Tanzania Work Plan - ENVISION...Tanzania Work Plan FY 2017 Project Year 6 October 2016–September...

Tanzania Work Plan FY 2017 Project Year 6 October 2016–September 2017

ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by the US Agency for International Development under cooperative agreement No. AID-OAA-A-11-00048. The period of performance for ENVISION is September 30, 2011 through September 30, 2019. The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

http://www.imaworldhealth.org/

ENVISION PROJECT OVERVIEW

The U.S. Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), trachoma, and three soil-transmitted helminths (STH; roundworm, whipworm, and hookworm). ENVISION’s goal is to strengthen NTD programming at global and country levels and support ministries of health (MOHCDECs) to achieve their NTD control and elimination goals.

At the global level, ENVISION—in coordination and collaboration with WHO, USAID, and other stakeholders—contributes to several technical areas in support of global NTD control and elimination goals, including:

drug and diagnostics procurement, where global donation programs are unavailable

capacity strengthening

management and implementation of ENVISION’s Technical Assistance Facility (TAF)

disease mapping

NTD policy and technical guideline development

NTD monitoring and evaluation (M&E).

At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including:

strategic annual and multi-year planning

advocacy

social mobilization and health education

capacity strengthening

baseline disease mapping

preventive chemotherapy (PC) or mass drug administration (MDA)

drug and commodity supply management and procurement

program supervision

M&E, including disease-specific assessments (DSA) and surveillance

In Tanzania, ENVISION project activities are implemented by IMA World Health.

TABLE OF CONTENTS Page ENVISION PROJECT OVERVIEW ..................................................................................................................... 2

LIST OF TABLES .............................................................................................................................................. 4

ACRONYMS LIST ............................................................................................................................................ 5

COUNTRY OVERVIEW .................................................................................................................................... 7

1) General Country Background ............................................................................................................ 7

a) Administrative Structure ............................................................................................................... 7

b) NTD Program Partners .................................................................................................................. 8

2) National NTD Program Overview .................................................................................................... 11

a) Lymphatic Filariasis ..................................................................................................................... 12

b) Onchocerciasis ............................................................................................................................ 13

c) Soil-Transmitted Helminths ........................................................................................................ 14

d) Schistosomiasis ........................................................................................................................... 15

e) Trachoma .................................................................................................................................... 16

PLANNED ACTIVITIES ................................................................................................................................... 18

1) NTD Program Capacity Strengthening ............................................................................................ 18

a) Strategic Capacity Strengthening Approach ............................................................................... 18

b) Capacity Strengthening Interventions ........................................................................................ 18

c) Monitoring and Evaluating Proposed Capacity Strengthening Interventions ............................ 19

1) Project Assistance ........................................................................................................................... 21

a) Strategic Planning ....................................................................................................................... 21

b) NTD Secretariat ........................................................................................................................... 22

d) Social Mobilization ...................................................................................................................... 23

e) Training ....................................................................................................................................... 26

f) Mapping ...................................................................................................................................... 27

g) MDA Coverage and Challenges ................................................................................................... 28

g) Drug and Commodity Supply Management and Procurement .................................................. 30

h) Supervision .................................................................................................................................. 31

i) M&E ............................................................................................................................................ 32

APPENDIX 1. TANZANIA FY16 WORK PLAN TIMELINE ................................................................................ 35

LIST OF TABLES

TABLE 1: NTD PARTNERS WORKING IN TANZANIA, DONOR SUPPORT, AND SUMMARIZED ACTIVITIES ... 10

TABLE 2. STATUS OF THE NATIONAL NTD PROGRAM IN TANZANIA .......................................................... 17

TABLE 3: PROJECT ASSISTANCE FOR CAPACITY STRENGTHENING ........ ERROR! BOOKMARK NOT DEFINED.

TABLE 4: SOCIAL MOBILIZATION/COMMUNICATION MATERIALS ............................................................. 24

TABLE 5: USAID SUPPORTED COVERAGE RESULTS FOR FY16* AND TARGETS FOR FY17 ................... ERROR! BOOKMARK NOT DEFINED.

TABLE 6 PLANNED DSAS FOR FY17 BY DISEASE .......................................................................................... 34

ACRONYMS LIST

AFRO Africa Region Office, WHO ALB Albendazole APOC African Programme for Onchocerciasis Control ASTMH American Society of Tropical Medicine and Hygiene CCHP Comprehensive Council Health Plan CDC U.S. Centers for Disease Control CDD Community Drug Distributor CDTI Community-Directed Treatment with Ivermectin CHMT Council (or District) Health Management Team DC District Council DED District Executive Director DEO District Education Officer DFID U.K. Department for International Development DMO District Medical Officer DQA Data Quality Assessment DSA Disease-Specific Assessment EPIRF WHO Epidemiological Data Reporting Form EU Evaluation Unit FLHF Frontline Health Facility FLHW Frontline Health Workers FPSU Filariasis Program Support Unit (Liverpool School of Tropical Medicine) FTS Filariasis Test Strips FY Fiscal Year GAELF Global Alliance for the Elimination of Lymphatic Filariasis GoT Government of Tanzania GTMP Global Trachoma Mapping Project HKI Helen Keller International ICT Immunochromatographic Test IEC Information, Education, and Communication ITI International Trachoma Initiative IVM Ivermectin JRSM Joint Request for Selected Medicines KAP Knowledge, Attitudes, and Practices KCCO Kilimanjaro Centre for Community Ophthalmology LF Lymphatic Filariasis M&E Monitoring and Evaluation MC Municipal Council MDA Mass Drug Administration MOHCDEC Ministry of Health, Community Development, Gender, Elderly and Children MMDP Morbidity Management and Disability Prevention Program MSD Medical Stores Department MUHAS Muhimbili University of Health and Allied Sciences NBS National Bureau of Statistics NGO Nongovernmental Organization NIMR National Institute for Medical Research

NTD Neglected Tropical Disease OV Onchocerciasis PC Preventive Chemotherapy PCR Polymerase Chain Reaction PMO-RALG Prsedident’s Office–Regional Administration and Local Government PZQ Praziquantel QEDJT Queen Elizabeth Diamond Jubilee Trust RDT Rapid Diagnostic Test REMO Rapid Epidemiological Mapping of Onchocerciasis RHMT Regional Health Management Team RPRG Regional Programme Review Group SAC School-Age Children SAE Serious Adverse Event SAFE Surgery–Antibiotics–Face cleanliness–Environmental improvements SCH Schistosomiasis SCI Schistosomiasis Control Initiative STH Soil-Transmitted Helminth STTA Short Term Technical Assistance TAF Technical Assistance Facility TAS Transmission Assessment Survey TEMF Trachoma Elimination Monitoring Form TF Trachomatous Inflammation–Follicular TFDA Tanzania Food and Drug Administration TFGH Task Force for Global Health TIPAC Tool for Integrated Planning and Costing TIS Trachoma Impact Survey TOEAC Tanzania Onchocerciasis Elimination Expert Advisory Committee TOT Training of Trainers TT Trachomatous Trichiasis TWG Technical Working Group TZNTDCP Tanzania NTD Control Program USAID United States Agency for International Development WHO World Health Organization ZTH Zithromax

COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Tanzania is divided into 31 regions, 5 of which make up the semi-autonomous islands of Zanzibar (which have a different government structure). Mainland Tanzania has 26 regions with 186 administrative councils (as of August 2016, when the most recent redistricting occurred). These districts are subdivided into divisions, wards, and villages, which are further subdivided into hamlets. Each village and ward has a chairperson and executive officer, and each hamlet has a chairperson. District councils are the governing body at the district level and are headed by district executive directors (DEDs). These local government councils have substantial decision-making power with regard to planning, budgeting, and implementation of policy and development matters. Elective representation levels begin at the villages, moving upward to wards and then districts, which are the primary units responsible for public service delivery, including primary health care.

In October 2015 Tanzania elected a new President whose administration changed the name of the Ministry of Health and Social Welfare to the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDEC). The MOHCDEC guides policy development, strategic planning, resource mobilization, quality control, and evaluation, and also provides guidelines to regions and districts on the overall direction of health program implementation and service delivery throughout Tanzania. Service delivery, leadership, and governance are decentralized, with key roles and responsibility divided among four levels (Figure 1). Regional Health Management Teams (RHMTs) interpret policy and provide overall technical supportive supervision to the respective Council (or District) Health Management Teams (CHMTs) of that region. The CHMTs develop health plans and budgets as well as implement, monitor, and evaluate the impact of these plans. The district level is where health plan execution and coordination actually occur. The lowest level of the health system is the community. Activities incorporated into the CHMT health plans are derived from community needs identified through community (village) health committees.

The national health budget is developed annually based on comprehensive council health plans (CCHPs). The MOHCDEC and the President’s Office–Regional Administration and Local Government (PMO-RALG) provide inputs on prioritization and guidelines for the development of CCHPs. CCHPs are funded through district basket funding, which is made up of funds from the MOHCDEC, PMO-RALG, Ministry of Finance, and domestic and international development partners. Many district councils also have activity-specific funding from various other sources that does not flow through the established government mechanism.

The Tanzania Neglected Tropical Disease (NTD) Control Program (TZNTDCP) is under the MOHCDEC’s Office of the Chief Medical Officer, Directorate of Preventative Services, and is housed at the Tanzania National Institute for Medical Research (NIMR). At the central level, there is a national NTD program

Figure 1: MOHCDEC Leadership and Governance Levels

Community (Village) Health CommitteeHealth Services Demand Generation and Utilization

District Health Management TeamPlanning and Implementation of Strategic Plans

Regional Health Management TeamPolicy Translation and Supportive Supervision

MOHCDECPolicy and Policy Guidelines Development, Strategic Planning, Resource Mobilization

coordinator and six program officers who are employed by the MOHCDEC. The NTD program coordinator is assisted by the NTD Secretariat for overall program coordination and management. Several partners support the NTD Secretariat by providing technical and management resources to work on secondment basis with the MOHCDEC. ENVISION has seconded five officers to the Secretariat, namely, a senior technical advisor for monitoring and evaluation (M&E), two M&E program officers, a drug logistics officer, and a finance/administrative officer; the Filariasis Programmes Support Unit (FPSU) of the Liverpool School of Tropical Medicine funds a database manager; and Sightsavers, through Helen Keller International (HKI), funds a Program Officer who manages the U.K Department for International Development (DFID)/Surgery-Antibiotics-Face cleanliness-Environmental improvements (SAFE) activities from the NTD Secretariat side and works closely with the trachoma focal point.

The NTD control program is largely integrated into the existing primary health care system. The NTD program works through the RHMTs, CHMTs, and local communities to plan and implement NTD control activities and is led by national, regional, and district coordinators at each respective level. At the district level, there are cascade leaders and zonal managers who provide the frontline health workers (FLHWs) with supportive supervision and aid in data collection. At the community level, community drug distributors (CDDs) are trained to distribute medicines to the household level and report accordingly. On average, one FLHW is responsible for supervising 15 to 20 CDDs. For school based intervention, mainly targeting STH and SCH, primary school teachers help distribute the medicines and report to the health facilities.

Redistricting

Since 2010, there has been a significant amount of redistricting—from 132 districts in 2010 to 166 as of August 2015. In fiscal year 2017 (FY17), an additional 20 districts will be created, increasing the total number of districts to 186.

b) NTD Program Partners

NTD control and elimination activities in Tanzania are supported by many partners (Table 1). The MOHCDEC provides funding for the TZNTDCP staff mentioned above as well as salaries for all MOHCDEC-linked staff working in the NTD program from regional to district levels. Also, the MOHCDEC provides vehicles at the district and regional levels for the implementation and supervision of activities. As described below, the U.S. Agency for International Development (USAID) has provided funding for the NTD programming in Tanzania since 2010 through the NTD Control Program (2010–2011) and ENVISION (2011 to date). Both efforts have been managed by RTI International centrally and IMA World Health in country. USAID also provided funding for the African Program for Onchocerciasis Control (APOC) to implement an integrated NTD program in six regions (Ruvuma, Mbeya, Iringa, Njombe, Tanga, and Morogoro). APOC, whose mechanism through USAID was initiated in 2009, supported pre- and post-mass drug administration (MDA) activities as well as M&E activities (such as funding for onchocerciasis [OV] epidemiological and entomological surveys and pre-transmission assessment surveys [pre-TAS]). APOC ended in December 2015, and ENVISION took on the programmatic support in these six OV endemic regions.

DFID funds several partners to support the TZNTDCP. DFID funding to the TZNTDCP through FPSU supports community-based lymphatic filariasis (LF) MDA in three districts of the Dar es Salaam Region. In FY16, FPSU funding included training, community mobilization, MDA, and data collection. In addition, there are plans to start establishing lymphedema care and hydrocele surgeries following the FY15 FPSU-funded pilot of an LF morbidity mapping project for the Temeke Municipal Council (MC) in Dar es

Salaam. As noted above, FPSU funding also employs a database manager seconded to the NTD Secretariat. For FY16, FPSU continued to provide funds for MDA in the Dar es Salaam Region, where they piloted community MDA data transfer using mobile electronic devices to the NTD database. In addition to completing the LF morbidity mapping for the three districts, FPSU provided care packages for lymphedema and hydrocele patients. FPSU also worked closely with the TZNTDCP to develop a national morbidity management and disability prevention program (MMDP) strategy and framework for scaling up MMDP activities across the country.

DFID funds the Schistosomiasis Control Initiative (SCI) to address SCH and STH. SCI has supported school-based MDA in the Mwanza and Dar es Salaam regions. In FY16, SCI has continued to provide funding to TZNTDCP to support praziquantel (PZQ) and albendazole (ALB) school-based MDAs in the Kagera, Kigoma, Mara, and Shinyanga regions, which received the intervention for the first time. In addition, SCI funded sentinel site assessments in Kagera, Mwanza, Shinyanga, Mara and Kigoma. SCI also procures PZQ for areas where it operates.

DFID also funds a five-year SAFE project through Sightsavers. The project has worked on the “S” (surgery) component of the SAFE strategy since July 2014, with linkages to other partners and sectors for other components. The project started in October 2014 and works to support national-level trachoma surgery planning and coordination through its Tanzania coordinating partner, HKI. DFID also supports partners to carry out trachomatous trichiasis (TT) surgeries, with activities in regions distributed as follows: IMA supports surgeries in Mtwara, Sightsavers in Pwani, Tanga and Ruvuma; and Kilimanjaro Centre for Community Ophthalmology (KCCO) in Arusha and Manyara. In addition, the Queen Elizabeth Diamond Jubilee Trust (QEDJT) is funding a three-year project to expand SAFE efforts. Currently, QEDJT funding supports partners to carry out TT surgeries, with activities in regions distributed as follows: Sightsavers in Lindi, Kongwa Trachoma Project in Dodoma, and KCCO in Arusha. DFID is also funding the facial cleanliness (“F”) and environmental improvement (“E”) components of the SAFE strategy. Simavi receives funding for Dodoma Region and HKI for Arusha and Pwani regions. DFID funded TT only surveys through Sightsavers to the NTD Secretariat for the Arusha region. DFID plans to conduct more TT-only surveys in districts where needed and to be determined for FY17.

Sightsavers has focused on eye care, education, and rehabilitation services. It has provided training and funding for eye examinations and implements the “S,” “F,” and “E” components of the SAFE strategy in two districts in the Morogoro and Ruvuma regions. Furthermore, as noted above, Sightsavers seconds a program officer to the NTD Secretariat. It has also provided TT surgeries across the country when there is funding, in addition to the two regions where it works under the DFID SAFE project.

Since 2014, with funding from the Presbyterian Church (USA) and IZUMI Foundation, IMA World Health has trained clinicians in hydrocelectomy surgeries in the Lindi and Mtwara regions through a hospital-based approach. This funding ended June 30, 2016.

In addition to its work on the DFID SAFE project and the QEDJT expansion, KCCO supports research projects for trachoma, including treatment for endemic villages in the Siha District in the Kilimanjaro Region.

Finally, CBM International has provided funding for TT surgeries periodically throughout the country.

Table 1: NTD partners working in Tanzania, donor support, and summarized activities

Partner Location Activities

Is USAID providing NTD

financial support to this partner?

Other donors supporting these

partners/ activities?

CBM International

Country office in Dar es Salaam

Provision of some TT surgeries

No Other

Helen Keller International

Manyara, Singida, and Tabora regions

TT surgery coordination; potential funding for “F” and “E” components of SAFE strategy

No DFID SAFE and QEDJT

IMA World Health

Lindi, Mtwara regions Hydrocelectomy and TT surgery

Yes (ENVISION only)

IZUMI Foundation (hydrocelectomy); DFID SAFE (TT surgeries)

World Vision Countrywide Support for PZQ procurement

No for NTD work Other

Filariasis Program Support Unit

Dar es Salaam, and other regions covered periodically through transmission assessment survey and other research efforts

Funding for MDA and monitoring and evaluation in Dar es Salaam; seconded database manager to NTD Secretariat; provision of care packages for lymphedema and hydrocele patients; development of national MMDP Program strategy

No DFID; other

Sightsavers Morogoro, Pwani, Lindi, and Ruvuma regions

Focused on eye care- related activities, including trachoma control; support mainly for TT surgeries; seconded program officer to NTD Secretariat


Schistosomiasis Control Initiative

Mwanza and Dar es Salaam regions

School-based MDA for SCH/STH; various studies

No DFID

Kilimanjaro Centre for Community Ophthalmology

Kilimanjaro Region TT surgeries; research and treatment of high-prevalence villages in Siha District


Kongwa Trachoma Project

Dodoma TT surgeries, research and technical assistance on Kongwa District

No DFID/QEDJT

Partner Location Activities

Is USAID providing NTD

financial support to this partner?

Other donors supporting these

partners/ activities?

Council & Chamwino on MDA

International Trachoma Initiative

Trachoma endemic districts

Supply Zithromax® (ZTH) No Pfizer

Stat Oil Mtwara Hydrocele surgery (100 surgeries planned for FY17)

No None

2) National NTD Program Overview

Several NTDs are endemic in Tanzania, the five most common being LF, OV, SCH, STH, and trachoma. A large portion of the population is at risk of co-infection of two or more of these diseases.

The overall TZNTDCP goals for elimination and control are as follows:

Continue to implement a modified community-directed treatment with ivermectin (CDTI) approach to community MDA in targeted regions. Ivermectin (IVM), ALB, and ZTH will be distributed using a modified CDTI approach1 that relies on active community participation with supervision from the TZNTDCP, focusing on empowering communities to take responsibility in MDAs.

Sustain the national geographic coverage achieved through phased expansion. The TZNTDCP started in FY09 in six regions (Mbeya, Iringa, Njombe, Tanga, Morogoro, and Ruvuma), then expanded in FY10 to seven additional regions (Mtwara, Lindi, Coast, Dodoma, Singida, Rukwa, and Katavi), and in FY11 to two additional regions (Tabora and Manyara). In 2013, TZNTDCP expanded further to Dar es Salaam and Mwanza regions, in 2014 into four additional regions (Arusha, Geita, Kilimanjaro, and Simiyu), and in 2015 expanded to Kigoma, Shinyanga, Kagera and Mara regions to cover all 26 regions of Mainland Tanzania. During this expansion, the national NTD Secretariat has gained knowledge and experience in coordination and implementation of an integrated NTD program.

Expand MMDP efforts. Currently, MMDP activities such as TT and hydrocele surgery are being supported by partners, including Sightsavers International, IMA World Health, FPSU, HKI, Stat Oil and IZUMI Foundation. The TZNTDCP would like to expand MMDP activities to reach hydrocele and lymphoedema patients in Dar es Salaam, but also the large numbers of cases in Tanga, Mtwara, Pwania and Lindi regions, which are believed to have the majority of hydrocele and

1 In traditional CDTI, the community determines everything related to the MDA (i.e., when, where, and by whom). In the modified approach, some aspects are determined by the Ministry of Health at the central level to ensure harmonization across the entire country. In Tanzania, the TZNTDCP determines when drugs and funds will be available and determines a national MDA schedule. In traditional CDTI, different communities within a region/district may choose different dates to suit their specific local conditions; in Tanzania, TZNTDCP plans a schedule so that all districts in an entire region conduct MDA at the same time.

lymphedema cases. Additional activities include training, hydrocelectomy, and lymphedema management and the TZNTDCP is seeking partner support to fund these activities.

a) Lymphatic Filariasis

The TZNTDCP has a national goal of elimination of LF by 2020. LF mapping in Tanzania was carried out from 1999 to 2004, and the results showed that LF was endemic in all districts in the country. Mapping data indicated high endemicity in the coastal regions and lower levels further inland. Accordingly, the national strategy was to start MDAs in areas with high endemicity first and then progressively add regions further inland.

In 2012, FPSU funded a TAS in Mwanza Region, despite the fact that treatment with IVM+ALB had never been initiated in the region. Results indicated there was no ongoing transmission. Following consultation with the World Health Organization (WHO)’s Africa Regional Office (AFRO) Regional Programme Review Group (RPRG), the TZNTDCP decided to remap the 63 districts where MDA had not yet started, including those in Mwanza Region, with funding from ENVISION and the Task Force for Global Health (TFGH). Results indicated that all 63 districts were below the MDA threshold. This has reduced the number of LF endemic districts from 166 to 103 in 2015.

Regions received LF MDA since 2000, particularly those along the coast where prevalence at the time of mapping was very high (treatment was at times interrupted due to lack of funding support). Following the continued funding support from USAID through ENVISION and APOC, and from DFID through FPSU, MDAs have become an annual feature of the TZNTDCP. The LF MDA package in Tanzania includes IVM and ALB and is distributed once a year.

LF disease-specific monitoring is an ongoing process, and various districts are at different stages of LF control/elimination. Although the district is the implementation unit and would typically be monitored at baseline, midterm, and after five MDA rounds, funding constraints have led the TZNTDCP to initiate MDA in some districts based only on mapping data, without baseline assessment. Routine impact assessment and progress monitoring through sentinel and spot check sites at midterm (i.e. at completion of three rounds of MDA) or pre-TAS (after five rounds of MDA) are implemented, usually, as funds become available. To determine TAS eligibility, the post-fifth round sentinel and spot-check site assessments are conducted in every district in accordance with WHO guidelines. This strategy has allowed Tanzania to monitor programmatic progress as well as to present clear data about TAS eligibility for decision making by the program and the RPRG. In order to ensure strong program monitoring and gather data for decision making toward LF elimination, the TZNTDCP’s long-term strategy has been to establish two integrated sentinel sites in each new region when treatment starts to monitor the impact of LF MDAs over time and make informed decisions about when to stop MDA. The TZNTDCP recommends that wherever possible, any parasitological sentinel/spot-check site assessment should be integrated and include samples from three NTDs—LF, STH, and SCH. When determining where to establish new sentinel and spot-check sites, the TZNTDCP uses the disease-specific WHO Guidelines.2 For LF in each implementation unit, the TZNTDCP selects one village as the sentinel site and one as a spot-check site. Criteria for village selection include (1) stable population, (2) approximately 500 inhabitants or more, and (3) known high LF endemicity or expected low coverage. Within the site, 250 to 300 individuals aged five years and older are tested for circulating filarial antigen. For STH and SCH sites, the

2 WHO, Global Programme to Eliminate Lymphatic Filariasis. (2012). Monitoring and epidemiological assessment of mass drug administration in the global program to eliminate lymphatic filariasis: A manual for national elimination programs. Geneva. WHO.

TZNTDCP selects two schools in known high-transmission zones and in similar ecological zones. In each school, 50 pupils in Grade III are examined; techniques used include Kato Katz, urine filtration, and anthropometric measurement.

By the start of FY15, six districts (Lushoto, Muheza, and Bumbuli [Tanga Region]; Newala and Tandahimba [Mtwara Region]; and Mkuranga [Pwani Region]) had reached the criteria for stopping LF MDA. In late FY15, 33 districts in the OV endemic regions underwent a LF TAS. Results indicated that they also had achieved the criteria for stopping IVM+ALB MDA for LF. The RPRG and WHO were informed of these results through the WHO Epidemiological Data Reporting Form (EPIRF) submitted by the country program in April 2016. These 33 districts, added to the 5 other districts that reached the criteria for stopping MDA in 2015 and 1 that passed TAS1 in 2009 brought the total number of districts to stop LF MDA in Tanzania to 39.

In FY16, the TZNDTCP has received approval from RPRG to conduct TAS1 surveys in 27 districts in July 2016. Based on preliminary field results, of the 27 districts, 25 districts will achieve criteria for stopping LF MDA and will not take part in IVM+ALB MDA in 2017. Two districts (Chemba and Kondoa) will have to continue with additional two rounds of MDA before they can be re-assessed for possibility of stopping MDA.

Overall, using the FY 2017 redistricting as a baseline, only 47 districts will need LF MDA in 2017, 41 of which will be treated with ENVISION support and 6 with FPSU support. Over 15 million people now are living in 74 districts (previously 64 districts) that have achieved criteria for stopping MDA for LF.

Tanzania has not had an LF morbidity burden assessment in most regions. As discussed above, FPSU provided funds and technical assistance for LF morbidity mapping in all Dar es Salaam region councils where they provide support for LF MDA. Volunteers are used who go house-to-house to collect information via a questionnaire, using mobile data collection devices. An estimated total of 6,000 patients have been identified. FPSU has planned to support hydrocelectomy for up to 1000 patients in 2016 and an additional 500 patients in 2017 in Dar es Salaam via routine hospital based surgeries and special hydrocelectomy camps in Dar es Salaam.

IMA received funding from the IZUMI Foundation for hydrocele surgeries in the Mtwara region. The project funding (July 1, 2014 to June 30, 2016) subsidized surgeries for 1320 men suffering from hydrocele.

In FY10-under the NTD Control Program, USAID started supporting LF MDA (IVM+ALB) in seven regions (Mtwara, Lindi, Coast, Dodoma, Singida, Rukwa, and Katavi), and in FY11 under ENVISION - two additional regions (Tabora and Manyara). In FY16, ENVISION began funding IVM+ALB MDA in addition to school-based PZQ+ALB MDA in the six OV-endemic regions previously supported by APOC. Under ENVISION integrated LF/STH/SCH sentinel and spot-check site assessments as well as pre-TAS and TAS were also carried out. In FY15, in collaboration with the Task Force for Global Health, ENVISION supported LF remapping efforts for 63 districts where no LF MDA had been done.

b) Onchocerciasis

The TZNTDCP’s goal is to eliminate OV by 2025 in line with WHO targets, and as guided by the new WHO guidelines for OV elimination. OV is endemic in 7 foci across 23 districts in 6 regions: Mbeya, Morogoro, Njombe, Ruvuma, Iringa, and Tanga. The CDTI program was launched by APOC in Tanzania in 1997. The 7 CDTI foci, comprising 21 districts, were treated with APOC support through a phased scale-up approach: Tanga, Tukuyu, Ruvuma, Tunduru, Mahenge, Kilosa, and Mogororo. By 2009 when two additional districts Mufindi and Njombe were included, the TZNTDCP had moved to an integrated MDA

approach and the TZNTDCP treated all districts in the 6 regions with IVM+ALB with APOC funding. Due to redistricting, the number of OV-endemic districts has increased from 23 in FY16 to 27 in FY17 and a new region, Songwe, was established in 2016, thus increasing the number of OV endemic regions from 6 to 7 in FY17.

All OV-endemic districts are co-endemic for LF, and from 2009 to date, these districts have received IVM+ALB through annual community-based MDA. From 2009 to 2015, APOC supported OV activities with USAID funding through APOC. By FY 16, all districts had received 10 to 16 rounds of IVM MDA with effective coverage. In FY16, ENVISION started supporting training and pre-MDA and MDA in the OV-endemic regions. Under APOC support, nine districts in Tanga and Mbeya regions had conducted Phase 1b epidemiological evaluation in 2012 and showed 0% O. volvulus microfilardermia. However, these districts never had an entomological assessment to ascertain OV prevalence in the vector, Simulium spp. vector.

In February 2016, the TZNTDCP had its first meeting of the Tanzania Onchocerciasis Elimination Expert Advisory Committee (TOEAC). The committee reviewed the progress of the OV program and recommended the following: development of a national OV elimination plan and re-evaluation of OV endemicity in humans and vectors using the new WHO guidelines and tests.

In FY17, the program will be stopping LF MDA in 33 districts across the OV endemic regions; however, 18 districts (3 in Mbeya, 1 in Songwe, 3 in Tanga , 7 in Ruvuma, 3 in Njombe, and 1 in Iringa) will have to continue with district-wide IVM+ALB MDA due to co-endemicity with OV and STH. Therefore, MDA cannot stop until the OV status is determined in humans and Simulium vectors.

c) Soil-Transmitted Helminths

STH is considered to be endemic throughout Tanzania, although baseline mapping of STH has not taken place. In 2004, the MOHCDEC conducted a desk review of hospital and health facility records. At the time, all regions were found to require some level of STH intervention according to WHO guidelines. Control efforts for STH through the TZNTDCP target primary school-age children (SAC), aged 7–13 years, who are the group with the greatest risk of STH infection. Pre-school children 1 to 6 years of age are treated through the Vitamin A/deworming program run by the Reproductive and Child Health Section of the MOHCDEC. The main intervention for SAC is MDA with ALB—implemented by trained school teachers supported by health personnel, which is complemented by school health education and environmental sanitation. In FY16, 100% of the country was reached with at least one round of STH treatment with support to the MOHCDEC provided by ENVISION, SCI, and FPSU. In districts not endemic for LF and those that have passed TAS, the TZNTCP conducted school-based ALB or ALB+PZQ MDA (depending on SCH treatment protocol). In districts that are still LF-endemic, the TZNTDCP conducted school-based MDA with ALB or ALB+PZQ and a second round of MDA through community distribution of IVM+ALB

In FY17, the TZNTDCP plans to review the STH and SCH treatment strategy. Results from sentinel and spot-check site assessments, as well as various independent surveys, indicate a decline in STH and SCH prevalence. Given these preliminary findings, the TZNTDCP plans to engage a consultant to work with key program partners and conduct an in-depth review of these data to re-categorize endemicity levels by district and/or ecological zones. In FY17, the program will review and analyze assessment results collected from 100 districts surveyed by TZNTDCP between 2012 and 2016 as well as independent surveys carried out by NIMR and Muhimbili University of Health and Allied Sciences (MUHAS). Based on WHO guidelines, a new treatment strategy will be proposed. Programmatically, it is anticipated that this

will mean that some districts may not need to have twice-yearly treatments with ALB (given as IVM+ALB, ALB+PZQ, or ALB alone).

USAID started funding MDA (IVM+ALB) and school MDA (PZQ+ALB) in FY10 under the NTD Control Program in seven regions (Mtwara, Lindi, Coast, Dodoma, Singida, Rukwa, and Katavi), and in FY11 under ENVISION in two additional regions (Tabora and Manyara), for a total of nine regions. In FY16, ENVISION began supporting IVM+ALB MDA in addition to school based PZQ+ALB MDA in the six OV-endemic regions previously supported by APOC. Integrated LF/STH/SCH sentinel and spot-check site assessments as well as integrated TAS were also supported. In FY17, the TZNTDCP, with ENVISION funding and IMA’s technical assistance and supervision, will continue deworming for SAC in 141 districts.

d) Schistosomiasis

SCH was mapped in 2004 through blood-in-urine questionnaires administered to school children in all districts. Results indicated a high prevalence (≥30%) in 13 districts and a moderate prevalence (>1 and <30%) in 153 districts. It is important to note that this questionnaire provides information about Schistosoma haematobium, but does not provide a baseline profile of S. mansoni. Of the 186 districts that are endemic, 15 districts are treated annually (high prevalence) and 126 biennially (moderate prevalence) through ENVISION other districts are covered by SCI. Control efforts for SCH target SAC who are enrolled in primary schools as well as the ones who are not enrolled.

As discussed in the STH section, the TZNTDCP plans to engage a consultant to review mapping and sentinel site data to determine optimal treatment strategy going forward. This information is expected to be available in the first half of FY17. This review will also include analysis of mapping and sentinel and spot-check site data on S. haematobium and S. mansoni, in order to update district endemicity data and shape the treatment strategy. Currently, all districts are either treated annually or biennially, and high-risk adults are not treated. This analysis will help identify which districts can be treated less frequently (twice during a child’s school years) and those where a high prevalence in identified foci/communities require treating high-risk adults with PZQ as per WHO protocol for SCH control.

Until a new strategy is developed, the TZNTDCP will continue to distribute PZQ with ALB in a separate school-based distribution. In districts where community MDAs with IVM and ALB take place, PZQ+ALB will be distributed six months after the community MDA. In districts where there is no community distribution with IVM+ALB, then PZQ+ALB will be distributed through school-based MDAs. Currently, 18 districts require annual treatment with PZQ, and 168 districts are treated every other year with PZQ. In off years, they are treated with ALB only. In FY17, ENVISION will be treating 87 districts with PZQ+ALB, and 54 with ALB only, depending on the district’s treatment schedule and endemicity.

The re-categorization of SCH endemicity that will inform the new treatment strategy will also help improve coverage, as efforts will be more focused to areas of most need. It has been learned that where the disease is highly endemic, and the communities vividly see SCH morbidity, MDA uptake is very high and communities even request PZQ.

USAID started funding MDA (IVM+ALB) and school MDA (PZQ+ALB) in FY10 under the NTD Control Program in seven regions (Mtwara, Lindi, Coast, Dodoma, Singida, Rukwa, and Katavi), and in FY11 under ENVISION in two additional regions (Tabora and Manyara), for a total of nine regions. In FY16, ENVISION began supporting IVM+ALB MDA in addition to school-based PZQ+ALB MDA in the six OV-endemic regions previously supported by APOC. ENVISION has also supported integrated LF/STH/SCH sentinel and spot-check site assessments.

e) Trachoma

The TZNTDCP’s goal is to eliminate blinding trachoma in Tanzania by 2020. Mapping for trachoma was completed in 2014 with ENVISION and the Global Trachoma Mapping Project (GTMP) providing funding and technical assistance for grader and enumerator training. Through inclusion of Tanzania in the GTMP and electronic data capture during baseline and impact surveys, mapping speed and quality have been improved significantly. A total of 56 districts were ever trachoma endemic above 10% trachomatous inflammation-follicular (TF) prevalence. Another 4 districts were endemic with TF prevalence of 5-9.9% at baseline. By the end of FY16, all districts that require MDA were receiving treatment.

To eliminate blindness resulting from trachoma, the SAFE strategy must be implemented for one to five years in districts determined to be endemic (depending on baseline prevalence) before impact assessments are conducted. Trachoma impact surveys (TIS) were carried out by the TZNTDCP in 2009, and then annually since 2012 in various districts. By the beginning of FY16, 37 districts have reached the stopping MDA criteria for trachoma (<5% TF); five had TF=5-9.9% and were eligible for one additional MDA round; five had TF of ≥10% following TIS (requiring 3 more rounds of MDA), and 8 districts were not yet eligible for TIS. By September 2016, the TZNTDCP will have completed TIS in 20 districts. Of these, 4 were implemented in districts that were never treated, and 8 will be eligible for TIS following a minimum number of Zithromax MDA—3 districts will undergo impact surveys for the first time and 4 will have their second TIS (following one round of ZTH MDA), and 1 will have a third TIS. Eight districts will have pre-validation surveillance surveys.

In FY17, a total of 9 districts will continue MDA: 5 districts that are not yet eligible for TIS and 4 that had TF≥10% after TIS. The TZNTDCP expects another 8 districts may continue MDA in FY17; however, these will be known after results are obtained from the FY16 impact assessments. In FY17, trachoma surveillance surveys are planned in 12 districts and TIS in 6 districts. Among the six trachoma impact survey (TIS) districts, four will be eligible for their first impact survey, and funding will be allocated for an additional 2 districts, since previous experience suggests at least two districts surveyed in FY16 will have a prevalence of 5%–10%.

Looking at the current trend, the TZNTDCP is on track for meeting trachoma 2020 elimination goals. The last five trachoma-endemic districts to be evaluated through TIS will be Longido, Moduli, Ngorongoro, Ngara and Chunya..

Table 2. Status of the National NTD Program in Tanzania

Columns C+D+E=B for each

disease Columns F+G+H=C for each disease

MAPPING GAP DETERMINATION MDA GAP

DETERMINATION MDA

ACHIEVEMENT DSA NEEDS

A B C D E F G H I

Disease

Total No. of

Districts in

Tanzania

No. of districts

classified as

endemic

No. of districts

classified as non-

endemic

No. of districts in need of initial mapping

No. of districts receiving MDA as

of 1st Oct 2016

No. of districts expected to be

in need of MDA at any

level: MDA not yet started, or

has prematurely stopped as of

09/30/16

Expected No. of

districts where

criteria for stopping

district-level MDA have

been met as of 09/30/16

No. of districts

requiring DSA as of 09/30/16

USAID- funded

Others

Lymphatic filariasis

186

121 65 0 41 6 0 74

Pre-TAS: 30

TAS1: 24

TAS2: 5

TAS3: 0

Onchocerciasis 27 159 0 27 0 0 0 Ent: 27

Epi 27*

Schistosomiasis 186 0 0 141 45 0 0 SS/SC: 30

Soil-transmitted helminthes

186 0 0 141 45 0 0 SS/SC: 30

Trachoma 59 127 0 21 0 0 39 TIS: 6

TSS: 12

PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

The goal of the capacity strengthening strategy for Tanzania is to develop a resource mobilization plan with the aim of shifting capabilities for project implementation and management to the NTDCP over time, while sustaining the gains of ENVISION. This approach is expected to support sustainability by harnessing and tapping into contributions of multiple and interconnected stakeholders, while ENVISION continues to provide the needed capacity strengthening and technical assistance needed to achieve the objectives as established by USAID.

b) Capacity Strengthening Interventions

In order to more fully engage the national program in capacity strengthening, ENVISION has already supported the TZNTDCP with the training on the WHO integrated NTD database and development of the Tanzania National Database, in order to have a more centralized, complete approach to data management and evaluation. Further, ENVISION has funded the training of technician teams to carry out DSA. In addition, the ENVISION project carries out joint supervision of all MDA, pre-TAS, and TAS activities with national, departmental and communal level TZNTDCP staff, which provides the opportunity for ENVISION to build their managerial capacity in terms of planning, logistics, data management, data quality, etc.

i. Transition Plan for ENVISION-supported Seconded Staff

Three ENVISION staff seconded to the NTDCP (Finance and Admin, Monitoring and Evaluation and a Drug Logistics Officer) have, over the years, strengthened the NTD management capacity at the national, regional and the district levels. To sustain these gains, ENVISION will engage intensively with the leadership of the NTDCP and the MOH to develop and begin to implement a transition plan for these three key seconded staff members. ENVISION will support the NTDCP to identify personnel currently working within the Secretariat to become counterparts to the seconded staff, so the secondments can begin transferring critical skills and experience in financial management, monitoring and evaluation, and supply chain management. The counterpart personnel will be mentored/coached and trained with the aim to institutionalize the needed NTD capacity skills within the NTDCP and the MOH during the remaining life of the project.

ii. Resource Mobilization Plan

In FY17, in addition to those ongoing capacity strengthening activities, ENVISION will request short term technical assistance (STTA) from a Resource Mobilization consultant to work closely with the NTD Secretariat to develop a partnership and resource mobilization plan/business plan. Once a plan has been developed, ENVISION will work closely with the Secretariat and MOHCDEC over the following two years to implement the plan with a goal of diversifying partners and resources for a more sustainable NTD program.

Table 3: Project assistance for capacity strengthening

Project assistance area

Capacity strengthening interventions/activities How these activities will help to correct needs identified in

situation above

Strategic planning

1. Support the NTDCP to develop a national NTD implementation plan in consultation with other partners, government institutions and communities in endemic regions and districts.

2. Collaborate with ITI to support the revision and development of the national trachoma action plan

3. Continued use of the Tool for Integrated Planning and Costing (TIPAC), which has been in use for several years. The TIPAC is updated annually to plan activities and identify gaps.

Planning together with the NTDCP and stakeholders encourages coordination, reduces duplication of activities and a sense of ownership.

Program and financial management

Build the financial monitoring capacity of the districts for effective management, utilization and reporting of donor funds

This ensures effective resource planning, transparency, accountability and smooth reporting of donor funds

Drug supply management and procurement

Using the ENVISION seconded Logistics Officer to build the NTD supply chain capacity of the secretariat including custom clearance and working with district pharmacy teams to improve reporting, storage and distribution of drugs, inventory systems, and reduce wastage

Improve the on-time delivery of drugs for MDA thereby reducing stock out and delayed MDA

j. Short-term technical assistance

Work with a consultant to develop partnership and resource mobilization plan to expand the pool of partners and identify opportunities for additional resources.

This approach will support the NTD program leverage the broader ecosystem of various partners (international and domestic) to mobilize additional resources to extend the gains and address the ever increasing demand for NTD services.

c) Monitoring and Evaluating Proposed Capacity Strengthening Interventions

In order to ensure continual monitoring of capacity strengthening efforts, ENVISION staff will continue to regularly meet with the TZNTDCP and discuss capacity strengthening progress and needs in key technical, managerial, financial, and operational areas. ENVISION will also liaise with other relevant government stakeholders, including the Department of Preventative Services (DPS) and NIMR.

These meetings will serve as a platform to regularly monitor and assess capacity strengthening and to update the SWOT analysis mentioned above. The Annual Joint Planning Meeting, Technical Working Groups (TWG), and other meetings described under Strategic Planning will also be an opportunity for

ENVISION and the TZNTDCP to more broadly discuss capacity strengthening needs and opportunities with Tanzania’s NTD partners and donors. ENVISION will ensure there will be clarity and awareness of establishing the resource mobilization vision, mission goals and priorities among all the stakeholders.

1) Project Assistance

In FY2017, IMA will continue supporting the MOHCDEC and TZNTDCP to implement NTD control activities in line with the Tanzania NTD Master Plan (2012–2017). The NTD Secretariat will continue taking the lead in initiating, planning, implementation, management and monitoring of planned activities. ENVISION/IMA will provide technical guidance, project management and operational support to the national Secretariat at the district, regional, and the national level. Proposed activities outlined are expected to contribute to ENVISION objectives in support of the national program:

Technical assistance and funding for NTD control and elimination activities

Capacity development for NTD control and elimination

Improved M&E for NTD program activities

In FY2017, ENVISION will continue providing funding and technical assistance to the TZNTDCP for the 19 regions (Lindi, Mtwara, Pwani, Manyara, Dodoma, Singida, Tabora, Rukwa, Katavi , Geita, Simiyu, Arusha, Kilimanjaro, Tanga, Morogoro, Iringa, Njombe, Ruvuma, and Mbeya, and the associated 127 districts covered in FY16. ENVISION will support an additional region (Songwe which split from Mbeya) and 15 districts created after redistricting; for a total of 20 regions and 142 districts. ENVISION will also support school-based distribution of PZQ+ALB in all 142 districts and LF community-based distribution of IVM+ALB in 76 districts. In addition, ZTH community-based distribution will be carried out in 19 districts including Ngara District Council in the Kagera Region where SCI supports school MDA.

a) Strategic Planning

FY17 Activities:

Annual regional and district review/planning meetings: IMA staff, in partnership with the national NTD Secretariat members, will facilitate the regional meetings. District-level meetings will be led by the regional NTD coordinators. Regional and district meetings will be held in the 142 districts and 20 regions covered by ENVISION. These meetings focus on the review of previous MDA activities and lessons learned to develop and inform plans in line with the national NTD plan for upcoming MDA-related activities. These meetings are an important opportunity for the exchange of feedback to the region and district levels on activities that works well and areas of challenges. MDA coverage information is reviewed and discussed which helps to inform any needed changes or additions to activities for the upcoming year. Disease-specific TWG meetings: In FY17, ENVISION and the TZNTDCP will continue to organize and facilitate these disease-specific TWG meetings to allow for and promote discussions to address disease-specific issues that might otherwise be lost in the framework of integration. The NTD Secretariat will present data for discussion and this will drive planning and decision making. The meetings will provide a space to review and discuss disease-specific data to inform decision making and planning. These working groups will meet two times in FY17, and ENVISION, in collaboration with the national NTD Secretariat, will organize and participate in discussions in these meetings.

Annual Joint Planning Meeting: ENVISION will provide funds and help in organizing an Annual Joint Planning Meeting for local and international stakeholders in FY17. This meeting is led by the NTD Secretariat, FPSU and SCI will also provide some funding support. It is critical for the MOHCDEC, in

planning with all partners and donors and establishing how best to plan activities, to consider differing fiscal years and planning cycles. Each year the TIPAC is used to plan activities and identify gaps. As proposed in the capacity strengthening section, ENVISION will be engaging with other partners and the Secretariat during the meeting to assess and agree on capacity building priorities and a plan of strengthening the national program. In addition to partner presentations, the NTD Secretariat presents activities completed while highlighting success and challenges. The meeting promotes active discussion on issues of MDA coverage, data quality and region and district level concerns. As in previous years, the disease specific technical working groups will be held the day before the AJMP to take advantage of partner organization representatives who will be in Tanzania to attend both sets of meetings.

OV Expert Committee (TOEAC) Meetings: In FY17, the TZNTDCP plans to conduct one OV expert Committee Meeting in order to plan and agree on the way forward for OV efforts in the country. Representatives from USAID, RTI, Uganda MOHCDEC, END Fund, CDC and others will be invited to attend this meeting. The meeting will provide a platform for the review of OV data and for formalizing a plan for the way forward for the TZNTDCP. Goals of the meeting include reviewing the elimination strategy, making a decision on stopping MDA in specific foci/districts, and determining the way forward for any remaining areas of unknown endemicity.

STH/SCH Review Meeting: The TZNTDCP will engage a consultant to review available data on STH/SCH to establish the current prevalence and foci of high transmission for the purpose of prioritizing implementation of MDA. Evidence exists from individual research reports pointing to lower SCH/STH transmission in urban settings and some highlands. It is important to review the available data and develop a dossier of recommendation for proper implementation of the STH/SCH MDA in Tanzania for the next five years. Based on WHO guidelines, the frequency of MDA for SCH is determined by the levels of prevalence. In areas with parasitological prevalence of ≥50% the MDA is done or >=30% blood in urine SCH MDA is recommended once every year.

Trachoma Action Plan Workshop: In FY17 there is a need to plan and monitor strategies for trachoma elimination progress. ITI will co-fund the workshop and participant travel and will assist in facilitating the activity for the country. A workshop is planned to be conducted to update and finalize the Trachoma Action Plan (TAP).

b) NTD Secretariat

In Tanzania, the TZNTDCP is led by a national NTD coordinator who heads the central coordination unit for the program, which is referred to as the national NTD Secretariat. The major role of the secretariat is to provide leadership, direction, overall supervision, and coordination of all TZNTDCP-related activities in the country at all levels. From project inception, ENVISION has provided funding for some of the NTD Secretariat’s daily operating costs, travel, and meetings. SCI and FPSU also contribute funding toward administrative costs for the NTD Secretariat, and FPSU provides funds for a seconded database manager.

In FY17, ENVISION funding will continue to provide administrative and operational support to the national NTD Secretariat, including stationery, and other office supplies, communication costs, including telephone and email/internet services. Transportation assistance includes the provision of fuel and vehicle maintenance to support the NTD Secretariat with supervisory activities and some general operations. In addition, ENVISION will provide minor funds for bi-monthly secretariat meetings to discuss the program’s progress and develop two-month operational action plans.

In FY17, ENVISION proposes to fund procurement of office furniture for new staff as well as air conditioners as part of ENVISION’s contribution to overall partner support to the NTD Secretariat.

c) Advocacy for Building a Sustainable National NTD Program

FY17 Activities:

Region-level advocacy meetings: In FY17, the TZNTDCP intends to continue conducting regional and district-level advocacy meetings to introduce leaders to NTD program activities and the implementation strategy. The need for repeated advocacy meetings is necessitated by changes and reshuffling of employees following the election of a new government which came into office in November 2015, and the addition of the new region of Songwe. The TZNTDCP will also focus on advocacy meetings for the five regions (i.e. Arusha, Dodoma, Manyara, Singida and Morogoro) where there are large nomadic and pastoralist populations. A focus during these meetings will be on improved MDA coverage and strategizing for improved social mobilization to reach these populations.

District-level Advocacy Meetings: Advocacy meetings will be conducted in 25 districts with persistent low MDA coverage. As it has been noted, these advocacy meetings are key to the sustainability of program achievements and improved MDA coverage. During these meetings, ENVISION will highlight district-specific MDA coverage achievements and challenges encountered. In FY17, ENVISION is planning to conduct district-specific tailored advocacy meetings to ensure full participation of district leaders and managers to support addressing low MDA coverage challenges and through implementation of targeted activities.

NIMR 30th Annual Joint Scientific Conference: The National institute for Medical Research (NIMR) is holding its 30th annual joint scientific conference from October 4 to 6, 2016. The goal of AJSC is to foster and facilitate communication and collaboration between scientists, trainers, policy makers, donors, students and the media across Tanzania and East Africa. The conference will feature speakers discussing the latest research elucidating the need for innovative research to address the Sustainable Development Goals, as the theme this year is “Achieving the Sustainable Development Goals: Investing Innovative Research to fill the Critical Gaps”, which covers a wide range of critically important research and recent innovations in health systems, communicable and non-communicable diseases and social determinants of health. NIMR has allocated a symposium with the title “Neglected Tropical Diseases in Sub-Saharan Africa: Tanzania’s Prospects for Elimination of NTDs”. The TZNTDCP will use this forum to disseminate its program research activities results that have been conducted over time. There will be presentations and discussions not only from surveys on the five diseases but also from program experiences since its inception. This is an opportunity for the TZNTDCP to showcase its work and linkages to global public health goals and efforts and advocate for its continued support and even funding.

d) Social Mobilization

Activities for FY17 Production of integrated information, education, and communication (IEC) materials: ENVISION will fund the production of integrated information, education, and communication (IEC) materials for both school- and community-based MDAs in the ENVISION supported areas. Taking into consideration results from past coverage surveys, improvements have been made over the years in messaging and materials. Messages are updated, and in many areas the messages have become more disease specific. The TZNTDCP has found these types of more disease-specific messages are more effective than those that group NTDs and have been better received in the communities. Proven educational messages will be printed on posters, flyers, banners, and brochures. Other partners will fund printing materials for the geographic areas they support.

Develop and air radio and television spots at national, regional, and district level: ENVISION, in collaboration with the NTD Secretariat, will provide technical assistance and fund to develop and air radio and television spots at national, regional, and district level. These programs will be aired through different national and local radio stations for all 20 ENVISION-supported regions and 142 districts. Messages will not only be aired during the MDA period, but also will also be rolled out one to two months prior to the MDAs so as to saturate the communities with correct information to rectify any key misconceptions prior to MDA implementation, thereby creating demand for drugs and increasing MDA coverage.

Delivery of the IEC materials: ENVISION will fund the delivery of the IEC materials to regions and districts. ENVISION will also fund district distribution of the materials to the facility, school, and household levels.

Specific nomadic/pastoralist social mobilization strategy: The TZNTDCP with the support of a behavior change communication consultant will gather all existing information on coverage surveys, IEC materials, and research recommendations, and will synthesize and highlight key information to be used during development of communication strategies aligned with nomadic/ pastoralist culture and settings. The consultant will work with the Health Education and Promotion Unit of the MOHCDEC to develop an NTD social mobilization strategy and materials for the following: training community mobilizers as change agents; organizing school competition games and essay writing, using folk media groups;

Folk media such as traditional dances, drama, art, and skits: The TZNTDCP makes every effort to reach out to individuals in communities, regardless of literacy. Information is spread both through written IEC materials, as described above, and through town criers and dramas incorporated into all social mobilization efforts, and these methods differ by district. Additionally, ENVISION will fund the use of folk media such as traditional dances, drama, art, and skit groups to communicate NTD messages through an entertainment approach so as to sensitize and at the same time mobilize communities to allow their children to attend the school-based and community-based MDAs in their respective districts.

Table 4: Social mobilization/communication materials

Category Key

Messages Target

Population

(IEC) Strategy

(materials, medium,

activity etc.)

Where/when will they be

distributed? Frequency

Is there an indicator/

mechanism to track this

material/activity? If yes, what?

MDA participation

Inform the community about the MDA dates and locations in the commune

School children and the entire population in the community (except pregnant women and children under 2)

Banners, posters, and brochures

Banners hung in main crossroads 4 weeks before MDA

Posters used during community sensitization meetings starting from 8 weeks before MDA.

Brochures and flyers given to CDDs, FLHWs, and Teachers for distribution to target audiences before MDA

Banners posted for duration of MDA

Posters used throughout mobilization and during MDA

No. of banners and posters produced and distributed

No. of brochures and posters received and distributed by FLHWs, teachers, and CDDs

Category Key

Messages Target

Population

(IEC) Strategy

(materials, medium,

activity etc.)






MDA participation

Treatment medications are free and safe drugs; they come from the best laboratories overseas.

School children and the entire population in the community

Radio and TV spots

Radio and TV spots aired starting from one month before MDA

Radio and TV spots: aired 4-6 times per day

Name of TV/radio station and number of broadcasts aired on radio and TV

If sometimes you experience side effects, this is a sign that the medicine is working and we have drugs to handle these side effects


Posters, flyers, brochures

Posters, flyers, and brochures distributed and used 2 weeks-1 month in advance of MDA.

Posters hung in schools and in community locations with traffic

Number of posters, flyers brochures received and distributes by FLHWs, Teachers, and CDDs

If sometimes you experience side effects, this is a sign that the medicine is working and we have drugs to handle these side effects


radio/TV spots

Radio and TV spots aired starting from one month before MDA except in the west, where spots are aired 3 months in advance of MDA



Disease Prevention

The drugs are preventative and curative for NTDs; the earlier you take the medications the better


Posters, flyers and, brochures

Posters distributed to CLs, CPs, and CDDs and used 2 weeks-1 month in advance of MDA.

Posters hung in schools and in community locations with traffic

Number of posters, flyers brochures received and distributes by FLHWs, Teachers, and CDDs

Disease Prevention



radio and TV spots

Radio and TV spots aired starting from one month before MDA except in the west, where spots are aired 3 months in advance of MDA.

Radio and TV spots aired


Community meetings held prior to pre-MDA activities


Category Key

Messages Target

Population

(IEC) Strategy

(materials, medium,

activity etc.)






starting 1 month before MDA

Community meetings

Disease Prevention



Community public address systems

Megaphones distributed to CLs, CPs, and CDDs and used 2 weeks-1 month in advance of MDA.

Community locations with heavy traffic

Number of community announcements conducted using megaphones

e) Training

MDA training

Refresher Training of Trainers: In the current 20 regions and 142 districts where ENVISION will be implementing activities, each region will have a one-day refresher TOT. All region and district teams received a refresher training in FY16. Because the TZNTDCP is moving toward implementing more M&E activities in these regions, these refresher TOTs will emphasize M&E activities that will be conducted in the districts, and the role the district and regional NTD coordinators will play in managing them. Training will center on the requirements for a successful MDA, particularly training and supervision of lower-level health care personnel and teachers, as well as MDA data review and reporting. In both new and refresher trainings, MDA coverage will be a major focus because a key role for NTD coordinators is ensuring that lower-level health care staff (i.e., regional/district NTD teams and FLHWs) and teachers are well-versed in MDA procedures through the cascade trainings.

Training of Trainers in Songwe region: In the new 5-district, OV-endemic region of Songwe a two-day TOT for district and regional NTD coordinators will focus on school- and community-based MDAs.

Supportive Supervision Training: To ensure effective supportive supervision in line with ENVISION and the TZNTDCP framework, the TZNTDCP will conduct a two-day supportive supervision training at all levels (regional district, zonal and community) during planning, training, MDAs and M&E activities. In FY17 supportive supervision training will be strengthened at all levels. The TZNTDCP has used a supervision checklist which has been updated and modified each year and this year will incorporate revisions based on the supervision checklist developed by ENVISION-RTI.

Supervision activities by districts: ENVISION will also fund the training of district NTD teams. Trainings will be conducted in a cascade fashion, with regional and district NTD coordinators facilitating training for the regional and district NTD teams, which in turn train FLHWs and teachers. Teachers and FLHWs will receive a one-day refresher training from the district NTD teams prior to the school-based MDAs. Teachers will then distribute medicines during the MDAs under the supervision of FLHWs and district NTD teams.

Teachers:

Teachers will receive a one-day refresher training, but for Songwe Region, and the 15 new districts where teachers will receive two-days training because this will be their first experience with the ENVISION model for MDA. Training will be conducted by district NTD teams.

CDDs

In districts where community-based MDAs for LF and or trachoma are planned, FLHWs and CDDs will each receive one or two days of training for continuing and new districts. Training will focus on key MDA steps, including NTD overview, drugs used for MDAs, eligible populations for each drug package, dosing, how to introduce the program, and how to use household registers.

Reprinting of Training Materials: ENVISION will fund the reprinting of training materials for FLHWs, teachers, and CDDs. This includes manuals for all the 15 new districts and Songwe Region where school- and community-based MDAs are taking place.

Finance refresher training: To ensure that ENVISION funds are managed according to USAID, RTI, and IMA requirements, ENVISION will conduct refresher finance training for a select number of district and regional accountants managing ENVISION funds. A one-day refresher training for ENVISION sub-grantees at region/district level will be held for these select district/region accountants. For the accountants in the new Songwe region and its five districts, two-day training will be required to introduce them to working within USAID RTI and IMA rules and regulations. Furthermore, ENVISION accountants will provide onsite mentorship to all accountants as they visit these districts for supportive supervision. At the training, ENVISION will also provide to accountants who are new to ENVISION a simple guidance manual that has been developed highlighting key compliance issues.

Data management training: Data Management trainings will continue in FY17 in selected ENVISION-supported regions and districts to enhance accurate data reporting.

Database Training: In FY17, the TZNTDCP will carry out a database training for the Tanzania national-level NTD database system developed with ENVISION funding in 2012–2013. This training was carried out in the Pwani Region in June 2015, and the Pwani district staff started to report MDA data both in hardcopy and electronically. In FY16, ENVISION trained two regions, Morogoro and Mtwara. These regions were chosen for the next rollout of this training because they had MDAs for several more years and they have the capacity at the district level for reliable electronic reporting.

Trachoma Refresher Trainings: ENVISION will also work with the TZNTDCP to organize and lead trachoma graders refresher training for district eye care coordinators who will carry out the impact surveys. Because trachoma grading can be highly variable, it is critical to conduct refresher trainings that review techniques and processes for field graders to determine their concordance with more experienced graders.

f) Mapping

All trachoma mapping for Tanzania has been completed, and LF remapping was completed in FY15.

SCH was mapped in 2004 through blood-in-urine questionnaires administered to schoolchildren in all districts. STH are considered to be endemic throughout Tanzania, although baseline mapping of STH has not taken place. The TZNTDCP does not treat in all districts twice a year, and does not treat high-risk adults. In 2004, The MOHCDEC conducted a desk review of hospital and health facility records. At the time, all regions were found to require some level of STH intervention according to WHO guidelines. A more vigorous analysis of SCH and STH data to date is needed to develop a clear treatment strategy for both diseases. During the FY15 Annual Joint Planning Meeting, it was agreed that the TZNTDCP will

contract a consultant to review all SCH and STH mapping and sentinel site data available so that the TZNTDCP can decide on the optimal way forward. This will include a determination regarding a need for STH assessments in country.

In the six former APOC regions, the following districts would benefit from OV remapping to establish infection levels: Liwale (first mapped in 1997); Songea Municipal Council , and Mufindi District Council Rapid Epidemiological Mapping of Onchocerciasis (REMO in 2006); Njombe DC (REMO in 2006); Kilolo (borders Kilosa DC, which is hyper-endemic); and Makete (borders Ludewa). In addition, the following districts need to be checked for OV endemicity because they share borders with endemic countries: Karagwe and Ngara districts, which border Burundi and Uganda; Kyela, which borders Malawi; Nyasa and Mbinga, which border Zambia; and Newala and Tandahimba, which border Mozambique. Tanzania looks forward to clarification of the best way to proceed with mapping. As noted in the Strategic Planning section, ENVISION will continue to support the TZNTDCP to convene an OV Expert Committee, which can advise whether and how to proceed with remapping in these areas.

g) MDA Coverage and Challenges

In FY 2015, ENVISION supported LF MDA (IVM+ALB package) in 53 districts, SCH MDA (PZQ and/ALB package) in 70 districts and trachoma MDA in 32 districts. Overall, 28.3million treatments were distributed to 11.5 million people. The percentage of districts achieving the minimum coverage was 96% for LF, 100% for STH, 81% for SCH and 56% for trachoma.

School-Based MDA

The TZNTDCP implements school-based and door-to-door community-based MDAs in ENVISION districts. The district is the implementation unit for all MDA activities, and district NTD teams distribute drugs to schools and health facilities before the MDAs. School-based MDAs will take place in February and March for those districts where community MDA will not take place, and May and August 2017 where community MDA will take place, using ALB (for all) and PZQ (where appropriate based on SCH endemicity and treatment guidelines) in Dodoma, Singida, Rukwa, Katavi, Lindi, Mtwara, Pwani, Manyara, Tabora, Morogoro, Tanga, Ruvuma, Iringa, and Njombe.

Community-based MDA

Community-based MDA with IVM+ALB, and ZTH where appropriate, will take place in a phased fashion in FY17. Both booth and house-to-house approaches will be used in urban and peri-urban areas. The TZNTDCP observed higher coverage in urban areas in some locations than the program had seen in previous years using the booth approach during the co-implemented joint MDA and vaccination campaign in November 2014. The joint campaign, however, had more resources, and more resources were put into social mobilization and promotion than when MDAs are carried out. During the FY17 MDA, the TZNTDCP will continue to pay close attention to the best method of reaching urban and peri-urban populations. All districts requiring PC will be treated in FY17.

LF MDA

ENVISION plans to treat 41 districts for LF through ENVISION in FY 2017. FPSU will conduct IVM+ALB MDA in the six districts of Dar es Salaam region, providing 100% geographic coverage for LF MDA.

OV MDA Twenty-seven districts are endemic for OV. These districts lack recent epidemiological assessment data to estimate current disease burden. Three districts in the Tanga focus (Lushoto, Bumbuli and Muheza) passed the APOC Phase 1b epidemiological evaluation in 2012 and also passed LF TAS in 2014 and LF

MDA was stopped in 2016. However, due to new WHO guidelines, OV treatment will be re-established in 2017 until stop-MDA epidemiological and entomological assessments are warranted based on guidance from the TEOAC. In FY17, through ENVISION funding, ENVISION will fund MDA in all 27 OV-endemic districts. While ENVISION plans to conduct an epidemiological stop-MDA assessment in the four districts of the Tukuyu focus (see M&E section), MDA is still budgeted for these four districts in case they do not pass the assessment.

SCH and STH MDA SCH and STH are endemic nationwide and treatments are provided largely targeting SAC. For STH, where LF/OV are co-endemic, the IVM+ALB package is distributed in communities via house-to-house distribution, and six months later, a school-based distribution of ALB alone or with PZQ is conducted. The program achieved 100% geographic coverage since FY16, providing 2 rounds of ALB treatment per annum. In FY 2017, 58 districts will benefit from this twice a year package with ENVISION funding as they also receive ALB through community LF MDA and OV MDA. All remaining districts will receive one round of ALB with or without PZQ depending on SCH-endemicity. ENVISION funds 83 other districts (141 in total) and SCI treats the remaining 45.

In FY16, SCH MDA was planned for 62 out of the 126 endemic districts under ENVISION support, with 2.9 million SAC targeted. Other districts were not treated since they only receive MDA every other year since they are moderately endemic. MDA will be completed in July- August 2016.

Trachoma MDA

Trachoma MDA in FY16 was planned for 20 districts targeting 5.4 million people. To date, 16 districts reported treating 2.7 million people. Of the 20 districts, two (Ngara and Chunya districts) are carrying out Zith MDA for the first time and four are re-initiating treatment after having stopped for many years due to lack of funding (Ngorongoro, Longido, Monduli and Meatu). All trachoma endemic districts have nomadic pastoralists populations. However, 6 /20 have about 90% endemic populations,( e.g. Longido and Ngorongoro, Kiteto, Monduli, Meatu and Kilindi), others have 50%-75% of their population being nomadic, e.g Igunga and Ngara districts.

Activities for FY17:

Production of replacement MDA supplies: For MDA data collection, the TZNTDCP uses school and household registers. ENVISION will fund the production of dose poles, PVC for PZQ, and school and household registers, which are budgeted at 10% replacement across the ENVISION-supported districts.

Printing of summary data forms: ENVISION will fund the printing of forms for all 20 regions, and 142 districts. These summary forms are used to aggregate data from the service delivery point to the district and from districts to region.

Transportation of MDA supplies: In FY17, ENVISION will fund the transport of replacement MDA supplies and summary data forms to regions and districts.

MDA: In FY17 ENVISION will provide funding for drug distribution which includes payments to FLHWs, teachers, and CDDs. ENVISION will fund community and school MDA in 77 districts, school MDA in 65 districts, and Zithromax MDA in 21 districts.

Table 5: USAID supported coverage results for FY15* and FY16** and targets for FY17

NTD # Rounds of

annual distribution

Treatment target (FY

2016) # DISTRICTS

# Districts not meeting

epi coverage

target in FY 2016*

# Districts not meeting program coverage

target in FY15* and FY16**

FY 2016 #

Treatment targets

PERSONS

FY 2016 # treated PERSONS

FY 2016 %

of treatment target met PERSONS

FY17 treatment

targets #

DISTRICTS

FY17 treatment

targets #

PERSONS

LF† once a year 94 18 17 18,047,129 14,554,928 80.65% 45 8,049,994

OV once a year 20 2 4,027,379 2,973,592 73.83% 27 4,739,682

SCH once a year 70 20 2,913,180 118,159 4.06% 89 4,140,985

STH depends on

district*** 80 23 6,238,989 1,038,698 16.65% 141 6,319,333

TRA once a year 20 12 5,429,536 2,740,485 50.47% 21 5,086,831

g) Drug and Commodity Supply Management and Procurement


Seconded Drug Logistics Officer: ENVISION funds a drug logistics officer seconded to the TZNTDCP, who has been invaluable in improving relationships with the MSD and the TFDA, ensuring accurate counts of drug quantities at district, regional, and central level; and training pharmacists at all levels

Drug transportation: All medicines, after clearance from the port, are stored at MSD and transported to the districts by MSD before MDAs. In FY17, if there are any delays in transport by MSD before MDAs, ENVISION will provide funds for drug transportation by hiring third party logistic providers (3PL) to move the drugs to the districts. This will only need to be considered if there are delays in receiving the drugs from outside of Tanzania, or if customs clearance is slow and the drugs are only released two weeks or closer to the MDAs. The transport of medicines from the district to the community is normally conducted by the DMOs using district vehicles.

Pharmacists Supervisory Visits: In July FY15, the TZNTDCP carried out a regional pharmaceutical supervisors training led by the drug logistics officer. Three selected pharmacists from 13 regions were trained on NTD drugs and inventory management; quantification, and reporting, including how to complete summary forms at each level (household, register, health center, district, and region); as well as on peer mentorship skills and techniques. Once trained, the pharmacists in each region will form a mentors/supervisors team under the leadership of the drug logistics officer. The regional teams will also select high-performing district-level pharmacists to join the regional team. The supervision will be conducted in regions and districts where there are issues. Costs include a stipend for their time and some phone time or fuel costs.

In addition, the TZNTDCP, in collaboration with PATH, has developed supply chain booklets for pharmacists, FLHWs, and CDDs. The supply chain booklets printed with WHO support will be provided during trainings, and all health care workers, particularly pharmacists, will improve NTD medicines management and therefore reduce overstocks or understocks during MDAs, as well as reduce the amount of wasted and expired medicines.

Drug supply management and stock verification: In FY17, ENVISION will provide funding for regional-level pharmacists to conduct drug supply management and stock verification at district-level pharmacies before and after MDAs. After an MDA is completed, district-level pharmacists work with CDDs and FLHWs to record and collect all unused drugs. Unused drugs are first transported to other

districts/hamlets conducting MDAs to be used, or they are brought back to the health facilities if they cannot be used during the current MDA round.

Reverse logistics: Experience has shown that after completing MDA in most districts unused medicines are left in health facilities sometimes in poor storage conditions. Some of these medicines have long expiry dates warranting proper storage so that they and can be used in future MDAs. In FY 2017, ENVISION will fund this activity for districts and regions that will not be supporting this activity.

Adverse Events (AE) and Serious Adverse Events (SAEs): All FLHWs and CDDs are trained to be aware of and identify SAEs. SAEs are registered with the district health teams and reported to the TFDA and the NTD Secretariat. Should there be an SAE, the TFDA takes the lead on managing the patient. Mild side effects, such as headaches, nausea, abdominal pain, fever, and nodules, are treated at health facility as needed. FLHWs, CDDs, and the NTD district teams address any side effects free of charge. If there are any complications, patients are transferred to hospitals for follow up. SAE cases will be reported on health facility “yellow forms” and reported to the NTD Secretariat and the TFDA. The NTD Secretariat will then report it to WHO and the drug donation program. RTI will be notified by IMA within 24 hours if any SAEs occur. The TZNTDCP has been working with TFDA and WHO to make sure this process is improved. In addition, the summary data forms at the district and regional levels have a space to collect this information so that the NTD Secretariat will quickly learn of any SAE if the forms are filled out properly. ENVISION will work closely with the TZNTDCP during training and supervision activities to highlight reporting of any adverse events or SAEs and use the manual developed by ENVISION/TFGH for guidance.

h) Supervision

In FY17, the TZNTDCP and IMA staff will provide supportive supervision during MDA and plan to increase focus on quality supervision from the central level as well as through funds provided to region and district level. The TZNTDCP will increase supervision efforts during trainings for FLHWs, and trainings of CDCs and teachers. Monitoring mechanisms in use are supportive supervision checklists.


Supportive supervision during advocacy and community mobilization: ENVISION will provide funds for supportive supervision of all MDA-related activities at all levels from national, regional, and district to health facility and school levels. With ENVISION funding, the TZNTDCP staff will conduct supportive supervision during advocacy and community mobilization activities. TZNTDCP and IMA staff will travel to districts during the advocacy and community mobilization activities in advance of the school-based MDAs.

Supportive supervision for school- and community-based drug distribution: ENVISION will also provide funding for NTD Secretariat members and ENVISION staff to carry out supportive supervision for school- and community-based drug distribution before and during the community- and school-based MDAs. TZNTDCP staff, along with IMA staff, will supervise all activities at regional and district levels and will carry out a spot supervision of the activities implemented at the health facility, school, and community levels. ENVISION and the NTD Secretariat will organize and lead cascade trainings for supportive supervision (captured in the Training section of the budget). To build capacity, regional and district NTD teams will be trained to conduct more effective supportive supervision.

i) M&E

Activities planned for FY17

Plans for DSA and Post-Treatment Surveillance

LF pre-TAS and stop MDA TAS: In FY17, 30 districts—Lindi (3), Manyara (7), Morogoro (9), Tabora (8) and Tanga (3) —will be assessed through pre-TAS sentinel and spot check sites. Of these 30 districts it estimated that 24 will achieve criteria for conducting stop MDA TAS. Manyara and Tabora regions (15 districts) will have completed five effective rounds of IVM+ALB MDA and will be due for stop MDA TAS. The program is confident that these areas are marginally endemic for LF and are near elimination. Morogoro Region (9) is co-endemic with OV and thus LF and OV evaluation, possibly using the biplex filarial test might be helpful in understanding the co-endemicity. The remaining six districts in Lindi and Tanga regions are known to have had high initial prevalence and have gone through 10 rounds of MDA. This survey will help the program understand the current prevalence and inform treatment strategy, including stopping MDA where the criteria are met and upon RPRG approval.

LF post MDA surveillance TAS 1: The first post-MDA surveillance TAS (TAS 2) will also be carried out in 5 districts including Lushoto, Bumbuli, Newala, Mkuranga and Muheza. This will help the program detect any recrudescence. Only one district, Tandahimba, has completed all required surveillance TAS but, this success comes with an even greater challenge in surveillance as there is no ongoing surveillance mechanism in place in this district. There is an obvious risk or recrudescence because Tandahimba is still surrounded by highly endemic districts like Mtwara MC, Mtwara DC and Masasi. The TZNTDCP has used a TAS checklist and this will be updated to reflect the ENVISION developed TAS check list. The checklist will be incorporated into planning and supervision of the activities. It will also be useful for reviewing when reviewing preliminary data that may indicate a failed TAS.

Trachoma Impact Surveys: In FY17 the program will continue to monitor the impact of trachoma control activities. Impact surveys are planned for 6 districts. These include, first TIS: Misungwi DC; second TIS: Meatu, Kiteto and Kilindi; and third TIS: Tunduru and Mpwapwa. Misungwi DC was TIS 2 surveyed in 2014 and had TF of 4.2%. During a re-run of analysis using GTMP methods, however, it was found to have TF at 5.5%. TZNTDCP has agreed to continue implementing S, F & E components and re-evaluate in 2017. For this reason, no Zithromax MDA was implemented in Misungwi. In Meatu, Kiteto, and Kilindi, the first TIS indicated great reduction in TF prevalence from the baseline. However, since prevalence was between 5 and 9.9 %, one additional round of MDA was required before a next evaluation was due. In FY16, that one round of Zithromax MDA was implemented in addition to the other S, F and E interventions.

Overall, proposed surveys in FY17 will help program strategize on how to implement appropriate SAFE strategy including stopping MDA where applicable.

Trachoma Surveillance Surveys: Twelve districts that already stopped implementing MDA, but are still implementing “S, F, &E” strategies will conduct a surveillance survey that will help detect any recrudescence. ENVISION will support these evaluations. The Trachoma Expert Committee has also recommended carrying out a TT-only survey in selected districts where full impact survey are not yet warranted. The TT only surveys are funded via the DFID/TRUST program and will help the program develop the MMDP strategy.

OV Epidemiological Evaluation to Obtain updated Onchocerciasis Endemicity information: In FY16, ENVISION supported the TZNTDCP to establish the TOEAC, which recommended re-establishing endemicity/prevalence levels using the most recent WHO guidelines. All 27 endemic districts across the country have completed 13 to 18 rounds of IVM MDA. In 2012, epidemiological evaluations in two foci

of Tanga and Tukuyu recorded 0% microfilaraemia. This is seen as a sign of good progress towards elimination but given the lack of entomological assessment in the same sites and given new WHO recommendations on using OV16 serological markers for epidemiological assessment and O150 PCR for entomological assessment, the TOEAC recommended reevaluation.

ENVISION supports leveraging the existing human and lab capacity for OV evaluation for the program. Some laboratory training has already been provided by CDC to NIMR-Tanga, and this facility is very capable of analyzing as blackfly specimens. CDC will conduct an expanded training on ELISA to the NIMR-Tanga lab in December 2016. TZNTDCP is soliciting funds from other partners to carry out entomological evaluations using O150 PCR across all districts/foci. Findings from these evaluations will be used as to inform the OV elimination strategy for Tanzania and will serve as standard benchmarks against which the program will be evaluated in the future.

In FY16 all surveys conducted so far achieved the critical cut off point (more surveys are scheduled for the last quarter of FY2016, and only preliminary results are available). These surveys were funded by CDC the prevalence in adult humans is about 2% in humans but the sample size was small, and it is not clear how this would be interpreted under the WHO guidelines. The TZNTDCP recently met with partners including CDC, USAID, IMA and the Task Force for Global Health during the AFRO RPRG meeting in Dar es Salaam. The following recommendations for FY17 epidemiological studies came out of discussions from the meeting.

Epidemiological Evaluation in Tukuyu focus, 4 Districts: In FY16, the CDC funded a study in the Tukuyu focus which tested 948 individuals with only 2 positives (one 11 year old, and one 63 year old). All 948 skin snips were analyzed per PCR and 8000 black flies were found negative. While the study did have 2 positives, the negative black flies indicate that transmission has dropped significantly, and therefore a larger epidemiological study is needed. In FY17, ENVISION proposes carrying out epidemiological surveys in the Tukuyu foci which includes 4 districts (Busokelo DC, Kyela DC, Rungwe DC, and Ileje DC) that have met the criteria for stopping LF MDA. These studies are scheduled to take place in late November 2016. Prior to the surveys taking place, ENVISION will work with the Secretariat to develop a protocol, which will be shared with WHO, USAID and other OV stakeholders for review.

OV Monitoring during TAS 2 in 3 districts of Tanga: o The Tanga focus is made up of 5 districts. In FY17, TAS 2 is scheduled for three of the

districts: Muheza DC, Bombuli DC, and Lushoto DC and the other two districts, Korogwe DC and Mkinga DC, still require LF treatment. In FY18, TAS 1 is scheduled Korogwe DC and Mkinga DC.

o Preliminary results from a CDC study conducted in the focus in 2016 using OV-16 RDT and Elisa, sampled 2000 children in Muheza DC and found 5 positives, indicating that transmission is still ongoing.

During the pre-TEOAC meeting, the NTD Secretariat, USAID, WHO and other OV stakeholders agreed that all of the data for the Tanga focus will need to be reviewed during the TOEAC meeting in February 2017. However, since TAS 2 is scheduled in the 3 districts mentioned above in November 2016, and the TZNTDCP already has the OV-16 RDTs in country, the meeting participants agreed that the program will add the OV-16 RDT to TAS 2 and collect additional OV information at a relatively low cost.

Oncho Monitoring in Tunduru focus: o The Tunduru focus includes just one district: Tunduru DC. It is bordered by Selous Game

Reserve. The district has had 11 rounds of treatment and passed LF TAS in 2015. In

2013, an APOC Phase-1a evaluation tested 3211 individuals and found 0% microfilaraemia.

During the pre-TEOAC meeting, the NTD Secretariat, USAID, WHO and other OV stakeholders agreed that it would be helpful to capture updated OV epidemiological information before the next TOEAC in this focus. To that end, ENVISION will fund the TZNTDCP will carry out OV monitoring in Tunduru by sampling 300 children in 10 high risk villages (near known breeding sites) with OV16 RDTs.

Data Management Training: The program will continue to build capacity of region and district NTD teams and zonal leaders, and frontline health workers in NTD data collection, aggregation, reporting, and data utilization.

National NTD Management Information System: In another effort to improve data quality and facilitate rapid reporting and utilization of data for decision making, a web-based MDA database will be introduced to all districts in the country. ENVISION will continue to support the TZNTDCP to roll out training in phases to the priority 8 districts (two staff to be trained per district) on how to use the web-based national NTD database for MDA reporting.

Table 6: Planned DSAs for FY17 by disease

Disease No. of ever-

endemic districts No. of districts

planned for DSA Type of assessment

Diagnostic method (Indicator: Mf, FTS,

hematuria, etc.)

LF 121 24 TAS 1 Filariasis Test Strip (FTS)

LF 121 5 TAS 2 FTS

LF 121 30 Pre-TAS FTS

STH 186 30 Sentinel sites assessment

Kato Katz

SCH 186 30 Sentinel sites assessment

Kato Katz and Urine Filtration

Trachoma 57 6 TIS Clinical grading

Trachoma 57 12 Surveillance survey Clinical grading

OV 27 4 OV Epi surveys OV-16 ELISA

OV 27 4 OV monitoring OV-16 RDT*

APPENDIX 1. TANZANIA FY16 WORK PLAN TIMELINE

Activities

Project Assistance

NTD Capacity Strengthening

Manuscript Review and Finalization

Strategic planning

Region and District Review/Planning Meetings

Technical Working Group STH&SCHISTO

Technical Working Group Trachoma

Technical Working Group OV&LF/

Annual Joint Planning Meeting

National Review and Planning Meeting

OV Expert Committee Meeting

Extension of NTD Master Plan

STH/SCH Consultant and Review Meeting

Publication Meetings

Trachoma Action Plan Meetings

NTD Secretariat

Ongoing Support of Operational Costs

Furniture and Equipment

Advocacy

Regional-Level Advocacy Meetings (5 regions)

District-Level Advocacy Meetings (34 districts)

Social mobilization

Printing/Production Integrated IEC/BCC Materials

Develop Radio and Television Spots Cultural appropriate messages

Airing Radio and Television Spots Cultural appropriate messages/MDA adverts/jingles

Delivery of IEC Materials

Media Awareness Meetings (Songwe region)

Community Sensitization (40 districts including low MDA coverage and Nomadic districts)

Capacity Building/Training

Database Training-National NTD secretariat/IMA staff

Data Management Training Phase 1 (Mbeya, Songwe, Ruvuma, Njombe, Tanga)

Data Managemnet Training Phase 2 (Arusha, Kilimanjaro, Singida, Dodoma, Lindi, Rukwa, Katavi, Tabora, Manyara

Data Management Training Phase 3 (Geita, Simiyu)

Finance Training for accountants in new Districts/Regions; Songwe (6 accountants) and 78 accountants from 19 regions

Training of Trainers (Central), Training of National team

TOT (Training of Trainers 20 regions + Districts)

- Training of trainers Regional + Districts (Lindi, Mtwara, Pwani, Manyara, Tabora, Morogor, Tanga, Ruvuma, Mbeya, Iringa, Njombe, Songwe) Nov 2016

- Training of trainers, (Arusha) July 2017

TOT (Training of Trainers) School MDA (Dodoma, Singida, Rukwa, Katavi, Lindi, Mtwara, Pwani, Geita, Arusha, Kilimanjaro, Simiyu) Jan 2017

TOT (Training of Trainers) School MDA (Tanga, Mbeya, iringa, Njombe) April 2017

TOT (Training of Trainers) School MDA (Dodoma, Singida, Rukwa, Katavi, Lindi, Mtwara, Pwani, Manyara, Tabora, Geita, Arusha, Kilimanjaro, Simiyu, Ruvuma, Morogoro) July 2017

Activities

Training of FLWHWs

Training of FLWHWs for MDA (Lindi, Mtwara, Pwani, Manyara, Tabora, Morogoro, Tanga, Ruvuma, Mbeya, Iringa, Njombe, Songwe)

Training of FLWHWs for MDA (Zithromax), (Arusha) June 2017

Training of CDDs

Training of CDDs MDA (Lindi, Mtwara, Pwani, Manyara, Tabora, Morogoro, Tanga, Ruvuma, Mbeya, Iringa, Njombe) Nov 2016

Training of CDDs for MDA (Arusha) July 2017

Training of Teachers

Training of Teachers School MDA (Dodoma, Singida, Rukwa, Katavi, Lindi, Mtwara, Pwani, Geita, Arusha, Kilimanjaro, Simiyu) Feb 2017

Training of Teachers School MDA (Tanga, Mbeya, Iringa, Njombe)

Training of Teachers School MDA (Dodoma, Singida, Rukwa, Katavi, Lindi, Mtwara, Pwani, Geita, Arusha, Kilimanjaro, Simiyu, Ruvuma, Morogoro) Aug 2017

Other Trainings

Supportive supervision traing; Nation team supervisors and 2 from 20 regions = 40 people)

Training on Supply Chain management, (Tanga, Mbeya, Iringa, Njombe, Morogoro, Songwe, Ruvuma)

Printing of Training Materials

MDA

MDA Supplies (dosing poles and measuring papers)

Production of Registers and Summary Data Forms

- Region and District Strategic Planning

- and District Social Mobilization

- Training of Trainers

- Training of FLHWs

- Training of Teachers

- Data Management Training (phase 1,2,3)

- Drug Distribution ALB+PZQ (1st Batch)

- Drug Distribution ALB+PZQ (2st Batch)

- MDA Registration (census)

- Drug Distribution of IVM+ALB

- Drug Distribution of ZTH

- Region and District M&E (MDA data collection)

- MDA Supportive Supervision

Drug supply management

Drug Transportation from MSD Dar to Districts

Drug Supply Management Oversight and Stock Verification

Supervision

Supportive Supervision During Advocacy and Community Mobilization

Supportive Supervision on Drug Distribution (IVM/ALB and ZTH)

Supportive Supervision on Drug Distribution (PZQ and ALB)

Trainings for Supportive Supervision

STTA

STH/SCH Consultant

Specific Nomadic and Pastoralist Consultant

Resource Mobilization Consultant

M&E

Routine Data Collection

Activities

Trachoma Impact Surveys

Trachoma Surveillance Surveys

LF/STH/SCH Sentinel Site and Spot Check

TAS (26 evaluation units)

TAS 2 in 3 districts of Tanga

OV Epidemilogical Evaluation in Tukuyu Foci (4 districts)

Oncho Monitoring during TAS 2 in 3 districts of Tanga Region

Oncho Monitoring in Tunduru Foci (1 district)

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