,!'r,ri_ _?il I ll?'3 THE UNITED REPUBLIC OF TANZANIA (including e-mail address ) COUNTRY/NOTF : TANZANIA Proiect Nanqe: MOROGORO CDTI Approval year: 2002 Launching Year: 2003 Reportine Period: From: JANUARY 2012 To: DECEMBER 2012 Month/Year APOCfundinsvear: (circleone) I 2 3 4 567(8) 9 10 1l 12 13 circle one 123 4 567 910111213 Date submitted Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - GlaxoSmithKline(GSK) - Morogoro District (MDC) and Mvomero District Councils(MvDC) - Sightsavers - 1059 Communities ORIGINAL : Enslish WHO/APOC, 14 September 2009I 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 ONCHOCERCTASIS CONTROL (APOC) ll 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: TANZANIA National Coordinator Name: Dr. Upendo Mwingira Signature Date Zonal Oncho Coordinator Name: : Dr. Godfrey J.B Mtey Signature Date NGDO Representative Name: Mr. Gosbert Katunzi Signature: Date This report has been prepared by Name : Dr. Deborah Kabudi Designation : Project Coordinator Signature Date lll WHO/APOC, 14 September 2009 Table of contents ACRONYMS VI DEFINITIONS vIII FOLLOW UP ON TCC RECOMMENDATIONS I EXECUTIVE SUMMARY 3 1. GeNpRer- rNFoRMATroN..................... I . I .1 Description of the project (briefly) 1.1.2. Partnership 2. Popu1arroN............... SECTION 2: IMPLEMENTATION OF CDTI....... .......8 2.1. Trrraer-mp oF ACTIVITIES 2.2. Aovocacv 8 .. 10 2.3. MoerI-rzeuoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMt-rNtues 11 2.4 CouuuNrrY INVoLVEMENT ...12 2.5 Cepactrv BUTLDING 13 2.6 TRparupNTS............... .... 15 2.6.1. Treatmentfigures .......... .......Erreur ! Signet non ddJinl 2.6.2 Wat are the causes of absenteeism? .......... ..................... 17 2.6.3 Wat are the reasonsfor refusals?................ ................... 17 2.6.4 Briefly describe all lcnown andverified serious adverse events (SAEs) that....... l7 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curuent year l9 2.1. Onpennqc, sroRAGE AND DELIVERY oF IVERMECTIN .......20 2.8. Covlau.ltry sELF-MoNIToRING aNo SrareHoLDERS MeprlNc 2t 2.9. SupeRvrsroN.. ........21 4 4 6 7 2.9.1. 2.9.2. ddJini. 2.9.3. 2.9.4. 2.9.5. ddJini. 2.9.6. SECTION 3: Provide a/low chart of supervision hierarchy. ............21 What were the main issues identified during supervision? . Eneur ! Signet non Was a supervision checklist used? ......... Erueur ! Signet non difini. Wat were the outcomes at each level of CDTI implementqtion supervision? Erreur ! Signet non ddJini. Was feedback given to the person or groups supervised?... Erreur ! Signet non How was the feedback used to improve the overall performance of the proiect? Erreur ! Signet non ddftni. suPPoRT TO CDTI ..............23 3.1. EqureveNr ..............23 ..,.,.,.......24 ..............28 ..............28 3.2. FmaNcw- coNTRIBUTIoNS oF THE PARTNERS AND coMMUNITIES.... 3.3. OrHeR FoRMS oF coMMUNITy suppoRT... 3.4. ExpeNprruRE PER ACTIVITY ... SECTION 4: SUSTAINABILITY OF CDTI....... ..........28 4.1. INreRu,l,r-; TNDEeENDENT rARTICIPAToRY MoNIToRINc; Ever-uarloN.......... ..........28 4. 1 .1 Has the project ever been evaluated/monitored? (fick any of the following which are applicable) ........... ............ 28 4.1.2. Wat were the recommendations? ............. 28 lv WHO/APOC, 14 September 2009 4.1. 4.2. Yn 3) 4.2 4.2 4.2 4.2 4.2 4.3. 3. How have they been implemented? ............. SusrerNeetl-lTy oF PRoJECTS: PLAN AND sET TARGETS (MANDAToRY AT 1. Planning at all relevant levels.. 2. Funds....... 3 Transport (replacement and maintenance) 4. Other resources 5. To what extent has the plon been implemented................ INrpcRertoN .......28 .......28 .......28 ....... 29 ....... 29 ....... 29 ....... 29 ....... 29 .......29 4.3.1. Ivermectin delivery mechanism.s............... .......-..........- 29 4.3.2. Training.... .......-.-.-..29 4.3.3. Joint supervision and monitoringwith other programs........... ....-. 30 4.3.4. Releose offunds for project activities ..-.--.- 30 1.3.5. Is CDTI included in the PHC budget? .............. ........-.- 30 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .........-.-..-..... 30 4.3.7. Describe others issues considered in the integration of CDTI. ..... 30 4.4. OppnerroNAl RESEARCH ...-.34 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. -.-..... 34 4.4.2. How were the results applied in the project?.... .-........- 34 SECTION 5: STRENGTHS, WEAKNESSES' CHALLENGES' AND oppoRTUNrrrES.... ................... 34 SECTION 6: UNTQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 v WHO/APOC, 14 September 2009 Acronyms APOC ATO ATrO CBO CCHP CDD CDDs CDTI CHMT CSM DNTDco DOT FLHF FLHW IANET LF LGA LLNs M&E MDP MOH MSD NGDO NGO NNTDco NOTF NTDs PHC REMO RHMT RNTDco SAE SHM African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Comprehensive Council Health Plan Community-Directed Distributor Community Drug Distributer Community-Directed Treatment with Ivermectin Council Health Managemnt Team Community Self-Monitoring District Neglected Tropical Disease Coordinator Distrct Oncho Team Front Line Health Facility Front Line Health Workers Integrated approach to NTD Elimination inTanzania Limphatic filariasis Local Government Area Longlasting Insectisides Treated Nets Monitoring and Evaluation Mectizan Donation Programme Ministry of Health Medical Stores Department Non-Govemmental Development Organization Non- Governmental Or gan izatron National Neglected Tropical Disease Coordinator National Onchocerciasis Task Force NTD Neglected Tropical Diseases Primary health care Rapid Epidemiological Mapping of Onchocerciasis Regional Health Management Team Regional Neglected Tropical Disease Coordinator Severe adverse event Stakeholders meeting v1 WHO/APOC, 14 September 2009 STH TCC TOT TV UNICEF US AID UTG wHo Soil Transmited Healmith Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Television United Nations Children's Fund United States Agency for International Development Ultimate Treatment Goal World Health Organization vlt 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). (i i) Eligible population: calculated as 84Yo 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 CDTI. (viii) Sustainabilit),: 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 govemment. (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. vl11 WHO/APOC, 14 September 2009 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 35rd 1 Number of Recommendatio n in the Repon TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 368 Recommendations on the report Up-date the list of acronyms Action taken the list of acronyms in this report are updated Ensure consistency of numbers andJigures presented in the background section of the report and the presentation of information should be in prose rather than bullet points Much attention have been put in this report to make sure that numbers and figures are in prose. Recalculate the UTG (the current Jigure is wrong) ; UTG calculation are normally done by using a formula provided by APOC management In this report the recalculation. Provide an explanation on the increase in the number of villages from 893 in 2010 to 1,059 in 2011 (an increase of 166 villages); The increases are due to split of large Ward and villages. When the village is being splited in two or three automatically the number of community (sub-village) increases too Although it is plausible that the advocacy strutegies and outcomes could be the same for Morogoro and Tanga, it lb suspicious that it is the same table, stated in the same way (cut and paste); The project normally sent the report after writing it to the National office for corrections and review. May be that error occurs there. The project regret on this issue. Complete Table 10 on drugs The table was updated for this reporting period show clearly drug received, used and remain one. Complete Table 13a on financing Table 13a is completed in this report Recommendations on the project Increase the proportion of communities undertaking CSM and SHM, the current levels are quite low - 27.7% ond 24.4?6, respectively; The project is in its plan to encourage community member to hold this meeting every distribution cycle. Moreover the WHO/APOC, 14 September 2009 project has get assistance from Sightsavers through IANET project to facilitate the conduction ofthese meeting. Share the results of the study conducted in collaboration with Cincinnati University & SSI on the role of CDDs in CDTI and indicate how these have i nfor me d i mp I e me n t at i o n. The result of the study was share in the Annual review meeting and there is plan to circulate to other partners APOC Management Transport is a key challenge because the only vehicle and the 4 moto r b ike s are n o nfu nctio nal. lYhen should the equipment be replaced? We anticipate that APOC management will provide new capital equipment to the project Has sustainability evaluotion been undertaken? The project was evaluated on the progress of NTD by a team form WHO/APOC. We are waiting for the reort. (Please add more rows if necessary) 2 WHO/APOC, 14 September 2009 Executive Summary Morogoro Rural CDTI i,roject is in the eighth (8th) year of CDTI implementation and the fifth (5th) year for the implementation of integrated NTDs activities in Oncho and non Oncho endemic areas. The project covers two districts out of six districts in Morogoro region namely Mvomero and Morogoro District councils. The two districts are decentralized with separate government funding for CDTI, using its own Comprehensive Council Health Plan (CCHP) and support of APOC fund. However, CDTI strategy has been introduced in None Oncho endemic areas for the implementation of integrated NTDs control activities. In the year being reported, the project focused mainly on the following components:- training, monitoring, sensitization, mobilization, Community Self Monitoring (CSM) and Stakeholders meeting (SHM). The project trained and retrained 2533 CDDs, 133 FLHWs, 57 CHMT members and 7 ToTs. Sensitization and mobilization meetings were conducted in the entire project area with more attention paid to places where there is new leadership. The projects do follow the APOC guideline on conducting CSM and SHM activities. Moreover, we do use the existing governmental Sub village monthly meetings for SHM. These meetings do help the communities to plan how they will make follow up treatments, data collection and feedbacks after the Mass Drug Administration activities. Onchocerciasis is found in 1059 communities which are Hyper and Meso endemic and the total population is 372,727. Drug administration extended from October to December whereby total of 296,435 people were treated using Mectizan and Albendazole drugs whereby the Therapeutic coverage was 79.5%. The geographical coverage was 99%o whereby UTG is 313,091 and ATO is 305,637. The CDD per population ratio ranged between 1:100 and 1: r20. The Project received a total of 1,379,000 Mectizan tablets for treatment of Onchocerciasis and Lymphatic Filariasis in oncho and non oncho endemic areas. The tablets used to treat people in Oncho endemic areas were 649,682 remain tablets 729,318 were collected sent to other area for treating Lymphatic Filariasis. The project has used 1,267,798 Mectizan tablets for treating both Oncho and LF, remain lll,202 tablets are stored in the District pharmacy. Challenges and how they were overcome: . Delay of report submission at all levels each 5th date of next month the report should be submitted. o Delay for disbursement of funds to the project o Other programmers who comes with different approach by providing payment to Village Health Workers and CDDs to implement their activities. F District planning to increase incentives to the CDDs o Submitting implementation reports in different format as required by partners ( APOC, Sightsavers and NTD). This increases the workload to project coordinators and other staff. > APOC and NTD office should provide one reporting format. o Worn-out of capital equipment and office equipment. > APOC should supply capital equipment as the project has evaluated after five years of implementation. o Increasing community demand for hydrocelectomy services since integration started J WHO/APOC, 14 September 2009 SECTION 1: Background information 1.1. General information 1.1.1 Geographical Location Morogoro Rural and Mvomero districts where CDTI activities are being implemented are found in Morogoro Region which is one of the 21 regions in Tanzania Mainland. It is an inland area lying towards the East and Southern boarder of Tanzania Mainland. The region lies between latitudes 5o 58" and l0o 0" South of the Equator and between longitudes 35o 25" and 38o 30" east of Greenwich. It has a total area of 73,039 sq km which is 8.2Yo of Tanzaria. According to the 2002 population and human settlement census, the region had an estimated population of about 1,759,805 people with a growth rate of 2.6oh arurually. The two districts lie between latitude 8o and 10o south of Equator and between longitude 37o and 38o East of Greenwich. The region is inhabited by Luguru, Kaguru, Kwere and Masai tribes. These communities consist of indigenous and nomadic population; the mountainous areas being much more densely populated than the low land. The young people keep on migrating to look for employment in towns and to areas or neighboring regions where there are newly discovered mines. The main occupation of the community is farming of foods and cash crops, cattle herding, small scale fishing and timbering. Several rivers and tributaries originating from the mountains cut across Morogoro region. Major rivers include Kilombero, Ruaha, Luwengu, Ruvu, Wami, Ngerengere, Mkondoa and Mkindo. There are about 143 rivers, which form very large plains in the lowlands consisting of fertile alluvial soils. Due to the climatic influence of the Indian Ocean, the Eastern Arch Mountans have unique plant and animal life. Although environmental degradation has affected the area for many years, there are still different species of fauna and flora. This is particularly true in the case of the Udzungwa and Uluguru Mountains. Topography The two districts are divided into three geographical zones which are (i) Mountainous or Highland Zone (25%o) This zone covers the Uluguru Mountains located at an altitude of 1200 - 2000 m, above sea level with the clay type of soils. The zone is suitable for the production of maize, beans and horticultural particularly Mediterranean types of fruits. (ii) Semi- Mountainous/Low Land Zone (20%) This zone covers most of the Southern part of MorogoroAvlvomero districts, at an altitude of 800 - 1200 m above sea level with sandy clay loam type of soils. The zone is suitable for the production of maize, cassava and sorghum as staple food crops. (iii) SavannahZone (55%) This zone is located at the altitude of 600 - 800 meters above sea level; with same clay loamy type of soils. The zone is suitable for paddy, maize and cassava, for both food and cash crops; and also suitable for sugarcane, cotton and sisal as cash crops. Part of South East of the zone falls under Selous National Park, funher the district has big valleys and numerous fast running rivers such as Mgeta, Ruvu and Wami- Luhindo. 4 WHO/APOC, 14 September 2009 Climate The region enjoys two rain seasons - the short rains, which normally starts in October and ends in January and the long rains which commence in Mid-February and end in May. The annual rainfall ranges between 600 mm in the Savannah areas up to 1600 mm in the mountainous areas. . The temperature ranges between 20oc up to 28oc. Population According to the 2012 national population census, Morogoro Rural district has a population of 329,497 with an average household size of 4.7 where as Mvomero district has a total population of 314,185 with an average household size of 4.5. Major tribes are Luguru, Kutu, Zigua and Kwere; minor ones are Kaguru, Sukuma and Masai. Their main activities are Subsistence farming, Business and Livestock keeping Cultures Main cultures are Traditional ngomas, (dances), Use of traditional medicine and Conduction of church sessions over the hills. Languages Main languages include Kiswahili as a National Language and Local languages ie. Luguru, Kwere, Kikutu and Masai. Communication The total road network in the district is 1168 km. The roads are divided into the following categories National truck roads-188 km (tarmac), Regional roads-343 km, District roads - 295 km and Village feeder roads 342 krfl. Most of the road network is passable during the dry season, but some feeder-roads to the villages are impassable during the rainy season. Administrative Structure Administratively the two districts are divided into 10 (ten) divisions, 52 wards and 260 registered villages. They also constitute 3 parliamentary electoral constituencies. Health System The Morogoro Focus CDTI Project area is constituted by 3 hospitals. One owned by the Government, one (1) by Parastatal organization and the 1 (one) by Voluntary Agency. There are eleven (l l) Rural Health Centers; nine (9) being Government owned and one (1) belonging to Parastatal organization, (1) by Voluntary Agency.And 115 dispensaries of which 83 are owned by the Government, 16 by Religious agency, 13 by Parastatal organizations and Three (3) bV individual/private organizations. 5 WHO/APOC, 14 September 2009 Table 1: Number of health staff involved in CDTI (Please add more rows dnecessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage BFBzlBr *100 MVOMERO 195 134 68.7 MOROGORO RURAL 196 t42 72.4 Total 391 279 7t 1.1.2. Partnership Ministry of Health and Social Welfare: Provides strategies and guidelines in approaching any planned activity. The Ministry also provides financial and technical support through supervision and internal monitoring during implementation of program activities. Sightsavers: Sightsavers is supporting the program in financial and technical, through new project called IANET. Funds provided are earmarked for conducting advocacy, community sensitization and training of FLHW on Community Self Monitoring and Stakeholders meetings. Also they provide support on capacity building and project monitoring. District Councils: Both Morogoro and Mvomero district councils are providing human resources and technical support to the project. The districts provide support by conducting supervision and monitoring. Moreover, project activities are being integrated into district plans to ensure sustainability. Community: The communities in the project areas are the critical supporters of the project implementation. They are supporting in providing human resources such as CDDs, collection of drugs from FLHF, support supervision to CDDs and self M&E. 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There are trained FLHFs most of them have CDTI philosophy knowledge, CDDs have been in the project since inception of the project in2004. A well experienced Regional coordinator and 2 District coordinators are adequate to carry out CDTI and NTD activities. The project gets support from RHMTs and CHMTs at regional and District levels respectively to ensure proper implementation CDTI and integrated NTDs activities are executed in good manner. The project has also conducted training to primary school health teachers and community development officers residing or working within the project area on how to implement NTDs activities using CDTI philosophy. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. Normally training is done to the in charge of FLHF on how to carry CDTI activities. He/she trains hislher colleagues and delegate power to them so that, in case of transfer CDTI activities will continue as normal. 13 WHO/APOC, 14 September 2009 oclL t) Q Lq) z o i:$ r:zv .L c.t N a.t N o\ c.) ca € N c.l o\ O\o co (f) (f)ia OI l')i6 o\\o q) o o c) v U cn N oool l?) l?)iaN ah q) .a'a cl t-rt-i L t-rol eah .oE La!olr z Ss e .iav $ $ ca r- t.- q) C) q) (,) Y Q $ a.t r- q) cd tr 8E!E .rE E --- zE= q) o E,'t+ U ,L e N\o \o F- + r- ?a) l?) rn ol € q) () o c) s QL c.l\o F- ?ota ah o I CJ q) a!Y 0) z ori+ dq z \o t \o .I \o o\ LO N o c) 0) \U U \o \o ol -] o O \J E] o o& \J d) ^=>& i Fr Fr o\ N L 0)p O a() v) + o o.{ - B $ b0 oo € € o N o B o M o * o t o\ e € B o ,L -$ ; S %4q) u 4 > \. q) L t q) Fi 5 (n C) (,) F l-1() +r v) q) o oLraqi o (B bo (dlr - .iil ol -ot(dt FI Table 6: Type of training undertaken Qick the boxes where specific training was carried out during the reporting period) Any other comments: Nil Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Management ofSAEs CSM SHM Data collection Data analysis Report writing Others (speci&) l5 WHO/APOC, 14 September 2009 o\o c.l L()p 0) 0)a O o Or o ts \o q) b6\qJ I\E E$\ oa ! EO \ rivs -\q Ev$ \9E(! ,si()Uq, ':rP's \f \* €is .= 's, t +iqlE 't .s .I a.=EEETH S3US .=>E ea6E: 9i:i oci=itE Ls$ .ai sASF;EUI .S 'SsH ; \..8: $ {Rg E* SS ot ts it ta'ol * \] q\ -l o)ttE:ixlf E E5rl U a tEgl! E i! .gI il F ESol o- .Y Y\Er S l:Hlb s s'stslE $ Ei rl j X Sfe .Bl = x' .sstrl (B i \u =I E T TSzl? I ic .: s36. odE 'S\'= o-s .aiEll * xsB\ S'Y -8. *$ r B€r E! = se\-qY t S*v s :t .q F .s's _c 's {\H s s+ rhSSr\J h t\='F rr lrS? P FSo\ \ ag o oo o oLF d (n oL(c o C) 'a Lr o lJ.]& -oEoE 0) (t)6 (r) o o() o C) (.) ol -r ol C)o.x = (.) ZNoE o) lio -ob9 c0) -o o=FZ ol -t!()i Cd 0.)L9 o on cd ao o C)(H o L 0.) -o z (t oL(€ o 0) 'a L () B U)o E o c) o (.) 0.) ILr(.) 9taol o -l trxt -IL 9l ooGt c o)l .-Ll > t-6)I oI= 9l H HI Jol 0.rl O(,)l o- -ol _trl (d =t bzt? I C) L o oo(! Lo o o o- ,q o\ L bo o(.) TJ C) (n l< o bo(!L 0) o O7^ P.\ o o. o t- al 6)l o( EI C)l >t olol -lol sl OJ(dtlrlh{ o 0) o{ t d o oo lr(.) OI F o Lr € cO) ;-{ o trr tl o (6 C) 00$^ 9E oo oF H! oi' ^ - =C.i;tb' o-t; O €ePgSd tr:'- taod o>ooOL o LO o3 E z 9uaE bEl = L< Zoa :.0 s.g ",:.=oE;o6 tr€ 6 !n' -o = \/ o. :'iFE-!v> =HeO9zir-=' N co c-\o ao o\\o\o EoUn 2i3*u o\N o\ol at al ^=Pva+CLE--oO ^ gf, - .o;-c d trcr>6= = E -€ p2q! O F- € F- o\s r-\o l?) l?l CB q o lrixo\ o =oood =oooEoF @ o\r- ra o\ F- b 2'o €-59tso!r(B , 69z o! oo co 00 rJ c- o\ od ca rn ?a) =-\o o\N E:(!-Eooco'=4,' = N oo\ \o € cO+ t-fri\o ia tt LA ^.rdL^= d.Y,, >'.. --vL' a 39 o- (r) o\c\ r- Ot N c.t$^(r) r- r-Nr- olr-(fl ar) O oo(6 an o O ll * o\ (€ .9o ailE-tr !eo&i 6o \r- o\ \o cia E.9 .^ -8 5 Sfr =tr>-AO o co $ C.l in$o =o? E.z ./ 9.o' -l:o co co$ at\o o\ia a_LOL! rr tr _o^o Z.E H _ d c 6='>; trH E E= E E'"5\ tr cO cO+ \o c.l\o o\l,o c)n -^Y ! o& tr.l o O-r(r< od&)o&Eo I 3 tr -:. R 44q) u\) q > v\ a)\ o * q) xiIq) s 'lzU) H d cn oLr (! j o H (/) >' .o a trl a o9el -tuLOEt9 -ts+.5 rEeOHLtrF '.. r-.1 .crl(o -olr CUINFI 2.6.3 2.6.2 What are the causes of absenteeism? Migration of young people from rural area to urban area is one of the major factor cause of absenteeism also there is local mining activities, if new area is said to have mine people tends to move from their settlements to the said to have mines. What are the reasons for refusals? Ignorance to some of the community members who have no sign and symptoms they think that are healthily therefore there is no need to swallow drugs. There is still stigma among community members, who still think that the drugs are for the birth control that why they provided at no cost. 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 Parasitologisttrained? o Existence of microscope? In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report t7 WHO/APOC, 14 September 2009 o\ c.l o -o () Eq) c/) $ Q > a q) \) \.. Lq) .a u L$)q t6 aq a) c) a) 4: \ q) L t u q)q q) 5 tr c)q bo li o (.)tr c.) b0 Lr (.) Li ()() o CB ch u.l a U) c) o C) U)tr() t)) l-ro(nqr o c/) O C')(t O #r arl -ol cdlFI () o99 -.c-L?o=l2>v <.E E L ;98 .;=(d cgoa == b a;);=c IJ.,l o o o o.= CAo- 910)Y(J O- a O-(FY a9 ^ d.9 u o-c I Fi (Fi;o- o.2E o O E CJ cBooooEee o ^6>vaE;-' ^9vd z €-9?9'! = = -o.= c)flEEiS o o. a A\J -^ = (.) -vL0)=0) x>, a.lJoa(, = (:) .N -59Bsd>; z o C)00c6.r =oo>6 X(.) U) o bo .l+ a o\ c.l L C) -o c)q 0)a s O o o.{ iii > o\ (.) oo E US -o (.) vl r-\o 9 o\ 09 s o\ n o\ O o\ o\ o\ so\ o CB q o ll { ,_i rIJ ri o o &o- F ()o\ -o o c] o6 \ o\ oo oo c]$ o\ $ oo o\ o\ F-o\ ll * rd li t.l 6\ o -o =bood =oooEOF r-\o cr.] r- r- ..) 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Irr 6 .=9'= -Y.-I aF9 v= l-o? A+liP^ .91w=otr qi ..iHtreEi; s .l GtEEI 99El iLI6el E 6)OI .EtilE9-ol n; &:ts!w59btr H8-gEY :cF !dpvaEE;tro!gtr0) Lil!F-rEG ' 6) (J .riaaEg '.. .Ee.i o\l 6)C)l .nEl *(utFl tr 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH { f] wHO tr UNICEF E NGDO tr Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer)MoH{N WHOtr UNICEFN NGDO tr Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project. We calculate the number of tablets require by multiplying the ATO times 2.2 then we get total number of required tablets. The Regional office request Mectizan and Albendazole to NTDs Secretariat. The request is sent to Mectizan@ Expert Committee for approval. Mectizan@ arrives in country through the same channel and is cleared by Medical Store Department (MSD) which sends the information to the NTDs Secretariat. The NTDs Secretariat within the Ministry sends the distribution list to MSD. MSD delivering of drugs up to the District level . The District authority distributes drugs to the FLHF by following request sent to them by FLHF staff. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Mectizan thereafter the CDD or any selected community member comes to the FLHF to collect Mectizan@ ready for distribution to other Community members. Mectizan ordered/received for this reporting year has change compared to the previous three years because of integration between Onchocerciasis and Lymphatic Filariasis and decentralization were by district(Councils have given full mandate-where by drugs are sent straight to districts)Region remain with supervisory role) Table 10: Mectizan@ Inventory (Please add more rows if necessary) o How are the remaining Ivermectin tablets collected and where are they kept? The remaining Ivermectin tablets are collected into bottles and taken back to the nearest health facilities and then they are transported to the district pharmacy waiting for re- allocation, next year distribution cycle. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Advocacy and sensitization to community members and political leaders in the area of jurisdictions. . Training to CDD's . Supervision during drugs distribution. . Data collection and report writing a State /District ILGA Number of Mectizant tablets In stock from previous year Requested Received Used Lost Wasted Expired Remaining MVOMERO 730,000 720,000 346,980 132 372,888 MOROGORO RURAL 668,000 659,000 302,702 146 356,r52 TOTAL 1,398,000 1,379,000 649,682 278 729,040 20 WHO/APOC, 14 September 2009 . Any other comments Note that the remaining Mectizano tablets above are used in none Oncho areas. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes, If so, When? Prior to drug distribution the project normally conducts training to FLHF staff. One of lesson is how to conduct CSM and SHM. Table 1l: 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. Create awareness and increases ownership among community members hence elimination can be achieved as therapeutical coverage is high. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. COMMUNITY District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetinq (SHIO MVOMERO MOROGORO RURAL 433 626 +JJ 626 234 276 TOTAL 1059 1059 510 NOTF/ N NTD SECRETARIET RIIMT/ RNTD / RNTD SECRETARIET CHMT/ DNTD/ DNTD SECRETARIET FLIIW CDD 2t WHO/APOC, 14 September 2009 Level 2.9.2 Main issues identified 2.9.3 Superwision check list used Yes/l\lo 2.9.4What were the outcome of CDTI implementation supervise 2.9.5 Was feedback given to the supervise d Yes/I.,lo 2.9.6How was feedback used in improving the overall performance of the project DISTRICT a) Incorporate of CDTI/I{TD activities in CCHP b)Committed DOTs c)Some District budget small amount of funds Yes Problems and Successes Identified Yes -Council continue to put CDTIAITDs activities in CCHP -More commitment of DOTs -Improve performance of the implementation. FLHF a)Maintained High therapeutic coverage b)Due to shortage of staff supervision of CDDs are mainly done in nearby communities Yes Problems and Successes ldentified Yes Maintained high therapeutic coverage -FLHFs supervise CDDs& to involve pr. School teachers to do supervision to CDDs COMMIjNITY a)Distribution period was carried out during rainy season when most of the community members are at farming hence many absent seem b)Full involvement of community leaders Yes Problems and Successes Identified Yes - Distribution to be done per community Need hence high therapeutic coverage c)Increase ownership and sustainability of the project. d)Improvement of filling of treatment registers 22 WHO/APOC, 14 September 2009 SECTION 3: Support to CDTI 3.{. Equipment 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? - Maintenance of motorcycles are being done using funds from council (CCHP), NGDO Partner supports the project to maintain office equipment - The project has requested replacement of existing equipment from APOC Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condition No. Condition No Condition No Condition No Condition 1. Vehicle 1 CNFR 2. Motor cycle(s) 5 CNFR 1 CNFR 3. Computer(s) 1 F 4. Printer(s) 1 F 1 1 wo F 5. Photocopier (s) 1 CNFR 6. Fax Machine(s) 1 F 7. Others a)Laptop 1 wo b)Biycles 77 F c)Scaner J F Z3 WHO/APOC, 14 September 2009 3.2. Financial contributions of the partners and communities Fill tables 13a, l3b and 13ca a If there are problems with release of counterpart funds, how were they addressed? o Additional comments 24 WHO/APOC, 14 September 2009 o, o c{ L 0) 0) o.O U) s O o. IJ l.a) N G;(n tt{ N('ilo @N ON H* P e r-T\lo oq to qu? 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Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) o Collect Mectizan from the nearest FLHF o CDDs are being exempted from community development work in the drug distribution period in same area of the project o Make a follow up to other community members to encouraging them to swallow Mectizan 3.4. Expenditure per activity 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. Indictate exchange rate used here US$1600 Any comments or explanations? o o SECTION 4: Sustainability of CDTI 4.t1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) {-year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation ' 5 year Sustainability Evaluation _{_ Internal Monitoring by NOTF {_ Other Evaluation by other partners 4.1.2. What were the recommendations? The project are sustainable because the council are contributing through CCHP for some CDTI activities. 4.1.3. How have they been implemented? 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? N/A { 28 WHO/APOC, 14 September 2009 Was a sustainability plan written? N/A- When was the sustainability plan submitted? N/A_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels CDTI activities are already incorporated into CCHP, and the plan is bottom up plan which is based on the priority of the community themselves. 4.2.2. Funds The district council has already started releasing funds for implementation of NTDs activities. In this reporting year most the activities were conducted using LGA funds. 4.2.3 Transport (replacement and maintenance) Maintenance of motorcycles are being done using funds from council (CCHP). The project has requested placement of existing equipment from APOC 4.2.4. Other resources The project mainly depends on the support from APOCruSAID, Sightsavers, Council and Communities to Implement NTDs activities. 4.2.s. To what extent has the plan been implemented The Project had been evaluated in year Six of implementing CDTI activities, since then Action Plan was developed in year three evaluation and have been incorporated into CCHP and planned activities are funded. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery is within Government system using the existence structure. Mectizan drugs are being delivered to FLHF in Oncho and Non Oncho endemic areas through normal channel together with other essential drugs/drug kit and vaccines. The FLHF in charge and his/her subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect Mectizan ready to distribute to the community members. The same CDD are also responsible on distribute Mectizan and Albendazole for Lymphatic Filariasis Elimination Training Normally prior to drug distribution the project conducts training to CDDs, FLHF staff and school teachers in Oncho and non Oncho endemic areas, where the project is implementing integrated NTDs activities. 4.3.2. 29 WHO/APOC, 14 September 2009 4.3.3. Joint supervision and monitoring with other programs Supervision and Monitoring of CDTI activities are integrated within PHC system. Therefore at Region and District level supervision is done jointly by a team using the developed checklist. 4.3.4. Release of funds for project activities Funds are released through normal channel according to budget line item even though disbursement of funds sometimes it takes a long time. The project is mainly depending on APOC and Council. 4.3.5. Is CDTI included in the PHC budget? YES Ir IS 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? o Explain what are the combinations of interventions co-implemented? o How were the interventions implemented? (at the same time?) 4.3.7. Describe others issues considered in the integration of CDTI. 30 WHO/APOC, 14 September 2009 o\ o a.l Lq) 0) a. C)a t \J ca q) () c!o O 0 q) 0) z 6t F (n c.)q \o o\N oo\o\o c{ oot r-t-\o^ $r- oo\o\oN@$ 0 o) c! q) h tr)NN r-lr) NNctl r 1.)N oo o\ oo ca NN ctl ra) tr) c...1 Oo 6t 2 c..l o\ co \os c.I r-N C.l o\\o\\.) ca \o+ c.I r- olN Eo (D o! 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N/A SECTION 5: Strengths, weaknesses, challenges' and opportunities STRENGHS o Availability of local Radios, TV and news papers helped to disseminate information to the community. o Council Health Management Team (CHMT) and FLHF staffs are fully aware of the implementation of NTDs activities. o Contribution from the councils is increasing each year o Policy makers are aware and willing to participate in the implementation of NTDs activities. WEAKNESS o No Project ownership in some community o CDDs are demanding more money in training as their incentives because the communities provide nothing to them. CHALLENGES . Delay of report submission at all levels . Delay for disbursement of funds to the project o Other programmes who comes with different approach by providing payment to Village Health Workers and CDDs to implement their activities. o Submitting implementation reports in different format as required by partners (APOC, Sightsavers and NTD). This increases the workload to project coordinators and other staff. o Worn-out of capital equipment and office equipment. OPPORTUNITIES o NTDs activities are incorporated in the CCHP in all oncho endemic districts. o CDTI approach is now used in the implementation of integrated NTDs activities o CHMT members in both districts have knowledge on the CDTI approach o Political stability makes the project to have 99%o geographical coverage SECTION 6: Unique features of the project/other matters: 34 WHO/APOC, 14 September 2009 \