2016 Annual Report

…excellence in community eye health

Table of Contents

Foreword……………………………………………………………………………………………..…3

Acknowledgements ...... 5

Acronyms ...... 6

About BICO ...... 7

1. INTRODUCTION ...... 8

2. KEY ACHIEVEMENTS ...... 8

A. PROJECT IMPLEMENTATION ...... 8

2.1 TRACHOMA ELIMINATION PROJECT ...... 8

2.2 MORDOR PROJECT ...... 11

2.3 LOW VISION ...... 15

B. RESEARCH AND ADVOCACY ...... 19

i. Operational Research ...... 19

ii. Trachoma Mapping ...... 20

iii. Trachoma Impact and Surveillance Survey ...... 21

iv. Trachoma Impact Survey Results Dessemination ...... 23

v. Drug Coverage Survey ...... 24

C. SUPPORT TO PARTNERS ...... 24

i. SUPPORT TO MOH & OTHER PARTNERS ...... 24

D. CAPACITY ENHANCEMENT & DEVELOPMENT ...... 28

i. Local & International Training ...... 28

E. BICO RELIEF & YOUTH DEVELOPMENT PROGRAMME ...... 29

i. Youth Development Programme ...... 29

F. INSTITUTIONAL DEVELOPMENT, STAFFING & STAFF WELFARE ...... 29

i. New offices ...... 29

ii. ICT Development ...... 30

iii. Project Proposal development ...... 33

iv. Human Resource Policy Hand Book & Financial Guidelines...... 34

v. Staff Recruitment, Development & Deployment ...... 34

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vi. Staff Team Building ...... 35

vii. Staff News ...... 35

G. 2016: BICO VISITORS (selected) ...... 37

H. APPENDIX 1: FINANCIAL PROGRESS REPORT ...... 42

I. APPENDIX 2: 2016 BICO STAFF ...... 45

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Foreword

2016 was an extraordinary and one of the most successful years in the history of BICO. We continued our innovations, using local solutions to solve global problems. Our target remains the local communities that we work with, though in our 2016- 2020 strategic plan, we have changed from focussing only on community eye care to focusing on general health care. Our branding changed from “Blantyre Institute for Community Ophthalmology” to “Blantyre Institute Community Outreach” - BICO. Our successes are many to mention, but some highlighted ones include the Trachoma operational research that we conducted on behalf of the global trachoma community, and successfully demonstrated that one round of Mass Drug Administration (MDA) with Zithromax is adequate for districts with Trachoma Follicular Prevalence of between 5 and 9.9%. The findings were presented in London at the Trachoma Expert Committee (TEC) in December 2016, and these have contributed to formulation of a global policy, where all districts that fall in this category will now be eligible to access Zithromax donation for mass treatment from Pfizer through International Trachoma Initiative (ITI). We were also the first partner to pilot test the global Mhealth tools for tracking Trachoma Trichiasis patients, using data captured and uploaded on Tropical data. The MORDOR study is 80% completed and expected to wind up in June 2017. In the Malawi Trachoma Elimination program, through operational research (impact surveys), we demonstrated that more than two thirds of formerly endemic Malawian trachoma districts are now free from trachoma. We recruited more staff, and had two senior staff being certified as master grader and master recorders trainers for the trachoma program using Tropical data. For infrastructure, we moved into new larger offices in Blantyre, and also expanded our low vision work to Ntcheu district, central region of Malawi. The visits of high profile teams to BICO throughout the year gives a testimony of our success. We had consultants for the Low Vision Program, Deworm3 team, and the Mhealth Team. The climax of the visit was in October 2016 when the Chief executive and President of the Task Force for Global Health-TFGH (our collaborator), Board Member of TFGH, the Director of

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Communications for TFGH, the director of International Trachoma Initiative (ITI), the finance director of the Sightsavers UK, film crews, saw the impact of our community work on the ground, and were impressed with the findings. Our success has yielded more projects. We will be undertaking work to address the feasibility of interrupting soil transmitted helminths (hookworm and other worms) from 2017 -2022, through our collaborations with London School of Hygiene and Tropical Medicine (LSHTM), and Natural History Museum (NHM) for the DeWorm3 project. This is no ordinary achievement, and I would like to thank all BICO staff for their dedication. It gives me great pleasure to present to you our annual report for 2016. It is my hope that this report will stimulate your interest to engage with BICO now or in the future.

Dr Khumbo Kalua PhD (London), Msc, MMED, MBBS, DLSHTM Director Blantyre Institute for Community Outreach – BICO, Lions Sight First Eye Hospital, P. O. Box E180, Post Dot Net. Blantyre, Malawi. Tel: +265 1 875 377/ +265 999 958 176 Email: [email protected] / [email protected] Website: www.bicomalawi.org Registered charity (CONGOMA) No: C627/2013

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Acknowledgements

The BICO End of Year Report has been made possible through the efforts of the following members of staff: David Chinyanya (who compiled the report), George Moyo, Ignasio Wachepa, Limbani Mitengo, Zachariah Kamwendo, Alvin Chisambi, Florence Kalua, Lesley Mulaga, Tisungane Chitimbe, Christopher Phiri and Mumderanji Salomie Balakasi who provided write ups and proof reading and Dr Khumbo Kalua for providing the guidance and direction of the report.

BICO would like to thank all members of staff because without their dedication and commitment to duty these activities could not have been fully implemented. It is through them that BICO’s contribution towards the prevention of avoidable blindness in Malawi in 2016 has been outstandingly visible and significant. We also thank BICO’s Board of Directors for their oversight and policy guidance, Assistant Director of Clinical Services (Ophthalmology) - Ministry of Health and DHOs and staff from Nsanje, Chikwawa, Zomba, Machinga, Ntcheu, Mangochi, Dedza, Mchinji, Mangochi and Dowa DHOs and Zomba Central Hospital for supporting and directly involved in the implementation of various BICO supported projects and activities in their respective districts during the year under review. BICO is also indebted to Sightsavers Country Office support. In addition, BICO would like to acknowledge the financial and technical support from the following development partners:

1. Queen Elizabeth Diamond Jubilee Trust Fund: Trachoma Elimination Programme 2. Lions of Netherlands and Wilde Ganzen: Low Vision Project 3. London School of Hygiene and Tropical Medicine - Mordor Study. 4. Neglected Tropical Disease (NTD) Centre, USA -Trachoma Coverage surveys and Impact surveys. 5. USAID – Low Vision Project 6. DeWorm3 Project, Natural History Museum (NHM) 7. Heart to Heart Foundation – collaborator, for supporting TT programme in Machinga

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Acronyms AMREF African Medical & Research Foundation BICO Blantyre Institute for Community Outreach CBM Christofell Blinden Mission CCAP Church of Central Africa Presbyterian CBR Community Based Rehabilitation CEO Chief Executive Officer CICOD Circle for Integrated Community Development DBS Dry Blood Sample DEC District Executive Committee DFID Department for International Development DHO District Health Office DPD Director of Planning & Development EU Evaluation Unit / European Union F & E Facial cleanliness & Environmental management HB Haemoglobin H S A Health Surveillance Assistance H2HF Heart to Heart Foundation ICT Information Communication Technology ITI International Trachoma Initiative KCCO Kilimanjaro Centre for Community Ophthalmology LSHTM London School of Hygiene and Tropical Medicine MASM Medical Aid Society of Malawi MATAMA Mineral & Appropriate Technology Applicable in Malawi MDA Mass Drug Administration MERIT – RTI Malawi Early Grade Reading Improvement – Research Triangle Institute. MOH Ministry of Health MORDOR Mortality Reduction after Oral Azithromycin NHM Natural History Museum NPS Nasal pharyngeal Swabs NTD Neglected Tropical Diseases OCO Ophthalmic Clinical Officer OT Optometry Technician SEZ South East Zone TDC Teachers Development Centre TEC Trachoma Expert Committee TEVETA Technical Education, Vocational & Entrepreneurship Training Authority TF Trachoma Follicles TFGH Task Force for Global Health. TT Trachomatous Trichiasis UAM Universal Anaesthetic Machine USA United States of America USAID United States Agency for International Development VI Visual Impairment VA Visual Acuity / Verbal Autopsy WVI World Vision International ZCH Zomba Central Hospital

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About BICO

Mandate

BICO exists to champion community eye health in Malawi and the region in order to achieve extraordinary improvements in eye care service delivery for the prevention and control of avoidable blindness in Malawi and the region.

Vision ‘Quality and affordable eye care services for everyone’

Mission Statement To improve the quality of lives of people through facilitation and or the provision of quality and affordable eye care services, eye care operational research, capacity building in community eye health and advocacy and partnership, girl child education and water and sanitation.

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1. INTRODUCTION The BICO’s Annual Report is an overview of all projects and activities implemented in 2016. While the focus of the report is on major programmes and projects implemented in the year under review such as Trachoma Elimination Programme, MORDOR Study, Low Vision Project, this report does attempt to highlight all Trachoma operational researches undertaken on behalf of MOH and in support of other partners such as Sightsavers, CBM and Amref Health Africa. These researches include the Trachoma Mapping conducted in Dedza and Mulanje Districts, Trachoma Impact (Mchinji, Nsanje, Zomba, Machinga, Ntcheu, Dowa, Ntchisi, Mwanza, Neno and Lilongwe), surveillance survey in Chikwawa District and Drug Coverage Survey in Dedza, and Chikwawa following the Trachoma 2016 MDA. The 2016 BICO Annual Report also gives the reader a synaptic view of all events, special assignments/activities undertaken in the year including visitors to BICO and staff news and welfare. 2. KEY ACHIEVEMENTS

A. PROJECT IMPLEMENTATION

2.1 TRACHOMA ELIMINATION PROJECT

a. TT Surgeries

During the year under review, the following have been achieved • A total of 145 TT Case finders trained, most of them done in Machinga 116 (72 males & 44 females) and Nsanje 29 (15 males and 14 females). • 2516 suspected TT patients screened (877 Males, 1639 Females) in all three districts of Machinga, Chikwawa & Nsanje. • 600 TT patients identified and confirmed (114 Males, 486 Females) in all the above districts. This translated into 543 TT patients operated (99 males and 444 females.

Table 1: 2016 TT Surgeries Summary Total of TT patients Total No TT patients No of TT patients No of Reporting Screened Identified operated surgeries period M F Total M F Total M F Total Qtr1 (Jan - 100 180 280 37 94 131 30 82 112 144 Mar) Qtr2 (Apr - Jun) 57 149 206 22 111 133 20 101 121 172 Qtr3 (Jul - Sept) 81 177 258 21 85 106 16 72 88 95 Qtr4 (Oct - 639 1133 1772 34 196 230 33 189 222 255 Dec) Total 877 1639 2516 114 486 600 99 444 543 666 As a % of the total 35 65 19 81 18 82

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Figure 1: TT Surgeries in Chikwawa

Right: Rex Bwanausi (OCO) conducting TT surgery. Left: TT patients after surgery.

b. Mass Drug Administration

i. Village Census

July – August 2016, BICO facilitated village census in Dedza District. While in Chikwawa the same exercise took place between August to September 2016. The table below shows the results of the two censuses.

Table 2: Results of Pre MDA Census in Dedza & Chikwawa Dedza District POPULATION BY AGE GROUP 0-6 months 6-59 months 5yrs + M F M F M F Total by Gender 6,547 7,471 54,678 57,136 299,638 340,486 Total by age 14,018 111,814 640,124 Percentage by age 1.8% 14.6% 83.6% TOTAL 765,956 Chikwawa District 0-6 months 6-59 months 5yrs + M F M F M F Total by Gender 5564 6331 41986 48035 218428 238278 Total by age 11,895 90,021 456,278 Percentage by age 2% 16% 82% TOTAL 558,662

As shown in table 2 above, a total of 1,324,618 people was registered in the two districts of Dedza and Chikwawa in readiness for the Trachoma MDA.

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ii. Actual Mass Drug Administration

27th August 2016 to 4th September 2016, BICO conducted Trachoma Mass Drug Administration with Azithromycin in Dedza district. A total number of 703,594 people were treated representing 92% coverage. Table below shows total population treated by sex

Table 3: Total treated against total population

Total Population Total treated Coverage

M F Total M F Total

360,863 405,093 765,956 319,141 384,453 703,594 92

Of those treated, about 55% were females. Similarly, 95% of females registered took the drug as opposed to 88% of their male counterpart.

Figure 2: Actual Trachoma MDA in Dedza district (left) and Chikwawa district(right)

17th October – 5 November 2016, BICO conducted another Trachoma MDA in Chikwawa. A total number of 501,940 people were treated representing 87% coverage. Table below shows total population treated by sex

Table 4: Population treated in Chikwawa District

Total Population registered Total treated Coverage

M F Total M F Total 265,978 292,644 558,622 225,873 276,067 501,940 89.9

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2.2 MORDOR PROJECT

Mortality Reduction after Oral Azithromycin (MORDOR), is a multi-country (Malawi, Niger, and Tanzania), multicentre randomised clinical study that is being undertaken by BICO in collaboration with London School of Hygiene and Tropical Medicine and the Ministry of Health in Malawi. The study aims at testing if MDA with Azithromycin (used for MDA in trachoma endemic areas) can reduce child mortality and morbidity that are caused mainly by malaria, pneumonia and diarrhoea in the under-five children. In Malawi, the study is being conducted in Mangochi district. The district was chosen because it is estimated to have relatively high infant and child mortality and low prevalence of active trachoma (estimated at between 7 and 8% of 1-9 year olds) which would normally only require mass treatment with Azithromycin for trachoma control for one year.

 The study has two main arms; mortality (focus on community census and treatment) and morbidity which involves anthropometry on all children aged 1-60 months, samples and tests. The mortality arm is mainly involved in community census and treatment. Treatment is done in all children aged 1 month to 59 months (<5 years) and those weighing over 3.8 kg. The treatment is distributed every 6 months for 18 months with follow-up over 2 years. The MDA for Azithromycin and placebo started in 2015 and ended in 2016. In 2015, the team administered the drugs during MORDOR-0 and MORDOR-6 while in 2016 it was during MORDOR-12 and MORDOR-18. In 2017 of which it will be MORDOR-24, the mortality team will only conduct census. In the morbidity arm, 30 communities have been selected for further tests to assess the effect of Azithromycin on major childhood diseases. The team is mainly involved in conducting anthropometry on all children aged 1-60 months and samples and tests such as finger prick for HB, malaria slides and DBS, Nasopharyngeal swabs (NPS), Trachoma grading and conjunctival swabs and Stool samples. In the year under review, the morbidity team collected samples in MORDOR-12 and conducted anthropometry while in MORDOR-18. In a nut shell the following activities were undertaken in the year under review.

a. Conducted trainings for Health Surveillance Assistants (HSAs) and Nurses

• 25th March to 13th June 2016, a total of 357 HSAs (155 females and 202 males) were trained in protocol for Azithromycin MDA. In the second phase (MORDOR-18) 374 HSAs were trained, 163 were females and 211 males. The table below shows the details of the trainings conducted.

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Table 5: HSAs trained during MORDOR-12 and MORDOR-18 in the Year 2016

MORDOR-12 MORDOR-18

Zone Date Trained Males Females Date Trained Males Females

Monkey- 25th March 28 19 5th September 2016 28 22 Bay 2016

Chilipa 15th April 2016 38 19 20th September 2016 40 17

Makanjira 9th May 2016 31 13 10th October 2016 27 17

Namwera 23rd May 2016 51 33 27th-28th October 57 34 2016

Mangochi 13th June 2016 54 71 21st-22nd November 59 73 DHO 2016

Total 202 155 211 163

• 24 – 25th March 2016, BICO conducted training for 30 (19 males and 11 females) field enumerators on the operation of the then latest application.

• Between 22nd and 23rd March 2016 Dr Sarah Burr and Dr John Hart conducted refresher trainings for old nurses and full time training to newly recruited nurses. The nurses were trained on basic growth measuring tools (Anthropometry) and sample collection (stool, blood and NPS).

• 29th March 2016 James Simwanza, trained all general nurses on basic ophthalmology including basic anatomy and physiology of the eye, visual acuity, differentials of a red eye and visual loss in the elderly and common eye conditions that were being brought at the Mangochi Eye Care Centre. The training also included patient flow, MASM procedure and general knowledge on the BICO Eye Care Centre. b) Conducted Community sensitisation campaigns in all the 30 morbidity villages

• Between 29th February 2016 and 10th March 2016, BICO conducted sensitisation campaigns in all the 30 morbidity villages (villages where nurses collect different samples i.e. Blood, NPS, stool and measuring growth monitoring tools (Anthropometry) to sensitize chiefs on the procedures and protocols of the MORDOR field study work. The purpose of the activity was to inform chiefs about what was happening in their areas and encourage them to act as torch bearers and mobilise their subjects to take part in the study.

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c) Conducted Mass Drug Administration

• 4 April - 16th December 2016, two rounds of MDA for azithromycin were done for both phases of the project (MORDOR-12 field work started on 4th April and was completed on the 8th July 2016 and MORDOR-18 which started on 7th September and completed on 16th December 2016

d) Conducted Anthropometry and sample collected.

• 4th April -16th December 2016, MORDOR conducted anthropometry (first from 4th April to 8th July 2016 and secondly from 12th September 2016 to 16th December 2016) and collected samples once. Samples that were collected during MORDOR-12 include:

- Blood samples for assessment of malaria - Nasopharyngeal swab samples to assess bacterial carriage and antimicrobial resistance - Stool for microbiology and resistance studies - Eyelid photographs and conjunctival swab samples for assessment of trachoma

Figure 3: James Simwaza taking conjunctiva swab in Mangochi

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e) Census and Sample Collection in the Enteropathy Study • 12th September - 16th December 2016, BICO conducted the infant Enteropathy study (whose team consisted of two nurses, two enumerators and a physician/medical doctor) in three villages of Michesi, Saiti Kadzuwa and Chindamba under Koche, Mpondasi and St. Martyns health centres respectively. The activities undertaken included: - Identification of clients through household census. - Village meetings (sensitization) - Preparing clinic visits for clients which are done at specific periods/phases. - Anthropometry measurements - Stool and urine samples collection.

A total number of 98 clients were recruited from all the three villages and 39 clients have successfully completed all the visits.

f) Conducting Verbal Autopsy • 3rd May – 16th December 2016, BICO conducted a verbal autopsy (VA) in its area of study. In total 718 clients were interviewed, 452 and 266 during MORDOR-12 and MORDOR-18 respectively. VA is a method of gathering health information about a deceased individual to determine his or her cause of death. Health information and a description of events prior to death are acquired from conversations or interviews with a person or persons familiar with the deceased and analysed by health professional or computer algorithms to assign a probable cause of death.

Table 7: Number of interviews conducted in 2016 MORDOR 12 & 18. MORDOR-12 Verbal Autopsy Field Work from 3rd May - 11th August 2016 Zone Targeted Visited Male Female Monkey Bay 96 76 42 34 Chilipa 108 100 56 44 Makanjira 68 65 31 34 Namwera 143 105 52 53 Mangochi 126 106 47 59 Total 541 452 228 224

MORDOR-18 Verbal Autopsy Fieldwork From 17th October –16th December 2O16

Zone Targeted Visited Male Female Monkey Bay 36 33 21 11 Chilipa 99 79 41 38 Makanjira 66 63 29 34 Namwera 104 91 43 48 Mangochi ------Total 305 266 134 131

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g) Conducted Census Verification • March – December 2016, MORDOR team conducted data verification exercises in two phases - MORDOR-12 (March - July, 2016) and MORDOR-18 (September-December, 2016). A total of 16 villages (8 in each phase) were visited.

Figure 4: Data verification personnel checking health passports at a household in Mangochi

2.3 LOW VISION January to December 2016, BICO with financial support from USAID and Wilden Ganzen (Netherlands) implemented the following activities in the two education divisions zones of South East and Central West of Malawi.

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(a) Capacity building

Table 8: Summary of the number and type of trainings done under the Low Vision program in 2016. No Number of Number of Total Start Date of End Date of Subject Area of Training Female Male Number of Training Training Participants Participants participants 1 Training of regular classroom teachers in low vision at ST Teleza TDC Machinga 14/01/2016 15/01/2016 4 11 15 2 Training of CBR workers in low vision at Nsanama TDC in Machinga 16/01/2016 16/01/2016 9 5 14 3 2nd session training of regular and specialist teachers in low vision at Songani TDC, Zomba 18/01/2016 19/01/2016 3 7 10 4 Training of community volunteers in low vision at Songani TDC, Zomba 20/01/2016 20/01/2016 12 3 15 5 orientation of teachers in low vision at Montfort Resource Centre, Chiradzulu 18/02/2016 19/02/2016 4 7 11 6 Curriculum piloting (training of regular teachers in Low Vision) at Montfort demonstration Primary School 22/04/2016 22/04/2016 8 3 11 7 Curriculum piloting (training of regular teachers in Low Vision) at Nazombe Primary school, Phalombe 30/04/2016 30/04/2016 4 9 13 8 Curriculum piloting (training of regular teachers in Low Vision) at Mponda primary school, Zomba 14/04/2016 14/04/2016 7 3 10 9 Training of Ophthalmic Clinical Officers and Optometry Technicians in Low Vision at Zomba Central Hospital 11/8/2016 13/08/2016 5 2 7 10 1st Training of Specialist teachers in low vision at Gumbu TDC, Ntcheu 01/09/2016 02/09/2016 5 12 17 11 1st training session of community volunteers in Ntcheu at Msiyaludzu TDC 04/11/2016 04/11/2016 4 4 8 12 2nd session training of specialist and regular teachers in low Vision at Msiyaludzu TDC 05/11/2016 05/11/2016 3 14 17 13 Training of regular classroom teachers in low vision at Nkope Primary School, Mangochi 12/11/2016 12/11/2016 9 11 20

Total 77 91 168

(b) MEETINGS

During the year under review, BICO held several meetings prior to start of the project and during implementation as detailed below:

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• 25th July 2016; BICO held meetings with the Special Needs Education Coordinator, Director of Planning and Development (DPD) for Ntcheu and Nsiyaludzu teachers (Mrs. Mpekesambo and the head teacher) to brief all these officials on the new low vision project and expected results plus time frame. The meeting was also called to brief the districts on the planned 2nd August 2016 orientation meeting for stakeholders planned. In turn, the district requested for a formal invitation letter. The DPD also invited BICO to attend a District Executive Committee (DEC) meeting planned for 26th July, 2016.

• 26th July 2016; BICO attended Ntcheu DEC meeting and made presentation of its new project in Ntcheu district. DEC gave BICO a go ahead to implement its project and pledged its total support.

• 2nd August 2016; BICO organized an orientation meeting for different stakeholders drawn from Ministries of Health and Education at Alendo Hotel on the implementation modalities of the Improving Eye Health and Educational Services for Visually Impaired Children in the targeted district with funding from USAID. Salima, Ntcheu, Balaka and Dedza districts attended the meeting.

• Between January and December 2016, BICO managed to conduct screenings for children identified by teachers and community volunteers in schools and communities respectively. A total of 1,834 children were screened (824 Males, 1010 Females) in both the South East and Central West Education Division Zones. About 34 children from various service delivery sites were referred to Zomba Central and Queen Elizabeth Central hospitals for other services like cataract surgeries.

Figure 5: Bruno Chimaliro taking VA during school screening at Zomba Central Hospital

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Figure 6: Elizabeth Phiri and Hendrina Nyondo captured while assessing low vision learners at Msiyaludzu Resource Centre

• A total of 405 children with refractive errors were given glasses to correct such errors. 34 children with low vision were also given other assistive devices.

(d) LOW VISION PROJECT KEY ACHIEVEMENTS Among key achievements under this project, the project managed:

i. to establish low vision and refractive services centre at Zomba Central Hospital - Eye department

ii. to donate a Universal Anaesthetic Machine to Zomba Central Hospital which is being used in the theatre at the Eye Department of the hospital

iii. to expand its low vision and refractive services to the Central West Education Division with financial support from USAID by opening a second eye care centre at Ntcheu Boma, an initiative under the Community Eye Centre Initiative supported by USAID on 8th November 2016. The opening of this clinic fulfilled BICO’s vision

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of making quality and affordable eye care services available to the people of this country especially those from central region.

Figure 7: People captured during Mass Eye Screening at BICO Eye clinic in Ntcheu

B. RESEARCH AND ADVOCACY

i. Operational Research 14 – 22 October 2017, BICO conducted an operational research in Chikwawa District to assess correlation between observed clinical Trachoma Follicular (TF) as observed and presence of chlamydia infection in blood to guide policy and decision making on whether to stop MDA or not.

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Figure 8: One of the Operational Research Teams at a household in Chikwawa

Figure 9: An OCO taking blood samples

ii. Trachoma Mapping

7-8th July 2016: Trachoma Mapping was conducted in Makanjira in Mangochi District following the observation of high TF prevalence among children between 1 and 9 years during the grader training in readiness for impact surveys.

The objective was to determine using the GTMP methodology, the prevalence of trachoma and associated risk factors in each of the suspected hot spot sub district. The mapping was a cross-sectional population-based survey designed to obtain sub district level prevalence estimates for Trachomatous inflammation Follicular (TF) in children aged 1-9 years; and Trachomatous Trichiasis (TT) in persons aged 15 years and above which could inform and guide Ministry of Health, Malawi in determining whether there was need for a trachoma program in the suspected sub district or not.

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Table 9: Results of the Baseline Survey

Children Adult’s BASELINE 1-9 years 15+ years EU SUSPECTED District EU Population TF TT ID HOTSPOT prevalence prevalence (%) (%)

Makanjira 10505 Mangochi Makanjira 89528 9.4 0.5

Since the TF prevalence was observed to be above 5% and less than 10%, one round of Mass Drug Administration with Zithromax in 2017 is recommended together with a sustained F & E intervention.

iii. Trachoma Impact and Surveillance Survey 29th May, 2016 to 29th July, 2016. A Trachoma Impact Assessment Survey was conducted in Ntchisi, Dowa, Salima, Lilongwe, Ntcheu, Mwanza, Neno, Machinga, Zomba and Nsanje. While the surveillance survey was conducted in Chikwawa following the impact survey two years ago. The purpose of the survey was to determine whether the disease was still prevalence in the districts after three years of MDA with Azithromycin in Nsanje and one round of MDA in the other districts.

The table below shows the results.

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Table 10: Impact Surveys Results

TF % Evaluation unit TT % No. EU ID District Population (1-9 (sub district) (>15 years) years)

1 80229 Dowa Dowa Mponela 188112 1.1 0.1

2 80230 Dowa Dowa Madisi 188459 2.4 0

3 80231 Dowa Dowa Central 215813 1.2 0

4 80232 Lilongwe Lilongwe Kalolo 259000 1.1 0.4

5 80233 Lilongwe Lilongwe Kasiya 259100 2.1 0.1

Lilongwe 6 80234 Lilongwe 259121 1.6 0.1 Kabudula

7 80235 Ntcheu Ntcheu Lizulu 253607 0.6 0.1

Ntcheu 8 80236 Ntcheu 116399 0.6 0 Tsangano

9 80237 Ntcheu Ntcheu Bwanje 251095 1.2 0.1

10 80238 Ntchisi Ntchisi DHO 141206 0.2 0

11 80239 Ntchisi Ntchisi Malomo 130000 0.1 0.1

Zomba Mayaka 12 80249 Zomba 214042 0.8 0 Rural

Zomba Rural 13 80250 Zomba 183520 0.8 0 Likangala

14 80242 Machinga Machinga DHO 186153 1.5 0.1

15 80243 Machinga Machinga Ntaja 243140 0.9 0.1

16 80244 Machinga Machinga Mpiri 315845 2.9 0.4

17 80245 Mwanza Mwanza 106493 2.5 0 18 80246 Neno Neno 121070 0.3 0

19 80240 Salima Salima Chipoka 264141 1.6 0.1

Salima 20 80241 Salima 180316 1 0.1 Khombedza

Nsanje East 21 80247 Nsanje 129753 4.1 0.2 Bank Nsanje West 22 80248 Nsanje 192839 4.4 0.3 Bank

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Table 11: Surveillance Survey Results

TT % Evaluation TF % No. EU ID District Unit Population (>15 (1-9 years) (subdistrict) years)

Chikwawa 23 60015 Chikwawa 171206 5.9 0.1 Chapanganga

Chikwawa 24 60016 Chikwawa 187413 6.4 0.1 Ngabu

Chikwawa 25 60017 Chikwawa 177101 6.4 0.3 Kasisi

iv. Trachoma Impact Survey Results Dessemination 2nd September 2016. BICO organised a Trachoma Impact & Surveillance Survey results dissemination workshop at Sun ‘N’ Sand Holiday Resort in Mangochi. The purpose of the workshop was to present survey findings and other important developments on the same to the Ministry of Health and other partners such as Sightsavers, AMREF, MATAMA, WaterAid, Heart to Heart Foundation, WVI, CICOD and CBM. The survey was conducted in the 26 evaluation units in 12 districts in Malawi (Nsanje, Chikwawa, Mwanza, Neno, Zomba, Machinga, Mangochi, Ntcheu, Dowa, Salima, Ntchisi and Lilongwe).

Figure 9: Participants at the dissemination workshop with Dr Charles Mwansambo, Chief of Health Services in the Ministry, seated in the middle (in a suit and tie).

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v. Drug Coverage Survey

9-13th October 2016. BICO conducted Trachoma Drug Coverage survey in Dedza district while the one in Chikwawa took place between 28th November and 10th December 2016. The aims of the survey were to validate results reported by DHOs (MOH), unmask other things not covered in the normal MOH/DHO report, act as an appraisal of the exercise to give guidance to MOH about progress and give confidence to the donors/partners giving the drugs and finances.

Table 12: Drug coverage survey results for both districts

Trachoma MDA Therapeutic Coverage No. of people No. of people No District interviewed who took drugs Coverage % 1 Dedza 1052 856 81.37% 2 Chikwawa 3670 2800 76.29%

In term of treatment distribution by sex, the table below shows that 57.13% of the respondents who received the treatment in Dedza were females and the rest (42.87%) were males. This shows more females than males received treatment for Trachoma.

Table 13: Total number of people treated by sex No District Males (%) Females (%) Total (%) 1 Dedza 367 (42.87) 489 (57.13) 856 (100) 2 Chikwawa 1309 (46.75) 1492 (53.25) 2800 (100)

C. SUPPORT TO PARTNERS

i. SUPPORT TO MOH & OTHER PARTNERS During the year under review, BICO donated a number of items to her traditional partners’ support of their day to day work.

a. DONATION TO ZOMBA CENTRAL HOSPITAL

21st March 2016; BICO donated a brand new Universal Anaesthetic Machine (UAM), with specifications: Anaesthesia work station including oxygen concentrator, one vaporizer (halothane and isoflurane), oxygen and nitrous oxide rotameters, oxygen monitoring and alarm system, bellows and breathing circuit.

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Figure 10: Ignasio Wachepa in red T-Shirt (BICO) handing over the machine to ZCH Director, Dr Martias Joshua in maroon neck tie

Figure 11: Eye department staff doing operations using the donated machine.

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b. DONATION TO MANGOCHI DHO

23rd September 2016. BICO donated MK500, 000.00 (Five hundred thousand Malawi kwacha) to Mangochi District Hospital to buy food for patients. This followed a request made through media by the District Hospital asking for support from well-wishers to assist them with food for patients.

Figure 12: Ignasio Wachepa (BICO, Senior Projects & Administration Officer in black T-shirt) presenting a cheque to Mangochi District Hospital Administrator

c. DONATION TO MINISTRY OF HEALTH (MOH)

16th December 2016. BICO donated assorted office materials to Ministry of Health Headquarters, Department of Clinical Services as a contribution for the office running costs for its smooth operations.

The donated materials included a lap top and stationery. Figure 13 below shows David Chinyanya (BICO Senior Programme Manager giving a lap top to Mr Michael Masika, Assistant Director (Ophthalmology) on behalf of the Ministry at a ceremony held at BICO Chinyonga Head Office in Blantyre.

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Figure 13: David Chinyanya (BICO) in black suit presenting donated items to Mr M.P Masika (MoH)

- BICO continued its monthly support of MK100, 000.00 to the Department of Clinical Services (Ophthalmology Section) in the Ministry of Health to enhance its communication with partners within and outside Malawi.

d. DONATION TO NEWLY QUALIFIED DOCTORS

7th September 2016; BICO sponsored 20 young medical doctors to attend the 2016 Society of Medical Doctors (SMD) conference which took place at the College of Medicine from 8th to 10th September, 2016. A total sum of MK300, 000.00 was given. This gave the newly qualified doctors an opportunity and platform to interact with other experienced doctors from different specialisations.

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Figure 14: Presentations during the SMD conference

D. CAPACITY ENHANCEMENT & DEVELOPMENT

i. Local & International Training

25th November 2016: Limbani Mitengo, BICO Accountant, attended training on Employment & Labour Law Risk Management for NGOs at Mt Soche Hotel facilitated by Mumba and Attorneys. The course covered Managing Specific Grants/ Projects related contracts of employment, Best Practices and Hot Spots in implementing redundancies and retrenchments; Risk Management in Employee Disciplinary Processes, Understanding and applying the fairness equation, best Practices and avoiding Hot Spots, Dealing with and termination of contract of employment due to prolonged sickness and incapacitating injuries: the law and equitable principles, termination of Employment and how to deal with and report suspected criminal activities.

20 to 24th June 2016: Alvin Chisambi, BICO Project Officer (ICT & Data Management) and Dr Khumbo Kalua (BICO Director) attended a WHO Tropical Data Super Training at Arusha Hotel in Arusha, Tanzania. After the training, the two qualified as Recorder and Grader Master Trainers respectively.

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E. BICO RELIEF & YOUTH DEVELOPMENT PROGRAMME

i. Youth Development Programme a. On 15th September 2016, BICO donated MK200, 000.00 to UKANI Malawi, a youth organisation in support of its community outreach which was held on 24th September 2016 in Chemusa Township in Blantyre. The project aims at supporting youth to acquire entrepreneurial skills, self-esteem, leadership skills, improve communication in English, preach the Gospel of The Lord Jesus Christ, gender knowledge and foster volunteerism among the youth.

Figure 15: Ukani Representatives displaying the cash envelope and signing the forms for the donated money

F. INSTITUTIONAL DEVELOPMENT, STAFFING & STAFF WELFARE

i. New offices

1st March 2016, BICO Head Office moved out of John Hopkins building to a house in Chinyonga Township, as shown in the picture below.

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Figure 16: BICO Head Office, Chinyonga, Blantyre.

ii. ICT Development In order to enhance reporting and communication of all BICO activities and projects and visibility to wider society, the following were done;

a. UPDATES ON SOCIAL PAGES – all project activities have been updated on

Facebook, Twitter, Blog, and other pages of the organization.

Figure 17: Screenshot of BICO twitter page

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b. BICO VIDEOS (YOU TUBE) A total number of 6 video clips have been produced and uploaded on You Tube of the organization.

Figure 18: Some of the uploaded BICO videos

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c. Partnerships with Radio and TV Stations (Radio Maria and MBC TV) have been

enhanced. So far, BICO programmes and activities have been featured on the above

channels hence increasing awareness and visibility of the organisation.

d. Configuration of one drive accounts on officer’s laptops

This was done to ensure officers are backing up the project data online in addition to the documents backups that are kept on local machines.

e. Purchase of new Samsung tablets

3 Motolora phones that BICO was using for capturing trachoma data were stolen during Impact Surveys in Neno. BICO bought 4 Android tablets to add up to the remaining ones.

Figure 19: Samsung Tablet bought for data capturing at BICO

f. Equipment branding

BICO & USAID stickers have been printed. All BICO equipment has a BICO sticker and those bought under the USAID funding have USAID stickers.

Figure 20: One of the USAID funded project laptops

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g. Business cards

In addition to the Director, BICO purchased Business cards for all its Project Officers and Programs Managers to enhance its visibility and identity of its officers.

h. Mhealth

During the year under review BICO captured trachoma data (TT Surgeries & Coverage Survey Data) using links app on androids which was directly uploaded on the BICO iCloud server managed by BICO IT. Tropical Data; an android app for capturing NTDs data was used during the 2016 Malawi Trachoma Impact & Surveillance Surveys which were facilitated by BICO.

Figure 21: Screenshot of the data capturing forms on BICO iCloud server

iii. Project Proposal development

a. One project was approved under low vision during the year under review – Improving Eye Health and educational services for blind and visually impaired children in Central Malawi funded by USAID.

b. The pre-award assessment for the National Reading Programme proposal was done and awaiting final award and contract agreement.

c. Two project proposals were not successful – Reducing incidences of HIV/AIDS through keeping girls in secondary schools in Machinga district by DREAM – Working together for AIDS free future for Girls and Women and Creating youth employment and business opportunities through technical and vocational skills

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development in Blantyre, Thyolo, Mangochi and Mzuzu Districts by EU under TEVET programme.

d. The Vision 2020 Eye Care Programme for South East Zone supported by KCCO with funding from Seva Foundation Canada wound up its project support.

e. The Deworm3 Project was approved, awaiting implementation in November 2017.

iv. Human Resource Policy Hand Book & Financial Guidelines

a. March 2015 BICO revised its financial management guidelines to incorporate current trends in financial trends.

b. April 2015. BICO developed its Human Resource Policy Hand Book to guide staff entry, stay and exit in the organisation.

v. Staff Recruitment, Development & Deployment BICO continued to increase its permanent staffing levels from 28 in December 2015 to 42 by 31st December 2016. The increase in staff recruitment came about because of opening of Ntcheu Office (Low Vision) and Eye Care centre and increased Trust Project activities and responsibilities. The following were recruited during the year under review

Table 14: BICO Staff recruited in 2016

1 Lesley Mulaga Accounts and BICO Head Office Administration Officer Trainee 2 Tisungane Chitimbe Communications BICO Head Office Officer Trainee 3 Pilirani Makuta Field Worker/Nurse MORDOR 4 Gomezgani Mkandawire Field Worker/Nurse MORDOR 5 Philip Pinto Driver MORDOR 6 Patrick Zulu Driver MORDOR 7 Cedreck Mkomera Garden Boy MORDOR 8 Raphael Maganga Garden Boy BICO head office 9 Hendrine Khumbo Nyondo Optometry Technician BICO Eye Clinic - Ntcheu 10 George Moyo Programme Manager, Trust Project - Research & Innovations Blantyre 11 Sara Mwasulama Receptionist BICO Eye Clinic, Ntcheu 12 Brave Bwanausi Field Worker/Nurse MORDOR 13 Mtisunge Wandale Field worker MORDOR 14 Christopher Phiri Project Officer Trainee Low Vision - Ntcheu

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vi. Staff Team Building

On 12th March 2016, BICO organized a third team building workshop at Hippo View Lodge in Liwonde for all members of staff. The theme of this workshop was “fostering interaction, unity and team work in the execution of the goals of the organization”. It was also an opportunity to celebrate 8 years of BICO’s existence

Figure 22: Above, BICO staff posing for a picture at Hippo View Lodge in Liwonde Machinga.

vii. Staff News 1. This year saw three BICO staff promoted.

a) Mumderanji Salomie Balakasi from Project Assistant Trainee (ICT & Data Management) to Project Assistant effective 1st May 2016.

b) David Chinyanya from the position of Programme Manager to Senior Programme Manager effective 1st July 2016.

c) Chikondi Chalera from Accounts Trainee to Accounts Assistant effective 1st March 2016.

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2. 21st December 2016; BICO organised a Christmas party for BICO staff at Andrews Hotel – Mangochi. The party was organised as a get together for BICO employees to share and update each other on experiences and the projects status for the year ending 2016, and also to chat the agenda for 2017.

Figure 23: Dr Kalua addressing staff prior to the party in Mangochi

3. 31st December 2016: Paul Mkandawire, Project Officer for Consultancy, Research and Publications left the organisation after the expiry of his contract. BICO wishes him all the best in his future career.

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G. 2016: BICO VISITORS (selected)

1. Victoria Nyahoda, Assistant Quality Assurance Manager at MASM came on the 24th March 2016 to discuss with Mangochi Eye Care Centre staff on different MASM schemes and also train them on how to transact with MASM when it comes to spectacle quotations, missing members and dealing with special members from companies who have a special arrangement with MASM.

2. 2nd May 2016 and 9th June 2016 Leon and Marline from London school of Hygiene and Tropical Medicine (LSHTM) visited BICO to collect samples for their Master of Science thesis.

3. 7th June to 16th June, Dr Karin van Djk, Global Low Vision Specialist visited BICO to review and finalize Low Vision curriculum for Montfort College, conduct training of trainers in Low Vision Care and help in developing training curriculum for Eye Health staff.

4. 29th June 2016 to 26th July 2016 some Optometry students from Cardiff University visited BICO and supported in mass screening in Zomba and school screening in Mangochi Boma and Nkope Resource Centre and Machinga rural.

5. 30th September – 5th October, 2016, Students from Germany (Klaus – Daniel Cortés Franco, Kai Georg Pohl, Dominika Wawrzyniak and Samira Huβ) came to make a documentary on how BICO is managing Trachoma.

6. 28th June 2016 - 28th July 2016. David Jennings and Tim through LSHTM came to support BICO in screening children for skin infections and quick chest stethoscope examinations, collection and analysis of stools from under five children.

Figure 24: The visitors observing the exercise in Mangochi

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7. Nicole Butler and Colleen Mulhall, final year Optometry students from the University of Waterloo School of Optometry, Canada came on 9th September 2016 for Childhood blindness, Refractive error and low vision internship at BICO.

8. Nancy Chidzankupa, Capacity Building Specialist, MERIT –RTI and Zeru Mwandira, Chief Community Development Officer, Ministry of Gender, Children, Disability and Social Welfare visited BICO on 24th September 2016 for BICO pre-award assessment for the National Reading Programme, a USAID funded project.

Figure 25: Nancy Chidzankupa (center) & Zeru Mwandira (right) at BICO Head Office, Blantyre during pre-award assessment for National Reading Programme.

9. Deworm3 team visitors for site assessment: Dr Rachel Pullan, Dr Catherine Halliday, Ann Njoka, Paul Gichuki, Iain Gardner, Dr Judd Walson, Dr Peter Jordan, Dr Stefan-Witek Mac Manus, Samuel Jemu, Laston Sitima and Khristiana (Natural History Museum– Deworm3, LSHTM and MoH (Malawi)). These visitors came to discuss the feasibility of conducting the large Deworm field clinical trials in Malawi with BICO on 13th May, 2016 and also came for baseline assessment work from 12th September – 03rd October, 2016 which took place in Mangochi.

10. Sophie Mhone, Community Mobilisation and Engagement Specialist for MERIT – RTI and the Finance Manger visited BICO on 10th October 2016 for the final financial part of pre-award assessment for the National Reading Programme.

11. David Ross, President & CEO Task Force for Global Health, Teri McClure, Senior Vice President of Legal and General Council, UPS & Board member, Task Force for Global Health, Poul Olson, Director of Communications and Development, The Task Force for Global Health and William Weeks, Photographer, visited BICO between 15th October and 21st October 2016 and observed the Chikwawa Trachoma MDA.

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Figure 26: David Ross (Centre) & Teri McClure (right) with Dr Khumbo Kalua during their visit to Chikwawa

12. Dr Paul Emerson, Director of ITI, visited BICO between 15th October and 21st October 2016 and observed the Chikwawa Trachoma MDA, and also in Dec 2016.

Figure 27:Left: Dr Paul Emerson demonstrating how to open and reconstitute syrup while Mr Masika and Alice Bagire (HSA) look on at Mbalame village in Chikwawa. Right: Dr Paul Emerson giving a health talk before start of MDA

13. Ken Moon, Director of Finance and Performance, Sightsavers, UK came between 15th October 2016 and 21st October to observe the Chikwawa Trachoma MDA.

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Figure 28: Mr Masika – centre (Ministry of Health) explaining to Ken Moon at Nkhungubwi village in Chikwawa during MDA

14. Prof Robin Bailey, the Principal Investigator from LSHTM and came to check on the progress of Mordor Project, and also supervise masters students at least 4 times in 2016.

15. Roy Hauya, Country Director Sightsavers Malawi Office, who accompanied the ITI and Sightsavers delegation to Chikwawa MDA from 16th to 20th October 2016

16. Bright Chiwaula, Programme Manager, The Trust Project, Sightsavers Malawi Office who accompanied the ITI and Sightsavers delegation to Chikwawa MDA from 16th to 20th October 2016.

17. Mr Michael Masika – Assistant Director responsible for Ophthalmology, Ministry of Health who visited BICO on several occasions such as Trachoma Impact Survey training, TT Application training and also accompanied the ITI delegation to Chikwawa MDA from 16th to 20th October 2016.

18. Dr Paul Emerson and video crew from Task Force for Global Health visited BICO the second time between 12th -18th December 2016 to produce a TT documentary in Chikwawa.

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Figure 29:Left: Paul Emerson with Dr. Kalua at Fodya Village, Right: Rex Bwanausi explaining to Dr. Paul Emerson (right) on how TT surgeries went on

19. Dr Amir Bedri Kello – Community Eye Health Consultant and Ophthalmologist for Light for the World & Sarah Bartlett – mHealth Advisor at Sightsavers, USA visited BICO from 12th December to 17th December 2016 to conduct pilot training in TT Application. They also observed surgeries in Chikwawa and follow up in Nsanje as part of the training.

Figure 30: Dr Amir (second from right) & Sarah Bartlett (third from right) standing at the back pose with some BICO Officers and Dr Paul Emerson at BICO Headquarters in Chinyonga – Blantyre; December 2016

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H. APPENDIX 1: FINANCIAL PROGRESS REPORT

a. Report of the independent auditor of BICO (2016 AUDIT)

2.1 Introduction

Chaula and Associates has been contracted by Blantyre Institute for Community Ophthalmology (BICO) to conduct a financial statement audit of the organisation. The audit has been undertaken to address the following specific objectives:

• To perform an audit in accordance with International Standards on Auditing in order to provide an opinion on the truth and fairness of the organisation’s statement of financial activities, statement of movement in fund balances, statement of financial position and statement of cash flows for the year ended 31 December 2016; and

• To confirm that the costs charged to the organisation are in compliance with organisation objectives, and those of donor requirements.

The organisation’s statement of financial activities, statement of movement in fund balances, statement of financial position and statement of cash flows and the establishment of an effective system of internal controls are the responsibility of Management. This report is furnished solely for the information of Blantyre Institute for Community Ophthalmology (BICO) and should be used only for this purpose.

2.2 Scope

We planned to conduct our audit as follows: • Audit of the organisation’s financial statements in accordance with International Standards on Auditing. • Audit of organisation payments in accordance with agreed upon procedures regarding financial information. • Evaluation of the organisation’s internal controls.

2.3 Reporting

We have presented the Independent Auditor’s Report on the organization and its performance to the BICO board and have summarized results of this report.

2.4 Summary of results

• Audit of the organisation’s Statement of Financial Activities – Our report on the Statement of Financial Activities for the year ended 31 December 2016 is unqualified.

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• Review of the organisation’s expenditure - Nothing has come to our attention that indicates that the costs charged to the organisation are not eligible under the conditions set out in the organisation’s constitution.

• Evaluation of internal controls - nothing has come to our attention that indicates that internal controls were not properly designed or placed in operation during the year.

Chaula and Associates Certified Public Accountants Blantyre

10th February 2017

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b. Summary of Income and Expenditure for BICO Projects for the Year Ended 31 December 2016

INCOME Kwacha (MK) Dollar ($)

Total Funds received 969,409,297 1,319,323

EXPENDITURE

Projects 628,039,247 854,734

Salaries 182,491,731 248,363

Administration 201,966,358 274,867

Total expenditure 1,012,497,336 1,377,964

Deficit/Surplus for the year (43,088,039) (58,641)

Opening Fund Balance 373,427,012 555,159

Closing Fund Balance 330,338,973 496,518

BICO EXPENDITURE

Administration 20%

Projects Salaries 18% Salaries

Projects 62% Administration

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I. APPENDIX 2: 2016 BICO STAFF Name Position Email address Dr Khumbo Kalua Director [email protected] David Chinyanya Senior Programme Manager [email protected] George Moyo Research & Innovations Programme [email protected] Manager Limbani Mitengo Accountant [email protected] Ignasio Wachepa Senior Projects & Administrative Officer [email protected] Alvin Chisambi Project Officer (IT, Data Management & [email protected] Quality Assurance) Florence Kalua Project Officer ( Logistics & [email protected] Procurement) Zachariah Kamwendo Project Officer – Mordor [email protected] Ranneck Singano Research & Logistics Assistant [email protected] Project Assistant (-ICT and Data) & [email protected] Mumderanji Salomie Balakasi Personal Assistant to the Director Accounts Assistant - accounts and [email protected] Chikondi Chikoti Chalera logistics, Mordor James Simwaza OCO – Mordor [email protected] Glory Muleya OCO – Mordor [email protected] Geoffrey Maseko Field Worker Mordor [email protected] Mercy Patel Field Worker Mordor [email protected] Milliano Dzimbiri Field Worker Mordor [email protected] Christine Lukhere Field Worker Mordor [email protected] Yamikani Hoja Field Worker Mordor [email protected] Chimwemwe Mateche Field Worker Mordor [email protected] Memory Kachitsa Field Worker - Mordor Elizabeth Phiri Optometry technician – Low Vision [email protected] Henry Chikanda Data Clerk – Low Vision Willy Majiya Clinic Technician [email protected] Maghanoghano Mpata Driver - Mordor Lifa Mandala Driver - Mordor [email protected] Fraser Chisale Driver & Logistics [email protected] Chester Phiri Driver & General Duties Officer [email protected] Nellie Chatsika Driver & General Duties Assistant Lesley Mulaga Accounts and Administration Officer [email protected] (Trainee) Tisungane Chitimbe Comunications Officer (Trainee) [email protected] Christopher Phiri Project Officer (Trainee) – Ntcheu [email protected] Pilirani Makuta Field Worker/Nurse Gomezgani Mkandawire Field Worker/Nurse Philip Pinto Driver Patrick Zulu Driver Cedreck Mkomera Garden Boy Raphael Maganga Garden boy – BICO Head office Hendrine Khumbo Nyondo Optometry Technician [email protected] Sara Mwasulama Receptionist – Ntcheu Brave Bwanausi Field Worker/Nurse - Mordor Mtisunge Wandale Field worker - Mordor

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A staff dedicated a low vision and refractive error program

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