Mwanza CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from April 2004 to March 2005

t\ ORIGINAL : English COUNTRYINQIE: MALAWI ProiecJ Nome: MWANZA CDTI Approvol veor: 1998 lounchinq veor:1997 Reporlinq Period: From: April 2004 To: Morch 2005 (Monlh/Yeor) ( Month/Yeor) Proiect veor of this reporl: (circleone) 1 2 3 4 5 6{J(8) 9 l0 Dole submitled: 3OTH. MARCH,2OO5 NGDO porlner: IEF ANNUAL PROJECT TECHNICAT REPORT SUBMITTED TO TECH N ICAL CONSU TTATTVE COMMTTTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Monogement by 3l Jonuorv for Morch TCC meeting To APOC Monogement by 3l Julv for Seplember TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROT(APOC) 5o { (, I I '-r "il(L I t' '),Li't,,i itr,' I .L i:O,. r,-,1:rir,c ro \ i,r, rO' t\ r' ,t 1", -' ,, r ,, 1 ( 3 0 A0tJl 2000 I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Pleose confirm you hove reod this report by signing in the oppropriote spoce. OFFICERS lo sign lhe report: Country: MALAWI Notionol Coordinotor Nome: Mr M do Signoture: . c) Dote .*, This report hos been prepored by Nome : Popius Mtunduwotho Chiwoyo Designotion ncho. Coordinotor Signoture:. . . . Dote:. l.?. . . . !a.4.:t + .L opt. District Heolth Officer Nome: Mr W P. Tomoono Signoture, ,4f^ Dote: ..1 .q I.,.q2..f ,-...2P.+.L. ftfu'{to-e 2 District O W I Toble of contents ACRONYMS DEFINITIONS FOLTOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION l: BACKGROUND INFORMATION GrNennL TNFoRMATToN l.l Descripfion of the project (brietly) 1.2. Portnership............ PopulnloN............ SECTION 2: IMPLEMENTATION OF CDTI 2.3. MoatltznloN, sENStTtzATtoN AND HEALTH EDUCATIoN oF AT RrsK coMMUNtTtES 2.4. CoUUuNTTYTNVoLVEMENT 2.5. CepnctrvBUr,-DtNG 2.6. TRrnrueNrs............... 2.6.1. Treotment figures ... 2.6.2 Whot ore the couses of obsenfeeism? 2.6.3 Whot ore fhe reosons for refusols? 2.6.4 Briefly describe oll known ond verified serious odverse evenfs 2.6.5. Trend of treotment ochievement from CDTI project inception to the current yeor......... 2.7. ORorntNo, SToRAGE AND DELTvERy oF TvERMECTTN 2.8. CouuuNrry sELF-MoNrToRrNG nNo SrnrrHoLDERS MerrrNc .t I I .2 2.9.t. 2.9.2. 2.9.3. 2.9.4. Provide o flow chort of supervision hierorchy. Whot were the moin issues identified during supervision?................ Wos o supervision check/ist used? Whot were fhe oufcomes of eoch level of CDTI implementotion EeurplarNr FrNnnctnl coNTRTBUTtoNS oF THE pARTNERS AND coMMUNtTtES OruEn FoRMS oF coMMUNrTy suppoRT............... ExprNolruRE pER ACTrvrTy............. supervision? 2.9.5. Wos feedbock given to the person or groups supervised?.............. 2.9.6. How wos fhe feedbock used to improve fhe overoll performonce of the project? .......... SECTION 3: SUPPORT TO CDTI 3.1 . 3.2. 3.3. 3.4. SECTION 4: SUSTAINABIIITY OF CDTI J 4.1 . lNrrRNnl; TNDEpENDENT pARTtctpAToRy MoNtToRtNc; EvnlunrroN t !l 4.1.1 Wos Monitoringlevoluotion corried out during the reporling period? (tick ony of fhe following which ore opplicoble) 4.1.2. Whot were the recommendotions?.............. 4.1 .3. How hove they been implemented? 4.2. SusrnrNnarLrTy oF eRoJECTS: eLAN AND sET TARGETS (unNonroRy AT YR 3)............... 4,2.1. Plonning of oll relevont /eve/s 4.2.2. Funds 4.2.3 Tronsport (replocement ond mointenonce/............. 4.2.4. Other resources 4.2.5. To whot exfenf hos fhe p/on been implemented..... 4.3. lNrroRnroN.............. 4.3.1. lvermectin delivery mechonisms........... 4.3.2. Troining 4.3.3. Joint supervision ond monitoring with other progroms 4.3.4. Re/eose of funds for project octivities.............. 4.3.5. /s CDI/ included in the PHC budget?........ 4.3.6. Describe other heolth progrommes fhof ore using the CDTI structure ond how fhis wos ochieved. Whot hove been fhe ochievemenfs? 4.3.7. Describe ofhers issues considered in the integrotion of CDTI 4.4. Oprne,TroNAL RESEARCH 4.4.1. Summorize in not more thon one holf of o poge the operotionol reseorch undenoken in the project oreo within the reporting period 4.4.2. How were the resu/fs opplied in the project? SECTION 5: STRENGTHS, WEAKNESSES, CHALTENGES, AND OPPORTUNlTlES........ SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS. 4 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO Africon Progromme for Onchocerciosis Control Annuol Treotment Objective Annuol Troining Objective Comm unity-Bosed Orgonizotion Comm unity-Directed Distributor Community-Directed Treotment with lvermectin Comm unity Self-Monitorin g Locol Government Areo Ministry of Heolth Non-Governmentol Development Orgonizotion Non-Governmentol Orgonizotion Notionol Onchocerciosis Tosk Force Primory heolth core Ropid Epidemiologicol Mopping of Onchocerciosis Severe odverse event Stokeholders meeting Technicol Consultotive Committee (APOC scientific odvisory group) Troiner of troiners United Notions Children's Fund Ultimote Treotment Gool World Heolth Orgonizotion 5 Definilions (iv) (i) Totol populotion: the totol populotion living in meso/hyper- endemic communities within the project oreo (bosed on REMO ond census toking). (ii) Elioible populotion: colculoted os84% of the totol populotion in meso/hyper-endemic communities in the project oreo. (iii) Annuol lreotment Obiective: (ATO): the estimoted number of persons living in meso/hyper-endemic oreos thot o CDTI project intends to treot with ivermectin in o given yeor. Ultimote Treotment Gool (UTG): colculoted os the moximum number of people to be treoted onnuolly in meso/hyper endemic oreos within the project oreo, ultimolely to be reoched when the project hos reoched full geogrophic coveroge (normolly the project should be expected to reoch the UTG of the end of the 3ra yeor of the project). (v) Theropeutic coverooe: number of people treoted in o given yeor over the totol populotion (this should be expressed os o percentoge). (vi) Geoorophicol coverooe: number of communities treoted in o given ),eor over the totol number of meso/hyper-endemic communities os identified by REMO in the project oreo (this should be expressed os o percentoge). (vii) lnteqrotion: delivering odditionol heolth interventions (i.e. vitomin A supplements, olbendozole for LF, screening for cotoroct, etc.) through CDTI (using the some systems, troining, supervision ond personnel) in order to moximise cost- effectiveness ond empower communities to solve more of their heolth problems. This does not include octivities or interventions corried out by community distributors outside of CDTI. (viii) Sustoinobilitv: CDTI octivities in on oreo ore sustoinoble when they continue to function effectively for the foreseeoble future, with high treotment coveroge, integroted into the ovoiloble heolthcore service, with strong community ownership, using resources mobilised by the community ond the government. (ix) Communitv self-monitorinq (CSM): The process by which the community is empowered to oversee ond monitor the performonce of CDTI (or ony community-bosed heolth intervention progromme), with o view to ensuring thot the progromme is being executed in the woy intended. lt 6 encouroges the community to toke full responsibility of ivermectin distribution ond moke oppropriote modificotions when necessory. 7 I FOttOW UP ON TCC RECOMMENDATIONS Using the toble below, fill in the recommendotions of the lost TCC on the project ond describe how they hove been oddressed. TCC session (P/eose odd more rows if necessory/ Number of Recommend olion in the Reporf rcc RECOMMENDAI'ON s ACI'ONS TAKEN BY THE PROJECI FORTCC/APOC MGT USE ONI.Y 1 tExeculive Summory CDTI progromme in Mwonzo is on susloinobility phose since 2003. Efforts hove been mode to improve both geogrophicol ond iheropeutic coveroge. lr/wonzo hos monoged to improve boih theropeutic ond geogrophic coveroge since 2003 ond our geogrophicol coveroge is now 100% ond theropeutic is now of B0%. The following is the 2005 treotment ond populotion dotoq Totol populotion .l68,863@ Totol villoges 256@ Totol villoges treoted 256@ Totol U/5 21,336@ Pregnont Women 2,286@ Totol very sick 648@ Eligible pop 144,616q Totol Pc,p treoted 134,730 e Percentoge coveroge 80% CDTI octivlties in Mwonzo now cover 256 villoges os compored to the previous 156 villoges. The theropeutic coveroge for 2004 wos73 %. BACKGROUND. - CDDS, heolth workers, Totol populotion (community) per CDD troined. Most people in Mwonzo ore formers ond they hove their gordens in the neighbouring Mozombique ond during some seosons they move to thot side for forming. Some others eorn o living through businesses ond they trovel to ploces like Blontyre, Lilongwe, Boloko etc. @ ln 2004 Mwonzo with the ossistonce from WHO - Molowi, hod monoged to troin 330 CDDs in the newly introduced CDTI oreo. e There ore of leost 2 CDDs per villoge. L Chollenges ond how they were overcome. r' Ihe moin problem we hod wos luck of funds to trcrin ond refresh new ond old CDDs respectively ond olso their supervisors. Mony Villoges hove insufficient number of CDDs resulting from eilher dropping out or deoths ond in some oreos HSAs hod to toke over CDDs' responsibilities. - Another problem wos the deoth of the then District Oncho Cordinotor ond o new one hod to toke over ond coupled by being o new member of stoff in the District some hiccups were experienced in the implementoiion. 2 Oncho teom from Thyolo come ond helped us in mopping our way forword. ,/ Plons ore olso underwoy to brief members of DEC ond other NGOs ond stokeholders on Oncho so os to solicit their support in CDTI octivities. J 'SECTION I : Bockground informotion I .l . Generol informotion 1.1.1 Descriplion of the projecl (briefly) Geogrophicol locolion, lopogrophy, climole. o Mwonzo District is in the southern Region of Molowi, It borders with Blontyre district to the Eost, Chikwowo district to the south, Republic of Mozombique to the west ond Boloko district to the North. e Mwonzo District is mountoinous except olong the Shire river. P opulotion: octivilies, cultures, lon guoge. o= The CDTI populotion occording to the CDDs ond Heolth workers 2005 census is .l68,863. G Most people in the District eorn o living by doing forming. Commonly they grow moize, the stople. A good section olso relies on growing tongerines os o cosh crop, which they horvest from April to July. o The people ore originolly Ngoni but due to inter morrioges, the Ngoni culture, which wos there in Mwonzo district, is now diminishing. a The most common locol longuoge in the district is Chichewo Communicolion sysfems (roods...) ln Mwonzo district, there is only one moin tormoc rood, which joins Blontyre ond the Republic of Mozombique. There ore some secondory roods ond feeder roods most of them in very bod condition. - Administrolionstructure e The District Commissioner is the overoll lnchorge of the district. Most octivities in the district ore run by District Assembly. - Heollh sysfem & heollh core delivery. e ln oddition to the District Hospitol the district hos got eight Government Heolth Centres, 4 CHAM (Christion Hospitols Associotion of Molowi ) Heolth Centres, 2 privote Clinics ond I Compony heolth centre. 4 Number of heollh stoff in project ctreo ond number of heolth sloff involved in CDTI ocfivifies. Toble l: Number of heolth stoff involved in CDTI Dishicl/LGA Number of heollh stoff involved in CDTI oclivilies. Totol Number of heolth stoff in lhe enlire projecl oreo Br Number of heolth stoff involved in CDTI Bz Percentoge g.=12l Br{'100 Mwonzo District Hospitol 205 .l50 73% l.l.l2:Portnership a ln Mwonzo, there is no ony NGDO, NGO ond CBOs, which ossist in the implementotion of CDTI octivities. CDTI octivities depend on District Heolth Officer's budget colled ORT (Other Recurrent Tronsoctions) e The overoll working otmosphere in Mwonzo is good wifh the support from DHO, who gives the progromme oll necessory support from the ORT. -However funds permitting plons ore under woy to sensitize other stoke holders like DEC (District Executive Committee), Assembly, ond other CBOs ond NGOs so thot they should toke on octive role in the implementotion of CDTI octivities in the District. 5 \o a(l) ci () q) o'\\g q) >\ a) () \)L q) -a q) s r3j= $\:\ -u .[i a_Eq)s) "S >' Ss %O'Bx sqr .ts E{ tB q)( $!Su ta()p!\P o L()a oo L o a. c) r<() o0 li C) o o C) 'a L o L .o C) ah c) C) a c6 $\\':SUis. yq) Y-O\J! \i !-\ o:: E.h. a-9br 5=' -a: Suo .:L HP \9 s" -r .Y ci$ :M *::\ ild t\S\U % L q)L t 4 <, o L o o. o0 L o 0) li o bo L Lo C) 63() L oLd >'(.) L 0) 0) B c! q,) Iq) q) q) C) JZa L o (B p. o a. a 0) () c-ir ol -oldtFI E o fl6 fc oE N F Fp=ECE = fl9 \olr) $ \oin t + il -ruo .= oNt -3.gE> EF 8€ co\o oo od\o tl\o6 €\o r.:E gtsE.Eu; >rEoo\EEEg \oo\ri o\ \c o\ Fr o\ Cr 'EgB ^9= HE.=??0.,Egsi NO cr N Fr I c) -o ON 6() F + il \o la) a.l \o ra N .e3E'-:E. E o :''l9E Ei!6(l)E >roFE N N$ G{!f ah o AT cl U) c) o Lq) z 'EgE :i: tr .= ,!:',1?oUo E'=3S! 2 + $ 6ttr9 uv-t- L !t9.- -g-Ja9E = O.SlX *o 9' -v9-rLA-A c.)\o @ oo\o t)\o € €\o 4)() 'arodEL0)irE LlfcG E:.qA!O cg N (€ B I F F r- ;+(/, C) o+ .g o)c '= o _c a/, Ef ar,l i =o O o o c =+' o)c 't o o ob .C o alll o _c E 0) ot/, oc o C o E! o o _c o o) o o a/, Ot/, o E o Q Oy;Pb\J:: =o>-oOp ocNOl-69()3\<E<-_ t-O os+ oC o+tlt C)c Cf o o -c =,9 .CF C.) o) _a 't o =Cf E E o U oc+ arl C)+)+ +t/l C o O + o -C 3 C) C l+ oo o o) _9 o =Cf E E o(-) g E9bo++ -.o(U ,\ !.-+O o)xC- '6(l)l-c+(D-bo -oJ-OE>gtsO =O oo vl (, o f ot) o -C+ o o o O tltlt/, c o O E C o + oz o" O5-oo ./) > N. o oo o o E o+ o _c+ .C o+ o r3 oc+ o o o l oU) o -C+ .2 + os; oz F SECTION 2: lmplementolion of CDTI 2.1. Timeline of octivities Fill in toble 3, timeline of ocfivities for oreos treoted in current yeor, indicoting when the key octivities were implemented by the month they begon ond the month they ended. 8 o\ +c o E E o U I E o u)(r, o O o C h aa) oIr C)l* o E !! o C) rn o e o_ o 0) +c o l U o -C+ .g o o+ o o + l/', o o o o -C+ oF .q+ :>+ O o o o .Eb E F c.ir ol _ol olFI c .9 aa .E ooft1 8=oEooEEO-o- o)c 'o o) C o EDa E9 t) - o) C 'o o) C o tr o fo .2! of o E-c9cE 5.e P o + O o EDa E9 o C) ./) o oEo = aA D aatr oU E..9cE 5.e P U Cl -) EDa bP o oc .s o EE9cE 5.e PU z EDe E9 ar', - z Ogr -aOE tr2NI- 6E5o =u E-tr9cE E.9 P U EDa b9 ,rt - U ta o oNC o 3 o 2.2. Advococy This octivity wos not done in the just ended yeor ond one of the mojor reoson wos lock of funds to coll together vorious leoders for on odvococy meeting. 2.3. Mobilizotion, sensilizotion ond heollh educolion of of risk communilies Mobilizotion ond heolth educotion compoign were conducted in the yeor using Dromo group ond megophones were olso utilized for publicity. The dromo performonces were blessed with o good turn up of people of o cross section of oges ond this brought obout on increose in the theropeutic coveroge. Funds permitting we wish to orient odditionol locol dromo groups on Oncho so thot publicity ond mobilizotion should be continuous during their other performonces in the communities. Sensitizotion wos olso done in churches, schools ond of other meeting ploces. 2.4. Communityinvolvemenl Toble 4: Comnnunities porticipotion in the CDTI (P/eose odd more rows if necessory/ District Number of c ommu nities/villoges wilh community members os supervisors Number of CDDs ond lhe communilies involved Number of communilies /villoges wilh femole CDDs Totol no. communi lies in lhe enlire projecl oreo Bn Number with communit Y members os supervisor s Bs Percenl oge Be= Bs/ Bq 'r100 Mole CDDs Bt Femole CDDs Bs Totol Bs= Bz+Ba Number of communit ies with femole CDDs Bro Percenl oge Brr= Bro/Ba*l 00 Mwonzo 0 0 0 289 309 598 256 0 Totol 0 0 0 289 309 598 256 0 10 ./ During heoth educotion meetings we sow o higher number of femoles thon moles but the fewer moles tended to dominote in the discussions. ,/ So for no community is giving incentives to its CDD. r' There is o high ottrition of CDDs. Mony villoges do not hove their CDDs ond Heolth workers were doing CDTI octivities by themselves. We ore plonning to conduct o Reseorch to determine the foctors thot ore contributing to this problem so thot in the long run we should curb it. ll 2.5. Copocily building Some HSAs ore not yet troined on CDTI concept. Monogement is trying to ensure thot oll HSAs ore troined so thot once tronsferred the incoming HSAs should be knowledgeoble. t2 ca o C + C) o O ao) o! o C U) ot* o * + o * o\f, an q) -\z o r. C o E+ o+ o r_ E C oaU) ot- o o o e + op ol* a eo o o o + o C o+ o! : L C.)g ] C) 7 * \L- o u.tta q) o C) :* v',) ol- o o Et! o otn o o or C o o+ C o E o o E =o(-) ts o I o o + c o ots =!() s + o o)c :s o F ,rit ol _ol olFI E otr o a^o o U o o .o Efz EU+.p966u E.o U : U o o< iq) z z z z tr o E o .9 .c U bq (Yt U o Z 3 oEa '6e EO O- TEo.= !.OttEofz [+c{o66u o U U E o o o< f: Z = z tr o E o .9E U bq orUio z E* Eg otaEio =oor.r6c E E-E trts =oI r-t E-o;o Ir d U l- o o< = z tr o E o .9 -cu bq lo Uio z aa o .12 o .9 at OE oE C, ta -o E Dz En+o# !l c{ r'i9UU" (, U c{U C) o< i oz = z z co E o .q -c u bq 6o z U an o oNc o ; o Toble 6: Type of troining undertoken (Tick the boxes where specific troining wos corried ouf during the reporting pe,iod) Any other comments Troinees Type of troining CDDs Other Communi ty members e.g Communi ty supervisor S Heolth Workers (frontline heolth focilities) MOH stoff or Other Politicol Leoders Others (spe cify) Progrom monoge ment NA NA NA NA NA NA How to conduct Heolth educotion Monogem ent of SAEs CSM SHM Doto collection Doto onolysis Report writino Others (specify) t4 2.6. Treolments 2.6.1. Treolmenl figures lf the project is not ochieving 100% geogrophicol coveroge ond o minimum of 65% theropeutic coveroge or the coveroge rote is fluctuoting, stote the reosons ond the plons being mode to remedy this l5 t-{lolo lro l-, _{ o o + 3 of+ o :lo (-/, TN aJ1 o o6'+ =.o+ t- C) ='g o o o o+ =.N I o oltt o oaa 3 o d d{ <rt =f, o o o U)(tt o3 o { ofN o -.Ul6o=>o+ N)(lt o. N)(, o. "eoqEA},fa3-+ o o 3 3 Cf. ott 5 o(o o ara s5 o. o. s5 o. o. I a'+ co co I lll naLa Jn?' (D= IN N)(.rt o. N)(.rt o. +fa!7d o =d eo-q g 3 q 3&*== [I(., oo Oo ooo Y/I -'r (U -.-'q o 0 6',Po oE(o -o -:P.s O:' llo I o.po @ o.(, o. -@@ o.(, oo 3 ! e aH P = e ! dggi*.e.3qI(r -E oo C o =of s5 o. o. s5 o. o. 'E= *e C, o. (,5\(, o (,I\(, o +o zoo co;oIg3 *E-I @o bq @o bq 8E B3$o "1) I6*UU -i{ oo\' llo I\)\o o. N\o o. * d =3;E e fr+6 B f 6 e =J iie = -o _c -O N)(.rl -G\o N)(lt Oz fi 13 5a-o o o 9e-rnO i - *o o o E3g;$69frH.il l-Tl lota t3lc lol*lo t; lolf lo ICl+ lf tol*tf lrul-tob lolcl= lo lo l= lo- to lo to Iol-to Dlf o o ; o o o lo ott lzlc l= lcr lo t; E. lolob lq ldlol+lolo lxt-tolo -{o+ o o o1l C o =o = l(o ='3 otlt o :t .i3 o T ofo o 3 -' o o 3 3 Cf =o lr1 {+z =+ J o o -4.o o+ o o o d" o Ztz 3lE Bl+ - l(Dol- -lOlll eluolf\- l= =lJ-( lc]f, l=ol= tsls:tiIEJ(o o'lg ol= 913ilaglo +lx s18 o ?.o of+ =oo o. n TN o ='+f o o -0.og o d o -{f o o ^o>qo v(- =o o o o o(o o o + o o o o(o ^=ro L)o\- -L' f o' o_ o o o o(o o o + o o\ n ro icol Theropeutic coveroge rote = Number of people treoted x .l00(%l Totol populotion living in meso/hyper-endemic communities within the project oreo Geogrophicol coveroge rote = Number of communities/villooes treoted x 100 (%) Totol number of meso/hyper-endemic communities os identified by REMO in the project oreo ATO coveroge rote (%) Number olBeaplqtreqled x l!0 Annuol Treotment Objective % UTG ochieved = Number of people treoted x .l00 Totol number of people to be treoted in meso/hyper-endemic oreos within the project oreo (UTG) ATO = Ihe esfimofed number of people living in meso/hyper-endemic oreos thot o CDL project infends io lreot wilh ivermecfin in o given yeor. UTG = The moximum number of people fo be lreoled in meso/hyper-endemic oreos within lhe project oreo, ultimolely lo be reoched when the projecf hos reoched full geogrophicol coveroge (normolly the projecf should be expecfed to reoch the UTG ol ihe end of the 3,a yeor of the project) 2.6.2 Whot ore lhe couses of obsenleeism? Mony people ore out to Mozombique for forming during the distribution period. 2.6.3 Whot ore the reosons for refusols? Religious beliefs. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period ond provide (in toble B) the required informotion when ovoiloble. ln cose the project did not hove ony coses of serious odverse events (SAE) during tiris reporting period, pleose tick in the box. No SAE case to report 18 l-{lolo lo lod^ < (,6o6 =oJ-ooo*;o(Da QO3s oo o o o of+ G mI + f o+ o o o C a oo oc =.f(o + f o oo o - =f(o o o =.oo T o ol/, o o o_ o- 3 o o * ctt o a. f, C 3o o o + J o tr o + of, + \o a z * o (o a ox o< q.o fCI o o x5 0 <u+o r 6-oQ- Oo' N 3! 3E =Eo6 -q o <r', 3o+ o 3t, = f +$g{Sto d - j o $il= aE =+ J oi<j A'o6'- Q'A- d" 3 P =o_l3 *'<r 8o(J- 20*nJ/1:XO a 5 dE = L2^ +J =o6qx a'p 3 0oocQoo'd *o o o f o(o m s -'3 q #(_:ro=):2r)0oo=+)J I f ='> 1.,I !,' of o. o o o 3 of o o =o o 3 o :, o 3 o(f =I, o o o =o oE of o t o o c o = o o A l:tolu El[ _{ o o+ 3 o f +vt ofo o o o o CI o lo F< lo lo loll lo- lol- o o o + f o o = =o E o o o o oI t.. o o Ut o 5 =o oac o o. O! e6-5sdoGt ='oa o6'O6 sqo= =oO- g6t q J o E .0. o o o Ct o =a ct C o o t 5 o CL o =o l. =o o =o c o ^o QcdE; d t\)oo(, N)oo N) N)Oo t\)oOo \o .O\o G -O @ \o -O\ TN n r 3 {.R _{ - o o <.x oQ I ? := + *B A'3il,fl= ?tu )< \v -t ='o :. = 9- "(D f o I a'+g._A- oo-lYf +-; a tn]9 aga=,*m(r, rn ^o oO dtnBs t "8,8 o 8st3 o llr! r,r o\. llo o o 3l Cf o't/, 5 o() o A f ooO i- 6 r O -r"d b'H X qP go=T<.*loa ). f :to -O .<O= JI 6'>JJ. OfO O *=l ^ -{C1< -.(Dv m z +! coof tt6t- o'a 6od a mo 8s t 3$o "o m -*rflm iio.o o\. llo o8st3 o m -,r rn .T J-@ C,o\ llo 1l ooC o =of NJ <o ro @ N E o C o .N+ U o oo o o '- f E E o U c f+ .c o C o o1] o E ot4 at, C) O oc =t,i o ola o E EE o olt, o a5 o+ C o c @c o .N+ O o 9r orl -ol olFI o =O ots -c =o oI o+ .i3 .q ooltt o o o)f c oc+ r_r )o=trOtn()ts -CC ..oYo! - + l . EI i(-) o E o .Co +(.) E o o5 .g 6E =o?i:CCEo 36 C'S =oI a.r uoCbs 3e ;:oc -corLb*,CO o9 co EPoo E .::Oc r.rr O :.N(9t C\Jn0) F> 8e50:aJoolsuna;rtc '= n\ 9UOcoo oo) I I .- :i6oo O- co : =O oo o a/, o o e o -C+ o g o(9 z C o)t4 c o oEtr 'E trQtsOU o-zQ-= o os+ tz .a +/' o.'6l /p. oQ-- T= .o ! E o $r G)-EO E= O o SF 'a; o ,o ' a/, o o C)g o .C+ o n r- o;Eooo oOtz a eaao_ or ll .c * -\z € HurOUa= Q.= I .opl o .a &oo- c U o E o o I. o E! oc o o o) o o v, dtr o N e.i o @C o .N 60 >= beq cf) o. beo@ o(f) r\ + cr) .O .O +s cr)\o co_ @ : bqcl cf) o. bqO9 \oto N \o \o +s \o ro N tooN roooN \oooN 2.7. Ordering, sloroge ond delivery of ivermeclin Mectizon@ olclgred/opplied for by - (p/eose tick fhe oppropriofe onswer)MoH LA wHo tr UNIcEF N NGDO N Other (pleose specify): Mectizon@ delivered by - (pleose fick fhe oppropriofe onswer) MOH ET WHOtr UNICEF tr NGDC Other (pleose specify) : Pleose describe how Mectizon@ is ordered ond how it gets to the communities Bosing on census updote, Mectizon is ordered from the Zone Offices ond stored in the District phormocy. From the phormocy the drugs ore supplied to Heolth focilities on order ond in turn communities order Mectizon from heolth focility. Toble l0: Mectizon@ lnventory [P/eose odd more rows if necessory/ Number of Meclizono loblels How ore the remoining ivermectin toblels collecled ond where ore lhey kept? Drugs ore collected ond delivered by HSAs to the Heolth centers ond Oncho Coordinotor collects them to the District. Remoini 140,991 140,991 District Request ed Receive d Used Losl Woste d Expired Mwonzo 478,256 478,256 335,883 0 1,382 0 TOTAT 478,256 478,256 335,883 0 1,382 0 Any other comments 2.8. Community self-moniloring ond Slokeholders Meeling Hos ony troining (of troiners) for community self-monitoring been done in the project oreo? No. lf so, When? Toble I l: Community self-monitoring ond Stokeholders Meeting (Add rows if needed/ Describe how the ,esults of the community self- monitoring ond stokeholders meetings hove offected project implementotion or how they would be utilized during the next treotment cycle. 2.9. Supervision 2.9.1. 2.9.2. 2.9.3. 2.9.4. Provide o flow chorl of supervision hierorchy. From NOTF to TOTs; ond TOIs to CDD supervisors(HSAs) to CDDs Whot were the moin issues identified during supervision? Drugs were stored in unsofe ploces, lock of stotionory, inobility to use meosuring sticks correctly. Wos o supervision checklisl used? No Whot \,vere lhe oulcomes ol eoch Ievel of CDTI implemenlotion supervision? District/ LGA Totol # of commu nities/villoges in the entire project oreo No of Communities thot corried out self monitorins (CSM) No of Communities thot conducted stokeholders meetins (SHM) NA NA NA TOTAT 2.9.5. Wos feedbock given lo the person or groups supervised? Yes 2.9.6. How wos lhe feedbock used lo improve the overoll performonce of the projecl? SECTION 3: Support to CDTI 3.1. Equipmenl Stotus of e ui ment P/eose odd more rows if nece *Condition of the equipment (F=Functionol, CNFR=Currently non-functionol but repoiroble, WO=Written off). How does the project intend to mointoin ond reploce existing equipment ond other moteriols? Monogement through ORT is responsible for periodic mointenonce of the equipment. APOC MOH DISTRICT/L GA NGDO Others Type of equipment Source No Cond ition N o Cond ition N o Cond ition N o Cond ition No Cond ition L Vehicle 2. Motor cycle(s) I 2 CNFR F 3. Computer(s) 1 F 4. Printer(s) I F 5. Photocopier (s) 5. Fox Mochine(s) 7. Others o) b) c) a3.2. Financial contributions of the partners and communities Toble l3: Finonciol contributions by oll portners for the lost three yeors Yeor 3 vide the TOTAL ( Releo (usr K210,000. K210,000.( lf there ore problems with releose of counterport funds, how were they oddressed? 3.3. Olher forms of communily support Describe (indicote forms of in-kind contributions of communities if ony) Locol leoders ossist in community mobilizotion. CDDs toke port in collecting Mectizon from heolth focilities. Yeor 1 ('provide fhe period') Yeor 2 ('provide the period') Conlributor TOTAL Cosh Budgeted (us$) TOTAL Cosh Releose d (US$) TOTAL Cosh Budgeted (US$) TOTAL Cosh Releose d (US$) TOTAL Cosh Budgeted (US$) MOH (Centrol + Provinciol/Stote) K410,000.00 MOH (District/LGA) Locol NGDO(s) ( if onv) NGDO portner(s) Others o) b) Communities APOC Trust Fund TOTAT K4r0,000.00 3.4. Expendilure per oclivity aa lndicote in toble ,l4, the omount expended during the reporting period for eoch octivity listed. Write the omount expended in US dollors using the current United Notions exchonge rote to locol currency. lndicote exchonge rote used here_ I a Toble l4: lndicote how much the project spent for eoch octivity listed below during the reporting period Any comments or explonotions? SECTION 4: Sustoinobility of CDT! 4.1. lnlernol; independenl porlicipolory monitoring; Evoluolion 4.1.1 Wos Moniloring/evoluolion corried oul during the reporling period? (tick ony of lhe following which ore opplicoble) Yeor 1 Porticipotory lndependent Aclivity Expendilur e (s us) Source(s) of funding Drug delivery from NOTF HQ oreo to centrol collection int of commun Mobilizotion ond heolth educotion of communities Troining of CDDs Troini of heolth stoff of oll levels Super_yj914g CDDs ond distribulion lnternolmolllgfng gl Cpll octivities _ AQyogocy visils to heolth ond p_olillcqlq_u_lh_o_fltlel IEC moteriols Summ re n forms for treotment Vgf l [c! eq/ Motorcyc lesl p, jgyc le: m{dglgnce Office Equ_ip1n91t _(q.g _qof p!.lt_el!, plnl_ers etc) Others r 4,000 MOH MOH MOH MOH MOH MOH ,l32,000 35,200 2,000 4,000 22,800 TOTAT 210,000 Tolol number of persons lreoled 134,730 monitoring Mid Term Sustoinobility Evoluotion atl ./ 5 yeor Sustoinobility Evoluotion lnternol Monitoring by NOTF Other Evoluotion by other portners 4.1.2. Whol were lhe recommendolions? 4.1.3. How hove they been implemented? 4.2. Susloinobility of projecls: plon ond sel lorgets (mondotory ot Yr 3) Wos the project evoluoted during the reportingperiod?_No Wos o sustoinobility plon written?_No When wos the sustoinobility plon submitted ?_N Whot orrongements hove been mode to sustoin CDTI ofter APOC funding ceoses in terms of: 4.2.1. Plonning ol oll relevonl levels Plonning octivities ore done ot vorious levels e.g. Community, CDD, Heolth workers level. 4.2.2. Funds lntegrote CDTI into routine DIP octivities 4.2.3 Tronsporl (replocemenl ond moinlenonce) Routine ond periodicol servicing ond requesting from portners 4.2.4. Olher resources 4.2.5. To whot exlenl hos the plon been implemenled CDTI octivities ore included in DIP ond ORT hos funded octivities like distribution, supervision, collection of drugsetc. J ,.t 4.3. lnlegrotion Outline the extent of integrotion of CDTI into the PHC structure ond the plons for complete integrotion: 4.3.1. lvermectin delivery mechonisms These drugs ore collected form centrol point by o vehicle from the DHO ond olso delivered to Heolth Centres using the some system. 4.3.2. Troining 4.3.3. Joint supervision ond moniloring with other progroms DOC or TOTs join vehicle for routine visits to peripherol focilities. Also other coordinotors check Oncho octivities during their own supervision. 4.3.4. Releose of funds for projecl oclivities 4.3.5. 4.3.6. ls CDTI included in lhe PHC budget? Yes. Describe olher heolth progrommes thol ore using the CDT! slructure ond how lhis wos ochieved. Whot hove been lhe ochievements? 4.3.7. Describe others issues considered in the inlegrolion of CDT!. 4.4. Operolionol reseorch 4.4.1. Summorize in not more lhon one holf of o poge lhe operoliono! reseorch underloken in lhe project oreo within the reporting period. 4.4.2. How were lhe resulls opplied in the project? t a* t , t SECTION 5: Slrengths, weoknesses, chollenges, ond opporlunilies Strengths include : ,/ The obility to treot up to 80% of our populotion. ,/ The oworeness compoign lost yeor using ORT funds. ,/ Provision of fuel from ORT. Weokness ond chollenges: ,/ lnobility to troin ond refresh heolth workers ond CDDs. ,/ Sustoinobilitv is not guoronteed os we ore still relying on heolth workers to distribute Mectizon. Opportunities: ,/ Avoilobility of dedicoted heolth workers./ Avoilobility of lvermectin. SECTION 6: Unique feolures of lhe project/other motters