UNITED REPUBLIC OF TANZANIA
ORIGINAL . English
_t COUNTRY/NOTF : TANZAI\IIA Proiect Name: TANGA CDTI \J^a Aporoval Year:1999 Launchins vear: 2000 LJ Renortins Period: From: l"t IINE 2oo4 To: 3lsr MAY 2oos \A (Month/Year) (Month/Year) Proiectvearofthisreoorfi (circleone) I 2 3 (4) 5 6 7 8 9 10
Date submitted: 10th December2hD4 NGDO partner: HELEN KELLER INTERNATIONAL
ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEB (TCC)
D L
DEADLINE FOR SUBMISSION: (,DM \cc2 o $b (tP To APOC Management by 31 Januarv for March TCC meeting l'* t i.!,.- r-t To APOC Management by 3l Julv for Sentember TCC meeting ' .Drs t--o b
I.: I'.t /i
AFRICAITPROGRAMME FOR " oNCHocERCIASTS coNTRoL (APoc) RECU 0 4 FEV. 2005 APOC/DIR
I WHO/APOC, 24 November 2004 ANINIUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the report:
Country: l-'iN-:-\N1+
National Coordinator Name: .w..G.Wc+ Sk, ul
Signature
Date as.li c6 a Regional Medical Offrcer NmrelR .&l.n+.qn4gt Nh*\o I Signature .MEO'CAL tsi lDlrbecJ rD+ Date a
c1-'s'-ft t NGDORepresentative Name: ifo--. ,
,, 'a.- ' Signature a
V Date: 2"r:,
tv1 Acra1i This reporr has been prepared by Name b8. : . B.e+ Y+tl R.Drul\1.1r Designatio,r' fug,Jft.T.. :ol
Signature &
Date lqih &s ?qy!
a
ii WHO/APOC, 24 November 2OO4 Table of contents
ACROI\TYMS v
DEFINITIONS ...... VI
FOLLOW UP ON TCC RECOMMEIYDATIONS I
EXECUTTVE SUMMARY 2
l. l. GSNERAL rNFoRMATroN...... 3 1.1.1 Description of the project (brieJty). 3 1.1.2- Partnership 3 I.2. POPT]LATION 4 SECTION 2: IMPLEMENTATION OF CDTI...... 5
2.1. TnrmrwB oF ACTIWIIES ...... 5 2.2. Aovocacy 7 2.3. MosnzetloN, SENSITZATIoN AND I{EALTH EDUCATIoN oF AT RISK coMMUNTTIES 7 2.4. ComrmurY INVoLVEMENT 8 2.5. Capacrry BUILDING 9 2.6. Tnperug1rrs...... ,.... 2.6.1. Treatmentfigures 2.6.2 What qre the causes of absenteeism?...... 2.6.3 What are the reasons/or refusals? 2.6.4 BrieJly describe all lcnown and venfied serious adverse events (SAE{ that.... l3 2.6.5- Trend of treatment achievementfrom CDIT project inception to the cunent year 15 2.7. OnoERnrlc, sroRAGEANDDELvERyoFIVERMECTIN...... 16 2.8. Colavru.ury sELF-MoNTToRINGarqo SraxBnoLDERS Mrprnqc t6 2.9. SupsRvrsloN t7 2.9.1. Provide aflow clnrt of wpervisionhierarchy- t7 2.9.2. Whot were the main issues identified during sapervision? 17 2.9.3. Was a supervision checklist used? I7 2.9.4. What were the outcomes at each level of CDTI implementation supervision? l7 2.9.5. Wasfeedback given to the person or groaps sapervised? ...... I7 2.9.6. How was the feedback used to improve the overall performance of the project? l7 SECTION 3: SUPPORT TO CDTI ...... 17 3.1. Equewvr t7 3.2. FnqRNcrer coNTRIBtmoNS oF TIIE pARTNERS AND coMMtiNrrIES 18 J.J. Orrmn ponrrls oF coMMUNTTy suppoRT. 18 3.4. E>crtrtolruRs pER ACTIVITy ...... l8 SECTION 4: SUSTAINABILITY OF CDTI...... 19 4.1. IlrrrnNar;rNDEIENDENTpARTrcrpAToRyMoNrroRrNG;EvaruauoN...... 19 4.1.1 Was Monitoring/evaluqtion carried out during the reporting periodT (tick any of thefollowingwhich are applicable)...... tg 4.1.2. Whst were the recommendations? t9 4.1.3. How have they been implemented? l9 4.2. Susrenlasll.lTy oF PROJECTS: PLAN AND sET TARGETS (trlexoeronv er 20 YR 3) 20 4.2.1. Plaming at all relevant levels 20 20 4.2.3 Transport (replacement and maintenonce) 20 4.2.4. Other resources-... 20 4.2.5. Towhat extent has the plm been implemenled....-... 20 4.3. hrrscnerroN ...... 20 4.3.1. Ivermectin deliverymechanisms 20 4.3.2. Training 20 4.3.3. Joint supervision and monitoring with other programs 20 4.3.4. Release offundsfor project activities. 20 4.3.5. Is CDII included in the PHC budget? 20 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved Whot hove been the qchievements? ...... 20 4.3.7. Describe others issues considered in the integration of CDTI..--.-- 20 4.4. OppnenoNAl RESEARCH...... 20 4.4.1. Summarize in not more than one half of a page the operatiornl research undertaken in the project area wilhin the reporting period.....--... 20 4.4.2. How were the resalts applied in the project? 20 SECTION 5: STRENGTHS, WEAI(NESSES, CHALLENGES, AI{D oPPORTrINrrrES...... 21
SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...... 21 /
Acronyms
APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UMCEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Or ganization
V WHO/APOC, 24 November 2OO4 Definitions
(i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking).
(iD Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area
(iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year.
(i") Ultimate Treatrnent Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project are4 ultimately to be reached \ illen the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project).
(") Therapeutic coverage: number of people treated in a given year over the total population (this should be e>ipressed as a percentage).
(vt) Geographical covera€re: 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 percent4ge).
("tD Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI.
(viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high teatment 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 raihich the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), *ith 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.
vt WHO/APOC, 24 November 2004 FOLLOW UP OlI TGG REGOTTENDATTO]IS
The recommendations of the last TCC on the project and how they have been addressed TCC session lt
Nurrter TCC ACTIONS TAKEN BY T,HE FORTCAAPOC MGT of RECOMMENDATIONS PROJECT USE ONLY Recotttne nddionin the Repofi 186 Project respond to all TCC 15 Respond to TCC 15 recommendation recommendation
186(a) Clarification provided. Health Improve hedth education and worker/population ratio is 2CDDs duration of treatment to talre to 107 person, which is satisfactory care of ebsentees and refusals
186O) Clarify conflicting infomation Clarification provided. 1fi)7o of communities agrced on Communities agreed on time but period of distribution vis a rains started early than expected. in farming distribution and fmd Few communities in Korogwe shortage period experience food shorage spent time to fetch food 186(c) Recalculate coverage in Table 6 Coverage has been recalculated
186(c) Clarify conllicting infoomation Clarification provided. Few refuse on knowledge of disease vis a because of little knowledge. Project 1007o of communities having strategy is to have appropriate IEC received herlth education materials at right time
1E6(d) Discuss management of reactions Plans are made to intensi& HSAM. as one may improving coverage Those who get reaction in previous treafrnent cycle to be given antihistamine prior next cycle 1e0(D Provide misring infomation on Information on trainingrnonitoringpupervi sion fraining,monitoring,supervision and and funding for the past years funding provided
1e0iii) Provide timdine for activities Timeline of activities Provide 190(iv) To conduct REMO refnement in REMO in Korogwe conducted in Korogwe so that pnoper coyerage May 2004.411 CDTI vill4ges can be determined identified 190(v) Use new formet in subsequent New reporting format is used. repofts
1 WHO/APOC, 24 November 20[,4 Executive Summart/
The Implementation of Community Directed Treafrnent with Ivermectin(CDTl) under the African Programme for Onchocerciasis Confrol(APOC) entered its fouth year in three districts among seven in the reglon, which are Mutreza, Korogwe and Lushoto. Year four activities started in September 2003 and treatnent started in March 2004. Re-fraining of FLFIF staffconsisted of running through ttre whole programme based on the problematic area identified during supervision. The DOTs took very active part in re-training of FLHF staff.53 FLHF staff were trained in all three endemic districts. After re-fraining of FLHF staff,2624 CDDs were re-fiained by FLHF staffat their areas.
Out of 289,896 people,235,353 were ffeated in 1309 communities giving Therapeutic Coverage of 817o.
Annual Treatment Objective (ATO) was 240,681.
The population increase rapidly due to the discovery of gold mine in some communities in three endemic districts of Lushoto, Muheza and Korogwe,as many people are came from different areas to try their Lucky in gold mine.
Main challenges were inadequate financial support from Korogwe district and inadequate motivation to CDDs in some few communities. Advocacy and sensitazation to policy maker is still going on. Before each distribution communities are sensitized concerning community ownership and the impotance of motivate their CDDs.
2 WHO/AFOC, 24 November 2OO4 SEGTION {: Background infiormation
1.7. Gcncnl infiorrnetion
1.1.1
Tanga Regron where the three endemic districts of Lushoto, Muheza and Korogwe are located is in the extended north - east Corner of Tanzania between 40 and 60 and below the equator and 3f - 390 East of the Greenwich Median. The region occupies an area of 27,348 Sq. Kms, being 3 per cent of the total area of the entire Country.
Tanga shares borders with Kenya to the North, Morogoro Region and Coat Region to the South, Kilimanjaro and Arusha region to the west. lndian Ocean borders it on the East.
Distractively, the region is divided in to 7 District namely, Lushoto, Korogwe Muheza, Handeni, Pangani, Kilindi and Tanga Municipality. The Region has 37 DIVISION, 155 WARDS, 701 Villages and many sub-villages. Most of the villages in project area in all three disticts occupies with about 1500-3000 inhabitants per each village their main occupation is peasant farmers. The major activities of the farming season are compressed during the long rain from April, May to June with the harvest soon afterwards. There many ethnic groups living in both districts although the major ones are - Sambaa,ZilWL Bondei, with few Digo and Segeju and are almost similar to all 3 districts. This ethnic groups speak, their mother tongue, but all younger people speak Kiswahili, the national language, which has become the most important language in the countr5r, spoken nearly by l0Oo/o of the Tanga Population.Few of the population are also able to communicate in English.
The major religions remain Moslems and Christians.
Access to the endemic districts (Lushoto, Korogwe and Muheza) fuom Tanga and Dar es salaam is via a good quafity maintained tarmac road although the final 32 km winding road to Lushoto District is though mountains, most of the roads from district headquarter to the peripheral are muddy, rough and mountainous roads which are risky and not easily passable especially during rain season. Ottrer means of commutation are telephone radio call and Mobile phones which are working effectively from regional to district level. LUSIIOTO DISTRICT. Is situated in the Northem part of Tanga Region, is about 187 km from the regional headquarter where Tanga CDTI office situated, and 350 km from capital city Dar es salaam.
Its bounded with Republic of Kenya on the Noflhern part. Korogwe district on the South and Kilimanjaro Region in the Northwest. The district covers an area of about 3500sq km. Resultirg io a population density of 127 people per sq. km. Much of the district lies in the midst of the Usambara Mountains where altitude range is 4500 meters above the sea level.
3 WHO/APOC. 24 November 2OO4 The District divided in trvo physical features the highland which cover almost 75%o of the lan{ and is characterized by cold weather and the low of 25o/o whtch is having a hot weather.
An average amount of rainfall is 1100mm with heavy rains mainly in the months of March and May which is the wet season, from June to September is cold season with the temperature dipping as low as freezing. The dry season is from October to March.
More than 80% of populations live in rural area and are peasants engaged in small- scale farming and petty Business. Main food crops are Potatoes, Bananas. Rice, Maize, Beans and Cassava. Cash crops are Vegetables, Fruits, Tea and ginger.
Administratively the district is divided into 8 division, 32 wards and 163 villages
KOROGWE DISTRICT: Is located in the center of Tanga reglorL is 87 km from Tanga town and 290 km from Dar es salaam.
It's bounded wittr Muheza district to the Eastern side, Lushoto district to the Northern and Western Southern part is bounded by Handeni District.
The district covers an area of 3,756sq. km resulting in a population density of 69 persons per sq. km. The district forms a narow lining to the whole Southern half of the Usambara Mountains.
The district is divided into three zones, which have different physical features and weather as follows; - Arid lowlands on the western part rainfall is below 800 mm - Wet lowlands on the south and eastern part average annual rainfall 800mm- l000mm - Mountainous on northern part with cool weather and more rainfall ranging from 1000-2000 per year, so the average rainfall of the district ranges between 800- 2000 per year, with heavy rains on April to July and October to December within the yare. Most of the population live in the rural area and are depending in agriculture small scale farming grow Maize, Cassava, Rice, Bananas, and Beans as food Crops, while Coffee, Cardamom and vegetables are grown as cash Crops. Like other Districts in the Region there are big Sisal and Tea Estates, which are owned by foreigners.
Administratively the district is comprised of 4 divisions, 20 wards andl33 villages.
MUHEZA DISTRICT: Is situated in the Northeast corner of Tanga Regron, is about 39 km from Tanga town and 310 km from Dar es salaam. It is the second largest district in the Regron next to Handeni. The district is bounded in the North by Republic of Kenya, East with Indian
3 WHO/APOC, 24 November 20O4 Ocean, South with Pangani district and West with Korogwe district It covers an area of 4,922 sq.krn. resulting in a population density of 55 persons per sq.km.
The district altitude is between 0-2000 meters above the sea level, the temperature rangng from 30 - 32 degrees however the climate varies mainly wittr altitude with Usambara Mountains(forest) posing a great deal of influence. The district can be divided into three climatic belts as follow;
Coastal belt
Mountains
Low plains
There is a series of major and minor rivers Pangani, Zigt and Umba are few of the major rivers which pour their contents into the Indian Ocean. Mkurumuzi is one of the minor rivers in the District.
The district generally gets three rainy seasons in the year,long rains between March and June (Masika) scaffered showers (Mchoo) in August and September and short rains between October and December (Vuli) average annual rainfall is between 1000- l500mm.
90o/o of the population live in rural areas about 20%o of them live in a radius of 12- 14km from the nearest health facility while 807o have to walk a distance of 5-10km to the nearest health post, and most of them are peasants in which they grow Mniz.e, Cassav4 Rice, Bananas, Beans as a food crops. Black-peppers, Iliki, Vegetables are the cash crops. However there are big tea and sisal estates which are owned by foreigners.
Administratively Muheza district is comprised of 6 divisions, 24 wards and 174.
Th6 district hospitals owned by gorverrnent direct oversees all health facilities in the district.DMos are in charge of all health facilities,helped by CHMT
3 WHO/APOC, 24 November 2OO4 District hospital are responsable to detver drugs to health centers and dispensaries which are under goverrnent There are health facilities in most villages in Tanga regron and the big population (70y.) has an access to health facility within a distance of 5 Km. On the other hand we have to state that about one third of the Tanga population has no health facility in their catchment area.
There are also a growing number of private health facilities but mostly concenfrated in urban areas except for faith-based facilities, which are mostly in rural areas There is a very good mix of public and private services and even working relationship as partners is improving.
There are 46 FLHF in the project arca.2Z in Muheza,12 in Korogwe and 12 in Lushoto Table l.Number of health staffinvolved in CDTI
District Number of health staffinvolved in CDTI activities Total Number of Number of health Percentage health staff in the staffinvolved in entire project area CDTI Br Bz $3:82/81*1(X) Muheza 25 22 88 Korogwe 36 t4 53 Lushoto 60 t7 28.3 Total t2t 53 56.4
1.1.2 Partnership
Tanga Focus CDTI project started in 2000 with a general indemnity of 48 per cent. The project is currently in the fouth year of APOC fuodiog with the HKI as an NGDO parfirer in the project. There is strong partership in the programme,HKl NOCP support supervision, train project staffand CCDs. Rdgron and District councils fuel vehicles/motocycles during advocacy and mobilazation. During planning, project staffare supported by regron and districts.
Community members are willing to take Ivermectin and some motivate CDDs by exempt them in communial work. Mobilazation of decision-makers at different level to assist CDTI implementation is done
3 WHO/APOC, 24 November 2004 =l (l) cl (\l V) -A lr ! c) l-r -o