Tanga CDTI annual project technical report submitted to technical consultative committee (TCC)

-:( '{.-,\J U u THE UIYITED REPUBLIC OF TA|YZAIYIA ORIGINAL : English COI.INTRYNOTF: TANZANIA Proiect Namt: TANGA CDTI ApprqYaheat: Launchinq year: 2000 Reporting Pe riod (vlonth/Year): Date submitted: NGDO nartner: HELEN KELLER INTERNATIONAL ANNTIAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRTCAN PROGRAMME FOR ONCHOCERCIASIS CONTROL APOC WHO/APOC. 26 September 2003 aANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSE,ME,NT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country : TLIlZania National Coordinator Nu-. D{ Signature: . Provincial Delegate Name Signature: , Date This report has been prepared by Nu-. .bQ Designation Signature : Date......... \ .A,D !Xa\B\^\LE 20: T'o i+, : rnngt' l-D t?^ I Coc(i)r xlA3-o tZ, CL OJFq, -)f'\-_) i- i ' :.i u([ :-t. 'ul .t Date q ll WHO/APOC, 26 Septonber 2003 p o )I Dr. Grace Saguti National Coordinator Eye Care & Onchocerciasis Control Programme P.o Box 9083 Dar-es-Saalam. Dear Madam, Re: WRITING OF ANNUAL REPORT AND ACTION TAKEN ON 18TH TECHNICAL CONSULTATIVE COMMITTEE (I8" TCC) QUERIES Refer to your letter with ref.no.NECPlTCCl}z2 with the above subject. TCC 18 queries for Tanga Focus CDTI Project (3'd year) TCC requested that the project: (i\To respondto TCC 15 recommendations namelv: a) To improve health worker/populatton ratio, improve health education and duration of treatment to take care of absentees and refusals. The present situation in our project is that each sub-village is served with 2 CDDs. For the current situation Tanga CDTI Project has a total population of 213249 and 1994 cDDs, this means that2 cDD are attending 107 people, while ratio guidelines is 250 persons to be attended by I CDD. Therefore our present ratio of 107:1 is reasonable, we need to do more sensitization and advocacy meetings for community to reduce the number of absentees and refusals. Few mectizan could be left behind with the CDDs for those who are temporarily absent and full term pregnant mothers. b) clarify the contlicting information "l00ok of communities agreed on period of distribution"vis distribution in farming and food shortage periods It is true that l00oh of communities decided on time of distribution and the time chosen was the dry season when people are not involved so much in farming activities. Unfortunately the rains started a bit early than expected so people have to move to their farms for cultivation, others hesitated to swallow during that time because of fear of side effects that they will not be able to work in their farms. Again here more education on the effect of Mectizan on subsequent treatment needs to be emphasized. In few areas in Korogwe District they experienced food shortage therefore they spent most of their time in looking for the food. 1 )c i)Recalculate the coverage in table 6 The formula used to calculate treatment coverage is Number of people treated x100 : Treatment Coverage Total population Therefore 147.856x100 :69.3 213,249 On the other hand if you calculate the coverage by average from the three districts you get a different figure (This is also gave us a bit of confusion) DISTRICT 1. Muheza 2. Korogwe 3. Lushoto COVERAGE 64% 75.5% 72% ztt.5 Average: 211.5 :70.5% aJ c,ii)Clartfy conJlicting information on knowledge of disease vs100% of communities having received health education. As reported that l00oh of communities received health education on the CDTI concept, knowledge of disease, benefit/side effect of Mectizan ect. Within these communities there were few eligible individuals who did not swallow Mectizan for different reasons. We need to think on how to reach those few with little knowledge. Availability of appropriate IEC materials at the right time is one of the strategy which could help to overcome this problem. As behavioral changes are an on going process, we hope those few will finally accept taking Mectizan. d. i) The project needs to discuss management of reactions as one way of improving coverage. More health education, sensitization and advocacy meeting still needed to the community so that they know how Mectizan works and its side effects, and when it is swallowed for several times the reaction decreases. At Regional level we already discussed that for those few cases /individuals who got reaction in their first treatment cycle to be given antihistamine/analgesics prior the next cycle. iil Provrde missins information on training, monitorine, sunervision and fu n din s for the past vears 2 .l o Training: Table I below show Training at different level of CDTI implementation aJ \f q) GI ta U 0 q) z Gt1 I Hv\.- .L\: a< \f > a) = \o \o@ I \o @ $ ca\f, + co+ ra o\ o ra o\ \o @ \o \o \o \o @ $ $ c.t * $6t srr o\ ra o\ t6l \o \o \o c\oo\\c)O @* Oco\o ra)oo$ $ co\o 6 \o N tF. o\ t t?l\o oo q) q) q,) s F \o O\o oo $ ao$ in €\ \o\o O\o @ oo s tr- o\ \o NOO\ coi a \o N a,Lq) .1 a ct trrri I F-ro)- og? !-(!q,L z +- *.: a<v CB F q) z $ t .f, I .+ $ $ N 6l o\ * t o\ s r- : N : ia c.l N C..l N c.t N \o \o O q) q) q) io $ * s N o\ o\ o\ F-N N c.t N \o 6) drr iI rii Eg c) u) €ttr:- zE q)(.) Gi,vE-"+F-L- \q i = N o6l N N o 6l$ Nt N N l+ N c{ o in!+ ta N : S tt- $o t-- 6lin iA = r- oo 0) o c) I vio N c.l Nt N .f O int+ c.l $ t-- alr,o tr 6l (a\u,f{z:'l rh o) €i.= =9.112 .?' 0 q) = o\$N o\$N c{ * c.l $N ra6l ra laNin o\ o\ o\ o\ r-6l rrN 6l N I N (..l NN \o \o o q) o) o <,) \oio o\.+ol 6l sN raNra o\ o\ o\ rrN N 6lN \o () F1 () o N rI]+ r! \J & v oF o U) D F.1 Fl t'r t'r Nt!H r! F o -& oV F LJ a Fl Fl t'r t'r N rll D z 9o -, xa VJ Fl t-l oF a& ri & t! & H 4 rrl I o\ i ,(Tables II a, b & c shows tlpe of training undertaken for the past three years Table (IIa) Type of training Trainees CDDs Other Communrty members e.g. Communrty supervisors Health Workers (fronthne health facilitres) MOH staff or Other Polrtrcal Leaders Others(specrfy) Program management ./ / ./ / How to conduct Health education ./ ./ ./ ./ .,/ Management of SAEs / \i "/ \/ JCSM SHM Data collection ,/ J ./ ./ / Data analysis ./ ./ / J Report writing J t/ ./ ",/ JOthers (specify) IYEAR Any other comments 5 Table tr YEAR II Any other comments-To improve quality of Data collection and report writing the training of Primary School Teacher and Sub- village leaders was conducted Type of training Trainees CDDs Other Communrty members e.g. Communrty supervisors Health Workers (frontline health facrlrties) MOH staff or Other Politrcal Leaders Others(preschoo I teachers /Sub- village leaders Program management J ./ ./ / / / How to conduct Health education \i / / ,/ ,/ ^/ Management of SAEs ./ J J t/ ./ / CSM SHM Data collection ./ / ./ ./ / ./ Data analysis J / ./ / / ./ Report writing \r / .,/ J / / Others (speciff) 6 ,YEAR III Table c Any other comments Type of training Trainees CDDs Other Community members e.g. Community supervisors Health Workers (fronthne health faci Iities) MOH staff or Other Politrcal Leaders Others(specify) Program management J ,/ ",/ ,/ ./ How to conduct Health education ./ ./ / \/ ./ Management of SAEs ./ t/ / / ./ CSM SHM Data collection / \r ,/ / J Data analysis \i / ./ / J Report writing ./ J / / / Others (specif,,) 7 t. Monitoring Year I-None of below done Year I Participatory Independent monitoring -Mid term Sustainability Evaluation ------ 5-Year Sustainability Evaluation --- lnternal monitoring by NOTF -Other Evaluation by other partners Yea r II-None of below done Participatory lndependent monitoring -Mid term Sustainability Evaluation ------ 5-Year Sustainability Evaluation --- Lrternal monitoring by NOTF -Other Evaluation by other partners Year III-The first two done -------{----- Participatory lndependent monitoring ---------+-- -Mid term Sustainability Evaluation ------ 5-Year Sustainability Evaluation --- lnternal monitoring by NOTF -Other Evaluation by other partners RECOMMENDATIONS:- From Participatory Independent monitoring Training of health staffand CDDs Current training period is enough only the ratio of trainee-trainer to be improved. Training and supervision checklists should be made available to all levels. More attention to paid on the aspects of record keeping and reporting during training. Supervision at all levels to be emphasized especially during and after distribution by village leaders and health personnel. Consider the possibility of involving literate members of the communities on CDTI implementation. 8 tRecommendations from Mid term evaluation Planning . We recommend that FLHF be empowered to plan for their CDTI activities and encourage communities to plan for time and mode of distribution PRIORITY - High lndicator of success . Drug delivery is at the time requested by the community. ACTOR - FLHF staff Monitoring and Supervision . Recommend an integrated approach in monitoring and supervision of CDD at village level PRIORITY - Medium lndicator of success: . Reduce number of visits by FLHF Staff to the communities Actor- FLHF Staff Time:- lmmediately Leadership . We recommend that village chairmen take full charge of mectizan .distribution.(CDTI) in their communities, . They should establish a village fund to support CDTI activities PRIORITY:- High lndicator of success: . CDD are motivated ACTOR: Village chairmen are empowered in the next three months Mectizan Procurement & Distribution . We recommend that mectizan tablets be left with the village chairmen for at least two months after distribution period to resolve the problem of absenteeism and refusals. PRIORITY: - High lndicator of success . lmproved treatment coverage rate ACTOR:- FLHF Staff Mobilization, Training, Health education and Sensitization . We recommend that, CDDs be trained at the community level. PRIORITY:- High lndicator of success: . lmproved health education level at the village level. Actor:- FLHF Staff Human resources We recommend that the staff at the FLHF be motivated by awarding certificate of excellence to the those who perform creditably. I PRIORITY: - High lndicator for success: , lmproved motivation and willingness to continue with CDTI work. ACTOR:- DOTs Time:- within this year, by the end of 2003. Coverage . We recommend that FLHF staff should monitor closely distribution activities by CDDs and to also ensure that census is accurately carried out. PRIORITY:- High lndicator of success: . lmproved therapeutic and geographical coverage . Accurate census figures. Actor:- FLHF Staff 9 HOW HAVE BEEN IMPLEMENTED The recommendations from the monitors and evaluators have been taken care of when preparing our Sustainability plans for year four, five and six. Advocacy and mobilization to all relevant players i.e. on CDTI implementation should be an ongoing activity. Full Integration of CDTI into the routine health plans. "For the sake of sustainability this should be taken seriously. However the issue of integration has started already. The districts and the region has included Onchocerciasis in their Comprehensive plans from the 2"d year of CDTI implementation". CSM NOT YET DONE IN ALL 3 PAST YEARS . 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L oa 4)L oa0 r,.E c)LA> o: EEoGI U)qGiB €a flU c) q) Fl (J tr (t) e E!EL 6t ';': =q)xE( E tii EA 6Ee ri trlillrl 3 4 f-l I ao Funding Table IV show financial contributions by all partners for the last three years YEAR Year I ('provide the period') Year 2 ('provide the period') Year 3 ('provtde the penod') Contributor TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) Ministry of Health (MoH) 38,397 31t..197 17,993 l7.()9.1 'r) 1 1) 7),1.\) Local NGDO(s) ( if any) NGDO partner(s) 48,740 48,740 45,448 45,448 51,730 12,306.53 Others District a) Muheza 156..25 156..25 1 695 1 695 b) Korogwe 115.20 1 15.20 200 200 c) Lushoto 2350.23 2350.23 2080 2080 Communities APOC Trust Fund 149,014 89,018 67,305 67,305 66,906 54,238 TOTAL 236,307.25 176,31t.25 t33,211.43 r33,211.43 144,743 92,651.53 Year I-us $ 59,996 retained by WHO (for capital equipment) from APOC Trust Fund Year II-All money from APOC Trust Fund were released Year III- us$ 12,668 retained by WHO (for capital equipment) from APOC Trust Fund There were no problems with release of counterpart funds t6 Table V a,b& c indicate how much the project spent for each activity listed below in the past three years Table V YEAR I Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Sup_ervising CpDs and distribution Internal monitorilg of CDTI activities Advocacy visits to health and IEC materials Su4ma_ry_(Igportllg) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Otfigp Equ_ipment (e.g computers, printers etc) Others(communic ation) staffat all levels political authorities Training of CDDs 14,830.38 10,630 4972.55 6000 24,000 61 50 600 4000 2357.69 t324.83 2s0 10,400 MOH APOC APOC APOC APOC APOC AP,qI APOC RN4O APOC APOC APOC TOTAL 85,515.45 Total number of persons treated 140,640 t7 Table V (b) YEAR II Activitv Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health_staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials lqlqqery Qggggline) forms for treatment Vehigl_ev Motolgycf gs/ bicycles maintenance 9!fi q.-EqqlplqgqlG€.lg-pqlgrs, printers etc) Others (Communic ation) 351.38 4603.21 11,050 seoq tzio 8400 5480 2000 s00 +ioo 3877 3669 MOH APOC APOC APOC APOC APOC APOC APOC RMO APOC APOC APOC TOTAL 59,904.59 Total number of persons treated 147,856 18 t Table V (c) YEAR III Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection pqir,rl qf qqrygr'ltity lvl_obilization and health education of communities Training of CDDs Tra_ining _o_f_heal!b staffat all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to healttr a"d pqtrliqal aut-horities IEC materials !,,4q!ry.ry_Ge_pq{iq$-lQrm_s,for,tryqlq1eqt Vehic les/ Mo_torcyc les/ bicyc les maintenanc e Office Eqqpment (e.g. co-pute.s, _-__ Others(C ommunication) 200 2807.069 13,000 2730 6230 4230 eeiS 4036.265 500 32:,8.44 2300 2540.t26 MOH APOC APOC APOC APOC APO-C APOC APOC RMO APOC APOC APOC TOTAL 48,036.9 Total number of persons treated 224,439 Comments t9 O4) CN 9: BEtrHo U ol<d d tr C)H Cd olr A o lid li ti ti aoEE?tr bo Li 0) -o () o >, oo) bo) bo ,.oo lrr >' l- h o o BD o 3E EE Q p c)tr H oLr(o -oo tu t.(o L C) Irr -oC) tu olr cd C)ti Cd 2 o t<(n z h,0 .E crl: Cdl- ol-r Cd z -o0) d h' c0 tr pc)tr h d =Lp q) tli -o0)IL o 6! o o ()(, o 9: trE I Cd l<(! d (n oo o o !o tJr !O! o oc d P. 1i tr c= oo l-l o C) l-t oo t-.] o 0.)a o z o z CN a C)a oo t-.1 ol 6! H 3E EEI oz oz o o a b0 o z z bo a bo o z ADtrE 6!x C) o C)tr oo o l- lio € o o o - >. l- >' l- o o .=.)ijE s= -otroo a o PE EE Q oa z bo g oa p. oa oa o l- o f- (.) l- ao ?tr CD- th ho lio C) l- b0 U) bo bo Cd >'d d z F] 9 0 CON 0) o B bo l<o M o o a F.l dN C)) 0.) B 00 lro v o o a l.1 dN C) z 0.) B bo otr o M o o a r.1 q N t< clo O c.l I N lr C) c.tO N I N lr(d o c-t c{ I c.l ol a I N U) l-< ()x C) 0)li U)d (.) lr € o E(n a o o rh 0) P (-) C6qr o 0) o) B o o o -odF a, C) o qi o \) q) o) l< Or I fComments Year I Korogwe District- o After conducting Advocacy meetings at different levels training was done to Rural Health Staff who together with village leaders mobilized Communities. Communities selected CDDs who were trained. That's why there is a big interval between starting and completion months of Training o Supervision is done quarterly (4 times per year) or (6times per year) but is more done frequent during the implementation of key CDTI activities (in all three District) Muheza District- o Teule District Designated Hospital had stock of Mectizan before programmed started. . Therefore the distribution was done earlier to meet the expiring date of the tablets compare with other two District Year II We received Mectizan late; distribution was done two months after census updating (in all three Districts) Muheza District started with the training of RHWs and CDDs followed by conducting mobilization to sub-village leaders and Primary School Teachers (those who normally deal with health matters). But for the other two Districts they started to do mobilization followed by re-training of RHWs and CCDs Most of the activities were done between one up two months with the exceptional of few activities which was done more than two months and the reasons were given (iv) To conduct REMO refinement in Koroswe so that proper geographical coverage can be determined REMO refinement was done in Korogwe in May 2004 and the villages, which were identified to be endemic will be included in the list of CDTI villages in Tanga CDTI Project. Therefore now our geographical coverage will be 100% (v) Use the new reporting format in subsequent reports As we had been advised by TCC, for the next report we will use the new format. 2t I