t t I N
1 { I t
-t. t
World Health Organfsation ' African Program for Onchoferciasis Control
SUSTAINABILITY PLAN IMPEMENTATION MONITORING VISIT TO YUMBE DISTRICT, UGANDA
REPORT
SUBMITTED TO: THE DIRECTOR AFRICAN PROGRAM ON ONCHOCERCIASIS CONTROL/WHO
BY: YISA A. SAKA, MBBS,,vrpr -SUB TEAM LEADER EPIIRAIM TUKESIGA
SEPTEMBER 2OO5 Table of Content
BACKGROUND.. .l FINDINGS .2 DISTRICT LEVEL...... 2 SUB DISTRICT...... 4 FIRST LINE HEALTH FACILITY (FLHF) 5 COMMUNITY ...... 6 STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS 7 STRENGTHS...... 7 WEAKNESSES.... 7 OPPORTUNITIES 8 THREATS .8 ACTIONS PROPOSED ...... 8 CONCLUSION 8 RE,COMMENDATIONS... 9 AI\NEXES ll BACKGROUND yumbe District was created late 2000 from the North Eastern part of Arua District arising from as part of the populations concern over the quality of services. Nile, It is bordered in the North by Sudan, East by Moyo District and River South by Arua District West by Koboko District' Arua - Moyo highway traverses the District and it has a number of community and feeder ioads, which are not well maintained making access to service delivery very difficult.
Yumbe District had a populationof 253325 people according to the National population census of 20b2. Today (in 2005) it has a population of 295,475 people.
The economic activities carried out by the indigenous people is majorly subsistence farming. The people of Yumbe District grow food crops such as grow cassava, sweet potuto"t and tereals like millet, sorghum' They also simsim, groundnuts and beans on small scales. Animals such as goats, cattle, and poultry are as well kept by the people but in small quantities'
Yumbe District started CDTI activities way back in 1998 (according to the DOC-Arua) it however took charge of the CDTI activities as a District in 2OO3 in the 4 sub counties of Romogi, Midigo, Apo and Kei. The District then extended CDTI treatment to cover the whole District in2004. This was due to the fact that the whole district is covered by fast flowing Rivers that provide the best biomas for the breeding of the Simulium fly.
In the l't treatment course year 200212003,88,687 people were registered for treatment. Out of which 6},442people were treated giving coverage of 680/o' While in2003l 2OO4 treatment,2O2,O53 people were registered and 160,601 were treated giving coverage of 79%o. A geographical coverage of 100% was obtained in both 200212003 and 2003 12004.
I LIST OF SUBDISTRICTS, FLIIF, AND TTIE COMMLTNITIES SELECTED.
Subdistrict FLIIF Village or Community 1. MIDIGO 1.l MATUMA 1.1.1 tnl 1.1.2 Inbetre 1.2 BARAKALA 1.2.1 Obero 1.2.2 Onoko 2. ARINGA 2.l DRAMBA 2.1.1 Om 2.1.2 Ayivu 2.2 KULINKULINGA 2.2.1 u 2.2.2Wandi Total 2 4 8
FINDINGS
DISTRICT LEVEL
On arrival at the district office the DOC, Mr Yeka Abal Kassim introduced us to the following officers in the district; lyiga. Chairman of the District ----- Mr. Rashid Govule Vice Chairman Mr. Kassim AYisiega Director District Health Services --Dr Nelson Mande District Health Educator------Mr. Adiga. K .P District TBL Coordinator------Mr. Morris Buga' Chief Finance Officer ----Mr. Abdul Monsor Owino Chief Administrative Oflicer---Mr. Drajiga Rasul Health Educator ----Mr. Mansur Abass
We informed them of the objective of our mission and a brief on the background of APOC, and now that APOC is withdrawing, there is need for the district and the community to sustain the program. As part of our monitoring exercise we shall visit the sub district, some seleited First Line Health Facility (FHLF) and communities to ascertain the state of the program.
The assessment will include looking into necessary documents to find out if sustainabitity plans are being implemented as earlier planned and advice given where there are short falls. The exercise will end with a debriefing on our findings and recoillmendations for the progress of the prograrnme.
2 In response to the above, the chairman replied that in as much as the funding in the district is inadequate, they are still supporting oncho prograrnme, and promise to continue. He also informs us that he has attended many advocacy progratnme on oncho where he took his Mectizan in the presence of his community members. He thus wished us well and hopes that he would be around to hear the outcome of the visitation.
The administrative officer welcomed us and wished us well, he informed us of the district budget cut but that he hoped that Oncho will be better funded this year.
The finance offlrcer inform us that the last 3 quarters releases were not realized and the funding of most progrtmlme were affected including the main hospitals in the district. In fact the hospital would have been closed if not that a lot of diversion and in sourcing of fund for drugs and other essential activities were carried out. He showed us the budget for 200512006 where some fund has been allocated for oncho and hope it would be released this year.
The district health educator and the district TBL coordinator inform us that the programme is well integrated and that they all work as a team. New areas of endemicity resulted into increase in drug requirement to meet community demand.
The DOC further inform us that the overall integrated health service plan has a detail list of CDTI activities such as Mectizan supply, targeted training HSAM, monitoring and supervision including dates for implementation. Advocacy to community leaders was created at different level through council meetings. This led to increased awareness from the political, technocrats and the community ownership and support of CDTI. Mectizan supply insufficiency occurred as result of newly refined REMO areas, and proper census update. Chronic late releases of fund led to untimely aistribution of Mectizan. The supply is also not integrated into the district drug delivery system. Uses of transport are well integrated. Motorcycles and vehicle are shared between CDTI and other health progratnme activities like home pack, EPI, DOTs, in drug distribution, monitoring, supervision and training in an integrated maruter, though not properly establish at the lower levels.
J Although there was poor fund release as a result of last year budget cut to the district, some releases from internally generated fund was made available for the running of the programme. Also 2 sub counties released fund for CDTI activitiei in their areas. There was no PHC release for the last 3 quarters in the district.
CDTI data were available, properly recorded and stored. They were analyzed, utilized for planning CDTI activities and reliable' They were integrated into the normal heatth record system - NHIMS' For-year 2OO4]2OO5 geographical coverage was 100% and the theurapetical coverage was760/o.
SUB DISTRICT
Findings: Two iub district Aringa and Midigo were visited .The medical superintendent seen in Aringa, Dr Mwange Joseph and the clinical officer in charge of Midigo health sub district hospital, were not well informed about CDTI.
There were focal person at this level for outreaches services and CDTI can also be carried oritoo. There was no integrated work plan now but the heads of the two-sub district saw the need to include CDTI in their next work plan. At this level training on CDTI was not included, but the staffs were very well interested in knowing more on oncho.
HSAM activities have not been implemented, though the level interacts with affected communities on other health progralnmes. CDTI monitoring and supervision is non-existent and does not appear on their supervisory forms for checklist, though it is on the HMIS form.
At this level issues on Mectizan supply, distribution and monitoring do not exist but they can be useful for the treatment of side effects reaction. Available staffs at this level were willing to be trained in CDTI; presently there is no focal person knowledgeable and trained.
In the use of transport, there was no integfation and resources were not shared between CDTI and other health progralnme. Transport like motorcycle and vehicle available were not shared. There was willingness to cooperate and use these transport facilities once oncho is integrated.
4 include No fund was allocated to oncho at this level, but staff were willing to CDTI in activities in outreach plan. Presently there were no records keeping, though all resources needed were available' It was difficult to ascertain ivermectin coverage because there were no records on CDTI activities.
FIRST LINE HEALTH FACILITY (F'LHT)
Four FHLF were visited and of this 2FLIIF have integrated plan but without key cDTI activities outlined. Training of cDDs was conducted early this For the 2 FLItr that had trained, 98 year-coos by the focal person at this level. panicipated. The other 2 FLTIF have no plan and no focal persons but are willing to get involved in CDTI in the next plan'
Training was done in the 2 FLIIF with the focal persons, to improve knowlelge and skill on oncho, transmission and control, treatment using height, if,o should be treated and when, side effect, supervision and moiitoring. Training resources were not enough. There was no training in the other 2FLHtr that has not been sensitized.
Sensitization of community and opinion leaders about Oncho was by participating FLFIFs, the district staff with the aim of creating awareness on bncho as a disease and treatment using CDTI strategy through churches, council, meetings, markets, and house to house. HSAM led to more participation of th. to--rttity and about 40 to 50 people were educated at Lach meeting. People sensitized included the pastors, imams, opinion leaders, local organizations and youth groups.
Monitoring and supervision were done at the trained FLHF level, during treatment, but ther. *ur no checklist. M/S was integrated with other health programme. The 2 other FLI{F not sensitized do not monitor or supervise any activities. There was always feedback to those supervised.
The participating FLI{F got adequate supply and on time for dates of ptanneA distribuiion but in Matuma, there were drugs about to expire t""u.rr" of delay by CDD in collection of the drugs for distribution- The distribution was however not through the regular health care system'
5 2 FLtIFs have designated focal person, trained in GDTI activities and have The the capacity to .oribin. CDTI with other community-based activities' other iff-fif with no focal person also had both human and other resources but need to be trained. jointly Home pack distribution, DoTs, and the control of bilharzias were lnurrug.d with GDTI activities in the 2FLIIF that have focal persons' Resources such as staff, space and time were equally shared in training and monitoring. Coverag. not be assessed, as all FLHF were yet to be on "orrld board.
COMMTJNITY The following communities were visited: oriajini, Inbetre, obero, onoko, Mbgokolo, Ayivu, Mogoju, and wandi.
For the year 2OO4:2OO5, all communities had health education and mobilization in community meetings markets, burial funerals, places, and house to house by cDDs distributing Mectizan. This led to increase community awarenlss and improved treatment coverage. At least 75 %o of the community members were sensitized and mobilized.
Mectizan supply was adequate at the last distribution cycle, but made available at the sub countieJheadquarters rather that the FLIIF. It was timely collected by the sub county supervisor and distributed according to the community requirement.
All of the 8 sub counties in Yumbe, had training of the cDDs done, in year 2OO4:2OO5 but there were more men than women. Some CDDs complained that the work was much and they would need some support. There was no motivation by the community, and no serious attrition rate of CDDs.
Record at the community level cannot be relied upon because registers were left at home, but from the verbal discussion the record seem to be properly recorded. One of the villages has register that was properly recorded and kept. Reliability at this level cannot be determined. Reports at this level were integrated into record system. All househotd in the 8villages visited were treated in the last distribution with an achievement of 760/o therapeutic coverage and geographical coverage of 100%.
6 STRENGTHS, WEAKNESSES, OPPORTUNITIES AND TIIREATS
STRENGTHS
{. The District level has an integrated work plan' {. There is integration of CDTI with other health progralnme in the district and FLFIF. t Leadership of the programme is well demonstrated at all level in the district. * DOC calculation of Mectizan required was with the population of the district. * DOC and the focal person at the FLTIF are trained and knowledgeable in cDTI activities, and can impact such in the lower levels. * District Chairman and the Chief Finance Officer pledged the release of budgeted fund to oncho this 2005/2006. .t Uses of transport are integrated at al level where available' * A comprehensive listing of communities and census up date was available. * Staff receive salary and allowances regularly' * Expulsion of worrns and feeling of well being were some of the advantages the communities reported from Mectizan. {. Community supports were in kind and well accepted by the CDD' * CDD were willing to continue with CDTI work'
WEAKNESSES * Alt activities were initiated by DOC. {' Inadequate supply of Mectizan in some villages' {. Supply of Mectizan by Doc to villages, some times. * Propei inventory of Mectizan was not present in the village. * Yearly training and HSAM was regarded as part of the standard protocol before distributing Mectizan. * Poor or no release of fund for CDTI. {. Vehicle maintenance, repair and fuelling were dependent on individual progralnme donors. {. Late treatmeni of some communities as a result of inability of the FLIIF to train CDDs. * Some FLItr were not trained in CDTI activities' {. poor HSAM of the community on their responsibility and ownership in CDTI progralnme. * Drug supply to CDDs after training in some communities by FLI{F staff.
7 OPPORTUNITIES
{. Support from sub counties PMA funds for CDTI activities. {. Integrated transport facilities. * Stability in stafftransfer. {. Community immense appreciation on the usefulness and importance of the drug for their health. * Community acknowledgment of the CDDs work
THREATS
{. Lack of /poor funding and budget cut to CDTI at all level. t Presence of large amount of Mectizan in Matuma FLHF. * cDD not wanting to associate with FLHF to collect their drugs * DOC yet to train some sub counties' FLHF on CDTI.
ACTIONS PROPOSED
{. Census update and registration of all eligible people. * HSAM of all health workers. * Training of all health workers in the district. * HSAM of the political and the technocrats in the district should urgently be carried out. * Release of fund for day-to-day running of the progralnme at the district level from internally generated fund. t Sub-district health staffshould be train in CDTI philosophy. €. DOC to visit and resolve Matuma FLTIF crises and ensure that the drug left there was distributed.
CONCLUSION
Monitoring of the sustainability plan of Yumbe was carried out by Dr Y. A Saka and Mr. E. Tugesiga, and findings covering year June 2004lJuly 2005 to September 2005 was that the district though highly in support of the prograrnme, fund release has been very diffrcult due to budget cut and non ielease of the last 3 quarters of 2004.The programme is well integrated into the district health plan, and all facilities available were also used for monitoring, supervision, HSAM and training.
8 into the At the sub district level, CDTI activities has not been integrated in making sure system but the head of the health facilities were committed HSAM and that GDTI was included in the sub district plan and activities. training has to be carried out at this level' while the At the FLIIF, 3 sub counties health facilities have been trained, 2had their rest 5 sub counties were yet to be trained. of the 4FL[{F visited, Monitor and focal person trained, carry out HSAM of their areas, trained, and carried out Supervised their CDD, ct[ect Mectizan from the district prograflrme' CDTI programme in an integrated manner, with the other health like malaria, filariasis, DOTs and EPI' the HSAM activities were well carried out at the community level, and mobilized' members of the community were properly sensitized and the sub Collection of Mectizan was from the county to the villages, and The county supervisor carried out monitoring and supervision of the cDDs' the CDDs, communities were not aware of the fact that they have to support very low' but the CDD were not worried about this. CDD attrition was took place A debriefing session with the District Political and technocrats and atl the findings were related to them, with some recommendations' The DOC, Sub i{ealth District Officers, political and technocrats of the made District should be mobilized. Running cost /impress account should be be available to the progralnme and drug left in Matuma FLIIF should collected and distributed by the CDDs'
RECOMMENDATIONS
Following are the recofilmendations / suggestions we have for the egrowth of the Progralnme: -r . Urgent iet.Iat" of fund for the Monitoring and Supervision ot the project by the District Leadership' . planni"g *i budgeting for CDTI activities should be at all level. . DOC and DHT members should empower the immediate lower level to conduct monitoring and supervision. DOC can pay targeted supervisory visit to communities with specific problems or as part of its "spot checks"'
9 . Mobilization of the 5 remaining sub counties yet to be in line with the CDTI PhilosoPhY. . MectizanProcurement. -Each level should be encouraged to pick up their Mectizan requirement from immediate higher level using resources that preferably that of government' are dependable, - - Mectizan pro".r.r-ent should be early enough, and based on the population census to ensure sufficiency and timely too.
. Training of the FLTIF staff in all areas distributing Mectizan and involve them in CDTI activities' . Creation of impress account for Oncho project' . Community responsibility should be clearly stated in future HSAM activities in CDTI. . Creation and marking of Oncho day to fuither increase awareness in communities. r Recognize cDDs for their voluntarism spirit leadership. . Community Leaders to organize their people to select CDDs where the existing was overloaded with work or few' . Records of all activities at a level should be available for future references. . All means of transport and other logistics available to other health progralnmes should be used in an integrated manner with CDTI.
l0 ANNEXES
LIST OF PEOPLE INTERVIEWED.
DISTRICT HEADQUATER o The chairman of District - Mr. Rashid Govule Iyiga. Mr. Kassim Ayisiega o The Vice Chairman - o The Director District Health services --Dr Nelson Mande o The District Heatth Educator-Mr' Adiga K 'P o The District TBL Coordinator---Mr. Morris Buga o The chief Finance officer---Mr. Abdul Monsor owino o The chief Administrative offrcer---Mr. Drajiga Rasul o Health Educator ----Mr. Mansur Abass o District Oncho Coordinator -Mr. Kassim Yeka
SUB DISTRICT
ARTNGA o Medical Superintendent ---Dr Mwange Joseph
MIDIGO . Clinical Officer ----Mr. William Wongo
FLIIF
MATUMA o Clinical Officer-----Mr. Leku Stephen o Nurse Aid ------Mr. Swale Gule . Midwife (CDTI focal person) ------Ms Ndamaru M
DRAMBA o Nursing Assistance------Mr. Tokojo John o EnrolledMidwife------Egibazuy Joke o Security------David Payo
BARAKALA o Enrolled Nurse ------Mr. Mohammed Ali o Nursing Assistance---Mr. Adam Chaka
l1 KULINKULINGA . Clinical Officer in charge------Mr. Ondoga Simon o NursingAssistance------Mr. ChandigaJohn
COMMUMTIES
OMGBOKOLO l. Mr. Simon Esiga------CDD 2. Mrr. Omiga Luke------CDD 3. Mr. Rubega Alex 4. Mr. Kenyata Pontihous 5. Mr. George Onduga 6. Mr. AknguYo Fred 7. Mr. Maria Onavu 8. Mathia Charly------Village Leader
WANDI 1. Taban Majid 2. Ratib Ayub 3. Swale Maju 4. Ambaya safu 5. Baby Othman 6. Ratib Bashir 7. ShrajiYassin 8. Kama Kajumbe 9. Ejaga Abdu l0.Echega Swale l1.Kenus Abdallah 12.Taban Yassin l3.Ayiman Noah 14.Auma Kenus l5.Jafer Anku
1 6.Josiga Mansur -----CDD I 7 . Ayiga Abdallah-----Chairman l8.Dragona M. Julius---Odravu Sub county Chief
t2 MOGOJU l. Ansapa Jackson ------CDD 2. Aluma Rajab------CDD 3. Yassin Mansur 4. Juruga Manour 5. Ramandhan Yobuga 6. Burhan Yobuga 7. TabanRasul 8. Ayiga Zubeir 9. Mambo Tibo I 0.Atuma Ratib------Secretary LC I I l.Alungani Adisa 12.MawaMuzamil 13.Jimia Ojani 14.Peter Moses l5.Ayisa Owoko 16. Kemisa Obia
ONOKO l. Ombema Adinan ------CDD 2. Oyabo Seaca D 3. Aminu Omal------Chairman
AYIVU 1. Drapaga Allahay-Village Leader 2. DawaNyma ------Home pack distributor and CDD 3. Akinbo Amis------CDD
OBERO l. Musema R. K. Hakim 2. Nalai Rasul 3. Rasul Kemis 4. Zainabu Swaibu 5. Achidin Asharaf 6. Atama Ismail------CDD 7. Abdul Abass------CDD 8. Shuaibu Sebbi------Chairman
13 INBETRE 1. Ochaya Mawa D 2. Atama Wongoson----Community Chairman 3. Saban Boki 4. Bakere Lasul 5. Ahmad Ayi ORIAJINI I . Asibu Ramandan ------Village Chairman 2 . Yasin Saban------Vilage Supervisor J . Sadiq Shuaibu------CDD 4. AdebugaRasul------CDD 5 . Swayibu Ojonga 6 . lzamalatibu 7. Raosul Sebi 8 . Zubair Said 9. Sabari Toha 1O.Azub Ibrahim I l.Daiko Muzamib 12.Yiki Swale l3.Adaiga Habibu 14.Alaihi Mohamaido l5.Totoa Rasul 16.Bako1e Rasul l T.Tabani swaibu 18.Waila Bosco lg.Dungus Mohamad 20.ltimaZuberu 2l.Songao Tairi 22.Kemisi Mohammed 23.Langaju Baduru 24.Aini Noah A AT DEBRIEFING SESSION 1. Rashid Govule Iyiga----Chairman Rashid Govule Iyiga----Chairman Yumbe District 2. ------Vice Chairaman J. Education /PRO 4. Office 5. CAO 6. Mansour-FIE for DFIE 7. Vence ACC/ASS 8. A. Kassim DOC/DUCO
t4 PLANS MONITORING IMPLEMENTATION OF CDTTI SUSTAINABILITY
INSTRUMENT 1
(State/Regio n/P rovince)
COUNTRY UGANDA PROJECTNAME PHASE IlI CDTI PROJECT
NAME OF THE STA YUMBE
DATE OF COMMENCEMENT OF CDTI 1998
DATE OF EVALUATION JUNE / JULY 2OO4
DATE OF COtr,ttvtSNCSMENT OF 2004 PLAN IMPLEMENTATION DATE OF ASSESSMENT OF SUSTAINABILITY l9 SEPTEMBER 2OO5 PLAN IMPLEMENTATION DR. SAKA NAME OF MONITOR MR TUGESIGA AND
t5 TOOL FOR MOMTORING OF CDTI SUSTAINABILITY PLANS
verify whether conslraints earlier InStrUCtiOn : Check implementation of sustainability plan and (Training, Moniloring and supervision' identified are being rectified. Also check if ley CDrI activities implemented as planned' HSAM and Mectizan procurement and distribution) are being
STATE/ REGION/PROVINCE 1.1PLAI\INING of information Characteristics of the indicator Sources a with makers and o fs COn integrated into the overall health service Interviews PolicY level plan? managers at this a CDTI tr Does a detailed list of CDTI activities exist Inspection of Plans including the dates when they will be carried out? is integrated into the overall Findings: Describe the situation (*comment on ffiis level) CDTI yearly routine as any other programme' written plan and most staff at this level consider it as part of their provided for in the plan including budget Mectizan supply, targeted training and HSAM plus monitoring are
and dates for implementation. Ifplanning was not done give reasons why N/A
Suggest steps to be taken to improve situation N/A
1.2 HSAM (AdvocacY) Characteristics of the indicator Sources of information responsible for What was the o,bjective? a Interviews with officials (managers etc') Who was targeted for this advocacY? Onchocerciasis at this level reports What approach was used? a Inspection ofthe technical activity
What was the outcome? and suPPort of Findings: Describe situation. Objective of this advocacy is to create awareness, ownership council meetings' Political and CDTI. Advocacy to community leaders at different levels carried out through technocrats support ofoncho Program achieved
If advocacy was not done give reasons whY N/A
Suggest steps to be taken to improve situation N/A
l6 1.3 MECTIZAN
Sources of information Characteristics of the indicator for 5 Interviews with officials responsible Is ivermectin *pplv sufhcient (adequacY)? level (managers etc') (for distribution)? onchocerciasis at this Is the delivery of ivermectin timely a Inspection of techni cal reports/records Is it integrated into drug delivery system? proper census sufficient because of undefin ed REMO and Findings: Describe the situation. Supply not, releases of funds and 1S because DOC experiences chronic late update. Ivermectin IS not timely for distribution not integrated into drug delivery system' Late give reasons whY. ImProPer census ivermectin is not available fluffrcient, timelY, integrated) releaseoffunds. Newoncho areas discovered' out. Early registration and censos uPdate carried Suggest steps to be taken to improve situation into drug Establish of REMO map and integrate ivermectin to the community delivery system like any other drug taken ofFLHF.
l.4INTEGRATION
Sources of information Characteristics of the indicator o Interview of staff at this level Resources o Inspection ofreports, plans, budgets etc' are shared Mention the resources (e.g' transport staffl that (e'g' between CDTI and other health programme activities EPI, malaria, HIV/AIDS) Activities supply' List the activities (e.g. Mectizan procurement and lower level supervision and monitoring and training of CDTI staff) carried out in an integrated manner with and other health programme activities vehicl ES are shared between CDTI Findings Describe situation. Motorcycle and with CDTI though not monitoring and training ln an integrated manner like home pack, EPI DOT ln drugs distribution properly establish at lower level activities. Sensitisation of all health workers on CDTI tftnere is no evidence of integration give reasons
programme managers shoul d be trained in Suggest stePs to be taken to imProve All CDTI and empowered to manage CDTI activities'
t7 1.5 FINANCE
Characteristics ofthe indicator Sources of information this level o Are resources allocated at this level for a Interviews with officials at the continuation of CDTI? a Inspection ofthe plans, budgets, documents tr Are resources released for CDTI showing disbursement, for year of reference activities? o What proportion of allocated funds was released? year because of the 'budget cut' that Findings: Describe the situation. No fund releases for the last financial revenue at 2 sub counties' No affected the district budget. However small releases were realised from local
PHC releases for the last 3 quarters.
fffinances are budgeted but not released give Budget cuts.
reasons why
Suggest steps to be taken to improve situation
1.6 RECORD KEEPING
Characteristics of the indicator Sources of information offrcials at this level o Is data on CDTI available? Interviews with records system o Are they properly recorded and stored? a Inspection ofrecords and o Are they analysed and utilized for planning CDTI activities? o Are they reliable? Are they integrated into the normal health
record system at this level? are analysed, utilised for Findings: Describe situation. CDTI data available proPerlY recorded and stored. TheY planning CDTI activities and reliable. They are integrated into the health record system -HMIS
Ifrecord keeping is poor give reasons why N/A
Suggest steps to be taken to improve situation NiA
l8 1.7 COYERAGE
Characteristics of the indicetor Sources of information o What is the geographic coverage ? r Interviews with officials responsible for
o What is the therapeutic coverage for Onchocerciasis at this level year the last treatment cYcle? Inspection of records for previous
Describe situation. The geographical coverage for last year 2004 was 100%o while therapeutic
coverage was 760/o.
Ifgeographical coverage rates are below 100% N/A
and therapeutic coverage rates less than 650/o,
give reasons why
Suggest steps to be taken to improve situation N/A
19 MONITORING IMPLEMENTATION OF CDTI SUSTAINABILITY PLANS
INSTRUMENT 2 (DistricULGA) COUNTRY UGANDA PROJECT NAME PHASE IIICDTI PROJET (ARINGA AND MIDIGO NAME OF THE DISTRICT/LGA YUMBEHSDS DATE OF COMMENCEMENT OF CDTI 1998 DATE OF EVALUATION JLINE/JULY 2OO4 DATE OF COMMENCEMENT OF 2004 SUSTAINABILITY PLAN IMPLEMENTATION DATE OF'ASSESSMENT OF 20 SEPTEMBER 2OO5 SUSTAINABILITY PLAN IMPLEMENTATION NAME OT'MONITOR DR.Y.A. AND MR E. TUKESGA
20 TOOL FOR MONITORING OF CDTI SUSTAINABILITY PLAI\S (District/LGA)
Instruction.. Check implementation of sustainahility plan and verify whether constraints earlier Supemision, identified are being rectilied. Also check if key CDTI activities (Training, Monitoring and HSAM and Mectizan procurement and distribution) are being implemented as planned.
2.I PLANNING
Characteristics of the indicator Sources of information makers and managers at a Is CDTI integrated into the overall a Interviews with policy health service plan this level
a Is there a detailed list of the key CDTI a Inspection of the written Plans activities (monitoring, training, etc.) including their timing? Findings: Describe situation. There are no CDTI integrated work Plans in all health sub district visited. in their next planning' However ,the heads in charge of the HDSs saw the need to include CDTI If there is no plan give reasons whY They have not involved them in CDTI activities. them to get Suggest steps to be taken to improve situation Train HSD staff in CDTI and empower involved in CDTI acivities.
2.2 TRAINING
Characteristics of the indicator Sources of information o What was the objective of the a Interviews with policy makers and managers training? a Inspection of training Programme o What was the content of the training? o How was the need for training determined? o Who conducted the training? o Where was the training done? o Were training resources efficiently
used?
Findings: Describe situation. None has received training in CDTI activities and staffat this level showed interst to know more on oncho. If training is not done give reasons why They have not been involved in the programme. philosophy Suggest steps to be taken to improve situation Train HSD staff in CDTI and APOC
2l 2.3 HSAM (Sensitisation and Advocacy)
Characteristics of the indicator Sources of information
o Was there sensitization of officials, opinion a Interviews with oflicials responsible for
leaders about Onchocerciasis at this level? onchocerciasis at this level
o How was it done (approach)? a Inspection of activity/technical reports o What was the result? o How many people were sensitized? Findings: Describe situation. Sensitisation and advocacy on CDTI at this level has never been considered , though they interact with affected communities on other health programme.
If sensitization was not done give reasons why? This level has always been by-passed.
Suggest steps to be taken to improve situation Sensitisation and advocacy should be immediately carried out to empower and involve partners at this level.
2.4 MONITORING AND SUPERVISION
Characteristics of the indicator Sources of information
o Was there supervision and monitoring? a Interviews with officials responsible for
o When were CDTI supervisions and onchocerciasis at this level monitoring activities carried out? a Inspection ofactivity and technical reports as well
o How frequently? (at least once a year) as monitoring and supervision reports
o Is there a checklist on oncho. activities? o Is it integrated into other health care supervisory forms' checklist?
o Were strengths and weaknesses identified?
o Were weaknesses redressed?
o Were there reward systems?
o Was there feedback to those supervised? Findings: Describe situation. CDTI monitoring and supervision is non existent at this level and does not
appear on their supervisory form for checklist, though oncho it is on HIMS forms
If supervision and monitoring were not done Considered not a priority and taken care of by DOC from
give reasons why District.
Suggest steps to be taken to improve situation Advocate for integrated plan.
22 2.5 1jMECTIZAN SUPPLY
Characteristics of the indicator Sources of information
a Was ivermectin sufficient for last o Interviews with officials responsible for distribution cycle? onchocerciasis and drug supplies at this level
a Was ivermectin delivered in a timely r Inspectionofactivity/technicalreports
manner from the state to the DistricU o Inspection of drug delivery inventory records LGA?
..! Is ivermectin supply integrated into the
normal drug management component of
the health system? Findings: Describe the situation. Does not appear in their drug need list or requirement If ivermectin was not sufficient, timely and its Mectizan supply from District to communities. delivery not integrated give reasons why
Suggest steps to be taken to improve situation FLFIF should request Mectizan for communities in their catchments areas from HSDs to empower them on full involvement in CDTI activities.
2.6 HUMAN RESOURCE
Characteristics of the indicator Sources of information
a Is there an officer responsible for a Interviews with officials responsible for onchocerciasis onchocerciasis at this level
a Is s/he trained/knowledgeable in a Inspection of activity records CDTI?
a Is s/he responsible for other health projects or activities?
Findings: Describe the situation. No CDTI focal person at this level that is trained and knowledgeable in CDTI activities .The available staff are willing to take up CDTI. If responsible officer is not available or Staffat this level have not been involved in CDTI activities knowledgeable, give reasons why
Suggest steps to be taken to improve situation Train HSD staff and empower them to be involved in CDTI activities.
23 2.7 INTEGRATION
Characteristics of the indicator Sources of information a Which activities (e.g. training, monitoring) o Interview of staff are carried out jointly with other health o Inspection ofreports, log-books etc. programme activities? a Which resources (e.g. staff, transport) are shared between CDTI and other health EPI, malaria etc program Finding: Described the situation. CDTI activities are not jointly carried out with other health and other health programm€s at activities and resources like staff , transport ate not shared between CDTI this level.
If CDTI activities and resources are not well It has been a tradition integrated with other health programmes give reasons Suggest steps to be taken to improve the situation Sensitization and empowerment of HSD staff to get involved in CDTI activities in an integrated manner.
2.8 FINAIICE
Characteristics of the indicator Sources of information
a Are resources allocated at this level for the o Interviews with officials at this level continuation of CDTI? o Inspection ofthe plans, budgets, documents
a Are resources released for CDTI activities showing disbursement, for year ofreference in time?
a What proportion of allocated resources is
released Findings: Describe the situation. No fund allocated for the running of CDTI at this level. Staff willing to at
least include CDTI activities in outreach plan.
If proportion of resources budgeted, allocated Nothing budgeted for and allocated'
and released is inadequate give reasons why
Suggest steps to be taken to improve situation Should budget for oncho next financial year.
24 2.9 RECORD KEEPING
of information Characteristics of the indicator Sources o Inspection records, records system a Are data on CDTI available? o Interviews with officials at this level a Are they properly recorded, stored and
easy to retrieve?
a Are they analysed and used for planning,?
a Are they reliable?
a Are they integrated into record system at this level? at this level though all resources needed are Findings Describe situation. No record keeping is available available.
N/A If record ing is poor give reasons why
Suggest steps to be taken to improve situation
2.lOTRANSPORT
of information Characteristics of the indicator Sources a Interviews with officials respon sible for a Is transport available for CDTI activities? onchocerciasis transport at this level a Is it functional, adequate, and used in an a of records, reports, vehicles log-books integrated way with other health care Inspection activities? vehicl es are available at thi s lerel is not shared for Findings: Describe situation. Transport like motorcYcle and CDTI activities. There is willingness to share transport available'
Iftransport is not availab,le (as stated above) N/A give reasons why of managers at this l,evel to involved and Suggest stePs to be taken to improve situation Sensitisation support CDTI should be given a top priority byDDHS'office.
25 2.llCOVERAGE
of information Characteristics of the indicator Sources a Interviews with offi cials responsible for a What is the GeograPhic coverage for past at this level two years? onchocerciasis a lnspection of summary records for ivermectin a What is the therapeutic coverage for last and rePorts. two years? treatment can not be assessed at this level is they are handle Findings: Describe siruation. Ivermectin treatment coverage no CDTI records.
rates are below expected ('100o/o N/A
-r"ov.."g.geographical and 650/o therapeutic-) give
reasons why Introduce CDTI at this level and empowe. the to keeP Suggest steps to be taken to improve situation relevant records on the programme'
26 PLANS MONITORING IMPLEMENTATION OF CDTTI SUSTATNABILITY
INSTRUMENT 3 (Frontline Health Facility - FLIIF)
COUNTRY UGANDA PROJECT NAME PHASE II I CDTI PROJECT NAME OF DISTRICT/LGA YUMBE ULINGA NAME OF THE FLHF MA DATE OF COMMENCEMENT OF CDTI r999 DATE OF'EVALUATION JI.INE/JTILY 2OO4 DATEOF COMMENCEMENTOF 2004 SUSTAINABILITY PLAN IMPLEMENTATION DATE OF ASSESSMENT OF 2t-9-200s SUSTAINABILITY PLAN IMPLEMENTATION TUKESIGA NAME OF MONITOR DRSAKA.Y.A. AND MR.E.
27 MONITORING IMPLEMENTATION OF CDTI SUSTAINABILITY PLANS (FLHF)
INSTRUMENT 3
Instruction.. Check implementation of sustainability plan and verdy whether constraints earlier identiJied are being reaiJied- Also check if key CDTI uctivities (Training, Monitoring and Supervision, HSAM and Meclizan procurcment and distribufion) are being implemented as planned
3.I PLANNING
Characteristics of the indicator Sources of information
a Is there a list of the key CDTI activities a Interviews with officials responsible for (monitoring, training, etc) including dates? onchocerciasis at this level
a Where and when were they conducted? a Inspection of charts on walls, work plan, list of things to do.
Findings: Describe situation. zFLlJ[. have integrated plan but without key CDTI activities and training of g8attended CDDs was conducted early this year by the focal person at this level. the training. The other 2FLI{F have nothing like plan or focal person but are willing to get involved in CDTI in he next plan.
If planning was not done give reasons why CDTI recently introduced in the FLlIFs.
Suggest steps to be taken to improve situation CDTI activities should also be included in the integrated plan of the FLIIF
28 3.2 TRAINING
Characteristics of the indicator Sources of information o What were the objecti justifications for the a Interview with offrcials in charge, of training? onchocerciasis at this level tr What was the content of the training a Inspection of training manuals, training reports, tr How many CDDs were trained? notes etc. o Were training resources efficiently used? (disease) Findings: Describe situation. Training done in the 2FLHF to improve knowledge and skills on oncho effect 98 CDDs were transmission and control, treatment using height, who should be treated and when , side had no training train in the 2 health facilities together .Training resources were not enough . The other 2 FLfm
since they had not been involved.
If training was not done give reasons why In the 2 FLtIFs CDTI has not been introduced. enough training materials. Suggest steps to be taken to improve situation NOTF offrce should arrar.ge for (r.E.c.)
The 2FLIIF should be encouraged to start implementing CDTI activities in all 8-sub counties of oncho endemicity'
3.3 HSAM (Sensitization)
Characteristics of the indicator Sources of information o Was there sensitization of community and rI Interviews with offi cials responsible for opinion leaders about oncho. at this level? onchocerciasis at this level
o What was the objective of the HSAM? a Inspection of activity/technical reports o How was it done (approach) o What was the result? . How many people were sensitized? o Who were sensitized? particiPating Findings: Describe situation ion of community and opinion leaders about oncho was by strategy FLFIF and district staffwith aim of creating awareness oncho as a disease and treatment using CDTI through churches, council meetings, markets and house to house. All parishes sensitized. If sensitization was not done give reasons why N/A
Suggest steps to be taken to improve situation N/A
29 3.4 MONITORING AND SUPERVISION
of information Characteristics of the indicator Sources at this out tr Interviews with Persons in charge a Was monitoring and supervision (lWS) carried level for CDTI regularly (how many times in a year)? tr Inspection ofdocumented reports and o Is there a N0S checklist? supervisory checklist etc. o Were M&S activities integrated with M&S activities
of other health Programmes? o What were the strengths and weaknesses identified? o Was there feedback to those supervised? but no checklist for CDTI activities. IWS of Findings: Describe the situation. lrt/S done in 2 FLIIF during treatment CDTI is integrated with other health programme Theother2FL}IFshavenotstartedandarethusnotyetinvolve. There is always feedback to those supervised' have not been involved. ffrnonitoring or supervision was not done as planned give The 2 FLFIFs
reasons why IWs should be integrated with other health Suggest stePs to be taken to imProve the situation progtrmmes to minimize on use of available
resources at this level.
3.5 MECTIZAN ofinformation Characteristics of the indicator Sources tr Records of ivermectin ordering and stock With regard to the supply of ivermectin: control tr Are the suPPlies adequate? Interview with nurse or health staff in tr Is it delivered on time for dates of planned tr distribution? charge tr Is it ordered and distributed to the FLIIF and the communities within the regular health care system? and on tinr" Uut in Matuma there are Findings: Describe the situation The participating FLIIF get ad"qu"te suPPlY distribution' drugs about to expire because of delay from CDD to collect for commitment from district and some CDDs If ivermectin supPlY detivery was inadequate or Lack of "na untimely, give reasons whY should urgentlY sPot supervision to Suggest stePs to be taten to imProve the situation tr//s PaY Matuma CDDs find out why delay to distribute the
drug before expiring. Mectizan needs to be procured early enough to
ensure that it is available at community level at periods they need it.
30 3.6 HUMAN RESOURCE
Characteristics of the indicator Sources of information a Interview with the Head of the Health a Is there a designated Person for onchocerciasis control? Department a of documents a Is the designated person trained and Inspection knowledgeable in CDTI?
a Is the person able to effectively combine CDTI with his other community-based health responsibilities? focal to oncho and Findings: Describe the situation 2FLHF have designated Person trained in CDTI activities and have the capacity to combine with other community-based activities' The other 2FL!{F also have resources but need to be
brought on board. N/A If the use of human resources ls inappropriate or unsatisfactory, identify the weak points and give
reasons on CDTI and empower them to get Suggest steps to be taken to improve the situation Train all FLfIF fully involved in CDTI activities in an integrated manner.
3l 3.T INTEGRATION
Characteristics of the indicator Sources of information a staff a Which activities (e.g. training, monitoring) Interview of Project etc' are carried out jointly with other health a Inspection of reports, log-books programme activities? a Which resources (e.g. staff, transport, space, time etc.) are shared between CDTI and other health programme activities (e.g. malaria outjointly Findings: Describe the situation Home pack ,DOTs, Bilharzias are carried in 2 FLtIFs particiPating in CDTI activities and use same resources ln CDTI If integration is not effective give reasons why The 2FLIIF have not been sensitized on
areas should be Suggest steps to be to improve the situation Training of all FLHF in oncho carried out to empower all staffto integrate CDTI in an manner
3.8 COVERAGE
Characteristics of the indicator Sources of information responsible for a What was the Geographic coverage for a Interviews with officials past two years? onchocerciasis control at this level records for ivermectin a What was the therapeutic coverage for the a lnspection of summary previous years. last treatment cycle? treatment and reports for brought on Findings: Describe situation Coverage of2004 could not be assessed as all FLIIF none had been board.
Ifcoverage rates are below expected (-100% N/A
geographical and 650/o therapeutic-) give
reasons why
Suggest steps to be taken to improve situation N/A
32 MONITORING IMPLEMENTATION OF CDTTI SUSTAINABILITY PLANS
INSTRUMENT 4 (Community)
COUNTRY UGANDA PROJECT NAME PHASE 1I CDTI PROJECT NAME OF DISTRICT/LGA YUMBE NAME OF SUPERVISORY FLHF Ms NDAMARU. M, Mr., TOKOJO JOHN, MT MOHAMMED ALI, Mr. ONDOGA SIMON
NAME OF THE COMMUNITY ORIAJINI, INBETRE, OBERO, ONOKO, AYIVU, MOGOru, WANDI, MBGOKOLO. DATE OF COMMENCEMENT OF CDTI 1998 DATE OF EVALUATION JIJNE/JULY 2OO4
DATE OF COMMENCEMENT OF 2004 SUSTAINABILITY PLAN IMPLEMENTATION DATE OF ASSESSMENT OF 2t AND SEPTEMBER 2OO5 SUSTAINABILITY PLAN IMPLEMENTATION NAME OF'MONITOR DR SAKA Y. A. AND MR E. TUKESIGA
JJ MONITORING IMPLEMENTATION OF SUSTAINABILITY PLANS
(Community) INSTRUMENT 4
Instruction : Check implementation of sustainability plan and verifu whether constraints earlier identified are being rectified. Also check if kcy CDTI activities (Training, Monitoring and Supervision, HSAM and Mectizan procurement and distribution) are
being implemented as Planned.
4.1 PLANNING
NOT CRUCIAL AT THIS LEVEL
4.2 TRAINING
NOT CRUCIAL AT THIS LEVEL
4.3 HSAM (Health Education and Mobilisation)
Characteristics of the indicator Sources of information leaders and o Was there health education and Interviews with CDDs and community mobilisation of the communitY? members. o How was it done (approach)? a Inspection of village-kept records o What was the result? o How many people received health
education ? village Findings: Describe situation. All communities had health education and mobilization in community Community meetings, churches, markets, funeral places, and house to house by CDDs distributing Mectizan. was awareness created on CDTI and improved treatment coverage. At least 75o/o of every community sensitized and mobilized.
Ifsensitization was not done give reasons why N/A
Suggest steps to be taken to improve situation N/A
34 4.4. MONITORING AND SUPERVISION
NOT CRUCIAL AT THIS LEVEL 4.5 MECTIZAN SUPPLY Sor.ces of information Characteristics of the indicator Interviews with CDDs and communitY members a Was ivermectin suPPlY suffcient for last L distribution cYcle? a Inspection of drug delivery inventory records a Was ivermectin made available at the FLIIF when needed?
a Was ivermectin collected in a timely manner from the FLHF? and was made w as sufficient for last distribution cycle Findings Describe the situation Mectizan supply sub FLHF It was collected 1n timely manner from the availab le at the sub county headquarters instead of choice' county supervisor and distributed according to community N/A If ivermectin was not sufficient, timely and its mode of distribution not determined by community give reasons whY Drug flow should be from District, HSD, FLHF, and to Suggest steps to be taken to improve situation community like any other community based drug level distribution. There would be a focal person at every mentioned above to handle CDTI activities'
35 4.6 HUMAN RESOURCES
of information Characteristics of the indicator Sources with CDDs and community members tr How many trained CDDs are in the Interview communitY? tr Is there a fair mix of both sexes among the CDDs? tr Is the workload for each CDD compatible? with efficient distribution of ivermectin ? B Are the CDDs well motivated ? o What is the attrition rate among CDDs ?
visited had training last Year and some this Year Findings: Describe the situation. All CDDs in communities representation' Some CDDs complain of big village and there is a fair mix of both sexes, but more male needed support. They also complain of lack of covered by 2 cDDs and that the work is too much and motivation and no serious attrition rate' N/A If CDDs are not available or are not trained, give reasons whY leaders should organize for selection of new Suggest steps to be taken to improve situation Community CDD to support villages where existing CDDs are not sufficient. Community leaders should recognize cDDs as a type of motivation gesture.
36 4.7 INTEGRATION
NOT CRUCIAL AT THIS LEVEL
4.8 FINANCE NOT CRUCIAL AT THIS LEYEL 4.9 RECORD KEEPING
of information Characteristics of the indicator Sources a Inspection records, records system a Are data on CDTI available? a Interviews with officials at this level a Are they properly recorded, properly stored
and easy to access?
a Are they analyzed and used for planning,?
a Are they reliable?
a Are they integrated into record system at this level? treatment exerclse book properly recorded The Findings: Describe situation Only one community showed but from verbal discussion with CDDs there seem to be other community claim their register were left at home report can not be determined' but they seem proper records. Since we never saw the register, reliability ofthe
to be integrated into record system at this level N/A Ifrecord keeping is poor give reasons why ana community supervisors should ensure qualitY Suggest steps to be taken to improve situation DOc control ofdata at this level.
4.10 TRANSPORT NOT CRUCIAL AT THIS LEVEL
4.ITCOVERAGE Characteristics of the indicator Sources of information a Interviews with CDD and communitY members. a Were all households treated in the last records for ivermectin distribution cycle? a Inspection of summary and rePorts' a Were all eligible persons treated in the last treatment distribution cycle? person in the Svittages were treated in last Pindings: Describe situation All household with some Etigifte geographical of 100% distribution with an achievement ofT6Yotherapeutic coverage and N/A lf household coverage and therapeutic coverage
rates are below expected give reasons why N/A Srggest stePs to be taken to imProve situation
37 STATUS OF IMPLEMENTATION OF SUSTAINABILITY PLAN FOR YEAR 2OO4I 2005.
PLANNED STATUS REMARK ACTIVITIES oncho 1 HSAM Advocacy done in all endemic sub counties of the district. Community sensitization done in 8 sub counties ) Capacity Training of health workers, Fund yet to be Building community supervisors and CDDs released in the Only conducted in 3 sub counties. other 5 sub counties. released J Official Not done No fund launching of oncho in the District. 4 Mectizan Done in all 8 counties distribution. released 5 Monitoring Done in all 8 counties. No fund and supervision 6 Capital Nothing procured No fund released equipment from APOC and District. the 7 Travel 95 % of travel done Funding from district running cost.
38 STATUS OF IMPLEMENTATION OF SUSTAINABILITY PLAN FOR YEAR 2OO5I 2006.
PLANNED STATUS REMARK ACTIVITIES 3 sub counties. Fund yet to be 1 HSAM Advocacy done in Rumugi, Kei, and Midigo. released in the 5 other sub counties. yet be 2 Capacity Implemented in 3 sub counties, Fund to Building Rumugi, Kei, and Midigo. released in the other 5 sub counties. fund released J Official Not done. No launching of oncho in the District. 4 M.ectizan Ongoing in the 3 sub counties distribution. and fund released 5 Monitoring Done in all 8 counties. No and supervision released 6 Capital Nothing procured No fund equipment from APOC and District. from the 7 Travel Collection of drug from Nrational Funding office. district running cost.
39 FI-'ND RELEASED FOR YEAR 2OO4I2OO5
PERFORMED VOUCIIER AMOUNT RELEASED ACTIVITY NO SHS Return of retirement on 103 162,000 account to KamPala national oncho office. to schools in the t02 96,000 AdvocacY district Return of rePort to Kampala, 1,4 167,700 national oncho office Collection of the village 46 162,000 sters LeadershiP ffaining of DOC 47 122,000 in Arua. 429,000 of TOTAL 1,133 700
40 I or T -l or or I I I I ql t or I I (,r 5do (., d., (.) o, m c, -.- odr G' dr (, - ! I g f, q, ot t I I I I I I I ! I N N N ? (.) N N N N N NI I t I m !q N N I I I I ! I I T z ED I I I I T I ! t ! I c rn U) g o 5 m @ o v o ml 9. o o o m
Ot N (., { o, (n o o I s (o 1., (o b N) br br io o i, b b { (,l N (o o C' o o I I I I o I I I I I I I I I I I I I (j) (J) (/) (J) u) (, u) (, C. (j) (j) (J) UJ u) u) u) 1 UJ U) I I I I I I I I a 1 I I I I I I I I [.J \,J (! (,) tJ) u) u) N) t) TJ N) N) N.J N) N) I ()) UJ U) u) I I I I I I I I I I I I I I l I I N) tJ N) I t I I I I I I I I I I I I I I O o O (]) € { o\ (, 5 (]) N) 6 { o\ Lll 5 N)
V) a a Ir1 z a F o 'rl - tn U E z. e F! z Et o F U a rt o - F a a G o tn E1 o F Irl v U ED i t- o z o z, o o i a o z tn z a tn ED a a EE El F F t' ln FI t. P -l 2r- EE FI t oz o 7 E z a FI aFl ? - Fl 0FJ bJ
UI OhJ tJ UI tr o\ o\
t.) Ur (, L,I N) Ur (,r (, { L,I N) Llt L,I (,l (Jt N) NJ L'I o (, L'I .O 5 o @ (])5 o o I f
LIST OF DOCUMENTS SEEN IN THE DISTRICT.
I Map of Ugandashowing Yumbe district' form. 2 yumbe district ivermectin distribution summary J Midigo sub county work plan for CDTI activities' 4 orajiii sub county work plan for CDTI activities. annual work plan 5 yumbe district health sector comprehensive FY 200512006 June 2005.
6 Yumbe district post APOC sustainability plan' FY 2005/06' 7 Selected demographic characteristics in Yumbe district dated 3rd April 2 8 DOC report on.o'.-unity sensitization on CDTI, 2004. g. List of village health teams by reporting health unit 10. Sub counties work Plans.
44