Tanga Focus CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2012

THE UNITED REPUBLIC OF TANZANIA ( including e-mail address ORIGINAL : Enelish t.I l I COUNTRYAIOTF: TANZANIA Proiect Name: TANGA FOCUS CDTI PROJECT Approval year: 1999 Launching vear: 2000 Reporttug feriqd: From: JANUARY 20L2 To: DECEMBER 2012 (Month/Yqar) ( Month/Year) APOCfundinevear: (circleone) I 2 3 4 5 6 7 8 910 (11) 12 13 APOC Proiect implementation vear report: (circlq !49L1234s67891011(12)13 Date submitted: Partners: - Ministry of Health and Social Welfare (MoHSW) - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - <enter the name(s) of supporting NGDO(s)> NONE - 1320 communities I WHO/APOC, 14 September 2009 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 ONCHOCERCIASIS CONTROL (APOC) I ll WHO/APOC, 14 September 2009 IANNUAL PROJECT TECHNTCAL RBPORT TO TECHNICAL CONS ULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICEIf.S to sign the report: Country: TANZANIA NationalCoordinator Name:Dr.Upendo.Mwingira Signature: .. ou,., .?9. Jq Zonal Oncho Coordinator Name: Dr S Uredi Signature: oate: ..4* oa ao t3 oa 20L3 NGDO Representative Name: ..... Signature: . Date: ..... . . This report has been prepared by Name : Dr. Rehma Maggid Designation : Project Coordinator Signature : . *\*: oDate aalo:-: :'-' '-'I.::. ln WI'IO/APOC, l4 Septembcr 2009 CP' Table of contents ACRONYMS ........... .....................vI DEFINITIONS......... .. VII FOLLOW UP ON TCC RECOMMENDATIONS .........1 EXECUTTVE SUMMARY........ ......................2 SECTION l: BACKGROUND INFORMATION....... 1.1 GeNeRar- INFoRMATIoN............. 1.1.1 Description of the project (briefly)........ 1.1.2. Partnership 1.2. Popu1etroN............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1. Truer-rNe oF ACTIVITIES 2.2. AovocRcv 2.3. MoeILIznrtoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK CoMMUNITIES EnnruR ! Stcxpr NoN DEFINI. CovvtiNrry INVoLVEMENT.............. 2.5. CepecrrvBUILDING.. 2.6. TREervpNTS.............. 2.6.1. Treatmentfigures............. 2.6.2 What are the causes of absenteeism?.......... 2.6.3 What are the reasonsfor refusals?................ 2.6.4 Briefly describe all lmown and verified serious adverse events (SAEs) that 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year l6 2.7. ORoERruc, sroRAGE AND DELIVERY oF IVERMECTIN ........... l8 2.8. CotravuNlry sELF-MoNIToRING AND STAKEHoLDERS Meprrxc...... t9 2.9. SupERvrsroN t9 3 3 3 4 6 7 7 9 2.4 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. diftni. 2.9.6. SECTION 3: Provide aflow chart ofsupervision hierarchy.. ... . ................. 19 What were the main issues identified during supervision? .............................. 20 Was a supervision checklist used? .........Erreur ! Signet non diftnl What were the outcomes at each level of CDTI implementation supervision? Erreur ! Signet non ddfini, Was feedback given to the person or groups supervised?... Emeur ! Signet non How was the feedback used to improve the overqll performance of the project? Erreur ! Signet non diftni. suPPoRT TO CDTI ...............21 3.1. EqureueNr ...........21 ,...,.'....223.2. FrNeNctel coNTRIBUTIoNS oF THE PARTNERS AND coMMLJNITIES......... J.J OrHen FoRMS oF coMMUNITY suPPoRT. .......26 .......263.4. ExpeNorruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI 4.1. INteRNar-; INDEPENDENT PARTICIPAToRY MoNIToRINc; Eve1ueTIoN....................26 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) ........... ............ 26 4.1.2. What were the recommendations? ..'.......... 26 26 lv WHO/APOC, 14 September 2009 t5 .............. t3 4.1.3. How have they been implemented? -............ """"""""' 26 4.2. SUST4NRsILITY oF PRoJECTS: PLAN AND SET TARGETS (MANDATORY AT..............-.21 Yn 3)... 4.2.1 4.2.2 4.2.3 4.2.4 4.2.5 4.3. 4.3.1 4.3.2 4.3.i INrrcReuoN ............ ...28 ...28Ivermectin delivery me chanisms Training.... Erreur ! Signet non diJini, Joint supervision and monitoring with other programs...... Erreur ! Signet non Planning at all relevant levels.. Funds....... Transport (replacement and maintenance). . . . . Other resources To what extent has the plan been implemented' Release offunds for project activities ... Is CDTI included in the PHC budget? .. '.........'........''...'........... ?,i Erreur ! Signet non diJini. ...Erreur ! Signet non ddfini. ...Erreur ! Signet non ddJinl ...Erreur ! Signet non diJini. Erreur ! Signet non ddftni. Erreur ! Signet non ddJini. ddJini. 4.3.4. 4.3.5. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?....-........ 4,3.7. Describe others issues considered in the integration of CDTI. 28 28 4.4. OppnnrIoNAL RESEARCH ... 3l 4.4.1. Summarize in not more than one half of a poge the operational research undertaken in the project area within the reporting period. ........ 3l 4.4.2. How were the results applied in the proiect? .........-... .............-...... 31 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES... .................... 31 SECTTON 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........31 V WHO/APOC, 14 September 2009 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring LGA Local Government Area MOHSW Ministry of Health and Social Welfare NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Governmental Organization NTD NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization CHMT Council Health Management Team CDH Council Designated Hospital CCHP Comprehensive Council Health Plan DMO District Medical Officer DED District Executive Director DC District Commissioner DNTDco. District Neglected Tropical Diseases Coordinator DOCs District Onchocercasis Coordinator CDI Community Directed Intervention NTD Neglected Tropical Diseases NID National Immunization Days PPP Public Private Partnership RC Regional Commissioner RAS Regional Administrative Secretary RHMT Regional Health Management Team v1 WHO/APOC, 14 September 2009 Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (iD 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) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. [t encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (i) vll WHO/APOC, 14 September 2009 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 35th (Please add more rows if necessary) 1 Number of Recommend ation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY 358 Recommendations on the rePort -Ensure that all acronyms used in the report are included in the list of acrunyms (e.g. NTD, FLHF, etc).. This have been taken care in this report all acronyms have been included in the list - The background information is too long. The information on the districts should be presented more concisely Noted. This report the background information of the districts are briefly - Present the recommendations made following monitoring and how theY were implemented To include CDTI activities in CCHP Three district out of four included CDTI activities in CCHP - Ensure that the report reJlects p roj e ct's sp ec ilic exp erienc es and avoid "cut and pastett because it negates the purpose of reporting per proiect This presenting report ,things reported are specific for the entire project Recommendations on the Proiect - Pay attention to therapeutic coveragefor Mkinga, which is reported at 75.6% Yet the other three districts are at 80% and above. Supportive supervision have been strengthen and during advocacy and sensitization emphasize were more on the strategies of increase therapeutic coverage. - There are 129 villages reporting less than 80% coverage, which require attention to ensure that all the eligible persons are reached with treatment In the project area there is more than two times of rain season so in most of the time when distribution is taking place people are in the farm this cause the CCDs no able to reach all eligible persons advice were given to the CCDs to distribute drugs even in the evening so that to reach all eligible. WHO/APOC, 14 September 2009 Executive Summary Onchocerciasis elimination activities in Tanga Region are being implemented in four LGAs out of nine in the region. These LGAs are Korogwe, Lushoto, Muheza and Mkinga. It is now 12 years since we started the implementation of Onchocerciasis elimination activities in these four LGAs with the main objective to establish an effective and self sustainable community based on Ivermectin treatment in endemic communities by giving them authority to decide on the mode of operating the project, whereby the FLHF and district authorities are initiator. The implementation of these activities has been done by using CDTI strategy. This strategy has been adopted by other programme since 2009 to date for the implementation of integrated NTD activities. In this reporting period, advocacy meeting was done starting at regional level whereby the Regional Commissioner (RC) was the chair of that meeting. Other participant who attended the meeting were all heads of departments at region level including Regional Admistrative Secretary (RAS) who is a overseer of all administrative issues in the region. The project went funher by advocating Regional Management Health Teams (RHMT), District Executive Directors (DEDs),Districtct Medical Officers (DMOs), Council Health Management Teams(CHMT) and District Neglected Tropical Diseases Coordinators (DNTDs). This was followed by mobilization and sensitization at the community. These activities were conducted prior to Mass Drug Administration (MDA) to create awareness. FLHFs were trained by CHMT members from DMOs office after completion advocacy and sensitization. Total of 113 FLHFs were trained out of them 35 were newly trained and 78 were refresher. The FLHF trained CDDs whereby newly trained were 65 and refresher were 2585 which makes the total number of CDDs capacitated on CDTI knowledge to be 2650. Newly trained CDDs replace those who drop out (0.02%) mainly due to marriage for female CDDs who follow their husbands in their settlements. To the male CDDs they tend to go the cities to look for the green pastures. The CCD/Population ratio is I CDD to I l8 people. The project area comprises 1320 communities whereby total population living in that area is 312,788. Annual treatment objective was250,230 while UTG is 262,742. The total number of people who were treated was 255,917 which give the therapeutic coverage of 82%o. The project received 644,657 Mectizan tabs and have343,057 Mectizan tabs left over from last MDA. Therefore the proj ect had 987,7 I 4 Mectizan tabs before 20 12 MD A. 592,0 17 Mectizan tablets were used and 52,468tablets remains. In this reporting period the project received the funds from LGAs ,central government and APOC. Major Challenges and how they were overcome o Quality of data from the community and FLHF are not satisfactory. During training emphasis to be on data quality by re-train the FLHFs and CDDs and to tell the importance of a good quality of data. o Different period of financial year between APOC and Council it makes difficult to implement CDTI activities simultaneous. 2 WHO/APOC, 14 September 2009 SEGTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Muheza, Korogwe Lushoto and Mkinga are four endemic districts were CDTI is implemented among nine council in Tanga region. The Tanga region is located in the extended north - east Corner of Tanzania between 40 and 60 and below the equator and 370 - 390 East of the Greenwich Meridian. The region occupies an area of 27 ,348 Sq. Kms, being 3 per cent of the total area of the entire Country. Tanga shares borders with Kenya to the North, Morogoro Region and Coast Region to the South, Kilimanjaro and Arusha region to the west. Indian Ocean borders it on the East. Tanga region have nine councils which are Lushoto, Korogwe District Council, Korogwe Town council, Muheza, Handeni, Pangani, Kilindi,Mkinga and Tanga City. There are 38 Divisions, 175 Wards, 790 Villages and many sub-villages. The population of Tanga region is 2,054,042 The number of inhabitants in most of the villages varies between 1500 to 3000 people per village. Their main activities are peasant farmets, as well as few traders. The farming activities are more active during the long rain from April, May to June with the harvest soon afterwards in the months of July up to august. The major ethnic groups are Sambaa, Zigua, Bondei, with few Digo and Segeju and are almost similar to all 4 districts, Sambaa, Zigtn . Also are other many small ethnic groups. These ethnic groups speak, their mother tongue, but most of the younger people speak Kiswahili, which is the national language, and has become the most important language in the country, spoken nearly by 100% of the Tanga Population and the Tat:zanian as a whole. Few of the population in oncho endemic area arc also able to communicate in English. The major religions remain Moslems and Christians Access to the endemic districts (Lushoto, Korogwe , Muheza and Mkinga) from Tanga and Dar es Salaam is via a well maintained tarmac road although the final32 km winding road to Lushoto District is through mountains. Most of the roads from district headquarter to the peripheral are muddy, rough and mountainous roads which are risky and not easily passable especially during rain season. Other means of communication are telephone radio call and Mobile phones, which are working effectively from regional to the district level and even to the FLHF /Community in some villages. All four district which are in project area the rain season is between march-may which is not a good time for drug distribution in the community. Dry season which favour MDA is between July to December. Health System Korogwe and Lushoto district hospitals owned by govemment, while Muheza District hospital owned by the church as a Council Designated Hospital (CDH) perform district hospital services under special agreement with the government. J WHO/APOC, 14 September 2009 Mkinga which is the new district have no Hospital depend on Muheza Council Designated Hospital and Regional hospital which is near to it. DMOs in collaboration with CHMT members are overseer of all health facilities, both under the government, private and Faith based organization. The responsibility of delivering drugs to health centers and dispensaries that is via Medical Store Department which send drugs direct to all dispensaries and health centres which are under the government. In the places where there is no Government health facility the drugs like vaccinations and Mectizan which are only access in Government health facility are delivered to private/Faith based organization health facilities so that the community member can simply get it, this is one way of strengthening Public Private Partnership (PPP).which is one reform in health Sector. There are health facilities in most villages in Tanga region include onchocercasis endemic area and the big population (70%) has an access to health facility within a distance of 5 Km, it is in this health facilities CDDs collect their drug ready to distribute to the community. However 30% has no health facility in their catchments area which cause CDDs or any community member selected by the community to walk long distance for collecting Mectizan. In almost all project area they are government and few faith based organization health facilities. The relationship between public and private/faith based organization is good as partners in improving people health and possible eliminate other diseases of which Onchocercasis is among them. Table 1: 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 staffin the entire project area B Number of health staffinvolved in CDTI B2 Percentage BFBzI B' *100 Muheza 103 38 37 Korogwe 50 l3 26 Lushoto t5 22 30 Mkinga 54 t2 22 Total 292 86 30.2 1,1.2. Partnership Community members who are the key partners in CDTI are the ones collecting mectizan from the nearest health facility and are willing to do so and encourage other members within the community to swallow the drug. In other community CDDs are exempted from communal work as an incentive to them. FLHFs have the responsibility mobilize and training at community. They also, store Mectizan and give CDDs to distribute to the community. Supervision of the CDDs during distribution and report compilation at community level is done by FLHFs. Region and district provide manpower, both project staff at regional, district and FLHF are the government employee and Regional Administrative secretary is responsible to pay salaries to staff at regional level while for those who is at district level together with those from FLHF, District Executive director is responsible to pay salaries to them. Apart salary payment to the project staff also region and district contributes by conducting supportive supervision and monitoring in cascade way (region-district-FlHF-community- CDDs).The support is done by the region and district to provide vehicle/motorcycles fueling 4 WHO/APOC, 14 September 2009 them and incur the maintenance costs. Other partners who support CDTI activities are Ministry of Health and Social Welfare (MoHSW) in collaboration with APOC. MoHSW support is by conducting monitoring and supervision and providing office space while APOC provide funds for the implementation of CDTI activities. The project has no NGDO partner to support the implementation of NTDs activities for more than five years now. CDTI activities are mainly supported by community, region and respective councils. 5 WHO/APOC, 14 September 2009 o\O c.l L C;) ,o c) A() v) s O Or iL bI) o b0 C)lr C) o B (n() o Cd b0 E d b0 o (d ad B C,)fio C) (B (t (.) 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(tr|FFI cn t-- \o l.ri O \o cnr- oo+ ttr- N\oN 3 sE- =EcE = Ee +rn c..l c.) r.) o\ O oo h €6r- N ?a +1 il5 .6Jitr -c)o,= oN " E.e -\ EF AE \r} o\ cti ca\o \o\oNNf- ooo o\ (r) ca cA\o o\r\ o.l C.l ia$r- Nr- , ..3 EL'=ectE.=;; >,E 6J q) -EEEg co oo cnN C-l s c.)\o c.l oo ,q o\ cr) $\o € € r- ra\ rr) ra) $ oo r co (a!+ $ tr cll q otr a E9U ^9! h ?oUo tr'=gsi I o >s 8.= cq o) oF + I <f, N c.)$$ O$(n ca o.l N(a $o\ c.trrl co \or- oo\o r-6\o.eBE'F =-.dU.E Ei-c(Jtr >:oFE N ?a(a\o o,q) b0 cll at)o t E oI o Lq)E E z t) 'Eg8 :ed ?5 Egsi N o\ $\o co rf1 ra) (n o\ c.I cn\o \o\oNN c- oo o\ o\ &(n €6r- ol ?.) ;E o96l !.- .! -!-Ei E.EE Po 9' -v9-rH AE T (d oo x z -l Fr oF i:i (l) g) .:, E q) !aY- 5I rH FV+jEt a N(.) A (.) B a0 ok ov o o an) Fl .* SEGTION 2: lmplementation of GDTI 2.1. 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. 7 WHO/APOC, 14 September 2009 oo o\o c.l ko -o C) o.oa $ LJ o or o U)(B B oko C) bo (! o o Cd >< o C) o 0) =.o E8o(.)(6tbd> o(+i- o, eOo- o€)zrFil vt5HaD -8elrn()_cE€lo iJ= ?EHtr ErEooO€ o9 €H(to €() (vd €&Fe -a39 dHro(dU)bo >rtrL'-dx .2> r-l(),r3>r 8a at)q, 0)z*qr 0)oE AA oo0E(t L >rO Cd U)EarHE z2 C) (dkb0 ol-ra otr tr oo (n F z tro o -q B x(d B () dHbo c) 0o od t- () E C) o o) a a coiri oE'FEO -Q o.l(J -( ,F a\ v v2q q) uq) v) 1 \ q) t\ t u \)q Bq) U l-rd 0) tro E)o C) C) dol< (t)(d(.) k(d o k € (/')() (J(d +r o 4) () E F ..ir a.ll _ol clt IFI o ar) tq) o a o c)e -oEE U r!A (.) EI o (J r! OH n En= !itr 6: aE (, D E o E L an a! L a *oEE Q o z z o z o z hoEE .r=(r) - o z o z oz o z q) G U) Eh trq) U *oEE U z o z z z S= cE: oz o z z z aa clL Er o.^ HE o U FO o FO F(-) o FU P= +.tr 6: aE FO o FQ o FO o FO oa7 -O)o.ts 'Ei s= &troo -9A c6EE oI FA rr.l v) F0. r!a F r!a F orHa P= 1'E c!= F(h o F U) op Fa D(7 F(h Fl () L zh cd N(.) =a o Bh0 ot<oV o o v) r.l c, bI) J4 z Fl 3 o3 2.2. Advocacy Advocacy at all levels was conducted earlier before starting any activity. At region level number of 57 was advocated whereby at the district level 88 policy makers were advocated. At region the advocacy meeting was chaired by the Regional commissioner (RC). At district the District commissioners,(DCs) was the chair of the meeting. The advocacy at the ward level was conducted after completion at district level the participants to this meeting were Village Chairpersons, Village Executive Officer (VEOs), Extension officers, influential people and politicians from different parties. Total ofl 154 people were attended to the meeting. There was no major constraint although at all levels some of the leaders are new. This cascade way of advocacy and social mobilization before starting CDTIAITD activities aiming on creating awareness, hence development of sense of ownership for both lesders and community as a whole. The advocacy meetings together at the region and districts resulted in increasing support from the region and respective districts, either by budget more funds for CDTIAITD activities in Comprehensive Council Plan or direct support by contribution of vehicles/fuel during the implementation of activities. The following table shows the number of policy/decision makers advocated at different level per each district DISTRICT DISTRICT LEVEL WARD LEVEL Region 57 0 Muheza 24 580 Korogwe 20 130 Lushoto 32 283 Mkinga t2 160 Total 145 1153 At ward level depend on number of villages in entire Ward 2.3. Mobilization, sensitization and health education of at risk communities Information on: The use of media and/or other local systems to disseminate information o Meetings are the common way of disseminating information the meeting is being initiated by community leaders. o Teachers and School children are used to convey massages that automatically reach to the parents and community members. o Leaflets and posters which have the NTDs massage are also used to disseminate information. o CDDs also are used to give Health education, mobilize and sensitize community members when they are doing MDA. Response of target communities/villages o The response differ from one village to another other communities response is excellent whereas other is satisfactory. 9 WHO/APOC, 14 September 2009 Accomplishments o Participation and community involvement increases . Good maintained therapeutic coverage for almost eleven years leads to 0o/o onchocercasis disease prevalence o Low attrition rate of CDDs despite of distributing more than one drug (Mectizan & Albendazole) for treating Onchocerciasis and Lymphatic Filariasis. o Community members are more awareness no the benefit of the drug therefore when drugs are late community starts asking for their medicines. Saggest ways to improve mobilization and sensitization of the target communities. oMobilization and health education of at risk communities should be done continuously to make people aware as drugs distributed only once per year. oTo continue to use policy maker, influential people, politicians and social workers on sensitization of communities oTo adhere with time frame suggested by the community Table 4: Communities participation in the CDTI (Please add more rows d necessary) Comment on: Attendance of female members of the community at health education meetings o The strategy of female participation is now taken in consideration, compared with previous years female attendance has increase almost the same as male. o In most of the social activities female are the ones who participatelattendmore same as in CDTI meetings. o During training attendance rate and involvement in discussion between male and female is the same. Incentives provided by communities for the CDDs o Exception in the communal work is the only incentive given to the CDDs in few affected communities otherwise no incentives is given by other communities. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? CDDs attrition rate is very low in Onchocercasis villages which is the pioneer of CDTI strategy in Tanga region .This reporting year in all four district which had about 2640 CDDs only 65 were dropped out which is 0.02%.The attrition is mostly occurs to the DistricULGA Number of com munities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villagcs with female CDDs Total no. communities in the entire project area B. Number with community members as supervisors Bs Percentage Bo= BJ B. *100 Male CDDs B? Female CDDs Bs Total Bn= BrtBr Number of communities with female CDDs Btn Percentage Brr= Br0/8.* lo0 Muheza 214 214 100 2t4 2t4 428 210 100 Korogwe 443 443 100 443 443 886 443 100 Lushoto 540 540 100 540 540 1080 540 100 Mkinga 123 123 100 123 123 246 123 100 Total 1320 1320 100 1320 1320 2,640 1320 100 10 WHO/APOC, 14 September 2009 tyoung men who went to other place especially urban area to look for a better job other causes include marriage and old age. When this occurs the community members' select new CDDs .This is different in non onchocercasis area especially in urban area which the attrition rate is between 80-90% Other issues None 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. Tanga CDTI project coordinator and two RHMT members are the same since inception of the project hence are experienced in CDTI matters who share the knowledge with other RHMT members. District Onchocercasis/\lTD coordinators in three districts are the same since 2001 when the projectwas launched. Only Mkinga district which was split from Muheza has new coordinator but he already trained on the implementation of NTDs activities using CDTI strategy. There 78 retrained FLHFs and 35 newly trained. Newly trained FLHF are those newly appointed or those who are transfer in from non onchocercasis endemic area. This year 65 CCDs were newly trained while 2575 were retrained. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most importunt issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff arefrequently transferued during the course of the campaign). o Training and retraining at all levels are being conducted prior to MDA every year to ensure that proper knowledge is provided to NTDs implementers. The most important is that CDTI strategy is been used as platform by other Programme in the implementation of NTDs activities therefore the whole region is using CDTI. ll WHO/APOC, 14 September 2009 q) 6lL .r) e U o Lq) z .O $ ir *o *. 6Nt @ a.l$ \o oo oo \o$ oo o$ o oo \oO \o :l cl rt <t c.l t\oFI € rat\ ra\o oo q) () q) (J v F(J €N -t \o € oo o ooo \ot+ c.l o:l\oN o AA q) .=66frr-I LLra): ,a U2oq)tE9 tc{oL z o -i +F e.? Sur is *(j N a.l o sf $ $ t o a.t ?a) ?al o o q) o) I \oo\(JF c.l $ s E o) =6tdLo)- !s :E E: zEo 0)(.) Eit+F-d s+.q = € o\ o\ \o a.l $ r- .n- rr crl GI N ar- rAo oo () o c) c) \Y IF @ \o r-$ c.l ?a) !E c! ar) ah Fl ..3e(')6) tc! Lq)E z E.rfF-d U d* o\ € \o a{ $ (\.l o c\.1 t o^l al \o Nia o\ o o o e) v Q o\ \o a.l <f \o -] <J O a 63 NO) c) B b0 o F{ov o o a) -l d o0 ! :.] Fr H o\ o c.l Lo!F o o.oa$ d o o E > N rt oa s -o o\ U B o 50 o *It o + \\ o * + Bqq a)() \.- U1 > v T\ q) t\ t a)q q) 5 o d o ! oq tr O +< o (h c) o oke+i C) (d oo CB LrF .iir orl -ol(nt FI Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Primary School Teachers Program management \i ./ { { { ^/ How to conduct Health education ^i { { { { { Management of SAEs ^/ ^/ CSM ./ { { ^/ SHM Data collection { { { ^/ { Data analysis { Report writing \i .i ./ Advocacy/Sensitization { { { { { ./ Table 6: Type of training undertaken (Tick the boxes where specilic training was csrried out during the reporting period) Any other comments:Nil 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Project attained l0O% geographical coverage and the therapeutic coverage is stable ranging between 80-82% since inception of the project. 13 WHO/APOC, 14 September 2009 o\ c.l () -o C) aoa + d o H 6 s a E6 ls tJ >I E ,li$ s a) OO .|t\a{(] Bqr t!{i al .P q q)s ql .lii qJs Bql e)s I q) (J q) B q$r\.Yss't\ SaJES .ELls' sbsp BI t! qJ =s*'E:\Yr ..\siT{'sSr?BIi> sX \qrisd*sHqJ qJ .6\ ss qJ .!3 RT **$ b3 EEss SrIH .S'F ddss Srl\=' nS LS5€ L,/F Dv (0 C)L(€ Ioo 'a L () P .iL €U'El oP(d.a ooo HE o'S 'nr o9 HU LSoh EI >,.i ds EEs^ -b .= \i oi(.)E sr aEiIl g Il3 E cl fi 'ol .9 n*El6Elbs EIE EIE! el : -el ES tt E Eb E(l)l .= c)l L S)016 0lo:q=l I q=l€ Jqrl r- el E ':rrl' rl = tPIE 91tr* EI = EIE $ =l tr =l bIlzt< zt? d, € q U illl : bo s u Bq) .q.\G' Lq) 6\os9ai d)o\ hv:i:Et to9.S ::C)kxES3Cai- o!, I(-y <bi (! ot<(! oo 'a tr o. c) : a r!& >. -oE() E C)E rh ^,(d!{l o =1.9xt'= rl I(.)l=(!t =ot F -!l 5al <.> 9d.gsl E =l 0)>l E .ol ?PI L '=l c) =l o- =t xEI E trt oOl thol o)ql tr Li^ ol v -ol LEl3 =l'Fzt= E oII F s o dH 0)bo(! ! C) oo (B o dL00 o C) (! C)L(! o() 'a L o B U)() oo o c) C) ILroo >. o C,)o bo o d q oa 63 oF x o) d 0)L 0) o ooo(H o L C)! z il -o6\ 0.) CB C)bo(!k C) oo C) oa(€ li C) F al C)I o0(dthl o)l >l ot :ldlol -clol(dlhl 06 oI G)lbll €l trl(dt ,:l =l0)l ol(BlLI C)l -cl -J cl EI ol EIol :l €l .al ettrl OI f&l E ;i EaE;g Au qE ori = L<Zout Loa o.5,,'56.) i;EEs g 3 € m st s i!i Eb6?it2il AG t o$ or- o\€ rat-\o i,z!E E=Efe€E zoli s c.t o] \oal(.l E 6l Fr ll r 5ots^Gl 9 LrcL'5 oo\ EOFe \oo\ o.l co \oo\ t-- oo \oo\ o\r- \oo\ € s al6 E= iE \o la) F- rat o\ o{a c.l\o c.l t o\ c.l c-.1 F-t+ t- o\ iaiaN Io? 6.1 :Es \o F- r co oo ri \o6c\ ta o\ $ \o\l o ?o cl o rA ct Eo9 =5 o >.E oqs5{s 3 -e 5L O = LF +o 3 b €! OEL o\dI co\o \o\oc! alt,r €o o\ o\ o- € €6r- al ?a U)o u! G ahq) E E o U oo ll i a'is ? .9oEo0o. !E s!bboa EeI r.E o E a0.:E56tkE E= O = E >ajzz t N $$ o =t N t\ " 6.a =EEiit <to.l s$ o$ N 6l E €.E I.g+'E I " iE R - E EE'5ET H"F E'i 9' 9: s e.l s$ o a^l al(t) .9 FI cd No z (D Bbt olro M o o (n) .l (!bl }1 =A Fl 3 o Fr : B ta,o a.rqJ q) h h S\ a.r s \ t3 \,) V) Bq) s U) L cl ta 6lq)L 6l cl o -l (.) L qh E en ri a tr cl A 6) cloL Fr f\l o.rl -alcl t-.1 2.6.2 What are the causes of absenteeism? o Due to the change of weather harvest unsatisfactory lead to shortage of food in some communities so people had to move to fetch for the food hence increase number of absentees.On the other hand people have been engaged in entrepreneurship people move from their origin home for business and other move to lowland area for farming.. 2.6.3 What are the reasons for refusals? o The project has been distributing Mectizan drug for more than ten years now, signs and symptoms have disappeared among of the community members, hence some of them they think that the disease is no longer therefore there is no need to take drug. However the refusal rate is still negligible about 0.13% of the total population. Absentees is caused by people to shift from one place to other looking for good pastures, such if their new mining was established in the MDA period people will move from their places to the mining area. Moreover the number of people who absent in this distribution period is minimal about 1673 people which is equivalentto 0.66Yo of target population 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 any side effect occurs. . Parasitologist trained? None o Existence of microscope? None 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 ,v 15 WHO/APOC, 14 September 2009 o\ c.lk c)p 0) ao v)$ O o \o lid(.)x ok L< o (l) o! a 0)o o() 'a Lra F O oql o Eo C) od oq d 0)l-r +{ o okF ar;q N g\q) Lq) ta \ q * -\a q v) U\) u'2 L a)L t B q) r-i q) ea t o H()q bo li o () t-r (,) bo l-. a € C)kkJoo o d t)H a (h c) o 0) U)H C) (! U))o t<Oa +r o (n o andO #r 6)l -oldtFI () -Et=o9:Z 895 <.E E isg (goi, E o-=a?1T E.El!oo o a).9 EAaz, EP(J O. a o9o .*9 o9^ 5t (d6 .= a!)o-c q&9d = =d(r;C)-o.2Ea o i tr= cdoooO E r!,-E =a>e o-lu' q-:- A H-EqE d €-Eep.EE€€!-UIE;5S> o a a C)rd(.;)Ao(d0 oI l-l o =c)in* C)o.^ --a=A>; (,;) oocd.r -oO >b x C)a C) b0 * 1a o\ N () ,o 0)q oa * o O. o r- ob!rrr 6l ^!' L laF 9o\ I q @ @ v') N oo o\ 9\o o\ o\ n o\ oq Fr o\ 09 o\ c1 \o o\ 09 h o\ v1 o\ o a er o ili II] q) o Ha F oo\ < >v'o 0 od oo n co € q ao o\ \ r- o\ \ o\ q tr} o\ oq o\ @ o\ oo oq o\ o N ll *- r-i r-j t 5c)580o6l o.L- E:5 Fo r- (r.) o\\o oo oo c1 o@ oo N oo o 00 oo !,) o @ c! 00 N oo ri .o o6t .o oE2- =Oz7o o .+\o t \o € ri .+ o\ c.tq$ c.lN co ('1 aoN o\ v} \o coN <+ * o.l N\ovl co o\ cl c.l N t c.l c.l \!+ !f,N N .d$N ra F- inN r- q N l-l ?o " 6.2 iEe o\Nv} o\ \o\o o\r- !+o O^ o\ c.t N oo $N t'- t--c\ F-$N !+N ..i\o al \o@ N m rrN F-N $ oo c\ a.l ao r-$$N $ e.l O c.t c\ c.l Lo: TEE€ e 5X "3€5:'E', ' a 8.e o \o o\ oo oo o\$o{ co c{ oo N c.l € c.l \o o\ oo^ o\ oo c.l oor-dI .+ o\ cl c..l * C.l a.) co N F-|r) co r-\o6^ o\ o\N @ @q ol ao c.t oo v'I \.} c7) o\\o a,i 00 € Fr N co 0o EO c! 0q) o(,) lL *^ cri f-l e) o &'a F ga\ -o O o O o oo oo o o oo g= f r*l o O oo o oo Oo oo o oo Ii !'c o L E AD!2orc[-g! E= i{ EE*EzJa \o o\ c{ Fr o\ c.t 00 ..t o\o co o\ ca o\O a.t o\ a.) o\ co o\o co c.l co o c.l ao N c.| ti ? 6.2 =EEiEi \oo\ Nr-o\ c.) €N o\ co o\o c.) o\ co o\O co o\ co o\O ca c.l a.) c.lcn o c.l a.t c! o :i+ lH - .E E i"g._iS =';> E-O=ai0qF E lto9! Eo \o o\ NF- o\ co6N o\o co o\ co o\o ao o\O c.t o\ ao o\o co oN ao O e.l co o a.l c?) il ri N cl N ao c.l !f, oN c.l \oo N r-oo o] € N o\ C.l c.l o] (\l oN qh 6l I 6lI q) u0 GLq) IItr E L {) q) en cl oL UD ah q) ra Ntrr N\o ol GI c)L 6l q) 0) a q) li rh tr q) q) G() t o) ar) 6l c) e B a.) B.q.l q)s a)ta E AJ s ; q) L G oq) '= L €)L q) o l-< € L< CBox rl(dlEItrl ol dl ol >l -ol(.) ood l.<o oo € cd C,) dO tr (,) *<F O,f ol -ol crl IFI 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - @lease tick the appropriate answer)MoH{ tr WHOtr UNICEFE NGDO tr Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH{ tr WHON UNICEFN NGDO ! 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 2.2thenwe get total number of required tablets. The Regional office request Mectizan and Albendazole to the NTDs Secretariat after getting request from District. The district received request from respected FLHF. 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) MSD sent other essential medicine up to the FLHF this is because these medicine are ordered to them straight from the FLHF compared with Mectizan which its order pass through NTD secretariat where they receive district order rather than FLHF order. The District authority distributes drugs to the FLHF 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 to distribution to other Community members. Table 10: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? . The remaining tablets are collected from the communities and retumed back to FLHF then the DOTs(DNTD cord.) or any CHMT members collects and bring them to the District Pharmacy were they are stored waiting for another distribution period or sent to another district or project when needs arise. o In stock from previous year are combined together with those used for treatment of other NTDs List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Ordering and delivering Mectizan@ starting from National level to the Regional than to the district up to the FLHF level. State /District /LGA Number of tablets In stock from previous year Requested Received Used Lost Waste d Expired Remai ning Muheza 228,000 155,454 155,454 142,323 0 0 0 l3,l3l Korogwe 0 158,985 l5 8,985 146,224 172 0 0 12,589 Lushoto I15,057 233,218 233,218 207,262 0 0 0 25,956 Mkinga 0 97,000 97,000 96,208 0 0 0 792 TOTAL 343,057 644,657 644,657 592,017 172 0 0 52,468 18 WHO/APOC, 14 September 2009 . Manage minor side effects to the community members also to provide health education on how to handle drug especially to the CDDs ' Storage of Mectizan before sent to communities ' Storage of remaining Mectizan Handling of Mectizan after arrived in the county is under medical personnel as from MSD up to the FLHF, there the community member come to collects. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No training done this year but as the community members are conversant they normally done after each distribution cycle. Table 11: Community self-monitoring and Stakeholders Meeting 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. Community Self- Monitoring (CSM) and Stakeholders Meetings (SHM), increases community ownership, people have understood the importance of swallowing the medicines sustainability. This makes the therapeutic coverage to remain high in most places in the project. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NATIONAL LEVEL- NTD SECRETATIET J REGIONAL LEVEL- RHMT /PROJECT COORDINATOR J DISTRICT LEVEL (CHMT /DOCs) J FLHF LEVEL (FLHFS) J COMMLINITY (CDDs) 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 meetins (SHIO Muheza Korogwe Lushoto Mkinga 2t4 443 540 123 214 443 540 123 214 443 s40 123 TOTAL 1320 1320 1320 t9 WHO/APOC, 14 September 2009 Level 2,9.2M.ain issues identified 2.9.3 Superv ision check list used Yes/l\lo 2.9.4What were the outcome of CDTI implementation supervise 2.9.5 Was feedba ck given to the supervi sed Yes/Ilo 2.9.6 How was feedback used in improving the overall performance of the project DISTRICT l)Inadequate amount budgeted in some district for NTD activities 2)Datanot in good quality Yes Problems and Successes Identified Yes 1. Council to increase the amount of funds forNTD activities. -Data management have been improved. -Improve performance of the implementation. FLHF I)NTD drugs not entered in the ledger like any other medicine 2) Shortage of staff in most of FLHF cause supervision toCDDs/community during CDTI activities is minimum or not conducted at all. 3)Remaining mectizan not return to district pharmacy Yes Problems and Successes Identified Yes l) To ensure Mectizan are inter in the same ledger which used to enter other medicine. Now some of them enter Mectizan in the ledger. 2)To encourage FLHF to involve other stakeholder to supervise CDDs.Village leaders are fully involved in Supervision. l)Despite of low attrition rate some of the CDDs demand for incentives 2)CDDs ask for of any identity such as T-shirt, Cap ect. From project as the community have no the capacity to buy for them. 3) Distribution period was too short which resulted to low therapeutic coverage esp in Lushoto District. 4)Data in community registers are well filled in some communities Yes Problems and Successes Identified Yes l) Sensitization continues to the community to support CDDs 2) Community members understand the reasons of the short distribution time due to that the funds for retraining were delayed( council funds) hence late training. 3)CDDs with the support of their leaders promise to improve data. 20 WHO/APOC, 14 September 2009 SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipm ent (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 maintenance of existing equipments is done by the region and districts authorities. Moreover there is a good collaboration within the region and districts that, Project equipment can be utilized not only Oncho activities but also for other activities assigned by RHMTiCHMT. Replacement is not an issue as the equipments are used in integrated manner even thou the project still depend on donor assistance. Source Type of equipment APOC MOH DISTRICT tLGA NGDO Others No. Conditio No. Conditio No. Conditio No. Conditio n No. Conditio n 1. Vehicle 1 F 0 0 0 0 2. Motor cycle(s) 9 F 0 0 0 0 0 0 0 3. Computer(s) 2 F 0 0 0 0 0 0 4. Printer(s) 3 F 0 0 0 0 0 0 5. Photocopier (s) 0 6. Fax Machine(s) 0 0 0 0 0 0 0 7. Others a) Bcycile 0 0 0 0 0 0 0 b) c) 2l WHO/APOC, 14 September 2009 n nn 3.2. Financial contributions of the partners and communities - Fill tables 13a, 13b and L3c - If there are problems with release of counterpart funds, how were they addressed? No problems in releasing of counterpart funds - Additional comments On the column of other expenses on capital equipment on the region and district contributes by release vehicles for CDTI activities and use other equipments such as photocopier machines, LCD project ect 22 WHO/APOC, 14 September 2009 ao\OON Lq) -o Eo o. 0)a + -3(J o c.tN o) a.(\l(, oo o{ o oonl ooN. $ oOR + tt- t(, a, ; -iotts- o-oroN o$ @^ NN Ene T'c(J= olr +6?a\ f oq (D(o OOrorO)-Nr(o5R"d 1() o,t-(f) I I ! oo o oio ooo oo o g. (1, ! o o o o,o o o Io oo o E .E .Y c o I I Ec -v. s oE .Y c o .E =e,O =oE+r oo ! = =E DC .Y c o Ec -v. s o o ,o ooo oo o oo olo oloo r8qE o o,o o oo o o o o,oio il olo,o o oo(, z o o o o oo,o g of tr o E o e, f .o .9,It e oct(! 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'Fi 6, / :E * 3] EEt (/), t.lJi oEl .r ? sit did o GI (E lu EI o otr o tn I oaIq o o, .ctr (5 o olc 'Er (Ei LIFi c.il *l o, o, oloi Ol oJ .E,El '61 ol o, e{ ci '6i Fl .l N o o .Y o = G o Ia5to I o} G I I I i I i olccl o o,(E .'i .i (f) (f) G o Ia ao c.j UJz J ul oofE c. , .o' i (8, ot )l >,i EiHolIS',-EEE(: - g(r) V' a -- I ' 'q o o GN to o ,4\(, Go o E-Gb i'E6!! .SP s€ =oEs =3 =o (E .N Eo =i C o (E .N .=oE oo ..i I I 0)ok It)d O rr ,P (B a) = L< oo (d o (B t I(o q) cll t.{ I I I I I I I tr .9o .E o: o.,l f, @, (E olI, a3.3. Other forms of community support Excepting CDDs from communion work Collecting commodities from the nearest Health post Supervising CDDs during MDA 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. Indicate exchange rate used here US$ 1600. Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnterna!; 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 ,v 5 year Sustainability Evaluation { Internal Monitoring by NOTF { Other Evaluation by other partners 4.1.2. What were the recommendations? The project was found making good progress to sustainability. Therefore a need to develop sustainability plan 4.1.3. How have they been implemented? Sustainability plan have been developed and implemented 26 WHO/APOC, 14 September 2009 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NONE 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. 4.2.1. Planning at all relevant levels Planning started at FLHF this based on corlmunity priority, later are sent to the district and are incorpoiated in CCHP. Only few activities have been budgeted for CDTI activities(1 or 2 activities) this ii because of planning guideline that the big amount of funds to be budgeted for buying essential drugs and supplies. 4.2.2. Funds District Councils are ready to take over the programme. Budget for OnchocerciasisA'{TD has been included in Council Comprehensive Health Plans. The district council has started releasing funds for onchocercasis as all done together as NTD activities. However the funds released are very small compare to 3 previous years due to the above reasons mentioned. Local Government Authority continues supporting CDTI activities. 4.2.3 Transport(replacementandmaintenance) New vehicle received by the project from APOC two years back (2010), maintained using government funds as well as old ones. They are other vehicles own by region and districts which are also used by the project when needs arise this ensure the availability of transport. 4.2.4. Other resources Human resources is stable as all Onchocerciasis team members are government Employees As the govemment employee, the problem of shifting is not there so the human resource is very stable. Nowadays transfer is only in special case or if the staff went for further study were by the chances of stay at the same FLHF is after complete his/her studies is minimum, otherwise staff stays in one FLHF for a long period (human resource is stable).However in case of transfer the remaining staff are capable of doing CDTI work as more than one staff trained on CDTI in a respective Districts and FLHF. 4.2.5. To what extent has the plan been implemented Most planned activities were implemented but sometimes it was difficult to merge the activities supported by APOC and those supported by the council because of different period of financial year of APOC and that of the government.APoc financial year is from Jan to Dec while for the government is July to June. 1 27 WHO/APOC, 14 September 2009 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 is delivered within normal govemment system using the existence structure. CHMT member delivers Mectizan tablets to FLHF those are within the Onchocerciasis endemic area. However as a pilot project since 2010 essential drugs/drug kit and vaccines are sent direct to FLHF by MSD hoping that Mectizan deliver will use the same route. 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. 4.3.2. Training The project conducted refresher training to CDDs and FLHFs staff as there were few new staff in oncho endemic areas who are trained also training was conducted in none oncho areas where the project has started implementation of NTDs activities in the integration manner. 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. The team includes medical staff and program staff. At regional level the team sometimes includes other regional leaders 4,3.4. Release of funds for project activities Funds are released through normal channel according to budget line item and every responsible part plays its role. The responsible part in our budget is APOC, Council and Government 4.3.5. Is CDTI included in the PHC budget? Yes 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? t 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. - Drug used is the same to both Programmes - Mectizan addition is just only Albendazole - Communities served are the same therefore it is easy to conduct HSAM. - Community selects drug distributors themselves and they live together and are the same 28 WHO/APOC, 14 September 2009 ao\OON L 0) -oF O 0.() a t o o< o o (J ct 0) 0 0 q) o c) z c\ ca \oN (J\ c.l F- N ca\oN tr- cn N tr- c..l t\ o\(r) rr) N o\N {B a)\ bO $ 0a \\q) a) a) * V) s su * 3 p L a) q)s .a q) .a ll p "a q)s S AJ €B s B l] q] q) st\ tI +r cq +itIo -HI c)t )rI .- Io U !+ t-l q) -E Cg E'( cg o () c0L. o P-a E t/)o.(g tiL '52 HL8Eoo -E()Q. cfi A. cr) oo &E ->oFe o an o c/) g cr) rn c.)r- r- f- o\r- oo rf1 a\o * r- oo\o $ F- \o c.t r c..l $lrl 1.} \oo ca ra) \o\o .f, @ sf, oo cg 2 ooa\olrl cn aat- € a\o aa r- .t r-\o ca c.)F- co \o cncq F coN ar rn ca oo co N o\ o\s oo \E)$r- o\t oo\o$r- q o ct q) Er oo oo N r.) r-\oc\t-r- .+ crl $ \o s o.l t \o !q) q) E! cg 0 0 q) q)E z 0q,) cl a o\r-$ \a$ rt \ot \alct oF o$\o N O$ o\ .f caN ON ao o\s ca ol cl a8 t-- o\t-N o\r-r*o\F- c\ 0 Usu9 r-9 -otr z og cg N c.t N ra) N\o on r lr) Eo 9 ago& o c.l c.t N \o ++ .tt c.l -Bo.5 -o=EE =EZoo Eq) o bo 6t - a..l co .tt c.r r o\o\ o\ O c)& 0) .f, o\o\ o\6.9-o rr E.2a<t z q) bo F0) * r -JoJLus I PPJ6^LE; o ocP@E ZEOL -(Uo ot od 'Eg cc- oPE! 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I o F o o I - 0q)() 0o o 0 o nr (,) c!d EEC -Y Ecc -= I Ecc -Y x o o) vl o o! oil ttt o, OJ I c, o0 'i :.OA ?_ (n Ee OJ OJ I o o CB c) Q)q 0 90 O oc oc oc LO VIo tJ)OJ vlo FE s qa) ti o OJ I UI @ o€ ?u 2 or " =.eOoq/a) (u o I ti c) =o)5Eo()()(l)= qC OJ vto OJ o0 '=> s(2 (l) o boc (.Jut o ooc ov) o t bI) L .F o OJ o q) a E-e -9r.=(JJt/1P coE E.3 - 5P.=(JJthP coE E; -o'E x9P.=G,t4Fco€ O() c) c! rn c, t^(u I vlo q,) o) c,)o >aF .=3EE9E LL oJ|,>E o o c .lI .9o FNf(E €EEo .2 -oat a o_ coo, =(! €6 -t'fii^(! r-LOo- a o {.,co oN .-(! a9 =oJ .E -o(,oEE o riz = -t o c .9 f -ct L ,2o a c o E o bo(! E.eCLL(! oEEE ob -o a c o 'F(! c <ocE '= o) roX >6 a rt o cox '{= (! =E €6LL .9Foi< a a a a o (,) 6) 3 a (h(d ot<oo_O^ -cEc.r E \J c) 6 a^d L cd o d >. -1 a 6d a o 6 oa Fa o oo (B L(B (B z oL oo L(d(! a L d a (! o o(! LF a odLd (d O (_)() a an C) t q) B\ s- \$ q s .\r u c.) o U) O o0 a a C) d o0 o q o o rii t-l() -E c! t'( I I I 4.4. Operational research 4.4.1. 4.4.2. Summarize in not more than one hatf of a page the operational research undertaken in the project area within the reporting period. NONE How were the results applied in the project? N/A t SEGTION 5: Strengths, weaknesses, challenges, and opportunities STRENGHS Intergreted activities with all NTD diseases Results' following both epidemiology assessment done in 2010 and 2012 show Onchocercasis prevalence rate is decreased almost to 0o/o Attained a stable good therapeutic coverage for 12 yearc. WEAKNESS Delay of reports from community level resulted late submission of report in the upper level Replacement of photocopier machine is not yet fulfilled by APOC CHALLENGES o Quality of data from the community and FLHF are not satisfactory . Regardless of low CDDs attrition rate and community incentive of except their CDDs in communal work there is complaints from CDDs that incentive is inadequate. o Different months of financial years makes difficult to implement CDTI activities sequentially those support by APOC v/s support coming from Council. o Unable to fulfill CDDs request to provide them with any identity such as T-shirts, Cap, bag for carrying their register& pen/Umbrella incase it rain during the time of distribution.(also as an incentive) o In some Health Facilities Mectizan are not returned to the district pharmacy after completion of distribution. OPPORTUNITIES o All leaders were advocated and are aware of CDTIA{TDs o CCHP incorporate CDTIAITD activities o CCHP guideline features NTDs( Onchocercasis among them) activities . Political stability ensure ownership and sustainability SEGTION 6: Unique features of the proiect/other matters. NONE 31 WHO/APOC, 14 September 2009