U|YITED REPUBLIC OF TANZAIYIA
'r(. ORIGINAL: Enslis COUNTRY/NOTF:TANZANIA Proiect Name: TANGA FOCUS CDTI PROJECT \:}'-\ \-5 Approval year: 1999 Launching year: 2000 . :.1 \/[ Reporting Period: From: ls' JUNE 200aTo-lsr MAY 2oo5 (Month/Year) (Month/Year) t Proiect year of this report: (circleone)l 2 3 4 (5)6 7 8 9 10 t
Date submitted: NGDO nartner: HELEN KELLER INTERNATIONAL
ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)
^l DEAD FOR S SSION: io: '; t-
To APOC Management by 31 Januarv for March TCC meeting r'
To APOC Management by 31 Julv for September TCC meeting , t
tor lnl lin Tc,
i /tti,b ,4 L AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC)
nl4oe 4:0429PM I WHO/APOC,24 N 2004 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT
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OFFICERS to sign the report:
Country: TANZANIA
National Coordinator Name: Dr. Grace Saguti
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Date
-*.- \ Name: Dr. B.J. Ngoli -- Regional Medical Officer r:l,li r.u' io: Signature: ...
D atqs:6;1s J,?, t, i".,'#ft W,--9, i i L e $:. 0. bux aSZ frru0A"-" NGDO Representative Name: Manisha Tharaney
ffl_r'-'-Qr gnature Si f cr l, r':: ) Tat Date J
This report has been prepared by Name: Dr. Rehma Maggid. j:. h ,ffi Designatior' . .*3 I :.li:!. .?. 1: "
Signature: ... a,t ()L Date \b flFl L OFFICER IAIJGA.
4:04:29PM l1 WHO/APOC, 24 November 2004 Table of contents
ACRONYMS V
DEFINITIONS.. VI
FOLLOW UP ON TCC RECOMMENDATIONS 7
EXECUTI\TE SUMMARY 8
SECTION l: BACKGROUND INFORMATION...... 9 1.1. GSNBRAT- rNFoRMATroN...... 9 1.1.1 Desuiption of the project (briefly) 1 .1.2. Partnership. i;;; ; i ; ;;i; ;;; ;;; ;;i";: 1.2. Popur-erroN...... 13 SECTION 2: IMPLEMENTATION OF CDTI...... 15 2.I. Trrrau-weoFAcrrvlTrEs...... 15 2.2. Aovocecv.. t6 2.3. MoetLtzeuoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNlrles 17 2.4. CovvuNrty INVoLVEMENT...... 18 2.5. Capnctrv BUILDING... 19 2.6. TRpnrueNrs. ....21 2.6.1. Treatmentfigures ....21 2 6.2 What are the causes of absenteeism?...... 2i 2 6.3 What are the reasonsfor refusals?...... 23 2 6.4 Briefly describe all lcnown and verified serious adverse events (SAEs) that Ewor! Bookmark not deJined, 2 6.5 . Trend of treatment achievement from CDTI proj ect inception to the current year 2 5 2.7. ORoezuNG, sroRAGE AND DELIVERy oF IVERMECTIN ...... 26 2.8. CouuuNrry sELF-MoNIToRTNG aNo STITHoLDERS MperrNc ...... 27 2.9. SupnRvrsroN...... 28 2 9.1. Provide aflow chart of supervision hierarchy...... 28 2.9.2 V[hat were the main issues identified during supervision? ...... 28 2.9.3 Was a supervision checklist used? ... Error! Bookmark not deftned. 2.9.4 V[hat were the outcomes at each level of CDTI implementation supervision? Error! Bookmark not defined. I 2.9.5, Was feedback given to the person or groups supervised?.Error! Bookmark not t! deftned. 2.9.6. How was thefeedback used to improve the overall performance of the project? Error! Bookmark not defined, SECTION 3: SUPPORT TO CDTI ...... 29 3.1. EqurrvENr ....29 3.2. FrNaNctal coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES...... 30 3.3. OruBn FoRMS oF coMMUNITy suppoRT...... 30 3.4. ExpBNoITuRE PER ACTIVITY ....31 SECTION 4: SUSTAINABILITY OF CDTI...... 32 4.1. INreRNel; TNDEeENDENT eARTICIIAToRY MoNIToRINc; EvaluerloN...... 32 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable)...... 32
4:04:29PM llt WHO/APOC, 24 November 2004 4.1.2. Watwere the recommendations? 4.1.3. How have they been implemented? ...... 4.2. SuSteNnsILITy OF PROJECTS: PLAN AND SET TARGETS (UnNonrORY AT...... Yn 3) 4.2.1. Planning at all relevant levels.. 4.2.2 Funds...... 33 4.2.3 Transport (replacement and maintenance) ...... 4.2.4 Other resources 4.2.5. To what extent has the plan been implemented...... 4.3 INrpcnauoN ...... 4.3.1. Ivermectin delivery mechanisms...... -.-...-...... 34 4.3.2. Training.... .'...... 34 4.3.3. Joint supervision and monitoring with other programs.... .'...... -. 34 4.3.4. Release offundsfor proiect activities ...-.... 34 4.3.5. Is CDTI included in the PHC budget? ...... 34 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?...... -...'...... -...... 34 4.3.7. Describe others issues considered in the integration of CDTL .-.-. 34 4.4. OpenerIoNAL RESEARCH ...... 35 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. 35 4.4.2. How were the results applied in the project?...... 35 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND 0PPORTUNITIES...... 35
SECTTON 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...... 36
4:04:29PM lv WHO/APOC, 24 November 2004 Acronyms
APOC African Programme for Onchocerciasis Control ATO Annual Treatment Obj ective ATrO Annual Training Objective CBO Community-B ased 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 Organ ization 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 goup) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization
4:04:29PM v WHO/APOC, 24 November 2004 Definitions
(i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking).
(ii) Elieible population: calculated as 84%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 ivermectin in a given year.
(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper 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 ofthe project).
(v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage).
(vi) Geographical coverase: number of communities treated in a given year over the total number of meso/tryper-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 fi.rture, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government.
(ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary.
4:04:29PM vl WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS
The recommendations of the last TCC on the project and how they have been addressed.
TCC session 20 Number of TCC ACTIONS TAKEN FOR TCC/APOC MGT Recommendation RECOMMENDATIONS BY THE PROJECT USE ONLY in the Reporl The report reflected a The project staff 253 productive project year proofread the report with commendable careful to avoid achievements in typographical errors therapeutic coverage, supervision, goYernment support, and integration. The report was well written although it contained some typographical errors Project was advised to - The project is 254 carry out routine carrying out monitoring and make monitoring exercise concrete plans for roufinely using the replacement of equipment. checklist developed In subsequent reports the by RHMT at regional Executive summary and in should be comprehensive level CHMT and remaining Mectizan the district. tablets be accounted for. - The project intends The recommendation of to request for TCC 17 should be replacement of conclusively addressed Capital equipments in its sixth year. Moreover there is integration at all level so it is not an issue, as the project will use the capital equipments that are in other project or
I Govemment equipments.
-The Executive Summary in this report is Comprehensive and had exhausted all requirements, also remaining Mectizan was mentioned. -According to report we have is that the project had nothing to address from TCC17.
4:04:29PM 7 WHO/APOC, 24 November 2004 Executive Summ?4l. In 1999 APOC approved the commencement of the Tanga CDTI project and in 2000 implementation of COTI started in 965 Communities. Currently their arel309 communities in all three endemic Districts out of seven districts in the entire region.
Fifth year of CDTI implementation was aimed to empower all CDTI communities to spearhead CDTI activities by addition of Lymphatic Filariasis Elimination Programme activities parallel to primary aye carcwhich is there since third year of CDTI implementation.
The project treated a total of 236,559 people in 1309 communities commenced in early Octo-ber to December 2004.The total population of Hyper and Meso endemic is294,378 people in 1309 Communities. The geographical coverage for the reporting year is 100% whereby the therapeutic coverage is 80.3%. The UTG is247,278 and ATO is 247,277.
Total number of mectizan tablets received in Korogwe, Lushoto & Muheza districts was 2,205,000. Mectizan requested for treatment of onchocerciasis in endemic area was 662,744 where by Mectizan tablets used were 593,742 and 69,002 mectizan tablets remained. Mectizan tablets used in non-oncho endemic area for treatment of Filariasis were 1,312,714. This makes a total number of Mectizan used in the entire region to be 1,906,456 and298,544 Mectizan tablets were remained.
The gold mines activities in some parts of endemic areas in Muheza district make people to invade the gold mines areas, also there is in and out of people in this area due to tea estate and boarding secondary schools. Therefore there is fluctuation of number of people in those areas.
In this period 53 FLHFs arrd2624 CDDs were trained and re-trained on CDTI, CSM, how to control and treat Lymphatic Filariasis and Primary eye care. This is part of program integration as all training was conducted the same day and trainers were the same. The CDD ratio is l:112 people.
The major challenges are: -To ensure that all CDTI activities in Comprehensive Council Heath Plans are funded and fund released accordingly in -all three endemic districts. -To ensure that other Community Based Health Programmes are adopting CDTI method, and use the available resources (CDD) so that the attrition rate will be low. -To strengthened HSAM to the affected communities so that they will get sense of community ownership of the programme hence increases incentive to CDDs.
L
4:04:29PM 8 WHO/APOC, 24 November 2004 SEGTION 1: Background information
1.1. General information
1.1.1 Description of the project (briefly)
Tanga Region where the three endemic districts of Lushoto, Muheza and Korogwe are located is in the extended north - east Corner of Tanzania between 40 and 60 and below the equator and 370 - 390 East of the Greenwich Median. The region occupies at area of 27,348 Sq. Kms, being 3 per cent of the total area of the entire Country.
Tanga shares borders with Kenya to the North, Morogoro Region and Coat Region to the South, Kilimanjaro and Arusha region to the west. Indian Ocean borders it on the East.
Distractively, the region is divided in to 7 District namely, Lushoto, Korogwe Muheza, Handeni, Pangani, Kilindi and Tanga Municipality. The Region has 37 Divisions, 155 Wards, 701 Villages and many sub-villages.The population is Most of the villages in project area in all three districts occupies with about 1500-3000 inhabitants per each village ,their main occupation is peasant farmers. The major activities of the farming season are compressed during the long rain from April, May to June with the harvest soon afterwards. There many ethnic groups living in both districts although the major ones are - Sambaa,Zigua, Bondei, with few Digo and Segeju and are almost similar to all 3 districts. This ethnic groups speak, their mother tongue, but all younger people speak Kiswahili, the national language, which has become the most important language in the country, spoken nearly by 100% of the Tanga Population.Few of the population are also able to communicate in English.
The major religions remain Moslems and Christians
Access to the endemic districts (Lushoto, Korogwe and Muheza) from Tanga and Dar es salaam is via a good quality maintained tarmac road although the final 32 km winding road to Lushoto District is through mountains, most of the roads from district headquarter to the peripheral are muddy, rough and mountainous roads which are risky and not easily passable especially during rain season. Other means of commutation are telephone radio call and Mobile phones which are working effectively from regional to district level.
LUSHOTO DISTRICT. Is situated in the Northern part of Tanga Region, is about 187 km from the regional headquarter where Tanga CDTI office situated, and 350 km from capital city Dar es salaam.
4:04:29PM 9 WHO/APOC, 24 Novemb er 2004 Its bounded with Republic of Kenya on the Northern part. Korogwe district on the South and Kilimanjaro Region in the Northwest. The district covers an area of about 3500sq km. Resulting in a population density of 127 people per sq. km. Much of the district lies in the midst of the Usambara Mountains where altitude range is 4500 meters above the sea level.
The District divided in two physical feature the highland which cover almost 75'h of the land, and is characterizedby cold weather and the low of 25o/o which is having a hot weather.
An average amount of rainfall is I l00mm with heavy rains mainly in the months of March and May which is the wet season, from June to September is cold season with the temperature dipping as low as freezing. The dry season is from October to March.
More than 80% of populations live in rural area and are peasants engaged in small- scale farming and petty Business. Main food crops are Potatoes, Bananas. Rice, Maize, Beans and Cassava. Cash crops are Vegetables, Fruits, Tea and ginger.
Administratively the district is divided into 8 division, 32 wards and 163 villages .
KOROGWE DISTRICT Is located in the center of Tanga region, is 87 km from Tanga town and 290 km from Dar es salaam.
It's bounded with Muheza district to the Eastern side, Lushoto district to the Northern and Western Southern part is bounded by Handeni District.
The diskict covers al area of 3,756sq. km resulting in a population density of 69 persons per sq. km. The district forms a narrow lining to the whole Southern half of the Usambara Mountains.
The district is divided into three zones, which have different physical features and weather as follows; - Arid lowlands on the western part rainfall is below 800 mm - Wet lowlands on the south and eastern part average annual rainfall 800mm- 1000mm - Mountainous on northern part with cool weather and more rainfall ranging from 1000-2000 per year, so the average rainfall of the districtranges between 800- 2000 per year, with heavy rains on April to July and October to December within the year. Most of the population live in the rural area and are depending in agriculture small scale farming grow Maize, Cassava, Rice, Bananas, and Beans as food Crops, while Coffee, Cardamom and vegetables are grown as cash Crops. Like other Districts in the Region there are big Sisal and Tea Estates, which are owned by foreigners.
4:04:29PM 10 WHO/APOC, 24 November 2004 Administratively the district is comprised of 4 divisions, 20 wards and133 villages
MUHEZA DISTRICT: Is situated in the Northeast corner of Tanga Region, is about 39 km from Tanga town and 310 km from Dar es salaam. It is the second largest diskict in the Region next to Handeni. The district is bounded in the North by Republic of Kenya, East with Indian Ocean, South with Pangani district and West with Korogwe district It covers an area of 4,922 sq.km.resulting in a population density of 55 persons per sq.km.
The district altitude is between 0-2000 meters above the sea level, the temperature ranging from 30 - 32 degrees however the climate varies mainly with altitude with Usambara Mountains(forest) posing a great deal of influence. The district can be divided into three climatic belts as follow; - Coastal belt - Mountains - Low plains
There is a series of major and minor rivers Pangani, Zigi and Umba are few of the major rivers which pour their contents into the Indian Ocean. Mkurumuzi is one of the minor rivers in the District.
The district generally gets three rainy seasons in the year,long rains between March and June (Masika) scattered showers (Mchoo) in August and September and short rains between October and December (Vuli) average annual rainfall is between 1000- l500mm.
9Oo/o of the population live in rural areas about 20% of them live in a radius of 12- l4km from the nearest health facility while 80% have to walk a distance of 5-l0km to the nearest health post, and most of them are peasants in which they grow Maize, Cassava, Rice, Bananas, Beans as a food crops. Black-peppers, Iliki, Vegetables are L the cash crops. However there are big tea and sisal estates which are owned by foreigners.
Administratively Muheza district is comprised of 6 division s, 24 wards and 17 4.
Th6 district hospital owned by gorverment direct oversees all health facilities in the district. DMO are in charge of all health facilities, helped by CHMT. District hospital is responsible to deliver drugs to health centers and dispensaries which are under government. There are health facilities in most villages in Tanga region and the big population (70%) has an access to health facility within a distance of 5 Km. The remaining 30% which is one third of the Tanga population has no health facility in their catchments area.
4:04:29PM 11 WHO/APOC, 24 November 2004 There are also a growing number of private health facilities but mostly concentrated in urban areas except for religious facilities, which are mostly in rural areas There is a very good mix up of public and private services and even working relationship as partners in improving people health. There are 46 FLHF in the project arca.22 in Muheza, 12 in Korogwe and 12 in Lushoto.
Table l.Number of health staff involved in CDTI District Number of health staff involved in CDTI activities Total Number of Number of health Percentage health staff in the staff involved in entire project area CDTI Br Bz $1:p2lB1*100 Muheza 25 24 96 Korogwe 36 t4 53 Lushoto 60 t7 28.3
Total 1 2 I 55 59. r
1.1.2 Partnership
Tanga Focus CDTI project started in 2000 with a general indemnity of 48 per cent. The Project is currently in the fourth year of APOC funding though CDTI activities were implemented for the fifth year. This is because in 3rd year the project did not receive any funds from APOC Trust funds. CDTI activities were carried out with the support from HKI, District Councils and Region.
The CDTI activities in this project are implemented under the support of Ministryof health, APOC, HKI, Region authority and District councils. There is strong partnership in the project whereby, the Ministry of health provides Manpower for the implementation of several activities, provide funds for some activities conduct supervision and monitoring of CDTI activities implemented in the project. The region support supervision and fueling of vehicles during advocacy and mobilization activities. The NGDO (HKI) partner provides funds for training of FLHF staff especially in eye care, logistics (transport) and technical advice on how to execute integration of CDTI activities with other prograrnme. District councils provided salary to DOTs and FLHF staff also support the project to conduct HSAM, Supervision, planning and training of CDDs. Community members are willing to collect Mectizan from the nearest Health Post and encourage other members to take Mectizan drug every year for not less than 15 years. Some communities provides incentive to CDDs by exempt them in voluntarily work done by community members in their areas.
Normally decision-makers at different levels are mobilized to assist implementation of CDTI activities before the start of distribution cycle of mectizan tablets to the affected community members.
4:04:29PM t2 WHO/APOC, 24 November 2004 1.2. Population
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 Number of communities/villages Population of in Meso- Hyper- Total in Meso- Hype Total in Ultimate endemic zone endemic meso/h endemi r- meso/h treatment in the project zone in the yper- c zone ende yper- Goal mic endemi Total area project area endemi in the c zone project zone c zone (urG) CDTI population Districts/ A1 A2 area in the in the proje Ao= LGAs in the entire Al= N ct Ad As entire project project Aft A2 area area area A5
Muheza 107,370 175 153 328 57,680 49,6 107,37 90,191 90 0 Korogwe 68,480 9l 350 441 10,180 58,3 68,480 57,523 00 Lushoto 118,528 367 173 s40 79,648 38,8 118,52 99,564 80 8 147,50 146, 294,37 TOTAL 294,378 633 676 1309 8 870 8 247,278 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 ofthe 3" year ofthe project).
Was a census for the project done during the reporting period? Yes No If No, what is the source of the data in the table above? * Source: National census CDD-{, Other source, specify: -Non- Year: 2004 -, Deftnition of constitutes the community in proiect area:' Community is a sub-village, which is the lowest and smallest administrative structure in an area. Number of people varies from 80 people to 350. Each sub- village serves by two to three CDDs. In most sub-village, the femalelmale CDD ratio is equal one male CDD and one female CDD. (Total number of CDDs is 2624 out of this I324 are Male and I300 are Female therefore M/F ratio is 50.4%0/49.5%o) In areas where there are three CDDs either two are female and one male or vis-vesa - Numbers of communities/sub-villages constitute a village.
4:04:29PM 13 WHO/APOC, 24 November 2004 4:04:29PM t4 WHO/APOC, 24 November 2004 o oEE q U' G! d d I $ L o a6) N Lr.c ok a ;tr -o 6: () bO o0 oO zo Ns (I) o k li k (J () 0) (.) (n o -o -o -o o E tr E (n Fr q) () gE C) F != o o o \J a H L Q z z z U (r) B bo bn P. () o oE oL L p p d: €o o o n o o o 0) \J o ! od o) o H k c.) o c) o q) -o p -o e: F Lx -: cl trE3E () 9 o (s (D o o U z z z }.{ q) D A >. U) ro () (n d tr EDr GI e) k k k (.) 1itr po pC) po) tr Q 6l>i o o o o o o tr o cl o o o L (rl bo (.) o o prli tr d l< o cl EE q) o! (.) () (B Cg o oo Q o o F C) tr i-o 0) cl o P-r H L rq po) F{ S-c (, -r -c o) a/) 1'E (n F q) d Ld o. a L o () o or (d a (r) a E Utr t! Eo so o o .9 \e Cd (d fl _$ >) hC) oua 4)e G ts-o :Q PE a J P€ (!U) a & a l sg o EE o () o * E v1 L U CA U) C') F]
All leaders at different level were advocated, from Region up to Village level. The advocacy at Regional level was done at Regional Consultative Committee meeting which includes all government and political leaders in the Region. The village leaders including sub-village leaders were also sensitized; this was done after advocacy meetings at Ward and district level. No constraints were being faced, as majority of policy makers/community leaders were the same people since CDTI activities started so they well understand the CDTI strategy.
Normally the advocacy meetings were undertaken before each distribution cycle aiming at creation of more awareness for those who are familiar with CDTI and for others who is there first time to attend these meeting. Advocacy also aimed to build and maintain the sense of ownership to the community leaders and members. The outcome of this advocacy meeting is that Region and Districts has included CDTI activities in their Comprehensive Health Plans.
Therapeutic coverage remain stable in the past four years which shows that Community leaders and community members were well advocated and participated fully in implementation of CDTI activities therefore it shows that now most of the communities knew their responsibilities conceming CDTI.
Total number of Policy/decision maker advocated at Regional Consultative Committee were 50. The Committee is comprises of Regional Commissioner, District Commissioners, Member of Parliament at the region, Head of departments both from Region and Districts, Regional & District Administrative Secretaries, Religious and influential people
The following table shows the number of policy/decision makers advocated at different Ievel per each district
DISTRICT DISTRICT LEVEL WARD LEVEL COMMUNITY LEVEL Muheza 18 275 328 Korogwe 45 100 44t Lushoto 30 250 540 Total 93 625 1309
4:04:29PM t6 WHO/APOC, 24 November 2004 2.3, Mobilization, sensitization and health education of at risk communities
Information on
The use of media and/or other local systems to disseminate information , The project intensified mobilization and Health Education of endemic communities on the need for them to continue treatment even when the symptoms of the disease have subsided. The addition of Lymphatic Filariasis Elimination Programme as responsibility of CDDs was also highlighted in the health education messages. ' The use of drama and public meetings has been used to disseminate information to the community.
Mobilization and heatth education of communities including women and minorities . Schoolteachers, student and their fellow woman CDDs are the ones who mobilize and provide health education to the woman and minorities, with good response.
Resp on s e of targ et co m m u n itie s/vill ag e s . The response of target population was good.
Accomplishments of the project in tlds year are- r Increase of community participation in CDTI activities. . Able to maintain high therapeutic coverage. . Most of the communities know the important of taking drugs regularly. r Low CDDs attrition rate and committed CDDs . Willingness of the CDDs to volunteer to be responsible in more than CDTI i.e. Lymphatic Filariasis Elimination and eye care activities.
Suggestion of way to improve mobilization and sensitization of target communities - . Mobilization and health education should be done continuous to remind the community their responsibility. ' To continue to use policy maker and influential people on sensitization of communities.
4:04:29PM t7 WHO/APOC, 24 November 2004 2.4. Gommunityr involvement
Table 4: Communities participation in the CDTI
Number of communities/villages with Number of CDDs and the communities Number of communities community members as supervisors involved /villages with female CDDs Total no. Number with Percentage Male CDDs Female Total Number of Percentage communities community CDDs communities in the entire members as with female project area supervisors CDDs B; Brr: District/LGA B. B( B/ B. *100 B? B* Bq= Bz*Br Bto Bro/B.*100 Muheza 328 328 100 33r 331 662 328 100
Korogwe 441 441 100 MI 441 882 441 100
Lushoto 540 540 100 552 s28 r 080 264 48
1309 r309 r00 1324 1300 2624 1033 82.6 Total
Comment on: The attendance of female is very low. The culture in many communities, does not allow female to attend Public meetings and now communities were mobilized on the need for them to involve the women. Participation is minimal when compared to male and this is caused by culture. In most communities female are not allowed to talk in front of man especial in public
Few communities provide incentive to CDDs but most of the communities exempts them from voluntarily work as incentives.
Attrition is not a problem in the project; most of the CDDs are still the same since the project started the implementation of CDTI activities. CDDs attrition occurs in rare occasions, like death or marriage for a female CDD. Regardless of other responsibility i.e. participating in Elimination of Lymphatic Filariasis and eye care activities there is no attrition of the CDDs. In trainings female/male CDDs attendance rate is good in most communities. Participation of female CDDs during training discussion is good, compared to public meetings sessions.
18 WHO/APOC, 24 November 2003 2.5. Gapacityl building
Adequacy of available knowledgeable manpower at all levels. r The present of 53 well trained FLHF staffs and 2,624 CDDs in 1309 communities is adequate. At Regional and District level there is well knowledgeable Onchocerciasis Coordinators with RHMT and CHMT members who makes the availability of adequate staff to carry CDTI activities.
Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. Normally training is done to the in charge of FLHF on how to carry CDTI activities. He/she train his/her colleague.s and delegate power to them so that, incase of transfer CDTI activities will continue as norrnal. For the new staff transferred to oncho endemic area funds are solicited from Council and NGDO and immediately the training is done to them. So far more than one staff has been trained on CDTI implementation in most FLHF.
4:04:29 PM r9 WHO/APOC, 24 November 2004 P Ns o + O o o .: N N 00 \o Fv-: \o oo o N 0) \o : : GI L \o o F- N .+ € lr1 U) S,i \o co o N a \o : : Q 6) 0) i, rl. € U t q) q) zv co o t I z !+ o\ o GT aO FU c.l (\l @ \o o \o @ o N o \o 6 C\ H (.) -o'tr 6 il U o o (t) + co e F U o c) I c\t N z .=G t s 6fr C\ fi '^ \o -\ L t-{ q's Q d): o.l N 6t q) U2 v, oq) 9 s) cFg ie o U (\l o) a) r. 6l *6 oL o N o c) B L. o\\c + L 6 o z F Q L e-l $ N p (+) bo o 'l: E rn€ () Ei'l+ a.t o\ c- F-o' N o\ t P U :cr(tL q) -o q c.) o o< c{ sf F- in q) !t: 6t q) o qJ s au) > tr ^O U (.) ta q) o E:- a I O O I (g N o tr Z2 L 0) q) 6 o\ I F I in a E N o\ F- +d 0) N g i , 6r E*f rr F. F U) F-d o\ (, € A * € bo (tU o FI ,L € o (n s' 0< $ (\.l GI oi* 3o € oo !. o o0) o C) ;'e s (r) c.) o t Lr z t,r \o c.t I (+le L a. 0) € 0) € o o t) c) Q F- q,) z @ ra o cl $ o o 00 tr \Q d d lr F 'E.L .iir Fl () Fl F cg B o o:l N bo o 0) o Fi -ol-l 0 o C(tt o o FI z M rl Fi =t Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period)
Trainees Other Health Community Workers members e.g (frontline MOH Type Community health staff or Political of training CDDs supervisors facilities) Other Leaders Others(specifu) Program ,/ \r ,/ ./ management ',f How to ./ ./ ./ ./ ,/ conduct Health education Management ./ / ./ ./ ofSAEs CSM ./ ./ ,/ J ^/ SHM / J ./ ./ / Data J ./ ./ ./ ./ collection Data analysis / ',/ / Report ./ ./ writing Primary eye ./ ./ / care ',/ ^/ Lymphatic ./ ./ .,/ / Filariasis ^/ Elimination Sustainability .,/ ./ ,/ ./ ./
The training of CDTI was integrated with Lymphatic Filariasis Elimination and Primary eye care.
2.6. Treatments
2.6.1, Treatment figures
The project has 100% geographical coverage and 80.3 o/otherapeutical coverage, which is 0.7%o less as compared to last year, and this is caused by some of the community members leave their normal place and move temporally to other area to look for a fertile land to cultivate. The plan made to overcome this problem is for the CDDs to retain Mectizan for those who went for cultivation temporarily.
2t WHO/APOC, 24 November 2003 G ?..3 E ^HP;9 g< os'E E E€?eE# 'Z 9d o a o o- 0o OL o o o ll el q!a s o$ t<>a t N .3 (.) 2z *t. -o o Et' Eo C) S o\ c) o bs \o 0O z -otr co \ $ co o.l N d !f, c) E N \o lr \ =-o N o\ CB o q) zd oo N r- .Ii O I F I o !t Oi o q) z- -3; 'a GI b E oI9 ctX HC) q o ! 6t o L o cl *i o $ L. (D o (r5d q O^ * !+ o e) B >E[}EE oE o 99 o s + o $ o 'a S' o.= H o 'A^ a E3 !o Lv () \s (.)(d=bo ll + c) r'\ ps o\ .sgoi 'E ooE9 \ V? ctl rd -\ So N r- E E\ F @ oo r- oo '=-o a E .ss B € .= qr V) U) qr t4 ? :! q) o q C) -- o\ 6.i Lr Q erSg N cO s (n s'sTI q) h o\ o= L iHE ra) o o\ tri .=o o us = a! co \o co c! z @ o\ c\ A E q o da C) EE' > trd 'o c) (lE p Eo I rr EB l< PE q) o. ? 6.2 F- o..j o L o co co o{ o. ss o A 01 ai \o F- .9E J x r ..D .-o' tr) * tr ot tr \iE -Fo o r- o\ N c) ol E o IF o\ \a o\ .o t: rn .su N \ -l*l o .S 'ts li N E 8 tr E \.!. .=-'d El.g tr V1 i''t o o.I tBl tr = iq s{ q) t, Ek 6-{ io c) \ '=.S=a @ @ .e Hg (d (-- t\ g o':oEt? a.l r- E] E o) =J' o cO @ arl oQ,r ol ^, jr H ls' }1 -- r- =f od $ o) ol tsl (n al o.r pH -o o oo 01 tr +lAsl 6 ar -l : F "6 \o (.t oirl x ' -lxl > xl P ts l\ L b{ tr >t x o dt !l E *l S:L Ll 0) rYl c) EI (n E o:rl (0 ; Bt< ; crl .9o >l o .E EI ; EIE o FM ol L El8 L -o- !s',: ll * o EI H !l I s Ei d E 0x o C) i ol a .! ?tr bo<- ^.i :l(Bl El ,* el E c o ol c) E f S (u 6o a ol o o trl ot tr 81ts s \: O C) ot -E 6l S s"= -dl E vtAHI u ol iR olo- OI g< - ql '= ol -O ? t: t) dl o b g_rr (.) lrl o- oltr ol E b0 Lr O pl 5 Elt Ll 5 * sP () bo ts.u .^ ol C) o- oltr tr s' sR Fl cl u.E [i ! o\ 0)l -o 3lE 9l E tr bo-!l oo o 'Gi o b{ L trl d trl c El= D E; 3 c.l r+$ $ cO .Ea f es c.l r) EI a o b .EE trl =lo =t E c/) =tr>! z F Zl? 2la Zlt- s Pt (A (,) cBl .; G) ,:l ts 'XS €\ h JI ss p (I)l d =oo.= il an o\ ol itrk o (Bt * ts E] b=o ca lil o < 94 co ol N $ $ -cl 0.) a (J FU c.) s Es.u *r od C) cl r S's € ct l< P .a\ E \O@A--td o o\ L C) q o=:: o oo rf, $ O () 00 SE c\ cO Cd E tr an s o0 : ss A tr +ts".= oE ol ((, k o q) tr'- >., - L{ 0) o\ EI d o) \r !r =a?t'=o C) o Lr S :E ci ol () B t's cd E EEfiE ol o o c) a o= tr t bo s l\ C) ' r.l o rd E d\ H o>-o O,^ S^ + .F \o o- o 3 EP F €t CB q)E .cl Eo\ 9E u r-l o) o (, 3l ct C) E ES o.ll () Fl (6 ti F nS .9< l-r bo rr (d ? o EI () o o D -ol(Bt ()N bo o C) F ;v o Fr ol c- R PS FI H q frr I o o\ \ \)S o o A V F.l t'r 2.6.2 Causes of absenteeism. r In most areas the climate is favorable for farming throughout the year so people have a tendency to leave their living place and shift temporally to look for fertile land. r Young people are business oriented therefore they likely to move from one place to another look for the markets so that they can sell and purchase good.
In spite of above reasons the number of absenteeism compared to eligible is very low out of 247,277, (11,369 people were absent during the exercise) Therefore the percentage of absenteeism is 4.5o/o.
As it was stated above, CDDs were advised to retain Mectizan for those who were absent during the distribution period.
2.6.3 Reasons for refusals. . Few members in the communities are still reluctant to take mectizan without any apparent reason . Those who are addicted to alcohol usually refuse to take mectizan. . There is still rumors for few community members that the drugs is given to all eligible and is free of charge therefore it aim for people to be impotence, so some people refuse to take the drug.
Despite the fact that some members in the community refuse to take the drugs due to the above reasons still refusal rate is negligible compared to eligible in the project area. (Out of 247,277 elegible, 4,404 refused to take the drugs) Therefore the percentage of refusals is L.8%. To overcome this problem intesive HSAM will be conducted before the start of next distribution cycle.
2.6.4 No case of SAEs reported.
ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box.
No SAE case to report
23 WHO/APOC, 24 November 2004 3E=Ep u $ <.E E O o N (.)lr ! 'triis$n'g C) clo'o zo tf, gHE o ol (* U o oA -\ o: .9 Ca s oE o V2 + ra gq0 U B q) 5E k- o o V) ()H 3 p oOHO q) i2F^ L ().(i, .= C) &cd tr o
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Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MoH (0 wHo ( ) UNICEF ( ) NGDO ( )
Other (please specify):
Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH ({) wHo ( ) UNICEF ( ) NGDO ( ) Other (please specify)
Description on how Mectizan@ is ordered and how it gets to tlre communities . Mectizan tablets are ordered after conducting census in the affected community and getting the total population of the project. We calculate the number of tablets require by multiplying the ATO times 2.2 then we get total number of required tablets. The Regional office request Mectizan and Albendazole to National Lymphatic Filariasis Elimination Programme both for oncho endemic and non- oncho endemic areas. The request is sent to Mectizan@ Expert Committee for approval. Mectizan@ arrives in country through the same channel and is cleared by World Health Organization (WHO) which handle over to the National Lymphatic Filariasis Elimination Programme. The LFEP in collaboration with the Ministry of Health are responsible for delivering of drugs up to the Region level where by the CHMT members -District authority) come to collect their drugs from Regional Pharmacy under the supervision of Region Oncho Coordinator. The District authority distributes drugs to the FLHF by following request sent to them by FLHF staff. After getting Mectizan the FLHF staff informs the Village authority on the arrival of Mectizan thereafter the CDD or any selected community member comes to the FLHF to collect Mectizan@ ready for distribution to other Community members.
Mectizan ordering/receiving for this reporting year has changed compared to the previous four years because of integration between Onchocerciasis and Lymphatic Filariasis.
26 WHO/APOC, 24 November 2004 Table 10: Mectizan@ Inventory. State/DistricU Number of Mectizan tablets LGA Requested Received Used Lost Wasted Erpired
Muheza 250,000 250,000 236,907 0 0 0 13 093
Korogwe l5 1,983 l 5 1,983 128,936 0 0 0 ,041
Lushoto 260,761 260,761 227,899 0 0 0
TOTAL 662,744 662,744 593,742 0 0 0
The remaining ivermectin tablets collected and where are they kept. The remaining tablets are collected from the communities and returned back to FLHF then the DOTs or CHMT member collects and bring them to the District Pharmacy. The District Pharmacist sent the tablets to the Regional Pharmacy where they are stored waiting for another distribution period or destruction if they are expired.
The activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Ordering and delivering Mectizan@ from Regional to the FLHF level r Manage minor side effects to the community members also to provide health education on how to handle drug especially to the CDDs.
2.8. GommuniQr self-monitoring and Stakeholders Meeting
The training of trainer for Community Self- Monitoring has been done in September 2004 to October 2004.
Communi self-moni and Stakeholders M DistricU LGA Total # of communities/villages No of Communities that No of Communities that in the entire project area carried out self conducted stakeholders monitoring (CSM) meeting (SHM) Muheza 328 105 105 2rt 1tr - 4eresrye !4t Lushoto s40 320 iio- TOTAL r309 636 636
4:04:29PM 27 WHO/APOC, 24 November 2004 Describe how the results of the communiqt self- monitoring and stakeholders meetings have alfected project implementation or how they would be utilized during the next treatment cycle.
o The results of conducting CSM are increase community awareness on how to implement CDTI activities, project ownership and sustainability of the project. a In the next treatment cycle community will be able to solve the problems identified and maintain the successes.
a 2.9. Supervision
2.9.1. Provide a flow chart of supervision hierarchy.
NOTF t REGIONAL LEVEL- /PROJECT COORDINATOR TRHMT
I I +
DISTRICT LEVEL - CHMT /DOCs I FLHF LEVEL - FLHFs
./\ CDDs COMML]NITY LEADERS
Level 2,9.2Nlain issues 2.9.3 2.9.4What were the 2.9.s 2.9.6 How was identified Supervi outcome of CDTI Was feedback used in sion implementation feedba improving the overall check supervise ck performance of the list used given project Yes/No to the superv ised Yes/No DISTRICT -Delay in reporting Yes -Problems and Yes Improvement in report -Cascade Success identified submission Supervision Empowerment at each level. FLHF -Poor record Yes -Problems and Yes Records are well
4:04:29PM 28 WHO/APOC, 24 November 2004 keeping Success identified kept(suggestion on -Lack of staff introduction of project diary). -Committed FLHFs COMMUNIT -Few CDDs drop Yes -Problems and Yes - Good coverage Y out Success identified - Increase ownership -Good response to show there will be CDTI activities sustainability -Inadequate support -Increase community (incentive) to support to CDDs CDDs from -CDTI concept well community understood members -Committed CDDs
SECTION 3: Support to GDTI
3.{. Equipment
Table 12: Status of equipment (Please add more rows if necessary)
Source APOC MOH DISTRICT/ NGDO Others LGA Type of No. Condition No. Conditron No. Condition No. Condition No. Condition equipment
1. Vehicle 1 F 1 F 2. Motor cycle(s) 6 F 3. Computer(s) 2 wo 2 F 4. Printer(s) 1 F 2 F 5. Photocopier (s) 1 F
6. Fax Machine(s) 1 CNFR 7. Others a)Air Conditioner 1 F b)Office Funiture J F 8 F 13 F c) *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, a WO=Written off).
How does the project intend to maintain and replace existing equipment and other materials? Government is responsible in maintaining the available project capital equipment moreover, the project is expecting that, in year six APOC management will provide new capital equipment to the project. If the available capital equipments are written off, the project will depend on the available government other programme capital equipment as the project is already integrated into the health system.
4:04:29PM 29 WHO/APOC, 24 November 2004 3.2. Financial contributions of the Partners and communities
Table 13: Financial contributions by all partners for the last three years
Year 2 ('provide the Year 3('provide the Year 4 ('provide the period') period') period') TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL Cash Cash Cash Cash Cash Cash Budgeted Released Budgeted Released Budgeted Released Contributor (us$) (us$) (US$) (us$) (us$) rus$) MOH (Central + Provincial/State) 17,993 17,993 22,132 22,132 17,122 17,122 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 45,448 45,448 5 r,730 12,306.53 15,850 15,850 Others
a) Muheza District r,695 I,695 4,366 4,366 b) Korogwe District l r5.20 I15.20 200 200 450 450 c) Lushoto District 2350.23 2350.23 2080 2080 1,620 t,620 Communities APOC Trust Fund 67,305 67,305 66,906 s4,238 37,619 32,929 TOTAL 133,211.43 133,211.43 144,743 92,651.s3 77,027 72,337
There were no problems with release of funds
Additional comments r Year 2 -Allmoney from APOC trust fund, NGDO and respective district were released. . Year 3, US$12,668 retained by WHO-for Capital equipment (from APOC trust fund.) r Year 4, US$4,690 retained by WHO-for the purchase of the bicycles. (from APOC trust fund.)
3.3. Other forms of community support Forms of in-kind contributions of communities.
. The CDDs are exempted from the public works especial during distribution. . Community leaders do advocacy and sensitization to community members before distribution.
4:04:29PM 30 WHO/APOC, 24 Novemb er 2004 3.4. Expenditure Per activitY
- In table 14, indicate the amount expended during the reporting period for each activity listed. The amount expended in US dollars using the current United Nations exchange rate to local currency. Exchange rate used here-1$:l000Tsh.
Table l4: Indicate how much the project spent for each activity listed below during the reporting period
Expenditure ($ Source(s) of Activity US) funding Drug delivery from NOTF HQ area to central collection of communi 10,504 MOH Mobilization and health education of communities 3p_q0 COUNCIL COUNCIL/APOC& r141_njnggf CD_!q_ 12,148 HKI COUNCIL/APOC& 6-r-9 82 HKI Training q{ lrealth s!a[ a! a,ll levels COUNCIL/APOC& HKI Sqpgrvi,qiqg 9Po=s en! {qtribulion 11,168_ _ __ COUNCIL/APOC& Internal monitoring of CDTI activities 1,1,050 HKI Advoc agy vlsits to health and political authorities 3,000 COUNCIL IEC materials
_(reporting) forms for treatment COI-INCIL COUNCILiAPOC& Vehicles/ ES maintenance HKI COUNCIL/APOC& HKI Office Equipment (9, g _co-ryputers, printers etc) Others TOTAL 90,895.999
236,559 Total number of persons treated
4:0429PM 31 WHO/APOC, 24 Novemb er 2004 SEGTION 4r SustainabilitY of GDTI
4.1. lnternal; independent participatory monitoring; Evaluation
4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable)
Year 1 Participatory Independent monitoring
Mid Term Sustainability Evaluation
{ Sustainability Evaluation
lnternal Monitoring by NOTF
Other Evaluation by other partners
4.1.2. What were the recommendations? It is recommended that l. The national Health Information Management System (HIMS) form should be expanded to include CDTI. We understand that this is being implemented at the national level. 2. Motivation of the FLHF personnel is important and should be encouraged as part of the progtamme 3. Programme implementers should be note that add-on is not the same as integration and that the latter is more demanding and at the community level could be demanding and complex, requiring data compilation using the same register for different interventions. 4. Top level prograrnme planners should recognize the pivotal role of the FLHF in CDTI and empower it in order to maintain current strength 5. ApOC should check Item 4.9 in the tool for monitoring which seems out of place and inappropriate for this level. Similarly Item 4.11 On coverage should be re-examined for appropriateness at the community level' 6. ApOC should commend the Tanga CDTI project for its achievements within one year in implementing the sustainability plans.
4:04:29PM 32 WHO/APOC, 24 November 2004 4. 1.3. How have they been implemented l. The National is making effort to make sure that CDTI is included into HIMS 2. APOC management has provided bicycles to FLHF staff; moreover they have been re-trained before the distribution of mectizan where by they are getting money so it is part of motivation to them. J. In the case of Tanga it is not add-on because eye care has been with its method also LFEP has its way of implementing in other region. In Tanga Focus we are using CDTI approach in both progralnme. 4. FLHF personnel have been empowered to perform all CDTI activities at their level (i.e. Training/supervision to the CDDs). If there is a problem which needs more attention they consult high authority (CHMT)
4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) (Not Applicable)
Was the project evaluated during the reporting period? - NO
Was a sustainability plan written? -NA
When was the sustainability plan submitted? NA What arrangements have been made to sustain CDTI after APOC funding ceases in terms of:
4.2.1. Planning at all relevant levels) CDTI activities are already incorporated into CCHP, moreover for the next year, plan will be in the form of bottom up which will base on the priority of the community themselves. 4.2.2. Funds District Councils are ready to take over the programme. Budget for Onchocerciasis has been included in Council Comprehensive Health Plans. The district council has started releasing funds for oncho activities. For the past two years, Local Government Authority has supported CDTI activities 4.2.3 Transport(replacementandmaintenance) In year six APOC management will provide new capital equipment at the same time maintenance will be done by using government funds 4.2,4. Other resources Human resources is stable as all Onchocerciasis team members are government employees
4.2.5. To what extent has the plan been implemented CDTI activities has been incorporated into CCHP since 2002 and all planned activities were implemented.
4:04:29PM 33 WHO/APOC, 24 November 2004 4.3. lntegration
The extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI activities are already incorporated into PHC system. When CDTI activities are being implemented (i.e. supervision, training, advocacy ect) any RHMT/CHMT member is allowed to monitor the activities to make sure that are well implemented 4.3.1. Ivermectin delivery mechanisms Ivermectin is delivered within normal govemment system using the existence structure. Mectizan tablets are delivered to FLHF which are within the Onchocerciasis endemic area together with other essential drugs/drug kit and vaccines by CHMT member. The FLHF in charge and his/her subordinates are responsible to all medical drugs and equipment brought to them from DMO's office including Mectizan drug. The CDD come to the FLHF to collect Mectizan ready to distribute to the community members. This CDD is the one who also does primary eye care and Lymphatic Filariasis Elimination activities. 4.3.2. Training As the attrition rate of CDDs is very low and there were no transfer for FLHF staff the project has conducted re-training for CDTI at the same time conducted training for them on Lymphatic Filariasis Elimination programme.
4.3.3. Joint supervision and monitoring with other programs Supervision and Monitoring of CDTI activities are integrated within system. Therefore at Region and District level supervision is done by joint team using the developed check list. The team includes medical staff and program staff. 4.3.4. Release of funds for project activities Funds are released through normal channel according to budget line item and every responsible part plays its role. The responsible part in our budget is APOC, Council, Government and NDGO.
4.3.5. Is CDTI included in the PHC budget? Yes
4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Other programme that is using CDTI structure is Lymphatic Filariasis Elimination Programme. . Achievements are: Cost and time effective : Many people are served within short time. I : Tanga region scored good coverage even though it was the first time to combine two activities.
4,3,7. Describe others issues considered in the integration of CDTI. . Drug used is the same to both Programme - Mectizan addition is just only Albendazole I Community served are the same therefore it is easy to conduct HSAM. . Drug distributors are selected by community themselves and they live together. r Community members should be encouraged to own Community Based Programme
4:04:29PM 34 WHO/APOC, 24 November 2004 4.4. Operational research No operational research undertaken so far. We have sent our proposal with the title- (Effect of APOC withdrawal from supporting routine CDTI activities on health personnel and CDD performance in Tanga region) to management of APOC and the proposal was accepted. The project is waiting for the funds to conduct 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 conducted to date.
4.4.2IJow were the results applied in the project? Not yet conducted
SECTION 5: Strengths, weaknesses, challenges, and opportunities
Strengths of CDTI implementation process. o CDDs Attrition rate is very low o Able to maintain a good therapeutic coverage above 650/o and 100% geographical o covoroge for 5 yr now o Most communities are fully aware with the importance of taking Mectizan drugs every year for not less than 15 year. o Integration of oncho with other health programme (i.e Lyphatic Filariasis and Eye Care) o Knowledgeable CDTI implementers at all level o CDTI activities are incorporated into CCHP in all three districts
Weaknesses of CDTI implementation process o Delay of APOC funds o Councils are not releasing funds as per budgeted
Challenges o To ensure that CDTI activities are lntegrated in CCHP and funds are released accordingly in all three endemic districts. o Inadequate motivation from communities to CDDs o To ensure that other health programme are integrated into CDTI o Maintained low CDDs attrition rate o To empower communities to own the program Opportunities o Present of well understanding policy makers on CDTI . Availability of funds (basket fund) in all three districts where by CDTI activities will be budget for. ' Integration of Lymphatic Filariasis into CDTI
4:04:29PM 35 WHO/APOC, 24 November 2004 SEGTION 6: Unique features of the proiecUother matters lntegration of Lymphatic Filariasis Elimination programme with CDTI Monitoring of the implementation of Sustainability plan, and it was observed that the project is highly sustainable. Tanga CDTI is the first project within CDTI projects in Tanzania to integrate Onchocerciasis activities with Lymphatic Filariasis, and we recorded good achievements because Muheza district rank number one and Lushoto district number three with high therapeutic coverage among 24 districts, which are distributing Mectizan and Albendazole in the country.
?
4:04:29PM 36 WHO/APOC, 24 November 2004