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ORIGINAL : English
COUNTRYAIOTF: Tanzania Proiect Name: CDTI Tunduru focus
Approval vearz 2004 Launchins vear: 2005
Reportins Period: From: l't Januaryr2007 To: 31't December 2007 (Month/Year) ( Month/Year) Proiectyearofthis report: (circleone) I 2 13] 4 5 6 7 8 9 10
Date submitted: January,2008 NGDO partner: Sightsavers International
ANNUAL PROJECT TECHNICAL REPORT
SUBMITTED TO
TECHNICAL CONSULTATIVE COMMITTEE (TCC)
DEADLINE FOR SUBMISSION:
To APOC Management by 3l Januarv for March TCC meeting
To APOC Management by 31 Julv for September TCC meeting
AFRTCAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC)
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tcce6 rsb' (0P' AfiC: t 1 rF\r lrt0ir Afi) Fo Gluu*-*" cn TO, \iR I WHO/APOC, 24 November 2004 Ao Afi H. ANNUAL PROJECT TECHNICAL REPORT TO TECHNTCAL CONSULTATTVE COrVrVtrrEE (TCC)
ENDORSEMENT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the report:
Country: Tanzania
National Coordinator Name: Dr.Grace Saguti
Signature:
Date: ......
Zonal Oncho Coordinator Name: Dr. Daniel wtJtekela sisnature: S[/ RgGloliil. i[3i}1. fiFF]r"j;l ;,, iirrelq 1_h... arz. Date: . ..1.kv.9 ;.. .?g*, I,
NGDO Representative Name: Dr. lbrahim Kabore / sion,ture Date b
Thrs report has been prepared by Name . Mr. Nurdin tvlalloya
Design ation ect Coordi
Sign ature
Date e?u.9 u)6Y-e
2 WI-lO/APOC. 24 Nor,crnbcr 2(X)-l Table of contents
ACRONYMS 5
l.l. GeNBRar INFoRMATIoN ...... 9 t.2. PopurertoN ...... l0 2.2. Aovocecy ...... 11 2.3. MosIttzRtloN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNrrrES ...... 12 2.4. CourrluN IrY TNVoLVEMENT 13 2.5 Cnpacny BUTLDTNG. 13 2.6. TRrnturNrs.. t6 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year...... l9 2.7. ORDERTNG, sroRAGE AND DELIVERy oF IvnnurctrN ...... 20 2.8. ColruurNrry sELF-MoNIToRTNG eNo STRxTHoLDERS MgBrrNc.... 2t 2.9 SupeRvrsroN ....22 2.9.1. Provide aJlow chart of supervision hierarchy. ....22 2.9.2. W'hat were the main issues identified during supervision?...... 22 2.9.3. l[las a supervision checklist used?...... 22 2.9.4. lV'hat were the outcomes at each level of CDTI implementation supervision?...... 22 2.9.5. Was feedback given to the person or groups supervised? ...... 22 2.9.6. How was the feedback used to improve the overall performance of the project? .... 22 SECTION 3: SUPPORT TO CDTI...... 23
3.1. EeurpusNr...... 23 3.2. FrxaNcnr coNTNBUTToNS oF THE pARTNERS AND coMMtrNITrES...... 24 3.4. ExpgNoITuRE PER ACTIVITY... 24 SECTION 4: SUSTAINABILITY OF CDTI 25 4.1. INrnnner; INDErENDENT pARTICTpAToRy MoNTToRING; EvnruRttoN ,.,.25 4.1.1 Was Monitoring/evaluation caruied out during the reporting period? (Tick any of the following which are applicable) ...... ,,..,..... 2 5 4.1.2. V[rhat were the recommendations? ...... 2 5 4.1.3. How have they been implemented?...... ,...... ,. 26 4.2. SusrerNesrlrry oF rRoJECTS: rLAN AND sET TARGETS (MANDAToRv AT ...... 26 Ysen 3) ...... 26 4.2.1 Planning at all relevant levels ...... 26 4.2.2. Funds. ,....,...... 2 7 4.2.3 Transport (replacement and maintenance)...... 27 4.2.4. Other resources ...,.., 27 4.2.5. To what extent has the plan been implemented...... 27 4.3. INr8cnanoN...... 27 4.4. OpBnerroNAL RESEARCH...... 27 4.4.I. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period...... 27 4.4.2. How were the results applied in the project? N/A ...... 27 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES... 28 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...... 28
3 WHO/APOC, 24 November 2004 4 WHO/APOC, 24 November 2004 I
Acronyms
APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers LTNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization
5 WHO/APOC, 24 November 2004 Definitions
(D Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking).
(ii) Elisible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area.
(iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with lvermectin in a given year.
(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project).
(v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage).
("i) Geographical coverase: number of communities treated in a given year over the total number of meso[typer-endemic communities as identified by REMO in the project area (this should be expressed as a percentage).
(vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI.
(viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment.
(ix) Community self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention prograrnme), with a view to ensuring that the prograrnme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary.
6 WHO/APOC, 24 November 2004 FOLLOW UP ON TCC RECOMMENDATIONS.
Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed.
TCC session 25th Number of TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR Recommen TCC/APOC dstion in MGT ASE the Report ONLY 323 TCC recommends for project improvement
a More health stalf be More health staff has been trained and trained and involved in sensitized i.e. CHMT members, Co-opted CDTI members and various department heads of the Council hospital were sensitized and trained on CDTI philosophy in 2O'h November, 2007. a The Project should agree The comnrunities has agreed to distribute ' 'Mectizan' with communities to carry the drug ' in dry season , rn 200'/ out distribution outside the we distributed the d.ug from Hospital farming season, to reduce pharmacy to health facilities in September absenteeism and at Community level in October - November,2007. a Funds should be Funds have been internally mobilized to internally mobilized to cary out repairs of the equipment. carry out repairs on equipment, rather than using NGDOfunds a More mobilizqtion be Community members were mobilized prior carried out to remove to drug distribution hence the misconception on elfect of misconception on effect of Mectizan drug Mectizan@ has been minimized and in this report the therapeutic coverage is higher compared to the last distribution. People are willing to swallow the drug. Therapeutic coverage has raised from 7lo/o lhe previous year up to 77oh rn reporting year. a Prompt retirement of The project had managed to retire all allocated funds be canied allocated funds in time and in 2007 we oul to avoid late didn't experience any delay of funds from disburcement offunds by APOC Trust Fund. APOC a CSM and SHM should be Community self monitoring and SHM has introduced as soon as beerr conducted in December,200l in 531 possible communities. Up to now the project had received minutes of the meeting fronr 66 sub village. Still waiting from other sub village. a Operational research National Institute for Medical Research topics be identiJied and [NIMR] has been approached to assist in proposals written for same identifying topics and proposal writing as it is them who are dealing with vector control.
7 WHO/APOC, 24 November 2004 EXECUTIVE SUMMARY
The report covers a period of 12 months starting from l't January, 2007 to 3lttDecember, 2007.Year 3 of the project saw many activities being implemented by the district council using funds from APOC, Council and Sight Saver's International all being directed at creating sustainability of the program by involving leaders at district level who are the policy makers and warrant holders. We held several sensitization meetings from the grass root of the community leadership up to District level i.e. Sub village leaders, village leaders, ward leaders, divisional leaders as well as Council [District] leaders.
Independent Participatory Monitoring is one of the activities conducted in Tunduru CDTI in the year 2007.The activity was conducted with team from various institutions which was supported by APOC. The activity commenced on2 - l4 August 2007. This is a customary with the APOC partnership, CDTI projects undergo independent participatory monitoring after one or two distribution. This is aimed at ensuring adherence to the CDTI process, early in the age of the projects. Tunduru CDTI was in the second year of drug distribution.
The treatment cycle of this reporting period started in October and lasted in November 2007 where by a total of 93,5 1 6 people were treated in 53 I [Although some I 0 big communities divided into two in order to reduce work load of the CDDs, so the APOC base report contains 541 communities. The total population in Hyper and Meso endemic communities is 120,714 people. The geographical coverage for the reportin g yeil is 100% whereby the therapeutic coverage is77%o. The ATO is 101,400 and UTG is 93,969.
Mectizan@ tablets arrived in the country early enough and the project office in Tunduru received the drug in August 2007.The project received 295,000 (3mg) Mectizan@ tablets to be distributed to hyper and Meso endemic communities in the project. We had an old stock of 2,839 Mectizan tablets expiring in December 2009.The drug was distributed in all endemic communities using existing health system and sent to all FLHF in hyper and meso endemic communities. A total number of 297,839 Mectizan tablets were available at the beginning of treatment, 270,972 were used and 592 lost. We have a balance of 26,275 (3mg) tablets stored in the district Pharmacies. The expiring date for the tablets is December,2009.
We received a total amount of U$ 38,104 from APOC for implementing various CDTI activities. The district council released U$ 4,517, while SSI released US 17,850.
The major challenges are: o To ensure that most of CDTI activities in Comprehensive Council Heath Plans are funded and fund released accordingly.
o The influx of people from outside the district prospecting for gemstone.
o Presence of man-eating lions in the project area limits CDTI implementation in the communities. Mectizan distribution and data collection by CDD's is seriously affected by this.
8 WHO/APOC, 24 November 2004 1.1. General information
Tunduru district is located far south of Tanzania between I 0o I 5 and 1 1 .45 south of equator and longitudes 36"30 and 38o East of Greenwich. It borders with Namtumbo district to west - in Ruvuma Region, Liwale and Nachingwea to the north in Lindi Region. Masasi district (Nanyumbu district) in Mtwara Region to East. In south there is the Ruvuma River which forms a physical lnternational boundary with peoples of Mozambique.
Tunduru district covers a total land area of 18,778 Sq km out of which 413 square kilometers (2.2%) are covers by water bodies leaving the area of 18,365 Sq km the land.
Tunduru district situated between 200 and 500 meters above sea level.
There are three ecological zones namely:- l. MATEMANGA ZONE: This covers the north - west part of Tunduru and includes almost all of Matemanga division. This part falls under Selous Game reserve, it's a zone where by big rivers such as Muhuwesi, Nampungu and Mbarang'andu "Luwegu river" starts at the rolling hills. 2. SOUTHERN TUNDURU ZONE: This zone covers the whole of the Southern part of Tunduru District including the divisions of Lukumbule, Nalasi, Namasakata, Nampungu and West Mlingoti ward. It is a zone characterized by rolling hills, dominated by miombo woodland. 3. NAKAPANYA ZONE: This small zone located eastern part of Tunduru district bordering to Masasi district (Nanyumbu district). It covers Nakapanya division and East Mlingoti ward. It has Rock Mountains and miombo woodland.
CLIMATE: The temperature ranges between 20'C up to 30oC
Dry season: June - November
Rain season: December - May
Farming season: o Preparation: August - October o Planting and weeding: November - April o Harvest: May to July (Food crops) o Harvest Cashew nuts November to December (Cash crop)
Table 1: Number of health staff involved in CDTI (Please add more rows if necessary)
Number of health staff involved in CDTI activities. Total Number of Number of health staff Percentage health staff in the involved in CDTI entire project area Bz District/LGA Br B::BzlBr *100 Tunduru 281 43 15
9 WHO/APOC, 24 November 2004 1. Partnership
1.2. Population The project has completed 3'd year Mectizan distribution. The project is implementing its 3'd year of APOC support with SSI as an NGDO partner. There is good relationship between all the partners. The district council has given good support during CDTI activity implementation. The community in general, is willing to take Mectizan and in some communities the CDD's are well motivated both in kind and by exempting them from communal work.
Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period.
add more rows n Number of communities/villages Population of in Meso- Hyper- Total in Meso- Hyper- Total in Ultimate endemi endemic meso/hyp endem endemic meso/hyper treatment c zone zone in er- ic zone in -endemic Goal Total in the the endemic zone the zoIIe CDTI population project project zone in the project (urG) Districts/ in the area area projec area A6= Aa* A5 LGAs in the entire t area As entire project Ar Az A3: A7* project area area Az At Tunduru 277,000 185 346 531 43489 77225 120,714 93,969
* Source: National census other, specify: CDD Year z 2002
UTG = calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reachedfull geographic coverage (normally the project should be expected to reach the UTG at the end of the j'd year of the project).
If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area. - We use term community to define sub village which is the lowest level of administration in the government structure in Tanzania. It is headed by a sub village chairperson elected democratically by all community members. A village is made up from several sub villages. The size of the village population may vary from 400 - 3,000 people.
Is there any other information of interest about the population in the project area? If so, include it here.
Tunduru district has recently been invaded by people outside the district looking for gemstone mining. This inversion leads to population fluctuation leading to unstable census in sub villages where mining takes place.
10 WHO/APOC, 24 November 2004 SECTION 2: IMPLEMENTATION
2.1 Timeline of activities
Table 3: Timeline of activities for the areas treated in the current year (Please add more rows if necessary)
Mobilization of communities Training Censusfupdate Drus distribution Supervision Starting Complet Starting Complet Starting Completio Starting Completion Starting Completio DistricU month ion month ton month n month month month month n month LGA month month Tunduru June Aug Aug Oct2007 Sept Oct 2007 Oct 2007 Nov 200 Oct2007 Nov 2007 2007 2007 2007 2007
TOTAL
- Comments Implementation of CDTI l) 1075 CDD'S were trained in SeptemberlOctober 2007 2) 3l RHW were trained twice June &September 2007 3) Sensitization meetings conducted at various levels: - District level 70 people sensitized - Ward level2l people sensitized - Village level132 sensitized - Community level 531 leaders sensitized 4) Supportive supervision was done in October A.[ovember following Mectizan distribution 5) Distribution of capital equipment from APOC to Tunduru district wasn't done though we have informed [In January 2008] to go and collect 32 bicycles for FLHWs.
2.2. Advocacy We conducted advocacy meetings to Councilors and Council Management Team members (Heads of Department) in order to sensitize them on the philosophy of CDTI. This advocacy was conducted following new election to these councils. SSI and Central Government provided funds for the activity.
The outcome was the increase of fund allocation for CDTI in the districts.
The reason for mobilization and sensitization: New general elections were done in 2005 through out the country. Following these election we had new councilors, directors and some heads of department got transferred to non endemic areas. In this set up there was need to conduct Mobilization & Health education to the new officials so that CDTI continue to be supported by the council
Problems encountered We had no problem in the district when conducting these meetings, participants demanded to have similar meetings every year especially when new councilors are elected. In Tunduru district advocacy to full council members has been implemented in December,2007. Funds from SSI.
Suggestion to improve advocacy All policy makers should be invited to attend advocacy meetings at all level and there is a need to request the Tunduru District Executive Director to finance these meetings.
ll WHO/APOC, 24 November 2003 The following table shows the number of policy/decision makers advocated at different level per each district.
DISTRICT DISTRICT LEVEL WARD LEVEL COMMUNITY LEVEL Tunduru 70 2t 663 Total 70 2t 663
2.3. Mobilization, sensitization and health education of at risk communities o Leaflets and T-Shirts carrying various CDTI massages were used to mobilize and sensitize communities in our district. We also used the National Radio Tanzania when opening up the new office space constructed from funds provided by SSI. Also the country wide radio station was used to disseminate information on CDTI activities nationally. o There is need to develop more IEC materials translated in Swahili so that more people accesses them. o We involved leaders at all levels in the district in conducting mobilization to targeted communities. Mobilization and health education of communities including women and minorities o We have mobilized women, teachers, pupils and female CDD's to assist in mobilizing the community prior to Mectizan distribution. Response of target communities/villages r The response of target population was good as evidenced by high treatment coverage rate in this cycle.
Accomplishments of the project in this year are- o The project managed to conduct CDTI activities depending on funds provided by Councils, APOC and NGDO partner (SSD. o Community ownership of the Programme is still maintained amongst community members as we have conducted HSAM and CSM meeting to the community leaders to prioritize ownership of the project and yet some they have provided us the minutes of their CSM meetings. o CDDs are willingly to continue to distribute Mectizan@ voluntarily. In a few of them the question of incentives still crops up from time to time.
Suggestion of way to improve mobilization and sensitization of target communities - o Mobilization and sensitization meetings should be conducted every year prior to Mectizan@ distribution cycle. o Health education should be done continuous to remind the community their responsibility. o Inclusion of primary school teachers in mobilization should be part of CDTI activities. o To strengthen Community self Monitoring and Stakeholders meetings in all affected communities
t2 WHO/APOC, 24 November 2004 2.4. Communityinvolvement
: Communities in the CDTI add more rows neces, Number of Number of Number of health staff Number of CDDs and communities com munities/villages with involved in CDTI the communities /villages with community members as activities. involved female supervisors CDD's Total Numbe Percentage Total no. Number Percentage Male Female Total Number Percent Numbe rof communi with CDDs CDD's of age rof health ties in the community communi health staff entire members as ties with staff in involve I' project supervisors i 1,, female the din It, lr, It,{) area lt. lil l 0(t It, I t, CDDs tl entire CDTI li ll I tl l' ,li project li, l{ll area ti
District li,
Tunduru 281 43 l5 531 531 100% 542 s33 1075 527 99.3
Total 281 43 15 531 531 1000h s42 s33 1075 527 99.3
Females CDD's selected in 2 communities were married and migrated to near by communities. Replacement done.
Attrition of CDDS
ln Tunduru to be a CDD carries pride in the community. This has led to low or no attrition in the whole project. But following new countrywide elections in some communities new CDD's were selected. This was mainly done in communities which had low treatment coverage in the previous distribution.
CAPACITY BUILDING
At district level we have adequate staff competent on CDTI implementation. We have trained 43 FLHF Workers who supervise CDD's during training and subsequent Mectizan distribution and data collection. Involvement of CHMT Members in supervising CDTI activities is an added advantage to the project.
2.5. Capacity building
- Describe the adequacy of available knowledgeable manpower at all levels. So far the staff at all levels are stable and competent in executing CDTI activities. There is no shortage of staff in all health facilities where CDTI is implemented. With the exception of the two communities where the female CDD's migrated to nearby communities after getting married, the other communities have stated CDD's implementing CDTI activities.
Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation.
We have extended training of FLHF staff to include other competent staff at this level in order to decrease the work load of the FLHF in charge or when is transferred.
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Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH{ WHO UNICEF NGDO
Other (please speciS)
Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH { wHotr UNICEil NGDC
Other (please specify)
Please describe how Mectizan@ is ordered and how it gets to the communities o Mectizan retirement by filling in the ordering forms and sending them to the National Onchocerciasis Control Task Force in the Ministry of Health. o The NOTF Secretariat went through the Re - Application Forms, approved them and then send it to Mectizan@ Donation Programme (MDP) o The MDP scrutinize the Form and send the drug to the Ministry of Health through the Government Clearing and Forwarding Agent in Tanzania. (Medical Store Department- MSD) o The MSD notifo the NOFT Secretariat on arrival of Mectizan@ who then informs the Project Coordinator. o The Project Coordinator collects the drug from the zonal Medical Stores Department and enters the received drug to the District Pharmacy. o The Coordinator sends Mectizan to the nearest health facility for dishibution to the community through normal drug distribution channel. o FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan@ . They come for collection and distribution to the community member in the entire area
Table 3: Mectizan@ Inventory (Please add more rows if necessary)
Number of Mectizano tablets Requested Received Used Lost Was Expired Remaining Project District Merck te
TLINDURU 297,839 2,939 295,000 270,972 s92 Nil Nil 26,275 TOTAL 297,839 2,839 295,000 270,972 s92 Nit Nil 26,275
- How are the remaining Ivermectin tablets collected and where are they kept? The remaining tablets were collected from the communities and retumed back to FLHF by CDD's and then the DOT'S or CHMT members collected them and bring them to the district pharmacy where they are stored./re allocated to other FLHF.
20 WHO/APOC, 24 November 2004 List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area.
Activities performed by Health personnel in handling Mectizan@ o Supervise census update in his/her catchments area. o Mectizan ordering by filling in the forms and sending them to the District Onchocerciasis Coordinator. o Makes follow up to the District Office. o FLHW inform the sub-village leaders and CDD's about the arrival of Mectizan. o Organize and attend mobilization and sensitization meeting to the community members o Conduct supportive supervision during Mectizan@ drug distribution to CDD's. o Data collection and report writing and send it to District Oncho Coordinator o Conduct feedback meeting with community members.
Any other comments
NONE
2.8. Community self-monitoring and Stakeholders Meeting
Has any training (of trainers) for community self-monitoring been done in the project area? YES
If so, When? December,Z0}7
Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed)
DistricU LGA Total # of communities in the No of village that No of villages that entire project area carried out self conducted stakeholders lSub villagesl monitoring (CSM) meeting (SHM) Tunduru 531 6t 0 TOTAL 531 6r 0
Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle:
Community self monitoring meetings held in December,2007 so we expect to see raised and maintained good therapeutic coverage in next distribution cycle for the year, 2008.
2t WHO/APOC, 24 November 2004 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy.
NOTF J DISTRICT EXECUTIVE DIRECTOR J DITRICT MEDICAL OFFICER J
PC t DOTS J FLHW'S J CDD's J Community I House hold
2.9.2. What were the main issues identified during supervision? o In adequate CDD motivation. o Inadequate IEC material o Improper recording in treatment registers in villages where the CDD was new . Staffs transfer at some FLHF
2.9.3. Was a supervision checklist used? . NO, APOC developed check list has been requested from the National Office 2.9.4. What were the outcomes at each level of CDTI implementation supervision? o Levels concerned gave a positive answer to improve their performance during the next distribution.
2.9.5. Was feedback given to the person or groups supervised? o yes.
2.9.6. How was the feedback used to improve the overall performance of the project? t The majority of community leaders provide incentives to CDD's O Community members were encouraged to provide incentives during distribution. o The District replaced all worn out registers in communities that had this problem.
22 WHO/APOC, 24 November 2004 SECTION 3: Support to CDTI
3.1. Equipment
Table 12: Status of equipment (Please add more rows if necessary)
Source APOC MOH DISTRICT/ NGDO Others LGA Type of No Conditio No Condit No Condit No Conditio No Condit equipment n lon lon n lon l. Vehicle I F 0 0 0 2. Motor cvcle(s) 0 0 0 2 F 0 3. Lap top 0 I F 0 Computer 4. Printer I F 0 0 0 5. Photocopier I F 0 0 0 6. Fax Machine I F 0 0 0 7. Others 0 a) Dieital camera I CNFR 0 b)Desk Top I F Computer c) 0 *Condition of the equipment (F:Functional, CNFR=currently non-functional but repairable, WO:Written offl.
How does the project intend to maintain and replace existing equipment and other materials?
The existing equipment is maintained through the normal process in the district. Repairs and services are carried out using funds from the hospital and from the NGDO partner- Sight Saver's International. Sight Saver's lnternational has provided the project a digital camera for training purposes.
23 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities
Table l3: Financial contributions by all partners for the last three years
Year 1 (2005') Year 2 (2006) Year 3 (20071 TOTAL TOTAL Cash TOTAL TOTAL Cash TOTAL TOTAL Cash Released Cash Released Cash Cash Budgeted (us$) Budgeted (us$) Budgeted Released Contributor rus$) (us$) (US$) (US$) MOH (Central+ 37,518 37,518 40,400 40,400 28,000 28,000 Provincial/State) MOH (District/LGA) 1,500 2,780 0 3,8 lg 8,130 4,517
Local NGDO(s) ( if any) 0 0 0 0
NGDO partner(s) 26,000 23,000 26,002 27,000 20,1 8 1 17,850 Others a) b)
Communities 525 525 530 530 531 531
APOC Trust Fund 37,146 37,146 16,817 8,409 38 , I 04 38,104
TOTAL 102,709 100,969 83,749 76,939 94,946 89,002
If there are problems with release of counterpart funds, how were they addressed? There are no problems with release of counterpart funds.
Additional comments: We are thankful to The APOC Management for providing funds to the project as budgeted for the year 2OO7 [3m Year]
3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) o The CDDs are exempted from the public works especial during distribution. t Community leaders and CDDs collect Mectizan from the nearest of the FLHF t If there is any work in that particular village which involve payment CDDs are given priority therefore act as some sort of support to them (eg.Zithromax distribution)
3.4. Expenditure per activity
Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here IUS$ = TSH.l,000/=
24 WHO/APOC, 24 November 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period
Expenditure Source(s) of Activity ($ us) fundins Drug delivery from NOTF HQ area to central collection point of communl 12p19-- MOTVLGA Mobilization and health education of communities 5,133.29 APOCiSSI Training of CDDs 9,917 APOC/SSyl&A Trei4lqg-g f health slqff at all levels 4,540.48 APOC/SSI Supervising CDDs and distribution 2,400 APOC/LG4/Sqr Monitoring and Evaluation q!CDTI actly1lies 3,500 LGA/APOC/SSI Advocacy visits to health and political authorities z,oo0 SSVAPOC IEC materials 600 SSI Sqqmaty_Ggpq44g) forms for treatment 3,000 SSI/APOC Vehicles/ Motocycles/ bigycles maintenance 4,212 SSYAPOC Oflce Eqq$ment (e.g. computers, etc 1,060 SSI Others- Installation of AC machine in CDTI Proiect office 1.02e LGA TOTAL 39,432 Total number of persons treated 93,516
- Any comments or explanations?
SECTION 4: Sustainability of CDTI
4.1. Internal; independentparticipatorymonitoring;Evaluation
4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable)
{ Year 3 Independent Participatory monitoring None mid Term Sustainability Evaluation None 5 year Sustainability Evaluation ./ Internal Monitoring by NOTF None Other Evaluation by other partners None Year I Participatory Independent monitoring
4.1.2. What were the recommendations? o Continued reorientation, training and involvement of the health service personnel at policy and implementation levels on the APOC philosophy and their roles. o Adequate time should be devoted to the project for proper dialogue with community on the benefit of the Ivermectin treatment, their roles and commitment in the long-term sustenance of the treatment process. o The CHMT should ensure that communities are empowered to make decision on implementation especially with to timing.
25 WHO/APOC, 24 November 2004 o Training and retraining of CDDs should be improved by increasing the number of days. . Improve quality of record keeping o The district should have a plan in place to train new CDDs o CHMT should endeavor to retire funds early in order to access more funds for distribution activities o APOC and the NOTF should iurange technical support for Tunduru CDTI as they plan for the next round of distribution
4.1.3. How have they been implemented? l. Training for health staff has been improved, we conducted twice each session for more than two days [June & September,2007]. 2. Training of CDDs and supportive supervision has also improved [Twice a year] September and Decemb er, 2007 . 3 Record keeping has improved with new register provided to the community [CDDs] and reporting format used is the modern APOC Base format. 4. The NOTF member and PC of Ruvuma Focus came to facilitate sensitization meeting and to conduct training on APOC philosophy to CHMT members and Council Management Team members in November,20}7. 5 Integration of CDTI into the CHMT system are now maintained the distribution of Mectizan together with essential drug Programme to FLHFs, more the Project vehicle has been used to provide other health services i.e. Material and child health services hospital emergencies ect.
4.2. Sustainability of projects: plan and set targets (mandatory at Year 3)
Was the project evaluated during the reporting period? NO
What arrangements have been made to sustain CDTI after APOC funding ceases in terms of cash:
Both the government and NGDO partner do budget for CDTI every year. Moreover, Onchocerciasis activities in the districts have been incorporated in CCHP.
4.2.1. Planning at all relevant levels o At community level they plan on how to collect Mectizan@ from the nearest health facility and distribute to the community members o FLHF order Mectizan@ from the District Oncho Coordinator and inform community members on arrival of the drug, also conduct HSAM and perform supervision, monitoring, data collection and report writing. o The DOC performs spot check supervision, monitoring, data collection and report writing. Also participate in planning of CDTI activities at district level as a co-opted member of CHMT and attend Project annual review meetings. o The Project Coordinator compile report form district, prepares Technical APOC annual report, Mectizan@ retirement and Re-application, supportive supervision to district and attend various CDTI meetings.
26 WHO/APOC, 24 November 2004 4.2.2. Funds As in the previous year the district council allocated funds for implementing CDTI activities. It is encouraging to note that money allocated for CDTI activities is increasing.
4.2.3 Transport (replacement and maintenance) Motor vehicle and motor cycles provided by APOC are still in good running condition. Regular maintenance is carried out using both APOC and SSI funds. 4.2.4. Other resources NONE
4.2.5. To what extent has the plan been implemented
4.3. Integration
Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration:
CDTI activities are executed under the directive of /DMO who is the in charge of all matters pertaining to Health and therefore all plans to implement CDTI activities passes in his/her office then are table in CHMT. The Project Coordinator is a co-opted member of this team at district level and always they conduct routine supervision as a team. The districts have included CDTI in the CCHP budget.
CDTI structure is being applied in many projects in our District. International Trachoma Initiative is using the same structure in Tunduru District in Implementing the SAFE Strategy. The structure is not identical but has many components similar to CDTL The Mectizan@ drug is transported through the existing PHC structure during supervision and monitoring.
4.4. Operational research
4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period.
No operational research was carried out in this period
4.4.2. How were the results applied in the project? N/A
27 WHO/APOC, 24 November 2004 SECTION 5: Strengths, weaknesses, challenges, and opportunities
List the strengths and weaknesses of CDTI implementation process.
In the process of the implementation of CDTI within Tunduru CDTI Focus the achievement has been recorded for three-year period. However, a number of challenges and constraints have been encountered.
The challenges and constrains are listed below
STRENGTH WEAKNESSES The project has prominent Partner (SSI) who Late disbursement of funds from NGDO supports the implementation of CDTI activities partner [SSI] for implementation of CDTI activities Funds from APOC were released timely as Capital equipments [32 bicycles] for FLHWs budgeted supervision delayed to be delivered from WHO/MoH office CDTI activities are incorporated in the CCHP Council ure providing limited funds to implement CDTI activities Community acceptance to take/swallow the Some of the community members had drug Mectizan and implement CDTI activities Misconception on the effect of the drug Key project staff are committed to work in the In adequate funds to conduct frequency project follow up visits to the community level Adequate working facilities are available Brake down of traveling facilities Motor vehicle/cycle affects supportive supervision
List the challenges and indicate how they were addressed.
CHALLENGES SOLUTION The main challenge is drug misconception More sensitization to be done Drug distribution during farming activities Distribution of drugs will be done after harvesting when all people are back from their farm "June -Sept" Some of CDDs still demand allowance in Community members have been requested to terms of money for drug distribution. provide incentive to CDDs.
OPPORTUNITIES
Availability of knowledgeable staff in the project area. The project has prominent and committed donor who is likely to support the project by providing more resources
SEGTION 6: Unique features of the proiecUother mattens
NONE
28 WHO/APOC, 24 November 2004