 138 communities WHO/APOC, 14 September 2009 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 \ J-- Nurn.lwH\X t+u Signature: Date o\ &d\\ Nu-.'Lr,/ . . .lx*.I.tt: .''<. q \4 Signature: Date 2 2o1lI National Coordinator Name: . . .AK iq ry. . . .! Signature: ... t [r 41R Date 18 This report has been prepared by Name,9!lP{!Ntt e Qtrft7so Designation: Aoc Signature Date n i-, \t ll WHO/APOC, 14 September 2009 I I Table of contents ACRONYMS V DEFINITIONS. VI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION....... 1.1. GpNpRer-rNFoRMATroN..................... 1 .l.l Description of the project (briefly) 1.1.2. Partnership 1.2. Popur.euoN............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1. TrNaer-rNE oF ACTrvrrrES ... 2.2 z.) Aovocacy Mogtt-zeuoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMLTNITIES 2.4. CovvLNrrY rNvoLVEMENT...... 2.5. CapecrryBUrLDrNG... 2.6. TneRruENrs.............. .....12 2.6.1. Treatmentfigures.......... ........... 12 2.6.2 What are the causes of absenteeism? .......... ..................... 14 2.6.3 What are the reasonsfor refusals?................ ............. . ... 14 2.6.4 Briefly describe all lcnown andverified serious adverse events (SAEr) that ....... I4 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year 16 2.7. ORpeRrNG, sroRAGE AND DELIvERy oF rvERMECTrN............... .............. 18 2.8. Courptxrry sELF-MoNrroRrNG nNo SrareHoLDERS MserrNc ............ l9 2.9. SuppRvrsroN............... ...................... 19 2.9.1. Provide aflow chart of supervision hierarchy. ............ 1g 2.9.2. Wat were the main issues identified during supervision? .............................. 19 2.9.3. Was a supervision checklist used? ............. 19 2.9.4. What were the outcomes at each level of CDTI implementation supervision? l9 2.9.5. Wasfeedback given to the person or groups supervised?................................ l9 2.9.6. How was the feedback used to improve the overall performance of the project? 20 SECTION 3: SUPPORT TO CDTI ..............20 I 2 3 3 6 8 8 9 ............10 EqunueNr FntaNctat- coNTRTBUTIoNS oF THE pARTNERS AND coMMLTNITIES Orupn FoRMS oF coMMUNITy suppoRT ............... ExpeNorruRE PER AcTrvrry SECTION 4: SUSTAINABILITY OF CDTI 3.1. 3.2. J.J. 3.4. .....,.,,,20 ...,...,..21 ..........26 ..........26 26 4.1. INrrRNnl; INDEIENDENT pARTICTpAToRy MoNrroRrNc; Ever-uerroN.......... ..........26 1. 1.1 Has the project ever been evaluated/monitored? (Iick any of the following which are applicable) ........... .. Error! Bookmark not deJined. 4.1.2. What were the recommendations? ............. 26 4.1.3. How have they been implemented? ............. . .. ...........26 4.2. SusreNesrlrry oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT...... ..........26 lll WHO/APOC, 14 September 2009 5 Yn 3) .......26 4.2.1. Planning at all relevant levels.. .................. 27 4.2.2. Funds........ .............. 27 4.2.3 Transport (replacement and maintenance) ........ 27 1.2.1. Other resources ......27 1.2.5. To what extent has the plon been implemented................ .............. 27 4.3. INrpcRarroN............... 4.3.1. Ivermectin delivery mechanisms .... 1.3.2. Training.... 27 27 27 4.3.3. Joint supervision and monitoring with other progrqms........... ...... 27 4.3.1. Release offunds for project activities ........ 274.3.5. Is CDTI included in the PHC budget? ............ ............. 27 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements?............. .................... 28 4.3.7. Describe others issues considered in the integration of CDTI. .....28 4.4. OpenarroNAL RESEARCH ..34 1.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ........ 34 4.4.2. How were the results applied in the project?............. .................... 34 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTUNrTrES.... ................... 34 SECTION 6: UNIQUE FEATURES oF THE PROJECT/OrHER MATTERS...........34 IV WHO/APOC, 14 September 2009 , IAcronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT T]NICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Health Surveillance Assistance Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization 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 V WHO/APOC, 14 September 2009 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 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/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) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (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) Communit), 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. vl WHO/APOC, I 4 September 2009 a FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT ASE ONLY WHO/APOC, 14 September 2009 Executive Summary The Onchocerciasis control program in Neno district is not new because it has been carrying out ivermectin distribution since 1993 under CBTI and in 1997 under CDTI when it was under Mwanza district. Neno district has 138 communities and all are under the Community Directed Treatment with Ivermectin (CDTI) project with 84 communities under hyper and 54 communities under meso-endemic areas. This year 2010, a total of 101,891 persons were treated out the population of 122,196 people representing treatment coverage of 83.6Yo. The Ultimate Treatment Goal was 102,645 people. The people in the district move in certain seasons of the year. The district shares an international boundary with Mozambique. During the rainy season, the people from the district particularly those who are along the border move to Mozambique to cultivate. They stay there until harvest time; however they come for treatment during MDA. A total of 106 health workers and 706 CDD's were trained and all the 706 CDD's were involved in MDA representing a I CDD to ratio of 173 people. The most notable challenge was that the drugs to be used for integration came in late that's Albendazole, since we are integrating onchocerciasis control program and lymphatic filariasis, we were waiting until all the drugs were available for mass administration. This problem was addressed by mobilizing the Health surveillance assistance to supervise the CDD's more closely in order to speed up the distribution and it really worked. 2 WHO/APOC, 14 September 2009 SEGTION 1: Background information 1.1. General information Onchocerciasis control activities have been going on in the district for more than l0 years, under Mwanza district. Neno as an independent district has been conducting Mectizan distribution since 2008 Established in the 2002, Neno district is one of the smallest districts in the southern region and Malawi in general. The district share boundaries with Ntcheu district to the North, Balaka and Zomba districts to the Northeast; Blantyre district to the East; Chikwawa district to the south; Mwanza district and Peoples Republic of Mozambique to the southwest and to the west respectively. The topography of the district is mountainous and hilly with difficult terrain. Accessibility is therefore good in the dry season. The climate is tropical and falls into two main seasons, wet and dry season. The annual rainfall ranges from 500mm-l200mm on the heights of the Kirk Range, west of the district. Neno district had a population of 122,196 people according to 2010 onchocerciasis census update. The main ethnic groups in the district are the Ngoni's and the Mang'anjas. The Ngonis are the predominant tribe. The languages spoken are Chichewa, Ngoni and English as an official language. The people of Neno follow matrilineal system of marriage whereby the Men live at their wife's home. Administratively, Malawi is divided into three regions with 28 districts. The local community is mainly a village set up which follows a common clan ancently and /or a similar cultural grouping. The village is headed by a village headman, and a cluster of villages are headed by a Group Village Headman. But the highest authority in the community belongs to the traditional authority (TA), who has much power over a certain geographical area. Malawi's health care system is decentralized, the District Health Officers report directly to the Ministry Of Health Headquarters. In Neno we have a district health officer who heads the district hospital the only big hospital at the district level, then health centre in-charges at health centre level. In Neno district there are t health centres 2 dispensaries and one district hospital and a total of 106 health workers who were involved in the CDTI. J WHO/APOC, 14 September 2009 Table l: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staffinvolved in CDTI B, Percentage Br=Bzl Br *100 NENO 106 r06 l00o/" Total 106 106 100% 1.1.2. Partnership The district has a number of partners involved in project implementation area. Most of these partners are directly involved in Ministry of Health (MOH) programs like the Christian Health Association Of Malawi(CHAM) also some other international NGDO's namely the Partners In Health (PIH), Clinton Hunter Development Initiative(CHDl), World Vision International (WVf Malawi and the Sight Savers International (SSI). Some international partners like the African Program for Onchocerciasis Control(APoc), world health organization (wHo) and Mectizan Donation program (MDP) contributes a lot towards program marlagement including funding of CDTI activities. These organizations have an overall working relationship in areas like advocacy, mobilization and planning to some extent. They conduct planning meetings together As of now there are plans to involve some of these organizations to assist in CDTI implementation as others have already started. 4 WHO/APOC, 14 September 2009 N 0) -o () o.() a + Q L.) - I I I I I I I Ith 0) c\.. 'E O bO -0-) B; (.) qd Pc)bo.< Es 0)cg c15 E-i Oqr0)o 'aoLP oil +b !C) ath 2E 0)Fo,(€ .{re2 sg \) o' \)\ I !J b.-5 q) U \ \)l-Iq)\ qj q) .a a 4 q) o'\\ x \ o q) M\g I u \ M o'q) bo g q) 4 !-,U a) o'\\ : q) U \ ^o qr ! q) L l.) \\) 5 E\ o \ q)\q) l{ tq qJ \) \)L q) o \ .\\\q) :{ q) { U g ()L 4 > o\ T\ tR q) q) ! C) bo f q q) *< 0,) a0 L lr o C) Cd C)H 0)k(! >' C) tr() (.) 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Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 6 WHO/APOC, 14 September 2009 , o\ N () -o (.) o. 0.)at (-) o. o > t-- rt) C) E O -:\ 4q) U q t\ a) t U 4 vq) 5 lr CB o >a C) tr C) C) C) olr .r) 0)Hd C) I l-r .oH a C) o(B q-i o o F ".i 10)l -ol(ol t-l o trq) a o.=EF (.) 0) -o () z L(.) -o 0) o z T. c: q oo q 00 E L q) DO L o 5E Q L c)p (.) o z 0)p 0) o z T. c!= H C) -o o o. C) U) Lop 0) 0.q) V) o E i) q) un () U o *oEE Q 0) 0) u0EE a' o. Lo. at CBfr3 9: E=Etr(J >. bDEE C) (.) rC) ii= =9a o EE o U C)p o o 0) -oo o o a0trE cg d z Fl C) L ah z rrl z Fl F F t 2.2. Advocacy At the district level advocacy meetings were carried out before the ivermectin distribution. The participants who were involved in these activities were members from the district assembly the District Health Management Team, partners and the Village Headmen. This was done because the partners in the district have to take part in supporting CDTI activities in one way or the other. The Oncho national office conducted the higher level advocacy while the District team conducted advocacy to the village heads. 2.3. Mobilization, sensitization and health education of at risk communities The community structures were actively involved in the mobilization of at risk communities. At community level the village criers were used to spread the message to the entire community. Meetings at community, health centre and district levels were conducted to disseminate information. On IEC, the communities were mobilized through the IEC materials like Posters, Megaphones etc. Higher treatment coverage was realized due to intensive mobilization and health education at different levels. Mobilization and sensitization can be improved by sensitizing the schools and churches and continuing involving the local leaders and other influential leaders. 8 WHO/APOC, l4 September 2009 2.4. GommuniQl involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) More female members of the community attended the health education meetings. The participation of female members is more than that of males when CDTI issues are being discussed. This may also tell why the number of female CDD's is more than that of male CDD's. No monetary incentives are being provided to the CDD's by the communities as of now. 9 DistricULGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B! Number with community members as supervisors Bs Percentage Be= BJ B. *IOO Male CDDs B: Female CDDs Bt Total Bo= B,tB. Number of communities with female CDDs Brn Percentage Blr= Bro/84*100 NENO 138 0 0Y" 305 401 706 132 95.7 Total 138 0 0"h 305 401 706 132 95.7 WHO/APOC, 14 September 2009 2.5. GapaciQr building Available knowledgeable manpower is adequate at all levels. This include the district team, health centre team and at the community level. There was a replacement where not enough knowledgeable manpower was available and Training enough health workers so that a gap can be filled where ever there is a shortage of staffdue to transfer or any other cause. 10 WHO/APOC, 14 September 2009 *, -!qv 2EilU { (J* $ : \o t'- N 01 \oOt-. $ N 0) 6lL ah (, C) z L $ @ .+ \o o\ i q) o q) a o\ :I +. () lt U o o aL 0) .a o' c! frLh. Lfro: ,ahoc) ,-9 Lc! crtr z O! q) q,) o a -\ U Eit+ .L\q u F- F- F- F- F-r- c,- c- o dL0r l- t!! 92 *r=tr:- zY. q) I QL r-r- t-r- c) 6) c) (.) ^\ q = .? Eil+ @ @ f----. oo € ct ah ar) Fl 3eoo) ;'f, 0) z U € oo j o Fl 3 3 o q) o o\ N C) -o E() o-(.) a $ U L' > bo o q 4q) uq) q l \ q) r- tR q) q) E P (.) c.) p. F O(H U) (.) C) (.)! ,O +i 0.) (! oo Lrt- ..iir o-,l -ol(dl t-l o I s p s o B o { t o\ d s tr o b .r :- * Table 6: Type of training undertaken Qick the boxes where specific training was carried out during the reporting period) Any other comment 2.6. Treatments 2.6.1. Treatment figures The project is achieving 100o/o geographical coverage and a therapeutic coverage above 80%. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(Monito rs) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifo) t2 WHO/APOC, 14 September 2009 o, O ol o -o 0) o. 0) a t Q IJ o > aa oo llL A/ I\ v .ll S T sq) OO \Os' FS U1tr Ud\93d ,rl eFf.i ^'-Ltrs\f \* !u: .= '3" ti5Ba '-E\/t'.* a.:EG:.r$H Ss .9xs HsSo.tsi :ri()Bsi.P=(.)\_ o-oE !aJ5'€ itsEI .S 'FFtr 5 i..!q .! sJO: g s\ X q. EqJ{: \ '={d l\ :t> et g s'iE =I ; : EFxl! E r >,t^El lJ E Ji-He ! SsEl E : *i'()l o_ .: Y\E.* S bSol o S \: e+q i \=tsti i EsLl = = tY9l tr s' sQrl _ a .\vtrl cd d \u =l E E !'sat- - $'s .: s: oa qSS 'A\ '! ,, : qr\ '' E F$ *\ *$i' 5tE ET : s..s\rb x \ ssE E S$ -c : da.9 3 Srrv u $i raSS:Y t\ l\='FrrttSD o ut 1o I\ !r:o\ \ as o o 0) u/ 0) C)LF 0.) 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Some people left their home and lived in temporary shelters at their gardens Some could leave earlier for their businesses and come back late in the evening. a o 2.6.3 What are the reasons for refusals? Religious beliefs 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. o No Parasitologists were trained o Just ordinary microscope are inexistence. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report t4 WHO/APOC, 14 September 2009 n n aa o, ON o -o o a.Oa$ U \-, > ta) a) q) r-q) "s \ uq tF -:\ qq q) uq) 4 > o\ ur. N q) % q) 5 € lr(.) b0 tr o ()k (.) bo tr ol-rlr)oo o aI! a U) C) C) 0)a! c) 03 U) Lro U) +i Ch C)th 63 O #r ol -ol(ut FI () 998E;i - 4t2 L;s3E'.= tr e(B.:ooo 6:+=iEP l!oo o o.9 9C 900 =s/(J O. O q qO+Px q9 ^ 6.= (.)o-q tr qii;()- o as, aJ C) tr c= cB4O(JA = .L.(E -9H9 Er-> v1!- ^9vd ab0 (!iz _ @ijcc 5 q;,NE€ ts .-: (.) < '))s2 o o. U) O trE _YL x(Bo+oEb O Ei-l oacd =0) .NrgE; ag i (.) ooc d.; =bo>5 x 0) U) C) oo * 1a o oo I bs' -'><-Jo O o\ o\ o\ o\ r- o\ o\ * o' o\ Cd) a. Pr ll r .-i r-l tI] o ^bo9 E:;F Oo\ -o o q o, F- o\ \ F- o\ ll * Et ti ti o 'Eo =d0O (€^ a!ro\ ooFoF o\\o @ o\\o 00 o\ n co co ri .o o6 .o6b EZ z?,o o. oor- .{ N o\ c.lvl $ o\ 00 ti :oE 6.u 2 99 F t-) t c\ \o o\ € a.t F- o\ $ N LA -o9L^= iY': o =ro € o- [i# o- -d @ c\l $ N o\ \o o\ c.iN q o oo cd 0) O ll * ri li ti o ^hoL,) !q-F 6.\ <.>+ o o\ o\OO o\ o.bo=tr-S':il; Er, * 6 "\ .-1.-;a - i -*= Oold o\ o\ o o\ Ll aO o'=' 6 o =:Yo 70a -o 00 a.t oo @ t-l Eo d o.= < 9€FIJ oo a.) oo ooaa oo(! =@;5 e 8-Hr+.9 = >;; _S .= r-r i: c'- o b a=?qniF tr U 9! EO o oo co oo co @ F- o\ oo o\ o\ o, o, o\ OON c.l cl N caOO a.l $ a.l N \o O c.l r- N 00 N o\ N N I o\OO a.l () -o o a.oa =U L' r o > \o -an L I .l3 -- -I -clI o u0 6lL() v 9 rA\J3 D -d tB-b I tv ItrtEdtr3Edtr\c) :\JEljse r>ri= :.:0d=cEF R. .q,)L i\)-(.)=a0 o)dtE\Eq..2 ovE!.- ((6)!9u)9LI5d.=A:lq)9l9c)1E'=l ':ElEql .gel -tE5loll :ol -oJlh€luxltrqYl LIOctilL()l ilGltrEl IEEI ;6-el E q)()I .-E:i E :fr:E [;: 9aL!1 5)^:rvLU sd .HL =(gPvAEE;tro!9tc)Ll9HdCE - 6r I .-qaE\otr(.i o\l '; C)l tt) -l -ol :'?'-t vlutFl nr a.l L() -o 0) o.()a$ (-) o \J t-- )I 2.7. Ordering, storage and deliveqy of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH wHo UNICEF Mectizan@ delivered by - (please tick the appropriate answer)E(please specify) wHon UNICEF tr NGDO NGDO trMOH Other Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan tablets are ordered from the Central Medical Stores basing on the eligible population and how many tablets remained from the previous distribution. From the district, ivermectin is delivered to health centres. At the health centres level, there are Health Surveillance Assistants who are the CDD supervisors, they collect Mectizan from the health centres and the CDD's collect Mectizan drug from them. Some of these health surveillance assistants live right away in the communities while others at the health centre. Then the CDD's take the drug to the community Table 10: Mectizan@ Inventory (Please add more rows if necessary) Note that the remaining drugs were taken to non Oncho districts. When the distribution is over, the CDDs 'deliver the remaining Mectizan to the health surveillance assistants who in turn deliver the drug to the health centre. The district collects the tablets from the health centre and store at the district pharmacy. The health care personnel in the project areas cary out the following activities under Mectizan delivery: 1. Mobilization of communities 2. Collection of drugs 3. Reporting the drug usage 4. Supervision of Mectizan distribution 5. Census update State /District /LGA Number of Mectizant tablets In stock frorn previous year Requested Received Used Lost Wasted Expired Remaining NENO 13.50.1 380,000 380,000 363,067 0 280 0 16,653 TOTAL Ii,50,1 380,000 380,000 363,067 0 280 0 16,653 18 WHO/APOC, 14 September 2009 l. 2.8. GommuniQr self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? YES The training took place in August 2010 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. The community self-monitoring and the stake holders meeting proved a success in such a way that the therapeutic coverage was above 80% because the communities themselves took part in the MDA process and were fully mobilised as a result people did not refuse treatment. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. National level +district level dhealth centrer-) community 2.9.2. What were the main issues identified during supervision? Inadequate supervision at district and community level Inaccurate recording by the health centre staff Some Mectizan stock were not updated by the CDD's 2.9.3. Was a superuision checklist used? YES 2.9,4. What were the outcomes at each level of CDTI implementation supervision? It improved the implementation hence better results Was feedback given to the person or groups supervised? Yes after the supervision was done District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSND No of Communities that conducted stakeholders meeting (SHI\it) NENO 138 5 !38 TOTAL 138 5 138 2.9.5. t9 WHO/APOC, 14 September 2009 t2.9.6 SEGTI I.l 3: Support to GDTI 3.{. Eq,prnent Table l2: S :trr' rrl'cqrliny11snl Please add more rows if necessary) I Iurv u'rrs the feedback used to improve the overall performance of the 1l ro.jcct? J'lrroueh the feedback the members were encouraged and the problems itlcrrtillcd u'ere solved in the course of MDA and the outcome was superb Type of equipment l. Vehicle 2. Motor c1 ,e (s) 2 Source b ---i \l,oc No 0 omCJ 4. c rs) 5. Photoco 'r'' \ -t- 6. Fax Macl rnt 7. Others Bi S c +-t .'r.1rr -rnent (F:Functional, CNFR:currently non-functional but repairable, 'lrncl 1o maintain and replace existing equipment and other materials? rcl rcplaces the equipments and other materials using government -' tlr.-l.rict level comes as part of Other Recurrent Transaction (ORT) l tl rl il'lcrc-nt areas. *Condition WO:Writtr How does ' I The projec funds. Thc and are usc lll MOH DISTRICT/ LGA NGDO Others Condrtron No Condrtron No Condrtron No Condrtron No Condrtron 0 0 0 5 F 6 F 0 0 1F 1wo 0 0 7 F 4 F 0 0 0 0 0 0 6 F 6 F 0 0 0 5 F 4 F 0 0 0 I F I F 0 0 0 0 0 0 0 0 0 0 0 F 8 F 20 WHO/APOC, l4 September 2009 .' t'rll 3.2. Financial contributions of the partners and communities Fill tables l3a, 13b and 13c If there are problems with release of counterpart funds, how were they addressed? The DHO took full responsibility of the CDTI activities by funding the planning meetings and the entire MDA process activities through ORT. Additional comments 2t WHO/APOC, 14 September 2009 o\ N C)& c) o. 0)a * O o E o > U I'r rE t* orrlroo F-N;O-eN^oEO\tc,(o\i<: F- oooooo ociciN@Oocoo) olodcoo(o(Y)r$ oooo ociooovo@od@@N(\l ooqq ooooolo- lo- Nt*(o (t oo88v@c.i(o(otr)rr) oo @- GII.- oo6-(\I t- oo(, ,dolo- {l ot o ooooo ooo oooo ooo ooo o o o oo f,!, E 6(J ooooo ooo oooo ooo ooo o o o i:8 e8 -2 ooooo ooo oooo ooo ooo o o o b rot ,ttu? o 5 s. il,lu Fo $o c!(}2 ooooo ooo oooo ooo ooo o o o s tto E I}o? lr) l- ctNCO(v) @rfNN o oooooooor r F oo oo oooo o o oooooooo- o- <riONN@o(oo ooooo- o_ ooloo -O oooooooooolora) o@toJ(rroN@ -rt oo ooo lo o) ooo o o oo o- NN ooooo_ o- ON@o(o oooooo ooroo rO ooooooooooloto o(o1r)JCD (, f- (O -r$ oo o-(,(n ooo ,r, o) oo o_ @t CON o o o ooooo ooo oooo ooo ooo o o g o&Etb _ogF ;oEE s.E;o{l u@rErrc oEtG{'s*9lERIEEltEl =t ooooo ooo oooo ooo ooo o o o o E{ UJ .!Etrg(!(} 5.gl. lr: L] gl ol(r] l-l z1 ur1 E1 21 E1 lUl >l tr)lr)OlorONl-ON(\lN$o)!.- oNoc.tdO, l-@NFt ooo o(f)G)N- lo- N- @$NNNlf!ros(D oooooooooorora o@toi(r) l,li) I\ @ r\t oooooo lr) l(,o) o) ooooooooo cooodt@Nco- og @ S(ort oo$- o N ooq @ (\t ro rO(,) d(o\t* rUn luoo E o s o G .N lrt o to\o GOcoo >ER. c F I:c, a.Y l EE E 8 T EEs ='t: X ={E € s ; E E f I : : : : f On 0)O .YE :.E = .:i _G o=lu3i $ Ee.=33 E\ .c_cogg E o(DdLLEE .9 o'.E = ='31EII$B6i e.i F -:l =q=l 5-= '6 .c .9ReE= +E E E -c.i <.idc'i c.i <"i ri Itrlo 6lB sE3s:SG : -Ebc b Iis E 2 'Lo E bEg € E :U E E "qE E $ > t$E s $\o r N aIb r $ d t4 o Ut tro a-x'oE* .coE(EEAE Jro c 0.) E o.] rldi rrJ Iql ."l G o Ia an l.s,L o =C o E I 0)o >J trl ,l EI EIol ol s G o aaIt4 J oF oz t(9 N oI C) C)L (h d o ! € cd U') -o ! o (B c) Cd t ?t) {) F o\ c.l !() -o Eo o CN$ U o co c.l oQooeogHF E3g(r)t ootsq q:oo H 8-' 3.iF.-t!V'N oooooodoci oo600 ooo (Dt rod(\t. o o o oo o o ooo o ooo oooo oo ooo o ooo oooo oo ooo o c o Eq, o lt ,9t e o trt(! CLt u.l ! o ooo oooo oo ooo aq('?@(o(v)(o ro,@ (f)6io) c)(t o oo ooo o tl FOi?' or Ni Ni -, (Ol t-i -,-t-lFFtNr(o vioi(.) Nl@l oo o- oNo I oo'o, oiNi -i o o o ooo (\ti\o - @(f) oiNI(oi -I 5iN] o oo o- oN olo,ol -lOrNirl O ooo log) oiolo, lr) O), o EESi SS.S oo o o oio,o ooo ooo ooo oooo ooo ooo o o toE olt d, UJ (gt,cI(l, o o o .9 oL CL o tr o c o 5tt L c oo Fz ut =zE uJ o(:, oooo(o('N_ lr)- N-@vAlNNIO()itO) oooooooooo|r)lo o@rrlJ(?)lr)t-(o (o ooooo-oo-(ol() oo) ooooooooo cooodv@61(r)N(l' c.i,c"l d oo uio O){(v) <. t- o (! stlt 6 o o j o ln tl ol al:t 1l o'o, rOjol lo,c c r'6 o c,)CED= '= rE FT .N g, 0)f< o) -c =(E o)I o o)tc, .E (Ir' OJ oI c' ,Ei 6, F, ^iiNi (! o a q olcco o,o .=' f oS >r [J C.r' <.1 (fr I r"j G o a q fa; c"j ootrEdeP6soGlD EO!iC6Go Et E H '39 _tsr 9i 'Lo.:'E{fl: ori E [ =E; E 3: Eg g S ErrNiQIi sr o'd v,, ot4 oax-oc _-oE [J E.\ - ^ J .9(o=:Eor ur +,Err€ <TNI Q s -,u, d -J F oF oz t(9 og)oo(J 6 -iI- o co o E .o ^i coNsr' o) g: o-o:<; cs c ooooo tr ooooo ooooo oooo rl ct oooo ? L cJ ((( Z' $lr, otroc.i .lt) NOF O) CO oNO t- OF O) 'o (t O o o) o O) '= o =o o (! o o o a = E coooo (.)() L chd o € (h Lo (h L o o (! ?a q) GF a'r)(JN c- co :-. f.- c E rNxo r3o):a35- urrfoi: N(esd (h 3 ! -1 4 )r -(. i!-. r C' s a o, o o o a a N o -o C) o. 0) U)$ (J o (J sN C) oo 0) C)! U)(d O l-{ a -otr oo o fr. C,)(') q) F HgE .dF u* frB g coEO EE(, EE, tt E of *o#tt!G f,It a. utEFo tI(, z, Bf Eo 2 &o E ! rl,EEttt ocl- .E ogE 3EE6tt Es{!AE .trl[6lDEE sEE9Eii = o :E E4llt IE E e o{f., o ol)* l trg $: o;9ll*l 21 uJl t*1 z1 u1tui >l olol 1'o o{htt3E tu - F uroAtt m. o I(E N 'E o u, to GOE9e Es E E E .iiE E E TE ST E fr € E i sE : i : : r{q u, 6r oo .v. 't :(!i* AiE U ,-iP d .=33 E\cc6EE EEE iE, E) .9 o''E.= ='3F'.=.=\a :EES$$ t:ro!a'rt .N6rsi =q= oorc '6 .c .oREE= +E E E -c.ic.jdcrj c.j c.j IU' HgsoGg,s:! _u6s b e S0, ) t^ EB E" E '!X o .9. z :$ E H HE E H,> E$g E $\(,' F N AIt + o ,; to o .4 soa x!OCEEE\\ '- A 'S * TE >roro,; J Fo oz tr o o\O N r 0) .o O o.oa$ O o o. U tr)N 0) lrd th (.) z (d tr- o c.l C) fr C') o (€ N (! a C) a(! cn(h C)o olra oo (d o (.) o ch o ti oLr G)s o 8; oP (^jq .s? o -!gP,?; a 'r= -d !Y a-l l<lvqYE .=o drh6(! 'E ,n -cB3at .EA '- !- o2ooo Etr oX ; (.) a l3.3. Other forms of communiQr support Identification of suitable CDD's Collection of drugs Distribution of drugs Community awareness Mobilization of communities 3.4. Expenditure per activityr Indicate in table 13, 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 Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaruation Year 1 Participatory Independent monitoring Mid Term Sustainabili ty Evaluation 5 year Sustainability Evaluation ,/ _Intemal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? T Was a sustainability plan written? NA 26 NA WHO/APOC, l4 September 2009 When was the sustainability plan submitted? _2009-2010_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms ofl 4.2.1. Planning at all relevant levels The planning at all levels that is at community, health center and district levels is integrated including Onchocerciasis control program 4.2.2. Funds The district health office funds onchocerciasis control program activities using district ORT funds. These activities are integrated into district implementation plan (DIP) 4.2.3 Transport (replacement and maintenance) All transport expenses including replacement and repair is covered by the District Health Office ORT funds as per program and plan 4.2.3. Other resources Through the same ORT as indicated in the DIP 4.2.5. To what extent has the plan been implemented It is being implemented now 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms Mectizan is taken as any other drug, when the DHO is dispatching other drugs to the health centres; Mectizan is included in the transportation. 4.3,2. Training There is an integration of trainings with other program activities wherever possible, for example,the 12 weeks HSA training. 4.3.3. Joint supervision and monitoring with other programs An integrated checklist is used during supervision 4.3.4. Release of funds for project activities Since onchocerciasis control is one of the programs in the DIP, during monthly allocation this program is considered as any other program in the DIP. Is CDTI included in the PHC budget? Yes 4.3.5 27 WHO/APOC, 14 September 2009 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The Lymphatic filariasis Elimination, Malaria and the primary eye care program under sight savers international are programs that are using the CDTI structure. This was achieved through integration at all levels that is central, district and community levels. The LF program has produced results which are as good as Onchocerciasis control program results since eligibility of taking the drug is the same. The following interventions co-implemented, the MDA, ITN distribution, identification of cases with eye problems and distribution of Albendazole. This was possible because the intervention were conducted in the same community; the planning meetings were done together, the reporting and evaluation processes were also done together. 4.3.7. Describe others issues considered in the integration of GDTI. Use of transport is not limited to one program; Onchocerciasis Control program can use any vehicle or motor cycle from other program and vice versa. 28 WHO/APOC, 14 September 2009 o\ N o -o () o.()a $ O o o\ a'l c) q) o oo 0)a o z F oo o\ ooo\ r-- oo$ ca s .t a.l rr) N ca) q) q) tr o\+\ .+ \a) o\+\ =f,\n t-- N \o o(,) =a N cn c* t--$ N cnc{ tr-+ € ao \o q \o N q) o u0 GI q O q) o () z F \o o\ N c.l \o o\ NN \.) ra) co \o + N \o tr) N ca O 0,) (E qlfr \o oo oo\o NN N \o 0 C) G e Ot + ra) o\ $lr) ca o\ c.) \o $ \o 6l q .0) o> z F r- \o f-- \o r-- \o F- q q) c) ,* lr) .+ tr) + tr) tr) + lr) +0 0) GI 2 ca cn c.) ca :.8 -otEE za o clo oo ca 00 ca F- oo c.t @ cn q) 0) bD CEt- oo co @ ca I-* oo ca oo ca 0, .=!L 8.2 =,8z 6) 6l c)il ql o a0 - =.str\ >,R -ot o€ c!.= Es" a cn O!otr i63 U- .HPLHEE "b'e.9L{ () C ,;r r:j +.tE-E.E E N N P =o)P=.-'-'i ^n.l E Q E.= = ri'c,.ll I c U)s O5t +f H f E 0' rt) cn o.ooc i(! u-!HfLHE E " h,.e.9 *<()C.-r:jp-^ .E€.9 E S S H -0.)e!.-i':'- .n.I E a E.= = EfEs3i22?LJ^i:-v*o H 5.U 5 ts E I i o'Ea ELA= lv v)9 -rvUk .= 9 >.o o -J-.-!H!E5SSH(V::!r.i.- !!!-- An'! L tr .: H =i-.,! C U) -O OiFtitroo.A.E 3 g E 9 i oEa E!A= €Yru '=(s trtr .= 9 Xo O - I -.H'-!EESNH " -c i'.= ='F3,I E E € e o-H 3I E I o Cd(.) >)5r C)= -qtr(dtr oo -Co tr .! x9 >.LLi 0) CCEOO= olc-OI-'- OLa>E a oco €5fo -oc'= 0)E_o ooo a bC= €brf -oo' 'E 'NEO ooo a o -NxoEofcpq LL,Eo oot0) a C .9+ az- +J oo a oo F.! -ar OF(, ch v) olr C)9-H9 \ro () 2a su)o.(s H! =(d V)(! E o ch o ct) c)Aa ?i FO oL o (d ! (B z L +) Cg+. -L c) )iIq) x IL I U t Fl o - G Fl o, N H 0) -o 0) o.(.)a $ (-) o c.) \o|r) .rI + $ + C.I o\ NN \o o\ NN \o o\ c.iN \o o\ c.iN \o oo \o @\o \o od\o \o oo\o o\ $ta) o\ trn o\ .+ ta) o\ $tat \o o\ c.iN \o .t \o N \o o\ NN \o o\ NN \o O, NN \o O. NN \o €\o \o oo\o \o oo\o \o oo\o \o oo\o o\ $ta) O, $(a) o\ \t\.) o\ $ta) o\ $ rr) \o r- \o t-- \o t-r \o I-r \o t-- \o r- (r) + ta) $ ra) $ tr) =t \n $ ta) $ cn ca co cn c-) a.) oo ca oo co oo ca oo ca € cn oo aa oo ca oo co oo ca @ co oo ca oo cn (d -ioo HHooNNtr U).o 0troo-gEs €! -tu 0)tAl ^ >,o ob0 c'.E 'E 'EE.i Ccdcg .E.: J N N E cs H.==X u H ia-OrlU-^&E 8 g E c/) a OEOC6! lu U- .-P!HHG ^i.e.9L< () C .: ji -.1 ^^ .E +.9 E N S E"; 0J H =.F'i'--;r=c---EP'Es I E'aE o -!vJLd^^!J^!:-V*o H =ts 3 g E g -) Li EruddX ho o - P.r.dU'EEElO a -'l .!l .)l .5EH.!=E E E E€ A:EEBE9 JE .=dEtu x >.6 0EEEEg € EET.E E E E€ AEUgE9 rv(.) |:Fir (u ci .E --. b.9.9 u/U.H9PL^ >.v E ii N n9E E:E=Etr Y c u2S Oo! x tr o a.iEUSgE9 € U(€c C)d a t-i .= ^>rO urLri! >.9 E ii()td tr'.= tAar^ ^ J L F;'o o 6 +i()O(, o.g EOOrrotsooc F60 ItC a +C <C) -C -L_ '= (Dt= co xo >da a o)c Ec q) o U a o) .go C oo o U a F oo a F oo a otr o Lr(d z t< z o o !t- a, o *<6(t O a mF o\O N ro -o () o.() a$ UU o. L.) I cn q q) >{q) > q a)I\ q) v q) q) .Ei q ! q) t\q) q) a e a i o 'E oi,Ntr -ooOQrE9 a a a a o, N (.) -oF o o.()a = o o > N ca oq) I(r o 0) L q) o lt a c)q) o a) O cg6 E \ \ \ 60 oI \ \ \ E! oa --a5e ts(a CE q) {,) Q o o o \ \ Lo \ \ \ 3nP -F =.e o<) ?* Z a -E " =.eIt =o 5Eo90) aE \ \ \ bo '=z Ea C) (.)g0o0.=sb >E ., bo oo.=(g! -o =o>E tr=9)X ^EL.,) bo (€ a)loho.=(E{f -0) =()>E o q) --og,b ooou(r-o E O) Er()Qr )O0)Or cr-o q ai I>,()(nC z.a o 0) oe6CE-N >cc.o <>,3bE.9 ocd(grN >ctrs <>,5e.E.9 oc(!Cq-No= ^-E>ctr€ < >,8e.E.9 I (giN 6c E =>cc.o < >.ubE.9 0) o o i- CC =ooFolc-oI-'- OLn>E a oo CO EUf.i3 -Oc'E c);_oi-E a bo C= €bll _ocr .E .F Egoo a *Ooa rN E€lcc}o '= _oi; c.ri5E o o C o =l -oi-z a=i-i a o + C o E o o)ooC--ho II a q) >tF a a oLoc-2? l-, o a ad trd C) (! J o(,(€ oa o ch oa Fo oL oo (n L o oo ! 2 a) s sq \) *q U C) O Ch O o0 a a(.) CN bo q (.) i';Ft q) - cg3 o. N () -o o a.oa$ (-) o r o ca aa q q) a" H\) l .q) q \)\. q) .a q) ! a) 4 q ! T\ 1) q) FA \ \ \ \ \ \ \ \ \ \ \ \ \ \ 9ocGCE-N x- tr J >cE-o <>,5bE.9 - E CtrE Q .=-!N-NFr=.-='- -dL!ru- -:YL.: a=i>*^9^E E ; 3.9 9.; E.; - E CtrE Q .:-rN-N1 i) = .- =.-4 - Lu.! 8E;E+U€EE o .E o o E C o =o+ C <P -l- '= (D Cnox >d a O) .go CiE c) o O a o) .co C E 0) o U a a a a a a a o a o o F a o L(€ Q o 0.) rD aL C) \J I tt a t t) , 4.4. Operational research No operational research was done. SEGTION 5: Strengths, weaknesses, challenges, and opportunities The inclusion of CDTI activities in the District Implementation Plan (DIP) is the most cherished strength. These planned program activities are for the entire year. The dropping out of CDD's is the problem we are facing but they are very few and not to a significant figure and where there are drop outs there is a replacement. The most notable challenge was that the drugs to be used for integration came in late that's Albendazole, since we are integrating onchocerciasis control program and lymphatic filariasis, we were waiting until all the drugs were available for mass administration. This problem was addressed by mobilizing the Health surveillance assistance to supervise the CDD's more closely in order to speed up the distribution and it really worked. The opportunities that we have are the ORT funding from the District, the district is able to fund some activities and meet any cost for transport, repair and maintenance of capital equipments, stationery etc. The presence of health Surveillance assistants and NGDO partners in the district is another opportunity. SEGTION 6: Unique features of the proiecUother matters The most notable unique feature is the presence of health Surveillance assistants. These health workers are the CDD supervisors and are based in the community. They work under Ministry of Health and are employed by the government. They conduct various health related activities in the community. They are really very important figures in the health delivery system. They support the CDD's technically and advice wherever possible. They also train and brief the CDD's. 34 WHO/APOC, I 4 September 2009