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THE UNITED REPUBLIC OF TANZANIAMINISTRY OF HEALTH AND SOCIAL WELFARE

COUNTRY/I.{OTF:TANZANIA

Proiect Name: TUKUYU CDTIFOCUS PROJECT

Approval year: JULY, 1999 o Launching year: APRIL,2000Reporting Period ( From ): January,2008 - December,2008

PROJECT YEAR OF THIS RE,PORT:1234567(8)910Date submitted: January, 2008 NGDO partner: SIGHT SAVERS

INTERNATIONAL (SSI)

ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

DEADLINE FO SUBMISSION:

To APOC Management by 31 January for March TCC meetingTo APOC Management by 31 Julv for September TCC meeting

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL(APOC)(9}

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ANNUAL PROJECT TECHNICAL REPORT

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

ENDORSEMENT

Please confirm you have read this report by signing in the appropriate space.

OFFICERS to sign the report :

COUNTRY: TANZANIA

Ag. National Coordinator Narne: Dr. Edward Kirumbi

TO

Signature: .

Dut , ....1.1.,'.Zs?s.5f

NGDO Representative

Regional Medical Officer

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Name: Dr. Haruni Machibya

Signature: ...V.=L:(...

o^r,,*//.'2':::(

Name: Dr. Ibrahim Kabole

Signature

Date: ....

tsaversINTERNATIONAL

sigh

] ,.).,\R. ES SALAA]V]I

i"\NZANIA

This report has been prepared by Name: Dr. Abel Asilia Mwakafwila

Designation: Project Coordinator

Signature: .

a.o lo*lQ.w 1,Date

2 WHO/APOC. 2.1 November 2004

.... NZANIA COT]NTRY OFFICE i

r:.o..8ox.25.1.:1. I

I

Table of contents

Project Name: TUKUYU CDTI FOCUS PROJECTAcronyms.DefinitionsSECTION 1 : BACKGRoUND INFoRMATIoN

1.1.. KYELA DISTRICT PROFILE....,

1

46

l0t0llll

1.2: RUNGWE DISTzuCT PROFILEI.3 ILEJE DISTRICT PROFILETOTAL 13

SECTION 2: IMPLEMENTATION OF CDTI2.1 . PERIoD oF ACTIVITIESTOTAL 14

2.2. ADVoCACY..2.3. MOBILZATION, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK CoMMLTNITIES

2.6.1. Treatmentfigures..........Toble 7: Treatment and SAEs by district/LGA in all oreas at risk

SupsRvrstoN..

14

t4

.15

.15

2020

2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year232.7 ORDERING, sroRAGE AND DELIVERy op IveRNlgcrnl2.8 CoMMUNITY SELF-MoNIToRING AND STAKEHoLDERS MEETING

Provide a flow chart of supervision hierarchy . . .. . .. ................. 26V[/hat were the main issues identified during supervision? .............................. 26LI/as a supervision checklist used? ............. 26Wat were the outcomes at each level of CDTI implementation supervision? 26Was feedback given to the person or groups supervised? ............................... 26How was the feedback used to improve the overall performance of the project?

2.9.1.2.9.2.

2.9.3.2.9.4.2.9.5.2.9.6.

of the following which are applicable)............4.1.2. Wat were the recommendations? NONE.......4.1.3. How have they been implemented? NONE

4.2. SusrerNesrLlTy oF IRoJECTS: nLAN AND sET TARGETS (MANDAToRv ATYn 3) 30

4.2.1. Planning at all relevant levels...4.2.2. Funds.......4.2.3 Transport (replacement ond maintenonce). .... ... . .. .. .

4.2.4. Otherresources..4.2.5. To what extent has the plan been implemented..............

4.3. INTEGRATIoN4. 4 OPERATIoNAL RESEARCH.

242526

282929

29

263.2 FTNANCIAL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES3.4. EXPENDITUREPERACTIVITY.....

SECTION 4: Sustainability of CDT1............4,1 . INTenNaL; INDEPENDENT PARTICIPAToRY MONIToRING; EVALUATIoN

4.1.1 Was Monitoring/evaluation carried out during the reporting period? (fick any293030.30

3030303I31.31.31

4.4.I. Summarize in not more than one half of a page the operational researchundertaken in the project area within the reporting period. ........ 31

SECTION 5: Strengths, Weaknesses, Challenges, and Opportunities.............. ........31SECTION 6: Unique features of the projecUother matters ...................32

J WHO/APOC, 24 November 2004

AcronymsI. APOC

2. ATO

3. ATrO

4. CBO

5. CCHP

6. CDD'S

7, CDTI

8. CHF

9. CHMT

10. CSM

I1. CSSC

12. DMO

13. DOC

14. DOT

15. DPHC

16. IEC

17. IMA

I8. NGDO

19. NOTF

20. PHC

2I. PORALG

22. REMO

23. RMO

24. RHMT

25. RHS

African Programme Onchocerciasis Control

Annual Treatment Objective

Annual Training Objective

Community-Based Organization

Council Comprehensive Health Plan

Community Directed Distributors.

Community Directed Treatment with Ivermectin

Community Health Fund

Council Health management Team

Community Self-Monitoring

Christian Social Service Commission

District Medical Officer

District Oncho Coordinator

District Onchocerciasis Team

District primary Health Care.

Information Education and C ommunication Material

Interchurch Medical Association

Non Government Development Organization

National Onchocerciasis Task Force.

Primary health care

President's Office Regional Administration and Local

Government

Rapid Epidemiological Mapping of Onchocerciasis

Regional Medical Officer

Regional Health Management Team

Rural Health Staff

Stakeholders meeting

4 WHO/APOC,24 November 2004

26. SHM

27. SS I

28. STAMICO

29. TCC

30. TOT

3 1. UTG

32. UNICEF

33. WHO

34. WPHC

35 LF

Sight Savers Intemational

Subsiding of state mining Cooperation

Technical Consultative Committee

Training of Trainers

Ultimate Treatment Goal

United Nations Children's Fund

World Health Organization

Ward Primary Health Care.

Lymphatic Filariasis

5 WHO/APOC, 24 November 2004

Definitions

(i) Total the total population living in meso/hyper-endemiccommunities within the project area (based on REMO and census taking)

(ii) Eligible population: calculated as 84%o of the total population in meso/hyper-endemic communities in the project area.

(iii) Annual Treatment Objective: (ATO): the estimated number of persons livingin mesolhyper-endemic areas that a CDTI project intends to treat withivermectin in a given year.

(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of peopleto be treated annually in meso/hyper endemic areas within the project area,ultimately to be reached when the project has reached full geographiccoverage (normally the project should be expected to reach the UTG at the endof the 3'd year of the project).

(v) Therapeutic coverage: number of people treated in a given year over the totalpopulation (this should be expressed as a percentage).

(vi) Geographical coverage: number of communities treated in a given year overthe total number of meso/hyper-endemic communities as identified by REMOin the project area (this should be expressed as a percentage).

(vii) Integration: delivering additional health interventions (i.e. vitamin Asupplements, albendazole for LF, screening for cataract, etc). Through CDTI(using the same systems, training, supervision and personnel) in order tomaximise costs-effectiveness and empower communities to solve more of theirhealth problems. This does not include activities or interventions carried outby community distribution outside of CDTI.

(viii) Sustainability: CDTI activities in an area are sustainable when they continueto function effectively for the foreseeable future, with high treatment coverage,integrated into the available healthcare service, with strong communityownership, using resources mobilised by the community and the govemment.

(ix) Community self-monitoring (CSM): The process by which the community isempowered to oversee and monitor the performance of CDTI (or anycommunity-based health intervention programme), with a view to ensuring thatthe programme is being executed in the way intended. It encourages thecommunity to take full responsibility of ivermectin distribution and makeappropriate modifications when necessary.


FOLLOW UP ON TGG REGOMMENDATIONS

Using the table below, fill in the recommendations of the last TCC on the project and describe how theyhave been addressed.

COMMENT/QUERIES OF TCC 25

7

NUMBER OFRECOMMEND

ATION INTHE REPORT

TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGTUSE ONLY

319 TCC was accepted the previousfairly well written report with thefo llowin g recommendations :

a Correcl dkcrepancy in llejedistrict population figures

The Oncho endemic area in Ileje isnear by Coal mining plant, instabilityof this plant has caused big number ofpeople to shift to other places andhence fluctuation of population figuresin Ileje.

o Correct the UTG colculation UTG calculation corrected.

a Indicate clearly, if sustainabililyplans are being implemented

. CDTI activities are incorporated inCCHP and RHMT plans.

. CHMT and RHMT conductssupervision

inclusive CDTI activities. Funding by districts has beenincreasedFrom $ 2,500 in 2007 to $ 8,121 in

2008.. CHMTs and RHMT provides fundsfor

project equipments services andmaintenance

a Clearly give an occount ofintegration effort.

. Integration now has taken place; in2009 CDTI activities will beimplemented in conjunction with LFactivities.. CDTI activities are incorporated indistricts PHC routines.. Some activities are done throughCCHP funds.

Project related

. More advocacy to districts toincrease funding support to CDTI

Efforts has been made to advocate thedistricts to increase funding, increase offunding in 2008 is a result of advocacy.

a Upscale CSM snd SHM Communities' sensitization was donewith good results, CSM was increasedto135 communities from 13

communities, and SHM increased to 49communities from 2l communities.

Gel more health staff involvedin CDTI

a In 2008 year we managed to increasethe number of FLHFs from 71 to 88,efforts are being made in collaborationwith Districts to train all FLHFs withinthe project area.

WHO/APOC, 24 November 2004

Train more CDDs to increaseratio lo I:100from I:176

Following community sensitizationmore CDDs were trained and theirnumber has increased from 493 in2007to 63I in 2008, we are stmggling totrain more CDDs in year 2009.

a Cslculute Mectizanaccurately lo reduceleft over

needssmounl

The problem will be corrected in 2009application.

a Districts to improve funding toproject

Slowly the districts has started toincrease amount of funds for CDTIactivities, further advocacy to districtleaders will be continued duringProject annual review meeting 2009.

(Please add more rows if necessary)


5

EXECUTIVE SUMMARYTukuyu Focus CDTI was launched in year 2000 and CDTI activities implementation wasstarted in 2001. The Project operates its activities in 3 districts namely, Rungwe, Kyela andIleje.

This report provides information on financial & technical reports of activities conducted in theperiod of January to December, 2008. During this period, the project managed to conduct thefollowing activities: Training of PC on computer skills, training and re-training of FLHF staff,Sub-village leaders and CDDs, conduction of community mobilization, Community selfMonitoring, advocacy to Ward Executive Officers, census update, Mectizan distribution,Supervision and monitoring of the implementation of CDTI activities, Project Annual ReviewMeeting and maintenance of project capital equipment such as Motorcycles, Vehicle,Computer, Photocopy machine.

The project conducted training of 142 new CDDs at the same time re-trained 489. 17 newFLHF staff was trained in this reporting period whereby 71 were re-trained. The projectconducted advocacy to l5 RHMT members, also 30 PHC and CHMT were advocated in Ilejedistrict.

The total population in both Hyper & Meso Endemic areas is 86,638 people who reside in240communities. Mectizan distribution was started in September to November. Total of 69,812people were treated which is equivalent to 80.5% therapeutic coverage. Geographicalcoverage was maintained at 100% while UTG is 72,776 and also ATO is 73,642.

The project started with a balance of 218,903 Mectizan drugs whereby a total of 193,000Mectizan tablets received from Merck and 25,903 Mectizan drugs were stored in the regionalPharmacy. A total of 194,234 drugs were used by the people who are living in Onchoendemic area, whereby 84 tablets were lost and24,369 tablets remained and they are stored atthe districts pharmacies.

The project received funds amounting $ 44,292.5 from difference sources. These are: APOC$ 19,304.3, Sight Savers International (SS| contributed $ 16,876.4, Council $ 6,396.9 andRegional level $ 1714.9.

The major challenges are:

To increase the number of CDDs, especially female.o

a

a

Most of the project capital equipments are old hence they are expensive to run(Vehicle, Motorcycles, Computer, and Photocopier).

Transfer of Project Staff to non Oncho areas.

9 WHOiAPOC, 24 November 2004

SECTION { : Background information1.1. General informationIntroduction :

Tukuyu Focus CDTI project operates in 3 districts out of 7 in Mbeya Region located insouthern highland zone of United Republic of Tanzania, these district are Rungwe, Kyela andIleje and all three district are located in the southern part of the region. They are bordered in thesouthern by Lake Nyasa and Malawi, Southem west is Zarri:lia Country. There is a good annualrainfall leading to good production of various types of crops such as Maize, Irish, Rice andBanana.

People in the rural areas are engaged themselves in various activities such asagriculture,pastorarism and small busneses.Generally the road infrastructure throughoutMbeya's countryside is good however during the long rain season (illov - June), small sectionof the Region are cut off from the rest of the country. Tukuyu CDTI Focus Project operates in240 communities from three Oncho endemic districts in Meso. The project started as a verticalapproach under National Institute of Medical Research in l994.In 2000 the project was handledover to DED under heath department and in 2001 the project started CDTI activitiesimplementation.

1.1: KYELA DISTRICT PROFILE.

Kyela district (Fig. 1) is one among the eight districts of the Mbeya region. It is located at theextreme south of the region and is about 125 km from the regional headquarters, bordered byLake Nyasa (Malawi) on the southem part, Ileje district on the western, Rungwe district onthe north and Livingst^one Mountain ranges on the eastern part. Geographically, the districtlies between n 30o - 350 Longitude East and between 90 250 - 930 fatituae south. It is situatedat the altitude of 400 -520 meters above sea level and receives an average rainfall of l200mmannually. The district has two administrative divisions divided into 14 Wards and 84registered villages. Four wards containing a total of fourteen (14) villages which are under theproject area and thus receiving ivermectin annually. It occupies a total area of 1,322 squarekilometers (approximately 2.1%o of the area of the whole region). 965 sq. km is a dry landwhere as 375 sq. kms is occupied by water. The district has a total of 25 health facilities. Outof these, 7 health facilities are under the project area.

The District has four main ethnic groups namely the Nyakyusa, Ndali, Kisi and Yao. TheNyakyusa tribe lives on the lowland areas and depends mainly on subsistence farming andpastorals. Where as the Ndali tribes lives on the highland and are engaged on farming,livestock keeping as well as beekeeping. The later two are living along the like Nyasa areengaged in fishing and pottery.

Administratively Kyela district is comprised of 2 divisions, 15 wards and 101 villages withthe total population of 191,832 people according to national census. Onchocerciasis is foundin 58 communities.

Generally the communication network is good in almost all parts of the district, except somefew areas are inaccessible during the rain season (lrtrovember June) There is one highwaycrossing Rungwe district through part of Kyela district to Malawi.

l0 WHO/APOC, 24 November 2004

1,2: RUNGWE DISTRICT PROFILERungwe district is among the seven districts of Mbeya Region. The district is bordered byKyela district on the southern part, Ileje and Mbozi districts on the western part, Mporotovolcanic mountains and Livingstone mountain ranges on the northern and eastern partsrespectively. Geographically the district is located between 90'05's to 45's and 33o 20'E.From the 1988 census projections the district has an estimated population of 318,019 peoplewith a growth rate of l.4Yo and it is the most densely populated district in the region.

The district occupies approximately 2211 sq. divided into four divisions, 30 wards and 141registered villages. Eight wards (8) comprising of a total of 41 villages are under the projectarea and hence their communities are receiving ivermectin annually. There are 56 healthfacilities in the district which deliver health services to the inhabitants and people from theneighboring districts. Out of these, 13 health facilities are within the project area and thusserving CDTI activities

The district receives adequate rainfall of more than 2100Mm per annum, one of the highest inTanzania. It is fairly well distributed over the year, but a clean dry season exist from June toOctober and the rainy season from November to May, being heaviest in March, April andMay

On the high attitude hill slopes the weather is slightly cool throughout the year with annualmean temperature of 60c. The district possesses many-rivers and stieams originating from thenorthern and western hill slopes that are draining in Lake Nyasa. Most of these rivers andstreams have been found to be good breeding sites of Onchocerciasis vectors

Rungwe District is inhabited by three major ethnic groups namely: - Nyakyusa, Ndali andSafwa tribes. The Nyakyusa tribe comprises about 95%o of the total population and lives inthe highland areas. All the tribes depend on agricultural activities for subsistence and trade.The main crops grown for commercial purpose are rice, tea, banana, and Irish potatoes. Cropsgrown for subsistence is cereals, maize etc other activities include livestock production, tradetransportation, Artisan, Mining Industrial production and Harvesting of Forestry products.Tukuyu Focus CDTI Project in the district operates in 180 Hyper and Meso endemiccommunities.

Administratively Rungwe district is comprised of 4 divisions, 30 wards and 162 villages withthe total population of 317,611 people. Onchocerciasis is endemic 180 communities.

1.3 ILEJE DISTRICT PROFILE

Ileje District is located in the southern corner of Mbeya Regional. The District liesbetween latitude g0' 74" and 90 37" Eastof Greenwich. The district

"orr.r, a total area of 1,908

sq.km Ileje district shares common borders with other district in Mbeya Region wherebyMbeya in North, Mbozi North East, and East it borders with Rungwe and Kyela South East.The district also borders with the Republic of Malawi and ZaurrJ:ria on the South and SouthWest, respectively.

The Topography of Ileje district is of wide plateau and steep hills. The drainage systeminvolves on Major River called Songwe which pours its water into Lake Nyasa. The Districtlies at an altitude ranging from 1360m to 2500m above sea level. The Natural vegetation ofIleje district includes tropical Savanna open woodlands. The rain start in November and lastsin April in Bulambya division, while in Bundali division the rain lasts from November toJune/Julv. The annual rainfall is between 700 to 2000mm Temperature ranges from l60C to270 C.


Administratively, the district is divided into two Divisions, l6 wards, 68 villages, 320 hamlets

and26,852 households. During 2002 Population Census Ileje district had a total population of110,194 including 58,408 females and 51,786 males. Onchocerciasis is found in 2

communities.

HEALTH SYSTEM

Within the project area there are 4 Hospitals, 3 are district hospitals for Rungwe, Ileje andKyela while one is owned by voluntary agency in Rungwe district, and also there are 3 HealthCenters and 2l DispensarieslTable 1: Number of health staff involved in CDTI

DistrictrLGANumber of health staff involved in CDTI activities

Total Number of health staffin the entire project area,1

Number of healthstaffinvolved inCDTI,2

Percentage

"3= "2/'r 'loo

RUNGWE 524111 2t%

KYELA 29364 22%

ILEJE124 9 7%

Total 941 184 19.SYo

1.1.2 PartnershipCooperation between APOC, Councils, SSI and communities enables the project toimplement the CDTI activities in a positive side.

APOC and SSI support the project financially and by procuring equipments, while thedistricts councils play a big role in supporting supervision & monitoring. The councilsalso pay salaries, allowances and other costs.

Both APOC and SSI stand to be the main supporters for the implementation of CDTIactivities. Both have been supporting the project on various activities especiallytraining of CDDs, FLHF staff, Policymakers, Vehicle/Motorcycles maintenance,supervision and monitoring, conduction of Annual Review meeting of the Project andprocurement of working capital equipments.

t2 WHO/APOC, 24 November 2004

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2.2. Advocacy

The project managed to conduct advocacy to 15 RHMT members. During the advocacymeeting the following were included in the discussion, quick review on the disease, roles ofthe NOCP/MOH, APOC, SSI, and RHMT, it was insisted that RHMT supervision shouldinclude CDTI activities.

At district level the project conducted advocacy to district PHC and CHMT, this was done inIleje district. At community level VEOs and sub village leaders were advocated in all 3

districts.

The following table shows the number of policy/decision makers advocated at differentlevel per each district

2.3. Mobilization, sensitization and health education of at riskcommunities

Information dissemination :

These activities were done through communication with village leaders, andcommunity leaders using telephones and letters. Also head teachers and their schoolchildren in all affected areas. Head Teachers and their pupils played a big role ininformation sending to communities.

It was agreed that in any meeting conducted in the community whereby many peoplewill attend, implementation of CDTI activities should be one of the agenda.

Usually FLHF staffs who are very close to the communities at risk do attendcommunity meetings and they disseminate information.

Response of target communities/village. Was excellent

Accomplishments of the project in this year are-' More community members were involved in the implementation of CDTI activities.. There was no doubt on the side effects of the drug.

Suggestion of way to improve mobilization and sensitization of target communities -' Use of communities meetings conducted by FLHF, hence funds should be added.

a

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DISTRICT DISTRICT LEVEL WARD LEVEL COMMUNITYLEVEL

Rungwe 0 0 183Kyela 0 0 98Ileie 30 0 2tTotal 30 0 302

l5 WHO/APOC, 24 November 2004

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2.5. Gapacity building

Adequacy of available knowledgeable manpower at all levels.In this year 2008 the project was managed to train new RHWs 17 and re-train 71, also wetrained 142 new CDDs and re-train 489 in all240 Oncho endemic communities. Training ofnew CDDs was aimed to increase the number of CDDs, but also was to increase the numberof female CDDs as this move less than Male CDDs.

Advocacy to RHMT and CHMT in Ileje district was done so as to enable projectsustainability.

Where frequent transfers of trained staff occur, state what the project is doing, or intends todo, to remedy the situation.The issue of frequent transfer of staff is being solved by sustainable training of new FLHWsto increase their number at health facility and also the project discusses with CHMTs to avoidfrequent transfers of staffs from Oncho endemic area.

t7 WHO/APOC, 24 November 2004

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2,6.2What are the causes of absenteeism?o Human daily living activities such as moving business, schools, agriculture and

employments found in other areas far from Oncho endemic areas.

2.6.3 What are the reasons for refusals?o Some people in endemic areas has no symptoms hence they don't find reasons to take

drugs.

a In case the project did not have any cases of serious adverse events (SAE) duringthis reporting period, please tick in the box

No SAE, cese fo renorf

2t WHO/APOC, 24 November 2004

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2.7 Ordering, storage and delivery of Ivermectin

a Mectizan@ ordered/Applied by:

MOH WHO UNICEF NGDO

Other:

o Mectizan@ delivered by

MOH

Other:-

NGDO

Please describe how Mectizan@ is ordered and how it gets to the communitieso Project Coordinators requests drugs by filling in the ordering forms and send them to

the NOTF in the Ministry of Heath & Social Welfare.o The NOTF passes through the application forms, if they are okay, the forms are

forwarded to Mectizan@ donation progamme (MDP).o The MDP also passes through the forms, approves then send the drug to the MOH and

Social Welfare through MSD which is a govemment agent for clearing andforwarding.

. The MSD informs the NOTF on the arival of the drug, and then the NOTF notifiesthe Project Coordinators.

o The Project Coordinators takes the responsibility to collect the drug form ZonalMedical Stores or arrangement is made to go in Dar-es-Salaam to collect drug directfrom central MSD. The received drugs are sent to regional pharmacy for recoding andstoring.

o Project Coordinators receives request from DOCs and drugs are delivered to thedistrict through the Health system to the district pharmacy.

o District Oncho Coordinators also receives drug request from FLHW and distribution isdone accordingly.

o The FLHWs notifies the community leaders on the arrival of drugs at health facility,then the community leader send CDDs or any community member to come and collectdrugs ready for distribution to the community.

Table l0: Mectizan@ Inventory

- How are the remaining Ivermectin tablets collected and where are they kept?CDDs collects the drugs from communities and hands over to FLHF, The FLHF also handsover the drugs to DOCs and the DOCs hands over to Regional Onchocerciasis Coordinatorwhom he hands over to Regional Pharmacy for storage.

PROJECT/DISTRICT NUMBER OF MECTIZAN TABLETSRequested Received Used Lost West Expire

dRemaining

Regional MerckTUKUYU CDTI 193,000 25,903 193,000RUNGWE 151,353 10,353 141,000 142,600 84 9,669KYELA 56,050 10,550 45,500 44,783 0 71,267ILEJE 1 1,500 5,000 6,500 7,151 0 4,349Total 218,903 25,903 193,000 194,534 84 24,285


wHoI

List and briefly describe the activities under Ivermectin delivery that are beingcarried out by health care personnel in the project area.

Activities performed by Health personnel in handling Mectizan@o Retraining and training new CDDs prior Ivermect distribution. Supporting supervision during updating census.o Mectizan ordering from DOCs.. Conducts supportive super vision during distribution.o Management of serious adverse events (SAEs) when occurs.o Compilation of data from CDDso Report writing and submission to DOCs. Conduct feedback meeting with community members.

Any other comments - NONE

2.8 Community self-monitoring and Stakeholders MeetingHas any training (of trainers) for community self-monitoring been done in the projectarea?YES

Table 11: Community self-monitoring and Stakeholders Meeting

Describe how the results of the community self- monitoring and stakeholders meetingshave affected project implementation or how they would be utilized during the nexttreatment cycle

.Progressive decrease of refusals

.CSM and SHM has enabled the project to increase therapeutic coverage to80.5% fromTSoh of 2007 .

.Coverage above 80% will be maintained.

District/ LGA Total # of communities in theentire project area

No of communities thatcarried out self

monitoring (CSN[)

No of communities thatconducted stakeholders

meeting (SHn4;

ryryGWPK-YELA

ILEJE

180

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90

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31

16

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TOTAL 240 135 49


NOTF

R.M.O

D.M.O

DOT

FLHFGlafl

GOMMUNITIES/CDDG.

Superuision2.9.1. Provide a flow chart of supervision hierarchy.

National level

Regional level

District level

Health Facilities level

Community level

2.9.2

2.9.3.

2.9.4.

2.9.5.

2.9.6.

What were the main issues identified during supervision?. Still there is a problem of below standard recording. Inadequate motivation to CDDs. Some CDDs needs external force to perform CDTI activities

Was a supervision checklist used?Using both APOC & CHMT

What were the outcomes at each level of CDTI implementation supervision?a Most of people are much aware of the CDTI activities and problems are

being solved through discussion.Was feedback given to the person or groups supervised?

Yes.How was the feedback used to improve the overall performance of theproject?

a Training on proper report writing to CDDsa Dissuasion with communities on how to improve/ increase motivation

to CDD.


SourceType of equipment

APOC MOH DISTRICT/LGA

NGDO Others

No Condition No Condition No Condition No Condition No Condition

1. Vehicle I Functional2. Motor cycle (s) 3 Functional 2 Functional

3. Computer (s) 0 J Functional

4. Printer (s) 2 Functional J Functional

5. Photocopier (s) I CNFR6. FAX Machine (s) I wo7. Othersa)Bicycle(s) 20 Functional

SECTION 3: SUPPORT TO CDTI

3.1 Equipment

Table 12: status of equipment

* Condition of the equipment (F: Functional, CNFR:currently non-functional butrep airab le, ll/O: Writte n ofJ).

How does the project intend to maintain and replace existing equipment and othermaterials?

CDTI activities have been incorporated in CCHP and RHMT, through this systemmaintenance of project equipments is being done.

The project still requires assistance from APOC financially and on replacement ofequipments.


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3.4. Expenditure per activity

Indicate in table 14, the amount expended during the reporting period for each activitylisted. Write the amount expended in US dollars using the current United Nationsexchange rate to local currency. Indicate exchange rate used here US$l : TSH.l,300

Table 14: Indicate how much the project spent for each activity listed below during thereporting period

Comments

SEGTION 4: Sustainability of GDTI

4.1. lnternall independent participatory monitoring; Evaluation

4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tickany of the following which are applicable)

None Year 1 Participatory Independent monitoring

Mid Term Sustainability Evaluation

5 year Sustainability Evaluation

Activity

Expenditure ($US) Source(s) of funding

Drug delivery from NOTF HQ area to central collection point of

Mobilization and health education of communities

Training of CDDs

rrai ni ng 9 f !9at!h_s_!g{gll 4l&rp-t!Superv!_s!ng- CDDs and distribution

Interna! ryoniloqng gf CDTI acJlvltieg

Advocacy visits to health and political authorities

IEC materials

Sgmmqy (rgporting) forms for treatment

Vehicles/Motorc-ycleV!r-cyq!qs,mq-iq!9nq4cg

Offi9e Equipment (e.g

Others

etc

0

4,436.5g,o2o

5,xi.o

APOC

APOC,SSI & DISTRICT

APOC,SSI

SSI & DISTRICT

Aloc,q$_r

APOC,SSI

APOC

SSISSI, REGION,DISTRICT.

SSI &DISTRICT

SSI,APOC & DISTRICT

l,l4l.23,365.8

s,zeo

1,000

667.2

Irsi.t1,032.7

5,228.2

TOTAL 44,292.5

Total number of persons treated 69,812

None


None

4.1.2. What were the recommendations? NONE

4.1.3. How have they been implemented? NONE

Internal Monitoring by NOTF

Other Evaluation by other partners

None

4.2. Sustainability of projects: plan and set targets (mandatory atYr 3)

Was the project evaluated during the reporting period? NO

Was a sustainability plan written? NO

When was the sustainability plan submitted? N/A.

What arrangements have been made to sustain CDTI after APOC funding ceases interms of cash.

o Every year CDTI activities are presented during CCHP Plans meetings for fundingo The spirit of owner ship is insisted at all level

4.2.1. Planning at all relevant levelsa CDDs plans on when to update census, and collection of drug from

FLHF and also with community decide mode and time of distribution.o FLHF plans on updating census, ordering drug from DOCs, informing

community to come and pick the drugs, supervision during distribution tothe community, data compilation and report writing.

a DOCs plans on to execute CDTI activities and make sure that theyincorporated into CCHP, ordering drugs from ROC and make sure theyreach FLHF through normal health system, monitoring and supervision,report writing and submission to ROC.

a The Project Coordinator compile report form districts, preparesTechnical APOC annual report, Mectizan@ retirement and Re-application, supportive supervision to district and attend various Planningmeetings at district level.

4.2.2. Fundsa Project depends on District Councils, APOC and SSI

4.2.3 Transport (replacement and maintenance)a The present vehicle is old hence expensive to run but replacement is

expected in year 2009 according to 2008 Letter of agreement

o Maintenance of existing equipments is through CCHP support.

. Maintenance of existing equipment is done through RHMT & CCHPsupport.

30 WHO/APOC, 24 Novembcr 2004

4.2.4. Other resourcesNONE

4.2.5. To what extent has the plan been implementedCDTI activities are incorporated in PHC routine under supervision of DMOs.

4.3. lntegrationOutline the extent of integration of CDTI into the PHC structure and the plans for completeintegration:

o CDTI activities are implemented in line with Health system.o CDTI activities are now full incorporated in the CCHPo DOCs are members of CHMT.o CDTI activities have been included in the supervision check list of the district.o From 2009 CDTI activities will be performed together with LF activities.

4. 4 Operational research4.4.1. Summarize in not more than one half of a page the operational researchundertaken in the project area within the reporting period.

NONE

SECTION 5: Strengths, Weaknesses, Ghallenges,and Opportunities

List the strengths and weaknesses of CDTI implementation process.Strengths:

- Government is ready to support implementation of CDTI activities

- Accessible roads in the project area.

- The Community members are willing to take Mectizan drug

- Presence of Health structure in the country from National level to community level.

Weaknesses:

- Delay of release of funds especially from Council

- Most of working equipments are old hence they are expensive to run.

Challenges:

- Funds for the implementation of CDTI activities to be released on time by council

- Replacement of old capital equipment

- The council has to maintain roads in the districts so that they can be accessible through the

year.

- Change of Government leaders in the coming election

3l WHO/APOC, 24 November 2004

Opportunities:

- Permanent structure in the project area (Availability of buildings)

- Enough manpower to perform CDTI activities

SEGTION 6: Unique features of the proiect/othermatters


(9} - apps.who.int

Documents