Zambia “SAFE” Strategy Implementation Framework 2013 - 2017

Home , Bahati (constituency), Bangweulu (constituency), Bwacha (constituency), Cabinet of Zambia, Chadiza (constituency), Chasefu (constituency)

Ministry of Health

Developed and Compiled By the Directorate of Clinical Care and Diagnostic Services National Eye Health Coordination

FEBRUARY, 2013

TABLE OF CONTENTS Statement by the Honourable Minister of Health ...... iv Foreword by the Permanent Secretary ...... vi Message on Trachoma by the Directorate of Clinical Care and Diagnostic Services ... viii Abbreviations and Acronyms ...... xii

PART ONE: ZAMBIA BACKGROUND 1

1.1.0 Country Profile ...... 1 1.1.1 Zambian Provinces and Districts ...... 2 1.2.0 Zambia Health System Goals and Priorities ...... 3 1.3.0 Eye Health Services in Zambia ...... 6 1.4.0 Aims of the “SAFE” strategy implementation framework ...... 7

PART TWO: TRACHOMA IN ZAMBIA 8 2.1.0 Introduction ...... 8 2.2.0 Trachoma Disease Burden in Zambia ...... 9 2.3.0 National Trachoma Survey Results ...... 9 2.4.0 Case for Action ...... 12 2.4.1 Impact of trachoma control ...... 13 2.4.2 “SAFE” Strategy ...... 15

PART THREE: STRATEGIC AND OPERATIONAL FRAMEWORK 17 3.1.0 Stakeholder engagement /roles and responsibilities ...... 17 3.1.2 Implementation Structure ...... 24

PART FOUR: FACTORS FOR SUCCESS 28 4.1.0 Mass Drug Administration (MDA) ...... 32

PART FIVE: STRATEGIES AND LOGICAL FRAMEWORK OF “SAFE” STRATEGY IMPLEMENTATION 35 5.1.0 Surgery ...... 35 5.2.0 Antibiotics ...... 36 5.3.0 Face and hand washing ...... 41 5.4.0 Environment ...... 43

PART SIX: NATIONAL BUDGET PROJECTIONS FOR FULL “SAFE” STRATEGY SCALE UP 46

6.1.0 Cost estimate for each “SAFE” strategy components ...... 46 6.1.1 Surgery Cost Estimate...... 46 6.1.2 Antibiotics cost estimate...... 48 6.1.3 Face and hand washing...... 50 6.1.4 Environment...... 52

PART SEVEN: FUNDING FOR THE “SAFE” STRATEGY IMPLEMENTATION 57 7.1.0 Sources of funding ...... 58

PART EIGHT: GANTT CHART 59

PART NINE: REFERENCES 60

PART TEN: APPENDICES 61

10.1.0 Appendix 1: Schools and surrounding communities visited during ITM survey. 61

10.2.0 Appendix 2: Areas visited during trachoma mapping in fifteen districts using the WHO classical method ...... 87

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Statement by the Honourable Minister of Health

Zambia needs a healthy population in order to develop and thrive. The Zambian people are the largest and greatest asset the country has. As a country we still hold to the affirmation and promise to work towards elimination and eradication of all Neglected Tropical Diseases including trachoma. We keep this aspiration and momentum through our mission statement of, “Providing Quality Health Services as close to the family as possible.”

This document focuses on the trachoma situation in the country and re-affirms my government's commitment to work with all cooperating partners, civil society, the corporate sector and line Ministries in our pursuit to control, manage and eliminate trachoma in Zambia. It comprehensively highlights the goals, objectives and strategies toward control and elimination of trachoma in Zambia by the year 2020. It also provides an impetus in the reduction of the burden of other infectious diseases like cholera, typhoid, dysentery and other NTDs whose root cause is also related to poor sanitation and hygiene through the “SAFE” strategy components.

The challenge in the control of trachoma disease in Zambia has been inadequate resources towards prevention, control and case management coupled with the absence of the institutional framework to fight against trachoma. The inadequate data on the extent of the disease has now been addressed. The prevalence of this disease can be used as an indicator of poverty levels in the country as it mostly affects the poor and marginalized communities. The chronicity of the disease disables and deprives people of their dignity and self esteem. Our priority is to improve the standards of sanitation and hygiene as well as safe water supply as we contribute to the country’s effective response to trachoma.

I take sincere pleasure in thanking all our “It comprehensively highlights partners and the members of staff at the the goals, objectives and Ministry of Health for their hard work in strategies toward control and bringing to light this major public health elimination of trachoma in challenge in our country. It is my sincere Zambia by the year 2020. It will hope that this partnership will strengthen also provide an impetus in the and that ultimately we can achieve the goal reduction of the burden of other of eliminating trachoma by the year 2020. poor sanitation and hygiene Ministry of Health will endeavour to related infectious diseases such collaborate with other line Ministries in the as cholera, typhoid, dysentery fight against trachoma. and other NTDs through the

“SAFE” strategy components.”

We welcome any guidance, advice and support from our partners, civil society, line Ministries and all other stakeholders in the fight against trachoma and other Neglected Tropical Diseases.

My Government shall remain committed to ensuring that our country achieves the goal of eliminating trachoma by the year 2020.

Foreword by the Permanent Secretary

The trachoma survey conducted by MoH and cooperating partners revealed that trachoma is endemic in all provinces of Zambia, with highest prevalence rates found in Southern, Copperbelt, Northern and Muchinga Provinces. Areas affected by trachoma are characterized by perennial water shortages, inadequate sanitation, poor hygiene and poverty.

In its trachoma control programme, Zambia has benefitted from various stakeholders. These stakeholders include Ministry of Health, other line Ministries and the eye health co-operating partners such as CBM, Centre for Disease Control (CDC), Colin Glassco Foundation, Geneva Global (GG), International Trachoma Initiative (ITI), Lions Aid Norway (LAN), Operation Eyesight Universal (OEU) and Sightsavers (SS).

All 72 districts (as at 2011) were surveyed for trachoma. In fourty six “The WHO “SAFE” strategy is certainly the way to go in (46) districts trachoma was identified responding to the trachoma burden as a Public Health Problem which in the country. This strategy places emphasis on serious structural require the full implementation of the transformation in our delivery of “SAFE” strategy. This translates into water and sanitation services. This certainly provides yet another 70% of the districts being endemic avenue for attainment of the with active trachoma with an average MDGs.” prevalence of 15%.

The above findings call for a complete shift in mindset at the community and national levels and change of priorities, especially at the Local Government level. There is need to have a more comprehensive strategy if trachoma is to be eliminated. The WHO “SAFE” strategy is certainly the way to go in responding to the trachoma burden in the country.

This strategy places emphasis on serious structural transformation in our delivery of safe water and sanitation services. This certainly provides yet another avenue for attainment of the MDGs.

The “SAFE” Strategy has been instrumental in developing a framework that will provide a guide in the planning, delivery, and management of “Clean, Caring, Competent and Confidential eye health services at Community, District, Provincial and National levels” in trachoma elimination. The “SAFE” strategy also provides the Ministry of Health with yet another opportunity of synergizing resources in combating all the diseases arising due to poor sanitation and hygiene and lack of safe water.

The Ministry of Health and its partners in the trachoma response have found it prudent to apply the most appropriate strategies in the implementation of all activities and programmes pertaining to the “SAFE” strategy in the elimination of trachoma. Accompanying the implementation of activities will be a robust Monitoring and Evaluation program that would ensure that the program is not only on course but able to achieve the intended vision and goal.

The projected budget to fully implement the full “SAFE” strategy in the 46 districts over a period of five years is two billion three hundred fourteen million seven hundred sixty thousand four hundred sixteen kwacha and eighty ngwee (K2,314,760,416.80). In terms of USD this translates to $445,146,234.00 at K5.20n to $1.0 USD.

The expected source of funding will be MoH, the line Ministries, cooperating partners, the corporate sector and other well wishers.

It is my firm belief that with commitment, we shall eliminate trachoma by the year 2020.

vii

Message on Trachoma by the Director of Clinical Care and Diagnostic Services

The trachoma population survey conducted by MoH between 2007 and 2012 to determine the prevalence of the disease showed that trachoma is a Public Health problem in Zambia. The surveys also confirmed that trachoma is found in the areas with poor water supply and sanitation. This was compounded by lack of awareness, non-existence of trachoma prevention, control and management programs and lack of evidence which hampered planning and implementation of trachoma elimination programs.

It is a fact that trachoma arises from poverty “The trachoma population and propagates poverty. It also has grave survey conducted by MoH between 2007 and 2012 to medical and socio-economic ramifications. It determine the prevalence of the is encouraging to note that with the help of disease evidently showed that trachoma is a Public Health local and international partners, Zambia has problem in Zambia.” an opportunity to eliminate trachoma as a public health problem by the year 2020.

The response to the trachoma challenge begins with the strengthening of the trachoma elimination programme in the Ministries of Health and Community Development Mother and Child Health and further enhancing collaboration with other line Ministries and partners. As my directorate is responsible for co-ordinating all trachoma related activities and programmes, one of its broader mandates is to ensure that trachoma is eliminated by the year 2020. It is for the above reasons that the directorate embarked on an ambitious plan to map the prevalence of trachoma in the whole country – a task that was achieved in an unprecedented manner in 2012.

The major responses to the challenge of trachoma are as follows:

 Redesigning primary eye health care activities  Providing technical guidelines for interventions and training of various health care providers, (clinicians, community health workers and the neighbourhood health committees). viii

 Advocacy and resource mobilization  Lobbying for Political will in fighting trachoma  Enhanced partnerships and collaborations with all stakeholders

This “SAFE” strategy framework will serve as a road map for all stakeholders to fully implement the trachoma elimination programme in Zambia. This document provides information on the disease burden in the country and clear guidance on the principles and strategies of trachoma elimination in order to attain GET 2020.

The Ministry of Health would not have come up with this important document without the support of partners and individuals who worked tirelessly to ensure that Zambia had the evidence she needed to fully roll out the “SAFE” strategy.

My special thanks go to the following individuals and their organisations:

1. Dr. Kangwa Ichengelo Mulenga Muma NPBC secretary, NEHC, MoH

2. Dr. Davison J. Kwendakwema Consultant Ophthalmologist,

Beverly Eye Centre

3. Dr. Grace Chipalo – Mutati Consultant Ophthalmologist and

Head, Eye Department, UTH

4. Dr. Asiwome Seneadza Consultant Ophthalmologist and

Head, Eye Department, KCH

5. Dr. Namani Monze Consultant Ophthalmologist and

Medical Superintendent,

Livingstone G. Hospital

6. Dr. Edith Pola – Smith Consultant Ophthalmologist

Mining Conglomerate

7. Dr. Janie Yoo Consultant Ophthalmologist and

Medical Director, LEH

8. Dr. Bushimbwa Tambatamba Deputy Director, Epidemilogy

and Disease Control, MCDMCH

9. Dr. Simon Chisi Consultant Ophthalmologist and

Medical Superintendent,

St. Francis Hospital

10. Ms. Glenda Mulenga Country Director, Sightsavers

11. Mr. Jan Erik Larsen Country Director,

Lions Aid Norway

12. Mr. Delphin Kinkese Country Director, OEU

13. Mr. Alfred Mwenifumbo Country Director, Geneva Global

14. Mr. Cledwin Mulambo Director, Department of Housing

and Infrastructure, (DHID) MLGH

15. Mr. Christopher Chileshe Director, Water Affairs, MMEWD

16. Dr. Chileshe Mboni President, Zambia

Ophthalmological Society (ZOS)

17. Dr. Fatson Liche Secretary General, Zambia

Ophthalmological Society (ZOS)

18. Dr. David Kasongole Consultant Ophthalmologist, LGH

19. Dr. Consity Mwale Consultant Ophthalmologist and

Head Clinical Care,

Mansa General Hospital

20. Mr. Mathew Mwetela Programme Officer, Lions Aid

Norway

21. Mr. Benson Chulumanda Head of Department, Education,

(MoESVT)

22. Dr. Alex Mumba Consultant Ophthalmologist,

Chainama College of Health

Sciences

23. Dr. Elijah Mutoloki Consultant Ophthalmologist and

Medical Superintendent, KGH

24. Dr. Agatha Aboe NTD consultant, Sightsavers

25. Dr. Alemayeu Saya Country Director, Orbis, Ethiopia

26. Dr. Teshiome Gebre Africa Region Director, ITI

27. Ms. Grace Chanda Chikoti Senior Chiefs Affairs Officer,

MoCTA

28. Mr. Jason Mwanza Programme Officer, ADRA

Zambia

Abbreviations and Acronyms

ADRA Adventist Development and Relief Agency BCC Behavioural Change and Communication CBM Christian Blind Mission CHW Community Health Worker CIDA Canadian International Development Agency CLTS Community Lead Total Sanitation CSR Corporate Social Responsibility DANIDA Danish International Development Agency DDCC District Development Coordinating Committee DFID Department for International Development DMO District Medical Officer DTTF District Trachoma Task Force EC European Community GDP Gross Domestic Product GET Global Elimination of Trachoma GRN Goods received notes GRZ Government of the Republic of Zambia IEC Information Education Communication ITI International Trachoma Initiative JICA Japanese International Cooperation Agency KCH Kitwe Central Hospital KGH Kasama General Hospital LAN Lions Aid Norway LCMS Living Conditions Monitoring Surveys LEH Lusaka Eye Hospital LGH Lewanika General Hospital MCDMCH Ministry of Community Development, Mother and Child Health MDA Mass Drug Administration MDG Millennium Development Goal MLGH Ministry of Local Government and Housing

xii

MGH Mansa General Hospital MMEWD Ministry of Mines, Energy and Water Development MoCTA Ministry of Chiefs and Traditional Affairs MoESVT Ministry of Education, Science and Vocational Training MoH Ministry of Health MoU Memorundum of Understanding NEHC National Eye Health Coordinator NEPPMC National Epidemilogical Preparedness, Planning and Management Committee NGO Non-Governmental Organisation NTD Neglected Tropical Diseases NTTF National Trachoma Task Force OCO Ophthalmic Clinical Officer OEU Operation Eyesight Universal ON Ophthalmic Nurse PDCC Provincial Development Coordinating Committee PTTF Provincial Trachoma Task Force SAFE Surgery, Antibiotics, Face washing and Environment SS Sightsavers TF Trachomatous Inflammation Follicular TI Trachomatous Inflammation Intense TOT Training of trainers TT Trachomatous Trichiasis UNICEF United Nations Children’s Fund USAID United States Agency of International Development USD United States Dollar UTH University Teaching Hospital VAO Vision Aid Overseas VIP Ventilated Improved Pit Latrines WASHE Water, Sanitation, Hygiene and Education WHO World Health Organisation ZDHS Zambia Demographic Health Survey

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PART 1: BACKGROUND

1.1.0 Country Profile

Zambia is a landlocked Sub-Saharan country sharing boundaries with Malawi, Mozambique, Zimbabwe, Botswana, Namibia, Angola, Democratic Republic of the Congo and Tanzania (figure 1). It has a total surface area of 752,614 km2, thus ranking as one of the vastest countries in South Central Africa. It lies between 8° and 18° south latitudes and 22°and 34° east longitudes. It has a tropical climate, modified by the altitude of the country and three main seasons.1

Figure 1: Map of Zambia showing the provinces

The wet and warm season lasts from November to April, cool and dry season from May to July and hot dry season from August to October.1

Zambia has a number of major rivers that are the main sources of water — the Zambezi, Kafue, Luangwa, Chambeshi and Luapula rivers. The country also has major lakes namely Tanganyika, Mweru, Bangweulu and the man-made Lake Kariba.1, 2

The Zambian terrain is mainly high plateau with some hills and mountains. It also has valleys with the lowest point in the Zambezi River at 329 m and the highest peak on Mafinga Mountain at 2,301 m. The main vegetation is Savannah with areas of tropical grassland and woodlands comprising a variety of grass and tree species. The country has nine eco – regions in four biomes, with the largest being the Miombo, Mopane and Savanna. Several seasonal flood areas also exist in flat swampy and marshy plains.1, 2

The northern part of the country receives the highest rainfall, with an annual average ranging from 1,100 mm to over 1,400 mm. The southern and eastern parts of the country have less rainfall, ranging from 600 mm to 1,100 mm annually, which often results in droughts and inadequate food. The average monthly rainfall is around 10 mm. Zambia’s annual average temperature is 20OC and the relative humidity averages 61.5% and ranges between 34% and 86%.1, 2

1.1.1 Zambian Provinces and Districts

Administratively, the country is divided into ten provinces, namely Central, Copperbelt, Eastern, Luapula, Lusaka, North-Western, Northern, Southern, Western and Muchinga Provinces. Muchinga is the most newly formed Province, from the Northern and Eastern Provinces. These provinces are subdivided into districts which are then divided into constituencies and further divided into wards. Lusaka is the capital city of Zambia and the seat of government. The number of districts has increased from 72 in 2011 to 101 in 2012 as government promotes its decentralisation policy.1, 2, 3

The population of Zambia has continued to grow. The 1980, 1990, 2000 and 2010 censuses put the population of Zambia at 5.7, 7.8, 9.9 and 13.1 million respectively. The annual population growth rate is 3.1 as at the 2010 national census. The population by province ranges from 2.19 million in Lusaka to 0.7 million in North- Western Province.1, 2, 3 2

1.2.0 Zambia Health Systems Goals and Priorities

Table 1: Vision and Mission statement, MoH, Zambia

Vision: A nation of healthy and productive Zambians

Mission To provide equitable access to cost effective, quality health Statement: services as close to the family as possible

Overall Goal: To improve health services in order to attain significant reductions in morbidity and mortality.

Key Principles: Equity of access; Universal coverage; Affordability; Cost- effectiveness; Accountability; Partnerships; Decentralisation and Leadership.

To attain the policy objective of reducing poverty and improving income distribution, Zambia has adopted its macroeconomic objective, accelerated pro-poor economic growth through securing macroeconomic stability, structural reform and investment in human development.2, 3 The target is to reduce the poverty head count from the current 68% (2007 LCMS) to less than 20% of population living below the poverty datum line (World Bank-defined poverty line of U$1 per day) and to improve income distribution to a coefficient of less than 0.40 from 0.53 in 2006. Attainment of such targets would require sustained economic growth rates of 8% or more for a number of years. In the past 10 years Zambia has registered significant progress in reorganizing and stabilizing its economy and improving economic growth with an average growth rate of 6.1% with the GDP is at $1,472.00. The major economic drivers are copper mining and agriculture.2, 3, 4

Investment in human development in sectors such as health is key to fostering long term economic growth and poverty reduction. The presence of good health is necessary not just to improve the quality of life of an individual but also to raise the ability of people to increase their incomes at a micro level, thereby contributing to poverty alleviation and facilitation of a productive and growing economy at the macro level. Economic development including sanitation, hygiene and safe water supply is expected to improve the general welfare, health and education status of the population. This is a huge stepping stone towards trachoma elimination.2, 3, 4

Better child health and nutrition allow children to develop into healthier and more productive adults thereby promoting a nation’s overall productivity and growth. This will also support women to live more productive lives. Better health can also reduce the amount of money spent on curative care, thereby freeing up resources for alternative investments.2, 3, 4

Various Poverty Assessment reports have identified ill-health as the leading cause and consequence of poverty and for this reason health continues to be an important element in individual, community and national development. To bear fruit, economic investments should include investments in human capital through improved health and education as a way of sustaining the nation’s human capital base for sustained economic growth.2, 3, 4

In the Vision 2030, Zambia reaffirmed its commitment to achieving the Millennium Development Goals (MDGs). Notably, the MDGs are consistent with the objectives in the National Development Plans and the National Health Strategic Plans. With a focus on the attainment of the health-related MDGs, this National Health Strategic Plan is based on the World Health Organization’s (WHO) six building blocks for health systems, albeit with the addition of a seventh section on infrastructure as a framework for planning and priority-setting (figure 2).3, 4

The WHO health systems building blocks (figure 2) outline the essential functions of a health system, and this has been used for planning and priority-setting in the “SAFE” strategic implementation framework. The creation of strong health systems is not an end in itself. It is rather a means to achieve better health outcomes. Effective and equitable health systems are not only required for achieving the MDGs but also to ensure value for money.3 There is broad consensus that to maintain and improve the health of people, governments must shape sound and efficient health systems that provide effective disease prevention and treatment to all; women, men and children in an equitable manner. The full implementation of the “SAFE” strategy provides yet another hope of attaining the MDGs.2, 3, 4

Figure 2: Health System Building Blocks (Adapted from WHO)

1.2.1 Zambia Health Indicators

Zambia is experiencing a double epidemic of rapidly increasing NCDs and the ever troubling infectious diseases. The average HIV Prevalence of Zambian adults aged 15 to 49 years old is 14.3% and ranges from 7 to 21% depending on the province. More than 450,000 people are accessing ARVs currently freely. The malaria prevalence rate is 330/1000 with active trachoma being at 15% and ranging from 10 to 52.9%.2,3,4

Data from the 2007 ZDHS indicate that the infant mortality rate is 70 deaths per 1,000 live births, while the under-five mortality rate is 119 per 1,000 live births for the five- year period immediately preceding the survey. The neonatal mortality rate is 34 per 1,000 births. Thus, almost two-thirds of childhood deaths occurred during infancy, with more than one-quarter taking place during the first month of life.2, 3

Health service delivery is through a 5 tier system starting from health post, health centre, three level hospitals of primary or district hospitals, secondary or second level hospitals and teriary or third level hospitals.3 5

The referral system follows the hierarchy of health facilities. The health services delivery is 79.12% public, 6.48% faith based and 14.40% private. The MoH establishment is currently at about 50% capacity.3

1.3.0 Eye Health Services in Zambia

Currently, provision of eye care services is mainly done at provincial and tertiary centres namely UTH, KCH, LGH, MGH, KGH, Choma General Hospital, Ndola Central Hospital, Arthur Davison Hospital and Livingstone General Hospital. The existing eye care outreach programmes are inadequate and confined to selected parts of the country. The eye health services must certainly be extended to the primary health care level.4, 5

The service providers also include private eye centres such as Beverly Eye Centre, the Mining Conglomerate, Vision Care Appasamy and mission hospitals such as St. Francis Hospital, Lusaka Eye Hospital (LEH), Mwami Adventist Hospital and Chikankata Salvation Army Hospital.5

The Non-Governmental Organisations such as Cheshire, CBM, Lions Club, Lions Aid Norway (LAN), Operation Eyesight Universal (OEU), Sightsavers and Geneva Global (GG) have also been providing financial and technical support to complement government efforts, and have since contributed to implementation of full-fledged eye health programmes in various parts of the country.5

The MoH has committed itself to the provision of clean, caring, competent and confidential eye health care services across the country by buying equipment/instruments, medical/surgical consummables and supporting training of personnel at different levels of Eye Health Care. It also provides an enabling environment for the various partners to work in. The MoH has further committed to introducing Eye Health Services at primary health institutions such as district hospitals and health centres.4, 5

1.4.0 Aims of the “SAFE” strategy implementation framework

1.4.1 To provide a clear road map of the full implementation of the “SAFE” strategy. 1.4.2 To advocate for scaling up of Mass Drug Administration (MDA) of azithromycin to treat all active infections and control disease transmission. 1.4.3 To facilitate the spearheading of the trachoma control programmes by the National, Provincial and District Trachoma Task Forces in implementation of the “SAFE” strategy. 1.4.4 To enhance collaboration of MoH with the line Ministries, cooperating partners and the corporate world in the full implementation of the “SAFE” Strategy. 1.4.5 To build community participation, ownership and responsibility for the “SAFE” strategy. 1.4.6 To promote positive personal and community behavioural change towards sanitation, hygiene and safe water supply.

PART 2: TRACHOMA IN ZAMBIA

2.1.0 Introduction

Trachoma is the leading cause of preventable blindness in the world. It is characterized by an infection of the upper eye lid which is caused by a germ (bacterium) called Chlamydia trachomatis. It is common in developing countries that have poor environmental sanitation, inadequate safe water supply and poor social economic status. When trachoma occurs or is experienced for the first time, it might not cause a major problem. However, repeated infections cause scarring on the inner aspect of the upper eyelid eye, which in turn forces the upper eye lashes to turn inwards and consequently rub on the cornea, resulting in ulceration of cornea (the part commonly referred to as the black part of the eye), scarring of the cornea and eventually visual impairment and blindness.6, 7, 8

Globally, there are 1.3 million people blind and 1.8 million people with low vision as a result of trachoma. Trachoma exists in all parts of Zambia as it has been demonstrated in studies. It is now a known fact that 11.8 million people live in trachoma endemic districts in Zambia. In our environment, inadequate safe water supply and poor sanitation are some of the factors that define the risk and severity of trachoma.7

As the leading cause of preventable blindness, trachoma disproportionately affects those least able to help themselves, predominantly women and children. The disease contributes to a vicious cycle of poverty and infection. Living conditions associated with poverty contribute to the spread of trachoma, and the resulting vision loss exacerbates poverty by decreasing productivity (of the blind), and compromising the education of future generations (as children frequently miss school to assist their blind elders in the activities of daily life). Lacking intervention to interrupt this vicious cycle will result in many rural Zambians remaining subject to the risk of blindness and the associated ills of poverty and disability.6, 7, 8

2.2.0 Trachoma Disease Burden in Zambia

The earlier trachoma surveys were carried out, between 2003 and 2011, in seven districts of Zambia, namely Chienge, Choma, Kaoma, Mpika, Mufulira, Nchelenge and Sinazongwe.5, 6, 7 In all but one district (Mpika), trachoma was identified as a major health problem requiring “SAFE” strategy interventions. In an effort of continued mapping of trachoma more population surveys were conducted in the rest of the 65 districts between March and December 2012 as shown in table 2.6, 7

2.3.0 National Trachoma Survey Results

Figure 3: Picture showing a child’s dirty face and flies on the face

A total of 124,979 participants took part in the trachoma survey which occurred between March and December, 2012. There were 63, 099 children aged 1 to 9 years whereas the number of female adults aged 15 years and above was 61, 882. This sample size represented a population of 11,874,374.7, 8

Fourty six (46) districts were found to be endemic for trachoma and the population due for treatment of trachoma in the 46 districts is 8,156,982. The prevalence rates of active trachoma or trachomatous follicles (TF), among the 1-9 years olds ranged from 10.1% in Mpongwe and Luwingu districts to 52.9% in Gwembe.7, 8

Meanwhile the prevalence rates of trachomatous “10 to 30% people trichiasis (TT) among the group of women aged 15 have access to clean years or older ranged from 0% in a number of districts safe water.” ______to 6.9% in Kapiri Mposhi (Table 2). From the results “Only 20 to 40% obtained, the highest prevalence rates of trachoma households in villages have toilets” were found in Southern Province, followed by

Northern, Copperbelt, Muchinga, and Central Provinces. Other provinces endemic for trachoma include Luapula, Western, Eastern, and North-western. The rest of the description is shown in Table 2. Only 10 to 30 percent of the participants had access to clean safe water and only 20 to 40 percent of the households had toilets.7, 8

Table 2: Prevalence rates for trachoma (TF among children aged 1-9 years TT among adults aged 15 years and above). № PROVINCE DISTRICT TF rate (%) TT rate (%) 1 Central Mumbwa 4.0 0.0 2 Chibombo 4.9 1.5 3 Kabwe 7.2 1.2 4 Kapiri Mposhi 13.3 6.9 5 Mkushi 11.7 1.1 6 Serenje 15.3 0.5

8 Eastern Chadiza 14.4 0.5 7 Chipata 4.9 0.9 9 Katete 0.5 0.2 10 Lundazi 16.0 3.7 11 Mambwe 8.2 1.5 12 Nyimba 0.7 0.0 13 Petauke 0.9 0.0

14 Copperbelt Chililabombwe 17.8 0.0 15 Chingola 13.7 0.0 16 Kalulushi 14.6 0.0 17 Lufwanyama 11.0 0.0 18 Masaiti 12.1 0.0 10

19 Mpongwe 10.1 0.0 20 Kitwe 20.5 0.1 21 Ndola 15.1 0.1 22 Luanshya 13.6 0.0

23 Lusaka Chongwe 2.2 0.0 24 Luangwa 0.5 0.0 25 Lusaka 0.5 0.0 26 Kafue 7.1 0.0 27 Siavonga 4.8 0.6

28 Southern Mazabuka 46.5 0.6 29 Monze 52.3 0.6 30 Gwembe 52.9 3.8 31 Itezhi tezhi 35.8 0.5 32 Namwala 16.1 0.2 33 Kalomo 0.06 0.8 34 Livingstone 10.8 0.3 35 Kazungula 19.9 0.5

36 Luapula Kawambwa 7.3 0.7 37 Mansa 10.5 1.7 38 Milenge 16.4 0.8 39 Mwense 4.4 0.6 40 Samfya 7.9 0.5

41 Northern Chilubi 15.6 0.7 42 Kaputa 19.6 1.7 43 Kasama 11.4 2.8 44 Luwingu 10.1 1.6 45 Mbala 3.2 0.9 46 Mporokoso 18.7 2.4 47 Mpulungu 4.2 1.8 48 Mungwi 16.5 2.3

49 Muchinga Chama 15.5 4.5 50 Chinsali 28.5 0.6 51 Isoka 20.0 1.8 52 Nakonde 0.8 0.7

53 Northwestern Chavuma 1.8 0.0 54 Kabompo 6.4 0.0 55 Kasempa 10.7 0.0 56 Mufumbwe 5.6 0.2 57 Mwinilunga 9.4 0.5 58 Solwezi 7.0 0.0 59 Zambezi 2.9 0.0

60 Western Lukulu 15.3 0.0 61 Mongu 2.1 0.0 62 Senanga 7.4 0.0 63 Sesheke 4.7 0.0 65 Shang’ombo 15.2 0.0 65 Kalabo 42.1 1.2

The results from the 65 districts showed that trachoma is a major public health problem, with 46 districts having a prevalence rate for active trachoma above 10% for TF and 1% for TT. Similarly, the TT rates were significantly high, up to 6.9%.7, 8

The areas in the districts surveyed are listed in appendix 1 of the framework document.

2.4.0 Case for Action

The above findings call for a complete shift in mindset and priorities of the individuals, communities and the Local Government System. This, therefore, calls “In addition to eliminating trachoma, the core for serious structural transformation of components of “SAFE” delivery of effective sanitation, hygiene and strategy will also help to reduce the burden of other safe water supply services. Pursuing infectious diseases like trachoma elimination yields a number of cholera, typhoid and other Neglected Tropical Diseases broader benefits beyond the avoidance of such as schistosomiasis, disability and death. Personal hygiene, lymphatic filariasis and human African education and environmental change trypanosomiasis.” initiatives contribute to a broader development agenda.

In addition to eliminating trachoma, the core components of the “SAFE” strategy will also help to reduce the burden of other infectious diseases like cholera, typhoid and other Neglected Tropical Diseases such as schistosomiasis, lymphatic filariasis and human African trypanosomiasis.

2.4.1 Impact of Trachoma control

The aim of trachoma elimination – freeing all Zambians from an easily preventable cause of blindness – not only preserves the sight and health of our most vulnerable citizens but also enables them to live long and productive lives. Most importantly, it ensures that our children do not have to face the possibility of trachoma infection and blindness.

Zambia has made steady progress towards the attainment of a number of the Millennium Development Goals (MDGs) in the past few years. However, much more needs to be done to meet all of the MDG targets by 2015. Many of the challenges are anchored in the deterioration in economic and social conditions witnessed after many years of copper price depreciation and overall economic stagnation. The control of trachoma presents yet another avenue in the attainment of the MDGs by the year 2015 through the full implementation of the “SAFE” strategy. Integrated and collaborative efforts made towards eliminating trachoma would translate into:

1. Enhanced eradication of extreme poverty and hunger 2. Enhanced efforts in achieving universal primary education 3. Promoting gender equality and empowering women 4. Reducing child mortality rates 5. Increased efforts in improving maternal health 6. Combating HIV/AIDS, malaria, and other infectious diseases 7. Ensuring environmental sustainability

This calls for the integration of environmental considerations into mainstream country development programmes on sanitation, hygiene and safe water supply to the communities. This opportunity should focus on sustainable development outcomes that provide continuity to the communities. Environmental improvement and sustainability can be a boom for development solutions to social services and a key to a health Zambia. This presents a major link between MoH and MCDMCH in as far as involving community participation. The succees of this MDG is an absolute requirement of the success of other MDGs.

The “SAFE” strategy provides this opportunity of strengthening the journey

towards the attainment of MDGs.

8. Developing a global partnership for development

Sustained and robust economic growth is essential but not sufficient on its own for the achievement of these goals. Macroeconomic and structural policies that promote job creation, economic inclusion, social empowerment, social services improvement and significant levels of investment in health and education are also necessary.

Some key policy and investment choices that can accelerate the achievement of all the MDG targets include: (i) empowering the women through education and opportunities (ii) more accessible and efficient delivery sanitation, hygiene and safe water to the poorest (iii) implementation of environmental change adaptation and mitigation strategies (iv) commercialization of small scale agriculture and diversification of the rural economy (v) an institutionalized social security system to protect the most vulnerable

Eliminating trachoma results in healthy and happy communities

2.4.2 “SAFE” Strategy

The implication of the trachoma findings in Zambia is that there should be maximum application of the “SAFE” strategy, which is a WHO approved approach to fighting trachoma. The “SAFE” strategy is an acronym for: ■ S - Surgery to stop trichiasis from causing blindness.

■ A - Antibiotics to treat active infections and prevent further transmission.

■ F - Facial cleanliness helps to reduce the spread of trachoma by fingers, flies and fomites.

■ E - Environmental improvement such as access to adequate clean water and basic hygiene and sanitation. This will reduce exposure to the bacteria and re-infection.

Figure 4: “SAFE” strategy components in pictures 9

The critical role of education is very cardinal in the full implementation of the “SAFE” strategy. The F aspect of the “SAFE” strategy addresses IE&C and BCC issues. In all implementation programmes of the SAFE strategy, education is key. The education unit of the MoH will be actively involved. The Ministry of Education will also be involved in the education of all aspects of the “SAFE” strategy - as advocated for internationally. Therefore, this document stresses the importance of education and sensitization in order to have successful implementation of the “SAFE” strategy. The purpose of this is to contextualize the WHO “SAFE” strategy to the Zambian scenario. The political will be lobbied through provincial and district development coordinating committees, PDCC and DDCC, respectively

PART 3: STRATEGIC AND OPERATIONAL FRAMEWORK

3.1.0 Stakeholder Engagement / Roles and Responsibilities

In order for Zambia to effectively combat trachoma, a multi-sectoral approach is required to build concerted efforts and cohesion in the elimination of trachoma. In fully implementing trachoma “SAFE” strategy we are going to use the sector comparative advantage of the various line ministries, cooperating partners, corporate sector and all the stakeholders. The key factor will be integration of the trachoma elimination strategies into the individual line ministries existing programmes as well as those of cooperating partners and the corporate world.

The hallmark activity of this framework is to enhance capacity and build community participation, ownership and responsibility for the “SAFE” strategy implemention. The “SAFE” strategy will be implemented over a period of 5 years starting from 2013 to 2018.

In addition, both at national and district levels, advocacy and collaboration will be critical in order to proritise trachoma endemic areas for “SAFE” strategy implementation.

Table 3 below highlights scope of engagement and key responsibilities of Ministries as an implementation plan for the full “SAFE” strategy.

17 3.1.1 Government ministries implementation plan

Table 3: Scope of engagement and key responsibilities of Ministries

Ministry Scope of engagement Key responsibilities Ministry of Health Lead stakeholder to provide policy, implementation To establish and support the NTTF and PTTF (MoH) guidelines and coordination of the elimination of To coordinate and lead the full roll out of the “SAFE” trachoma. strategy framework To provide secretariat for the “SAFE” strategy To ensure that surgeries for TT are incorporated into the implementation. existing service delivery structures To ensure collaboration with other line Ministries, To coordinate MDA cooperating partners, and the corporate sector. To conduct monitoring, evaluation and reporting on all MoH will also be responsible for coordination with trachoma elimination initiatives at National level. the MCDMCH. To host NTTF meetings To enhance collaboration with other divisions of To engage cooperating partners to support the “SAFE” the Ministry of Health, including other NTDs, strategy implementation district leadership, and the broader health system To lobby for political will in the fight against trachoma shall be critical to ensure that trachoma is not To integrate trachoma in other programmes aimed at handled as a “vertical silo,” but rather as one fighting infectious diseases

component of the broader health system and NTD To enhance the activities of Community Led Total strategy that capitalizes on complementarities Sanitation (CLTS) To mobilize and allocate resources (human, financial and with other efforts logistical) mainly for the two components of the “SAFE” strategy (Surgery and MDA)

Ministry of Is the main driver of promoting community To inspire and mobilise positive behavioural change at Community participation and behavioural engagement towards community level tailored towards ownership of the Development “SAFE” strategy. trachoma elimination programmes. Mother and Child Will be vital in making the community take a lead Work with communities to encourage face and hand Health (MCDMCH) in implementing and running the “SAFE” strategy. washing, general health education, sanitation and MCDMCH will also be responsible for coordinating increased safe water supply. with the MoH. Engage communities in fundraising for drilling of boreholes and constructing VIP latrines. Directing “SAFE” strategy support to most needy and disadvantaged communities. Establishment and support of DTTF/DDCC Integration of “SAFE” strategy at primary health care level through their planning and service delivery To be able to conduct MDA To integrate trachoma in other programmes aimed at fighting all infectious diseases To play a community influential role in CLTS programme

Ministry of Local Is the lead ministry for WASHE activities Vital in enforcing and strengthening laws and regulations Government and with regard to community behavior towards safe human Promoting and protecting the public’s health in Housing (MLGH) waste disposal, water safety, general community hygiene addressing public health factors at a localised level. and sanitation Where there may be no legislation, there may be need to Protection and enhancement of the health and introduce some form of bylaws to strengthen the above wellbeing of the community To enhance the activities of Community Led Total As such, it will be the key partner in the scale-up Sanitation (CLTS)10 of environmental change activities Prioritise Trachoma endemic communities for drilling 2500

Will work through the National Rural and Urban boreholes, 600 hand dug wells and 60 intermediate Water and Sanitation Programmes to improve the options per year as profiled availability of safe water points To engage local government leadership such as councilors to take a leading role in trachoma elimination MLGH will upgrade the messaging and subsequent Working through WASHE committees to integrate dissemination to all districts programmed for trachoma in their community led water and sanitation accelerated sanitation efforts programmes Trachoma awareness will be integrated into the Advocate for the inclusion of trachoma in the WASHE ongoing National Rural Water and Sanitation strategies at district and community levels. Programme (NRWSSP) which is implemented Enhance efficient management of water at community countrywide through local authorities and other level stakeholders.10

Ministry of Will play an important role in the development and To introduce trachoma in the existing health programme Education, Science, execution of face washing education initiatives. called school health and nutrition Vocational Training Efforts to integrate trachoma control into the School coordinators to be equipped with relevant skills (MoESVT) national school health curriculum should be a and knowledge on trachoma elimination. priority. In addition, advocacy with district Give regular talks to learners on health matters in education officers would be included in district collaboration with Ministry of Health officials strategies to encourage and support the development of teacher capabilities in delivering Work with child to child clubs in schools as a platform to these lessons. promote good health practices

Strengthen existing clubs to make them more active in the dissemination of trachoma information among the children

Work with health workers to give health talks in schools

Ministry of Chiefs Is an important vehicle through which rural Work hand in hand with the Chiefs to disseminate and Traditional development can be delivered to the Chiefdoms. information on trachoma to all the chiefdoms Affairs (MoCTA) Will play an important role in ensuring that the To ensure that the subjects in various chiefdoms are traditional leadership across the country is sensitized on community based approaches to combating sensitized about trachoma. trachoma such as face and hand washing and maintaining basic hygiene standards Use traditional ceremonies as a platform for disseminating information on trachoma Promote exchange visits between chiefs and subjects to exchange knowledge on best practices in sanitation, hygiene and water utilization To integrate “SAFE” strategy in the community in the existing cultures To ensure enhanced community adherence to basic personal hygiene and sanitation Ministry of Mines, To improve water supply to all districts of Zambia To supplement efforts of MLGH

Energy and Water To drill 300 boreholes annually in trachoma endemic Development districts

(MMEWD):

Ministry of Finance: To spearhead the resource mobilization for the To prioritise funding of the “SAFE” strategy full implementation of the “SAFE” strategy. implementation programme.

To monitor resource are allocated to trachoma elimination To promote macroeconomic performance and development programmes in order to boost production and increase economic power and capacity of citizens so as to enable them sink boreholes and build VIP latrines through community mobilization. To include sanitation and hygiene programmes in the 6th National Development Plan – emphasis to be put on drilling of boreholes and construction of VIP latrines.

23 3.2.0 Implementation Structure

National Trachoma Task

Partners Force (NTTF) Corporate World

Provincial Trachoma Task Force through (PDCC)

DTTF (DDCC)

C O M M U N I T Y

Figure 6: “SAFE” strategy implementation framework schema

3.2.1 National Trachoma Task Force A National Trachoma Task Force (NTTF) to be appointed by cabinet will oversee all trachoma elimination initiatives implemented in the country. This task force will be chaired by MoH and shall have representation from other key line Ministries and cooperating partners. The NTTF shall function as a sub-committee of the National Epidemilogical Preparedness, Planning and Management Committee (NEPPMC). It shall be responsible for coordinating, planning, monitoring and reporting on all trachoma activities to the MoH, other line ministries and the cooperating partners. The NTTF will also be responsible for ensuring that the resources for MDA are secured for a period of 5 years. The MoH will provide the secretariat of the NTTF.

3.2.2 Provinces Each Province will have a Provincial Trachoma Task Force through which all Trachoma elimination initiatives in the Province will be implemented. The task force will be responsible for coordinating, planning, monitoring and reporting all trachoma activities to the NTTF. All line Ministries at Provincial level will have representation on the Provincial Trachoma Task Force which shall be a subcommittee of the Provincial Development Coordinating Committee (PDCC). The MoH will take a leading at the province.

3.2.3 Districts Each District will have a District Trachoma Task Force (DTTF) through which all trachoma elimination initiatives in the District will be implemented. This task force will be responsible for coordinating, planning, monitoring and reporting all trachoma activities to the National Trachoma Task Force through the Provincial Trachoma Task Force. All line Ministries at District level will have representation on the District Trachoma Task Force which shall be a subcommittee of the District Development Coordinating Committee (DDCC). MCDMCH will be a lead Ministry in this activity.

3.2.4 Community Community leaders will be mobilised to carry out sensitization and community mobilisation initiatives in partnership with the DTTF through the DDCC. Community leaders will work with their respective communities to ensure that community members are sensitized on basic trachoma prevention methods and initiatives. The whole essence of community participation in the “SAFE” strategy implementation is to encourage ownership and running of the trachoma elimination programmes at community level. This is very cardinal for the success of the strategy. Representatives from the chiefs will be part of the District Trachoma Task Force to make it effective and also to ensure that the Chiefs play their a critical in success of “SAFE” strategy

3.2.5 Corporate Sector

Through corporate social responsibility programs, the corporate world shall be encouraged to work with the trachoma task forces to support the “SAFE” strategy at National, Provincial, District and Community levels. The NTTF will work with them in the areas where they operate so that resources could be tapped through Cooperate Social Responsibility (CSR).

3.2.6 Cooperating Partners (NGOs)

MoH has engaged all partners and stakeholders in the implementation of the “SAFE” startegy

Zambia currently benefits from the presence of multiple eye health cooperating partners. Through the National Trachoma Task Force (NTTF) the cooperating partners’ efforts could be effectively aligned against the timelines and priorities of the “SAFE” strategy implementation plan. Focusing the resources and activities of these organizations against a common strategic approach would maximize their collective impact in the march to elimination of trachoma.

The Partners that are currently supporting “SAFE” strategy in seven districts are ADRA, GG, LAN, OEU and SS as shown in the table 4 below.

Table 4: Districts currently having support for “SAFE” strategy

DISTRICT NGO SUPPORTING “SAFE” STRATEGY

Chienge and Nchelenge Geneva Global

Choma and Mufulira Sightsavers

Sinazongwe Operation Eyesight Universal

Gwembe ADRA

Kaoma LAN

3.2.7 Bilateral development agencies

Given the broad scope of existing health efforts of bilateral development agencies including DANIDA, CIDA, USAID, DFID, UNICEF, JICA, EC and others, advocacy focused on trachoma control as addressing the MDGs in Zambia would lead to the inclusion of trachoma into broader bilateral agency support.

PART 4: FACTORS FOR SUCCESS

Achieving 2020 trachoma elimination shall necessitate a program-wide enhancement of activities. To make elimination possible key success factors will include:  Rapidly responding, well-functioning National Trachoma Task Force: This team shall spearhead all trachoma activities in Zambia, addressing all technical and programmatic aspects of scale-up. The NTTF shall work under MoH. This task force will be chaired by MoH and will include members from key line Ministries and cooperating partners. The NTTF shall function as a subcommittee of the National Epidemilogical Preparedness, Planning and Management Committee (NEPPMC).7

 Pro-active coordination of trachoma control activities by a National Eye Health Coordinator: The role of the National Eye Health Coordinator would be to manage and coordinate all trachoma control activities in the country.7

 Effective integration of trachoma control into NTDs: Trachoma is one of the Neglected Tropical Diseases (NTDs) and future resourcing for trachoma control will require effective integration of trachoma control into the national NTD programme.7

 Close integration of F&E with other ongoing efforts: Inclusion of trachoma into the WASHE programmes may help “ring fence” government financing for F & E efforts in trachoma endemic districts. This requires closer interaction with the agencies involved in WASHE efforts. The WASHE shall be part of the NTTF. The MoH will need to have a memorandum of understanding (MoU) with cooperating partners to secure funding for at least 5 years for the “SAFE” strategy.7

 Encourage district-level planning and ownership: Advocacy at district level, through the establishment of District Trachoma Task Forces as a sub committee of the DDCC, will be effective in encouraging district level planning and “SAFE” strategy ownership programme. The NTTF will need to assist districts with planning efforts and inculcate the ownership aspect of the programme through the DDCC.7

 Increased community outreach: A successful scale-up would require a new, broad-based plan to work with communities to inform, educate, and collaborate. In particular, it is recognized that targets for TT surgery shall only be met through extensive surgical outreach services using the campaign approach and active case search for TT cases and providing immediate surgery to them using eye camps. Ultimately, engaging CHW in antibiotic distribution would improve compliance and reduce the cost of MDA.

 Improved monitoring of “SAFE” implementation: A monitoring tool in form of a logical framework has been developed to monitor the implementation of all aspects of the “SAFE” strategy (PART 5). Monitoring will be against specific targets. It had been realized that there is need to identify indicators for F & E activities.

 Increase the number of TT surgeries: Districts where trachoma trichiasis was identified as a problem should scale up the surgeries in order to reduce the number of people becoming blind due to trachoma trichiasis. The mobile hospital services should be utilized as complimentary to the static services in addition to routine outreach programmes. Table 5 below shows the backlog of trachoma trichiasis cases obtained during the trachoma mapping/survey conducted in the year 2012 in 65 districts. Also shown are number of surgeries to be conducted annually in the various districts for a period of five years.

Table 5: Estimated numbers for TT surgery

№ PROVINCE DISTRICT TT BACKLOG/ESTIMATED CASES TO BE RATE № OF PEOPLE WITH DONE YEARLY FOR (%) TT FIVE YEARS 1 Central Mumbwa 0.0 00 00 2 Chibombo 1.5 2, 603 521 3 Kabwe 1.2 1, 339 268 4 Kapiri Mposhi 6.9 9, 347 1,869 5 Mkushi 1.1 919 184 6 Serenje 0.5 489 98 Subtotal 14, 697 2,940

8 Eastern Chadiza 0.5 325 65 7 Chipata 0.9 2, 651 530 9 Katete 0.2 191 38 10 Lundazi 3.7 6, 396 1,280 29

11 Mambwe 1.5 587 118 12 Nyimba 0.0 00 00 13 Petauke 0.0 00 00 Subtotal 10, 150 2,031

14 Copperbelt Chililabombwe 0.0 00 00 15 Chingola 0.0 00 00 16 Kalulushi 0.0 00 00 17 Lufwanyama 0.0 00 00 18 Masaiti 0.0 00 00 19 Mpongwe 0.0 00 00 20 Kitwe 0.1 287 58 21 Ndola 0.1 250 50 22 Luanshya 0.0 00 00 Subtotal 537 108

23 Lusaka Chongwe 0.0 00 00 24 Luangwa 0.0 00 00 25 Lusaka 0.0 00 00 26 Kafue 0.0 00 00 27 Siavonga 0.6 181 37 Subtotal 181 37

28 Southern Mazabuka 0.6 850 170 29 Monze 0.6 695 139 30 Gwembe 3.8 1, 100 220 31 Itezhi tezhi 0.5 178 36 32 Namwala 0.2 132 28 33 Kalomo 0.8 696 140 34 Livingstone 0.3 235 47 35 Kazungula 0.5 271 55 Subtotal 4, 157 835

36 Luapula Kawambwa 0.7 368 74 37 Mansa 1.7 2, 207 442 38 Milenge 0.8 192 39 39 Mwense 0.6 330 66 40 Samfya 0.5 420 84 Subtotal 3, 517 705

41 Northern Chilubi 0.7 321 64 42 Kaputa 1.7 1, 061 212 43 Kasama 2.8 3, 666 733 44 Luwingu 1.6 1, 183 237 45 Mbala 0.9 691 138 46 Mporokoso 2.4 1, 333 267 47 Mpulungu 1.8 954 191 48 Mungwi 2.3 1, 829 366 30

Subtotal 11, 038 2,208

49 Muchinga Chama 4.5 2, 510 502 50 Chinsali 0.6 534 107 51 Isoka 1.8 1, 628 326 52 Nakonde 0.7 271 54 Subtotal 4, 942 989

53 Northwestern Chavuma 0.0 00 00 54 Kabompo 0.0 00 00 55 Kasempa 0.0 00 00 56 Mufumbwe 0.2 74 15 57 Mwinilunga 0.5 303 61 58 Solwezi 0.0 00 00 59 Zambezi 0.0 00 00 Subtotal 377 76

60 Western Lukulu 0.0 00 00 61 Mongu 0.0 00 00 62 Senanga 0.0 00 00 63 Sesheke 0.0 00 00 64 Shang’ombo 0.0 00 00 65 Kalabo 1.2 894 179 Subtotal 894 179

Total 50, 490 10, 108

It is estimated that a total of 50,490 people will need surgeries due to trachoma trichiasis in the 65 districts. On yearly basis for a period of 5 years, 10,108 TT surgeries will be required to be conducted in the 65 districts.

 Mass Drug Administration of Azithromycin: Districts with active trachoma should be treated with azithromycin for at least three to five years depending on the baseline TF rate. Impact assessments will be carried out in all intervention districts following the requisite number of years of treatment and adequate MDA programme coverage (at least 85%) in all the years. Post MDA verification will be conducted one month after every MDA. This is to ensure that data is accurate and that the exercise was actually conducted. A mechanism will be developed to ensure accurate identification of people who received the azithromycin.

4.1.0 Mass Drug Administration

Figure 5: Distribution of Azithromycin in Kaoma in 2012

The first ever Zithromax Mass Drug Administration (MDA) took place in five districts namely Chienge, Choma, Kaoma, Mufulira and Nchelenge. The response from the communities was overwhelming with a huge turnout in all the five districts. This led to very high coverage rates (table 6).

Table 6: MDA coverage rates in 2012

DISTRICT COVERAGE RATE (%) Chienge 96 Choma 117 Kaoma 94 Mufulira 87.1 Nchelenge 92

Fourty six districts require Mass Drug Administration of azithromycin according to the trachoma survey in 2012, as shown in table 7.

Table 7: Population due for MDA № PROVINCE DISTRICT TF TT POPULATION FOR MDA 1 Central Chibombo 4.9 1.5 347, 005 2 Kabwe 7.2 1.2 223, 206 3 Kapiri Mposhi 13.3 6.9 270, 917 4 Mkushi 11.7 1.1 166, 980 5 Serenje 15.3 0.5 195, 442 Subtotal 1, 203, 550

6 Eastern Chadiza 14.4 0.5 130, 036 7 Lundazi 16.0 3.7 345, 709 8 Mambwe 8.2 1.5 78, 181 Subtotal 553, 926

9 Copperbelt Chililabombwe 17.8 0.0 99, 583 10 Chingola 13.7 0.0 234, 639 11 Kalulushi 14.6 0.0 105, 827 12 Lufwanyama 11.0 0.0 88, 565 13 Masaiti 12.1 0.0 132, 002 14 Mpongwe 10.1 0.0 100, 942 15 Mufulira 24.2 210, 140 16 Kitwe 20.5 0.1 574, 302 17 Ndola 15.1 0.1 500, 714 18 Luanshya 13.6 0.0 191, 665 Subtotal 2, 238, 379

19 Southern Choma 19.4 303, 887 20 Mazabuka 46.5 0.6 283, 380 21 Monze 52.3 0.6 231, 621 22 Gwembe 52.9 3.8 57, 882 23 Itezhi tezhi 35.8 0.5 71, 053 24 Namwala 16.1 0.2 131, 332 25 Livingstone 10.8 0.3 156, 237 26 Kazungula 19.9 0.5 108, 122 27 Sinazongwe 14.3 123, 042 Subtotal 1, 466, 556

28 Luapula Chienge 28.2 120, 062 29 Mansa 10.5 1.7 259, 668 30 Milenge 16.4 0.8 48, 014 31 Nchelenge 17.0 154, 539 Subtotal 582, 283

32 Northern Chilubi 15.6 0.7 91, 647 33 Kaputa 19.6 1.7 124, 775 34 Kasama 11.4 2.8 261, 839 35 Luwingu 10.1 1.6 147, 869 36 Mporokoso 18.7 2.4 111, 026 37 Mpulungu 4.2 1.8 105, 954 38 Mungwi 16.5 2.3 158, 991 Subtotal 1, 002, 101

39 Muchinga Chama 15.5 4.5 111, 553 40 Chinsali 28.5 0.6 178, 043 41 Isoka 20.0 1.8 180, 851 Subtotal 470, 447

42 Northwestern Kasempa 10.7 0.0 76, 594 Subtotal 76, 594

43 Western Kaoma 32.7 224, 942 44 Lukulu 15.3 0.0 95, 463 45 Shang’ombo 15.2 0.0 93, 817 46 Kalabo 42.1 1.2 148, 924 Subtotal 563, 146

TOTAL 8, 156, 982

 Environmental factors enhancement: from the studies conducted only 10% to 30% of the population have access to clean safe water and only 20% to 40% of households have access to well built toilets. This calls for maximum scaling up of strategies and actions tailored towards increased clean water supply and construction of modern toilets.

PART 5: STRATEGIES AND LOGICAL FRAMEWORK OF “SAFE” STRATEGY IMPLEMENTATION

5.1.0 Surgery

Over 50,000 people will require TT surgery by 2017

Strategy: The communities will be sensitized and trained in the identification of TT cases. Health personnel including Medical Officers and Clinical Officers will be trained by the Ophthalmologists to perform TT surgery.

Surgical cases will be referred to the nearest health centres where surgery will be conducted by trained health officers located in each District. TT surgery could also be provided within the communities in a good location such as classroom and chief’s palace. This will help to bring the service closer to the patients/clients.

Strategies to monitoring and follow up of all cases operated will be developed in order to ensure good outcome and be able to manage bad outcomes/complications.

Table 8 below shows the log frame for the surgery component.

Table 8: TT surgery log frame

Objective Key outputs / Outcomes Key Activities Indicators Means of verification To increase the TT surgical 50,490 total TT surgeries in 5 Carry out community Reduction in the number of TT cases Impact assessment report coverage from 7% to 95% by years sensitization in all the Districts to 2017 Number of TT surgeries perfomed 10,108 to be conducted identify TT cases and refer or

annually perform surgery Conduct clinical meetings for Knowledge levels on trachoma Number of consultations health workers on trachoma among health workers Number of referals TOT training for medical doctors Number of surgeries with good Hospital records and OCO/ON’S on how to outcomes perform TT surgeries

Number of trained staff Train community volunteers to Number of community volunteers DHO training reports identify TT cases and refer for trained surgery

Number of patients referred Procure surgical equipment Number of surgeries Equipment inventory records

Distribute TT surgical sets Number of surgeries Equipment inventory records

Provision of consumables Number of surgeries Equipment inventory records

Conduct surgical outreaches Number of surgeries Mobile health unit reports using the mobile hospitals platform Conduct surgical eye health Number of surgeries Hospital records outreaches

5.2.0 Antibiotics

Over 8,000,000 will require Antibiotic treatment by 2017

Strategy: This will be performed through Mass Drug Administration (MDA) of azithromycin. MDA means that all eligible individuals in a given area will receive the drug. It is expected that Pfizer will donate the needed azithromycin through ITI to Zambia. The drugs will be received by the Medical Stores Limited. The drugs will be delivered to the District pharmacy by the Medical Stores based on the distribution plan drawn by MoH. The district pharmacist will be responsible for the distribution of the drugs to all the health centres in the catchment area. The Health Centres and the dispensers will work with trained community health workers to administer the drug to the community, who will be mobilized during a one week MDA campaign in health centres, schools, churches and other public places. Another one week will be used for final mop up during a door to door exercise.

The DTTF under the leadership of the DMO will play a vital role in the actual MDA activity.

Table 9 below shows the log frame for the MDA.

Table 9: MDA Log frame Objective Key outputs / Outcomes Key Activities Indicators Means of verification To distribute Azithromycin to 8,156,982 people to receive District planning and budget District trachoma elimination District Medical Office Reports the entire population of the 46 Azithromycin. meeting for MDA plans trachoma endemic districts by Quantification and forecasting of Request for Azithromycin ITI correspondence 2017 Reduce the rate of active drug requirements for a 5 year submitted to ITI infections period

Order tablets and suspension from District request for drugs Medical stores records medical stores Submit annual reports to ITI Feed back from ITI NEHC records Train district health workers and Number of people trained District Medical Office Reports CHW in the use and distribution of azithromycin Transportation of the drugs to the Availability of drugs in the Goods recieved notes (GRN) districts and health centres. districts. Distribution of Azithromycin Coverage of 85% and above Distribution register

District Medical Office report

Impact assessment report To conduct post azithromycin Identification labels on people District Medical Office report distribution verification a month that received azithromycin after

5.3.0 Face and Hand washing (Health Promotion)

Face and hand washing are a key activity in archieving the “F” component of the strategy

Strategy: Working with existing Water and Sanitation programmes in the districts through the DDCCs, stakeholders meetings will be held to identify potential partners with interest in behavioural change programmes in an effort to identify funding sources. Teachers and community health workers will be trained in the promotion of proper face and hand washing, general hygiene and proper refuse disposal methods. Community based monitoring systems will be set up to conduct periodic monitoring visits. The strategy will also draw on and adapt relevant advocacy material developed in other trachoma endemic countries. A log frame has been developed to monitor the effectiveness and to measure the increase in the number of clean faces and hands, table 10. This will be aimed at developing and supporting programmes meant to reduce blinding trachoma through face and hand washing of children.

Table 10: Face and hand washing log frame Objective Key outputs / Key Activities Indicators Means of verification Outcomes To have 95% of children 1- 2,854,945 children with Conduct stakeholder’s sensitization Stakeholders actively NTTF/PDCC/DDCC reports 9years with clean faces and meetings. clean faces and hands. participating in face and hand hands by 2017 washing activities

Number of stakeholders’ sensitation meetings conducted Distribution of Information Education Increased knowledge levels on Number of clean faces and Communication (IE&C) face and hand washing materials. Train teachers to promote face and Number of teachers trained District Medical Office training hand washing of children. records

Train community leaders to promote Number of teachers trained District Medical Office training community in face and hand records washing Conduct community demonstrations Number of demonstrations District Medical Office training on correct hand and face washing conducetd records methods.

5.4.0 Environment

Supply of safe water is vital for trachoma elimination

Strategy: The NEHC office will work with District Trachoma Task Forces and NGOs working in this sector to disseminate data on the survey results on water and sanitation as a means of creating awareness on the need for VIP latrines and adequate safe water sources. The aim is to increase and improve the number of functioning safe water supply facilities through systematic investment in new water supply facilities and rehabilitate existing facilities. Focus will be placed on the community to mobilize and build quality household latrines and rubbish pits using community and outside resources. Community monitoring systems will be established to monitor the progress. This work will additionally be supervised by the Environmental Health Workers and the DDCC. In terms of implementation the MLGH will be a key partner.

Table 11 below shows the log frame for the environment component. 43

Table 11: Environment Log frame

Objective Key outputs / Outcomes Key Activities Indicators Means of verification To increase the number of safe To drill 22,795 boreholes in 46 Conduct stakeholders Stakeholders actively participating in DTTF/DDCC reports water points from 30% to 95% trachoma endemic districts in sensitization meetings safe water initiatives by 2017. five years. Impact assessment report (4,559 boreholes to be Community participation and drilled per year for 5 years) ownership of the programme

Number of stakeholders’ sensitation meetings conducted Distribute IEC materials on Increased knowledge levels on Number of safe water points. the importance of safe impotance of safe water water. Increase number of VIP To construct 185,511 VIP Conduct stakeholders Stakeholders actively participating in DTTF/DDCC reports latrines from 45% to 95% by latrines in 46 trachoma sensitization meetings safe human waste disposal initiatives 2017. endemic districts in five years.

(50,000 VIP latrines to built Number of stakeholders’ sensitation per year for 5 years) meetings conducted

Distribute IEC materials on Increased knowledge levels on Number of VIP latrines built. the importance of safe impotance of safe human waste water. disposal meothods Impact assessment report

Community participation and ownership of the programme

Current Commitments on Environment

The Ministry of local government and housing (MLGH) will construct fifty thousand (50,000) VIP latrines per year in the 46 trachoma endemic districts for a period of 5 years. It will further drill two thousand (2,500) boreholes, dig 600 wells and 60 intermediate options for a period of five years. These efforts will be further supplemented by an additional 300 boreholes annually from the department of water affairs from the Ministry of Mines, Energy and Water Development.

The implication of this effort is that of the expected 4,559 boreholes to be drilled annually, the Government of the Republic of Zambia (GRZ) shall contribute 3,460 annually for the next five years leaving an annual deficit of 1,099 boreholes.

The drilling of boreholes and construction of VIP latrines by GRZ will commence in 2013 and will continue for the next five years and even beyond.

PART 6: NATIONAL BUDGET PROJECTIONS FOR FULL “SAFE” STRATEGY SCALE UP

It should be kindly noted that the budget for the full “SAFE” strategy implementation framework document is based on estimates hence the cost may vary from region to region and based on estimates from different line Ministries.

6.1.0 Cost estimates for “SAFE” strategy components

The budget has been worked out on all the four components of the “SAFE” strategy as packages of each encompassing all aspects of each component. The costs are in both Kwacha and United States Dollar at K5.200 to $1.00.

1. Surgery: The cost of each surgery has been estimated on an individual basis of the complete package culminating to surgery starting from training, publicity, sensitisation, mobilisation, instruments, consumables and follow up. The costs have been worked out at district, province and national levels in districts only qualifying for MDA (Table 12). The complete package cost per person is K508.30n ($97.75) which comes to K25,664,067.00 ($4,935,397.50) for a total number of 50, 490 people in the 65 districts (Table 12). This cost also includes monitoring and evaluation.

Table 12 also shows projected annual cost of surgery for a period of 5 years.

Table 12: Surgery cost estimates

# OF BACKLOG TT YEARLY TOTAL COST OF № OF COST PER TOTAL COST IN COST IN USD PROVINCE DISTRICT RATE SURGERIES TT SURGERIES IN PEOPLE YEAR IN ZMK USD PER YEAR (%) FOR FIVE ZMK WITH TT YEARS Chibombo 1.5 2,603 521 1,323,104.90 264,620.98 254,443.25 52,924.20 Kabwe 1.2 1,339 268 680,613.70 136,122.74 130,887.25 26,177.45 Kapiri Mposhi Central 6.9 9,347 1,869 4,751,080.10 950,216.02 913,669.25 182,733.85 Mkushi 1.1 919 184 467,127.70 93,425.54 89,832.25 17,966.45 Serenje 0.5 489 98 248,558.70 49,711.74 47,799.75 9,559.95 Subtotal 14,697 2,940 7,470,485.10 1,494,097.02 1,436,631.75 287,326.35 Chadiza 0.5 325 65 165,197.50 33,039.50 31,768.75 6,353.75 Chipata 0.9 2,651 530 1,347,503.30 269,500.66 259,135.25 51,827.05 Eastern Katete 0.2 191 38 97,085.30 19,417.06 18,670.25 3,734.05 Lundazi 3.7 6396 1,280 3,251,086.80 650,217.36 625,209.00 125,041.80 Mambwe 1.5 587 118 298,372.10 59,674.42 57,379.25 11,475.85 Subtotal 10,150 2,031 5,159,245.00 1,031,849.00 992,162.50 198,432.50 Kitwe 0.1 287 58 145,882.10 29,176.42 28,054.25 5,610.85 Copperbelt Ndola 0.1 250 50 127,075.00 25,415.00 24,437.50 4,887.50 Subtotal 537 108 272,957.10 54,591.42 52,491.75 10,498.35 Lusaka Siavonga 0.6 181 37 92,002.30 18,400.46 17,692.75 3,538.55 Subtotal 181 37 92,002.30 18,400.46 17,692.75 3,538.55 Mazabuka 0.6 850 170 432,055.00 86,411.00 83,087.50 16,617.50 Monze 0.6 695 139 353,268.50 70,653.70 67,936.25 13,587.25 Gwembe 3.8 1,100 220 559,130.00 111,826.00 107,525.00 21,505.00 Itezhi tezhi 0.5 178 36 90,477.40 18,095.48 17,399.50 3,479.90 Southern Namwala 0.2 132 28 67,095.60 13,419.12 12,903.00 2,580.60 Kalomo 0.8 696 140 353,776.80 70,755.36 68,034.00 13,606.80 Livingstone 0.3 235 47 119,450.50 23,890.10 22,971.25 4,594.25 Kazungula 0.5 271 55 137,749.30 27,549.86 26,490.25 5,298.05 Subtotal 4,157 835 2,113,003.10 422,600.62 406,346.75 81,269.35 Kawambwa 0.7 368 74 187,054.40 37,410.88 35,972.00 7,194.40 Mansa 1.7 2,207 442 1,121,818.10 224,363.62 215,734.25 43,146.85 Luapula Milenge 0.8 192 39 97,593.60 19,518.72 18,768.00 3,753.60 Mwense 0.6 330 66 167,739.00 33,547.80 32,257.50 6,451.50 Samfya 0.5 420 84 213,486.00 42,697.20 41,055.00 8,211.00 Subtotal 3,517 705 1,787,691.10 357,538.22 343,786.75 68,757.35 Chilubi 0.7 321 64 163,164.30 32,632.86 31,377.75 6,275.55 Kaputa 1.7 1,061 212 539,306.30 107,861.26 103,712.75 20,742.55 Kasama 2.8 3,666 733 1,863,427.80 372,685.56 358,351.50 71,670.30 Luwingu 1.6 1,183 237 601,318.90 120,263.78 115,638.25 23,127.65 Northern Mbala 0.9 691 138 351,235.30 70,247.06 67,545.25 13,509.05 Mporokoso 2.4 1,333 267 677,563.90 135,512.78 130,300.75 26,060.15 Mpulungu 1.8 954 191 484,918.20 96,983.64 93,253.50 18,650.70 Mungwi 2.3 1,829 366 929,680.70 185,936.14 178,784.75 35,756.95 Subtotal 11,038 2,208 5,610,615.40 1,122,123.08 1,078,964.50 215,792.90 Chama 4.5 2,510 502 1,275,833.00 255,166.60 245,352.50 49,070.50 Chinsali 0.6 534 107 271,432.20 54,286.44 52,198.50 10,439.70 Muchinga Isoka 1.8 1,628 326 827,512.40 165,502.48 159,137.00 31,827.40 Nakonde 0.7 271 54 137,749.30 27,549.86 26,490.25 5,298.05 Subtotal 4,942 989 2,512,018.60 502,403.72 483,080.50 96,616.10 Kasempa 0 0 0 - - - - Northwestern Mufumbwe 0.2 74 15 37,614.20 7,522.84 7,233.50 1,446.70 Mwinilunga 0.5 303 61 154,014.90 30,802.98 29,618.25 5,923.65 Subtotal 377 76 191,629.10 38,325.82 36,851.75 7,370.35 Lukulu 0 0 0 - - - - Western Shang’ombo 0 0 0 - - - - Kalabo 1.2 894 179 454,420.20 90,884.04 87,388.50 17,477.70 Subtotal 894 179 454,420.20 90,884.04 87,388.50 17,477.70

GRAND TOTALS 50,490 10,108 25,664,067.00 5,132,813.40 4,935,397.50 987,079.50

2. Antibiotics: The cost of azithromycin distribution has been estimated on an individual basis as a complete package culminating to MDA starting from training, publicity, sensitisation and mobilisation. The costs have been worked out at district, province and national levels in districts only qualifying for MDA (Table 11). The complete package cost per person is K 3.64 ($0.70) which comes to K29,691,414.48 ($5,709,887.40) for a total number of 8,156,388 people in the 46 districts with trachoma endemicity (Table 13). This cost also includes monitoring and evaluation. This will be the cost of conducting MDA annually. The total cost for the whole period of 5 years will be K 148,457,072.40 ($28,549,437.00) as tabulated in section 7.0.0.

The above budget is a package that includes: 1. Sensitization workshops for line Ministries 2. Sensitization workshops for health workers on trachoma 3. Sensitization and education of the communities on trachoma 4. Mass Drug Administration 5. Complete package surgeries of Trachoma Trichiasis a. Static b. Outreach 6. Media engagement and publicity

Table 13: MDA cost estimates

TT POP FOR COST OF MDA COST IN PROVINCE DISTRICT TF (%) (%) MDA IN ZMK USD

Chibombo 4.9 1.5 347,005 1,263,098.20 242,903.50 Kabwe 7.2 1.2 223,206 812,469.84 156,244.20 Central Kapiri Mposhi 13.3 6.9 270,917 986,137.88 189,641.90 Mkushi 11.7 1.1 166,980 607,807.20 116,886.00 Serenje 15.3 0.5 195,442 711,408.88 136,809.40 SUB TOTALS 1,203,550 4,380,922.00 842,485.00 Chadiza 14.4 0.5 130,036 473,331.04 91,025.20 Eastern Lundazi 16.0 3.7 345,709 1,258,380.76 241,996.30 Mambwe 8.2 1.5 78,181 284,578.84 54,726.70 SUB TOTALS 553,926 2,016,290.64 387,748.20 Chililabombwe 17.8 0 99,583 362,482.12 69,708.10 Chingola 13.7 0 234,639 854,085.96 164,247.30 Kalulushi 14.6 0 105,827 385,210.28 74,078.90 Lufwanyama 11.0 0 88,565 322,376.60 61,995.50 Masaiti 12.1 0 132,002 480,487.28 92,401.40 Copperbelt Mpongwe 10.1 0 100,942 367,428.88 70,659.40 Mufulira 24.2 210,140 764,909.60 147,098.00 Kitwe 20.5 0.1 574,302 2,090,459.28 402,011.40 Ndola 15.1 0.1 500,714 1,822,598.96 350,499.80 Luanshya 13.6 0 191,665 697,660.60 134,165.50 SUB TOTALS 2,238,379 8,147,699.56 1,566,865.30 Choma 19.4 303,887 1,106,148.68 212,720.90 Mazabuka 46.5 0.6 283,380 1,031,503.20 198,366.00 Monze 52.3 0.6 231,621 843,100.44 162,134.70 Gwembe 52.9 3.8 57,882 210,690.48 40,517.40 Southern Itezhi tezhi 35.8 0.5 71,053 258,632.92 49,737.10 Namwala 16.1 0.2 131,332 478,048.48 91,932.40 Livingstone 10.8 0.3 156,237 568,702.68 109,365.90 Kazungula 19.9 0.5 108,122 393,564.08 75,685.40 Sinazongwe 14.3 123,042 447,872.88 86,129.40 SUB TOTALS 1,466,556 5,338,263.84 1,026,589.20 Chienge 28.2 120,062 437,025.68 84,043.40 Mansa 10.5 1.7 259,668 945,191.52 181,767.60 Luapula Milenge 16.4 0.8 48,014 174,770.96 33,609.80 Nchelenge 17.0 154,539 562,521.96 108,177.30 SUB TOTALS 582,283 2,119,510.12 407,598.10 Chilubi 15.6 0.7 91,647 333,595.08 64,152.90 Kaputa 19.6 1.7 124,775 454,181.00 87,342.50 Kasama 11.4 2.8 261,839 953,093.96 183,287.30 Northern Luwingu 10.1 1.6 147,869 538,243.16 103,508.30 Mporokoso 18.7 2.4 111,026 404,134.64 77,718.20 Mpulungu 4.2 1.8 105,954 385,672.56 74,167.80 Mungwi 16.5 2.3 158,991 578,727.24 111,293.70 SUB TOTALS 1,002,101 3,647,647.64 701,470.70 Chama 15.5 4.5 111,553 406,052.92 78,087.10 Muchinga Chinsali 28.5 0.6 178,043 648,076.52 124,630.10 Isoka 20.0 1.8 180,851 658,297.64 126,595.70 SUB TOTALS 470,447 1,712,427.08 329,312.90 North- western Kasempa 10.7 0 76,594 278,802.16 53,615.80 SUB TOTALS 76,594 278,802.16 53,615.80 Kaoma 32.7 224,942 818,788.88 157,459.40 Lukulu 15.3 0 95,463 347,485.32 66,824.10 Western Shang’ombo 15.2 0 93,817 341,493.88 65,671.90 Kalabo 42.1 1.2 148,924 542,083.36 104,246.80 SUB TOTALS 563,146 2,049,851.44 394,202.20

GRAND TOTALS 8,156,982 29,691,414.48 5,709,887.40

3. Face and hand washing: The cost of face and hand washing activity has been estimated on an individual basis of the complete package culminating to full performance of the activity by every child starting from training, publicity, sensitisation, mobilisation, drama and follow up. The costs have been worked out at district, province and national levels in districts only qualifying for MDA (Table 12). The complete package cost per person is K1.10 ($0.21) which comes to K3,053,835.40 ($587,276.04) for a total number of 2,854,945 children in the 46 districts with trachoma endemicity (Table 14). This cost also includes monitoring and evaluation.

Table 14: Face and hand washing (Health Promotion)

# OF CHILDREN TF TT PROVINCE DISTRICT POP FOR MDA BELOW THE AGE COST (ZMK) COST IN USD (%) (%) OF 9 YEARS Chibombo 4.9 1.5 347,005 121,452 133,596.93 25,691.72 Kabwe 7.2 1.2 223,206 78,122 85,934.31 16,525.83 Central Kapiri Mposhi 13.3 6.9 270,917 94,821 104,303.05 20,058.28 Mkushi 11.7 1.1 166,980 58,443 64,287.30 12,362.94 Serenje 15.3 0.5 195,442 68,405 75,245.17 14,470.23 SUB TOTALS 1,203,550 421,243 463,366.75 89,108.99 Chadiza 14.4 0.5 130,036 45,513 50,063.86 9,627.67 Eastern Lundazi 16 3.7 345,709 120,998 133,097.97 25,595.76 Mambwe 8.2 1.5 78,181 27,363 30,099.69 5,788.40 SUB TOTALS 553,926 193,874 213,261.51 41,011.83 Chililabombwe 17.8 0 99,583 34,854 38,339.46 7,372.97 Chingola 13.7 0 234,639 82,124 90,336.02 17,372.31 Kalulushi 14.6 0 105,827 37,039 40,743.40 7,835.27 Lufwanyama 11 0 88,565 30,998 34,097.53 6,557.22 Masaiti 12.1 0 132,002 46,201 50,820.77 9,773.23 Copperbelt Mpongwe 10.1 0 100,942 35,330 38,862.67 7,473.59 Mufulira 24.2 210,140 73,549 80,903.90 15,558.44 Kitwe 20.5 0.1 574,302 201,006 221,106.27 42,520.44 Ndola 15.1 0.1 500,714 175,250 192,774.89 37,072.09 Luanshya 13.6 0 191,665 67,083 73,791.03 14,190.58 SUB TOTALS 2,238,379 783,433 861,775.92 165,726.14 Choma 19.4 303,887 106,360 116,996.50 22,499.33 Mazabuka 46.5 0.6 283,380 99,183 109,101.30 20,981.02 Monze 52.3 0.6 231,621 81,067 89,174.09 17,148.86 Gwembe 52.9 3.8 57,882 20,259 22,284.57 4,285.49 Southern Itezhi tezhi 35.8 0.5 71,053 24,869 27,355.41 5,260.65 Namwala 16.1 0.2 131,332 45,966 50,562.82 9,723.62 Livingstone 10.8 0.3 156,237 54,683 60,151.25 11,567.55 Kazungula 19.9 0.5 108,122 37,843 41,626.97 8,005.19 Sinazongwe 14.3 123,042 43,065 47,371.17 9,109.84 SUB TOTALS 1,466,556 513,295 564,624.06 108,581.55 Chienge 28.2 120,062 42,022 46,223.87 8,889.21 Mansa 10.5 1.7 259,668 90,884 99,972.18 19,225.42 Luapula Milenge 16.4 0.8 48,014 16,805 18,485.39 3,554.88 Nchelenge 17.0 154,539 54,089 59,497.52 11,441.83 SUB TOTALS 582,283 203,799 224,178.96 43,111.34 Chilubi 15.6 0.7 91,647 32,076 35,284.10 6,785.40 Kaputa 19.6 1.7 124,775 43,671 48,038.38 9,238.15 Kasama 11.4 2.8 261,839 91,644 100,808.02 19,386.16 Northern Luwingu 10.1 1.6 147,869 51,754 56,929.57 10,947.99 Mporokoso 18.7 2.4 111,026 38,859 42,745.01 8,220.19 Mpulungu 4.2 1.8 105,954 37,084 40,792.29 7,844.67 Mungwi 16.5 2.3 158,991 55,647 61,211.54 11,771.45 SUB TOTALS 1,002,101 350735 385,808.89 74,194.02 Chama 15.5 4.5 111,553 39,044 42,947.91 8,259.21 Muchinga Chinsali 28.5 0.6 178,043 62,315 68,546.56 13,182.03 Isoka 20.0 1.8 180,851 63,298 69,627.64 13,389.93 SUB TOTALS 470,447 164,656 181,122.10 34,831.17

North Western Kasempa 10.7 0 76,594 26,808 29,488.69 5,670.90 SUB TOTALS 76,594 26,808 29,488.69 5,670.90 Kaoma 32.7 224,942 78,730 86,602.67 16,654.36 Lukulu 15.3 0 95,463 33,412 36,753.26 7,067.93 Western Shang’ombo 15.2 0 93,817 32,836 36,119.55 6,946.07 Kalabo 42.1 1.2 148,924 52,123 57,335.74 11,026.10 SUB TOTALS 563,146 197,101 130,208.54 25,040.10

GRAND TOTALS 8,156,982 2,854,944 3,053,835.40 587,276.04

4. Environment a. Boreholes: The cost of each borehole has been estimated for 250 people per borehole including components of training, education, publicity, sensitisation, mobilisation including monitoring and evaluation. The costs have been worked out at district, province and national levels in 46 districts qualifying for MDA (Table 13). The complete package cost per borehole is K35,000.00 ($6,730.77) which comes to K797, 825,000.00 ($153,427,884.62) for drilling a total number of 22,795 boreholes in the 46 districts with trachoma endemicity (Table 15). The annual cost to drill the expected 4,559 boreholes will be K159,565,000.00 ($30,685,576.92).

NB: For the Copperbelt province the number of boreholes would apply to the number of taps with running water.

The above budget is a package that includes: 1. Sensitization workshops for line Ministries 2. Sensitization workshops for health workers on trachoma 3. Sensitization and education of the communities on trachoma 4. Media engagement and publicity 5. Drilling of boreholes 6. Putting up VIP latrines

Table 15: Borehole cost estimates

EXPECTED # OF # OF # TO BE DRILLED POP FOR BOREHOLES BOREHOLES ANNUALLY FOR FIVE PROVINCE DISTRICT TF (%) TT (%) # OF HOUSEHOLDS COST (ZMK) COST IN USD MDA /DISTRICT REQUIRED YEARS (DEFICIT) Chibombo 4.9 1.5 347,005 69,401 1,388 972 34,020,000 6,542,308 194 Kabwe 7.2 1.2 223,206 44,641 893 625 21,875,000 4,206,731 125 Central Kapiri Mposhi 13.3 6.9 270,917 54,183 1,084 759 26,565,000 5,108,654 152 Mkushi 11.7 1.1 166,980 33,396 668 468 16,380,000 3,150,000 94 Serenje 15.3 0.5 195,442 39,088 782 547 19,145,000 3,681,731 109 SUB TOTALS 1,203,550 240,710 4,814 3,371 117,985,000 22,689,423 674 Chadiza 14.4 0.5 130,036 26,007 520 364 12,740,000 2,450,000 73 Eastern Lundazi 16 3.7 345,709 69,142 1,383 968 33,880,000 6,515,385 194 Mambwe 8.2 1.5 78,181 15,636 313 219 7,665,000 1,474,038 44 SUB TOTALS 553,926 110,785 2,216 1,551 54,285,000 10,439,423 310 Chililabombwe 17.8 0 99,583 19,917 398 279 9,765,000 1,877,885 56 Chingola 13.7 0 234,639 46,928 939 657 22,995,000 4,422,115 131 Kalulushi 14.6 0 105,827 21,165 423 296 10,360,000 1,992,308 59 Lufwanyama 11 0 88,565 17,713 354 248 8,680,000 1,669,231 50 Masaiti 12.1 0 132,002 26,400 528 370 12,950,000 2,490,385 74 Copperbelt Mpongwe 10.1 0 100,942 20,188 404 283 9,905,000 1,904,808 57 Mufulira 24.2 210,140 42,028 841 588 20,580,000 3,957,692 118 Kitwe 20.5 0.1 574,302 114,860 2,297 1,608 56,280,000 10,823,077 322 Ndola 15.1 0.1 500,714 100,143 2,003 1,402 49,070,000 9,436,538 280 Luanshya 13.6 0 191,665 38,333 767 537 18,795,000 3,614,423 107 SUB TOTALS 2,238,379 447,676 8,954 6,268 219,380,000 42,188,462 1,254 Choma 19.4 303,887 60,777 1,216 851 29,785,000 5,727,885 170 Mazabuka 46.5 0.6 283,380 56,676 1,134 793 27,755,000 5,337,500 159 Monze 52.3 0.6 231,621 46,324 926 649 22,715,000 4,368,269 130 Gwembe 52.9 3.8 57,882 11,576 412 11 385,000 74,038 2 Southern Itezhi tezhi 35.8 0.5 71,053 14,211 284 199 6,965,000 1,339,423 40 Namwala 16.1 0.2 131,332 26,266 525 368 12,880,000 2,476,923 74 Livingstone 10.8 0.3 156,237 31,247 625 437 15,295,000 2,941,346 87 Kazungula 19.9 0.5 108,122 21,624 432 303 10,605,000 2,039,423 61 Sinazongwe 14.3 123,042 24,608 492 450 15,750,000 3,028,846 90 SUB TOTALS 1,466,556 293,311 6,047 4,061 142,135,000 27,333,654 812 Chienge 28.2 120,062 24,012 480 336 11,760,000 2,261,538 67 Mansa 10.5 1.7 259,668 51,934 1,039 727 25,445,000 4,893,269 145 Luapula Milenge 16.4 0.8 48,014 9,603 192 134 4,690,000 901,923 27 Nchelenge 17 154,539 30,908 618 433 15,155,000 2,914,423 87 SUB TOTALS 582,283 116,457 2,329 1,630 57,050,000 10,971,154 326 Chilubi 15.6 0.7 91,647 18,329 367 257 8,995,000 1,729,808 51 Kaputa 19.6 1.7 124,775 24,955 499 349 12,215,000 2,349,038 70 Kasama 11.4 2.8 261,839 52,368 1,047 733 25,655,000 4,933,654 147 Northern Luwingu 10.1 1.6 147,869 29,574 591 414 14,490,000 2,786,538 83 Mporokoso 18.7 2.4 111,026 22,205 444 311 10,885,000 2,093,269 62 Mpulungu 4.2 1.8 105,954 21,191 424 297 10,395,000 1,999,038 59 Mungwi 16.5 2.3 158,991 31,798 636 445 15,575,000 2,995,192 89 SUB TOTALS 1,002,101 200,420 4,008 2,806 98,210,000 18,886,538 561 Chama 15.5 4.5 111,553 22,311 446 312 10,920,000 2,100,000 62 Muchinga Chinsali 28.5 0.6 178,043 35,609 712 499 17,465,000 3,358,654 100 Isoka 20.0 1.8 180,851 36,170 723 506 17,710,000 3,405,769 101 SUB TOTALS 470,447 94,089 1,882 1,317 46,095,000 8,864,423 263 Kaoma 32.7 224,942 44,988 900 630 22,050,000 4,240,385 126 Lukulu 15.3 0 95,463 19,093 382 267 9,345,000 1,797,115 53 Western Shang’ombo 15.2 0 93,817 18,763 375 263 9,205,000 1,770,192 53 Kalabo 42.1 1.2 148,924 29,785 596 417 14,595,000 2,806,731 83 SUB TOTALS 563,146 67,641 1,353 1,577 55,195,000 10,614,423 315

North Kasempa Western 10.7 0 76,594 15319 306 214 7,490,000 1,440,385 43

SUB TOTALS 76,594 15,319 306 214 7,490,000 1,440,385 43

GRAND TOTALS 8,156,982 1,586,408 31,728 22,795 797,825,000 153,427,884.62 4,559

b. VIP latrines: The cost of each VIP latrine has been estimated for 20 people per latrine including components of training, education, publicity, sensitisation, mobilisation, monitoring and evaluation. The costs have been worked out at district, province and national levels in 46 districts qualifying for MDA (Table 16). The complete package cost per VIP latrine is K7,222.00 ($1,388.85) which comes to K1,339,760,442.00 ($257,646,238.85) for a total number of 185,511 VIP latrines in the 46 districts with trachoma endemicity (Table 16).

Table 16: VIP Latrine Construction Cost Estimates

# OF VIP # TO BE LATRINES BUILT PER PROVINCE DISTRICT COST (ZMK) COST IN USD

MDA REQUIRED YEAR FOR

TF (%) TF (%) TT

LATRINES (DEFICIT) FIVE YEARS

POPULATION FORPOPULATION

EXPECTED # OF VIP OFVIP # EXPECTED # OFHOUSEHOLDS # Chibombo 4.9 1.5 347,005 69,401 17,350 7,808 56,386,577.48 10,843,572.59 1,562 Kabwe 7.2 1.2 223,206 44,641 11,160 5,022 36,269,858.97 6,974,972.88 1,004 Central Kapiri Mposhi 13.3 6.9 270,917 54,183 13,546 6,096 44,022,657.92 8,465,895.75 1,219 Mkushi 11.7 1.1 166,980 33,396 8,349 3,757 27,133,415.10 5,217,964.44 751 Serenje 15.3 0.5 195,442 39,088 9,772 4,397 31,758,347.79 6,107,374.58 879 SUB TOTALS 1,203,550 240,710 60,178 27,080 195,570,857.25 37,609,780.24 5,416 Chadiza 14.4 0.5 130,036 26,007 6,502 2,926 21,130,199.82 4,063,499.97 585 Eastern Lundazi 16.0 3.7 345,709 69,142 17,285 7,778 56,175,983.96 10,803,073.84 1,556 Mambwe 8.2 1.5 78,181 15,636 3,909 1,759 12,704,021.60 2,443,081.08 352 SUB TOTALS 553,926 110,785 27,696 12,463 90,010,205.37 17,309,654.88 2,493 Chililabombwe 17.8 0 99,583 19,917 4,979 2,241 16,181,739.59 3,111,873.00 448 Chingola 13.7 0 234,639 46,928 11,732 5,279 38,127,664.31 7,332,243.14 1,056 Kalulushi 14.6 0 105,827 21,165 5,291 2,381 17,196,358.37 3,306,991.99 476 Lufwanyama 11.0 0 88,565 17,713 4,428 1,993 14,391,369.68 2,767,571.09 399 Masaiti 12.1 0 132,002 26,400 6,600 2,970 21,449,664.99 4,124,935.58 594 Copperbelt Mpongwe 10.1 0 100,942 20,188 5,047 2,271 16,402,570.29 3,154,340.44 454 Mufulira 24.2 210,140 42,028 10,507 4,728 34,146,699.30 6,566,672.94 946 Kitwe 20.5 0.1 574,302 114,860 28,715 12,922 93,321,203.49 17,946,385.29 2,584 Ndola 15.1 0.1 500,714 100,143 25,036 11,266 81,363,521.43 15,646,831.04 2,253 Luanshya 13.6 0 191,665 38,333 9,583 4,312 31,144,604.18 5,989,346.96 862 SUB TOTALS 2,238,379 447,676 111,919 50,364 363,725,395.61 69,947,191.46 10,073 Choma 19.4 303,887 60,777 15,194 9,837 71,042,814.00 13,662,079.62 1,967 Mazabuka 46.5 0.6 283,380 56,676 14,169 6,376 46,047,833.10 8,855,352.52 1,275 Monze 52.3 0.6 231,621 46,324 11,581 8,211 59,299,842.00 11,403,815.77 1,642 Gwembe 52.9 3.8 57,882 11,576 2,894 2,344 16,928,368.00 3,255,455.38 469 Southern Itezhi tezhi 35.8 0.5 71,053 14,211 3,553 1,599 11,545,757.24 2,220,337.93 320 Namwala 16.1 0.2 131,332 26,266 6,567 2,955 21,340,793.34 4,103,998.72 591 Livingstone 10.8 0.3 156,237 31,247 7,812 3,515 25,387,731.32 4,882,256.02 703 Kazungula 19.9 0.5 108,122 21,624 5,406 2,433 17,569,284.39 3,378,708.54 487 Sinazongwe 14.3 123,042 24,608 6,152 2,768 19,993,709.79 3,844,944.19 554 SUB TOTALS 1,466,556 293,311 73,328 40,038 289,156,133.17 55,606,948.69 8,008 Chienge 28.2 120,062 24,012 6,003 2,701 19,509,474.69 3,751,822.06 540 Mansa 10.5 1.7 259,668 51,934 12,983 5,843 42,194,751.66 8,114,375.32 1,169 Luapula Milenge 16.4 0.8 48,014 9,603 2,401 1,080 7,802,034.93 1,500,391.33 216 Nchelenge 17.0 154,539 30,908 7,727 3,477 25,111,814.81 4,829,195.15 695 SUB TOTALS 582,283 116,457 29,114 13,101 94,618,076.09 18,195,783.86 2,620 Chilubi 15.6 0.7 91,647 18,329 4,582 2,062 14,892,179.27 2,863,880.63 412 Kaputa 19.6 1.7 124,775 24,955 6,239 2,807 20,275,313.63 3,899,098.77 561 Kasama 11.4 2.8 261,839 52,368 13,092 5,891 42,547,528.31 8,182,216.98 1,178 Northern Luwingu 10.1 1.6 147,869 29,574 7,393 3,327 24,027,973.16 4,620,764.07 665 Mporokoso 18.7 2.4 111,026 22,205 5,551 2,498 18,041,169.87 3,469,455.74 500 Mpulungu 4.2 1.8 105,954 21,191 5,298 2,384 17,216,995.23 3,310,960.62 477 Mungwi 16.5 2.3 158,991 31,798 7,950 3,577 25,835,242.55 4,968,315.87 715 SUB TOTALS 1,002,101 200,420 50105 22,547 162,836,402.00 31,314,692.69 4,509 Chama 15.5 4.5 111,553 22,311 5,578 2,510 18,126,804.74 3,485,923.99 502 Muchinga Chinsali 28.5 0.6 178,043 35,609 8,902 4,006 28,931,097.29 5,563,672.55 801 Isoka 20.0 1.8 180,851 36,170 9,043 4,069 29,387,383.25 5,651,419.85 814 SUB TOTALS 470,447 94,089 23,522 10,585 76,445,285.27 14,701,016.40 2,117 Kaoma 32.7 224,942 44,988 11,247 5,061 36,551,950.29 7,029,221.21 1,012 Lukulu 15.3 0 95,463 19,093 4,773 2,148 15,512,260.19 2,983,126.96 430 Western Shang’ombo 15.2 0 93,817 18,763 4,691 2,111 15,244,793.42 2,931,691.04 422 Kalabo 42.1 1.2 148,924 29,785 7,446 3,351 24,199,405.38 4,653,731.80 670 SUB TOTALS 563,146 67,641 16,910 7,610 54,956,458.98 10,843,572.59 2,534 - North Western Kasempa 10.7 0 76,594 15319 3,830 1,723 12,446,142.03 2,393,488.85 345

SUB TOTALS 76,594 15,319 3,830 1,723 12,446,142.03 2,393,488.85 345 -

GRAND TOTALS 8,156,982 1,586,408 396,603 185,511 1,339,760,442.00 257,646,238.85 37,102

The total cost for the environment component is K2,137,585,442.00 ($411,074,123.46)

To fully implement the full “SAFE” strategy in the 46 districts over a period of five years, the projected cost is two billion three hundred fourteen million seven hundred sixty thousand four hundred sixteen kwacha and eighty ngwee (K2,314,760,416.80). In terms of USD this translates to $445,146,234.00 at K5.20n to $1.0 USD.

PART 7: FUNDING FOR THE “SAFE” STRATEGY IMPLEMENTATION

The activities will be carried out at 20% of expected annually. In year 5 (2017) there will be completion of all activities. The table below shows the expected funding for each component of “SAFE” strategy on annual basis.

ACTIVITY 2013 2014 2015 2016 2017 GRAND TOTAL IN KWACHA IN USD IN KWACHA IN USD IN KWACHA IN USD IN KWACHA IN USD IN KWACHA IN USD IN KWACHA IN USD

TOTAL ESTIMATED COST OF TT SURGERIES 5,132,813.40 987,079.50 5,132,813.40 987,079.50 5,132,813.40 987,079.50 5,132,813.40 987,079.50 5,132,813.40 987,079.50 25,664,067.00 4,935,397.50 TOTAL ESTIMATED COST OF MDA 29,691,414.48 5,709,887.40 29,691,414.48 5,709,887.40 29,691,414.48 5,709,887.40 29,691,414.48 5,709,887.40 29,691,414.48 5,709,887.40 148,457,072.40 28,549,437.00 TOTAL ESTIMATED COST OF FACE AND HAND WASHING 610,767.08 117,455.21 610,767.08 117,455.21 610,767.08 117,455.21 610,767.08 117,455.21 610,767.08 117,455.21 3,053,835.40 587,276.04 TOTAL ESTIMATED COST OF DRILLING BOREHOLES 195,965,000.00 37,685,576.92 195,965,000.00 37,685,576.92 195,965,000.00 37,685,576.92 195,965,000.00 37,685,576.92 195,965,000.00 37,685,576.92 797,825,000.00 153,427,884.62 TOTAL ESTIMATED COST VIP LATRINES 267,952,088.40 51,529,247.77 267,952,088.40 51,529,247.77 267,952,088.40 51,529,247.77 267,952,088.40 51,529,247.77 267,952,088.40 51,529,247.77 1,339,760,442.00 257,646,238.85

GRAND TOTAL 499,352,083.36 96,029,246.80 499,352,083.36 96,029,246.80 499,352,083.36 96,029,246.80 499,352,083.36 96,029,246.80 499,352,083.36 96,029,246.80 2,314,760,416.80 445,146,234.00

7.1.0 Sources of funding

The funding for the full “SAFE” strategy implementation is expected to come from: 1. Ministry of Health and other line Ministries: government departments will operate on the principle of sectoral advantage and contribute to the full implementation of the “SAFE” strategy accordingly. 2. Cooperating partners: cooperating partners will mobilize funding for their areas of operation. 3. The corporate sector: cooperate sector will be mobilsed to take interest in supporting trachoma elimination initiatives at community level and in areas were there is no partners support. This will be performed through corporate social responsibility. 4. Other well wishers: well wishers will be encouraged to contribute towards the “SAFE” strategy by contributing resources by way of feeling in the gaps.

PART 8: GANTT CHART ACTIVITY 2013 2014 2015 2016 2017 2018 2019

Surgeries

Antibiotics administration

Face washing

Environment improvement

Eye Health Education

Monitoring and Evaluation

Progress review

Impact assessment

PART 9: REFERENCES

1. 2010 census of population and housing, Central Statistical Office, 2011 2. Zambia Demographics Profile 2012, World Statistics 2012 3. Zambia Demographic and Health Survey,Central Statistical Office, Ministry of Health, Lusaka and Tropical Diseases Research Centre Ndola, University of Zambia, Lusaka, 2007, March 2009 4. National Health Strategic Plan 2011 to 2015 5. National Eye Health Strategic Plan 2012 to 2015 6. Ministry of Health, Trachoma Action Plan for Zambia, 2011 – 2015 7. Ministry of Health, Trachoma survey report in 65 districts in Zambia, 2013 8. Ministry of Health, Trachoma survey report in 64 districts in Zambia, 2012 9. International coalition for trachoma control, The end in sight, 2020 insight 10. National Rural Water Supply and Sanitation Programme, 2006 – 2015, Ministry of Local Government and Housing, 2007

PART 10: APPENDICES

10.1.0 APPENDIX 1: SCHOOLS AND SURROUNDING COMMUNITIES (VILLAGES OR COMPOUNDS) VISITED DURING THE ITM TRACHOMA SURVEY

CHIBOMBO DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mulungushi Agro Agro M 2 Bombwe Upper Basic Bombwe 3 Mututu Upper Basic Mututu 4 Muswishi Basic Muswishi 5 Kabanga Upper Basic Kabanga 6 Chikuse Chikuse 7 Shimbilo Shimbilo 8 Liteta Upper Basic Liteta 9 Nachiyaba Primary Nachiyaba 10 Chankumba Basic Chankumba 11 Kasukwe Kasukwe 12 Kasuku Kaseke 13 Mufwambe Middle Basic Mufwambe 14 Shampande Basic Shampande 15 Kampekete Basic Kampekete 16 Hope Community Hope Farm 17 Okada Community Okada 18 Chibombo Upper Basic Chibombo 19 Chibombo Chibombo 20 Chinena John Chinena

KABWE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Bwacha Community Bwacha Compound 2 Kachema Basic Kachema 3 St Mary’s Basic Kasanda 4 Mine Basic Kasanda 5 Mukobeko Basic Mukobeko Compound 6 Family Future Community Bwacha 7 Nkwashi Basic Nkwashi 8 Danford Chirwa Chimani 9 Wayalukanga Wayalukanga 10 Ben Kapufi Upper Basic Kapufi 11 Bwafwano Community Bwafano 12 Raphael Nkombe Nkombe 13 Mukululu Community Mukululu 14 Buseko Basic Buseko 15 Kuunika Basic Kuunika 16 Naambe Upper Basic Naambe 17 Nyenyezi Nyenyezi 18 Chandamali Chandamali 19 Chilumba Chilumba 20 Chimanimani Chimanimani

KAPIRI MPOSHI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Machusa Machisa 2 Chankomo Chankomo 3 Chambulumina Chambulumina 4 Kashitu Kashitu one 5 Kampoyo Kampoyo 6 Fubela Fubela 7 Kope Kope 8 Chaande Chaande 9 Chintungulu Chintungulu 10 Chibesa Chibesa 11 Nkole Nkole 12 Kapela Jim Kapela 13 Brunelli Upper Basic Mboboka 14 St Paul’s Primary Mboboka 15 Chibwe Basic Chibwe 16 Ntasa Ntasa 17 Kakwelesa Basic Kakwelese 18 Makafu Basic Makafu 19 Mundake Mpenge 20 Mpula Mpula

MKUSHI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Nkumbi Upper Basic Manyenyema 2 Katuba Basic Katuba 3 Chipindi Chipindi 4 Momboshi Momboshi 5 Yembekezela Yembekezela 6 Chalata Upper Basic Mwendafye 7 Malali Basic Pelete 8 Tazara Basic Chiponya 9 Mushibeba Mushibemba farms 10 Changilo Basic Masanga 11 Kasalamakanga Basic Kasalamakanga 12 Nkolonga Basic Kapanda 13 Mkushi Boma Basic Chibefwe 14 Itala foundation Community Itala 15 Chimbofwe Chimbofwe 16 Matuku Matuku 17 Fyasasa Fyasasa 18 Chinunka Chinunka 18 Kasokota Kasokota 20 Katenge Katenge

SERENJE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Muchinka BASIC Muchinka 2 Nambo Nanbo 3 Mukando Mukando 4 Nakasala Kabamba 5 Kafunda Kafunda 6 Kazembe Kazembe 7 Kabamba Basic Kabamba 8 Malwita Basic Malwita 9 Miselo Kapika Basic Mwansankanu 10 Mulembo Mulembo farms 11 Mukando Basic Mukando 12 Ndabala Basic Ndabala 13 Kamalamba Basic Kamalamba Ridge 10 14 Muchinda Muchinda 15 Fitebo Fitebo 16 Chibobo Chibobo 17 Pilyeshi Pilyeshi 18 Chikubila Basic Chukubula 19 Chimupati Basic Chimupati 20 Mulilima Basic Milembo

MUMBWA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 KAlilwe Basic Rentals 2 Bulungu Basic Bulungu 3 St Edmond Basic Muchenje 4 Mukanda Basic Mwanang’umbwe 5 Shimbizhu Basic Nsenga 6 Nalusanga Basic Masumba 7 Nambala Basic Lutuna 8 Lusekelo Community Chitatabala 9 Moono Basic Moono 10 Mumbwa Basic Chitambala 11 Kanwanzhiba Basic Muchayanshimbi 12 Kandesha Basic Kabesha ‘A’ 13 Chibela Basic Mwiimbi 14 Makasa Basic Mayewa 15 Sanje Basic Chilimboyi 16 Mulili Basic Mululi 17 Malende Basic Mulobela 18 M.J Private Natani 19 Matala Basic Machipisha 20 Kasalu Basic Kasalu

CHILILABOMBWE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Butondo Basic Kawana 2 Chimeshi River Ba Lozi,Muya 3 Kasumbalesa middle Basic Kasumbalesa 4 Chinfushi Basic Kampeku,Chimfushi 5 Kanenga Middle Basic Kanenga,mine Farm 6 Canan Community Poor People of Zambia(PPZ) 7 Lubengele Catholic Community PPZ 8 Fitobaula Fitobaula 9 Kafue River Bed Basic Miteta 10 Samaritan Community P.P.Z.,Lubengele 11 Kakono Middle Basic Kakono 12 Fikolongo Middle Basic Fikolongo 13 Maina Soko Maina Soko 14 Lubansa Basic lubansa 15 Kawama Middle Basic Kawama 16 Kasapa Middle Baisc Kasapa 17 Konkola Middle Basic Nkokola 18 Miyanda Middle Basic P.P.Z. 19 Golden Eagle Community P.P.Z. 20 Mazubeni Middle Basic Kanengene

CHINGOLA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Luano basic Luano 2 Musenga Basic Musenga 3 Mushishima Middle Basic Chiwala 4 White Lilly Community Mulyata 5 Kids Hope Old Maiteneke 6 Chibanyama Chibanyama 7 Luano Kapisha 8 Wild Trust Community Wild life Trust,Chimuboshi 9 Chinukule Community Chinukule 10 Twapena Twapena 11 Mato Basic Mato 12 Chimakumbi Middle Basic Chimakumbi 13 Fibangula Boso 2 14 Muchinshi Muchinshi 15 Kayowelo Kayowelo 16 Mutende Mutende 17 George Mwelwa Middle Basic Kayowelo 18 Lwankole Baisc Lwankole 19 Mambili Middle Basic Chimata 20 Papopo Middle Basic Kapopo

KALULUSHI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Fibale basic Chati 2 Twayuka Chibote 3 Nkokonya Nkokonya 4 Buyantanshi Nsokoloko 5 Kalisha Chamwanza 6 Lushimba Lushimba 7 Kalisha Middle Basic Kalisha 8 Chisangwa Chisangwa 9 Kaputula Community Kankoyo 10 Tiwonge Community Chibote 11 Chati Basic Kaonga Farm block 12 Lunga Community Suze 13 Chasuma Community Chasuma 14 Kamatipa Community Chifupa 15 Pandula Community Pandula 16 Kafubu East community Kafubu 17 Kafubu West Kafubu West 18 Chembe Basic Chembe 19 Kafubu Depot Kafubu Depot 20 Chibuluma Basic Chibuluma

MPONGWE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Munkumpu Basic Munkumpu 2 Chamatete Chamatete 3 Chisapa Basic Cheelo 4 Lwamabwe Middle Baisc Lwamabwe 5 Kalweo Mpindamishi 6 Nkulungo Community Kasaboma 7 Sanfwe Community Kamiche 8 Kapili Basic Chenda 9 Bwembelelo Basic Chifumbula 10 Chitabale Basic Munkandu 11 Chintemfu Chimtefu 12 Mwinuya Basic Hauze 13 Mikata Chilekeni 14 Malembeka Malembeka 15 Agape Chitina 16 Miyanda community Kasanda 17 Kamabaya Serenje 18 Itanda Lot 19 Ikula Chikundwe 20 Grace Community Chambata,Nshingulusheni

LUFWANYAMA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Shimukunami Mumena 2 Minchika Community Minchika 3 Nkana Basic Nkana 4 Kashininkisha Basic Mashilipa 5 Katenda Basic Katenda 6 Kabamba Middle Basic Chilukusha 7 Shibuchinga Middle Basic Shibuchinga 8 Pwele Mutesha 9 St Mary’s Mutesha 10 Kapilimakwa Kapilimakwa 11 Milopa Basic Milopa 12 Mulemu Mulemu 13 Mpompo Kalembula,Dube 14 Kakompe Njapau 15 Milulu Basic Milulu 16 St Joseph Chasela,Mutondo 17 Mibenge Mibenge 18 Chimoto Chimoto 19 Chapula Chapula 20 Katuta Basic Katuta

MASAITI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Masaiti Basic Nnndabalo 2 Mulofwa Basic Mulofwa 3 Saka Basic Saka 4 Chamunda Basic Boma 5 Munyemesha Middle Basic Kapandula 6 Lwangobe Basic Lwangobe 7 Fifungo Basic Mulomwe 8 Chilese Basic Chilese 9 Mishikishi Middle Basic Mutampula 10 Mipundu Basic Chatyola 11 Matida Middle Basic Lusambo 12 Chankonte Basic Monika 13 Mutaba Basic Chakupa 14 Silangwa community Lubesha 15 Muteteshi Basic Kaindu 16 Kaunga Basic Chinchilye 17 Lisomona Community Lisomona 18 Mbotwa Community Mbotwa 19 Ntengwa Community Ntengwa 20 Mbutuma Community Kamachika

CHONGWE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Chilyabale Shipanuka 2 Lukoshi Basic Shamboshi 3 Chalimbana Basic Chalimbana 4 Lwimba Basic Shakola 5 Chongwe Basic Lusoke 6 Shikabeta Basic Shikabeta 7 Mulalika Basic Mulalika 8 Matipula Basic Matipula 9 Kasisi Basic Kasisi 10 Chainda Njovu,ndango 11 Kumena Basic Kasenga 12 Itope Basic Kacha 13 Palabana Basic Palabana 14 Chinyunyu Basic Wundawunda 15 Silver rest basic Research 16 Namanongo Basic Kabandi 17 Lubalashi Basic Shikabeta 18 Mwachilele Mwachilele 19 Rufunsa Basic Chipindani 20 Chipekete Basic Chipekete

LUANGWA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mwalilia basic Kasinsa,chisobe 2 Chilombwe Basic Kanyaze,Chikumbi 3 Chikansi Community Resettlement Scheme 4 Kavalamanja Basic Kavalamanja 5 Kakaro Basic Kakaro 6 Kaunga Basic Chibela 7 Kaunga Community Balakasau 8 Mankhokwe Basic Manuel 9 Mangelengele Community Mangelengele 10 Mwavi basic Chuzu 11 Kaluluzi Community Kanemela 12 Luangwa Basic Luangwa 13 Chilukusha Basic Lukunshe 14 Chiriwe Basic Nyamizi 15 Kapoche Basic Nyaukwindi,Nyaupite 16 Katondwe basic Siyawakoza 17 Jainero Basic Jainero

NYIMBA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Chifukuzi Community Chisenga 2 Kalongo Mwape Basic Chipundo,Kalongo 3 Chiweza Basic Mpeta 4 Nyima Basic Nyimba Boma 5 Mtilizi Basic Resettlement Scheme 6 Ambo Simpeta 7 Mambo Basic Lupenga 8 Nyalungwe Basic Nyalungwe 9 Nyakaloko Basic Muchimazi,Resettltment scheme,Chibandila 10 Mvuwa Basic Mutenga 11 Mombe Basic Simatanga 12 Milembo Community Kazolwe 13 Kamono Basic Kamono 14 Njalazi Community Miti 15 Chikontha Waited 16 Betele Sikwenda 17 Utotwe Basic Mulima 18 Kapakasa Basic Kanyuka 19 Chowa Basic Chowa 20 Ng’ambwa Basic Ben

PETAUKE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Ukwimi ‘A’ Basic Ukwimi 2 Minga Stop Basic Minga stop 3 Mizyu Basic Mizyu 4 Mawanda Basic Chimkhawamba 5 Matonje Basic Matonje 6 Merwe Mission Basic Mulilang’ombe 7 Lutwazi Basic Mphamba 8 Kalumbi Community Chikwela 9 Chikuse Basic Chikuse 10 Mwanjabanthu Basic Kaumbwe 11 Mumbi Basic Mumbi 12 Tirtonse Basic Tiritonse 13 Senya Basic Chifwiti 14 Ray Middle Basic Kasezya 15 Kapungwe Basic Makina 16 Kalindawalo Primary Kalindawalo Headquarters 17 Nyanje Basic Nyanje 18 Matambazi Naniwe,Kanchito 19 Chokato RCH Community Mpeni 20 Chassa Basic Chinkhumba

KATETE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Chiwayu Basic Chikomo,Michembo 2 Jersey Basic Yalela 3 Matunga Basic Ng’ombaila 4 Chimtende Basic Chipopela 5 Chisale Basic Chituza 6 Undi Basic Undi,Mchepa 7 Kafunkha Basic Chimutukulo 8 Chikwanda Basic Chikwanda 9 Katete Basic Soweto 10 Mbinga Mbinga 11 Seya Basic Seya 12 Nthongole Basic Mastala,Chikoko,Kango 13 Sinda Basic Madaliso 14 Chibolya Basic Mutaya,hygiene 15 Kagoro Basic Kagoro 16 Kambila Basic Chinzili 17 Mtandaza Basic Nyankhonzi 18 Kawaza Basic Kawaza 19 Kafumbwe Basic Alick 20 Chimbundire Basic Chilembwe

CHIPATA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Vizenge Basic Mlangeni 2 Kasenga Basic Nyambo 3 Makwe Basic Jojo 4 Mnoro Basic Kambezi 5 Nsanjika Basic Ngocho 6 Maguya Basic Chiminya 7 Walira Basic Mlembo 8 Nsingo Basic Lulaka 9 Dzoole Basic Dzoole,Chindima 10 Nkhoto Middle Basic Kalunda,Chaima 11 Chiparamba Basic Soweto 12 Mkowe Basic Chikumbe 13 Mtewe Basic Mtewe 14 Mbejere Basic Chizimati 15 Madzimawe Basic Madziwawe 16 Kapoko Basic Mnukwa 17 Katintha Middle Basic Kampala 18 Mtizwa Basic Zile 19 Chingazi Basic Kanyelele 20 Makungwa Basic Mphuzuzu

LUNDAZI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kambale basic Mtachi 2 Mankha open Basic Kafwandala 3 Kambaza Middle Basic Mahlalela 4 Chingando Primary Kazumba 5 Chilola Middle Basic Loti 6 Mphili Middle Basic Zangazanga 7 Chasefu Basic Chiswa 8 Mwanyi Middle Basic Mwanyi,Chimbila,Jembe 9 Kapekesa Basic Kapekesa 10 Tigone Basic Motondo 11 Chipembele Basic Makule 12 Kakumba middle Basic Dombola 13 Phikamalaza Basic Efumbezi 14 Katube Basic Gwai 15 Chaomba Basic Gundamkochi 16 Kachunga Primary Bulumuti 17 Sikatengwa Chitalalwe 18 Kapaipi Chitape 19 Chatemwa Kanjauke 20 Mpheluke Kapewele

CHADIZA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Katantha Basic Malenya 2 Kabvumo Basic Nunda 3 Taferansoni Zengwe,mzungaila 4 Mkumbudzi Basic Changunda 5 Chanida Basic Chanida 6 Robby Robby 7 Msakanyama Msakanyama 8 Chilenga Basic Chikoloka 9 Chamandala Basic Thanile 10 Kalemba Basic Ndondela 11 Mangwe Basic Kaphale 12 Kadzionere Basic Mbinga 13 M’sokosela basic M’kande 14 Champhanda Basic M’genthu 15 Manje Basic Kapela 16 Luli Basic Chathuluka,Chalungwa 17 Kalongezi Basic Kulika 18 Chiyambi Basic Chimpelela 19 Bwanunkha Basic Mukokoko 20 Madzaela Basic Mtila

MAMBWE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mfuwe Basic Mfuwe 2 Uyowa Community Fwalu 3 Nsefu Basic Malimbila 4 Kawaza Basic Mwizala 5 Kapita Community Chembe 6 Ncheka Basic Ncheka 7 Mphata Basic Kapole 8 Chitempha Basic Mumba 9 Chiutika Basic Chiutika 10 Mnkanya Community Mnkanya 11 Kamphasa community Kamphasa 12 Jumbe Basic Jumbe 13 Kamoto R.C.Z Mission Basic Gaga 14 Kasinga Basic Kayamba 15 Chisengu Sungani 16 Chivyololo Chimbuzi,Kalumba 17 Mdima Basic Saili 18 Msoro Basic Msoro 19 Wazaza Middle Basic Chimasola 20 St Francis Basic Mungawa

CHAMA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kajoto Community Mpundu 2 Bazimu Basic Bazimu 3 Chotheka Basic Tembwe 4 Mabinga Basic Mabinga 5 Dungulungu Basic Dungulungu 6 Chimbilima Community Chimbilima 7 Katete Basic Kazzembe,Chimbilima 8 Chimilila Middle Basic Mungwalala 9 Kambombo Basic Kasama 10 Kamphemba Basic Chizimba 11 Nkhanga Basic Chizembe 12 Chama Basic Lukombozi 13 Kasangani Basic Chama 14 Mundalanga Primary Mundalanga 15 Katovya Basic Chimseu 16 Kapalakonje Basic Kamizunga,kapalakonje 17 Buli Basic Chikumbilo 18 Nkhoka Basic Kawelele 19 Chibungwe Community Kabilo 20 Chitukula Basic Chitukula

LUKULU DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Ngimbu Basic Kashenga 2 Kasheke Basic Kasumpa 3 Ngomang’ulu Basic Simbaula 4 Liyowelo Middle Basic Lilondo 5 Kasombo Basic Simasiku 6 Mumbumbu Middle Basic Mumbumbu 7 Luanchuma Basic Mbambo 8 Namakando Basic Sipalo 9 Lishuwa Basic Mwiba 10 Nyati Middle Basic Matolokisi 11 Muyondoti Basic Kankwalala 12 Lubosi Basic Chimbanda 13 Lwande Basic Kamboyi 14 Imenda Basic Simakumba 15 Simakumba Simuchimba 16 Namayula Basic Katota 17 Nangandu Middle Basic Mushwato 18 Kalambwe Community Limbaba 19 Livuzi Chimwaso 20 Kamilende Middle Basic Kangombe

MONGU DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Katongo Basic Katongo 2 Mutwiwambwa Middle Basic Kandiyana 3 Mabumbu Basic Mabumbu 4 Malengwa Basic Malengwa 5 Maccu Basic Maccu 6 Kalangu Basic Sing’anda 7 Imwiko Basic Imwiko stage 2 8 Liunga Basic Libumu 9 Limulunga Community Limulunga 10 Limulunga Basic Limulunga 11 Nang’oko Basic Mushuwa 12 Kasimu Community Sachinga 13 Mawawa Primary Nasikela 14 Ilundu Basic Mumbuna 15 Sefula Basic Nalikola 16 Namushakendi Basic Namushakendi 17 Namachaha Basic Sefula 18 Kaande Basic Nawa 19 Ushaa Basic Kamwengo 20 Bethlehem OVC Ndinda

SENANGA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Ngundi Basic Nangombe 2 Sikumbi Basic Mpanda 3 Lukanda Basic Simbondwe 4 Namaenya Basic Sachiengele 5 Songa Basic Luka 6 Sayi Basic Nakalala 7 Itufa Basic Ikulaha 8 Situnga Middle Basic Situnga 9 Suunda Basic Lyendela 10 Senanga Basic Mungule 11 Nande Basic Maongo 12 Nanjucha Basic Mau 13 Nasiwayo Basic Limbwa 14 Likuma Basic Sitengenyi 15 Matongo Middle Basic Siteo 16 Muoyo Basic Muoyo 17 Lubosi Middle Basic Nakatindi 18 Sianda Mangongo 19 Liangati Basic Nakasa, Liangati 20 Namalangu Basic Namalangu

SESHEKE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Neongelo Community Mutanda 2 Katima Basic Katima 3 Lusu West Basic Jakobo 4 Sesheke Basic Kashongami 5 Silolo Middle Basic Silolo 6 Mwandi Basic (U.C.Z) Mwandi 7 Mangamu Middle Basic Mangamu 8 Maondo Basic Munguli 9 Simungoma Basic Kasamu 10 Katongo Basic Busitakulo 11 Sooka community Sooka 12 Kakulwani Basic Kakulwani 13 Manyekanga Basic Suulu 14 Lipumpu Basic Lichaha 15 Ng’ambwe Basic Ng’ambwe 16 Lutaba Basic Lutaba 17 Mutuwapafa Basic Mutuwapafa 18 Kangubu community Kangubu 19 Nakatindi Basic Simawewe 20 Mutemwa Basic Ilwendo

SHANG’OMBO DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mengo Basic Mengo 2 Matebele Basic Matebele 3 Naliyo Community Nalwanda 4 Nalwashi Basic Nalwashi 5 Sitoti Basic Naluwe 6 Mulangu Basic Nalutelutelu 7 Mboiwa basic Mboiwa 8 Matunda Basic Silukoma 9 Lwamaya Basic Lwamaya 10 Kaanja Basic Libita 11 Siwelewele Basic Silukoma ‘B’ 12 Liyuwayuwa Basic Lenge 13 Natukoma Basic Nashango 14 Shangombo Basic Kapengele 15 Nalimbwambwa Community Nalimbwambwa 16 Ngandwe Basic Ngandwe 17 Mbopuma Community Mbopuma 18 Nangweshi Basic Liko 19 Sioma Basic Malombe 20 Nakabunze Basic Nakabunze

MWENSE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mukumbwa Basic Mukumbwa, Chisalaba 2 Musunga Mpashi Lukwesa 3 Kasonge Basic Kasonga, Mululu, Kaumba 4 Kabundafyela Basic Kabundafyela 5 Mulundu Basic Mulundu 6 Tangwa Basic Tangwa 7 Katuta Basic Katuta 8 Kashiba Kashiba 9 Fisaka Primary Kufisaka, Mulila, Piba 10 Kawama Basic Kapala 11 Chebele Basic Kamboho 12 Kasengu Community Kasengu 13 Wanyange Community Wanyange 14 Chikumbi Community Labani 15 Mkonge Basic Kwesha, Chimimba 16 Chipili Upper Basic Maidambe 17 Mupeta Primary Mupeta 18 Mweshi Middle Basic Mweshi 19 Mulunda Community Mulunda 20 Lumino Basic Lumino Scheem

SAMFYA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Samfya Basic Mwamfuli 2 Miloke Miloke 3 Chibolya Basic Chibolya, Prisons, Police 4 Chinsanka Basic Sekonde 5 Chipako Primary Mwansa Chitima 6 Mufimba Community Mufimba 7 Mano Basic Malemba 8 Mabo Basic Mabo Kunda 9 Chiseshi Basic Pusikilo, Chifube 10 Nkulunga Kolosa 11 Masanta Basic Masanta 12 Mundubi Basic Mundubi, Sonkota 13 Nshungu Primary Kamukwamba 14 Chamalawa Primary Kamushopo, Chamalawa 15 Cholansenga Cholansenga 16 Mulilachembe Shipangwa, Yotam 17 Kafubashi Primary Chilundo 18 Lwame Primary Diamoni 19 Isaki Community Isaki, Chisokwa 20 Mushili Community Mushili

KAWAMBWA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Ntulo Primary Mutuna, Chisambe 2 Lusambo Lusambo, Chaba 3 Ntembo Bwalya, Kaka 4 Tea Estate Mupela south, North Compound 5 Seesa Seesa 6 Mushindike Chansongo, Matabishi Section 7 Mumbolo Community Mumbolo, Shimumbolo 8 Kabalenge Cholwe, Chimpunu 9 Kampemba Community Chibolya, Henry 10 Kamfukeshi Basic MApipo, Kamfukeshi 11 Chitondo Papipo, Shichungu 12 Mwangwe Funkwe, Mwangwe, Kapenfu 13 Kalasa Primary Kalasa, Ndaso 14 Kala Basic Chungu 15 Ntenke Basic Ntenke 16 Shinonde Primary Shinonde 17 Chabanya Chabanya, Kalyo 18 Chisha Community Chisha 19 Katungulu Basic Katungulu, Mubiti, Kabuluma 20 Mbereshi Basic F.T.C, Mulalami

MANSA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Chitanda Chinanda 2 Chakopo Buntungwa 3 Masaba Masaba 4 Chile Chiluwe, Katumbi 5 Milima Sepe 6 Kundafumu Kafusha 7 Chibende Musafili 8 Lubende Kabalika, Chibende 9 Mabumba Primary Mabumba 10 Musenga Basic Kolala 11 Mapalo Labi 12 Kale Primary Chikaya 13 Fibale Chitumbi 14 Mimpolombo Yawimu 15 Lukundushi Katuku 16 Mutiti Primary Mutiti 17 Kalaba Tuli 18 Muwanguni Sokoni 19 Lukangaba Kalungushi 20 Bahati Primary Katalwe,Mupanda

MILENGE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kapalala Basic Chipe 2 Katena Community Katena 3 Milenge Primary Tilayi, Nyembe 4 Milambo Primary Milambo 5 Chabuka Baushi Primary Nowa mali, Mutatila 6 Lwela Primary Lwela 7 Butibwe Basic Kapu 8 Moffat Basic Moffat 9 Chiswishi Basic Totola, Kuyafya 10 Mapula Basic Chifwalu 11 Matontola Primary Matontola 12 Chibende Basic Foloko 13 Milulu Basic Mondo 14 Mulumbi Basic Mulumbi 15 Kafwanka Primary Kafwanka,Mungulube 16 Sokontwe Sokontwe 17 Kasepa Primary John Nkumba 18 Mashuka Primary Sokontwe, Mashika 19 Changwena Community Nyeleti 20 Lunga Basic Lunga

SOLWEZI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kamano Basic Kayamba 2 Kisalala Kambilikichi 3 Mumena ‘A’ Basic Kaindu 4 Muchena ‘A’ Basic Road 6 Zone A 5 Lumwana East Basic Kanyemesha 6 Chovwe Basic Chovwe 7 Mushitala Mushitala 8 Kankonzhi Basic Kankonzhi 9 Kyeya Middle Basic Chiluba 10 Kilumba Basic Nkunta 11 Wakabilwa Wakabilwa 12 Luamalo Basic Taima 13 Kabuloba Basic Munangwa, Kabuloba 14 Kanang’a Basic Mukulumoya 15 Kingovwa Kingovwa 16 MitukutukuBasic Mwala 17 Kyansununu Basic Jingongole 18 Kimakolwe Basic Kawama 19 Kyalalankumba Basic Kyalalankumba 20 Kamabende Kamabend

MUFUMBWE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kamisombo Lukomona 2 Shukwe Kikulukumbwe 3 Kamabota Kamabota 4 Nyansonso Fuchika 5 Kakilufya Kakilufya 6 Kikonge Kangelesha 7 Lumwe west Settlement Scheme 8 Chalimbana Chalimbana 9 Kalambo Pepa 10 Wishimanga Kapenyi 11 Matushi Kazuba 12 Kashima Basic Sazende 13 Chilemba Sakangende 14 Kakikasa middle Basic Road 3 15 Kifuwe Basic Chingungu 16 Chizela Basic Chizela (Chief’s palace) 17 Kamayembe Middle basic Sambalachi 18 Kalende Basic Talamana 19 Kawama Basic Kawama Settlement Scheme 20 Kalengwa Basic Kalengwa

MWINILUNGA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Muzenzi Community Muzenzi 2 Kakoma Basic Kasawantu 3 Kamunzekeli Nfwela 4 Kansefu Kuchaya 5 Mukangala Basic Mukangala 6 Kasampula Kasampula 7 Saluzhinga Saluzhinga, Kapweka 8 Katuyola Katuka 9 Kambimba Kambimba 10 Nswanakudya Nswanamumi 11 Kampemba Kanzhimu Area 12 Nyingongi Community Tepa 13 Tom Ilunga Basic Tom Ilunga 14 Lwetondu Community Masumba 15 Kamfumbu Community Tambuka 16 Lwamisamba Malaya 17 Nkenyawule Mukamba 18 Kabanda Basic Kabanda 19 United Methodist Community Musela Hill 20 Mapesho Moyela

KASEMPA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mubambelumbe Msasa, Kabandanya 2 Shapenda Basic Kapayi 3 Kantenda Upper Basic Kantenda 4 Nselauke Basic Kiboko 5 Kafumfula Mungwe 6 Ingwe Basic Mutaka 7 Kamakechi Kabemba 8 Ng’oma Ntondo 91 Kabele Basic Tulisha, Kalungisha 0 Shikulukila Cholwe 11 Kang’ombe Kang’ombe 12 Kizhiba Primary Kasangami 13 Kaimbwe Mutono 14 Mukinge Basic Mukinge 15 Kabutwitwi Basic Kananda 16 Makaba Basic Ngungu 17 Mpungu Kashimoto 18 Kateele Middle Basic Katanga 19 Kelongwa Kalima 20 Dengwe Jamuselele

KABOMPO DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kabulamema Kabulamema 2 Chilumba Chilumba 3 Chatwika Njamba 4 Mawande Sekeseke 5 Katendwa Mbowela 6 Mushona Basic Mushona 7 Ndelo Nyachihawe 8 Samununga Samununga 9 Chitebe Chipoya 10 Kamashila Longwani 11 Mufuli East Mufuli Kawabi 12 Kananji Chilanda Mumbeji 13 Samafunda Samafunda 14 Ndoho Ndoho 15 Mabebe Chisengi 16 Kaula Mutanginyi 17 Pakasa Mingeli 18 Biyeko Biyeko 19 Kamafwafwa Kaivwa 20 Kalambo Mubana

ZAMBEZI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Lwapungwa Mushona 2 Kasesi Nyachipopa 3 Chitokoloki Chitokoloki 4 Lwatembo West Lwatembo west 5 Chizozu Chizozu 6 Chinyingi Chinyingi 7 Kawimbu Ishindi 8 Chozo Katali 9 Nsangula Kawele 10 Chileng’a Chileng’a, Lambakasa 11 Ilayula Chala 12 Mahengu Community Mahengu 13 Nyamong’a Nyamong’a 14 Lwatembo East Katumba 15 Lwitandi Lwitandi 16 Likunyi Chisamba 17 Mukonu Kalukoshi 18 Nyesong’a Nyesong’a 19 Chizenzi Kashima Area

CHAVUMA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kainda Lyaula 2 Sewe Chimuli 3 Kalombo Kunga, Chifisa 4 Mandalo Mandalo 5 Chambi Basic Chambi 6 Sanjongo Basic Lingwelende 7 Musunga Basic Musunga 8 Chilonga Community Chilonga 9 Luzu Basic Katule 10 Lukolwe Miyoba 11 Kakhoma Makupu 12 Mutwe wankanyi Mutwe wankanyi

KASAMA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kabulu Community Chandamukulu 2 Ngoli Basic Ngoli 3 Kanyanta Community Kanyanta 4 Mulanshi Basic Mukopa 5 Twikatane Muyotemenwe 6 Milima Milima 7 Kasenda Basic Kasama 8 Mumana Lupando Basic Mumana Lupando 9 Mwelwa Basic Kabwe 10 Mubanga Chipoya New town 11 Kasakula Basic Kasakula 12 Paul Kalemba Community Paul kalemba 13 Mapango Chisala Mwamba 14 Lubushi Upper Basic Mundubile 15 Kapada Middle Basic Kapanda 16 Mulenga Mapesa Basic Kanyanta 17 Misambo Primary Misambo 18 Lukulu South Basic Lukulu 19 Nkole Mfumu Kapoposanja Sanja kapopo 20 Itamina Basic Ponda, Kalense

MUNGWI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mumena Middle Basic Mumena 2 Kanyanta Upper Basic Koni 3 Milando Middle Basic Chishika 4 Ngulula Basic Koshima, Ngulula 5 Mabula Middle Basic Chilele, Nchumangulu 6 Chisali Middle Basic Chimba 7 Chibile Basic Kanuma 8 Mukuka Mfumu Basic Mukuka Mfumu 9 Ndasa Middle Basic Chisama 10 Itinti Middle Basic Itinti 11 Chitila White, Chibote 12 Kapolyo Basic Kapolyo, Panta, Mulabaila 13 Chewe Basic Chewe 14 Musungu Basic Location, Misasa 15 Kalafya Basic Chipowe 16 Musenga Basic James 17 St John’s Basic Lukonto, Lubemba 18 Mutemba Basic Mutemba Village 19 Mukosa Basic Mukosa 20 Luchindashi Kanyata

LUWINGU DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kapupu Basic Fumbata,Kapupu,kacenchete,lwembele 2 Saili Basic Saili,Lukonde Mwaba,Lima,Mulenga Chipopola 3 Sakeni Basic Sakeni,Chitangasha,Mumamba,chapa,Mundaya 4 Kapoma Middle Basic Kapoma 5 Chimbwi Basic Chimwbi,Mukwenga,Kafwimbi,Chimpole 6 Munshishinga Basic Chaswe,Kabuta,Mine 7 Chambo middle Basic Chambo,Chibwabwa 8 Washeni Middle Basic Washeni,Chisela,kaoma,Chanda,Ndolesha 9 Lundu middle Basic Lundu,Musengule,Chokwe,Lubanga,Chisansala 10 Luwingu Basic Coop,Chikoyi,Kapisha 11 Menga Basic Kakusa,Menga 12 Mucheleka Basic Kambasa,Mcheleka 13 Chabula Basic Chimembe,Chibota 14 Misabula Middle Basic Nkhoshi,Chuumba 15 Lobati Community Chisamu

CHILUBI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Chimfwembe Basic Kashitu 2 Chibula Basic Mule 3 Kapampa Basic Kapampa 4 Muchinshi Middle Basic Muchinshi 5 Mwima Basic Mwima 6 Chaba Middle Basic Chaba 7 Kasali Middle Basic Mulenga Mupangwe 8 Mpupo Basic Njeka and Meleki 9 Kawasa Basic Chisopo and Kapepa 10 Matipa Basic Kasonke and kawama 11 Yombwe middle Basic Yombwe 12 Chitimali Basic Chitimali 13 Katanta Basic Mpoto and malabi 14 Kasanda Basic Walusha, Pintu and Chibwete 15 Kabesha Basic Kabesha 16 Bulilo Basic Moombo 17 Chinika Mpundu Mpundu, Mupwila and Kapiri 18 Malyofo Middle Basic Malyofo, Nsakula, Kalumbwensali 19 Kashishi Middle Basic Chansa, Malulu 20 Lubilikilo Basic Chanda, Mulenga and Mulambi

MPOROKOSO DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mwita Middle Basic Mayanga 2 Katutwa Basic Katutwa 3 Chinika Middle Basic Mulenga, Chenda, Zeka 4 Chitoshi Basic Chitoshi 5 Mabingu community Mabingu 6 Lupunga Basic Yosafa 7 Muyembe Basic Muyembe 8 Mukolwe Basic Kaniki 9 Ng’andu Basic Chishamwamba 10 Kalabwe Basic Chilangwa 11 Kevi Middle Basic Levi 12 Bweupe Basic Bweupe 13 Mporokoso High Mwamona 14 Sambala Basic Sambala 15 Tapa Middle Basic Chilabi and Chikungulu 16 Mukanga Basic Mukanga 17 Chanda mali Basic Tanganyika 18 Mporokoso Basic Mwapona and Kapela

KAPUTA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Kabwe Basic Kabwe 2 Kapepula Basic Mukoyo and Kapepula 3 Chibote primary Amon 4 Nsemwe Basic Mutalalila 5 Kakomo Basic Kakomo 6 Sefya community Sefya 7 Kabobole Basic Kabobole 8 Kasongole Basic Kombe 9 Kapisha Basic Matembele 10 Mantapala Basic Mantapala 11 Matobwe Basic Nyasa 12 Chipili Basic Chipili 13 Luntofwe Basic Luntofwe 14 Katai Basic Katai 15 Nsama Basic Abelo and Musonda 16 Chichenchelebwe Basic Kafonka 17 Lunsangwe Basic Ndemani 18 Kaputa Basic Kaputa 19 Choma Mutima Sanelo

CHINSALI DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Nashinga Middle Basic Chipandula, Joseph, Ben and Bushimbe 2 Kabungo Basic Kabungo, Kasomo and Kabuta 3 Kantimba Basic Kantimba, Mwaba and Chibunde 4 Chungulo Basic Misonta, Chitankwa,Mutama and Kupya 5 Choshi Basic Masandiku, Choshi and Kapiri 6 Chumbu Basic Pitilosi, Kakusa and Chipope 7 Kabangama Basic Mushishi 8 Luko Basic Musanya 9 Mundu Basic Mundu 10 Kanakashi Basic Matumbo 11 Nambuluma Basic Mucheleka 12 Mulakupikwa Basic Mulakupikwa 13 Kampemba Basic Kampemba 14 Mulanga Basic Nsofu and Chuma 15 Esao community Mapampa, Kalonge and Chunika 16 Kabangwe Basic Kakusa, Chipope and Pitros 17 Mwenge Basic Nikayafuma, Pitala, Mala and Chisosa 18 Sele Basic Sele 19 Mukulo middle Basic Kasumo, Bright, Mukuka and Muleya 20 Mubanga Middle Basic Mubanga

MPULUNGU DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Musende Basic Musende 2 Kapondwe Basic Kapondwe 3 Makola Basic Makola 4 Isoka Upper Basic Yambayamba 5 Katulo Basic Katulo 6 Kasulo Kasulo 7 Kasakalabwe Kasakalabwe 8 Mankonga Mankonga 9 Uyamba upper Basic Jakab 10 Kakusu Basic Kakusu 11 Chitente Pre/Basic/High Muzabwela 12 Chinakila Basic Chinakila 13 Mupata Basic Mupata 14 Niamukolo Basic Posa 15 Ntema Community Ntema 16 Misombizi Community R.R 17 Kopeka Basic Kopeka 18 Mpulungu Basic/Tehila Location Nursery 19 Chitimbwa Chitimbwa 20 Kalonda Mwilye 84

ISOKA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Chiwanda Basic Location 2 Kafwimbi Basic Kafwimbi 3 Longwe Basic Longwe 4 Nangala Mandala 5 Tuta Community Tuta 6 Kapililonga Mukwavi 7 Chilanga Basic Chilanga 8 Chikana Chikana 9 Kamekela Kamekela 10 Nachisungu Nachisungu 11 Nsansa Mwenje Nsansamwenje 12 Malango Malango 13 Mutondo Mutondo 14 Mwenitawa Mwenitawa 15 Lualizi Lualizi 16 kampumbu Kampumbu 17 Chinyansi Chinyansi 18 Mulamba Mulamba 19 Sochitambule Sochitambule 20 Mukwiza Mukwiza

MBALA DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Chipoma Middle Basic Chipoma 2 Kaka Basic Kaka 3 Kawimbe Basic Kawimbe 4 St Pauls St Pauls 5 Uningi Uningi 6 Lumi Lumi 7 Katito Katito 8 Mbulu Upper Basic Mbulu 9 Lucheche Lucheche 10 Outward Community Outward 11 Celestie Celestie 12 Mbala Mbala 13 Zombe Basic Zombe 14 Kavumbu Kavumbu 15 Mwenda Middle basic Mweda 16 Mwamba Mwamba 17 Chalamanga Chalamanga 18 Nsangu Middle Basic Nsangu 19 Landula Middle Basic Landula

NAKONDE DISTRICT № SCHOOL COMMUNITY/COMPOUND 1 Mayembe Basic Mayembe 2 Mulizye Basic Mulizye 3 Movu Basic Movu 4 Tewele Tewele 5 Mukumbe Basic Mukumbe 6 Mutiwe Basic Mutowe 7 Mutachi Community Mutachi 8 Chilolwa Chilolwa 9 Kazembe Middle Basic Kazembe 10 Chiwala Basic Chiwala 11 Shem Basic Shem 12 Zyozyo Basic Zyozyo

10.2.0 APPENDIX 2: AREAS VISITED DURING TRACHOMA MAPPING IN FIFTEEN DISTRICTS USING THE WHO CLASSICAL METHOD

1. LUSAKA DISTRICT a. Linda compound b. Chipata compound c. Lilanda compound

2. MAZABUKA DISTRICT a. Mabwe atuba village b. Shimungalu village c. Musuma area

3. KAFUE DISTRICT a. Chanyanya b. Kabweza c. Kapongo d. Chiyawa

4. KALABO DISTRICT a. Kuuli b. Libonda c. Musheshengele d. Nene e. Konga f. Makaka g. Inkanda h. Siyanda i. Kanjana j. Litoya k. Nesha l. Liyundelo

5. LUANSHYA DISTRICT a. Walale b. Chufulube c. Kawama

6. KITWE DISTRICT a. Kawama b. Mulenga c. Kapoto

7. NDOLA DISTRICT a. Twapia b. Chipulukusu c. Kaloko d. Mackenzie e. Kawama

8. SIAVONGA DISTRICT a. Lusitu b. Sikoongo c. Musuya d. Ibwe munyama

9. NAMWALA DISTRICT a. Chitongo b. Kabula Mwanda c. Mafutu d. Maala

10. LIVINGSTONE DISTRICT a. Maramba compound b. Sawmills compound c. Kashitu compound

11. KAZUNGULA DISTRICT a. Sikanzwe b. Machenje c. Mukuni

12. KALOMO DISTRICT a. Namianga b. Kasukwe c. Siachitema d. Chawila

13. ITEZHI-TEZHI DISTRICT a. Kaingu b. Lubanda c. Munaluchema

14. MONZE DISTRICT a. Sigubbu b. Bweengwa c. Hamukachali d. Chipembele

15. GWEMBE DISTRICT a. Hamatebe b. Shebwa c. Sinafala d. Siabbamba e. Mundioli f. Chipepo g. Chibuwe