World Health Organisation African Programme for Onchocerciasis Control
Mid-term assessment of the sustainability of the TUKUYU FOCUS CDTI project.
15th –28th September 2003
Dr. Sebastian Olikira Baine (Team leader) Dr. Emanuel Emukah Mr. Geoffrey Tukahebwa Dr. Wade Kabuka Dr. Rehma Maggid Mr. Karoli Malley
1 Index
Page
Abbreviations/ acronyms and acknowledgements 3
Executive summary 4
Introduction and methodology 7 1. Introduction 7 2. Methodology 7
Findings and recommendations 12 1. Regional level 12 2. District level 20 3. First Line Health Facility Level 26 4. Village level 31 5. Overall self-sustainability grading for the project 36
Appendix I: Time table for feedback/planning workshop activities 38 Appendix II: List of attendance at advocacy and feedback/planning workshop 40 Appendix III: Report on the advocacy and feedback/planning workshop 41 Appendix IV: TFC Sustainability plans 43 Appendix V: CDTI Sustainability plans – Kyela district 49 Appendix VI: CDTI Sustainability plans – Rungwe district 56 Appendix VII: List of people interviewed 61 Appendix IX: Instruments used in the evaluation of TFC project 64
2 Abbreviations/ acronyms
APOC African Programme for Onchocerciasis Control CDA Community Development Assistant CDD Community Directed Distributor (of ivermectin) CDTI Community Directed Treatment with Ivermectin DC District commissioner DOC District Onchocerciasis Coordinator DOTs District Onchocerciasis Teams MSD Medical Stores Department of Ministry of Health TFC Tukuyu Focus CDTI FLHF First Line Health Facility HMIS health management information system HQ headquarters HSAM health education/ sensitisation/ advocacy/ motivation NGDO Non-Governmental Development Organisation NOC National Onchocerciasis Coordinator NOCP National Onchocerciasis Control Programme NOCT National Onchocerciasis Control Team NOTF National Onchocerciasis Task Force PC Project Coordinator PHC Primary Health Care RPC Regional/Project coordinator. REA Rapid Epidemiological Assessment REMO Rapid Epidemiological Mapping of Onchocerciasis SSI Sight Savers International WHO World Health Organisation
Acknowledgements
We would like to thank the following persons for their help: . The staff at the Headquarters of the African Programme for Onchocerciasis Control (APOC) in Ouagadougou: Dr A. Sékétéli, Dr Uche Amazigo, Mr Aholou, Victoria Matovu, and all the support staff. . Staff of NOCP/ MOH in Dar Es Salaam, for undertaking all the arrangements: Dr. Grace Saguti (NOC), Mr Oscar Kaitaba (Deputy NOC) and all the support staff.. . Political and traditional leaders, health workers and community members in the Tuyuku focus CDTI project (i.e. Kyela and Rungwe districts) for their contributions.
3 Executive summary
The Tukuyu Focus for CDTI (TFC) Project in Mbeya Region of Tanzania is made up of the districts of Kyela and Rungwe, and one FLHF located in Ilege district. APOC funding for the TFC project started from 2000 to date. All projects funded by APOC are evaluated in the third and fifth years for the sustainability and it is against this background that the TFC project has been evaluated.
The evaluation of the TFC project used the instrument developed by APOC to measure the sustainability of a CDTI project (Appendix…..). . This instrument has been pre-tested in the field and revised. The instrument was used to assess sustainability of CDTI activities at four levels of operation i.e. Region, District, FLHF and Village levels.
Purposive sampling of the study population took into consideration two criteria that included therapeutic and geographical coverage as a measure of impact, performance, and sustainability of the CDTI activities; and, endemicity (hyper- and meso- endemic areas) to ensure a representative sample of TFC project area. The sources of information were verbal reports from persons interviewed, and from documentary evidence.
Advocacy visits were paid to relevant persons at the regional and district levels (e.g. District Executive Secretary, District Administrative Officer, etc). Planning/feedback workshops were conducted for the relevant officials at the regional and district levels (as shown in the appendices….). During these planning workshops efforts were made to develop sustainability plans. Finally, MOH and WHO officials were debriefed at the end of the missions.
The key findings of the evaluation exercise are presented in the following sections:
Planning
CDTI activities are integrated into the overall comprehensive health service plan for the period beginning 2002. The plans vary from year to year according to specific needs of each year as more activities were introduced.
A participatory approach is applied in the routine planning for the TFC project. All partners are actively involved, clear about their own roles, and those of the others. The regional level is not involved in the planning process but is fully informed, as it is responsible for the approval of plans before they are funded.
The project management had made plans for the period ranging from 2002 to 2004 indicating needs, funding required identified resource gaps but strategies to cut expenditure and strategies to find dependable sources of resources were not indicated. There is no evidence that this plan is being successfully implemented. The FLHF levels had no detailed plans but locally developed timetables which are developed in a participatory manner and integrated with other health activities. There are functional committees at the community levels which make CDTI plans. Every sub-village decides on the mode, time and place of distribution.
Leadership and ownership
In each District, there are DOT members, who are responsible for implementation of CDTI. They are under the DMO who is the prime initiator of all integrated health activities. DOT members initiate CDTI activities based on the plan but occasionally depended on the Project Coordinator before action especially when APOC funds are not available. The level of political commitment of district leadership appeared satisfactory, although they have presently contributed little.
The in-charges of FLHFs are the focal persons who initiate CDTI activities. These in-charges plan together with other FLHF staffs, village leaders, PHC committee, and the ward leaders all health activities including CDTI activities.
4 In all communities, local leadership through committees support CDTI activities especially distribution and solving associated problems. The community appreciates the importance of CDTI, and the community is in the advanced stages of owning CDTI activities.
Monitoring/supervision
Monitoring/supervision are done according to the recommended approach by APOC. Each level is empowered to supervise CDTI activities at their own level, as well as levels further down. Monitoring/supervision of CDTI activities are integrated with that of other health programmes. Attempts are made to solve the identified problems and failure to do so; they are referred upwards through the established chain of command. Successes are also noted, reported and appropriate feedback given in various forms. These provide incentives to improve performance.
Training and HSAM
The Project Coordinator trains the DOTs who are then empowered to train the FLHF in-charges who also train CDDs. Training for 2-3 days is usually done to update those involved n CDTI activities and this is perceived to be adequate. They are trained at one of the district headquarters, which reduces the costs of training significantly.
HSAM activities are properly planned and carried out where there is an objective need for them. Decision makers have been approached and persuaded them to support CDTI activities in various aspects. HSAM activities have been effective e.g. support for CDTI activities has obtained from the district councils.
Mectizan procurement and distribution
The process of Mectizan procurement and distribution is properly done. A formula of total population x 2.2 was used and reported to facilitate acquiring adequate drugs. Distribution of mectizan at the community level is done at focal points (usually FLFT) that are close to the communities. There are by-laws that encourage swallowing of mectizan. Those who refuse to swallow mectizan are made to pay a fine of Tshs. 500 and then +swallow it in the presence of community members.
Financial resources
The costs for each CDTI activity were not segregated in the annual budget. There was no evidence of cost reduction/ containment strategies. The relative budgetary contributions of the government, APOC and SSI are clearly spelt out. APOC has been contributing most followed by the SSI (NGDO partner) and least contribution is from the government. However, central government contribution has increased as compared to the previous year. Government funding for CDTI activities is not half of the expenses; yet, the project is its fourth year. There is a budget control system. There are no contributions made by the FLHF and community.
Transport and other material resources
The project has one three years old Toyota hilux double cabin provided by APOC and two motorcycles (provided by APOC and SSI). They are in good working conditions. The project coordination office has: desktop computer photocopier and fax machine (non-functional) provided by APOC, and a laptop computer and printer provided by SSI. The project also has training/ HSAM material; a booklet, leaflets and videocassettes provided by APOC and SSI provided T-shirts used in mass mobilisation.
The use of the vehicle was properly controlled by the District Executive Director. Trips are authorised and logbook entries are regularly reconciled. There is a routine maintenance schedule for the vehicles that is adhered to and recorded. The costs for vehicle and equipment maintenance and
5 repair are currently dependant on APOC and SSI funds. The management is aware that replacements will be needed before the end of the programme but currently has no specific and realistic plans to meet these needs when they have lived out their useful time.
Human resources
There is adequate human resource that is stable; staffs have remained in one post since the project started. There are also opportunities to immediately orient new and unskilled project staff on CDTI activities. The CCDs at the community level are motivated through being exempted from communal work, and also households in some communities voluntarily make financial contributions to the CDDs.
Coverage
The therapeutic coverage situation in the Tukuyu Focus CDTI project is amazingly increasing and stable. This is based on the premise that the magnitude of community participation in the CDTI, development and enforcement of the by-laws regarding swallowing mectizan, and the observed increase in therapeutic coverage: at the last distribution for 2002 it was 76%; in year 2001 it was 69%; and, in year 2000 it was 66%.
Overall judgement of the TFC project
The sustainability of this project has been evaluated (in September 2003) after three years of APOC funding Sustainability of the TFC project is being achieved. The overall finding was that the project is ‘potentially sustainable, but will require re-thinking and mobilisation of support to strengthen and keep it on the road to sustainability’. The issues of concern raised by this evaluation mission ought to be addressed if sustainability is to be fully achieved and an evaluation of the TFC project after its fifth year of APOC funding is highly recommended.
Despite the adequate planning for the evaluation exercise, it was not without limitations. The following limitations were encountered:
* some of the documentations required at the various levels were not available;
* the routine data (e.g. treatment summaries) collected at project level were not aggregated for each FLHF and village levels, which made sampling for communities and the health facilities a little bit difficult;
* absence of REMO report made classification of endemicity very difficult;
* basket planning workshop being held at the time of evaluation made some key informants at district level to be absent at first visit; and,
* a considerable amount of time was lost at the beginning of the mission to travelling a long distance from Dar Es Salaam by road.
6 Introduction and methodology
1. Introduction
Onchocerciasis control in the Tukuyu Focus for CDTI Project
The Tukuyu Focus for CDTI Project in Mbeya Regon of Tanzania is made up of the districts of Kyela and Rungwe, and one FLHF located in Ilege district. A brief about each of these districts is given in the following sections:
Kyela district is located in the Mbeya region. Geographically, the district lies at an altitude between 400-520 metres above see level and receives an average rainfall of 1200 mm annually. The district occupies area of about 1,322 square kilometres of which about 965 square kilometres is dry and 375 square kilometres are covered by water. The district is hilly with a lot of fast running rivers/streams, which provide a good breeding ground for the simulium fly that transmits onchocerciasis. The district has two administrative divisions divided into fourteen wards and 84 registered villages. Four wards containing a total of fourteen villages are included in the project area and receive mectizan annually. The district has a total of 25 health facilities of which seven health facilities are in the Tukuyu focus CDTI project.
Rungwe district is also located in the Mbeya region of Tanzania. Geographically, Rungwe district has similar features to those of Kyela district i.e. a high altitude and many rivers originating from the northern and western hill slopes draining into lake Malawi (Nyasa). Most of these rivers have been found to provide good bleeding sites for the vector of onchocerciasis. The district occupies an area of about 2,211 square kilometres and is divided into four divisions, forty wards, and 141 villages. Eight wards containing forty-one villages are registered in the Tukuyu focus project and, therefore, receive Mectizan annually. There are fifty health facilities in the district of which thirteen are in the project area and thus participating in CDTI activities.
River Blindness Foundation operating under the National Institute of Medical Research (NIMR) supported the Tukuyu Focus CDTI project from 1994 to 2000. Then APOC started funding the project from 2000 to date. Sight Savers International (SSI), a non-governmental development organisation (only NGDO partner) since year 2000 has supported CDTI activities in the areas of office renovations, supplied a desktop computer, printer and a motorcycle, training of FLHF staffs, and supported the production of IEC materials and meetings. As the Tukuyu Focus CDTI project was inherited from other organisations no REMO was done by APOC. APOC simply took over the project and provided the needed support for it to continue operating.
2. Methodology
The evaluation team of the Tukuyu Focus CDTI project used the instrument developed by APOC to measure the sustainability of the project. The instruments used to evaluate project sustainability have been tested in the field and revised. A “John the Baptist” was sent to Tukuyu Focus CDTI project seven days prior to the commencement of the evaluation exercise. The purpose of ‘John the Baptist was to:
• introduce the instruments to the CDTI Project team; • to select times and dates for all interviews with government officials/policy makers; • plan initial planning and feedback meetings with all relevant staff; • sample sites for the evaluation; • ensure that all necessary documentation are made available to the team; and, • select local team members.
7 Sampling
Sampling was done purposively as stipulated in the guidelines and sample sites were chosen. Two criteria were applied to obtain sample sites:
The primary criterion was coverage (therapeutic and geographical). This is a measure of impact and, therefore, performance of the CDTI and its sustainability.
The secondary criteria took into cognisance were endemicity to ensure that the sample contains hyper- and meso- endemic areas similar to those identified by results for the project area; and, geographic spread to ensure that the sample contains areas representing the different zones where the project operates, and communities close to urban and in isolated rural settings.
First stage: the average therapeutic and geographical coverage rate for three years (2000, 2001 & 2002) was computed for each of the districts in the project.
Second stage: three health facilities (one with high coverage, a second-one having medium coverage and the third with low coverage) were selected. Two villages were selected from each health facility catchment area (one with high coverage, one with low coverage) and two communities were selected for each health facility chosen (one with high coverage, one with low coverage). Details of sampled sites are shown in Table I.
Table I: Details of Sampled Sites: District, Health facility, and villages for the evaluation of the sustainability of the Tukuyu focus CDTI project.
S/N District Therapeutic FLHF Therapeutic Village Therapeutic Coverage Coverage Coverage Ngana 76.2% 1. Mwalisi 76.2% 2. 1 Kyela Makwal 76.1% 1. Ngeleka 75% (Medium e 2. Makwale 82%) coverage Ipinda 76% 1. Mbunga 82% 73%) 2. Kingili 70% Ilima 69% 1. Lubanda 69% 2. Ilima 71% 2 Rungwe Kissa 81% 1. Bugoba 79% (Medium 2. Ndubi 76% coverage Lufilyo 76% 1. Lusungo 76% 72%) 2. Kipapa 78% 3 Ileje (low Kapeta 67% Ikinga 67% coverage 70%) Total 3 Districts 7 Health Facilities 12 Villages
1.3 Basics
Research question: How sustainable is the Tukuyu Focus CDTI project? Design: Cross-sectional, descriptive. Population: The Tukuyu Focus CDTI project, including: with relevant Regional Medical officials; the NGDO partner; the Districts with their District Onchocerciasis Coordinator, District Planning Officer, District Executive Director, District Medical Officer, and policy makers; the project staff; and the villages with their leaders, community members and the CDDs.
8 Instrument
Questionnaire (see appendix: 'Detailed findings') structured as a series of indicators of self- sustainability. The indicators are grouped into 9 categories.
The instruments assess sustainability at 4 levels of operation i.e. Region, District, FLHF and Village levels. The instrument guides the researcher to collect relevant information about each indicator.
Source of information: Verbal reports from persons interviewed, supplemented by documentary evidence.
Analysis
Analysis of the data collected from the field involved several stages. The first stage entailed assembly of all the data collected at each level by document study, interviews and observations. The team handled each indicator at a time. Every piece of information generated was recorded into the instrument template for each level.
Second stage: entailed grading of each indicator. Once evidence on particular indicator was generated, the team made a joint decision on the sustainability yardstick ranging from 0-4. The average sustainability score' for each group of the indicators was calculated, for each level.
Third stage: Once the team graded all the indicators, each numerical score was graded as fully (4), Highly (3), Moderately (2), and slightly (1). These are presented graphically in the text.
Fourth stage: Having graded the indicators, the team summarized the factual contents. Both negative and positive findings were considered and the totality of the data is presented in this report.
1.4 Team Composition
The team was composed of the following: 1., Dr. Sebastian Olikira Baine (Team leader). ∗ Institute of Public Health, Makerere University, PO Box 7072, Kampala, Uganda ∗ Tel: * 256 71 925 861; Fax: * 256 41 531 807 [email protected] or [email protected]
2. Mr. Geofrey Tukahebwa Department of Political Science and Public Administration, Faculty Of Social Sciences, Makerere University, P.O. Box 7062, Kampala Uganda. Or P.O. Box 5427, Kampala Uganda. Phone No: + 256-41-531499 (Office); + 256-41-532751 (Res.) Fax: + 256-41-534181 Tel (Mobile): + 256-77-612087 E-Mail: [email protected]/ [email protected]> 3., Mr. Malley Karoli .D. National Institute of Medical Research, Tukuyu Research Station. P.O. Box 538, Tukuyu, Tanzania. Phone No. + 255-25-2552214 (Office) Tel: + 255-25-2552249 (Res.) Mobile: +255-748-355164 Fax: +255-25-2552016. E-Mail: [email protected]/[email protected]
9 4. Dr Wade .A. Kabuka, Songea Regional Hospital, P.O.Box 5, Songea, Tanzania. Phone Nos: +255-25-2602698(Res) Mobile: +255-744899941 Fax: +255-25-2602048(Office) E-Mail: [email protected]
5. Dr Emmanuel Emukah. Global 2000 The Carter Center Nigeria 1 Jeka Kadima Street Tudun Wada Jos, Plateau State Nigeria. Or No 14 Ajuruchi Crescent Amakohia Owerri, P.O.Box 4034 Owerri Imo State Nigeria. Phone: +234-73-463870(Office) +234-73-461861 “ +234-83-232959(Home) Mobile: +234-8037077037 Fax: +234-73-460097 E-Mail: [email protected]/ [email protected]/[email protected]
6. Dr Rehma Maggid Tanga Cdti Project, P.O.Box 5547/452 Tanga, Tanzania. Phone No. +255-27-2647880(Office) +255-27-2647314( “ ) Fax: +255-27-2647314 +255-27-2647943 Mobile: +255-744-694366 +255-748-308822 E-Mail: [email protected] [email protected]
This team was divided into sub teams to evaluate operations at the various levels. One external and one internal evaluator were put together in one group plus a member of the District Onchocerciasis Team. External team members became the heads of the small sub-teams. A member of the DOT, acted as guide and facilitator, also accompanied each sub-team.
Team One
1. Dr S. O. Baine (Team Leader) 2. Dr. Wade Kabuka. 3. DOT member
Team Two
1. Mr. Geoffrey Tukahebwa. 2. Mr. Karoli Malley. 3. DOT member
10 Team Three
1. Dr. Emanuel Emukah. 2. Dr. Rehma Maggid. 3. DOT member.
The team met to familiarize themselves with the instruments and agreed on the tentative sub team compositions and schedule. The meeting was also held with the district team members to acquaint them with the objectives and expected outcome of the evaluation, and the health system.
1.5 Advocacy and Planning/Feedback Workshops
Advocacy visits were paid to relevant persons at the regional and district levels (e.g. District Executive Secretary, District Administrative Officer, etc). MOH officials were debriefed at the end of the field visits. Finally, planning/feedback workshops were conducted for the relevant officials at the regional and district levels (Appendices). During these planning workshops efforts were made to develop sustainability plans (Appendix…..). The sustainability plan will be endorsed by all partners to show their commitment to financing it.
1.6 Limitations
Limitations were present but not marked to significantly affect the outcomes of the evaluation such as: some of the documentations required at the various levels were not available; and a considerable amount of time was lost to travelling a long distance from Dar es Salaam by road.
The routine data (Treatment summaries) collected at project level were not aggregated for each health facility and village levels, which made sampling for communities and the health facilities a little bit difficult.
Information on some documents required at the FLHF were not easily available and where available were incomplete.
Absence of REMO report made classification of endemicity very difficult.
Basket planning workshop being held at the time of evaluation made some key informants at district level to be absent at first visit.
Treatment data at village level were at variance with those at FLHF and at district level.
11 Findings and recommendations
1. Regional/TFC Project level
1.1 Overall grading (on a scale of 0-4)
TFC project: sustainability at Regional/Project level 4 3.5 ) 4
/ 3 (
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e 2.5 d a r 2 g
e
g 1.5 a r e
v 1 A 0.5 0 g t n l s s e p s M o ia r e g in u i A ti c e c a n /S /d a n h r r n n o S r a t u e la o r /H g n o s v p n te i & re o P M n i n F rt C i ra I o n z T p a ta s m c n u e ra H M T Group of indicators
1.2 Main findings and recommendations
1.2.1 Planning
Onchocerciasis control is integrated into the overall comprehensive health service plan for the period beginning 2002. There is a detailed plan showing and providing for all key elements of the CDTI activities (Mectizan supply; targeted training; targeted HSAM; targeted monitoring/supervision). The plan varies from year to year-specific needs of each year due to inclusion of more activities.
Routine planning for the Tukuyu Focus CDTI project is done in a participatory manner. Sight Savers International (The only NGDO partner) is actively involved and has opportunities to contribute to the Onchocerciasis control plan. Sight Savers International (SSI) is clear about its own roles, and those of the other partners (i.e. government and APOC). The Regional level is not involved in the planning process, however, is receives copies of the plans for approval and is, hence, informed about CDTI plans.
The project management has made plans for the period ranging from 2002 to 2004 indicating needs, funding required identified resource gaps but strategies to cut expenditure and strategies to find dependable sources of resources are not indicated. Plans were examined and, hence, written evidence to such planning having taken place. There is no evidence that this plan is being successfully implemented.
12 Recommendations: ‘Planning’ Implementation Priority: 1. Develop strategies to cut 1, 2, 3: HIGH expenditure. Indicators of success:
2. Devise strategies to find 1. Written strategies for cost reduction or dependable sources of cost minimisation developed resources. 2. Dependable sources of resources and 3. Provide evidence of written commitments attained. successfully implementation of CDTI plans. 3. Records showing successful implementation of CDTI plans available. Who to take action: NOTF NOC. Project Coordinator. Deadline for completion:
1, 2 September 2004. 3, Continuous.
1.2.2 Monitoring/supervision
The project coordinator routinely only supervises the District Onchocerciaisis Teams (DOTs) in the two districts of Rungwe and Kyela i.e. level immediately below the Project Coordinator. Project Coordinator makes spot checks on the FLHF when they are training CDDs. The DOTs are empowered to supervise CDTI activities at their own level, as well as levels further down.
One routine supervision visit per year is done to each district in the Tukuyu Focus CDTI project because CDTI activities are ‘seasonal’ i.e. it is a one-time activity in a year. Supervisory checklists, plans and reports were made available for examination. Visitor’s books at all the levels revealed the signatures of the NOC and of the Regional Medical Officer.
Supervision visits for CDTI are integrated with that of other health programmes i.e. one official may supervise other health interventions in the same visit, and in other cases, a team of officials is dispatch to supervise different activities while using the same vehicle, hence, reducing the transport and other opportunity costs. Usually supervisory visits last 2 or 3 days depending on the distance from the project headquarters and the volume of work encountered.
When problems are identified e.g. as a result of supervision visits, attempts are made to find solutions and failure to do so, they are referred upwards through the established chain of command. Usually, they are minor problems and solved by the appropriate managers at the next level above. The respective officials have been given necessary support, thus, empowering them to address problems appropriately.
Successes are noted, reported and appropriate feedback given. Successes are acknowledged in various methods such as: giving the best performers certificates which are signed by the Minister of Health and Permanent Secretary; giving letters of commendation; giving them priority when selecting participants in workshops; etc. All these provide incentives performing well to work harder and produce better results for the poor performers to improve their performance so as to be recognised also.
13 Evidence of action taken based on recommendations in the reports of previous monitoring exercises was indicated by the increase in community awareness, desire to take Mectizan and therapeutic coverage.
Recommendations: Monitoring and Implementation supervision Priority: 1. Improve monitoring and 1, 2: LOW supervision beyond the existing Indicators of success: level. 1. Recommended monitoring and 2. Workout means to sustain the supervision taking place. existing monitoring and supervision quality. 2. Incentives for monitoring and supervision provided e.g. letter of commendation or appreciation. Who to take action: NOTF NOC. Project Coordinator. Deadline for completion:
1, 2: Continuous. .
1.2.3 Mectizan® procurement and distribution
Mectizan supply was controlled within the government system. Means of delivery from the MSD depended on whether or not it was time to deliver other drugs. In the case of the former, mectizan was delivered with other drugs to the Regional Medical Office from where it was delivered to the DOCs. In the case of the latter, mectizan the project coordinator collected it directly from Medical Stores Department (MSD) of the Ministry of Health and delivered it to the DOCs. The system of supply of mectizan was perceived to be effective, uncomplicated and efficient. The system has enabled the supply of sufficient Mectizan for the needs of Tukuyu Focus CDTI project and in good time. However, delivery in 2002 due to the introduction of value added tax (VAT) on all drugs including mectizan. There were no funds budgeted for the VAT on mectizan and this caused a delay in delivery and distribution.
This system of supply of mectizan was perceived to be dependable and sustainable because the resources used for its operation were borne by the government where drugs (including mectizan) were delivered on the same vehicle. The only drawback to this approach was that it would not be cost-effective to used a ‘ten ton lorry (currently being used) to deliver a few kilogrammes of mectizan. It was not, therefore, always appropriate means as mectizan could be delayed and not delivered at an appropriate time for distribution.
14 Recommendations: Mectizan procurement and Implementation distribution Priority: 1. Exempt mectizan from taxation. 1, 2, 3: HIGH Indicators of success: 2. Strengthen the government system of delivering 1. Mectazin free from any form of drugs (including mectizan). taxation. 2. Mectizan being delivered efficiently 3. Avoid/minimise delays to deliver and distribute and in time. drugs. 3. No delays reported. Who to take action: 1. Director, Preventive Servicess 2. NOTF and NOC. 3. Project coordinator. Deadline for completion: 1, 2, 3} Before next distribution.
1.2.4 Training and HSAM
The Project Coordinator trains the DOTs who are then empowered to train the FLHF in-charges who also train CDDs. The training was done to update those involved n CDTI activities. The turnover of DOTs has been zero since there has been no changes or transfers of DOTs since 2000. Training for CDTI has not yet been integrated with other training, e.g. in in-service training programmes.
There are only two DOTs in each district and all have been involved in training. Training is usually done for 2-3 days and is perceived to be adequate. They are trained at one of the district headquarters, which reduces the costs of training significantly.
HSAM activities are properly planned and carried out where there is an objective need for them. In some cases, CDTI staff have approached the decision makers who lack information about/ commitment to CDTI and persuaded them to support CDTI activities in various forms such as mobilisation of the communities, financial and material contributions, etc. HSAM activities have been effective as evidenced by, for instance, support obtained from the district councils, increase in coverage rates, etc.
15 Recommendations: Training and HSAM Implementation Priority: 1. Integrate CDTI training with other 1, 2, 3: MEDIUM health services trainings. Indicators of success:
2. Intensify HSAM activities. 1. CDTI training integrated with other trainings.
3. Supply more IEC materials. 2. Increased awareness and coverage. 3. IEC materials available. Who to take action:
Project coordinator and DOTs
Deadline for completion:
1, 2, 3} Before next distribution and thereafter a continuous process.
1.2.5 Integration of support activities
Staff at the regional and project coordination levels combine two or more tasks on a single trip, for instance, when they go out on supervision or health related activities they supervise all health services, delivery of drugs by the regional pharmacist includes mectizan except if it is not the distribution time or when mectizan is the only drug requiring delivery as it would be too expensive to deliver a small amount of drugs while using a big vehicle, etc.
Recommendations: Integration of support activities Implementation Priority: Strengthen the existing approaches. MEDIUM Indicators of success:
Integration of supervision activities. Who to take action:
Project Coordinator. Deadline for completion:
Continuous.
1.2.6 Financial resources
The costs for each onchocerciasis control activity in the year plan at this level were not clearly spelt out in a budget. It was presented in a block for eye activities in the comprehensive health budget and not split up into specific CDTI activities. There was no evidence of cost reduction/ containment strategies. Notwithstanding, the Project Coordinator has a clear estimate of the funds that will be available to them for onchocerciasis control in the coming year, and bases on the past experience to justify his belief. The total amount budgeted for in the year plan did not fall within this estimated income. The budget for the current and previous are detailed in appendix (Instrument 1: Regional/Project level).
The relative budgetary contributions of the government and other partners to onchocerciasis control are spelt out with APOC contributing most followed by the SSI (NGDO partner) and least contribution 16 is from the government. However, central government contribution has increased as compared to the previous year while local government has not yet made any contribution. Government funding for onchocerciasis control is not half of the expenses; yet, the project is approaching the end of its year 3.
The project coordinator was aware of the shortfall and of its size but did not have specific and realistic plans to bridge it. Previously, Local Government Council contributed vehicles (temporarily), diesel and stationery when there were gaps and it is likely to do the same in future when APOC funding ceases. There is hope that SSI funds will be used after APOC funding ends but no written commitment for this has been obtained at the highest level in the SSI. Nevertheless, a budget has been developed in which proportionate contributions from different sources are indicated
There is a budget control system. The accountant fills a request form (voucher) according to the budget lines and submits it for approval to the project coordinator. The voucher is returned to the project accountant and cheque is written. There are three signatories on the project bank account i.e. project coordinator (principal signatory), District Medical Officer and the District Health Secretary. Two i.e. the project coordinator and any other can sign and draw funds from the bank. Accountability for the use of funds drawn is made to the project accountant.
As regards the allocation of expenditure, all the funds released annually are spent as budgeted. With respect to having insight into budget line balances, both the project coordinator and accountant regularly calculate residual specific budget headings amounts under budget headings.
Recommendations: Financial resources Implementation 1. Clearly spell out the costs of CDTI activities in the Priority: health plans. 1, 2, 3: HIGH Indicators of success: 2. Devise strategies for cost reduction/ containment. 1. Costs of CDTI activities well spelt out 3. Develop specific and realistic plans to bridge the in the annual budgets. financial gaps. 2. Feasible and realistic strategies for cost containment present.
3. Practicable specific and realistic plans to bridge financial deficits present. Who to take action:
Council Chairperson, District Executive Director, District Medical Officer and Project coordinator and DOTs Deadline for completion:
1, 2, 3} June 2004.
1.2.7 Transport and other material resources
The project has one three years old Toyota hillux double cabin (provided by APOC) and two motorcycles (one provided by APOC and second provided by SSI). They are in good working conditions. The project coordination office has: desktop computer photocopier and fax machine (non-functional) provided by APOC, and a laptop computer and printer provided by SSI. The project also has training/ HSAM material; a booklet, leaflets and videocassettes provided by APOC and SSI provided T-shirts used in mass mobilisation.
17 Transport at the project level is used to carry out CDTI activities at this level and at the district level. The use of the vehicle was properly controlled: trips made for CDTI purposes are always authorised by the District Executive Director and are recorded in a logbook. Trip authorities and logbook entries are regularly reconciled; no discrepancies have been observed yet.
There is a routine maintenance schedule for the vehicles that is adhered to and recorded e.g. scheduled garage servicing, and replacement of worn out tyres. The vehicle is three years old and has not presented problems that disrupt CDTI activities. The costs for vehicle and equipment maintenance and repair are currently dependant on APOC and SSI funds. Repairs to equipment have so far been done fast and efficiently.
The equipment such as the photocopier, printer and computers are regularly maintained according to a schedule, and this is recorded.
Management is aware that replacements will be needed before the end of the programme but currently has no specific and realistic plans to meet these needs when they have lived out their useful time. It is not yet planned that replacement will be from non-government sources and, therefore, no written commitment from the potential donor organisations. They have the plans in mind but not yet on paper.
Recommendations: Transport and other materials Implementation Priority: 1. Develop feasible specific and realistic plans to replace 1, 2: HIGH and maintain transport and other materials. Indicators of success:
2. If non-government sources are sort, then obtain 1. Feasible specific and realistic written commitment from the highest level of the plans to replace and maintain potential donor organisations. transport and other materials present.
2. Written commitment from the potential donor organisations obtained. Who to take action:
District Executive Director, District Medical Officer and Project coordinator. Deadline for completion:
1, 2} September 04. 1.2.8 Human resources
There is adequate human resource that is stable; staffs have remained in one post since the project started. There are also opportunities to immediately orient new and unskilled project staff on CDTI activities.
18 Recommendations: Human resources Implementation Priority: Strengthen the existing incentive system. LOW Indicators of success:
Staff motivated and committed to provide CDTI services. Who to take action:
Project coordinator and DOTs
Deadline for completion:
Continuous.
1.2.9 Coverage
The therapeutic coverage situation in the Tukuyu Focus CDTI project is amazingly increasing and is prone to be stable in view of the magnitude of community participation in the CDTI, development and enforcement of the by-laws regarding swallowing mectizan, and the observed increase in therapeutic coverage: at the last distribution for 2002 it was 76%; in year 2001 it was 69%; and, in year 2000 it was 66%. Sustainability is being achieved.
Recommendations: Coverage Implementation Priority: 1. Increase therapeutic coverage. 1, 2: HIGH Indicators of success: 2. Improve and strengthen by-laws with respect to CDTI activities. 1, 2: Increasing therapeutic coverage. Who to take action:
Project coordinator and DOTs
Deadline for completion:
1: After next distribution.
2: Continuous.
19 2. District level
2.1 Overall grading (on a scale of 0-4)
TFC Project: sustainaility at district level
4 3.5 )
4 3 / (
t
h 2.5 g i e 2 w
e
g 1.5 a r e
v 1 A 0.5
0 g t n l s s e p s M o ia r e g in u i A ti c e c a n /S /d a n h r r n n o S r a t u e la o r /H g n o s v p n te i & re o P M n i n F rt C i ra I o n z T p a ta s m c n u e ra H M T Group of indicators
2.2 Main findings and Recommendations
2.2.1 Planning
There is a well written documented routine planning at the District level, and this is fully integrated. The plans contained all the necessary elements and were drawn up in a participatory way. The plan is approved at the District level and copies made available to the regional government and MOH.
Recommendations: ‘Planning’ Implementation Priority: HIGH The present comprehensive planning at district level Indicators of success: should be maintained. Availability of written plan (as described on the left) at the District level. Who to take action:
DMO and CHMT members. Deadline for completion:
Every financial year.
20 2.2.2 Leadership and ownership
In each District, there are designated DOT members under the leadership of the project coordinator, who are responsible for implementation of CDTI. However they are under the DMO who is the prime initiator of all integrated health activities. DOT members initiate CDTI activities based on the plan but occasionally depended on the Coordinator before action especially when APOC funds are not available. The level of political commitment of District leadership appeared satisfactory, although they have contributed only money for fuelling.
Recommendations: ‘Leadership and Ownership’ Implementation Priority: 1. Appoint a DOC for each district for efficient and effective 1,2} HIGH leadership. Indicators of success:
2. Appoint a Regional Coordinator for the TFC project based 1. a DOC present in each at the regional level for efficient and effective leadeship. district.
2. a Regional TFC project coordinator present. Who to take action:
RMO and RHMT DMOand CHMT members Deadline for completion:
January 2004
2.2.3 Monitoring and supervision
In the District DOTs compile the reports, which emanated from FLHF through CDDs. The report is comprehensive and transmitted through district council health information system. Supervision is carried out by DOTs five or more times to each community during each distribution- during training, census up-dates, distribution and data collection. Data collection takes place within the government health system, but in all cases DOTs have to go to the FLHF level to collect it (which is less sustainable). Visits for monitoring/ supervision at this level are not documented in report form, nor are supervisory checklists used. However, problem solving by DOTs appears satisfactory. Supervision is currently routine and not targeted. DOTs only supervise next level i.e. FLHF however at some occasions they have supervised community level. The supervisory visits are, however, integrated in most cases.
21 Recommendations: ‘Monitoring and supervision’ Implementation
Supervision and monitoring Priority: 1. Proper reporting system should be put in place. 1, 2, 3, 4} MEDIUM Indicators of success: 2. Undertake targeted supervision only in areas where there is need. 1. Availability of supervisory 3. DOTs should use supervisory checklist/matrix. checklist/matrix.
4. Plan all subsequent visits according to needs. 2. Integrated reporting system.
3. Supervisory schedule. Who to take action:
DMO/RPC DOT members Deadline for completion:
January 2004
2.2.4 Mectizan supply
Mectizan is stored in acceptable space at this level. Mectizan is delivered to this level through Government Medical Stores Department (MSD), the system is effective, efficient and appear very sustainable. This is the method of procurement of other drugs by the District and is run at government cost. Applications emanate from FLHF through request by CDDs after census up dates. A ratio of 2.2 is for the placement of order; this caused shortage during previous years distribution in Rungwe district. Late supply of drug from NOTF equally caused delay in treatment in the district. The late supply of mectizan experience in 2002 was caused by the imposition of value added tax on all drugs and; yet, this had not been catered for in the CDTI budget.
Recommendations: ‘Mectizan supply’ Implementation Priority: 1. Early application for Mectizan to MSD by NOTF 1, 2} MEDIUM Tanzania. Indicators of success:
2. Exemption of Mectizan from Taxation. Sufficient and timely supply of mectizan. Who to take action:
DMO/RPC/DOC. Deadline for completion:
October 2003
2.2.5 Training and HSAM
FLHF staffs are actively involved in CDD training and mobilisation, while DOTs only train FLHF staff. However, in some occasions when FLHF are new DOTs support CDD training. Training and mobilisation activities do not have any specific target or focus and, therefore, are routine. The trainings in Rungwe district are not integrated at present however in Kyela district it is integrated.
22 The CDTI training manual and programme are available to the DOTs for FLHF training, but there are inadequate numbers of training materials. DOTs have the intention to conduct targeted training this year.
Recommendations: ‘Planning’ Implementation Priority: 1. NOTF/SSI to produce adequate number of training 1, 2, 3, 4} MEDIUM and other IEC materials. Indicators of success:
2. All future training should be planned and targeted to 1. Appropriate and adequate number of areas of need. IEC material.
3. Training should be integrated. 2. Targeted and integrated training Plan. 4. Training duration should last 2-3 days and not 1 Who to take action: day. 1. NOTF/SSI 2,3,4. DMO/RPC/DOC Deadline for completion:
February 2004
2.2.6 Finances/ funding
There is a detailed budget that appears adequate for CDTI implementation, integrated in the overall budget (about Tsh 45,000,000) of the council from basket fund and block grant. In some instances, the District Council makes some funds available for fuelling CDTI activities and maintenance of vehicles at this level. The DOTs do, however, depend on the yearly disbursement from APOC.
Recommendations: ‘Finances/Funding’ Implementation Priority: 1. Advocacy visit to Council Management to release 1, 2, 3} HIGH budgeted fund. Indicators of success:
2. Render account of all programme activities to Amount of funds released from District. management. Who to take action:
3. Identify and use highly placed citizens as RMO/DMO and NOTF. advocates to achieve point one above. Deadline for completion:
January 2004
23 2.2.7 Transport and Other Material Resources
The present number of vehicles and motorcycles at this level is adequate but training and HSAM materials are inadequate.
There is a District Transport Management Information System under the Transport officer who is a health worker. He schedules all movements, controls logbooks, arrange for routine and major repairs as well as fuelling. All vehicles are in pool and allocated to projects by transport officer under the DMO. However in Kyela District motorcycles for CDTI are not regularly used for other health programmes e.g. at one time the DMO requested to use CDTI motorcycle for cholera outbreak supervision but the project coordinator refused, hence, transport utilisation is not yet sufficiently integrated.
Recommendations: ‘Transport and Others’ Implementation Priority: Transport should be integrated with other health programmes, HIGH especially in Kyela District. Indicators of success:
CDTI materials and vehicles integrated with other Health programmes Who to take action:
DMO/RTC/DOC Deadline for completion:
December 2003
2.2.8 Human resources
DOTs are stable and well trained, motivated and are fully committed.
Recommendations: ‘Human resources’ Implementation Priority: The present high level of commitment at this level MEDIUM needs to be maintained. Indicators of success:
Adequate number of Stable and committed staff. Who to take action:
CHMT Deadline for completion:
Continuous
24 2.2.9 Coverage
Geographical coverage could not be established because of lack of REMO and therapeutic coverage was good between 70 to 83% but treatment reports in the village register differs with those at the FLHF and the District level (It is only for two years treatment cycle). In some cases the therapeutic coverage is being incorrectly calculated (using Treatment figures that are different from those in the treatment registers in the village and FLHF) – as a result coverage rates are either high or low.
Recommendations: ‘Coverage’ Implementation Priority: 1. Proper and accurate record keeping. 1: MEDIUM 2: HIGH 2. REMO should be urgently conducted For Tukuyu CDTI Indicators of success: Project. 1. Accurate records. 2. REMO data available. Who to take action:
1: PC and DOC 2: NOTF/MOH/APOC-WHO Deadline for completion:
March 2004
25 3 First Line Health Facility level
3.1 Overall grading (on a scale of 0-4)
TFC Project: sustainability at FLHF level
3
2.5 ) 4 / (
t 2 h g i e
w 1.5
e g a
r 1 e v A 0.5
0 g n t l s s e n p s M ia r e g i w u i A c e c a n O /S /d n h r r n / n o S a t u e la d o r /H n o s v a p n i & re o P e M n i F rt C L i ra o n z T p a ta s m c n u e ra H M T Group of indicators
3.2 Main findings and recommendations
3.2.1 Planning
There are no detailed plans at the FLHF level but local time tables. The timetables are prepared by the FLHF in a participatory manner and are integrated.
Recommendations: ‘Planning’ Implementation Priority: FLHF should be trained on how to make detailed plans. HIGH Indicators of success:
Availability of plans at FLHF level. Who to take action:
DOTs Deadline for completion:
April 2004
26 3.2.2 Leadership and ownership
The in-charge of each FLHF is the focal person who initiates CDTI activities. He/she plans with other health staff and village leaders. PHC committee, ward leaders in a participatory manner all health programmes including CDTI.
Recommendations: ‘Planning’ Implementation Priority: To sustain the present leadership. LOW Indicators of success:
Who to take action:
FLHF staff. Deadline for completion:
Continous
3.2.3 Supervision and monitoring
RHS/FLHF staff carryout monitoring/supervision at this level, including data collection and compilation from CDDs but in some occasions DOT members join at this level. After distribution DOTs go to FLHF to collect treatment reports on regular basis. RHS have demonstrated good skill in problem solving at this level and the system appear effective and sustainable.
Recommendations: ‘Supervision and monitoring’ Implementation Priority: 1. DOTs should empower RHS/FLHF staff to carryout 1, 2} MEDIUM supervision at their level. Indicators of success:
2. Treatment data should be transmitted by FLHF through FLHF staff supervising their existing District Health Information System. catchments areas.
Supervisory checklist. Who to take action:
FLHF in-charges and the DOT members. Deadline for completion:
March 2004
3.2.4 Mectizan procurement and distribution
There is an effective an efficient supply system through the government (MSD). Orders are based on population emanating from CDDs. There is adequate and integrated storage space for Mectizan at this level. Records of Mectizan transfer are available and well kept by FLHF staff. There were no reports of inadequate supply, late supply or shortage at this level.
27 Recommendations: ‘Mectizan procurement and distribution’ Implementation Priority: LOW The project is encouraged to sustain this activity at this Indicators of success: level. Sustained Adequate supply of Mectizan. Who to take action:
FLHF staff.
DOTs
DMO/RPC/DOC Deadline for completion:
Continuous.
3.2.5 Training and HSAM
The RHS/FLHF staff carried out training of CDDs routinely with occasional influence from DOTs in case of new RHS. Training materials are however inadequate in number. HSAM is equally carried out routinely without plan and targets but well organised village administrative structures are identified and used effectively. All the trainings were CDTI specific and therefore not targeted.
Recommendations: ‘Planning’ Implementation Priority: 1. Target training at specific areas of need. 1, 2, 3} MEDIUM Indicators of success: 2. Proper planning and needs identification. 1, 2, 3} Availability of IEC materials. 3. SSI/NOTF to produce training /IEC /HSAM material in reasonable quantity. 1, 2, 3} Training manuals. Who to take action:
1, 2} FLHF staff.
3} NOTF/SSI. Deadline for completion:
May 2004
3.2.6 Financial resources
Management at this level have no budget but depend on supplies from the district and thus have no impress. However in one FLHF there was a local arrangement to raise money for fuel, transport and sterilization of equipments. Dependence on APOC fund is heavy at this level and the amount given is just adequate for training and mobilization.
28 Recommendations: ‘Financial resources’ Implementation Priority: CHMT to make adequate provision for this level in the overall comprehensive Health budget. MEDIUM . Indicator of Success:
Availability of budget. Who to take action:
CHMT Deadline:
April 2004
3.2.7 Transport
Government does not provide transport to project staffs at this level by at this level. The project staffs at this level use their own transport to carryout CDTI activities.
Recommendations: ‘Transport and other materials’ Implementation Priority: Future plans to incorporate and make adequate provision for MEDIUM transport at this level. Indicators of success:
Availability of means of transport during supervision Who to take action:
CHMT/DOTs. Deadline for completion:
January 2004
29 3.2.8 Human resources
The number is adequate for this level; they are stable and fully committed and prepared to participate in CDTI.
Recommendations: ‘Human resources’ Implementation Priority: Incentive should be put in place to motivate the staff MEDIUM
Indicator of success
Committed staff Who to take action:
CHMT and DOTs Deadline for completion:
Continuous process.
3.2.9 Coverage
Geographical coverage could not be established because there is no REMO data.
Recommendations: ‘Planning’ Implementation Priority: REMO should be done urgently. HIGH Indicators of success:
Availability of REMO map Who to take action:
NOTF/MOH and WHO/APOC Deadline for completion:
March 2004
30 4. Village level
4.1 Overall grading (on a scale of 0-4)
TFC Project: sustainability at community level
4 3.5 ) 4
/ 3 (
t
h 2.5 g i e 2 w
e
g 1.5 a r e
v 1 A 0.5 0 g n t l s s e n p s M ia r e g i w u i A c e c a n O /S /d n h r r n / n o S a t u e la d o r /H n o s v a p n i & e o P e M n i F rt r C L i ra o n z T p a ta s m c n u e ra H M T Group of indicators
4.2 Main findings and recommendations
Overall, the programme appears highly sustainable at this level. Communities appreciate the cost and benefit of the drug and accept that distribution will continue for a very long time. They are willing to meet their responsibilities within the resources available at the community level.
4.2.1 Planning
Generally census is done separately from, and preceding, the distribution. This effectively doubles CDDs’ workload. Communities have functional committees that plan and implement CDTI. Every sub- village decides on mode, time and place of distribution they also have by-laws to deal with refusals.
31 Recommendations: Planning Implementation Priority: Communities are encouraged to strengthen and enforce the LOW by-laws. Indicators of success:
High therapeutic coverage. Who to take action:
Village leaders. Deadline for completion:
Continuous.
4.22 Leadership and ownership
In all the communities, local leadership through various committees actively support Mectizan distribution, and help to solve all problems as they arise within the village/community. Community members value and accept long-term treatment. Community members reported that mectizan also cured other diseases like intestinal worms.
Recommendations: Leadership and ownership Implementation Priority: The village leadership is encouraged to keep up their interest LOW to the Project. Indicators of success:
High therapeutic coverage. Who to take action:
Village Leaders. Deadline for completion:
Continuous
32 4.23 Monitoring
In the majority of cases community reports were submitted in time to the FLHF. In most of the communities the village registers are well kept and the CDDs had well constructed measuring devices. However no transport is arranged for CDDs for collection, distribution and submission of reports to FLHF.
Recommendations: Monitoring Implementation Priority: CDD should be provided with transport MEDIUM Indicators of success:
1. High coverage. 2. Committed CDDs.
Who to take action:
Community leaders. Deadline for completion:
November 2004
4.2.4 Mectizan procurement and distribution
Adequate amounts of Mectizan are received and distributed to the respective communities. No shortage of Mectizan has been experienced since the programme started.
Recommendations: Monitoring Implementation Communities are encouraged to maintain and sustain this Priority: activity. HIGH Indicators of success:
1. High coverage.
2. Adequate number of Mectizan Who to take action:
FLHF staff
CDDs
Village leaders. Deadline for completion:
Continuous.
33 4.2.5 Mobilisation/ sensitisation
In almost all communities this is proceeding satisfactorily, although IEC materials are sometimes lacking. Leaders and CDDs are actively involved.
Recommendations: Mobilisation/sensitisation Implementation Priority: HIGH 1. Mobilisation/ sensitisation.
2. Communities are encouraged to sustain this high level Indicators of success: of awareness. High coverage. 3. SSI/NOTF to ensure that adequate IEC materials are produced and circulated. Few number of problem villages.
Availability of IEC materials. Who to take action:
FLHF.
CDDs/Village leaders.
SSI/NOTF. Deadline for completion:
May 2004
4.2.6 Finances/ funding
In most communities, villagers appreciate the programme, and support CDDs in kind or by exempting them from communal work and levies. Cash incentive of Tsh 1,000 to Tsh 5,000 was paid to each CDD by two villages.
Recommendations: Monitoring Implementation Priority: Communities are encouraged to support their CCDs. MEDIUM Indicators of success:
Number of motivated CDDs.
High coverage. Who to take action:
Village/Ward Leaders.
Village PHC committee. Deadline for action:
Continuous
34 4.2.7 Transport and other materials
All communities visited collect their Mectizan from collection centres themselves. No cases were reported where lack of transport led to the drug not being collected.
CDDs travel between 2 to 7 k.m to collect mectizan from FLHF and about same during distribution.
Recommendations: Transport and other materials Implementation Priority: Community leaders and their members are encouraged to MEDIUM provide CDDs with transport in areas with difficult terrain. Indicators of success
Sustained high coverage
Low CDD Attrition
Who to take action
Village leaders Deadline for completion:
Novermber 2004
4.2.8 Human resources
All villages visited had adequate number of CDDS with each sub-village having 2 CDDs. A sub- village has about 200 to 500 residents and the average distance covered is between 1.5 to 3 k.m. Central place Mectizan distribution was the common method of ditribution in all the villages. Communities and CDDs are generally prepared to continue supporting the programme in the long term.
Recommendations: Human resources Implementation Priority: Sustain the present level of human resources available. HIGH Indicators of success
High coverage rate
Adequate number of CDDs per village Who to take action
FLHF staff
Village leaders Deadline for completion
Continuous
35 4.2.8 Coverage:
Generally therapeutic coverage is good although in some cases it is incorrectly recorded.
Recommendations: Monitoring Implementation Priority: Accurate data entry between the levels CDD and FLHF. MEDIUM Indicator of success DOTs should cease from directly collecting treatment data from FLHF. Accurate data between CDD and FLHF and DOTs Who to take action
DOT
FLHF staff
CDDs Deadline for completion
January 2004
5. Overall sustainability grading for the TFC project
Following the instructions laid down in the manual, the team analysed the situation in the project as a whole under the following rubrics:
. Leadership – this is an issue of great concern in the TFC project. The organisation structure of TFC is unique The TFC Project Coordinator is under the District Medical Officer of Rungwe District and the project office is house in Rungwe District. Yet, TFC project covers three districts (Rungwe, Kyela and Ilege). This has generated dissatisfaction in the districts of Kyela and Ilege as regards management of the TFC project. It is against this background that the following s being recommended: * The Project Coordinator should be housed/based at the Regional headquarters in Mbeya and from where s/he can equitably manage the TFC project; and * A position of the District Onchocerciasis Coordinator should be created in each district.
Nevertheless, leadership at FLHF and community levels had no critical problems. What is needed is to improve and strengthen the existing situation as regards FLHF and community involvement in CDTI activities.
. Funding – It is going to be essential to formalise as much as possible the ways in which MOH will fund the running of the programme, at all levels, within the next year. The prospects of meaningful funding becoming available appear reasonable.
. Transport – The future availability at the Regional /Project levels depend on access to vehicles provided from time to time by MoH. The prospects here again are reasonable. At district level the integrated nature of transport use by District Heath Team augurs well for the future.
. Supervision – At project level this will depend on the availability of transport, which it is reasonable to assume will still be available, but will soon need replacement in view of the fact that the vehicle present is three years old. At district and FLHF levels again the integration of health activities bodes well.
. Mectizan supply – No problems are foreseen in this area.
36 . Political commitment – This seems to be adequate at all levels.
Following on the analysis above, the level of sustainability of the TFC project is judged to be as follows:
Level of sustainability Description High This project is potentially sustainable. With feedback from the team, the project staff should be able to undertake the required remedial action.
As is the case in all CDTI projects that are funded by APOC in its member countries, the most important factor determining future sustainability is probably the organisational structure, political/leadership environment, level of economic development, social organisation, technology development, and the strength and degree of development of the health system especially the district health service. All these are present in varying degrees in the TFC project. In the case of TFC this system is well developed but requires funding. Each district has a well-developed infrastructure support CDTI activities, There are committed village leaders in each village, there is a well established system of communication, there are favourable by-laws that are enforced by the communities, and supervision at the different levels of the CDTI service provision – all of this augurs well for the future sustainability of the Tukuyu Focus CDTI project.
37 Appendix I
TIME-TABLE FOR THE FEEDBACK AND PLANNING WORKSHOP, MBEYA TANZANIA
Date: 23-26th September 2003 Venue: Karibuni Centre Master of ceremonies: Moshi Ruhiso
AGENDA
Item Activity Time Facilitator 1 Registration of Participants 8.00 - 09.00 Project secretary/DOT 3 Introduction of participants 09.05 – 09:15 M. Ruhiso 4 Welcome Address 09:15 – 09:20 RC/RAS/RMO 5 Introduction to the workshop (an overview of CDTI) 09:20 – 09:40 G. Saguti 6 What are the objectives 09:40 – 10:00 S.O. Baine What is sustainability 7 Methodology 10:00 – 10:15 E. Emukah 8 BREAK TEA 10:15-10:45 M. Ruhiso 9 Presentation of main findings: . Community level. 10:45 – 11.00 G. Tukahebwa . FLHF level. 11:15 - 11:30 R. Maggid . District level. 11:45 – 12:00 K. Maley . Regional/project level 12:00 – 12:15 W. Kabuka 10 Plenary discussion 12:15 – 13:00 S.O. Baine 11 LUNCH 13:00– 14:00 12 Group work: SWOT analysis in 3 groups – What is the situation as regards sustainability of the Tukuyu Focus CDTI project. 14:00 – 14:15 G. Tukahebwa . Group 1: Community level/FLHF. 14:15 - 14:30 . Group 2: District level. 14:45 – 15:00 . Group 3: State/project level 13 Presentation of group work and plenary discussion 15.00 – 15.15 R. Maggid 14 Group work: What could be the solutions to identified problems: 15:15 – 15:30 E. Emukah. . Group 1: Planning, Monitoring and Supervision 15:30 – 15:45 . Group 2: Finances, Training ad HSAM 15:45 – 16:00 . Group 3: Transport, Mectazin and Coverage. 15 Presentation of group work and plenary discussion 16:00 – 16:30 K. Maley 16 Presentations Framework for the three year sustainability 16:30–17:00 W. Kabuka planning Planning process Criteria for further support
Rappateurs: Morning sessions Afternoon sessions.
38 Agenda (Day two+)
Item Activity Time Facilitator 17 Registration of Participants 08.00 - 09.00 Project secretary. 18 Identification of CDTI activities, resources 09:00-0915 and development of a sustainability plan S. O. Baine 19 Development of the 1st year post APOC 09:15 – 09:30 K. Maley sustainability plan. 20 COFFEE BREAK 09:30 – 10:00 21 Group work: Development of 3 year 10:00 – 13:00 E. Emukah. sustainability plans (what to be done, why, by whom, when, indicators, costs and priority. 22 LUNCH BREAK 13:00-14:00 23 Presentation of group work followed by 14:00–16:00 R. Maggid plenary 24 Review of plans 16:00 -17:00 K. Maley REFRESHMENTS 25 Endorsement of the plan RMO/NOC/SSI/Baine/ Emukah 26 The Way forward SSI/NOC/W. Kabuka.
39 Appendix II
FEEDBACK AND PLANNING WORKSHOP
VENUE: KARIBUNI CENTRE: MBEYA DATE: 23rd – 26th September 2003
ATTENDANCE LIST
NO NAME TITLE FULL ADDRESS 1. Dr. F.Philly Ag. RMO BOX. 259 – Mbeya 2. A.N.Luvanda CDA for RAS BOX. 754 – Mbeya 3. Joseph J.Mpiza R.PLO BOX. 754 - Mbeya 4. Dr. W.A.Kabuka Project Coordinator Ruvuma CDTI BOX. 5 Songea 5. Peter N.Salafu DOT – Rungwe BOX 38 – Tukuyu 6. Daudi Mwasamwene DOT – Kyela BOX. 4 - Kyela 7. Leonard Shaba DOT – Rungwe BOX 38 – Tukuyu 8. Dr. Maggid R.B. Project Coordinator Tanga CDTI BOX. 5547 - Tanga 9. Dr. Emmanuel Emukah Facilitator Global 2000 Nigeria 10. Malley Karoli D. Evaluator NIMR- Tukuyu 11. Dr. Grce Saguti PM NECP/NOCP BOX. 9083 – DSM 12. D.Lusigaliye DPLO BOX 148 – Tukuyu 13. Masanga E.M.Buliga DED BOX. 148 - Tukuyu 14. Dr. Moshi Ruhiso Project Coordinator Tukuyu CDTI BOX. 38 – Tukuyu 15. Dr. Mwakapalala DMO BOX 4 – Kyela 16. H.Mafimba DPLO BOX 4 – Kyela 17. Pius Mabuba SSI Country Rep. BOX. 2513- DSM 18. Dr. A.B.M.Gao DMO BOX. 38 – Tukuyu 19. Oscar Kaitaba Deputy – NOCP BOX. 9083 – DSM 20. Mboka John Council Chairperson BOX. 320 Kyela 21. Libenanga A.S Ag. DED BOX.320 – Kyela 22. E.M.Masawe DOT BOX 4 – Kyela 23. Neema Mwangalaba Secretary Tukuyu Focus BOX. 38 - Tukuyu 24. Geoffrey Tukahebwa Temporary Advisor Box 7062, Kampala (U) 25. S.O. Baine Temporary Advisor Box 7072, Kampala (U)
40 Appendix III
Advocacy and feedback/planning meeting report.
SUSTAINABILITY OF THE TFC PROJECT
Feedback/Planning Meeting Report – Regional and District levels
The workshop started at 10.20 a.m. with a welcome address by the Acting Regional Administrative Secretary. The participants and facilitators thereafter introduced themselves. Dr Grace Saguti then gave the NOC an introduction to the feedback/planning workshop and CDTI overview. After this presentation, Dr. S. O. Baine presented the objectives of the workshop and introduced the concept of sustainability. The paper focused on: the objectives of the workshop in relation to CDTI and the field component of the evaluation of the TFC project being done; concept of sustainability in the APOC context; trends of achieving sustainability; measurement of sustainability; and judgement of CDTI with respect to sustainability. This presentation was followed by one presented by Dr. Emmanuel Emukah on the methodology adopted for the evaluation of the TFC project. The highlight of the paper included a “John The Baptist” visit, which was to determine the areas to be covered during the evaluation. The two districts in the TFC project and FLHF located in another district (Ilege district) were included in this evaluation exercise. From these districts, six FLHFs plus one (Ikinga FLHF) located in Ilege district and 13 villages were selected for the exercise. Thereafter, Mr Geoffery Tukahebwa, Dr. Rehma Maggid, Mr Karoli Malley and Dr Wade Kabuka presented summaries of findings at the community, FLHF, District, and Regional/Project levels respectively.
Discussions followed each presentation on findings and the participants made observations. The workshop was adjourned at 2.00 p.m. to 3.00 to allow participants a lunch break.
The sessions started again at 3.20 p.m. Mr G. Tukahebwa presenting the philosophy that underpin SWOT (strengths, weaknesses, opportunities and threats) analysis and introduced SWOT analysis using the nine indicators that have been utilised in the evaluation of CDTI projects. Participants were then randomly divided into three working groups to conduct a SWOT analysis of the indicators of sustainability with regard to the TFC evaluation findings that had been presented. This was followed by group presentations and plenary discussion. The day’s sessions ended at 5.30 p.m. Due to delays in reporting for the workshop by the participants, the day’s programme could not be completed and the untouched session were postponed to the second day of the workshop.
One the second day, the participants were again put into three working groups and assigned to make out solutions to the problems identified. Solutions to the identified problems and weaknesses were proposed and feedback from each group was given in a plenary session.
Dr Wade Kabuka then presented guidelines and checklist for developing a CDTI sustainability plan. Emphasis was given to the framework for sustainability planning, planning process, and the criteria for further support. He provided food for thought on the roles of the different levels and partners. The presentation mainly focused on a post APOC role of the government. It was stressed that since APOC was pulling out of CDTI activities, the government needed to reconsider: the roles of the different partners; addressing the problems identified during the sustainability evaluation; and to focus on the major objective post APOC which is to maintain a geographical coverage of not less than 100% and a therapeutic coverage of not less than 65%. For these coverages to be sustained it was emphasized that the government’s major role should be to make Mectizan available to the communities. To facilitate this, the government’s basic activity was highlighted. A checklist of items/activities APOC would not fund after withdrawing from the project was given as well as areas where some funding may be done.
Participants developed a one-year sustainability plan and they also develop a two-year sustainability plan highlighting the key activities that must be done to get the CDTI activities going in the absence of APOC funding. They were also asked to identify alternative, dependable sources of funding for the
41 post APOC era. Participants developed a thorough budget justification for the activities to be undertaken. Finally, they developed a time frame suitable for them to implement the recommendations generated by the evaluation findings and workshop.
The workshop was attended by 25 people (Appendix II). The degree of participation was very high. Participants were fully engaged in discussing the ideas/issues generated by the presentations and a year plan for sustainability was developed. The workshop was thereafter closed.
42 Appendix IV
TUKUYU FOCUS CDTI PROJECT SUSTAINABILITY PLAN FOR THE REGIONAL/PROJECT LEVEL FOR THE PERIOD (2003/04)
SPECIFIC ACTIVITY COST SOURCE OF RESPONSIBLE TIME- PROGRESS OBJECTIVES FUNDING OFFICER FRAME INDICATOR
1.To establish the Review of - RPC Aug 04 Work on REMO going actual number of current REMO on village affected by and REA report Onchocerciasis in three District by the year 2003/04 To conduct 5,125,000 APOC RPC Aug 04 REMO being REA/REMO conducted. survey 2.To create To conduct RCC 4,240,000 Govt RAS Jan 04 Meetings with RCC awareness to Meeting being conducted. regional authority on CDTI activities To conduct 840,000 Govt RMO Nov 03 RCC Meeting in three districts by workshop to conducted year 2003/04 RS/RHMT To conduct 2,225,000 Govt RMO Dec 03 Regional Health Forum Regional Health Conducted Forum Workshop 3.To undertake To conduct 4,110,000 APOC RPC Oct/Dec 03 Number of periodic supportive Monitoring and Jan 04 monitoring/supervision supervision in three Supervision Visits missions doe districts in year to 3 districts 2003/4 To develop IEC 5,450,000 APOC RPC Jan 04 Number and types of Materials IEC materials developed. 4. To improve the To conduct start- 3,380,000 SSI RPC May 04 Meetings being capacity of 3 up meeting. conducted. CHMTs on To attend NOCP 1,860,000 SSI RPC July 04 National annual review planning and Annual Review meeting attended implementation of Meeting CDTI. To train project 5,246,000 APOC RPC Jan/ Feb Personnel at District personnel at 04 and Regional level s Regional and trained. District levels on Management skills and Report Writing 5. To create To pay for 2,075,000 APOC RPC Oct/03 – Supplies and services conductive working supplies and /= Apr/04 paid for. environment for services efficient and To pay for 840,000/= APOC RPC/RMO Oct/03 – Utilities paid effective utilities Aprl/04 coordination in year 216,000/= GOVT. 2003/04 To pay for 7,176,000 APOC RAS/RPC Oct/03 – Salaries paid salaries/incentive /= Apr/04 to project staff GOVT. 2,076,000 /= To pay for 7,000,000 APOC RPC Oct/03 – Well-maintained running and /= Apr/04 vehicles. maintenance of vehicle
43 To do 760,000/= SSI RPC Oct/03 – Well-maintained maintenance of Apr/04 equipment. office equipment
SUMMARY EXPENDITURE/PERCENTAGE CONTRIBUTION 2003/04
SSI APOC G’NT GRAND TOTAL
6,000,000/= 31,922,000/= 14,697,000/= 52,619,000/=
11% 61% 28% 100%
44 TUKUYU FOCUS CDTI PROJECT SUSTAINABILITY PLAN FOR THE REGIONAL/PROJECT LEVEL FOR THE PERIOD 2004/2005
OBJECTIVES ACTIVITY COST SOURCE RESPONSIBLE TIME-FRAME PROGRESS (Tsh.) OF OFFICER INDICATOR FUNDING 1. To undertake To conduct 4,315,000 APOC RPC May/July 04 Supervision report supportive supervision monitoring and Aug/Oct.04 available. in 3 districts in 2004/05 supervision visits Nov. 04/Jan 05 to 3 Districts Feb/Apr 05 To develop IEC 1,700,000 APOC RPC/NOTF Jun/05 IEC materials materials available 2. To improve the To conduct 3,550,000 SSI RPC April/05 CDTI plans capacity of 3 CHMTs review and available for the in planning and planning meeting next year implementation 2004/05 To attend NOTF 1,953,000 SSI RPC/? July/05 Meeting re annual Review available meeting
3. To ensure CDTI RPC to attend 330,000.0 GOVT. RPC Sept. 05 Regional and activities are Regional and District health integrated in Regional District Health Plans available. Health Plan and 3 Planning Districts sessions. Comprehensive Health Plans in year 2004/05 4. To create conducive To procure 2,180,000 APOC RPC May 04 to April Supplies services environment for supplies and 05 available efficient and effective services. co-ordination in year 2004/05 To pay for 1,260,000 GOVT. RPC/RMO May 04-April 05 Utilities paid utilities. To pay salaries to 7,530,000 GOVT. RAS May 04 – April 05 Salaries paid project supporting staff. 2,200,000 APOC RPC To pay for 7,350,000 APOC RPC May 04 – April 05 Vehicle in good running and running condi maintenance of vehicle. To do 800,00 SSI RPC May 04 – April 05 Office equipments maintenance of working. office equipments. Procurement of capital equipment 1 Vehicle (Hard top Toyota). May 04 – April 05 Capital Equipment 1 Computer 51,500,000 APOC RPC available. (Desk Top and Printer). 1 Photocopy machine. 1 Laptop computer.
45 5.To ensure Mectizan To request Mectizan ordering consignment is Districts to submit form available delivered to 3 Districts Mectizan Nil Nil ROC/RMO June/ 05 in year 2004/05 requirements To deliver MOH/MSD Augost/05 Mectizan delivered Mectizan to 3 districts Nil Nil
SUMMARY EXPENDITURE/PERCENTAGE CONTRIBUTION 2003/04
SSI APOC G’NT GRAND TOTAL
Tshs. 6,303,000 Tshs. 69,245,000 Tsh. 9,120,000 Tsh. 84,668,000
7% 82% 11% 100%
46 TUKUYU FOCUS CDTI PROJECT SUSTAINABILITY PLAN FOR THE REGIONAL/PROJECT LEVEL FOR THE PERIOD 2005/2006 (one year post APOC)
OBJECTIVES ACTIVITY COST SOURCE OF RESPONSIBLE TIME-FRAME PROGRESS Tsh. FUNDING OFFICER INDICATOR 1. To undertake To conduct 4,550,000 GOVT. RPC May/July 05 Monitoring and supportive monitoring and Aug/Oct.05 supervision supervision in 3 supervision Nov. 05/Jan 06 done in the 3 districts in visits to 3 Feb/Apr 06 Districts 2004/05 Districts To develop IEC 12750,000 APOC RPC Jun/06 IEC materials materials developed 2. To improve To conduct start 3,700,000 APOC RPC May/06 Capacit the capacity of 3 up meeting building for CHMTs in CHMTs in planning and planning and implementation implementation 2004/05 being carried out. To attend NOCP 2,050,000 APOC RPC July/06 Attended Review meeting NOCP review meeting.
3. To ensure RPC to attend 360,000 GOVT. RPC Sept. 06 RPC attending CDTI activities Regional and Regional and are integrated in District Health District Health Regional Health Planning Planning Plan and 3 sessions. sessio Districts Comprehensive Health Plans in year 2004/05 4. To create To pay supplies 2,300,000 GOVT. RPC May 05 to April 06 Supplies and conducive and services. services paid environment for efficient and effective co- ordination in year 2004/05 To pay for 1,350,000 GOVT. RPC/RMO May 05-April 06 Utilities paid utilities. To pay salaries 8,120,000 GOVT. RAS May 05 – April 06 Salaries paid to project supporting staff. 2,300,000 GOVT. RPC To pay for 7,800,000 GOVT. RPC May 05 – April 06 Well running and maintained maintenance of vehicles vehicle. To do 850,000 GOVT. RPC May 05 – April 06 Well- maintenance of maintained office equipment. equipments. 5.To ensure To request Adequate Mectizan Districts to quantities of consignment is submit Mectizan No costs NIL RPC Sept. 2006 Mectizan delivered to 3 requirements involved. available. Districts in year 2005/06
47 SUMMARY EXPENDITURE/PERCENTAGE CONTRIBUTION 2003/04
SSI APOC G’NT GRAND TOTAL
00 18,500,000 27,630,000 46,130,000 40.1% 59.9% 100
48 Appendix V
YEAR ONE CDTI SUSTAINABILITY PLAN FOR THE TUKUYU FOCUS PROJECT – KYELA DISTRICT (2003/04)
BROAD SPECIFIC ACTIVITY COST SOURCE RESPONSIBLE TIME FRAME OBJECTIV OBJECTIVE OF OFFICER E FUNDING 1. To reduce 1. Create/improve 1. Advocacy to 40 40 people X Council DMO/DED/DOT 1st or 2nd week of prevalence of awareness among Full members of Full Council 15,000/= 2 May 2004 Oncho from Council members, for 2 days on Oncho and days=(1.2m) MESO to PHC and CHMT Council contribution hypodemicity members by the end of by the end of 2004 2013 2.Sensitization meeting 25 peopleX2, Council DMO 4th week of May to 25 PHC members for 000/=X1day=(50,0 2004 one day 00/=)
3.Sensitization meeting 17 peopleX5, Council DMO 3rd or 4th week of to 17 CHMT members 000/=X1day=(85,0 April 2004 for one day 00)
4. Procurement of (559,500) Council DMO 4th week of July stationary
2. To improve 1. Procurement of 9 75,000/=X9 3.0m. DMO May, 2004 supervision for CDD’s bicycles for 9 FLHWS people=675,000/= APOC by FLHWS the end of 1.2.m DC June 2004.
3. To improve 2. Purchase of hand 30,000/= SSI DMO May, 2004 communication phones set and sim cards among DTO’s by the for 2 DOTS. end June 204
4. To main tray 1. Services of (240,000/=) APOC DMO October 2003 motorcycle and by the motorcycles end of June 2004 2. Procurement of Fuel (200,000/=) SSI DMO 2003/04
5.to carry out 1. Evaluation` (640.000/=) SSI DMO Continuous performance appraisal 2003/2004 June 2004
6.To improve 1. Purchase of office (650,000/=) SSI DMO Nov.2003 managerial capacity equipment and by the end June 2004 renovation
7. To improve data Data compilation (160.000/=) SSI DOT’s May, 2004 management by the end of June 2004
49 8. To improve Conduct advocacy (900,000) COUNCIL DOT’s 3rd week of Dec, awareness to 15 WDC meeting to 15 WDC 2003 and members and 12 including 12 WTTs for WTTs by the end of one day June 2004 9. To improve To training of 20 20 B/FUND DOT’s 3rd or 4th week of capacity building to pr.School head teachers participatantsX2,00 may 2004 20 primary school on CDTI activities 0/=- head teachers by the (40,000/=)2facilitat end of June 2004 orsX15,000/= =(30,000/=) Total 70,0000/= 10. To strengthen Community video shows (1,511,400/=) SSI DOT’s 1st or 2nd week of communication once WC 13 villages April, 2004 awareness to 13 villages by the end of June 11.Introduce targete4d Targeted training to 104 (640,000/=) APOC DOT’s 2nd to 4th weeks of capacity building to CDD;s for 2 days Sept, 2003 104 CDD and by the end of June 2004 12. To update census Updating of 56 sub (640,000’=) B/grant DOT’s 1st to 2nd week of yearly villages census oct.2003
13. Regular supply Mectizan distribution (640,000) B/Grant DOT’s 1st to 4th weks of supervision of drug and supervision in 13 Nov 2003 once annually villages
14. To improve Data collection and (200,000) APOC DOT”s 1st and 2nd weeks of DATA by the end of Mectizan collection 13 Jan. 2004 June 2004 villages 15. To improve Procurement of IEC (960,000) SSI CDTI 1st and 2nd weeks of awareness the end of material Coordinator Nov.2003 June 2004 16. To improve Training of 28 RHW’S (2,400,000) APOC DOTT’s 1st or 2nd week of capacity buildings to and on detailed Sept, 2003 28 RHW’s by the end of June 2004
GRAND TOTAL: T. SHs.16, 705,900
APOC SSI COUNCIL BALANCE BROUGHT FORWARD Tsh-7,151,400 Tsh- 4,210,000 Tsh-5, 274,500 Tsh-70, 000
42.8% 25.2% 31.5% 0.4%
50 YEAR TWO CDTI SUSTAINABILITY PLAN FOR THE TUKUYU FOCUS PROJECT- KYELA DISTRICT (2004/05)
BROAD SPECIFIC ACTIVITY COST SOURCE RESPONSIBLE TIME- OUTCOME PROGRES OBJECTIVE OBJECTIVE OF OFFICER FRAME INDICATOR S FUNDING INDICATO RS To reduce 1. To improve 1. 40 people COUNCIL DMO/DOT’s 1st or 2nd Local No of prevalence of awareness among Advocacy x15,000/=x 1 week of Government members Ocho from Full Council and to 40 day (600,000) July, officials and advocated/ MESO to CHMT and PGC members of 2004 appropriate minutes of hypoendemicity members by the Full Council CDTI, ownership the by the end of end of 2005 Members and sustainability meetings Dec. June 2003 for one day on oncho and council contribution ect 2. 25 people x COUNCIL DMO 4th week PHC Members No of Sensitizatio 2,000/= x 1 of July participate fully members n meeting to day (50,000/=) 2004 in oncho control sensitized 25 PHC minutes of members the for one day meetings 3. (559,500) COUNCIL DMO 4th week Smooth running No of Procuremen of July of office work stationary t 2004 procured 2. To maintain Service of 2 (240,000/=) APOC DMO Continue Efficient and No of and conduct 2 motorcycles s Smooth running services motorcycles by of motorcycles done/docum the end of mid ent 2005 2. (200,000) SSI DOT’s Continue Efficient and No of fuel Procuremen s Smooth running litres/receipt t of fuel of motorcycles s 3. To carry out 1. Conduct (640,000) SSI NOTF/DMO End of Impact of the Evaluation performance evaluation the year disease known report appraisal by the of the 2005 produced end of June 2005 project 4.To improve Conduct (160,000) SSI DOT;s May, Data well Data data management data 2005 compiled, proper compiled/do by the end of compilation records available cument June 2005 5.To improve 1. To (900,000) COUNCIL DOT’s 3RD WDC and WTT No of awareness to conduct WEEK are aware of people WDC’s and advocacy OF CDTI Project, advocated/e WTT’s meeting to Dec.2003 ownership and 12 liminate 15 WDC’s WTT’s and 12 sustainabilit and WTT,s members y members by for one day the end of June 2005 6. To improve 1. Training 20 participants B/FUNDS DOT’s 3rd or 4th Head teachers Number of capacity of 20 pr. 5x2000/= week of and school trained buildings to 20 School head 40,000/= 2 may 2005 children are participants pr. School teachers for facilitators x aware of CDTI teachers by end one day. 15,000/= total activities of June 2001. 70,000/= 7. To strengthen 1. (13 million) SSI DOT’s 1st or 2nd Community No of video communication Community week of members are shows awareness in video shows April aware of villages by the once in each 2005 CDTI/increased end of June 2005 village (13 coverage. villages) 8. To introduce 1. Conduct (1511400) APOC DOT’s 2nd to 4th CDDs are aware No of CDD trashed capacity target week of of CDTI and trained/train buildings to training to Septembe oncho ing report CDD’s by the 104 CDD’s r 2004 end of June 2005 for 2 days.
51 9. Update census 1. Updating (640,000) B/GRANTS DOT’s 1st and Updated and No of sub yearly of 56 sub- 2nd week accurate census villages village of Oct. records available updated census. 2004 10. To inquire 1. Conduct (720,000) B/GRANTS DOT’s 4th Week Communities are Oncho day community district of aware on CDTI report awareness on oncho day. October and Oncho oncho/CDTI by yearly activities the end of June (25.10th) 2005. 11. Regular 1. Mectizan 9640,000) COUNCIL DOT’s 1st to 4th Efficient and No of supply and distribution week of effective villages supervision of and Nov. mectizan covered drugs annually supervision yearly distribution and in 13 increase in villages coverage 12. To improve 1. Conduct (200,000) APOC DOT”s 1st and High geographic No of data management data APOC 2nd week and therapeutic villages by the end of collection of Jan coverage covered June 2005 and 2005 mectizan collection in 12 villages. 13. To improve 1. (2,357,000) SSI CDTI/COORDI 1st and IEC materials No of IEC awareness by the Procuremen NAATOR 2nd Week available and materials/re end of June 2005 t of IEC of people aware of ceipts materials Nov.2004 CDTI and drama. 14. To strengthen 1. (50,000,000) APOC NORF April, Reliable Vehicle supervision by Procuremen 2005 transport availabl the end of June t of vehicle. available ceipt/invoic 2005 2. e Procuremen t of 3 motorcycles . 2. (15,000,000/=) APOC NOTF April, Reliable Motorcycles procuremen 2005 transport available t of 3 available receipt/invo motorcycles ice 15.To improve 1. 1(1,50,000) APOC April Reliable No of managerial Procuremen 2005 transmission of facilities skills/services t of Fax information equipment machine available procured/re ceipts ledger 2. Lap top (2,730,000) APOC Reliable Secretarial computer secretarial equipment services available procured 3. (1,500,000) Reliable Secretarial photocopy secretarial equipment machine, services available procured printer, Desktop computer and soft ware 2. SSI NOTF April,200 Reliable Secretarial Procuremen 5 Secretarial equipment t of services available procured PowerPoint machine and CD camera
52 16. To improve 1. Training (1,200,000) SSI NOC June DOTs become No of capacity of 2 DOT’s 2005 competent in use DOT’s buildings by end for one of computer trained of June 2005 moth in certificates computer skills 17. Assess the 1. Conduct (3,500,000) APOC NOC July 2004 REMO data Reports magnitude of REMO/RE becomes Oncho in the A available District in the end by the end of June 2005
TOTAL GRAND = Tsh. 85,632,900/=
APOC SSI COUNCIL BASKET FUNDS Tsh. 76,181,400 Tsh. 5,857,000 Tsh. 3,594,500 -
88.9% 6.8% 4.1%
53 KYELA DISTRICT CDTI SUSTAINABILITY PLAN –POST APOC 2005/06
BROAD SPECIFIC ACTIVITY COST SOURCE RESPONSIBLE TIME INDICATO RS OBJECTIVE OBJECTIVE OF OFFICER FRAME FUNDING To produce 1. To improve 1. Procurement 2,357,7000/= SSI DMO/DOT’ 1st or 2nd week IEC material prevalence of weariness by the of IEC material of Sept. 2005 available and Oncho from end of June 2006 for 13 village people are ware MESO to and drama show of CDTI Hypoendemicity 2. Procurement 559,5000/= COUNCIL DMO 1ST WEEK Smooth running by the end of of stationers Aug.2005 of office work June 20013 2. Maintenance of Make regular 240,000 COUNCIL DMO May 200-April Efficient and 2 motorcycles and services 2006 Smooth running run them of motorcycles Major and 240,000 COUNCIL DOT”s Continues Efficient and minor services Smooth running of 2 of motorcycles motorcycles Procurement of 200,000/= COUNCIL DOT”s Continuous Reliable flue 800 litres transport available 3. To assess Evaluation 640,000 APOC DMO End of the Impoct of the performance by year disease known the end of June 2006 4. Management by Data 160,000 APOC DOT’s 1st week or 2nd FLHW’s the end of June compilation week of correctly do the 2006 Sept.2005 detailed plan 5.To improve 1. Training of 2,400,000 Apoc DOT’s 1st week or 2nd FLHW’s targeted capacity 28 RHW’s on week of correctly do the building to 104 detailed sept.2005 detailed plan CDD’s by the end plan/routine for of June 2006 3 days 2. 20 pr. School 1,300,000/= APOC DOT”s 3rd or 4th week Head teachers head teachers of Aug. 2005 and School training for one teachers aware day ofEDTI and coverage increases 6. Improve Conduct target 1,511, 400/= APOC DOT”s 2nd or 4th week CDDs aware of targeted capacity training to of Sept 2005 CDTI and have building to 104 104CDD’s and skills to CDD’s by the end facilitators and administer of June 2006 fuel for two mectizan days 7. To update Updating census 640,000/= SSI DOT’s 1st or 2nd week Update and census yearly or of 56 sub of Oct 2005 update census annually villages records 8. Regular Mectizan 640,000/= SSI DOT’s 1st or 2nd week Efficient and supply/supervision distribution and of Jan 2006 effective of drugs supervision in mectizan once/annually 12 villages. distribution and increase in coverage 9. To improve Data collection 200,000/= COUNCIL DOT’s 1st or 2nd week High data management and mectizan of Jan 2006 geographical and by the end of June collection to 12 therapeutic 2006 villages coverage. 10. To increase to 1. Conduct 720,000/= SSI DMO/DOT’s 25th Oct, Community community by the Oncho day yearly aware of CDTI end of June 2006 and coverage increased 2. Conduct 130,000/= SSI DOT’s 1st and 2nd Community video shows to week of April members aware 13 villages, 1 2006 of CDTI and day each. increased coverage
54 GRAND TOTAL = Tsh. 12,867,900
APOC SSI COUNCIL Tsh. 6,011,400 Tsh. 5,657,000 Tsh. 1,199,500 46.7% 43.9% 9.3%
55 Appendix VI
RUNGWE DISTRICT CDTI SUSTAINABILITY PLAN FOR THE TUKUYU FOCUS CDTI PROJECT 2003-2004
Objectives Activity Cost Source of Responsible Time-frame Progress indicator funding Officer 1. To enhance the 1. Training of 17 CHMT, 25 Tshs. 880,000 District PC November Number of CHMT, knowledge and DPHC, 2 DOTs on CDTI Council 2003 DPHC and DOTs understanding of CDTI services, and the concept of trained. activities and concept of sustainability for one day. self-help, and ownership in the district by the end of 2. To conduct sensitisation of Tshs. 3,792,000 Block grant DMO November Number of councillors 2004. 43 councillors and 25 CMC for 2003 and CMC trained. one day.
Number of service 3. To train 26 service providers Tshs. 2,860,000 APOC DMO November providers and VEO and 39 Village Executive 2003 trained. Officers for one day. Number and type of 4., To design, produce, adopt Tshs. 7,200,000 SSI PC November IEC materials and the distribute IEC 2003 produced and materials to the Onchocercisis distributed. endemic areas. Number of CDDs 5., Targeted training of 360 Tshs. 3,540,400 SSI DOT December trained. CDDs on CDTI activities based 2003 on problem identified. Number of head 6. To train 78 primary school Tsh 1,196,800 Basket fund DMO December teachers trained. head teachers. 2003 DOC 7., Appoint/recruit DOC No cost. Not District Executive October appointed/recruited. applicable. Director. 2003
2. Stakeholders 1., DOTs and FLHF staff to Tshs 1,784,000 SSI DMO November Action plan prepared. participation management prepare plans. 2003 and ownership of CDTI. Plan available and 2., To plan and budget with Tshs. 60,000 Basket fund. DPLO November utilised. district council authority for 2003 self-sustainability. Number of tins of 3., Mectizan distribution. Tshs. 563,400 APOC DOTs December mectizan distributed. 2003 Supervision done and reports written. 4., Monitoring and supervision Tshs. 3,768,700 SSI PC Decembe of all CDTI activities. r 2003 Number of eligible people treated. 5., Data analysis and report Tshs. 650,000 Basket fund. DMO production. January 2004 Number feedback meetings conducted. 6., To conduct feedback Tshs. 600,000 District DOTs meetings at community level. council. February 56 2004
3., To improve 1., Establishment of Tshs. 3,867,000 APOC DMO December Procedures for the institutional procedures for the 2004 requisition, utilisation requisition, utilisation and and maintenance management on vehicles established. CDTI in Rungwe maintenance vehicles. district.
District Onchocerciasis Tshs. 100,000 District December account. 2., To establish the district Council. District Executive 2003 onchocerciasis account. (i)Tshs. 600,000 SSI Director. December Video prayer and 3., To procure: (i)video player (ii)Tshs. DMO 2003 recorder procured. and recorder, and 4,000,000 (ii) generator. Generator procured.
APOC December Number of bicycles 4., To procure 15 bicycles for Tshs. 1,200,000 DMO 2003 procured. FLHF; District and 176 CDDs. Tshs. Council. DMO December Same as above. 14,080,000 2003
APOC April 2004 Amount of stationeries 5., To procure office stationery. Tshs. 3,408,700 DMO procured.
57 RUNGWE DISTRICT CDTI SUSTAINABILITY PLAN FOR THE TUKUYU FOCUS CDTI PROJECT 2004-2005
Objectives Activity Cost Source of Responsible Time-frame Progress funding Officer indicator 1. To enhance the 1. Training of WDCs including Tshs. 6,720,720 SSI PC July 2004 Number of knowledge and WTTs for 2 days. WDC and WTT understanding of CDTI members activities and concept of self- trained. help and ownership in the district by the end of 2005. 2. Targeted raining of 50 CDDs Tshs. 2,000,000 APOC CDO July 2004 Number of on CDTI activities based on CDDs trained. problem identified.
2. Stakeholders participation 1., DOTs and FLHF staff to Tshs 1,784,000 SSI PC August 2004 Action plan management and ownership prepare plans. prepared. of CDTI.
2., To plan and budget with district council authority for self- Tshs. 60,000 Basket fund. DPLO July 2004 Plan available sustainability. and utilised.
3., Mectizan distribution. Tshs. 563,400 APOC DOT September Number of tins 2004 distributed.
4., Monitoring and supervision Tshs. 612,800 SSI PC September Number of of all CDTI activities using 2004 supervisions checklist developed by APOC. (weekly) and reports prepared.
5., Data collection, analysis Tshs. 650,000 Basket fund. DOTs Number of and report writing. October eligible people 2004 treated and report produced.
6., To conduct feedback Tshs. 600,000 District DOTs meetings at community level. council. November 2004
3., To improve institutional 1., Institute proper running and Tshs. 3,867,000 District PC July 2004 to Number of management on CDTI in maintenance system for the council June 2005 maintenance Rungwe district by the end of vehicle and motorcycles. and services 2005. done.
July 2004 to Number f 2., Institute proper running and Tshs. 2,000,000 Basket fund. PC June 2005 equipment maintenance system for the maintained. equipment.
58 RUNGWE DISTRICT CDTI SUSTAINABILITY PLAN FOR THE TUKUYU FOCUS CDTI PROJECT 2005-2006
Objectives Activity Cost Source of Responsible Time- Progress Ex funding Officer frame indicator 1. To the 1. Training of WDC including Tshs. SSI PC July Number of WDC CDTI philosophy is knowledge and WTTs for 2 days. 6,720,720 2005 and WTTs clear to service to understanding of members WDC members and CDTI activities trained. sense of ownership and concept of enhanced. self-help and ownership in the district by the end of 2006. 2. Targeted training of CDDs on District CDO Knowledge of CDTI CDTI activities based on problems Tshs. Council Septemb Number of to CDDs and frontline identified. 2,000,000 er 2005 CDDs trained. health workers increased.
2. Stakeholders 1., DOTs and FLHF staff to Tshs SSI DOC October Plan prepared Efficient and effective participation in prepare plans. 1,784,000 2005 and in place. implementation of the the plan. management and ownership of CDTI. 2., To plan and budget with district Basket DPLO July Plan and budget Efficient and effective council authority for self- Tshs. 60,000 fund. 2005 done. implementation of the sustainability. plan.
3., Mectizan distribution. District DOC Number of tins Distribution Tshs. Council Septemb distributed and coverage increased. 563,400 er 2005 consumed.
4., Monitoring and supervision of SSI DOC Number of Efficient all CDTI activities using a checklist Septemb supervision to implementation of developed by APOC. Tshs. er CDTI activities CDTI activities 612,800 (weekly)
5., Data collection, analysis and Basket DOTs Number of Efficient report writing. fund. eligible people implementation of treated and CDTI activities Tshs. Decem report produced. 650,000 ber 2005 6., To conduct feedback meetings District DOTs Problems and at community level. council. Number of solutions identified. feedback meetings Tshs. Novemb conducted. 600,000 er 2005
3., To improve 1., To procure: one hardtop Toyota Tsh APOC NOTF Decem One hardtop Efficient institutional land cruiser; and 35,000,000 ber Toyota Land implementation of the management in APOC Cruiser CDTI project. running CDTI in 2 motorcycles. Tsh. NOTF 2005 procured. Rungwe district 7,000,000 by the end of
59 2006. 2., To procure a Fax machine, a APOC Efficient laptop computer, a photocopier, a DMO Two implementation of the printer, disc computer, software, Tshs. motorcycles CDTI project. and 3 sets of radio calls. 5,970,000 SSI Decem procured. ber DMO 2005 Number of Tshs.15, equipment 3. Institute proper running and 000,000 District Decem procured. maintenance system of the vehicle Council Efficient and motorcycles. DMO, OPC, ber implementation of the DOT 2005 Number of CDTI project. Tshs. maintenance 3,867,000 services done. 4., Institute proper running and Basket Efficient maintenance system of the fund implementation of the equipment e.g. computers, a DMO July Number of CDTI project. photocopier, a printer, etc. 2005 – maintenance Efficient June services done implementation of the Tshs. 2006 on equipment. CDTI project. 2,000,000
July 2005 – June 2006
60 Appendix VII: Persons who were interviewed
Regional Office
Regional Administrative Secretary Regional Medical Office Regional/project accountant
Rungwe district level
1. Project Coordinator 2. District Executive Director 3. District Medical Officer 4. District Onchocerciasis Team Members
FLHF level 1.Osiah Mwambulu –Flhf Incharge (Lufilyo Dispensary) 2.Solomon Kazimoto-FLHF Incharge (Ilima Dispensary) 3.Rehema Kodi-LHF Staff (Ilima Dispensary) 4.Yohana Salimu (KISSA HEALTH CENTRE)
Community level
1.Steven Mlawa- CDD (Ndubi Village) 2.Charles Mlawa- CDD (Ndubi Village) 3.Dornard Kasunga- CDD (Bugoba Village) 4.Maria Sambwiga- CDD (Bugoba Village) 5.Philip Shimwela- CDD (Lubanda Village) 6.Batton Mwambene- CDD (Ilima Village) 7.Oscar Mwakaliku- CDD (Kipapa Village) 8.Jacob Mwaiipokela- CDD (Kipapa Village) 9.Lawrence Mwakibete- CDD (Kipapa Village) 10.Sheria Mwakosya- CDD (Kipapa Village) 11.Atubonesia Mbebule- CDD (Lusungo Village) 12.Martin Mwasambili-CM (Kipapa Village) 13.Richard Mwembebule- CM (Lusungo Village) 14.Junes Kapola- CM (Lusungo Village) 15.A. Mwankenja- CM (Lubanda Village) 16.B.Assa- CM (Lubanda Village) 17.L.Mwananenge- CM (Lubanda Village) 18.M.Nyambo- CM (Lubanda Village) 19.B.Moses- CM (Lubanda Village) 20.A.Angetile- CM (Lubanda Village) 21.Evelina Magila- CM (Lubanda Village) 22.Lugano Andrew- CM (Lubanda Village) 23.Miss Baraka- CM (Lubanda Village) 24.Methew Mwapoja- CM (Ndubi Village) 25.Neruege Mbungu- CM (Ndubi Village) 26.Medson Msiyani- CM (Ndubi Village) 27.Exavery Kasunga- CM (Bugoba Village) 28.Rehema Herman- CM (Bugoba Village) 29.Two boys Kabulya-VL (Lubanda Village) 30.Laurance Swilla-VL (Ndubi Village) 33.Benjamin Mwakibete-VL (Kipapa Village) 31.Francis Mwangomale-VL (Lusungo Village)
61 32.Robert Kasunga-VL (Bugoba Village)
Abbreviation: 1. FLHF First Line Health Facility. 2. CDD Community Directed Distributor. 3. CM Community Member. 4. VL Village Leader.
Kyela District.
NO JINA CHEO 1. Edina Masawe DOT 2. Daudi Mwasamwene DOT 3. Kaini Kibona I/c Ngana Dispensary 4. Esnati Mwakyanjala Nursing Assistant Ngana Dispensary 5. Uswege Mwalubanda VEO – Mwalisi Village 6. Izidori Mlawa CDD – Kani Sub-village 7. Atupele Mwakaluku CDD – Makaje Sub – village 8. Casto Alik Mwalisi Village 9. Wilson Kyamba Mwalisi Village 10. Sanze Malusyo Mwalisi Village 11. Ali Samwe Mwalisi Village 12. Oliver Kasanga Mwalisi Village 13. Rhoda Jeremia Mwalisi Village 14. Salomny Albafine Mwalisi Village 15. Albertina Eneriko Mwalisi Village 16. Dr. Somoka Mwakapalala DMO 17. Hossan Mafimba DPLO 18. Musa Mwaihojo CDD Kingili A Sub village 19. Adam Faja Mwaisumo A.Sub-village - Kingili 20. Ephrahim Jonas Mwaisumo A.Sub-village - Kingili 21. Zakayo Matani Mwakisege A.Sub-village – Kingili 22. Langa Kasake Mwambebule 23. Matirida Samjo Mwaisumo CDD – Mabunga Village 24. Sefania Mwakilima CDD – Mpunguti Mabunga Sub village 25. Sikyome Akili i/c Ipinda Health Centre 26. Mrs. Atupele Kasyupa i/c Makwale Dispensary 27. Emmanuel Kiwangu Health Assistant Makwale Dispensary 28. Hamisi Mwakitalo WEO – Makwale Dispensary
WALIOHUDHURIA MKUTANO KATIKA KIJIJI CHA MWALISI, KINGILI NA MAKWALE KYELA DISTRICT
NO JINA CHEO 1. Edina Masawe DOT 2. Daudi Mwasamwene DOT 3. Kaini Kibona I/c Ngana Dispensary 4. Esnati Mwakyanjala Nursing Assistant Ngana Dispensary 5. Uswege Mwalubanda VEO – Mwalisi Village 6. Izidori Mlawa CDD – Kani Sub-village 7. Atupele Mwakaluku CDD – Makaje Sub – village 8. Casto Alik Mwalisi Village 9. Wilson Kyamba Mwalisi Village 62 10. Sanze Malusyo Mwalisi Village 11. Ali Samwe Mwalisi Village 12. Oliver Kasanga Mwalisi Village 13. Rhoda Jeremia Mwalisi Village 14. Salomny Albafine Mwalisi Village 15. Albertina Eneriko Mwalisi Village 16. Dr. Somoka Mwakapalala DMO 17. Hossan Mafimba DPLO 18. Musa Mwaihojo CDD Kingili A Sub village 19. Adam Faja Mwaisumo A.Sub-village - Kingili 20. Ephrahim Jonas Mwaisumo A.Sub-village - Kingili 21. Zakayo Matani Mwakisege A.Sub-village – Kingili 22. Langa Kasake Mwambebule 23. Matirida Samjo Mwaisumo CDD – Mabunga Village 24. Sefania Mwakilima CDD – Mpunguti Mabunga Sub village 25. Sikyome Akili i/c Ipinda Health Centre 26. Mrs. Atupele Kasyupa i/c Makwale Dispensary 27. Emmanuel Kiwangu Health Assistant Makwale Dispensary 28. Hamisi Mwakitalo WEO – Makwale Dispensary
WALIOHUDHURIA KIJIJI CHA NGELEKA: 20.9.2003
NO JINA KITONGOJI 1. Anyandwile Mwalugobo Mwenyekiti wa S/Kijiji 2. Emili Mwamaso Mtendaji wa Kijiji 3. Tumaini Kisungu Mwalingo – CDD 4. Bupe Neema Ngeleka CDD 5. Gerentina Kibibi Lukuju 6. Melise Nkili Iponjola 7. Edda Makula Iponjola 8. Sitwila Mpipile Iponjola 9. Gwalugano Mwasandele Ngeleka CDD 10 Zakaria Mwanipaja Iponoja 11 Tubone Kapimba CDD Iponjola 12 Elizeri Ngailo Lukuju CDD 13 Omary Mwambobule CDD Katago 14 Anyisile Mwamtobe Ngeleka I. 15 Ambakisye Mwankili Ngeleka I. 16. Adamson Mwakalinga Lukuju 17. Benadicto Makobo Lukuju 18. Uswege Mwakasibila Iponjola 19 Bernard panja Iponoja 20 Edina Mwakalebela Katago 21 Alan Mwamengo Ngeleka I. 22. Lauden Mwaseba Ngeleka I 23. Lwimiko Mwanjalila Katago 24. Kamage Mwansolo Mwalingo 25 Mbuli Mwasyani Mwalingo 26. Mbuhesya Mwaiswelo Ngeleka I. 27 E.G.Mwakapala Mwalingo 28 G.P.Mwang’onda Mwalingo 29. Festa Irafu Ngeleka I. 30. Nelusigwe Kabanje Mwalingo
63 Appendix IX: Instruments used in the evaluation of TFC project
Instrument 1: national/ State level (Mbeya Region & TFC project level)
NOTE: 7 This instrument is for national level which coordinates programme implementation in the country. It could also be used (modified slightly if necessary) for another level of support other than the main implementation level (district/ LGA). An example of this level is the ‘State’ in Nigeria.
The focus of this level’s activities in CDTI The main function of this level is to develop, revise as necessary, and oversee implementation of CDTI Policy. This level also provides support to the level below it: . Providing targeted training, HSAM and monitoring/ supervision. . Arranging for an adequate supply of Mectizan.
Country: Tanzania (TFC project)
Researcher: Dr. S. O. Baine and Dr Wade Kabuka.
Date: 18th September 03
Respondents: Mr. Fred Maisaka (Regional Administrative Secretary); Dr. D.W. Mmbando (Regional Medical Officer); and Mrs Tabu Mwasanjila (Project accountant).
Abbreviations/ acronyms CDD community directed distributor CDTI community directed treatment with ivermectin FLHF first line health facility HSAM health education, sensitisation, advocacy, mobilisation – i.e. activities which are aimed at getting all the key players to participate wholeheartedly in the programme NGDO non-governmental development organisation NOTF national onchocerciasis task force
64 1. Indicators of activities and processes: planning
1.1 Check whether there is a year plan for onchocerciasis control, appearing as part of an overall written plan for the health service at this level. This indicator assesses whether the programme has become integrated into the health service, and whether management is accepting ownership of the programme – both good for sustainability.
Characteristics of the indicator Sources of information a. Onchocerciasis control should be integrated . Examination of: into the overall written year plan of the health * Written plans: yearly, quarterly, monthly etc. service at this level. Note that this plan is * Minutes of planning meetings. usually not very detailed. . Interview with senior health service staff at this level.
Findings Describe the present situation:
Onchocerciasis control is integrated into the overall comprehensive health service plan for the period beginning 2002. Written plans to this effect were presented and examined.
If planning and implementation of CDTI is not part of the overall year plan: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
65 1.2 Check whether there is a year plan containing details of all activities needed for CDTI at this level. This indicator assesses whether the project is functioning effectively, and whether management accepts ownership of the programme – both good for sustainability.
Characteristics of the indicator Sources of information a. This more detailed plan should make provision for all key . Examination of written plans: elements of onchocerciasis control: Mectizan supply; yearly, quarterly, monthly targeted training; targeted HSAM; targeted monitoring/ etc. supervision. . Interview with senior health (Note that in the case of a country which contains many service and project staff at projects, the NOTF plan will be less detailed). this level. b. The plan varies from year to year, showing that it is targeted to the specific needs of each year.
Findings Describe the plan for the present year:
There is a detailed plan showing and providing for all key elements of the CDTI activities (Mectizan supply; targeted training; targeted HSAM; targeted monitoring/ supervision).
The plan varies from year to year-specific needs of each year due to inclusion of more activities.
The Regional level is not included in the planning process, however, is provided with copies of the plans for approval and is hence informed about CDTI plans.
Describe the plan for the previous year:
Same as above.
If the plan is incomplete, or simply a re-write of previous plans: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
66 1.3 Check whether all partners (government, UN agencies, NGDOs etc.) are meaningfully involved in the overall planning process. This indicator assesses whether the programme is functioning effectively – if each partner is clear about its role, this is good for sustainability.
Characteristics of the indicator Sources of information a. All partners should contribute to the . Examination of: routine planning of a project. * Plans: yearly, quarterly, monthly etc. b. Partners should be clear about their own * Minutes of NOTF meetings. roles, and those of the other partners. . Interview with senior staff at this level (project, government, relevant UN agencies, NGDOs etc.)
Findings Describe the present situation:
Routine planning for the Tukuyu Focus CDTI project is done in a participatory manner. Sight Savers International (The only NGDO partner) is actively invoved and has opportunities to contribute to the Onchocerciaisis control plan. Sight Savers International (SSI) is clear about its own roles, and those of the other partners (i.e. government and APOC).
If partners are not meaningfully involved in planning: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
67 1.4 Check whether specific planning for sustainability has taken place, for the period after APOC funding is withdrawn. This assesses whether the programme is functioning effectively, and that management has begun to take ownership of it and can mobilise the resources it needs.
Characteristics of the indicator Sources of information a. Members of NOTF have made plans for this period, which will enhance . Examination of the programme sustainability. This planning should include: identifying written sustainability resource gaps; strategies to cut expenditure; and strategies to find plans. dependable sources of resources. . Interviews with senior b. There should be written evidence that such planning has taken place. staff at this level c. There should be evidence that the plans are being successfully (government, NGDO, implemented. NOTF etc.).
Findings Describe the present situation:
The project management has made plans for the period ranging from 2002 to 2004 indicating needs, funding required identified resource gaps but strategies to cut expenditure and strategies to find dependable sources of resources are not indicated. Therefore, no commitments have made to this effect. Plans were examined and, hence, written evidence to such planning having taken place. There is no evidence that this plan is being successfully implemented.
If there has been little or no planning for sustainability: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
68 2. Indicators of activities and processes: monitoring/ supervision
2.1 Check whether staff at this level is being used appropriately for monitoring/ supervision. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. Staff members at this level should routinely only . Examination of: supervise the level immediately below them. Staff should * Supervisory checklists, plans not supervise the FLHF or community levels. ‘Spot and reports. checks’ may however be done from time to time. * Visitor’s books at all the levels b. Staff members at this level should have empowered staff below this one. members at the level below them to supervise activities at * Trip authorisations. their own level, as well as levels further down. . Interviews with: * Staff at this level. * Staff at levels below this one.
Findings Describe the present situation:
The project coordinator routinely only supervises the District Onchocerciaisis teams in the two districts of Rungwe and Kyela i.e. level immediately below the Project Coordinator. Project Coordinator makes spot checks on the FLHF when they are training CDDs. The DOTs are empowered to supervise CDTI activities at their own level, as well as levels further down.
Supervisory checklists, plans and reports were made available for examination. Visitor’s books at all the levels revealed the signatures of the National Onchocerciasis Coordinator and of the Regional Medical Officer both in the past.
If staff members are not being used appropriately for monitoring/ supervision: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
69 2.2 Check whether monitoring/ supervision is being planned and carried out in an efficient and integrated manner. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. One routine supervision visit per year must be done to each . Examination of: project (as a separate entity, or as a district). * Supervisory checklists, b. Supervision visits for CDTI should be integrated where plans and reports. appropriate with supervision of other programmes. * Visitor’s books at the level c. Resources for supervision (human, transport etc.) should be immediately below this efficiently used: one. * Using as few staff members as possible. . Interviews with: * Planning trips to cut down on distance travelled. * Staff at this level. * Not spending unnecessarily many nights out etc. * Staff at the level. d. Supervision visits should be thorough, using a checklist. immediately below this one.
Findings Describe the present situation:
One routine supervision visit per year is done to each district in the project because CDTI activities are ‘seasonal’ i.e. it is a one-time activity in a year.
Supervision visits for CDTI are integrated with that of other health programmes i.e. one official may supervise other health interventions in the same visit, and in other cases, a team of officials is dispatch to supervise different activities while using the same vehicle, hence, reducing the transport and other opportunity costs. Usually supervisory visits last 2 or 3 days depending on the distance from the project headquarters and the volume of work encountered. Visitor’s books revealed the signatures of the National Onchocerciasis Coordinator and of the Regional Medical Officer.
Describe the situation the previous year:
Same as above. If monitoring/ supervision is not being done efficiently: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not as above.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in monitoring/ supervision activity: is it becoming more efficient? . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
70 2.3 Check whether there is a routine process of management of problems and successes, which are indicated by the monitoring system. This indicator assesses whether the programme is running efficiently and effectively, and whether management is beginning to accept ownership of the programme.
Characteristics of the indicator Sources of information a. As soon as problems are identified as a result of . Examination of the following supervision visits, or from coverage data (i.e. areas documents: with low coverage) the appropriate manager should * Plans: yearly, quarterly, monthly deal with them. etc. b. Such problems should usually be passed on to the * Minutes of staff/ planning appropriate managers at the next level below to deal meetings. with, with the necessary support – thus empowering * Reports of previous monitoring these persons. exercises. c. Successes should be noted and reported, and * Letters of commendation. appropriate feedback given. * Letters with information and d. There should be evidence of action taken based on feedback. recommendations in the reports of previous . Interviews with: monitoring exercises. * Staff at this level. * Staff at the levels below this one.
Findings Describe the present situation:
Whenever problems are identified e.g. as a result of supervision visits, attempts are made to find solutions and failure to do so, they are referred upwards through the established chain of command Usually, they are minor problems and solved by the appropriate managers at the next level above. The respective officials have been given necessary support, thus, empowering them to address the problems arising appropriately.
Successes are noted, reported and appropriate feedback given. Successes are acknowledged in various methods such as: giving the best performers certificates which are signed by the Minister of Health and Permanent Secretary; giving letters of commendation; giving them priority when selecting participants in workshops; etc. All these motivate those performing well to work harder and produce even better results, and the poor performers to improve their performance so as to be recognised also.
Evidence of action taken based on recommendations in the reports of previous monitoring exercises was indicated by the increase in community awareness, desire to take Mectizan and the increased therapeutic coverage. If the system of managing problems/ successes is weak: . Why is this? Not applicable.
. Which steps are being taken to improve the situation? Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
71 3. Indicators of activities and processes: Mectizan® procurement and distribution
3.1 Check whether sufficient Mectizan is being ordered, stored and distributed within the government system at this level, in good time. This indicator assesses whether the programme is functioning efficiently, its processes are simple, and it is becoming more integrated into the government system.
Characteristics of the indicator Sources of information . The Mectizan supply should be controlled within a government system. . Examination of all This does not have to be the system routinely used for the supply of Mectizan ordering other drugs. and stock control . The system should be effective, uncomplicated and efficient. documentation at . This system should use dependable, sustainable resources for its this level. operation. It is desirable that these resources should be supplied by the . Interviews with staff government. at this level . The system should supply sufficient Mectizan for the needs of all the (government, projects concerned, in good time. NGDO etc.).
Findings Describe the situation the previous year: Mectizan supply was controlled within the government system. Means of delivery from the MSD depended on whether it was time to deliver other drugs in bulk; mectizan was delivered with other drugs to the Regional Medical Office from where it was delivered to the DOCs. When this opportunity was not possible, the project coordinator collected mectizan directly from MSD and delivered it to the district onchocerciaisis coordinators. The system of supply of mectizan was perceived to be effective, uncomplicated and efficient. The system has enabled the supply of sufficient Mectizan for the needs of Tukuyu Focus CDTI project and in good time, as delays were not common.
This system of supply of mectizan was dependable, sustainable since the resources used for its operation were borne by the government where a bulk of drugs was delivered on the same vehicle. The only drawback to this approach was that it would not be cost-effective to used a ‘ten ton lorry (currently being used) to deliver a few kilogrammes of mectizan. It was not, therefore, always appropriate means as mectizan could be delayed and not delivered at an appropriate time for distribution.
Describe the situation the year before that: Same as above. If the government system is not fully responsible for all steps of the Mectizan supply system: . Why is this? Not applicable. . Which steps are being taken to improve the situation? Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What has been the trend in Mectizan supply? . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
72 4. Indicators of activities and processes: training and HSAM
4.1 Check whether staff members at this level are being used appropriately as trainers. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. Staff at this level should . Examination of training materials, plans/ programmes, routinely only train staff at the reports: level immediately below it. * At this level. b. Staff members at this level should * At the levels below this one. have empowered the level . Interviews with: immediately below them to train * Staff at this level (the trainers). lower levels. * Staff at the very next level below (the trainees). * Staff at the district/ LGA level. * Staff at the FLHF level.
Findings Describe the present situation:
The Project Coordinator trains the DOTs who are then empowered to train the FLHF in-charges who also train CDDs.
Describe the situation the year before:
Same as above
If staff members are not being used efficiently as trainers: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in the way in which staff are being used as trainers:
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
73 4.2 Check whether training is being planned and carried out in an efficient and integrated manner. This indicator assesses whether the programme is functioning efficiently and in an integrated manner.
Characteristics of the indicator Sources of information a. There should be an objective need for each . Examination of training episode of training. This means there should be evidence that materials, plans/ programmes, staff to be trained lack knowledge and skills to perform the reports: job, and the training should then focus on this deficiency only. * At this level. Repeat training of already skilled staff should not happen. * At the levels below this b. If circumstances permit training for CDTI should one. be integrated with other training, e.g. in in-service training . Interviews with: programmes. * Staff at this level (the c. Resources for training (human, transport etc.) trainers). should be efficiently used: * Staff at the very next level * Using as few staff members as possible. below (the trainees). * Using as little time as possible (without sacrificing quality) * Staff at the district/ LGA * Choosing the most cost-effective site etc. level. * Staff at the FLHF level.
Findings Describe the present situation:
The training done is done to update those involved n CDTI activities. The turnover of DOTs has been zero since there has been no changes or transfers of DOTs since 2000.
Training for CDTI has not yet been integrated with other training, e.g. in in-service training programmes.
There are only two DOTs in each district and all have been involved in training. Training is usually done for 2-3 days and is perceived to be adequate. They are trained at one of the district headquarters, which reduces the costs of training significantly.
Describe the situation the year before:
Same as above.
If training is not being carried out in an efficient and integrated manner: . Why is this? Not applicable.
. Which steps are being taken to improve the situation? Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in training activities – is it becoming more efficient and integrated? . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
74 4.3 Check whether staff at this level is planning and carrying out HSAM activities in an efficient manner. This indicator assesses whether the programme is functioning efficiently and effectively, and whether managers are taking ownership of the programme.
Characteristics of the indicator Sources of information a. Staff members identify situations where decision makers lack . Examination of HSAM information about/ commitment to CDTI, and undertake activities plans/ programmes and to inform and persuade these persons. reports. b. HSAM activities are properly planned. They are only carried . Interviews with: out where there is an objective need for them, and not as a * Staff (programme and matter of routine. management) at this c. Such activities should only be carried out at the national level, level. and at times at the level immediately below (but only when staff * Civil authorities at this at that level asks for help). level. d. There is evidence that these HSAM activities have been * Staff and civil effective and have led to action. authorities at the next level down.
Findings Describe the present situation (in relation to efficiency and outcome):
In some cases CDTI staff have persuaded decision makers who may and may not be lacking information about/ commitment to CDTI and persuaded them to support CDTI in various forms such as mobilisation of the communities, financial and material contributions, etc.
HSAM activities are properly planned and carried out where there is an objective need for them. This is largely done at the regional and district levels. They have been effective as evidence by some support obtained, for instance from the district councils.
Describe the situation the year before (in relation to efficiency and outcome):
Same as above. If HSAM activities are not being carried out efficiently: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in HSAM activities – is it becoming more efficient and effective? . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
75 5. Indicators of activities and processes: integration of support activities
5.1 Check whether the various programme support activities are being planned and carried out in an integrated manner. This indicator assesses whether the programme is functioning efficiently and in an integrated manner.
Characteristics of the indicator Sources of information a. Staff combines two or more tasks on a single trip: . Examination of documents: trip ∗ Monitoring / supervision for CDTI (and other authorisations, log books, trip projects, if staff is responsible for them as well). reports etc. ∗ Training for CDTI (and other projects, if staff is . Interviews with: responsible for them as well). ∗ Staff from this level (managers, administrators, ∗ HSAM. drivers etc.). ∗ Fetching records. ∗ Staff from the next level ∗ Delivering Mectizan. below.
Findings Describe the present situation:
Staff at the regional and project coordination levels combine two or more tasks on a single trip, for instance, when they go out on supervision or health related activities they supervise all health services, delivery of drugs by the regional pharmacist includes mectizan except if it is not the distribution time or when mectizan is the only drug requiring delivery as it would be too expensive to deliver a small amount of drugs while using a big vehicle, etc.
Describe the situation the year before:
Same as above.
If integration between support activities is poor: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in the integration of activities – is it becoming more common? . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
76 6. Indicators of resources: financial
6.1 Check whether appropriate amounts are budgeted for planned onchocerciasis control activities at this level This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. The costs for each onchocerciasis control activity in the year plan at this . Examination of the level should be clearly spelt out in a budget. budget documents. b. There is evidence of a const reduction/ containment strategy (e.g. . Interviews with the targeted training, HMAS and monitoring/ supervision; training conducted health service at the next level below etc). managers at this c. Project managers should have a clear estimate of the funds that will be level. available to them for onchocerciasis control in the coming year, and should be able to justify this belief. d. The total amount budgeted for in the year plan should fall within this estimated income.
Findings The budget and estimated income . For this year: The costs for each onchocerciasis control activity in the year plan at this level were not clearly spelt out in a budget. It was presented in a block for eye activities in the comprehensive health budget and not split up into specific CDTI activities. There was no evidence of cost reduction/ containment strategies. Notwithstanding, the Project Coordinator has a clear estimate of the funds that will be available to them for onchocerciasis control in the coming year, and bases on the past experience to justify his belief. The total amount budgeted for in the year plan did not fall within this estimated income.
SSI APOC Central government Local government Tshs: 12,418,000 Tshs: 31000,000 Tshs: 2,000,000 (plus human resource and office) NIL . For the previous year: SSI APOC Central government Local government council US$10,000 US$ 44,287 Tshs: 750,000 (plus human NIL resource and office) If budgeting has been inappropriate: . Why is this? Not applicable.
. Which steps are being taken to improve the situation? Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in the budgeted amount and the expected income: . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
77 6.2 Check whether the government is budgeting and disbursing sufficient amounts for onchocerciasis control yearly, and in good time. This indicator assesses whether the programme is becoming integrated, and whether the government is accepting ownership of the programme and can mobilise the resources it needs.
Characteristics of the indicator Sources of information a. The relative budgetary contributions of the government and other . Examination of: partners to onchocerciasis control should be clearly spelt out. * Budget documents b. The amount that the government has budgeted in one or more (government, NGDO specific onchcerciasis control budget lines (e.g. current and capital) etc.) should be increasing yearly, as a proportion of total expenses. By * Records of the end of Year 5 of APOC funding the bulk of onchocerciasis disbursement and control expenses at this level should be met from government expenditure (ledgers, funds; by the end of Year 3 at least half of it orders, approvals for c. The amounts actually disbursed from such budget lines should be expenditure etc.) increasing yearly, as a proportion of total expenses. (Note that . Interviews with managers actual disbursement is more important than budgeting, and is a at this level (government, real sign of political commitment). NGDO etc.).
Findings The budget and disbursements: . For this year:
The relative budgetary contributions of the government and other partners to onchocerciasis control are spelt out with APOC contributing most followed by the SSI (NGDO partner) and least contribution is from the government. However, central government contribution has increased as compared to the previous year while local government has not yet made any contribution. Government funding for onchocerciasis control is not half of the expenses; yet, the project is approaching the end of its year 3.
. For the previous year:
The relative budgetary contributions of the government and other partners to onchocerciasis control are spelt out with APOC contributing most followed by the SSI (NGDO partner) and least contribution is from the government. The local government made no contribution.
. For the year before that:
Not applicable If the government proportion of expenditure is not increasing proportionately: . Why is this? Not applicable.
. Which steps are being taken to improve the situation? Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in government budgeting and disbursements: . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
78 6.3 Check whether in case of a deficit between estimated costs and the amount provided by the government, dependable provision is being made to meet it. This indicator assesses whether the government is able to mobilise the resources it needs, as well as its commitment to ownership.
Characteristics of the indicator Sources of information a. Project management at this level should be aware of . Inspection of: the shortfall, if one exists, and of its size. * The budget documents. b. Project management should have specific and realistic (government, NGDO etc.). plans to bridge the shortfall. * Records of expenditure c. If it is planned that non-government sources of funding (ledgers, orders, approvals are to be used after APOC funding ends, written for expenditure etc.). commitment for this should have been obtained at the * Letters of agreement. highest level in these donor organisations. Projects in Year . Interviews with managers at this 3 of APOC funding should also be well on the way to level (government, NGDO etc.). achieving such commitment.
Findings Describe the present situation:
The project coordinator was aware of the shortfall and of its size but did not have specific and realistic plans to bridge it. Previously, Local Government Council contributed vehicles, diesel and stationery when there were gaps and it is likely to do the same in future when APOC funding ceases. There is hope that SSI funds will be used after APOC funding ends but no written commitment for this has been obtained at the highest level in the SSI.
Describe the situation the previous year:
Same as above.
If the shortfall cannot be met: . Why is this?
Does not know.
. Which steps are being taken to improve the situation?
A budget has been developed in which proportionate contributions from different sources are indicated
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in shortfall and how it is to be supplemented:
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
79 6.4 Check whether funds disbursed for onchocerciasis control from the budget at this level are efficiently managed This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. The budget holder should be using a control system . Inspection of: with the following elements: * The budget documents * Approval of each item of expenditure. (government, NGDO etc.). * Allocation of expenditure against specific budget * Financial control records headings. (ledgers, orders, approvals * Regular calculation of residual amounts under budget for expenditure etc.). headings. . Interviews with managers at this b. All the funds released yearly should be spent as level (government, NGDO etc.). budgeted.
Findings Describe the present situation: . Approval of expenditure:
There is a budget control system. The accountant fills a request form (voucher) according to the budget lines and submits it for approval to the project coordinator. The voucher is returned to the project accountant and cheque is written. There are three signatories on the project bank account i.e. project coordinator (principal signatory), District Medical Officer and the District Health Secretary. Two i.e. the project coordinator and any other can sign and draw funds from the bank. Accountability for the use of funds drawn is made to the project accountant.
. Allocation of expenditure:
All the funds released annually are spent as budgeted
. Regular insight into budget line balances:
Both the project coordinator and accountant regularly calculate residual specific budget headings amounts under budget headings.
If the funds are not being well managed: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
No steps being taken.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
80 7. Indicators of resources: transport and other material resources
7.1 Check if adequate and appropriate transport and other material resources are available for necessary CDTI activities at this level. This indicator assesses whether the programme is functioning effectively, and whether it is able to mobilise the resources it needs.
Characteristics of the indicator Sources of information a. There are adequate numbers of functional vehicles . Inspection of: available for necessary CDTI activities. * Each vehicle in the pool, each b. The vehicles are appropriate for the purpose they are piece of equipment: its intended to fulfil – tough but not luxurious. source; its functional status. c. There is sufficient office equipment available, in working * Training materials and order: computers, printers, photocopiers – also stationery stationery stocks. and materials for training and HSAM. . Interviews with managers at this d. The running costs for these vehicles and equipment are level (government, NGDO etc.). met from dependable, sustainable sources.
Findings Describe the present situation: Type of vehicle No. Source* Adequacy for CDTI tasks** Toyota Hillux Double cabin 1 APOC Adequate and functional Motorcycles 2 APOC/ SSI Adequate and functional Type of equipment No. Source* Adequacy for CDTI tasks** Desktop computer 1 APOC Functional Laptop computer 1 SSI Functional Printer 1 SSI Functional Photocopier 1 APOC Functional Fax machine 1 APOC Not functional Training/ HSAM material No. Source* Adequacy for CDTI tasks** Booklet 1 APOC Not adequate. Leaflets & Video cassettes Several APOC Not adequate. T-shirts Many SSI Not adequate. * APOC, MoH, NGDO, other (specify) ** Is it working? Is there enough of it for the job? Is it suitable for the job? Describe the availability/ suitability/ functionality of the present vehicles, equipment and materials, considering the work still to be done in the coming 5-10 years: The vehicle, equipment and materials will be functional but will also need replacement. If transport, equipment and materials are inadequate and/or funded from sources which are not dependable: . Why is this? Not applicable. . Which steps are being taken to improve the situation? They will be included in the budget.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
81 7.2 Check if transport and other material resources in use at this level are adequately and appropriately maintained. This indicator assesses whether the programme is functioning effectively and efficiently.
Characteristics of the indicator Sources of information a. There is a routine maintenance schedule for each vehicle, . Inspection of: which is adhered to and recorded. This includes weekly driver * Vehicle and maintenance, scheduled garage servicing, and replacement of equipment worn tyres. maintenance b. Equipment such as photocopiers and generators is regularly schedules. maintained according to a schedule, and this is recorded. * Vehicle and c. Staff members have ways of coping when vehicles break down equipment or are not available, so that CDTI activities are not disrupted. maintenance records. d. The costs for vehicle and equipment maintenance and repair . Interviews with managers are met by from dependable/ sustainable sources. at this level (government, e. Repairs to vehicles and equipment are rapidly and efficiently NGDO etc.), drivers. done.
Findings Describe the present situation:
There is a routine maintenance schedule for the vehicles that is adhered to and recorded e.g. scheduled garage servicing, and replacement of worn out tyres.
The equipment such as photocopiers and generators is regularly maintained according to a schedule, and this is recorded.
The vehicle is three years old and has not presented problems that disrupt CDTI activities. The costs for vehicle and equipment maintenance and repair are currently dependant on APOC and SSI funds. Repairs to equipment have so far been done fast and efficiently.
If the vehicles and equipment are not being well maintained, and/ or funded from sources which are not dependable: . Why is this?
Not applicable
. Which steps are being taken to improve the situation?
None.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
82 7.3 Check if the transport available at this level is appropriately managed and used. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. Transport is used at this level, and to undertake support activities at . Inspection of vehicle the next level. It should not be used for CDTI implementation control documents: activities at lower levels. * Copies of trip b. The use of transport is properly controlled: authorities (also * Trips made for CDTI purposes should be properly authorised in noting destination writing by the relevant official. and purpose). * Each trip undertaken for CDTI purposes should be recorded in a * Log books. log book. . Interviews with * Trip authorities and log book entries and regularly reconciled, managers at this level and action taken if there are discrepancies. (government, NGDO etc.).
Findings Describe the present situation:
Transport at the project level is used to carry out CDTI activities at this level and at the district level. The use of the vehicle was properly controlled: trips made for CDTI purposes are always authorised by the District Executive Officer and are recorded in a log book. Trip authorities and logbook entries are regularly reconciled; no discrepancies have been observed yet.
If the transport is not being well managed: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
83 7.4 Check if there are appropriate and realistic plans for the replacement of transport and other material resources, when APOC support comes to an end. This indicator assesses whether the programme managers are taking ownership of the programme, and are able to find resources for it.
Characteristics of the indicator Sources of information a. Management should know that replacements will be needed before . Inspection of letters of the end of the programme, and have specific, realistic plans to meet agreement. the need at that time. . Interviews with: b. It should be planned that the government will: * Programme * Provide replacements for vehicles and equipment. managers at this * Maintain existing vehicles and equipment. level (government, * Provide stationery and materials for training and HSAM. NGDO etc.). c. If it is planned that replacement will be from non-government * High-ranking sources, written commitment for this should have been obtained Ministry officials at the highest level in these donor organisations (end of Year 5), and other decision or negotiations should have started (end of Year 3). makers at this level.
Findings Describe the present situation:
Management is aware that replacements will be needed before the end of the programme but currently has no specific and realistic plans, yet, to meet the need at that time. It is not yet planned that replacement will be from non-government sources and therefore no written commitment from the potential donor organisations, yet.
If the plans for replacing vehicles, equipment and materials are unsatisfactory: . Why is this?
They have the plans in mind but not yet on paper.
. Which steps are being taken to improve the situation?
None.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
84 8. Indicators of resources: human resources
8.1 Check whether staff at this level is skilled, knowledgeable and committed, regarding the implementation of CDTI in its area of operation. This indicator assesses whether the programme has been able to develop sufficient resources for itself.
Characteristics of the indicator Sources of information e. The number of staff members in the government health . Inspection of: service at this level should be appropriate to the task in hand: not too * Staff files. many or too few. * Training reports f. Team members should have enough knowledge and skill and timetables. to undertake all the key CDTI activities themselves, without help: . Interviews with * Planning * Data management * Managers and * Report writing * Computer skills other staff at this * Training and HSAM * Mectizan ordering/ distribution level * Monitoring/ supervision (government, c. There should be evidence that the team is committed to the success NGDO etc.). of the programme (from the evidence of the partners, as well as * Staff at the next workers at the next level below; from written reports and timetables). level below.
Résultats Describe the present situation: . Particulars of current staff No. of persons qualified in No. of persons competent Area of skill this area enough to perform the job Planning 3 Competent to do the job. Report writing 3 Competent to do the job. Training and HSAM 3 Competent to do the job. Monitoring/ supervision 3 Competent to do the job. Data management 3 Competent to do the job. Computer skills 1 Competent to do the job. Mectizan ordering/ distribution 1 Competent to do the job. . Number of persons who show that they are committed to thier work, and perform it well : Very Yes Moderately X Little evidence X committed committed of commitment
If the staff at this level lack skills and commitment: . Why is this?
They are not well trained
. Which steps are being taken to improve the situation?
When opportunities to study come they will be trained.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. 85 . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
86 8.2 Check whether staff at this level is stable, and whether provision is made for passing on CDTI skills when a trained person moves away. This indicator assesses whether the programme has been are able to maintain its resources.
Characteristics of the indicator Sources of information a. Staff at this level should remain in one post for at least five years. . Inspection of staff files. b. There should be immediate orientation (in CDTI) of new, . The table in 8.1. unskilled project staff members. . Interviews with managers and other staff at this level.
Findings Describe the present situation:
Staff remains in one post for a long time and this is not a problem of Tanzania in general. However, there are opportunities to immediately orient new and unskilled project staff on CDTI activities.
Describe the situation two years ago:
Same as above.
Describe the situation when APOC funding started being given:
Same as above.
If the staff is not stable, and new staff is not being trained: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation?
Not applicable.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in the number and quality of staff?
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
87 9. Indicators of output: coverage
9.1 Check whether all projects in the country (or districts in the project) have a satisfactory therapeutic coverage rate. This indicator assesses whether the programme is effective – if the rates are poor the project is clearly struggling, and less sustainable.
Characteristics of the indicator Sources of information a. All projects in the country (or districts/ LGAs . Inspection of distribution reports and statistics in a project) should have a therapeutic at project level, for the past 3 years. coverage rate of 65% or higher (the . Interviews with staff at: denominator being the total population). * This level. b. These rates should be stable or increasing. * The next level below.
Findings The therapeutic coverage situation in the projects (or districts/ LGAs): . At the last distribution:
Therapeutic coverage in year 2002 was 76%
. The year before:
Therapeutic coverage in year 2001 was 69%
. The year before that:
Therapeutic coverage in year 2000 was 66%
If the therapeutic coverage rates are poor: . Why is this?
Not applicable.
. Which steps are being taken to improve the situation? (if such steps are already being taken that is good for sustainability)
Not applicable.
Analysis . When writing the report you have to summarise the reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in therapeutic coverage?
. Your overall judgement: is this indicator of sustainability being achieved? Fully (100% of projects have Highly (90-99% Moderately (80- Slightly (70-79% Negligibly (<70% a therapeutic coverage rate of projects) 89% of projects) of projects) of projects) ≥65% - stable or increasing)
88 Instrument 2: district/ LGA level (in Rungwe district)
NOTE: . This instrument evaluates the level which actually takes responsibility for implementing CDTI in its area of operations. It is that level where health services are planned and provided. We are going to refer to it as the district/ LGA level . . The level below this one is the one where the health centres/ clinics/ dispensaries are located. We are going to refer to this level as the ‘FLHF’ (front line health facility) level.
The focus of this level’s activities in CDTI . The main function of this level is to take responsibility for the implementation of CDTI in its area of operation. . However its function is still largely one of support of the FLHF level: * Providing targeted training, HSAM and monitoring/ supervision. * Arranging for an adequate supply of Mectizan. . The FLHF level is the one that is finally responsible for working with the CDDs in the communities.
Geographical name of this district/ LGA: RUNGWE
Project: TUKUYU FOCUS CDTI TANZANIA
Researcher: Drs Emmanuel Emukah & Rehma Maggid
Date: 17 : 09 : 03
Abbreviations/ acronyms CDD community directed distributor CDTI community directed treatment with ivermectin FLHF first line health facility HSAM health education, sensitisation, advocacy, mobilisation – i.e. activities which are aimed at getting all the key players to participate wholeheartedly in the programme NGDO non-governmental development organisation
89 1. Indicators of activities and processes: planning
1.5 Check whether the year plan for CDTI appears as part of an overall written plan for the activities of the district/ LGA. This indicator assesses whether the programme has become integrated into the health service, and whether management is beginning to accept ownership of the programme – both good for sustainability.
Characteristics of the indicator Sources of information a. CDTI should be integrated into the overall written plan . Inspection of: (showing that staff at this level consider CDTI to be part of * The written year plans. their yearly routine, like any other programme). * Minutes of planning b. The plan should make provision for all key activities: meetings. Mectizan supply; targeted training; targeted HSAM, targeted . Interviews with: monitoring/ supervision. * Staff at this level: managers c. Year plans should be drawn up in a participatory way. and others (pharmacist, d. Year plans must take into account community requirements transport officer etc.). for the timing of distribution. * Staff at FLHF level.
Findings Describe the present situation:
There is a well written documented routine planning at the District level, and this is fully integrated. The plans contained all the necessary elements and were drawn up in a participatory way. The plan is approved at the District level and copies made available to the regional government and MOH.
If planning and implementation of CDTI is not part of the overall year plan: . Why is this?
Not Applicable
. Which steps are being taken to improve the situation?
Needs to sustained
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
90 2. Indicators of activities and processes: leadership
2.1 Check whether the district/ LGA health management team is taking full responsibility for the implementation of CDTI at this level. This indicator assesses whether management is taking ownership of the programme.
Characteristics of the indicator Sources of information a. It should be the management team at this level, . Inspection of year plans. and not higher levels/ NGDO leadership, which . Interviews with: is initiating the key CDTI activities: planning, * Management team at this level. targeted monitoring/ supervision, targeted * Person responsible for CDTI at this level. training and HSAM, Mectizan ordering/ * Staff at the project level distribution. * NGDO leadership. b. There should be a focal person for CDTI * Staff at FLHF level. activities.
Findings Describe the present situation:
In each District, there are designated DOT members under the leadership of the project coordinator, who are responsible for implementation of CDTI. However they are under the DMO who is the prime initiator of all integrated health activities. DOT members initiate CDTI activities based on the plan but occasionally depended on the Coordinator before action especially when APOC funds are not available. The level of political commitment of District leadership appeared satisfactory, although they have contributed only money for fuelling.
If leadership at this level is not taking the initiative in implementing CDTI: . Why is this?
There is heavy dependence on APOC funds resulting in delays in taking action at appropriate times
The District Council Authorities believe that APOC fund is more than enough for CDTI
. Which steps are being taken to improve the situation? District Council management to release approved budgets under Basket funding and Total Grants.
Undertake High level Advocacy to District Council Management team to obtain their support.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
91 3. Indicators of activities and processes: monitoring/ supervision
3.1 Check whether routine data concerning CDTI activities are being transmitted from this level, entirely within the government system. This indicator assesses whether the programme has become more integrated into the government system, and is functioning effectively.
Characteristics of the indicator Sources of information a. The reporting process should take place within the . Examination of reports and report government system, not using other resources. Data forms. being transmitted includes: coverage reports; Mectizan . Interviews with: statistics; training reports; distribution reports; financial * Managers and staff at this level. reports. * Staff at the project level.
Findings Describe the present situation:
In the District DOTs compile the reports, which emanated from FLHF through CDDs. The report is comprehensive and transmitted through district council health information system. Supervision is carried out by DOTs 5 or more times to each community during each distribution- during training, census up- dates, and distribution and data collection. Data collection takes place within the District government Health system, but in all cases DOTs have to go to the FLHF level to collect it (which is less sustainable). Visits for monitoring/ supervision at this level are not documented in report form, nor are supervisory checklists used. However problem solving by DOTs appears satisfactory.
If data are not being transmitted within a government system: . Why is this?
Not applicable
. Which steps are being taken to improve the situation?
DOTs to use supervisory checklist or matrix Undertake targeted supervision only in areas where there is need Integrate data collection into the District Health Information System
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately 2.5 Slightly Not at all Not applicable
92 3.2 Check whether the responsible persons at the district/ LGA level are efficiently supervising CDTI activity at the FLHF level in an integrated manner. This indicator assesses whether the programme is functioning efficiently and in an integrated manner.
Characteristics of the indicator Sources of information a. Staff at this level should routinely only supervise the FLHF, and not . Examination of: the community level. ‘Spot checks’ may however be done from * Supervisory checklists, time to time. plans, itineraries and b. Although one routine supervision visit per FLHF per year is reports. necessary, supervision visits should focus more on FLHFs where * Visitor’s books at FLHF there are proven problems – each supervision visit must be level. justified. . Interviews with: c. Supervision visits for CDTI should be integrated with supervision of * Staff at this level. other programmes (e.g. through a shared checklist). Transport for * Staff at the FLHF level. supervisory visits should be shared with other programmes.
Findings Describe the present situation:
• Supervision is currently routine and not targeted. • DOTs only supervise next level i.e FLHF however at some occasions they have supervised community level. • The supervisory visits are however integrated in most cases.
If supervision is not being done in an integrated and efficient manner: . Why is this?
Checklist are not used and
Supervisory visits are tagged unto routine activities such as training, distribution, HSAM, Census up- dates and data retrieval/collection.
. Which steps are being taken to improve the situation?
Start use of supervisory checklist/matrix.
Targeted visits to areas of need
Plan all subsequent visits according to needs.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
93 3.3 Check whether there is a routine process of management of problems and successes, which are indicated by the monitoring system. This indicator assesses whether the programme is running efficiently and effectively, and whether management is beginning to accept ownership of the programme.
Characteristics of the indicator Sources of information a. As soon as problems are identified as a result of . Examination of the following supervision visits, or from coverage data (i.e. areas documents: with low coverage) the appropriate manager should * Year plans and annual reports. deal with them. * Minutes of staff/ planning meetings. b. Where relevant such problems should be passed on * Reports of previous monitoring to the appropriate FLHF staff to deal with, with the exercises. necessary support – thus empowering these persons. * Letters of commendation. c. Successes should be noted and reported, and * Memos. appropriate feedback given. . Interviews with: d. There should be evidence of action taken based on * Staff at this level. recommendations in previous monitoring exercises. * Staff at the FLHF level.
Findings Describe the present situation:
Problem solving by DOTs appears satisfactory
If the system of managing problems/ successes is weak: . Why is this?
N. A
. Which steps are being taken to improve the situation?
N. A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
94 4. Indicators of activities and processes: Mectizan® procurement and distribution
4.1 Check whether sufficient Mectizan is being ordered and received yearly, and in good time. This indicator assesses whether the programme is functioning effectively.
Characteristics of the indicator Sources of information a. The order forms for the district/ LGA exist, and should be based . Examination of all Mectizan on FLHF and community requests. ordering and stock control b. The Mectizan should be available at this level in time for documentation at this level. distribution at the time requested by the communities. . Interviews with staff at this c. There should be no reports of shortages and/ or late supply. If level (managers and there have been shortages, there should be specific plans to pharmacist). remedy them.
Findings Describe the situation with Mectizan supply at the last distribution:
Mectizan is stored in acceptable space at this level. Mectizan is delivered to this level through Government Medical Stores Department-MSD, the system is effective, efficient and appear very sustainable. This is the method of procurement of other drugs by the District and is run at government cost. Applications emanate from FLHF through request by CDDs after census up dates. A ratio of 2.2 is for the placement of order; this caused shortage during previous years distribution. Late supply of drug from NOTF equally caused delay in treatment in the district.
Describe the situation the previous year:
Same as above.
Describe the situation the year before that:
Same as above. If there are problems with obtaining the Mectizan that is required: . Why is this?
N.A
. Which steps are being taken to improve the situation? Recom.
Early application for Mectizan to MDP by NOTF Tanzania.
Conduct accurate census before ordering.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in Mectizan supply at this level? The current system is effective and efficient, affordable to government and fully integrated into the government drug delivery system. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
95 4.2 Check whether Mectizan is being collected, stored and effectively delivered within the government system at this level. This indicator assesses whether the programme is functioning efficiently, its processes are simple, and it is becoming more integrated into the government system.
Characteristics of the indicator Sources of information a. The Mectizan should be controlled within a government . Examination of: system. This does not have to be the system routinely * All Mectizan ordering and stock used for the supply of other drugs. control documentation at this level. b. The system should be effective, uncomplicated and * Vehicle log books and/ or trip efficient. authority forms. c. The district/ LGA should ideally fetch its Mectizan from . Interviews with staff at this level the project level itself (although use of the routine MoH (managers, pharmacist, drivers). drug supply system to districts is acceptable). In either case transport should be supplied and paid for by government at this level.
Findings Describe the present situation:
Mectizan is stored in acceptable space at this level. Mectizan is delivered to this level through Government Medical Stores Department-MSD, the system is effective, efficient and appear very sustainable. This is the method of procurement of other drugs by the District and is run at government cost.
Bulk transfer form was not seen and it was difficult to determine batch # and expiration date from the records seen at this level.
If the Mectizan supply is not being administered within a government system: . Why is this?
N. A
. Which steps are being taken to improve the situation? Recommendation.
Use bulk transfer forms and indicate batch # and expiration dates.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
96 5. Indicators of activities and processes: training and HSAM
5.1 Check whether staff members at this level are being used appropriately as trainers. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. Staff should routinely only train staff at the FLHF level, . Examination of training materials, and not at the community level. plans/ programmes, reports: b. Staff should have empowered staff at the FLHF level to * At this level. see to their own training needs as much as possible, * At the FLHF level. and to conduct training activities at the community level . Interviews with: independently. * Staff at this level (the trainers). c. Wherever possible staff at this level should conduct * Staff at FLHF level (the trainees). their own training for CDTI, if they have need for such * CDDs. training.
Findings Describe the present situation: RHS are actively involved in CDD training and mobilisation, while DOTs only train FLHF staff. However in some occasions when RHS are new DOTs support CDD training. Training and mobilisation activities do not have any specific target or focus and therefore are routine and inefficient. The CDTI training manual and programme are available to the DOTs for RHS training, but there are inadequate number of training materials. DOTs have the intention to conduct targeted training this year.
Describe the situation the year before:
Routine Training If staff members are not being used appropriately: . Why is this?
N.A
. Which steps are being taken to improve the situation?
Recommendations: NOTF/SSI to produce adequate number of training and other IEC materials. All future training should be planned and targeted to areas of need. Training should be integrated.Training duration should last 2-3 days and not 1 day.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in the way in which staff are being used as trainers: DOTs are used as TOTs and are presently effective. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
97 5.2 Check whether training is being planned and carried out in an efficient and integrated manner. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. There should be an objective need for each episode of training. This . Examination of training means there should be evidence that staff to be trained lack materials, plans/ knowledge and skills to perform the job, and the training should then programmes, reports: focus on this deficiency only. Repeat training of already skilled staff * At this level. should not happen. * At the FLHF level. b. If circumstances permit training for CDTI should be integrated with . Interviews with: other training, e.g. in in-service training programmes. * Staff at this level c. Resources for training (human, transport etc.) should be efficiently (the trainers). used: * Staff at FLHF level * Using as few staff members as possible. (the trainees). * Using as little time as possible (without sacrificing quality) * CDDs. * Choosing the most cost-effective site etc.
Findings Describe the present situation:
Training and mobilisation activities do not have any specific target or focus and therefore are routine and inefficient. The trainings are equally not integrated at present.
Describe the situation the year before:
Same as above. If training is not efficient and integrated: . Why is this?
Implemented as it is contained in the approved APOC budget
Integrated District Health plan is not yet being implemented for CDTI because Management believes APOC funds are adequate
. Which steps are being taken to improve the situation? Recommendations.
Implement Comprehensive District Health plan as it affects CDTI irrespective of APOC funds by District Council Management
Integrate all Future trainings
Target and identify training needs before undertaking any future training.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in training activities – is it becoming more efficient and integrated?
Plans for targeted training likely this year. . Your overall judgement: is this indicator for sustainability being achieved?
98 Fully Highly Moderately Slightly Not at all Not applicable 2.5
99 5.3 Check whether staff at this level is planning and carrying out HSAM activities in an efficient manner. This indicator assesses whether the programme is functioning efficiently and effectively, and whether managers are taking ownership of the programme.
Characteristics of the indicator Sources of information a. Staff members identify situations where decision makers . Examination of: lack information about/ commitment to CDTI, and undertake * HSAM plans/ programmes and activities to inform and persuade these persons. reports. b. HSAM activities are properly planned. They are only carried * Year plans and annual reports. out where there is an objective need for them, and not as a * Minutes of planning meetings. matter of routine. . Interviews with: c. Such activities should only be carried out at this district/ * Staff (programme and LGA level, and at times at the FLHF level (but only when management) at this level. staff at that level asks for help). * Civil authorities at this level. d. There is evidence that these HSAM activities have been * Staff and civil authorities at the effective and have led to action. FLHF level.
Findings Describe the present situation:
HSAM are routinely carried before each distribution at this level. There is an effective, information to the decision makers at this level through District Health Information and Communication system in place.
Describe the situation the year before:
Same as above.
If HSAM activities are not being carried out efficiently and effectively: . Why is this?
There is need to get the Council Management to became more involved in CDTI and to make them begin to release fund for CDTI.
. Which steps are being taken to improve the situation? Recommendation.
Target only those that need to be informed.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in HSAM activities – is it becoming more efficient?
There is a plan for targeted HSAM . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
100 6. Indicators of resources: financial
6.1 Check whether appropriate amounts are budgeted for planned CDTI activities at this level. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. The costs for each CDTI activity in the year plan at this level should be . Examination of the clearly spelt out in a budget. budget documents. b. There is evidence of a cost reduction/ containment strategy (e.g. . Interviews with health targeted training, HMAS and monitoring/ supervision; training service and local conducted at FLHF level etc). government managers c. Managers at this level should have a clear estimate of the funds that at this level: will be available to them for CDTI in the coming year, and should be * Technical able to justify this belief. managers. d. The total amount budgeted for in the year plan should fall within this * Treasurer/ estimated income. administrator.
Findings The budget and estimated income:
At the previous distribution:
There is a detailed budget that appears adequate for CDTI implementation, integrated in the overall budget of the council from basket fund and Total grant (About Tsh 45.0m). In some instances (but not all) District council make some funds available for fuelling CDTI activities at this level. The DOTs do however depend on the yearly disbursement from APOC.
. For the previous year: Same as above.
. For the year before that: Same as above If budgeting has been inappropriate: . Why is this? Management thinks that the Project has enough funds from APOC.
. Which steps are being taken to improve the situation? Recommendations: Advocacy visit to Council Management to release budgeted fund Render account of all programme activities to management Identify and use highly placed citizens as advocates to achieve point one above
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in the budgeted amount and the expected income:
The budget is adequate if released. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
101 6.2 Check whether the government at this level is budgeting and disbursing increasing amounts for CDTI yearly, and in good time. This indicator assesses whether the programme is becoming integrated, and whether government is beginning to accept ownership of the programme and can mobilise the resources it needs.
Characteristics of the indicator Sources of information a. The relative budgetary contributions of the local government . Examination of: and other partners to CDTI should be clearly spelt out. * Budget documents b. The amount that the government has budgeted in one or (government and NGDO) more specific CDTI budget lines should be increasing yearly. * Records of disbursement By the end of Year 5 of APOC funding the bulk of CDTI and expenditure (ledgers, expenses at this level should be met from local government orders, approvals for funds; by the end of Year 3 at least half of it.’ expenditure etc.) c. The amounts actually disbursed from such budget lines . Interviews with health service, should be increasing yearly, as a proportion of total local government and NGDO expenses. (Note that actual disbursement is more important managers at this level: than budgeting, and is a real sign of political commitment). * Technical managers. * Treasurer/ administrator.
Findings The budget and disbursements: . For this year:
Only Fuel money is given when APOC fund is not available
. For the previous year:
Same as above.
If the government proportion of expenditure is not increasing proportionately: . Why is this?
Believes APOC fund is adequate for the programme
. Which steps are being taken to improve the situation? Recommendations: Advocacy visit to Council Management to release budgeted fund. Render account of all programme activities to management. Identify and use highly placed citizens as advocates to achieve point one above
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in government budgeting and disbursements: Adequate
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately 2.5 Slightly Not at all Not applicable
102 6.3 Check whether in case of a deficit between estimated costs and the amount provided by the government, dependable provision is being made to meet it. This indicator assesses whether management is able to mobilise the resources it needs, as well as its commitment to ownership.
Characteristics of the indicator Sources of information a. If there is a shortfall the management . Inspection of: should have specific and realistic * The budget documents (government and NGDO) plans to bridge it. * Records of expenditure (ledgers, orders, approvals b. If it is planned that non-government for expenditure etc.). sources of funding are to be used * Letters of agreement. after APOC funding ends, written . Interviews with health service and local government commitment for this should have managers at this level: been obtained at the highest level in * Technical managers. these donor organisations. * Treasurer/ administrator.
Findings Describe the present situation:
When APOC funds are not available Council provides only fuel money for CDTI but there is a comprehensive budget. Describe the situation the previous year: Same
If the shortfall cannot be met: . Why is this?
N.A
. Which steps are being taken to improve the situation?
N.A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in shortfall and how it is to be supplemented:
Good prospect from the Council management. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately 2.5 Slightly Not at all Not applicable
103 6.4 Check whether funds disbursed for CDTI from the budget at this level are efficiently managed. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. The budget holder should be using a control . Inspection of: system with the following elements: * The budget documents (government and * Approval of each item of expenditure. NGDO). * Allocation of expenditure against specific * Financial control records (ledgers, orders, budget headings. approvals for expenditure etc.). * Regular calculation of residual amounts . Interviews with health service and local under budget headings. government managers at this level: b. All the funds released yearly should be spent * Technical managers. as budgeted. * Treasurer/ administrator.
Findings Describe the present situation: . Approval of expenditure:
Project Coordinator disburses funds on approval.
. Allocation of expenditure:
. Regular insight into budget line balances:
If the funds are not being well managed: . Why is this?
N.A
. Which steps are being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
104 7. Indicators of resources: transport and other material resources
7.1 Check whether adequate and appropriate transport and materials are available for necessary CDTI activities at this level. This indicator assesses whether the programme is functioning effectively, and whether it is able to mobilise the resources it needs.
Characteristics of the indicator Sources of information a. There are adequate numbers of appropriate, . Inspection of: functional vehicles available for necessary CDTI * Each vehicle in the pool: its source; its activities. functional status. b. The running costs for these vehicles are met by the * Stocks of materials for training and government. HSAM. c. There are sufficient materials available for training . Interviews with managers at this level: and HSAM. transport officers, programme managers.
Findings Describe the present situation: Type of vehicle No. Source* Adequacy for CDTI tasks** Toyota Hillux 1 APOC Adequate and functional Motorcycle 1 SSI Functional Motorcycle 1 APOC Functional
Training/ HSAM No. Source* Adequacy for CDTI tasks** material All SSI/NOTF/ Inadequate in number produced need more visual APOC IEC materials for training CDDs & HSAM
* APOC, MoH, NGDO, other (specify) ** Is it working? Is there enough of it for the job? Is it suitable for the job? Describe the availability/ suitability/ functionality of the present vehicles and materials, considering the work still to be done in the coming 5-10 years:
The present number of vehicles and motorcycle at this level is adequate but training and HSAM are inadequate.
If transport and materials are inadequate and funded from non-government sources: . Why is this?
Quantity supplied by SSI and NOTF are insufficient.
. Which steps are being taken to improve the situation?
SSI and NOTF to produce and supply adequate training and HSAM materials.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately 2.5 Slightly Not at all Not applicable
105 7.2 Check whether transport at this level is adequately and appropriately maintained. This indicator assesses whether the programme is functioning effectively and efficiently.
Characteristics of the indicator Sources of information a. There is a routine maintenance schedule for each vehicle, which . Inspection of: is adhered to and recorded. This includes weekly driver * Vehicle and equipment maintenance, scheduled garage servicing, and replacement of maintenance schedules. worn tyres. * Vehicle and equipment b. The costs for vehicle and equipment maintenance and repair are maintenance records. met by the government. Repairs are rapidly and efficiently done. . Interviews with managers at c. Staff have ways of coping when vehicles break down or are not this level: transport officers, available, so that CDTI activities are not disrupted. programme managers.
Findings Describe the present situation:
There is a District Transport Management Information System under the Transport officer who is a health worker. He schedules all movements, controls log- books, arrange for routine and major repairs as well as fuelling. All vehicles are in pool and allocated to projects by transport officer under the DMO.
. Make particular enquiries about the ability of the government to pay for maintenance, repairs and tyre replacement:
The present arrangement is effective.
All Council vehicles are routinely maintained.
If the vehicles are not being well maintained, and/ or the government is not paying: . Why is this?
N. A
. Which steps are being taken to improve the situation?
N. A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
106 7.3 Check whether the transport available at this level is appropriately managed and used, in an integrated way. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. Transport is used at this level, and to undertake support . Inspection of vehicle control activities at the FLHF level. It should not be used for documents: CDTI implementation activities at the community level. * Copies of trip authorities (also b. Trips made for CDTI purposes should be properly noting destination and purpose) authorised in writing by the relevant official. Each trip * Log books. undertaken should be recorded in a log book. * The supervision plan/ matrix. c. Transport provided for CDTI, and that provided for other . Interviews with managers at this level: programmes, should be combined as a pool to be used transport officers, programme for legitimate activities of all programmes at this level. managers.
Findings Describe the present situation:
Transport officer does the integrated control of all vehicles.
If the transport is not being well managed: . Why is this?
N.A
. Which steps are being taken to improve the situation?
N. A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
107 7.4 Check whether there are appropriate and realistic plans for the replacement of transport and materials when APOC support comes to an end. This indicator assesses whether the programme managers are taking ownership of the programme, and are able to find resources for it.
Characteristics of the indicator Sources of information a. Management should know that replacements will be needed before . Inspection of letters of the end of the programme, and have specific, realistic plans to agreement. meet the need at that time. . Interviews with: b. It should be planned that the government will: * Programme managers * Provide replacements for vehicles. at this level: * Maintain existing vehicles. administrators, * Provide stationery and materials for training and HSAM. technical managers. c. If it is planned that replacement will be from non-government * NGDO project sources, written commitment for this should have been obtained at managers. the highest level in these donor organisations (end of Year 5), or * High-ranking local negotiations should have started (end of Year 3). government officials.
Findings Describe the present situation:
Budget did not include this but there is a proposal for replacement in 2004 budget being prepared.
If the plans for replacing vehicles and materials are unsatisfactory: . Why is this?
New budget is not yet out
. Which steps are being taken to improve the situation?
Recommendation: ensure that provision is made for replacement of vehicles in the next comprehensive Council budget.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly 1.5 Not at all Not applicable
108 8. Indicators of resources: human resources
8.1 Check whether staff at this level is skilled and knowledgeable, regarding the implementation of CDTI in its area of operation. This indicator assesses whether the programme has been able to develop sufficient resources for itself.
Characteristics of the indicator Sources of information a. Staff should have enough knowledge and skill to undertake . Inspection of: all the key CDTI activities themselves: planning, training, * Staff files. HSAM, ensuring Mectizan supply, monitoring/ supervision. * Monitoring reports. b. Staff at this level should remain in one post for at least five * Activity reports. years. . Interviews with c. There should be immediate training (in CDTI) of new, * Managers and other staff at unskilled project staff members who have CDTI this level. responsibilities. * Staff at the project level * Staff at the FLHF level.
Findings Describe the present situation: . Particulars of current staff No. of persons qualified No. of persons competent Area of skill in this area enough to perform the job Planning 3 3 Training and HSAM 3 3 Monitoring/ supervision 3 3 Mectizan ordering/ distribution 4 4 . Information about staff stability
All are Council Staff and therefore stable.
. Information about in-service training: In service training are carried out when need arises
If the staff at this level lack skills, and are often transferred: . Why is this?
N.A
. Which steps are being taken to improve the situation?
N.A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
109 8.2 Check whether staff members at this level are committed to their CDTI work. This indicator assesses whether the programme has been able to develop sufficient resources for itself.
Characteristics of the indicator Sources of information a. Staff members express satisfaction with their present . Inspection of: responsibilities * Staff files (for performance b. There is evidence of specific motivational practices and records and awards). rewards within the programme: awards, financial incentives, * Documentation about incentive compensation in cash or kind. schemes. c. Salaries/ wages and allowances are paid regularly. . Interviews with d. Staff members mention non-financial rewards inherent in * Managers and other staff at CDTI work. this level. e. There is evidence from partners and workers at the FLHF * Local government officials. level that staff members are committed to their CDT work. * NGDO project staff. * Staff at FLHF level.
Findings Describe the present situation:
DOTs are stable and well trained, motivated and are fully committed.
If staff members appear to have little commitment to CDTI work: . Why is this?
N.A
. Which steps are being taken to improve the situation?
N.A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
110 9. Indicators of output: coverage
9.1 Check whether the district/ LGA has a satisfactory geographical coverage rate. This indicator assesses whether the programme is effective – if the rate is poor the project is clearly struggling, and less sustainable.
Characteristics of the indicator Sources of information a. All sub-districts and . Inspection of: communities identified by the * Distribution reports and statistics at community level, for latest REMO should be under this district/ LGA, for the past 3 years. treatment (i.e. the geographical * REMO list of endemic communities for this district/ LGA. coverage rate is 100%). . Interviews with: b. This rate should be stable or * Staff at district/ LGA level. increasing. * Staff at FLHF level.
Findings The geographical coverage situation in the district/ LGA: . At the last distribution:
Both geographical and therapeutic coverage are affected by the absence REMO report for the Project. New communities were added to the original proposal without any guide thus DOTs do not have a complete list of communities they should be treating. In some cases the therapeutic coverage is being incorrectly calculated (using Treatment figures that are different from those in the treatment registers in the village and FLHF) – as a result coverage rates are either high or low. Geographical coverage is nearing 100%
. The year before:
Same as above.
. The year before that:
Same as above.
If the geographical coverage rate is poor: . Why is this? N.A
. Which steps are being taken to improve the situation? Recommendations: to conduct REMO exercise urgently within the Project area to define actual endemicity.
Analysis . When writing the report you have to summarise the reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in geographical coverage?
Increasing gradually and approaching 100% . Your overall judgement: is this indicator of sustainability being achieved? Fully (100% of Highly (95-99% of Moderately (90-94% of Slightly (85-89% of Negligibly communities are doing communities – stable communities – stable or communities – stable (<85% of CDTI) or increasing) 3.0 increasing) or increasing) communities)
111 Instrument 3: first line health facility (FLHF) level (in Rungwe district)
NOTE: . This instrument evaluates the level which finally interacts with the villages and communities, in ensuring that CDTI takes place in all the communities in its area of operations. This level has different names in different countries. In most countries there is a health centre – a clinic, or health centre, or dispensary, which we call a ‘first line health facility’. The health workers who work there are the ones who are responsible for training and supporting the CDDs in the villages. . When we speak of a FLHF we therefore mean: * The health facility and its staff. * The accompanying political/ administrative mechanisms between the district/ LGA and community levels. . By ‘FLHF team' is meant the group of persons working in the first-line health facility and in its catchment area. . The level below this one is of course the community, the villages. Here the CDDs – ‘community directed distributors’ – live and work. We refer to this level as the ‘community’ level.
The focus of this level’s activities in CDTI The main function of this level is to work with the village communities, so that CDTI is established in them: . Mobilising them to become involved in CDTI, by selecting CDDs. . Training the CDDs and supporting them in their work. . Arranging a dependable supply of Mectizan for them, at the right time each year. . Helping them to collect and forward the coverage data for their community.
Geographical name of this FLHF: Ilima HF, Kissa HF and Lufilyo HF Project: Tukuyu Focus CDTI Tanzania
Researcher: Drs Emmanuel Emukah & Rehma Maggid
Date: 17: 09: 03 to 20: 09: 03
Abbreviations/ acronyms CDD community directed distributor CDTI community directed treatment with ivermectin FLHF first line health facility HSAM health education, sensitisation, advocacy, mobilisation – i.e. activities which are aimed at getting all the key players to participate wholeheartedly in the programme NGDO non-governmental development organisation
112 1. Indicators of activities and processes: planning
1.1 Check if there is a written year plan for CDTI in the FLHF area. This indicator assesses whether the programme is being planned in an effective and integrated manner, and whether management is beginning to accept ownership of the programme.
Characteristics of the indicator Sources of information a. There should be a written plan or timetable in existence, for . Inspection of: the most recent round of CDTI (this is recommended). * The written year plans. b. Ideally the plan should be integrated into the overall year plan * Minutes of planning for the FLHF area. meetings. c. Ideally CDTI should form part of the ‘minimum’ or . Interviews with staff at this level. ‘recommended’ package for this level
Findings Describe the present situation:
This is done by the DOT team and passed on of the First Line health staff and then incorporate it into their local time tables.
The timetables are not detailed but integrated monthly duty allocations.
PHC management Committee meetings are held to draw up the timetables in a participatory manner.
If there is no written plan for CDTI: . Why is this?
RHS/FLHF have not been trained on detailed planning.
. Are any steps being taken to improve the situation?
Planning workshop for RHS/FLHF staff to be organised after DOTs training.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately 2.5 Slightly Not at all Not applicable
113 2. Indicators of activities and processes: leadership
2.1 Check whether the FLHF management team is taking full responsibility for CDTI at this level, in an integrated manner. This indicator assesses whether the CDTI project is integrated into the health system, and whether management is beginning to accept ownership of the programme.
Characteristics of the indicator Sources of information a. The FLHF management team and all health staff at this . Inspection of year plans. level consider the program as theirs and are initiating the . Interviews with: key CDTI activities: planning, monitoring/ supervision, * Management team at this level. training, HSAM, Mectizan ordering/ distribution. * Senior political figures at this b. The political head/ senior politician at this level should level. know about CDTI and have participated in some CDTI * Staff at the district/ LGA level. activities.
Findings Describe the present situation:
The in-charge of each FLHF is the focal person who initiates CDTI activities.
He/she plans with other health staff and village leaders. PHC committee, ward leaders in a participatory manner all programmes including CDTI.
If DMT is not taking full responsibility for CDTI: . Why is this?
N.A
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
114 3. Indicators of activities and processes: monitoring/ supervision
3.1 Check whether routine and necessary data concerning CDTI activities at this level are being transmitted entirely within the government system. This indicator assesses whether the programme is becoming more integrated into the national health system.
Characteristics of the indicator Sources of information a. The reporting process should be within the . Examination of reports and report forms. government system, not using other resources. Data . Interviews with: being transmitted includes: coverage reports; * Managers and staff at this level. distribution reports; Mectizan statistics; training * Staff at the district/ LGA level. reports.
Findings Describe the present situation:
RHS/FLHF staff carryout monitoring/supervision at this level, including data collection and compilation from CDDs but in some occasions DOT members join at this level. After distribution DOTs go to Health Facility to collect treatment reports on regular basis. RHS have demonstrated good skill in problem solving at this level and the system appear effective and sustainable.
If CDTI data at this level are not being processed within government system: . Why is this?
DOTs collect data from FLHF because there is fund available and reports may be urgently needed.
. Are any steps being taken to improve the situation?
Treatment data should be transmitted by FLHF through existing District Health information system
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately 2.0 Slightly Not at all Not applicable
115 3.2 Check whether health service staff at this level is routinely and efficiently supervising CDTI activity at the communities on site in an integrated manner. This indicator assesses whether the CDTI programme is being implemented efficiently.
Characteristics of the indicator Sources of information a. Although one routine supervision visit per community per . Examination of: year is necessary, supervision visits should focus more on * Supervisory checklists, plans, communities where there are proven problems – each itineraries and reports. supervision visit must be justified. * Log books. b. During visits to communities FLHF staff should turn their . Interviews with: attention to as many health related programmes and * Staff at this level. problems as possible. * Village heads and CDDs.
Findings Describe the present situation:
As in 3.1 above
If health service staff members are not routinely and efficiently supervising CDTI: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately 2.0 Slightly Not at all Not applicable
116 3.3 Check whether there is a routine process of management of problems and successes, which are indicated by the monitoring system (coverage data, visits and reports) This indicator assesses whether the programme is being implemented efficiently and effectively, and whether management is beginning to accept ownership of the programme.
Characteristics of the indicator Sources of information a. As soon as problems are identified through . Examination of the following supervisory visits, coverage data etc. (e.g. documents: communities with low coverage) health staff at this * Year plans and annual reports. level should deal with them. * Minutes of staff/ planning meetings. b. Where relevant such problems should be passed on * Reports of previous monitoring to the relevant community to deal with, with the exercises. necessary support – thus empowering communities to * Letters of commendation. make decisions on CDTI and cope with problems. . Interviews with: c. Successes should be noted and reported, and * Staff at this level: in-charge and appropriate feedback given to communities. others. d. There should be evidence of action taken based on * Community leaders and CDDs. recommendations in previous monitoring exercises.
Findings Describe the present situation:
See 3.1 above
If there is no routine process of managing problems and successes: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
117 4. Indicators of activities and processes: Mectizan® procurement and distribution
4.1 Check whether sufficient Mectizan is being ordered annually, and in good time. This indicator assesses whether the programme is functioning effectively.
Characteristics of the indicator Sources of information a. The order forms for the FLHF area exist, and orders should . Examination of all Mectizan be based on the requests from the community. ordering and stock control b. The Mectizan should be available at this level in time for documentation at this level. distribution at the time requested by the communities. . Interviews with: c. There should be no reports of shortages and/or late supply. If * Staff at this level (managers there have been shortages, there should be specific plans to and pharmacist). remedy them. * Village leaders and CDDs.
Findings What happened at: . The last round of treatment?
There is an effective an efficient supply system through the government (MSD). Orders are based on population emanating from CDDs. There is adequate and integrated storage space for Mectizan at this level. Records of Mectizan transfer are available and well kept by FLHF staff. There were no reports of inadequate supply, late supply or shortage at this level.
. The round of the year before?
Same as above.
. The round the year before that?
Same as above.
If sufficient Mectizan is not being obtained annually: . Why is this?
N.A
. Are any steps being taken to improve the situation?
N. A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in Mectizan ordering and supply?
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
118 4.2 Check whether Mectizan is being collected, stored and effectively delivered within the government system at this level. This indicator assesses whether the programme is functioning efficiently, its processes are simple, and it is becoming more integrated into the government system.
Characteristics of the indicator Sources of information a. The Mectizan should be controlled within a government system. . Examination of: This does not have to be the system routinely used for the supply * All Mectizan ordering of other drugs. and stock control b. The system should be effective, uncomplicated and efficient documentation at this c. The FLHF level should fetch its Mectizan from the district/ LGA level. level itself, by means of transport supplied and paid for by * Vehicle log books and/ government at this level. or trip authority forms. d. Communities should fetch their Mectizan from the FLHF . Interviews with staff at this themselves. However in situations where villages are very far from level (managers, health centres, or where it is easy/ practicable for FLHF staff to pharmacist, drivers). deliver the Mectizan, they may help with the delivery.
Findings Describe the present situation:
SEE 4.1
If Mectizan is not being received and stored within a government system: . Why is this?
N.A
. Are any steps being taken to improve the situation?
N. A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
119 5. Indicators of activities and processes: training and HSAM
5.1 Check whether training is being planned and carried out in an efficient manner. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. There should be an objective need for each episode of training. This . Examination of means there should be evidence that CDDs to be trained lack training materials, knowledge and skills to perform the job, and the training should then plans/ programmes, focus on this deficiency only. reports at this level. b. Resources for training (human, transport etc.) should be efficiently used: . Interviews with: * Using as few staff members as possible. * Staff at this level * Using as little time as possible (without sacrificing quality) (the trainers). * Choosing the most cost-effective site etc. * CDDs (the trainees).
Findings Describe the present situation:
The RHS/FLHF staff carried out training of CDDs routinely with occasional supervised by the DOTs in case of new RHS. Training materials are however inadequate in number. HSAM is equally carried out routinely without plan and targets but well organised village administrative structures are identified and used effectively. All the trainings were CDTI specific and therefore not targeted.
Describe the situation the year before:
Same
If training is not efficiently done in an integrated manner: . Why is this?
Done as a matter of routines.
. Are any steps being taken to improve the situation?
Target training at specific areas of need.
Proper Planning and needs identification.
SSI/NOTF to produce training /IEC /HSAM material in reasonable quantity.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in the way training is done – the method and content?
In a repetitive manner using a uniform programme and content. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.0
120 5.2 Check whether staff at this level is planning and carrying out HSAM activities in an efficient manner. This indicator assesses whether the programme is functioning efficiently and effectively, and whether managers are taking ownership of the programme.
Characteristics of the indicator Sources of information a. Staff members identify situations where decision makers . Examination of: lack information about/ commitment to CDTI, and * HSAM plans/ programmes and undertake activities to inform and persuade these reports. persons. * Year plans and annual reports. b. HSAM activities are properly planned. They are only . Interviews with: carried out where there is an objective need for them, and * Staff at this level. not as a matter of routine. * Civil authorities at this level. c. There is evidence that these HSAM activities have been * Community leaders and CDDs. effective and have led to action.
Findings Describe the present situation:
SEE notes on 5.1
Describe the situation the year before:
Same as above.
If staff is not effectively engaged in HSAM: . Why is this?
See 5.1
. Are any steps being taken to improve the situation?
See 5.1
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Examine the trend in HSAM activities – is it becoming more efficient?
Most community members are aware of CDTI and therefore may not require routine HSAM as is presently done. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.0
121 6. Indicators of resources: financial
6.1 Check whether the costs involved in planned CDTI activities at this level are clearly defined and budgeted for. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. The costs for each CDTI related activity in the year . Examination of the budget documents plan should be clearly spelt out in a budget. These (government and NGDO). activities include monitoring/supervision, training, . Interviews with: HSAM, and arranging Mectizan supply. * FLHF team managers (leader, b. The staff should be able to justify the amount they treasurer). plan to use. There should be evidence of cost * Local government managers at this containment (e.g. by targeting training, HMAS and level (chairperson, administrator, supervision). treasurer).
Findings What happened at: . The last round of treatment?
Management at this level have no budget but depend on supplies from the district and thus have no impress. However, in one FLHF there was a local arrangement to raise money for fuel, transport and sterilization of equipments. Dependence on APOC fund is heavy at this level and the amount given is just adequate for training and mobilization.
. The round of the year before?
Same as above.
If costs involved in CDTI related activities are not clearly defined . Why is this?
Government policy not to give impress/ budget at this level
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in the way costing for CDTI related activities is done? Fund usually come to this level through DOTs
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all √ Not applicable
122 6.2 Check whether sufficient funds to cover these costs are being disbursed from FLHF and/or district/ LGA resources. This indicator assesses whether the programme is becoming integrated, and whether management is beginning to accept ownership of the programme and can mobilise the resources it needs.
Characteristics of the indicator Sources of information a. Funding disbursed is enough to enable . Examination of: targeted, essential CDTI activities at * Budget documents (government and NGDO) this level to be carried out. * Records of disbursement and expenditure (ledgers, b. The relative contributions of all sources orders, approvals for expenditure etc.) of funding should be clearly spelt out. . Interviews with: c. The proportion provided by the * District/ LGA level managers (technical and government (FLHF and/ or district/ LGA administrative). levels) should be the major one by now * NGDO managers at this level. (end of Year 5) or covering at least half * FLHF team managers (leader, treasurer). of expenditure (end of Year 3). * Local government managers at this level (chairperson, administrator, treasurer).
Findings How much was provided by the government: . Last round of treatment?
See 6.1
. The round of the year before?
Same as above.
. The round the year before that?
Same as above.
If the proportion supplied by the government is not the major one by now: . Why is this?
Government does not operate budget at this level
. Are any steps being taken to improve the situation?
DOTs to make adequate provision for this level in the overall comprehensive Council Health Budget.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in the relative proportion of resources contributed by the official health service?
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all √ Not applicable
123 7. Indicators of resources: transport and other material resources
7.5 Check whether adequate and appropriate transport and materials are available for necessary CDTI activities at this level. This indicator assesses whether the programme is functioning effectively, and whether it is able to mobilise the resources it needs.
Characteristics of the indicator Sources of information a. There are adequate numbers of appropriate, . Inspection of: functional vehicles (of any type) available for * Each vehicle being used: its source; necessary CDTI activities. its functional status. b. The running costs for this transport are met by a * Stocks of materials for training and dependable source (e.g. the government). HSAM. c. There are sufficient materials available for training . Interviews with the FLHF management and HSAM. team.
Findings Describe the present situation: Type of transport No. Source* Adequacy for CDTI tasks** Bicycle 1 DCA Not adequate
Training/ HSAM No. Source* Adequacy for CDTI tasks** material All Not adequate
* APOC, MoH, NGDO, other (specify) ** Is it working? Is there enough of it for the job? Is it suitable for the job? Describe the availability/ suitability/ functionality of the present vehicles and materials, considering the work still to be done in the coming 5-10 years:
There is nothing at this level
If transport and materials are inadequate and funded from non-government sources: . Why is this?
There was no plan/Proposal made at this level who are not represented at CHMT that plans for all Health programmes.
. Which steps are being taken to improve the situation?
Future plans to incorporate this level and make adequate provision for transport at this level.
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all √ Not applicable
124 7.6 Check whether transport at this level is adequately and appropriately maintained. This indicator assesses whether the programme is functioning effectively and efficiently.
Characteristics of the indicator Sources of information a. There is a routine maintenance schedule for vehicles (where . Inspection of: relevant), which is adhered to and recorded. * Vehicle and equipment b. The costs for vehicle and equipment maintenance and repair are maintenance schedules. met by dependable sources (e.g. the government). * Vehicle and equipment c. Repairs are rapidly and efficiently done. maintenance records. d. Staff have ways of coping when transport breaks down or is not . Interviews with the FLHF available, so that CDTI activities are not disrupted. management team.
Findings Describe the present situation:
N.A
. Make particular enquiries about the ability of the government to pay for maintenance, repairs and tyre replacement:
N.A
If the vehicles are not being well maintained, and/ or the government is not paying: . Why is this?
N.A
. Which steps are being taken to improve the situation? N.A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all √ Not applicable
125 7.7 Check whether the transport available at this level is appropriately managed and used, in an integrated way. This indicator assesses whether the programme is functioning efficiently.
Characteristics of the indicator Sources of information a. Trips made for CDTI purposes should be properly . Inspection of vehicle control documents: authorised in writing by the relevant official. Each * Copies of trip authorities (also noting trip undertaken should be recorded in a log book. destination and purpose) b. Transport provided for CDTI, and that provided for * Log books. other programmes, should be combined as a pool * The supervision plan/ matrix. to be used for legitimate activities of all . Interviews with the FLHF management programmes at this level. team.
Findings Describe the present situation:
N.A
If the transport is not being well managed: . Why is this?
N. A
. Which steps are being taken to improve the situation?
N. A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
126 7.8 Check whether there are appropriate and realistic plans for the replacement of transport and materials when APOC support comes to an end. This indicator assesses whether the programme managers are taking ownership of the programme, and are able to find resources for it.
Characteristics of the indicator Sources of information a. Management should know that replacements will be needed before the . Inspection of letters of end of the programme, and have specific, realistic plans to meet the agreement. need at that time. . Interviews with: b. It should be planned that the government will: * The FLHF * Provide replacements for vehicles. management team. * Maintain existing vehicles. * NGDO project * Provide stationery and materials for training and HSAM. managers. c. If it is planned that replacement will be from non-government sources, * High-ranking local written commitment for this should have been obtained at the highest government level in these donor organisations (end of Year 5), or negotiations officials. should have started (end of Year 3).
Findings Describe the present situation:
If the plans for replacing vehicles and materials are unsatisfactory: . Why is this?
. Which steps are being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable
127 8. Indicators of resources: human resources
8.1 Check whether the team at this level is skilled and knowledgeable, regarding the implementation of CDTI in its area of operation. This indicator assesses whether the programme has been able to develop sufficient resources for itself.
Characteristics of the indicator Sources of information a. Staff should have enough knowledge and skill to . Inspection of: undertake all the key CDTI activities themselves: * Staff files. planning, training, HSAM, ensuring Mectizan supply, * Monitoring reports. monitoring/ supervision. * Activity reports. b. Staff at this level should remain in one post for at . Interviews with least five years. * Managers and other staff at this level. c. There should be immediate training (in CDTI) of * Staff at the district/ LGA level. new, unskilled project staff members who have * Village leaders and CDDs. CDTI responsibilities.
Findings Describe the present situation: . Particulars of current staff No. of skilled Area of skill Level of skill: is it adequate to perform the job? persons Planning 8 Yes Training and HSAM 8 Yes Monitoring/ supervision 8 Yes Mectizan ordering/ distribution 8 Yes . Information about stability and in-service training:
The number is adequate for this level, they are stable and fully committed/prepared to participate in CDTI.
If the staff at this level lack skills, and are often transferred: . Why is this?
N.A
. Which steps are being taken to improve the situation?
N.A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
128 9 Indicators of output: coverage
9.1 Check whether the geographical coverage in the FLHF area is satisfactory. This indicator assesses whether the project is effective – if the rate is poor the project is clearly struggling, and less sustainable.
Characteristics of the indicator Sources of information a. All villages identified by the latest . Inspection of: REMO should be under treatment * Distribution reports and statistics at community level, (i.e. geographical coverage should for this FLHF area, for the past 3 years. be maintained at 100%). * REMO list of endemic communities for this FLHF area. b. The rate should be stable or . Interviews with staff at FLHF level. increasing.
Findings The geographic coverage situation: . At the last distribution:
All (100%) villages treated before were retreated last year
. The year before:
100% (more villages treated than previous year).
. The year before that:
>90%
If geographical coverage is poor: . Why is this?
There are no defined endemic villages that are added by DOTs without guide.
. Are any steps being taken to improve the situation?
Conduct REMO/REA to define endemic villages needing treatment.
Analysis . When writing the report you have to summarise the reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in geographical coverage?
Is approaching 100% . Your overall judgement: is this indicator of sustainability being achieved? Fully (100% of Highly (95-99% of Moderately (90-94% of Slightly (85-89% of Negligibly communities are communities – communities – stable communities – (<85% of doing CDTI) stable or increasing) or increasing) stable or increasing) communities) √
129 Instrument 4: community level (in Rungwe district)
NOTE: . This instrument evaluates the CDTI programme at the level of villages and communities, where the actual distribution of Mectizan takes place. We use the term ‘community’ to refer to both villages (in societies where there are well-defined villages) and communities where family groups are fairly isolated from each other, and do not live in a ‘village’ in the accepted geographical sense of the word. . In these communities we find the following persons are involved in the CDTI programme: * The community or village leadership – both traditional and elected. * The community directed distributors (CDDs) – the persons who have been selected by the community to do the distribution of Mectizan. * The other, ‘ordinary’ community members, who take the Mectizan yearly. In this document these persons will be referred to as ‘community members’. . When collecting information from ‘ordinary’ community members discussion groups should be conducted.
The focus of this level’s activities in CDTI The main function of this level is to distribute the Mectizan yearly to the community members: . Communities select CDDs, who are supported by the leadership and the other community members. . The CDDs update the community census every year; distribute the Mectizan appropriately; and send a report on the distribution to the FLHF level.
Geographical name of this community/ village Rungwe District. Project: Tukuyu Focus CDTI Tanzania
Researcher:Drs Emmanuel Emukah & Rehma Maggid
Date: 17 : 09 : 03 to 20 : 09 : 03
Abbreviations/ acronyms CDD community directed distributor CDTI community directed treatment with ivermectin FLHF first line health facility HSAM health education, sensitisation, advocacy, mobilisation – i.e. activities which are aimed at getting all the key players to participate wholeheartedly in the programme NGDO non-governmental development organisation
130 1. Indicators of activities and processes: planning and management
1.1 Check whether CDDs are planning and managing their CDTI work efficiently. This indicator assesses whether the programme is efficient and simple. The more streamlined and time-efficient the job, the higher its sustainability.
Characteristics of the indicator Sources of information a. CDDs choose visiting times and routes which will make the . Inspection of community work less burdensome. treatment registers. b. CDDs arrange with the community leadership for help with . Interviews with: specific problems, such as families who are not willing to * CDDs. participate in the programme. * Community c. CDDs carry out census and distribution during the same visit members. (using this census data for the following year’s order). * Community leaders. * FLHF staff.
Findings Describe the present situation:
Generally census is done separately from, and preceding, the distribution. This effectively doubles CDDs’ workload. Communities have functional committees that plan and implement CDTI.
If CDDs are not working efficiently: . Why is this?
N.A
. Are any steps being taken to improve the situation?
N. A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
131 2. Indicators of activities and processes: leadership and ownership
2.1 Check whether community leadership is managing problems with the distribution. This indicator assesses whether the programme is effective, and whether the community is taking ownership of it.
Characteristics of the indicator Sources of information a. The community leadership should be taking responsibility . Inspection of minutes of community/ for the distribution of Mectizan within the community. council meetings (where available). b. If coverage (geographical and therapeutic) is not . Interviews with: adequate or not being maintained, the leadership should * CDDs. understand the reasons for this. * Community members. c. Together with the community at large, the leadership * Community leaders. should identify and solve problems related to the * FLHF staff. distribution.
Findings Describe the present situation:
In all the communities local leadership through various committees actively support Mectizan distribution, and help to solve all problems as they arise within the village/community.
If the community leadership is not involved in the distribution: . Why is this?
N. A
. Are any steps being taken to improve the situation?
N.A
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
132 2.2 Check whether the community at large has been involved in taking decisions on the distribution process. This indicator assesses whether the community is taking ownership of the programme.
Characteristics of the indicator Sources of information a. The community should have . Inspection of minutes of community/ council meetings (where taken responsibility for available). decisions such as: . Interviews with: ∗ The selection/ changing of * CDDs. CDDs. * Community members. ∗ The timing and mode of * Community leaders. distribution. * The persons supervising CDDs: FLHF staff, lay supervisors etc.
Findings Describe the present situation:
There are committees appointed to help leaders and community implement CDTI, all decisions are however made by the entire community.
If the community is not sufficiently involved in taking decisions: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
133 2.3 Check whether the community members value and accept long-term annual treatment. This indicator assesses whether the community is taking ownership of the programme.
Characteristics of the indicator Sources of information a. Community members should be able to mention one or Interviews with: more advantages of taking Mectizan. . CDDs. b. Community members should express the need for . Community members. annual treatment with Mectizan. . Community leaders. c. People should show understanding of the need for, and . The persons supervising CDDs: FLHF express interest in long term treatment with Mectizan. staff, lay supervisors etc.
Findings Describe the present situation:
All the communities are willing and eager to support and take Mectizan as long as it is available.
If community members do not value and accept the treatment: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.5 Moderately Slightly Not at all Not applicable
134 3. Indicators of activities and processes: monitoring
3.1 Check whether CDDs are reporting appropriately to the FLHF level. This indicator assesses whether the programme is effective. If such reporting is not taking place Mectizan supply will be compromised, which is bad for sustainability.
Characteristics of the indicator Sources of information a. Reports to the FLHF level should get there on time. . Inspection of community distribution Reports may be summary reports, or the original reports. community distribution record, depending on the level of . Interviews with: skill of the CDD. * CDDs. b. Adequate transport should have been arranged for * The persons supervising CDDs: distribution records/ reports to be handed to the FLHF staff, lay supervisors etc. appropriate person.
Findings Describe the present situation:
In the majority of cases community reports were submitted in time to the FLHF. In most of the communities the village register was well kept and the CDDs had well constructed measuring device.
If the reporting by CDDs is poor: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
135 4. Indicators of activities and processes: obtaining and managing Mectizan
4.1 Check whether the right amount of Mectizan is received. This indicator assesses whether the programme is effective. If the right amounts are received it will foster community ownership, which is good for sustainability.
Characteristics of the indicator Sources of information a. All community members who were . Inspection of treatment register for the community eligible for treatment got it, and some (held by CDDs; or at higher levels) Mectizan was left over for absentees and . Interview with: those who were temporarily non-eligible. * CDDs. b. There should be a rational explanation * Community members. about how the amount ordered for the * Community leaders. community is calculated (on the basis of * The persons supervising CDDs: FLHF staff, lay population). supervisors etc.
Findings What happened at: . The last round of treatment?
In all the villages enough Mectizan was received, on time. CDDs collected all the drugs from FLHF for their Village.
. The rounds before that?
Same as above.
If the wrong amount of Mectizan was received: . Why is this?
N.A
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in Mectizan supply?
. Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.5 Moderately Slightly Not at all Not applicable
136 4.2 Check whether the CDDs or community members themselves fetch the yearly supply of Mectizan. This indicator assesses whether the project fosters community ownership.
Characteristics of the indicator Sources of information a. The CDDs or community members fetch the Mectizan they Interviews with: need every year, from a designated and mutually acceptable . CDDs. place. . Community members. b. Adequate transport should have been arranged for Mectizan to . Community leaders. be collected from such a place. . The persons supervising c. In the case of remote communities, the district/ LGA, in CDDs: FLHF staff, lay collaboration with FLHFs, should ensure that supplies reach supervisors etc. such groups. . District/ LGA staff.
Findings What happened at: . The last round of treatment?
CDDs collected the mectizan using their own bicycles and all communities received it.
. The rounds before that?
CDDs collected the mectizan using their own bicycles and all communities received it.
If community members or CDDs have not been collecting the Mectizan: . Why is this?
N, A
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in CDDs or community members fetching the Mectizan they need?
Good . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.5 Moderately Slightly Not at all Not applicable
137 5. Indicators of activities and processes: HSAM
5.1 Check whether CDDs and community authorities continue to be engaged in HSAM of other community members. This indicator assesses whether the project is effective, and whether the community has taken ownership of it.
Characteristics of the indicator Sources of information a. CDDs/ community authorities identify situations where Interviews with: community members require information. . Community leaders. b. CDDs/ community authorities take necessary steps to . Community members. provide required information; encourage community . CDDs. members to provide resources; promote acceptance and . The persons supervising CDDs: ownership (meetings, sanctions, community by-laws). FLHF staff, lay supervisors etc.
Findings Describe the present situation:
In almost all communities this is proceeding satisfactorily, although IEC materials are sometimes lacking.
Leaders and CDDs are actively involved.
If CDDs and community leaders are not involved in HSAM: . Why is this?
N.A
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.5 Moderately Slightly Not at all Not applicable
138 6. Indicators of resources: financing
6.1 Check whether the community has made arrangements to fund local costs of distribution. This indicator assesses whether the project can mobilise the resources it needs, and fosters community ownership.
Characteristics of the indicator Sources of information a. The community should support individuals Interviews with: who are providing CDTI services for them. . Community leaders. b. The community should make provision for . Community members. the supply of record books, pencils, . CDDs. transport and other expenses incurred . The persons supervising CDDs: FLHF staff, lay during CDTI. supervisors etc.
Findings Describe the present situation:
In most communities, villagers appreciate the programme, and support CDDs in kind or by exempting them from communal work and levies. Cash incentive of Tsh 1,000 to Tsh 5,000 was paid to each CDD by two villages.
If the community is not supporting or helping to defray costs: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
139 7. Indicators of resources: human resources
7.1 Check whether there is a satisfactory ratio of CDDs to households. This indicator assesses whether the project can mobilise the resources it needs, and whether the community has taken ownership of the programme.
Characteristics of the indicator Sources of information a. A ratio of at least one CDD to 20 Interviews with: households (or 2 CDDs per 250 . Community leaders. population) is recommended. . Community members. b. The households for which CDDs are . CDDs. responsible should be close to their . The persons supervising CDDs: FLHF staff, lay own homes. supervisors etc.
Findings . The present ratio in the community:
All communities visited collect their Mectizan from collection centres themselves. No cases were reported where lack of transport led to the drug not being collected.
2 CDDs per sub village of 300 to 500 persons
. The average distances that CDDs have to walk to get to homes:
2 to 3 km
If the ratio of CDDs is too low: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly Moderately Slightly Not at all Not applicable 2.5
140 7.2 Check whether all CDDs have received appropriate training. This indicator assesses whether the project is effective.
Characteristics of the indicator Sources of information a. CDDs should be skilled at their work: doing the . Interviews with: census; giving the right dose; knowing who is * Community leaders. not eligible; knowing what to do with side-effects * Community members. b. There should be a plan in place for training * CDDs. CDDs to replace those who drop out, or when * The persons supervising CDDs: FLHF new ones are elected for other reasons. staff, lay supervisors etc. . Observing CDDs at work.
Findings Describe the present situation:
All CDDs are well trained and stable.
If CDDs appear unskilled, or if there is no proper plan for training replacements: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.0 Moderately Slightly Not at all Not applicable
141 7.3 Check whether CDDs are willing to continue their work in CDTI. This indicator assesses whether the programme has mobilised the resources it needs, and whether it fosters community ownership.
Characteristics of the indicator Sources of information a. CDDs should express willingness to Interviews with: continue with distribution in the long term, . Community leaders. given the conditions which prevail in the . Community members. community. . CDDs. b. Few CDDs in this community have . The persons supervising CDDs: FLHF staff, lay dropped out from the distribution work. supervisors etc.
Findings Describe the present situation:
All CDDs are well motivated and willing to continue as long as required of them
If some CDDs are doubtful or unwilling to continue, or have dropped out: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise: * The evidence about how well this indicator is being achieved. * Reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . Your overall judgement: is this indicator for sustainability being achieved? Fully Highly 3.5 Moderately Slightly Not at all Not applicable
142 8. Indicators of output: coverage
8.1 Check whether the household coverage in the community is satisfactory. This indicator assesses whether the project is effective – if the rate is poor the project is clearly struggling, and less sustainable.
Characteristics of the indicator Sources of information a. All households and areas in the . Inspection of: community are being treated. This * CDDs’ treatment registers. includes the hamlets for which the * Yearly distribution reports for that community. community has agreed to be . Interviews with: responsible. * Community leaders. b. If this household coverage is not * Community members. 100%, it should be improving. * CDDs. * FLHF level staff.
Findings The household coverage situation: . At the last distribution:
Generally therapeutic coverage is good although in some cases it is incorrectly recorded
. The year before:
Same as above.
. The year before that:
Same as above. If household coverage is poor: . Why is this?
. Are any steps being taken to improve the situation?
Analysis . When writing the report you have to summarise the reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in household coverage?
Increasingly higher each year. . Your overall judgement: is this indicator of sustainability being achieved? Fully (100% Highly (only nomads Moderately (the Slightly (some wards Negligibly (no-one coverage of all in the surrounding outlying hamlets of the community got treated, or only households) area were missed) √ were also missed) were also missed) a few families)
143 8.2 Check whether the community has a satisfactory therapeutic coverage rate. This indicator assesses whether the programme is effective – if the rate is poor the project is clearly struggling, and less sustainable.
Characteristics of the indicator Sources of information a. The community overall has a . Inspection of: therapeutic coverage rate of 65% or * CDDs’ treatment registers. higher. * Yearly distribution reports for that community. b. This rate should be stable or . Interviews with: increasing. * Community leaders. * Community members. * CDDs. * FLHF level staff.
Findings The therapeutic coverage situation in the community: . At the last distribution:
Good between 70 to 83%
. The year before:
69 to 76%
. The year before that:
56 to 76%
If the therapeutic coverage rate is poor: . Why is this?
. Which steps are being taken to improve the situation?
Analysis . When writing the report you have to summarise the reasons for poor performance (if any); steps being taken to improve it; and how this is likely to affect sustainability. . What is the trend in therapeutic coverage?
Gradual increase each year . Your overall judgement: is this indicator of sustainability being achieved? Fully (the community has a therapeutic Moderately (the therapeutic Negligibly (the therapeutic coverage rate ≥65% - stable or coverage rate is ≥65%, but it is coverage rate is <65%) increasing) √ unstable or decreasing)
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