NOTF HQ annual project technical report submitted to Technical Consultative Committee (TCC): from January 2009 to December 2009

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE OzuGINAL : Enelish C OUNTRY/NOTF : TAI\IZANIA Proiect Name: NOTF HQ Approval year:1997 Launchins year:1997 Reportins Period: From: January 2009 To: I)ecember 2009 (Month/Year) ( Month/Year) APOC fundins vear: (circleone) I 2 3 4 5 6 7 8 9 10 1l t2 t3 (circteone) I Z 3 4 5 6 7 8 g t0 (ll) t2 13 Date submitted: Partners: - Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - NGDO(s) NONE - sJs4 communities ior Hrromn To.\ie. H,B.God RTCU LE + i ifFt- ,,'t,:', - u .=.*, :.irJ APOC I DIR, I WHO/APOC, 14 September 2009 a\ ANNUAL PROJECT TECHNICAL REPORT SUBMITTBD 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 AFRICAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) 1l WHO/APOC, 14 September 2009 ANN UAL PITOJECT TIiCHNICAL RT,] PO IT'I' TO TECHNICAL CONSULI'n'flVE COMMIl"tlltl (]'CC) EI\iDORSEMEI{T : Please confirm you have read this report by signing in the appropriate space. OFF|CtlllS to sign the rcport: Country: TANZANIA NationaI Coordinator Namc: Dr. Nkundrvc Mrvakvusa 'Tlris report has bcen prepared by Name : Mr. Oscar Kaitaba I)csi-enation : Prograrnnre Olliccr NO'f[' Chair I)atc: . Nanre: Dr. Donan Mnrtrando alftksp (j,::? :Yl1l::,: , t$ffiftfl@lo' ar\ell*lp- @4Signlture Si-unaturc I)atc Si-urr:.rture Datc llt Wl lO/AP()('. I .r Scptun'rr*sr 2(XI) Table of contents 1.1. GexeRar. rNFoRMATroN............. I.l.I Description of the project (briefly)... L1.2. Partnership 1.2. Popu1arroN............... SECTION 2: IMPLEMENTATION OF CDTI....... .......9 2.1. Tnmlrm oFACTrvrrrES . .............9 ........... I I2.2. Aovocacy..2.3. Mosil,zarloN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuxrnrs I I2.4. CorvruruNtry nwoLVEMENT............ ........... I I 5 J 6 7 2.5. 2.6. Capectry BUILDING.. TnrervnNTs....................... . Treatmentfigures....... t2 t4 l42.6.1 2.6.2 What are the causes of absenteetsm? 2.6.3 Whot ore the reasons for refusals?.... SECTION 4: SUSTAINABILITY OF CDTI. 4.1. INreRNer.; INDEpENDENT pARTrcrpAToRy MoNTToRING; EvetunrroN.................... t7 t7 2.6.4 BrieJly describe all btown and verified serious adverse eyents (SAEs) that ....... 17 2.6.5. Trend of treatment achievement from CDTI project inception to the current year l92-7. OnoeRrNc, sroRAGE AND DELwERvoF IVERMECTTN ....-..-.-.202.8. cotvruuNny sELF-MoNrroRrNG eNo SrereHoLDERs Mrernqc ......-.--..212.9. SuppRvrsroN 2t2.9.1. Provide aflow chart of supervisionhierarchy. ............212.9.2. What were the main issues identified during supertision? . Erreur ! Signet non d[JinL 2.9.3 2.9.4 was a supervision checHist used? .........Erreur ! signet non deJinl Wat were the outcomes at each level of CDTI implementation supervision? Erreur ! Signet non dilinl was feedback given to the person or groups supertised?... Erreur ! Signet non2.9.5. diJinL 2.9.6, How was the feedback used to improve the overall pedormance of the project? Erreur ! Signet non diftnl SECTION 3: SUPPORT TO CDTI ...............22 3.1. EqununNr 22 24 29 29 29 29 3.2. FrNnNcIeL coNTzuBUTroNS oF THE pARTNERS AND coMMUNrrrEs.. 3.3. Ornen FoRMS oF coMMlrNrry suppoRT3.4. ExpeNonuRr pER AcTrvrry 4.1.1 Has the project ever been evaluated/monitored? (Tick any of thefotlowtngwhtch are applicable) ........... ............294.1.2. Wat were the recommendattons? ......-......29 lv WHO/APOC, 14 September 2009 4.1.3. How have they been implemented? ............. .................29 4.2. SusrerNesrt.rry oF eRoJECTS: rLAN AND sET TARGETS (MANDAToRv AT...... ..........29 Yn 3)......... ..............29 4.2.L 4.2.2. 4.2.3 4.2.4. 4.2.5. Planning qt all relevant levels.. Funds....... Transport (replacement and maintenance) . . . Other resources.. To what extent has the plan been implemented E ;;;;,;; i i;;,;, i ;; ; n;:t Erreur ! Signet non difml Erreur ! Signet non diftnl Erreur ! Signet non defrni 4.3. INrrpcRArroN ... Ennnun ! Srcxnr NoN DEFrNr. 4.3.1. Ivermectin delivery mechanisms................ Erreur ! Signet non difuti 4.3.2. Training.... ..........8rreur ! Signet non difml 4.3.3. Joint supervision and monitoring with other programs...... Erreur ! Signet non ddftnL 4.3.4. Release offundsfor project activities ....Erreur ! Signet non ddJini 4.3.5. Is CDTI included in the PHC budget? .....................Erreur ! Signet non diftnl 4.3.6. Describe other heolth programmes thot ore 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. .....31 4.4. OpenerIoNAL 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?...........Eneur ! Signet non diftnl SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... . ERREUR ! SIGNET NON DEFINI. :::]iT::T*::i::Y:::::::-T::Effi,HI,ffiTRKDEFINI v WHO/APOC, 14 September2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community S elf-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organi zation National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization 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). (ii) Elieible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with lvermectin 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 3d year ofthe project). (i) (iiD (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Inteeration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilifi: 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. It encourages the community to take full responsibility' of Ivermectin distribution and make appropriate modifications when necessary. 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 28th 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT ASE ONLY 174 Report related (t) Ensure that the approved reporting format is used and not oltered in reporTing This report is in a reporting format received from APOC management(it) List of Acronomy should be updated and explained The list of Acronomy have been update (iit) Explakwhy Ultimate Treatment Go al is high than total population in the report The UTG was high because the total population was not included Ruwma data.(w) TheJinanciaU in kind support by APOC and other Purtners in the cunent yeu and the last 2 yearc The Project has been supported by Government and APOC. Their contribution is shown in this report(v) Percentage of Health staff involved in CDTI The percentage of Health staffinvolved in CDTI are clearly indicated in the report(v0 Detailed timeline of CDTI activities A detailed timeline on the implementation of CDTI activities per project is well elaborated in this report in table 3.(vi[ Reason for late commencement of distrib ution of Mectizan The county was embarking on NTDs implementation by integrating activities therefore everything was to be planned again together with other Programme and agreed on the way forward. Proiect related (t) Provide more informution on the Previous Ruvuma CDTI Coordinator WHO/APOC, 14 September 2009 distribution pro b lem and reporting in Ruvuma project; have retired, but the handling over process between the incoming and outgoing Coordinator was not done in good manner that make the new Coordinator to fail in report writing as there was no data in the office and no communication from DoTs.(it) Correcl fieatmenl covefltge by including the Ruvuma population; In this report Ruvuma data was included therefore treatment coverage is correct.(ii| Conduct census update Census has been updated by CDDs during drug distribution time every year.(w) Train more CDDs The community have selected more CDDs and trained them. The ration in most Project is l:100(u) Incresse number of communities implementing CSM and SHM More FLIIF staff were trained on how conduct CSM and SHM therefore the number of communities implementing this have increased (Please add more rows if necessary) 2 WHO/APOC, 14 September 2009 Executive Summary In the year 2009 Taruarria stated implementation of NTDs activities in five Onchocerciasis endemic regions which are Mbeya, Morogoro, Tanga, Iringa and Ruvuma. Co-implementation of these activities was supported by the Govemment in collaboration with APOC and USAID. The implementation of activities had followed CDTI strategy whereby communities are involved in the decision making and this was done in oncho and none oncho endemic areas. The National Office Head Quarter in collaboration with NTDs secretariat, in this reporting period was able to achieve the following: i) Developed NTDs Strategic Plan and reviewed budgets, financial reports from all five regions implementing NTDs activities. ii) Therapeutic coverage of Mectizan was high compared to last year whereby the average of 80% was reached in these reported seven (7) projects iiD Hon. Minister for Health led Tanzania delegates to attend the Joint Action Forum in Tunis- Tunisia. iv) Conducted training to NTDs implementers from the all districts in five oncho endemic region. v) Managed to provide technical backstopping and guidance to sampled Projects that are in Morogoro and Kilosa CDTI Projects on Mectizan drug distribution activities. We had visitors, APOC Director, Madam Dr. Uche Amazigo; she was accompanied by USAID representative from Washington DC, Ms. Angela Waiver. They visited Ruvuma and Morogoro region where they held a meeting with the regional Administrators. In Ruvuma, they had meeting with community members two villages of Likarangiro and Lyangweni located in Songea D.C. MAHENGE CDTI In this reporting year in Mahenge Focus, treatment took place only done in Kilombero district as Ulanga district had been scheduled for epidemiological Evaluation. All274 communities in Kilombero district have received treatment. The total population living in Meso and Hyper endemic areas is 256,727 . A total of 211,543 people received treatment reaching a therapeutic coverage of 82Yo and the geographic coverage was 100%. Ultimate Treatment Goal (UTG) was 215,651 people and the Annual Treatment Objective (ATO) was 205,382 people. RUVUMA CDTI Treatment in Ruvuma region started in October and lasted in December 2009 whereby in Ludewa district, treatment started in December 2009 and lasted in January 2010. The total population in Hyper and Meso endemic communities is 376,187 people, whereby total of 302,507 people was treated in 1,127 communities. The geographical coverage for the reporting year is 100% and the therapeutic coverage is 80% The ATO was 316,165 people and UTG being 316,132 people. TANGA CDTI As for the previous year, the project has a total of 1309 communities which are Hyper and Meso endemic. The total population in Hyper and Meso endemic areas is 302,488 people. The ATO is 255,284 while the UTG is 254,093. Number of people treated was 244,712 making the therapeutic coverage of 8l%. The project attained 100% geographical coverage. J WHO/APOC, 14 September 2009 TUKTIYU CDTI Both hyper and meso endemic areas has a total population of 107,155 living in 298 communities. There is a sharp increase of communities following REMO which was done in 2005 whereby,25 villages was found to be ONCHO endemic and hence the number of communities from these village was added to the previous communities in project area. Mass drug administration started in October and was completed in November 2009. A total of 87,235 people were treated, the geographical coverage was 100% whereby the therapeutic coverage was 81.4%, the ATO was 90,010 and UTG was 90,314. KILOSA CDTI Kilosa CDTI Project has 970 affected communities with a total population of 482,954 people A total of 389,243 people were treated giving a therapeutic coverage of 80.6%. The Ultimate Treatment Goal (UTG) was 405,681 whereby the Annual Treatment Object (ATO) was 386,363. Geographical coverage for this reporting year was maintained at 10006. MOROGORO CDTI Mass drug administration activities started in September and ended in October. The total population in Hyper and Meso Endemic was 346,777 people who are living in 871 communities. The project managed to treat a total of 278,963 people and attained a therapeutic coverage of 80.4o/o. The geographical coverage was l00yo, UTG was 291,292 and ATO was 270,000. TUNDURU CDTI The treatment cycle in Tunduru CDTI started in December 2009 and lasted in January 2010 where by in Oncho endemic areas a total of 102,554 people were treated who lives in 536 oncho endemic communities. The therapeutic coverage attained this reporting year was 82%o. The total population in Hyper and Meso endemic communities was 125,449 people. The geographical coverage was l00oZ, ATO was 105,480 and UTG was 107,392. Challenges and how they were overcome. o Some of district, NTDs activities are not featuring and or funded in the CCHP. - Conduction of sensitization and advocacy meeting to ensure that all CDTIA{TDs activities are in Comprehensive Council Health Plans, to ensure that the activities are funded and fund are released timely and to ensure a progressive increase of fi.rnds by districts/council through CCHPs for the implementation of CDTI/NTDs activities. o The projects were subjected to write more than one report while reporting on one thing implemented at the same time (CDTIAITDs), this gives them more confusions and delays in reporting. - There is a need to consolidate reporting format to have one for all NTDs that is based on the existing government structure. t Lack of NTDs IEC material which were supposed to be distributed in all five regions - NTD secretariat is working in collaboration with APOC and other partners to make sure that IEC materials are developed and distributed in all five regions. 4 WHO/APOC, 14 September 2009 SEGTION 1: Background information 1.1. General information 1.1.1 Description of the country programme (briefly) Tanzania is situated on the east Africa coast, and lies between latitudes lS and l2S and longitudes 29F- arrd 4lE. It shares borders with 8 countries i.e. Kenya and Uganda to the north; Rwanda, Burundi, Zaire and Zarftia to the west and Malawi and Mozambique to the south. It covers 940,000Km, of which 60,000 are inland water bodies. It is surrounded by the Lakes of Victoria to the north, Tanganyika to the west and Nyasa to the southwest, while the Indian Ocean is to the east. The country physical geography and associated drainage patterns are largely influenced by the Great Rift Valley that runs northwards from near the mouth of the Zarrrbezi River, through Tanzania, Kenya, Ethiopia, across Red Sea into Israel. It is topographically extremely varied, often within very short distances. Except for a 900 Km coastal plain, most of the mainland is above 200 metres altitude, and much of this is even higher than 1000 metres above sea level. Onchocerciasis is endemic in 19 of the 135 districts, namely Lushoto, Muheza, Nkinga and Korogwe in Tanga Region, Morogoro Rural, Kilombero, Ulanga, Mvomero and Kilosa in Morogoro Region, Songea, Mbinga, Namtumbo and Tunduru in Ruvuma Region, Rungwe, Ileje and Kyela in Mbeya Region, Njombe, Mufindi and Ludewa in Iringa Region. It is estimated that more than one Million people living in the endemic area are affected with Onchocerciasis and three Million are at risk. Seven CDTI Projects and One Vector Elimination project have been launched up to now to control Onchocerciasis in the country since 1997. The projects are Mahenge Focus, Ruvuma Focus, Tanga Focus, Tukuyu Focus, Kilosa Focus, Morogoro Focus, Tunduru Focus and Tukuyu Vector Elimination Project. Almost all villages in CDTI Focus Projects have a number of village health workers and these are people who have been trained in a number of simple health interventions by Ministry of Health and Social Welfare trainers. All villages utilize these people in collecting, distributing, and data collection during Mectizan@ distribution. In other area these people are selected to be CDDs and they are performing a good job. In principal, the structure and function of the PHC system starts from the community level at the village, therefore the health system is decentralized. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) 5 WHO/APOC, 14 September 2009 Project Number of health staff involved in CDTI rctivities. Totrl Number of hcalth steffin the entire projcct erca Br Number of health steffinvolvcd in CDTI Br Percentege B.=8,/ B' *l(X) MAHENGE (Kilombero dishict only) 327 156 38 RUVUMA 1,33 8 498 37 TANGA 147 66 45 TUKUYU 247 9t 37 KILOSA 350 114 33 MOROGORO 542 457 84 TTINDURU 323 65 20 Totrl 3,274 1,447 44 1.1.2, Partnership The partners involved in the implementation of CDTI activities with the National Onchocerciasis Control Programme (NOCP) are Ministry of Health and Social Welfare(MoHSW), District councils, Sightsavers Tanzania (formerly known as Sightsavers International) and Christian Social Services Commission (CSSC). Ministry of Health and Social Welfare - Provision of office space, - Pay salaries to her employee - Provision of Human resource - Provision of additional capital equipment - Provide technical backstopping and guidance to sampled LGAs on Mectizan drug distribution activities. SST NGDO partner in Ruvuma, Tukuyu, Kilosa, Morogoro and runduru CDTI projects - The partner has been particularly instrumental in the provision of interim funds to the projects for conducting advocacy, mobilization and sensitization meetings; assist in capacity building of project staff and provision of capital equipments. - Provisions of funds for development of IEC material CSSC Supports National HQ and CDTI Project in the respect to financial control of APOC trust funds. 6 WHO/APOC, 14 September 2009 r\ o\ oN Lq) -o o ao(/) * o o. o .lz I I fr'oq) B doL a l-i 0) o I ol "t+.O9oo ,o(dlql €l9t ollf{' .= ,7 dt E ,,lsa tAgq trr(Doo !?E !Hao (,,)(d Y,Z .=8LL EEEEa> d zH* o z ./) C) o L{(.)a bI) L< oq (.) Lr q.) bI) tr L< otr o oo 'a l-ra o tr € u)tt) tr() o C(l t/)(, s Uq) '6. 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C) +r o o cd LLr € t{o o >r (d ol.io t/) q,)so \o)s'= Is8:raIo\oo *E\fiSaB(l)U\ L{sdtisaSEqJ IJr *q Eb '-o .kEs=t\Z$:>cd\ca.; .EHSE stSu) S9(). a):SEt.2s.gSE .4(! 8-U SEaaq)ESHS x* ---S" 6', S ocdE -cC.) \ .28: -eu .s f ES 3;S $$!u-(,) = .s s :+e a.6S cE\v)t)$;E'3ssE x s E? TE-qBs .I1 l,/ ..raelh\, I oo 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. , a 9 WHO/APOC, 14 September 2009 o\oo c.l Lr(.)p q) ao v) tt Q o O" o V) o trtr oO uq 4q) U (i.- q =i\ q) L t q)q Uq) E t{ Cd(,)x (.) E o O €q)(t 0)lr u)(d oL (.) lr € U) O 9Q(B +r o (.) tr o) H F c.ir o)l .oldtFI Ao (n toa a o +oEE (.) o\O o 6.) o I o\ -8 -o'^O EIL o\o () C) a o\ z o\o o z o\ dd P. litr d: o\ 3o trr t^ o o\o a o\ () o o\ o o\ Cd o\ o z E o E L 02 E oa fr o o.= EE oI o\o oz I o\oc) o- =G, o o o\ o o\O o() H o\o o z o\o o 6 P.e 1itr 6: aE o\o o oo o ,O\()o o\O o() U) o\ o z o\ o o o\ o C) CA o\ oo o q) cl e a2 th tr c)U o o o a o(J o\ b{ o\o oo t-1 o\o o. C) U) o\O o z o\ o z o\ o \J o\ o P. .F EI cr= a- o\ o() A rO\;o o\o oo U) o\ z o\ o o\O o() U) o\o o c.)a E! E E rlLtr o POEE o U o\ o z o\ oo o I oo o\O ot o\ oo o\ o\ o o\ b! H= 1i E c: o\ oo o\ oo a o o\o b0 o\o oo o\ o\O h0 o\o (- va -6) .E .E s= EEooF{9a o a= EE(J o\ o z d o o,=o o z o\o o\ o z o\ ooa o\o b( o\ o EDiE 1itr o\ o\O oo o o o\ o\ o o\ 0{ o\ o o\ d 2 (J q) oL F.( rI]() zr! D & o z F V F v) rl v o& o(, o& o & o z PF F] H o Fr o\o c)oo 2.2. Advocacy The following are number of policy/decision makers mobilized at each relevant for level during the current year :- National level- 47 Regional Level - 150 District Level - 432 Ward Level- 1920 Sub-village Level - 3,089 2.3. Mobilization, sensitization and health education Reason for mobilization, sensitization and health education - To create awareness to new policy makers who had been elected or appointed to go and work in oncho endemic areas. - To provide oncho knowledge to community member and encourage them gain sense on project ownership and to conduct community self monitoring meetings - To encourage district leaders to incorporate and release funds for the implementation of CDTI activities which have been planned in the CCHP. - To aim higher in achieving for treatment coverage and cover all affected communities to get 100 % Geographical coverage in project areas. 2.4. Gommunityl involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment: - In general communities make their own decision on when to treat and what mode to use for drug administration. The participation of female members in the community meetings when CDTI issues are being discusses is increasing year by year though not much as most a a Number of communities/villages with community members es supervisors Number of CDDs rnd the communities involved Number of communities /vilhgcs with femele CDDs Totel no. communitics in the entire projcct ercr B. Number with community members es supervisors Bt Percentrge B; By' B. *100 Mele CDDs B7 Femele CDDs Br Totel Bo= B,*B. Number of communities with femrle CDDs B,n Percentege Blr= Bro,/B.*1nn 84MAHENGE 327 156 34 651 586 1,237 2',t4 RUVUMA 1,127 1,127 100 1,t79 1,247 2,426 1,120 99 TANGA r,309 1.309 100 r,334 1,294 2,628 1,309 99 TUKUYU 298 240 81 3t r 480 79t 298 r00 KILOSA 970 970 r00 1069 1,069 2,138 970 r00 MOROGORO 87r 871 100 1,150 l,139 2,279 865 99.3 TUNDURU 536 668 100 541 539 1,080 536 100 Totrl 5,438 5,341 9E 6,235 6,354 12,579 s372 9E.7 l1 WHO/APOC, 14 September 2009 female are more involved in taking care of house works and some are being hindered by culture. 2.5. GapaciQl building - The National officers trained Regional and District staff on the implementation of NTDs activities by using CDTI strategy. The training involved also staffs from Ministry of Education who normally supervise Primary School teachers in the distribution of Praziquantel drugs to school children. t2 WHO/APOC, 14 September 2009 U *. q o -r + .(J $d € r- N soN \o\o o\ c.lsf €(\.t\o N € c.l ro^ c-.t o\rr \o o\o € N @ o.l \o(a o\F-(\l N $ o\ o € F-O \o 6 \o\o o\ o : o ra6 otr GIL ah l-'i n(J o trq)E z ?!FO r-'c.l \oN o.l @ c-l .o" N o\t- @ oi o\F- e.l of O €o o\F-N N Eoq o (l) I s N o\ Q +. o< isto \os \ot e.le.l o\ r- \o O o r- € t N c.I st 6o F € cl OLq) .Eaatfi50 bts *jo) oq)t.l9 L6l orr z IF \o<, F- + 6o oo (, rt) o) I \o rL(J 6 o Fr (.) .L 0< U + U Q"e \o \o\o o o\ \o\o \o\o o\ o\ a.l t-- t c-- t-. =1. t \o € o\\o F- \ot- ra 66\o €\o t'- €) -EI dL0)- iI lri!s 3E E>. 28, I(, UF oN o\t-. tlc-- o\ $F- \o € 66 (l) (, o I \c r-.6 s+.o( * Eil+F-d I\o \o =l' @ t'. F- \o$ N =f + \o rf =trt o\ t-. t.- o\(.) o\inN GI6 +i 6l o an () hI 9eI 6,) ;.F o Lq)E z Q o F !t\o @s \o-t tst o\ ot- t-- o\(.) o(u 'a tr rI]o z rrl D & s z F v F a o F.lg od o o * D ozPF F] tr oH o (l)t a) €) I s o\ N kop tr 0) o.() u) !f, o c.t rt t o o go o BI o t q saE B B I Bt\ ,r E =+ -\i \S a4 v1q)(J q) s L q) L +is q) 4 q) s o d () C) a E F o(J +ro U) (.) o) ot{ .o)HH (l) P (d botr tr (dlrF .iit o)l -ol(dl FI Table 6: Type of training undertaken Qick the boxes where specific training was carried out during the reporting period) Any other comments NONE 2.6. Treatments 2.6.1. Treatment figures If the project is not ochieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reosons and the plans being made to remcdy this. In this treatment cycle, all CDTI Projects managed to achieve I00% geographical coverage and attain more than 65%o of therapeutic coverage as shown in the table below. Trainees Type of taining 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 (specifu) Lymphatic Filariasis { ./ ./ { .i Soil transmitted Helminths { { ./ ^/ \i Primary eye care { ./ { { Ownership ./ { { ^i t4 WHO/APOC, 14 September2009 o\oo a.t lr C) -otr q) a.(D U) + d O. (al (B o)l-r(0 €o c) 'a .LGA G'H0)G'. P9o(l),= 'aA Lv 9 tr.lr& =.B'9 v - rh .;io: .EotrE d6tr(n F65.9()! .38E ot tr(L) ol =E -l EI xl 8b El.go- dltr .e g€A olcot ; olo otol d) o0-r ol ;l E #l B. rl sol.! <l h ol Ffrls slE €lig:E El E 96 o.rl - =l , o.rl !EE EIb E+EIIE 8I E BI€<rl = tr.l * <rl !rol o. ol tr ol- rlO sl3 rl'ol o- ()l c ol= -ol -ol - El :rEI8 EIg EIEzl- zl? zl< il g cll< o a0 !d^gE oo o t o Cl,k o bI) clLro oo d .I :o -C o\9.v(B L bo ooo (D adlr o bo tr o oo (),A '- -Otso\ oa(d o) F qr A-E E ; g 9< a-e'd E E€:eESZ gqY o' 69 q o o o ,oa qE 6 lr.l3 p{Zoui o o o o o Ee+$pg >o-' toH()P F- r- 9g E:E[J Ld @ =t € c.l r- a.l e.lt-- e.l el m N € O \o o o\@\i r- oo o\ Gl ra o6 iE .E H.et E E['€E c.) a.l\o @ r+ \o\o\N \o r- \o\o €ln € tr d ao Oi o AK 88. $= E8F8 o.l € o € 6 € € 6 Noo 6 ts.- E EE E [Ez t N r- N at r-+\t e.l c\It- € (.)$ c.l oi € 6 \o o\ @r- o.l st No F rai- \o \o A tsoE U.Z E (!,= <.s A'FV c.l @ N \o \o m +@cl c.l o o\ m$dl @ o\ cq o o oo o\t- i\o 6t\-\o o ,:. c 9o =.9 .. X'E c €E=ET H OE r-- e.Ir- .d c.l t..00 \or- € €n e.l c.) t'. !f o\ c.l@t+ t-.r-r- .d -t o\ *$. c.l t-(.t t'- F- o\ o\ t,q) b0 cd u)(.) troO ll r aa z:\ o\ c, .9 q:i bI) o- !s!d6 bD< doo oo O oo =ov'5 o- 3 E S*tr tr= o)l>uzd o .+ r- a.l F- a..l o\O co @ o\ ol oF- o\ t..6 \oo ra6fO ro :(.)E 5.i -Eo 2(.)3' li (J =tr=N r- a{ o\O @o\ e.l o c-. o\ t'.-6 \o c.) ln6(.l rn s E g=€f *^ +F-N r-N o\O aa 00 o\ c.l o c- o\ F-@ \o rat ln6(.l ln o(l) 'a Hpr It pGZEEEE6iJ-i O'F1= F =g€ () z F v JF ao r.1 v il o o& o 2 & o zDF F1 F o t-. A B Ua 14q) aq) \- 4 =o\ q) L t S s) E4 Iq) 5 J1 v) k (€ u) cBoLr(d (€ tr -l o t< th >.s U) rrl (n € c, tr(l) tr € rg(l) l<F r-f o.rl -ol cdlFI il o\oo c.l Lo € o) o.()a !t t, o Or{o rr{ \o qJ $Ltr : .!s $!6s c) Oo a9\'FS o -. tr$ Cd\98d .ltXE .E .$9's \Od$'o)as € Is .g 'io -tf :i f;€ELllAcula .elsu\EsSE:E(l)Esb sE o-o!t 5\iBesEI .S E.ciE E E.ST $ SR qE $ :ixls E PX EI g S :L HIE S $$Et S E. I 8l u s €s :IE I FE3ld s'sStrl cd i \su -=IF T ESat- - q){ .: s!ba qr$ s- Q\ 'i s-q ,, EBE .i sti rSf E!d\-bY r s-E E S$ -tr 's da.H S Sr!, E EsF rr nS3 i sS aa 2.6.2 What are the causes of absenteeism? Most of absentees are people who are migrants, business people and some who go away from their villages and even districts for farm preparation before and during farming seasons. Some of the community members stay out of their homes for farm activities throughout the year 2.6.3 What are the reasons for refusals? Unawareness in few community members on Onchocerciasis as a disease and Mectizan as a drug used for it especially to those who do not attend commturity meetings. Because the drugs are given to all eligible and are free of charge, there are rumors that the drugs are for contraceptive purposes, so some people refuse to swallow it. Mainly due to misconceptions and myths build against Mectizan that it causes male impotence. 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. NONE o 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 a a a t7 WHO/APOC, 14 September 2009 o\oo c.l Ltl)p E(l) o.(l) v) .t oo ni{o rf{ € s) s a, q) k- o' Lq) "o s L o) c * L. vq 4q) Qq) \- V't: L q) L N s FS q) E E Lroa bI) L oq ok C) € b0 lr 'u Eot{k oo o (d v)t! a V) C) o 0) a)tro E t) o Lr() u)qr o U)o V)(d O #r o-rl -ol(Bt FI =Ee.E b <.E E L ;P8 5E.SG,oi, == cI eE EEHt o> .2EN E$oa O- €x(*Y 139^ ap Eo-c trd9a =d(*i;o-o.=-a6 o) E E= rd@a(Jo -5 E,E o!'A xe q-l ,' A H -E,-9 rq (dEqPs'H $EEEs z 0 E o a. E a C FE -YL xdrD = 6.):H o.A>' O.l-looGl z =() .:(€ o.r ii - a5 i o q) b0dG.! = bI) >b xoa o bD * a o bo P$s -oO Nto o\o coa- cl oor- !+ € € r- € 9 o.l o\ r-F- @ 9 co € \o o\ tro ad oo oi o rr i ti o 9SaF Oo\< B-o o ll r t{ tI] El \oo\ o 'Eo =00odgb oo -coF o\ ao cn cl o r-\o v? r-\o r-\o r- ,a? r- o\F- sr- 9\or- c..l @ € ri E ,*9 o6 x9 4o iozfi o r- c'- \o \o .-i ,.1 Ea) d o.= =trliit uFFL,, ca \O^ $\o c\l a] vl r- a.l \o\o o\ co c..l € t \o r- Nto € $q co c\ ca € 6 € c.l o\O ral oi o\q o o\ co o\ia \o co o\ $r- + c.t \o co € (\.l(\] C\l €F- c.lr-$ ts *H _ E E"h .S'E o.r ho .6 csq'a9-1L-=- o E' 6. 39 o r- c.to ra) co @ N c.l c.) c.l c.) ca .f\o € \o to € c.t !+ rl o\ c.l co o\ o\ \oto r+q r- a.l crt$ tftrl o c.t @t- I.r$ € € € r-$ € c.l \o F- cr) 6 o\ o \or-\ F. CO\r- o\ o\ 6o oI) cl o tr tr o(.) o Ht{ ri q) oSo F oo\< B-o o EoQa.bo= $= Esst Ootrl o oo o oo oo oo o oo oo o oo o oo f.l qO o'a q a = Hg tr E= ii5 E-a !17 06 oo co lr) td d o.= 4Eo E (E.= < g€'FIJ la) € c.I i bt)d =q:E g E E+t.9"r b;; _ =.ts tr {'= tr).:J tr'' O E&eEa$E E6 oo o\ o\ ..l c] @\o c.l €r- c.l $it c.l car- c.l tq o.l \o o\ € -f \o\o t.. ta) o\oq$ Friaq$ \a @to(a & rI] r- o\ o\ € o\ o\ o\ o\ o\ ooo ol oo o.l Noo o] aooo o] $oo o.l o c.l \oooN F-oo c.l € o ol o\oo o.l o o o{ o\oo c.l kq) -o E o) Aoa$ Ci Or * B o\ -t) o ._Js - - ^9clI q) a0 GLIs'Bi:9Nri -v\t,$ !-'\-) t!-S. clLTEGt '-B,s 5 :SH .H-9\.=L\-!R,E6e=()Eio)EUE :N9 --I?gEEH 56t19O-Lc)()=9()a0t'=tEE i.2 .geE 9.=elLrtr,,aE= c)v -0-)o\xEo\I.IPOQhof+i r\trL\OeEj :hHtrEl s)9El iE-qE (D()I .-r3l E -w6-) +.bO=a-x!v$9bL E8-gEY iJcF!c,i)e9,o EEEtr()-!)tr0)LH9hE9{ .!4.=ra-E vt '-- tr ci o,1 '; c)l cn -l €l uLVI -Fl Fr 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)MOH ./ WHO N UNICEF tr NGDO Other (please specify) : Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH { wIIo tr T]IIICEF tr NGDON Other (please specifr) Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan tablets are ordered by the National Lymphatic Filariasis Elimination Programme for treating all NTDs after receiving total population from the affected community. We calculate the number of tablets require by multiplying the ATO times 2.2 then we get total number of required tablets. The request is sent to Mectizan@ Expert Committee for approval. Mectizan@ arrives in country through the same channel and is cleared by World Health Organization (WHO) which handles over to the Ministry of Health and Social Welfare (MOHSW). The MOHSW is responsible for delivering of drugs up to the District level through Medical Store Deparhent (MSD) . 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. Table l0: Mectizan@ Inventory (Please add more rows if necessary) ! Project Number of Mectizan@ tablets In stock from previous year Requested Received Used Lost Wasted Erpired Remrining MAT{ENGE (Kilombero district) 146,000 0 387,103 507,703 483 0 0 24,917 RUVUMA 34,308 0 2.427.600 1,807,822 717 0 0 653,369 TANGA 0 771,188 771,188 716,839 5l tt2 0 54, r 30 TUKUYU 24,285 0 9,939,203 224,917 33 0 0 9, 738,538 KILOSA 0 I,095.500 1,438,926 886,218 0 0 0 209,282 MOROGORO 0 880,000 802,000 728,447 0 570 0 73,800 TUNDURU 3 13,038 0 677,500 890,103 900 0 0 100,235 TOTAL 517,63r 2,746,69E 16,443,520 5,762,049 2,184 682 0 r0,854J71 How are the remaining lvermectin tablets collected and where are they kept? The remaining tablets are collected from the communities and returned back to FLHF where the DOTs or CHMT member collects them and bring them to the District Pharmacy. The District Pharmacist sent the tablets to the Regional Pharmacy where they are stored. Activities of Ivermectin delivery that are integrated into the national health care system in the country. 20 WHO/APOC, 14 September 2fi)9 Ordering Mectizan@ from MDP Clear and forwarding drug at the entry point using the existing system. Sending the drug to the affected areas using the existing health system Any other comments 2.8. GommuniQl self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, when? Since 2005 the CDTI projects have been conducting trainings to the FLHF staff on how to conduct Community self-monitoring Table l1: 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. o Increases community awareness on project ownership hence makes the community to respect drug distributors and contribute to project. o Community members have ability to solve together the problems arises during drug distribution and they plan for the way forward. 2.9. Supervision NATIONAL LEVEL- NTDs Secretariat J REGIONAL LEVEL- RHMT /RNTD Coordinator I I + Project Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meetins (SHhO MAHENGE 274 274 135 RUVUMA 1,127 136 352 TANGA 1,309 1,309 I , aJ 09 TUKUYU 298 135 49 KILOSA 970 62 970 MOROGORO 87r t70 r02 TUNDURU 536 350 2 TOTAL 5,385 21436 2,919 2T WHO/APOC, 14 September 2009 DISTzuCT LEVEL - CHMT /DNTD Coordinator I 2.9.2. 2.9.3. 2.9.4. FLHF LEVEL - FLHFs CDDs/ School health teachers COMMUNITY LEADERS What were the main issues identified during supervision? . Some of activities in the sustainability plan were not funded by Councils o Some of community leaders are not supporting CDDs neither CDTI activities in their areas o Community members were not given a time to decide mode of Mectizan drug distribution and selection of CDDs was determined by FLHF staffand community leader. Was a superuision checklist used? o Yes What were the outcomes at each level of CDTI implementation supervision? o District Council were informed on the impact of session of APOC support in the year 2015 hence they agree in principle to fund all CDTI/NTDs activities in their area. o Community leaders were agreed to support CDDs and CDTI activities. The district leaders have agreed to make closer follow up to the Community leaders to make sure that CDTI activities are well implemented. . The Projects conducted training to FLHF staff and urged them to adhere to APOC philosophy in the implementation of CDTI activities. Community members were given mandatory of selecting CDDs in the community meetings and also they decided on the mode of drug distribution. 2.9.5, Was feedback given to the person or groups supervised? o Feedback was given and the team emphasized on the new move of co- implementation with NTDs activities. 2.9.6. How was the feedback used to improve the overall performance of the project? o NTDs activities are featuring in the CCHP as the integrated one and all district has set aside fi.rnds for the implementation of NTDs activities in year 201012011. SEGTION 3: Support to CDTI 3.{. Equipment Table 12: Status of equipment (Pleose add more rows if necessary) 22 WHO/APOC, 14 September 2009 Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle J lF,2 CFNR I F 2. Motor cycle(s) 3. Computer(s) 4 1F 3WO 2 F 4. Printer(s) 4 IF,ICN FR, 2WO I F 5. Photocopier (s) I wo I CNFR 6. Fax Machine(s) 1 wo I F 7. Others a) Air Condition F I F b) LCD I wo 1 F c) Digital Camera I wo *Condition of the equipment (F:Functional, CNFR=urrently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? 23 WHO/APOC, 14 September 2009 3.2. 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NN@ d c, oo o- (Y)(9 oi oo o- G'G' c{ lO @l'- .f lO @ oN oo ro- @(o N J ro 10G: G'!oo G' ot It dN soo$r '6 Il t, UI Gt,tr -cGo o N o =F tr o 5 .o E oo Fz IJJ =ztr UJ o o I i I ooq ro @t d oo o- rr)t'-|r) (o @ oo rfr- o @o c{o oo o- (Y)(r) e.i I I oo o- G'G' c{ rO @F- tlO @ oN ooto(o(o ol - ro @Nd co o, G' lo @N !oG' (o G' UJz F ul(9 o3o tr o G .N Eo o so G o €* $fi SE4rG ss{o E o o .N .cI o =n c o o .N =oc o U) .ri () (E o o ! "1F c o oofE o E =(l, o - a G o IaI 3n EIc s q oooo o cD .sc 'd L o ote .El(EI FI .trlNI 2(, .YL o =.C =oo J- o(, .E c (E L c)L c,) .Ec 'E F ..i N G o aa5q tr o GI G IU dt 'tr o o s o ltI oaI c, c .9o .E o CT =U) - <'i oic L o .=c o ..i(", c o o E [rJ ci (f, G o dI U, g so o o!ra EgstOG EE *gGO aa ,at5 EE]oo ES 0Hl IEI c .9 =lt .o! E oo E q,2 -$ ooL o o o E o oo o ol t o c o o) tE o IaI U, oo 9. oax o as o E! J o o Lg o U) -d E o E .slo UJ ari lo G o aoI U, o o z tr o (,) o)L t) Cd (.) L{ € cG a o s Lr I o() CtI() C6 tri g; ?a q) a clF o\oo ol L()str(l) 0.oV) .f o Or oo(\I 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) N/A 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 1 usD = Tshl350/: - Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated or monitored? (Tick any of the following which are applicable) None Year 1 Participatory Independent monitoring None Mid Term Sustainability Evaluation None 5 year Sustainability Evaluation N/A Intemal Monitoring by NOTF N/A Other Evaluation by other partners 4.1.2. What were the recommendations? N/A 4.1.3. How have they been implemented? N/A 4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting N/A 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: 29 WHO/APOC, l4 September 2009 4.2.1. 4.2.2. Planning at all relevant levels o At National level Oncho Control activities features in the MTEF and are being mentioned in the National Health Policy. At district OnchocerciasisA.ITDs activities has been included in Council Comprehensive Health Plans. Funds o The MOHSW has been supporting the Programme by providing funds to implement activities such as monitoring and supervision, payment of Telephone bills also to enable the Hon. Minister and delegates to attend JAF meeting. 4.2.3 Transport (replacement and maintenance) o Programme still depends on APOC for provision and maintenance of vehicles and other capital equipment. 4,2.4. Other resources o As we are embarking on NTDs the other source will be USAID. 4.2.5. To what ertent has the plan been implemented o Activities are being implemented according to cash flow and release of funds Sometimes funds are not release on time therefore there is delaying in the implementation of activities or frrrds not release at all so it affects the plan. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4,3.1. Ivermectindelivery mechanisms It is incorporated into the general delivery of govemment drugs up to FLHFL 4.3.2. Training Training has been conducted jointly with other NTDs prograrnmes as now treatment is also done in an integrated manner. 4.3.3 Joint supervision and monitoring with other programs CDTI activities have been integrated with other NTDs prograrnmes hence supervision is done jointly at all levels. 4.3.4. Release of funds for project activities Integrated in CCHPs and MTEF and depends on the cash flow 4.3.5. Is CDTI included in the PHC budget? Yes at National level and in the District level. 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? 4.3.6. 30 WHO/APOC, 14 September 2009 a 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?) Describe others issues considered in the integration of CDTI. o Mode of drug distribution is same with other Programmes moreover the community to be served are also the same therefore it is cost ef,flective to serve the same people at one time. o The disease itself has common feature that many affected people are those who lives in peripheral area at the end of the road where people are not getting health services easy. 4.3.7. 31 WHO/APOC, 14 September 2009 o\ N L(l) -ot (.) r o)a t d o Or s o ilr FtoN NoN rl N Ol r/) oo'NN o Ol6 oN(n <f F\ rn N 6l oF o I 6l c) o O q) a o! z N co l%t\) l\ IBll<lq) .q)\ a- q) B q) V q) a4 Va o I Lq) q) s q) qt otr O 0q) 6ttsA (t oF N @N N F- st F{ N sf r+do rn .i r{ N sl <t(o ot/l F{ F{ Oll/to NN(o FI Oq) ct q)E Eo q) a0 6l o oa oa o o! z q o(l ET2 ql oF olNN N Fl No Ol F{ t\ rn r.oo(n No Ol r.l r\,1 O)r\(n lr) ql c)fr 0q) O n eUsq9 LO(l)>&tr z 0 €) 6 E o I6oil rn €(n lnE.E6E ^o=EE z6 cl to o u0 ql t'r rn @(r'l rn () () Gtoil @ r'{ N(n for{ N(n (^o o I 0 ,lJ o o z (l) o u0 6F @ Fl r\(r') FlN N(n (o o n US a,G ^ E.S Eo -.s>,.= Ott" .ET oil -ts3e2L-=.-L .o H E.96i5€t(D CL u 6.; 8 3t 8boo bO6 =E]PL0]L(,l,oCJoo aaaa -tsEeL-=.-L .o x 5.o6i5€t0) Q- u 6.; 8 3t 8 o00@6 :fC:f,PLO)L(!o(Joo aaaa - PE p .9HE.o E E€ E 8 sti 8OOh OO6 =ctPLorLrgouoo aaaa -PEp .0'* E .E6t€rOCLu6; 8 st 8O0o OO6lC=PLorLaooLroo aaaa -ts8sE.EEEtii€tOQ-u6.; 8 3t 8OOo bO6tc=PL0JL(gouoo aaaa .o o: e6tttrrtD _c .:o6E9E (Uo>E a o r(lJOo EN -(E -6t E(lJ .9 -OOE a o_ co .9E =(! €6 ,: .Fa^(! oo- a ogco .eH =1,eb .L -oir0Ji5> a o C o .=) ll '-oi= o= a o Pc o E(u- -. ho .= E EEAl!(EiEE a E o (!Pc<o cE '= (Uh* >-q a a a a oo e!3tr .-. oF(.) t) C') CB oL a)9- .EPOE 58 o Paa Eu)Q(d liLFCd U)d tr o(/) o v) oAut F Fa oL{q o d L c, z olr oo cd li(l (g \=ia o tr Cd\<z dtr o c)(€ kF (n o GtLr cl d(-) -& E'guo I o .-5) cg+. -I() - -L 4) -x -xL .- Io() t t-l q) -E cttr o\oo o.t L(l) -o E(l) o.()a s Q Or B co c.t aaq) s_ BRq) .q) aa q) L v q) ".sU s) \q) U) C1 q) Lq) q) s 0q) +. I II I oo +( o q) : q) o - 0 €J() ooq) 0 o O o ti 6l () c !Etr ,y qD oa(l)il IIrJ l! ottr8f; IIIJt! 8u8g t-e6i 9 r.l oEro(!J-Olr\F (! l!EJ l! t! -J l! 8r8g bD 'E= o2?- u) EQ .gc =E E o L) Zc =E E oU 2c f E E oU .=c a E E oU t=E =E E oU o 6 o E(u a o 0 () O (! I -J l! (! l!IJ L Gqr3 IO>r =EjF (! L IJ l! (! P l! -J tl- E- liO E 6ooU ooI L - -o)o=_c €a x(J.:go vtLl- ooU oo(J tP.F E.9 0a) oo() oo(J g - -o)o=-cO= (J6_d3(.,)!F (q t!rJ t! ooU OE Er E sEH ooL) oo(J g --o)o=_cO= I583(, IF (E L -J l! oot) :o =a)5EocJo9EgE .=cf E E oL) .=C =E E o(J g OJ E --C3H l! 2 CE =(!,P =qEL85 .E E E o(J b& '=E su)A oE o .= f -oq.- @6- 2E o E = .o @6-Z'r, o .F Erc€ O(l,L €3E.(,-o!o ,F = -o GG -ZE o .F ll tl-q- ZE o o q) a c(! (J o c(! I uo c(! uo c(! I P() o c(! I (J o 0o q)(l c o =lt@'E -qOE c o) -o .9 ! u0) o c o .F f .ct .qE oof Lo c oE = -o o0 'tr OE c oEfll o0'tr -6o!, o (l)t() o (l)q Fr -C .=oEEor= L L o)q -z€ a rt o c(l,) .OOPN =(! _o 'o Eq, .9 -ooE a Io_ co oP- =(! €6 .-Ni,^ (! Oq. a Sog co .eH €bb-oa^(l,i5> a o c .9Pf -o '- tA *-4 i5i a o Pc c, E , s.Ec=(o ^lE(EiEE a c .9 (o L <(ucE '= Q) rsi > -vt a a a a a o o(J o q)q F (, .A(g oLr(l)tz -qtro= 68 U) rn(! L(d rE o (d a Fl ah cn C€ o ar) o U) oa rJ<Fa oL oo 60 t-d (€ z L! oo (d L(d rd z o L tr (n z (! o o cl F ah o CdL CI d O ,h oq)&t, .r) o o q) $ L a.o'T\ $ v) s *\et) (l) l-{ O J l-( a aU o0tr u) U) C) tr Cgf-r o0 o t-<q L<(.) o rii -q) -E GIF a4.4. Operational research Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NONE How were the results applied in the project? NONE 4.4.1. 4.4.2. SEGTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. Strengths o The National Onchocerciasis Control Programme is within the structure of National Primary Health Care under the directorate of Preventive Services in the Ministry. o CDTI implementers are well knowledgeable of CDTI philosophy at all level. o Ordering and delivering of Mectizan@ tablets is within the existing health system in the country which allows the community to collect their drugs from the nearest health facilities. o Government release funds for the implementation of CDTI activities through the MTEF to support NOCP activities. Weaknesses o Unavailability of past data in CDTI projects offices which cause difficulties for the National office to respond to urgent data needs from the APOC management. - List the challenges and indicate how they were addressed. Challenges o In some district, NTDs activities are not featuring in the CCHP. Conduction of sensitization and advocacy meeting to ensure that all CDTIAITDs activities are in Comprehensive Council Health Plans, to ensure that the activities are funded and fund are released timely and to ensure a progressive increase of funds by districts/council through CCHPs for the implementation of CDTVNTDs activities. a The projects were subjected to write more than one report while reporting on one thing implemented at the same time (CDTUNTDs), this gives them more confusions and delays in reporting. - There is a need to consolidate reporting format to have one for all NTDs. r Lack of NTDs IEC material which were supposed to be distributed in all five regions - NTD secretariat is working in collaboration with APOC and other partners to make sure that IEC materials are developed and distributed in all five regions. SEGTION 6: Unique features of the proiect/other matters: None 34 WHO/APOC, 14 September 2009