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Prevention of Water Born Diseases in Tegeruka Ward, Musoma Rural District, Tanzania

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Prevention of Water Born Diseases in Tegeruka Ward, Musoma Rural District, Tanzania FINAL REPORT Final Evaluation of the project: Prevention of water born diseases in Tegeruka Ward, Musoma rural district, Tanzania ENG.FRANCIS M.A. MTITU MEng Management, BsC Environmental Engineering Registered Professional Engineer (T). P. Eng Nº 3041 Conducted by: Albino Kalolo , Francis Mtitu & Yeronimo Mlawa For AMREF, Tanzania CONTENTS CONTENTS ................................................................................................................................. 2 LIST OF ABREVIATIONS .............................................................................................................. 3 ACKNOWLEDGEMENT ............................................................................................................... 4 EXECUTIVE SUMMARY ............................................................................................................... 5 CHAPTER ONE: INTRODUCTION ................................................................................................ 7 1.0 Background information .................................................................................................. 7 1.2 Project objectives ............................................................................................................ 7 1.3 Objectives of the final evaluation .................................................................................... 8 1.4 Evaluation Methodology ................................................................................................. 9 CHAPTER THREE: DISCUSSION ................................................................................................. 36 CHAPTER FOUR: CONCLUSION AND RECOMMENDATION ...................................................... 42 4.1 Conclusion ..................................................................................................................... 42 4.2 Recommendations ......................................................................................................... 43 REFERENCES ............................................................................................................................ 45 APPENDICES ............................................................................................................................. 47 A: Household questionnaire ................................................................................................ 47 B: Faclity questionnaire ....................................................................................................... 52 C: Focused Group Dicussion and Key Infomant Interview Guide ...................................... 57 LIST OF ABREVIATIONS AMREF African Medical and Research Foundation CHMT Council health management team CSOs Community Service Organizations CORPs Community Owned Resource Persons DWE District Water Engineer FGDs Focus Group Discussions TOTs Trainers of trainers WASH Water, Sanitation and Hygiene WDC Ward Development committee ACKNOWLEDGEMENT This evaluation would not have been possible without the dedication and hard work of many individuals and partners. We would like to thank all the staff at AMREF Mwanza in particular Ms Edna Matasha, Lake Zone program Manager. She was extremely generous in supporting all logistical arrangements and providing us with support staff that made the task easier to execute. We extend our thanks to Mr. Medard Rwakatare for field level arrangements and coordination in Musoma his insights and assistance was invaluable. We would also like to thank Mr. Zumba from AMREF Mwanza for his safe and considerate driving during our field visits. We also extend our sincere thanks to the project partners especially from Musoma district council, health facilities and village governments who were available for us despite their busy schedules. The open hospitality in detailing opinions of what this project was able to achieve with their involvement is highly appreciated. We deeply appreciate the support that village chairpersons and all other local leaders provided to the evaluation teams during data collection at community level. They provided direction for the teams to conduct their activities successfully. Finally we thank the sampled communities as a whole for their cooperation and provision of information individually and in focus group discussions that helped the assessment team get a better understanding of the changes made by the Tegeruka project in their areas. Disclaimer The views expressed in this report are those of independent consultants and do not necessarily reflect those of AMREF. EXECUTIVE SUMMARY In the context of a program funded by Madrid Regional Government, AMREF together with Musoma District council implemented a pilot project that integrated maternal, child health and WASH services . The Maternal, child health and WASH services project also known as TEGERUKA project was implemented in the Tegeruka ward and it started in March 2011 and was concluded in December 2012 . In March 2013, an external end of the term evaluation consultancy mission was conducted on the implementation processes and preliminary impact of the project.The objective of this consultancy was to asses the impact of the project on maternal child health and WASH services and asses the potential of sustainability and scalability The approach adapted in this evaluation consisted of data collection from both primary and secondary sources using quantitative and qualitative (mixed) methods. The following are key findings of the project The need of the project and awareness of the project was high. About 88% of the participants were aware of the project and explained that this project was highly needed by their community but it was found that only 30% knew the components of the project. Access to maternal and child health services was high whereby about 85% of the participants had accesed care in the past three months before this evaluation. Most participants (60%) rated the services at the dispensary to be satisfactory as result of the changes brought by the project. However, facility assessment revealed a suboptimal quality of care characterized by lack of essential drugs, inavailability of guidelines and protocols for patient management ,poor sterelisation of surgical instruments and poor management of waste Male participation in the project area stood at 32% and was not related to knowledge about the project Health system challenges ( human resources crisis and frequent stock outs of drugs) and lack of water affected the quality of services provided at the dispensary Rehabilitation of the infrastructures were successful but not in use during the time of evaluation, also some of the water structure (boreholes) failed to function soon after construction and some were abandoned by the users, which suggestion poor construction and sensitization respectively. The community appreciated the successes of the program in terms of infrastructure development but consistently explained that they do not necessarily need new or good buildings, but they need quality services. The project evaluated proved limited participation of the water department on supervising and certifying the works done by contractors, this can be explained by water borehole abandoned by the users and another borehole that stopped functioning soon after construction Lessons from the project Although, the project addressed some of the health system challenges, there is a need to broaden the scope and address issues related to human resource and availability of commodities in health facilities. Particularly, Future projects should also look at the supply chain challenges that causes frequent stock outs of essential drugs Future projects of similar nature should be of at least 5 years in order that gains of the project are maximized and monitored over time. Capacity building and awareness raising to communities on water policy is important, Participation agreements and sustainability plans should be discussed before starting the project CHAPTER ONE: INTRODUCTION 1.0 Background information Tegeruka project in Musoma District started in March 2011 and phased out on 30th December 2012. The project is funded by Madrid Regional Government through AMREF in Spain. The project was implemented by AMREF in one ward of Musoma Rural District in collaboration with Musoma Rural District council. The theoretical framework used to formulate the project was the Health belief Model. The major project interventions were as follows: 1. Maternal Health: Renovation of Tegeruka Dispensary and construction of maternal ward that will help in increasing privacy during women delivery, provide Antenatal room for pregnancy monitoring, Prevention of mother to child transmission (PMCTC), Refrigerated room to store vaccines, waiting shed for pregnant women and their accompanying partners/couples and ultimately improve the quality of reproductive health services delivery 2. Water supply and sanitation: This include the following Construction of three productive boreholes with hand pump for the three villages of Maneke, Tengeruka and Kataryo Construction of one borehole with solar powered pump and storage tank at Tegeruka dispensary. Rehabilitation and protection of one traditional well in Mayani village. Construction of one latrine with four stances at Tegeruka dispensary to improve sanitation and hygienic condition of the dispensary 1.2 Project objectives Since its inception the implementation process continued as it was planned and almost all activities have been completed. The district
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