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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.

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