ORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE AFRICAN REGION REGION DE L'AFRIQUE

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCH(rcERCOSE B.P. 549 OUAGADOUGOU, Burkina Faso Tdl6gr.: ONCHO OUAGADOUGOU Tel.:(226')342953-342959-34 2960Telex: ONCHO524l BFFU<:Q26)343647-342875

t I I MISSION TO

10- 17 November 2002

Dr A. Seketeli, Director, APOC I Dr U. Amazigo, Chief, Sustainable Drug Distribution Unit, APOC I I I We are grateful to the Government of the United Republic of Tanzaniafor allowing this mission to be undertaken. Sincere thanla to the Honourable Minister of Health, Mrs A. Abdallah, the Country Representative of IVHO, Dr Simon Katenga, Mr Charles Franzen and (9v the NOTF of Tanzania. Our special thanlcs to Mn Paul Chikira, Regional Administrative Secretary, Regional Medical Ofiicer, District leaders of Ulanga and Kilombero and all other APOC partners for their assistance in making this mission possible and successful.

WHo/APOCll0'|clo2-r BACKGROTII\ID

Tanzania is one of the Africa's hotbeds of onchocerciasis (river blindness). It has a population of 35 million people and is among the 19 countries of the African Programme for Onchocerciasis Control (APOC) that signed the first and recently second Memorandum to eliminate onchocerciasis as a disease of public health and socio-economic problem. The ultimate goal of the National Onchocerciasis Control Programme (NOCP) in Tanzania is to eliminate onchocerciasis as public health problem within a period of l5 -20 years in the 14 onchocerciasis endemic districts. Funding from APOC has been approved for 6 ivermectin distribution projects (in Ruvuma, Mahenge, T*gq Kilosq Morogoro, Tukuyu districts), vector elimination in Tukuyu district and national headquarter (HQ) support projects. The objective of APOC is to establish a sustainable ivermectin delivery system in each member country with the goal of eliminating onchocerciasis from Africa. In 1997, APOC partners including Tanzania adopted the community-directed treatment with ivermectin (CDTI) approach as the principal skatery for the control ofonchocerciasis. Progress in establishing sustainable community-directed treatment with ivermectin (CDTI) in APOC counffies including Tanzania depends on the systemic critical revieVevaluation of current implementation practices of the national onchocerciasis Task Forces (NOTFs) with a view to doing things better in the future. This is the essence of the recent assessments of the sustainability of seven (7) CDTI projects in 9 geographically distinct areas in four countries undertaken in May/June 2002. The CDTI project in Mahenge Focus in Tanzania was among the nine projects that were evaluated. '

PIIRPOSE OF THE MISSION

At the invitation of national onchocerciasis Task Force (NOTF) of Tanzania, an APOC management visit (Annex l) was undertaken to Tanzania with the purpose of:

(i) Attending district leaders meeting to develop a three-year sustainability plan of the community-directed treatment with ivermectin (CDTI) project in Ulanga and Kilombero districts (Mahenge Focus CDTI project).

The sustainability of projects has been the crucial ingredient in APOC CDTI programme and the Management has invested huge amount of resources into putting down the process of *APOC realising it. According to APOC Phase II document will monitor progress towards the establishment of sustainable CDTI and determine ... if and when a project has been successful. The success criteria would cover issues of treatment coverage, community directorship and ownership, health system support and integration of CDTI into the existing health care structures."

Between May and June 2002, participatory evaluation of seven CDTI projects in nine geographically distinct areas in Uganda, Nigeriq Malawi and Tanzania were undertaken. Teams of national and outside experts, using guidelines and instruments developed by the core group on sustainability and field-tested, carried out these assessments. The main findings were discussed at the second meeting of the representatives of the national onchocerciasis Task Forces (NOTFs) in Abuja, Nigeria and the meeting made recommendations on criteria by which projects are to receive further support from APOC Trust Funds after five years. The progress .meeting concluded that" the Mahenge CDTI project is not making satisfactory towards sustainabllily' and for sustainability to be achieved, ownership of the programme by target communities, integration into healthcare system, support of the primary health care establishment (commitment of government) and performance of treatment activities need immediate attention.

' The result of the evaluation is available in two APOC documents - " The assessment of self-sustainability of the Mahenge CDTI projecf'and "Report of the Second meeting of the National Onchocerciasis Task Forces (NOTFs) Representatives: sustainability indicators, assessment of projects and lessons learned" In the light of the results of the evaluation on the Mahenge project and recommendations of the Abuja meeting, and following series of consultations, the NOTF Tanzania invited the Management of APOC to a meeting with district and council leaders of Ulanga and Kilombero districts. The mission is to assist the leaders to develop a sustainability plan with a view to revitalization of the project and putting it on the track to sustainability.

(ii) Meeting with the Honourable Minister of Health of Tanzania ln 2001, the government of Tanzania represented by the Hon. Minister of Health. Mrs Anna Abdullah co-chaired the seventh session of the Joint Action Forum (JAF), the meeting of the . governing body of APOC. As is the practice, the Government of Tanzania will chair the eighth session of JAF that will be held in Ouagadougou in Burkina Faso. An aim of the mission was to debrief the Honourable Minister on the responsibilities of position that will be held by the Government of Tanzania for one year (December 2002 - November 2003).

(iii) Participating in an NOTF Meeting

The National Onchocerciasis Task Force (NOTF) Tanzania working towards enhancing sustainability indicators in all projects convened a meeting to review the programme. Following the meeting in Abuja, Nigeria in June 2002, APOC Management had written NOTF/Tanzania in October suspending further disbursement of funds to NOTF/HQ secretariat that oversees the implementation of APOC projects in Tanzania. The management noted that it would resume funding when there is discernible evidence of technical support to country projects by HQ office as foreseen in the Letter of Agreement. The APOC mission was therefore to dialogue and agree with the NOTF/Tanzania the way forward and find solutions.

DISTRICT LEADERS MEETING ON SUSTAINABILITY OF THE MAIMNGE CDTI PROJECT

Objective of the meeting

The objectives of the meeting as presented were: o To assist the leaders of Ulanga and Kilombero (Mahenge focus) districts to formulate a three-year CDTI sustainability plan. o To address critical indicators highlighted in the evaluation report of Mahenge project that stand in the way of sustainability. o To discuss and agree on the conditions for further support by APOC, district financing commitments and dialogue on sustainable approaches to secure community and district ownership of the project in foreseeable future. o To sensitise the leaders of the districts of Ulanga and Kilombero in Mahenge focus on the benefits of the Community -Directed Treatment approach.

Partners present at the meeting The partrrers represented at the meeting included: - Morogoro Regional Administration - Regional Medical Offrce, - District Health Management Teams of Ulanga and Kilombero - District Planning Office - Ulanga - Ulanga and Onchocerciasis Coordination teams - National Onchocerciasis Task Force (NOTF) of Tanzania - National Institute of Medical Research (NIMR) - WHO /Tanzania - NGDO Coalition, Tanzania represented by Inter-Church Medical Association (IMA) - WHo/APOC The list of participants at this meeting is attached as annex 2

Key issues

CDTI sustainability plan for Ulanga and Kilombero districts Onchocerciasis is endemic in two districts (Ulanga, Kilombero) of the Mahenge Focus. In 1995, the control of onchocerciasis through community-based ivermectin treatment (CBIT) strategy began in the two districts supported by MoH in partnership with lnter-Church Medical Association (tMA). ln 1997, the control strategy was converted to community-directed treatment with ivermectin (CDTI) with funding support from the African Programme for Onchocerciasis Control (APOC), and the project is in its fifth year of operation. The support for CDTI in both districts will tentatively end in December 2002.1n May/June 2002, an assessment of the project was undertaken. The major aim of the evaluation was to determine the level of sustainability of the Mahenge CDTI project, in order to know whether it can function optimally with little or no external resources, post-APOC funding. The other objectives were to determine the strengths, weaknesses, emerging issues, opportunities and threats of the project and propose recommendations, and develop action plans that can put the project on the sure path to sustainability. The evaluation report concluded, " The project is not making satisfactory progress towards sustainability." As consequence, the Abuja meeting of NOTFs recommended among others that a detailed post-APOC implementation plan that is dependent on local resources be developed for the district, community sensitisation and mobilisation should begin immediately and geographic and therapeutic coverage rates should be improved to acceptable levels. o The guest of honour, the Regional Administrative Secretary, Mr Paul Chikira, opened the meeting on strategic district sustainability plans. The objective of the meeting and expected outcome were presented by Dr Katenga, the national coordinator. This was followed by welcome remarks of the Dr Seketeli, Director of APOC. o The national co-ordinator presented the findings of the report of the assessment of sustainability of Mahenge CDTI project, recommendations of the NOTFs representatives meeting in Abuja, Nigeria and the letter of APOC Management regarding funding of HQ and Mahenge projects. He informed the meeting about series of actions taken by the NOTF/Tanz-ania and the districts following the evaluation exercise and the Abuja meeting. Steps taken by NOTF/Tanzania before the arrival of the mission included - o An extraordinary meeting of the NOTF, regional and district medical officers on the decisions of the Abuja meeting and to discuss the way forward for the project to become sustainable o Advocacy workshops and stakeholders meeting for CouncilHealth Management Teams and leaders of Kilombero and Ulanga. o The 196 meeting of the NOTF attended by non-NOTF members, Dr E.Tarimo, co-cordinator of the APOC evaluation activity and Dr J. Okeibunor, leader of the evaluation team for three districts in Uganda. o In his opening remarks the Director of APOC outlined the philosophy of the programme, emphasizing key aspects of programme execution by partners as detailed in the Phase II and Phasing-out Period Programme document and APOC Phase II Memorandum signed in December 2001 by all participating governments including Tanzania. He stressed on the critical relevance of sustainability of CDTI, the control strategy of APOC, for the elimination of onchocerciasis as a disease of public health and socio-economic importance. He further underscored the importance APOC management attaches to the results of the evaluation of CDTI sustainability after five years of APOC support, and to the decisions of the representatives of the NOTF in Abuja" Nigeria in June 2002. o The Regional Administrative Secretary in opening the meeting recognised as a big challenge the task of putting Mahenge CDTI project on the road towards sustainability. He identified reasons for the poor performance as lack of involvement of community leaders and under-utilisation of the

4 ten-cell leadership and administrative arrangement of the region. He promised to put in place positive changes in project implementation before the JAF meeting in December 2002.

Kev indicators o The meeting discussed project performance on five key indicators -Funding/ Financing; Training/ sensitisation/ mobilisation and Health Education; Mectizan supply and coverage (geographical and treatment), Planning and leadership. o Planning and Leadership: The meeting acknowledged that at the regional and district levels, leaders responsible for implementing the programme have so far played minimal role in the annual CDTI planning activities. Though Onchocerciasis features in the Comprehensive District Health i Plans, district financial commitment is minimal and supervision of CDDs is weak. The Mahenge project is not at the point where regions and districts responsible for implementing the programme meet and plan for program activities on a regular basis. The regional authorities have been marginalised. o The meeting also noted that the time DOTs devote to onchocerciasis activities especially at the community level is very minimal. The re,lson is there are in each district only two members of the DOT and who are also involved in other control activities. o Onchocerciasis has not become part of the culture of especially the Kilombero district. . The meeting reviewed the leadership for onchocerciasis activities at the two districts level and agreed it should be decentralised to improve effectiveness in planning and implementation. Coverage o While treatment coverage in has been maintained above 650 ,it is discouragingly low in Kilombero district. Geographical coverage rates in the two districts need to be rechecked. o The rates of refusals and/or absentees were determined to be the main cause of low treatment coverage in a number of communities especially in Kilombero district. The low coverage was partly due to non-adherence to the period of distribution agreed with the communities and fear of side effects. The meeting however agreed that operational research should be undertaken to address the problem of high absenteeism. Training/ mobilization / sensitisation o The critical deficiency indicators were noted as- community mobilization and sensitisation, training of health staffand CDDs, Coverage and Funding/Financing at community and district levels. Fundingy'Financing o Both Ulanga and Kilombero districts should start budgeting and disbursing funds for onchocerciasis activities to sustain the programme. o Budgets should be developed in a decentralized manner while focusing on activities to empower communities. o There is an urgent need to strengthen supervision of programme activities at all levels in a co- ordinated manner including guidelines and checklists. Local sources of funding e.g JICA, Basket funds and lreland Aid should be explored as a matter of urgency.

Criteria for further suoport bv APOC. The visiting team explained the criteria to qualiff to receive additional support and types of support from APOC after the fifth year of funding. This information is contained in the report of the NOTFs representatives meeting in Abuja (see footnote on pg.2 *) t

SustainabiliLv Plans of Ulanga and Kilombero districts ' o A three-year plan is required from Ulanga and Kilombero districts based on the criteria for further APOC support. Due to the limited time for the mission, the meeting agreed to develop a one-year plan and the remaining two-year plans to be submitted to APOC Management before 3l December 2002. . The mission provided guidance on the layout of the sustainability plan. The CDTI sustainability plan should be an integral part of the Comprehensive District Health Plan and clearly referred to in the district health Plan. The presentation of the plan should include the process, details of planned activities, timeframe of activities, actors responsible for implementation of the activities, budget, source of funds and detailed budget justification. o The district teams were advised from the onset not to lose sight of the fact that the essence of the planis to address sustainability of ivermectin distribution system. o On 12 November, ttre district Medical officers (DMOs) presented the first draft plans of Ulanga and Kilombero. The meeting reviewed the plans and suggested amendments. The district teams were asked to remain in Morogoro town to prepare a second draft plan to be presented to the meeting when it resumes on 156 November. They were carefully guided on how to revise the different sections of the draft sustainability plan, the budgets and the justification of the budgets. o The district teams of Kilombero and Ulanga presented the second drafts of CDTI sustainability plan to the meeting on l5 November. The group suggested further amendments and made recommendations/decisions as below. The districts were advised to present the amended versions the next day.

Key decisions o The mission observed that APOC financial support (substantial in the last 5 years) and the NGDO support were not mentioned in the Kilombero and Ulanga Districts' Comprehensive Council Health plans. The meeting advised the district leaders to correct this error in the background information section of the new District health plans. o The meeting decided the amounts being requested from APOC Trust Fund for CDTI activities in 2003 should be clearly stated in the final budgets of the Comprehensive Council Health plans of Ulanga and Kilombero districts. The contributions of the supporting NGDO should also be acknowledged in these plans. o The meeting agreed to dissolve the Mahenge project co-ordinating office. The project coordinator, Mr Kassiga of St Francis Hospital, Ifakara will become the District Onchocerciasis Coordinator (DOC) for Kilombero district. o The Ulanga District should appoint a new DOC to be trained on CDTI strategy and APOC philosophy. o A new accountant for the Ulanga district should be appointed and trained by the WHO/Tanazania and NOTF/ HQ offrce on the WHO accounting system. o Financial imprest returns of Ulanga and Kilombero districts will henceforth be forwarded to the NOTF/HQ offrce in Dar-Es-Salaam, not to the project officer in lfakara. The reports and returns will be collated by the HQ oflice and forwarded to APOC management after verification by the WHO/Tanzania offrce.

This new development aims at devolving decision-making processes to district and lower levels and should be completed before ld January 2003.

The meeting agreed to the suggestion of the national co-ordinator that some of the functionV activities of the project co.ordinating office (e.g. consolidation of financial reports and accounts of Kilombero and Ulanga districts) be taken over by the national office.

The district teams presented the final drafts to the meeting on 16 November. The meeting accepted the documents as final drafts suggesting additional amendments be incorporated in the final document that will be approved by the districts.

6 o The mission informed the meeting that two vehicles and two motorcycles for Mahenge project had arrived in Dar-Es-Salaam. However, the Director of APOC had requested the WHO country representative not to release these capital equipment until the Mectizan stock in bonded warehouse is released and the final version of Mahenge sustainability received by APOC management in Ouagadougou. o The national coordinator informed the mission that WHO/APOC vehicles assigned to HQ office have no drivers and are therefore being driven by himself and Mr Franzen. This is contrary to the rules of our Programme. The mission strongly advised that an urgent solution must be found and qualified drivers hired to drive project vehicles. This recommendation needs immediate attention.

Closure of the meeting o In his closing remarks on behalf of the APOC mission, Dr Seketeli, director of APOC commended the district medical teams of Ulanga and Kilombero for their hard work and production of detailed . one-year CDTI sustainability plans to become integral part of the District Health plans. He reminded the meeting that these are drafts; therefore, APOC management will be expecting the final versions of the District Comprehensive Health Plan and CDTI sustainability plan as soon as possible given that funding of Mahenge project will end in December2002. The remaining two- year plan should also be submitted soon. o He reassured the NOTF and district leaders that APOC management would take all necessary administrative steps to ensure the continuation of the Mahenge project as long as there is strong evidence of district and community ownership. o The mission regretted that due to time constraint the meeting did not hold in-depth review of the NOTF/HQ support project and no plan acceptable to APOC management was presented to the meeting. The director of APOC informed the meeting that funding of HQ offrce will continue but will be dependent on solid evidence of the catal),st role of the office. "YIle are expecting more support to projectsfrom the national HQ office. There is an urgent need to provide strong and convincing evidence for the existence and usefulness of the HQ support secretariat, to justify disbursement of more Trustfunds." He advised the NOTF to revise and submit for consideration, the plan and budget of the NOTF/IIQ offrce. o He urged the NOTF to assist the Ministry in their efforts for timely release of Mectizan from bonded warehouse in order to make the tablets available to the communities in the period they have chosen for distribution. o The Director of APOC and the national co-ordinator in their closing remarks thanked the members for their contributions to the success of this important meeting

NOTF MEETING . The meeting of the NOTF previously planned for 15 November could not hold because several of its members were attending the Global Forum for Health Research meeting in Arusha. o Few members of the NOTF/Tanzania who attended participated in the review of the CDTI sustainability plans of the Ulanga and Kilombero districts. o At this meeting, the mission advised the Mahenge CDTI sustainability plan should be presented as one plan from two districts and as integral part of the Districts' Comprehensive Council Health Plans.

7 MEETING WITH HON. MINISTER OF IfiALTIUTanzania (14/11/02)

o The visiting team, accompanied by the national coordinator, Dr Katenga, the chair of NGDO coalition, Mr Franzen, Dr Amri, DPC WHO/Tanzania and Ms Muro had a debriefing session with the Hon. Minister Mrs A. Abdallatr Key issues

The Director of APOC briefed the Honourable Minister of Health on important program issues. Chair of the eiefit session of the governing body of APOC. The mission briefed the Honourable Minister of Health on the role and functions of the chair of the governing body of APOC that will be assumed by the Government of Tanzania beginning with the upcoming eight session of the Joint Action Forum in Ouagadougou, Burkina Faso in December 2002.1n response the Hon Minister promised to arrive in Ouagdougou on 30 November in preparation of the meeting and for additional consultations with Programme management and the Committee of Sponsoring Agencies (CSA). Sustainabilitv olan of Mahenge CDTI project. The mission debriefed the Honourable Minister of on-going consultations and meeting to develop a sustainability plan of Mahenge project. The mission promised to work closely with the districts and the NOTF to address the recommendations of the evaluation. The CDTI plan willbe integrated into Comprehensive District health plan. Delay in the release of large stock of Mectizan to NOTF/Tanzania. The mission drew the affention of the Hon. Minister to the dire consequences of further delays of Mectizan in bonded warehouse. It was suggested moving the over US$3million worth of Mectizan to another APOC country to avoid the expiration. Internal audit. The mission informed the Hon Minister of plans to audit APOC projects in all countries. Responding, the Hon. Minister provided the background of the decision of govemment and promised to take immediate steps to secure a quick release of Mectizan. She asked the Permanent Secretary to write and urge all districts to include onchocerciasis line item in their budgets with annual increase in district financial commitment. The Minister pledged to top up the central budget for onchocerciasis control. The Federal Ministry will provide grants to match funds released by the endemic districts for CDTI activities. The Honourable Minister was strongly in favour of auditing all projects and pledged support to the programme in this respect. She thanked the APOC team and the NOTF/Tanzania for the good work so far and looked forward to the release before JAFS of the sustainability plan of Mahenge CDTI project.

Participation in meetins of the Resional Director and WHO/Tanzania country staffand debriefins of RD and WR/Tanzania

o The visiting team had a debriefing session with the RD/AFRO and WR/Tanzania on the outcome of the meetings with the leaders of Ulanga and Kilombero. The mission's briefing centred on issues pertaining to sustainability of the Mahenge CDTI project, procurement and delay in the release of Mectizan tablets worth more than US$3million from the bonded office and the role of Tanzania as chair of the upcoming eight session of the Joint Action Forum (JAF8). o The RD and Director of APOC discussed issues relating to the new Multi-disease Surveillance Centre in Ouagadougou. o The APOC team participated in the meeting of the Regional Director with the country oflice staff. During this meeting the professional staffmembers presented an update of WHO country support activities in IMCI, TB, Leprosy, HIV/AIDS, Malaria" EPI, GAV[, Essential Drug and Information/Advocacy programs of the Tanzania Ministry of Health. o In response, the Regional Director commended the stafffor numerous achievements. He spoke ,on worft ethics emphasizing integrity, accountability and professionalism in the service to the organization. CONCLUSIONS AITD RECOMMENDATIONS OF THE VISITING TEAM o The mission strongly recommends that special efforts must be made by NOTF/ HQ office and the entire NOTF /Tanzania to ensure that all districts with APOC funded projects start budgeting and disbursing funds for onchocerciasis activities to sustain the programme when external funding ceases. o All districts should develop a sustainability plan as an integral part of the District's Comprehensive Council Health Plan. The NOTF HQ should spear head the formulation of these plans o Funds disbursed to CDTI projects from APOC Trust Funds and NGDOs should feature in the annual budgets of the District Comprehensive Council Health Plan. o It was highly recommended that IEC communication strategy and material program that began two years ago financed by APOC be expeditiously concluded and materials made available to the districts to enhance the quality of community mobilization/sensitization/Health education activities. o Furthermore, the reporting system for onchocerciasis activities should be decentralized through the existing health channels with copies to the regional office and the districts. o The capital equipment (two vehicles and two motorcycles) in Dar-Es-Salaam for the Mahenge project should be made available to the project only after the release of Mectizan drug now in bonded warehouse and the receipt of Mahenge sustainability plan by APOC management.

AI\iI\TEX 1

ITINERARY

Tanzania 10 November - Arrival in Dar-Es-Salaam l0 November Departure to MorogoroRegion I I November - Meeting on sustainability of CDTI with Regional Medical Officer, Kilombero and Ulanga district health management teams in Morogoro 12 November Meeting with Regional Medical Officer, Kilombero and Ulanga district health management teams in Morogoro continued. 13 November Departure to Arusha. Dr Amazigo attended the Global Forum for Health Research. Made presentation on mainstreaming gender in tropical disease control. 14 November Meeting with Hon. Minister of Health, Tanzania Departure to Dar- Es -Salaam 15 November NOTF Meeting Meeting with Regional MedicalOfficer, Kilombero and Ulanga district health management teams on sustainability plan continued. Review of first draft plan 16 November Meeting with Regional Medical Oflicer, Kilombero and Ulanga district health management teams on sustainability plan continued.

17 November Departure from Dar-Es-Salaam AI{I\TEX2

MEETING OF TIIE SUSTAINABILITY OF MAHENGE CDTI PROJECT IN KILOMBERO & I,LAI\GADISTRICTS Oosis Hotet, Morogoro - November ll-lf , 2002 MinW of Heahh offrce and CSSC offtce, 15 & 16 November 2002 Participants: l. Mr. Paul Chikira Regional Admin. Secretary, Morogoro 2. Dr. M.M.Z. Massi Regional Medical Offrcer 3. Dr. Azodoga Seketeli Director, APOC-Ouagadougou 4. Dr. Uche Amazigo Chief, Sustainable Drug Distribution, APOC 5. Dr. Mohamed Amri DPC/WHO Dar es Salaam 6. Dr. Simon Katenga NOCP Coordinator 7. Mr. Oscar Kaitaba Deputy NOCP Coordinator 8. Dr. Bertha Maegga Coordinator, Tukuyu Vector Project 9. Ms. Eva Muro WHO/APOC Finance Ad. Asst. 10. Mr. Godfrey Christian Planning Ofiicer-Ulanga District I l. IvIr. David Venance DOT-Ulanga District 12. I\dr. Alfred Kilimba DOT'Ulanga District 13. Dr. Fred Lwilla District Medical Officer-Kilombero 14. Mr. George Kassiga Maherige CDTI Project Coordinator 15. Dr. Samuel Likasi Ag. DMO-Ulanga District 16. Mr. Theonest Mlolere DOT-Kilombero District 17. Mr. PeterZebedayo DOT-Kilombero District 18. Mr. Charles Franz6n NGDO Coalition ChairmanflMA Rep.

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