Annual North Gondar project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

t Ie The Federal Democratic Republic of Ethiopia Ministry of Health COUNTRYAIOTF: ETHIOPIA Proiect NamqNorth Gondar Approval year:2002 Launching year: 2003 Reportine Period: F ro m : Ja.n.u a.ry. ?.0.1.1.......... To ;.... De s.e.mh s.r..2 0.1 1......(Monthllear) ( Month/Year) Proiectyearofthisreport: (circleone) 1 2 3 4 5 6 7 8 10 Date submitted: 30 December 20ll NGDO nartner: The Carter Center ttI ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 July for September TCC meeting i .lSzr i Ii- I lLu. I ?tt c );l / i/ /tt/; i ,tL, "', "\ /' o''""L4i r; ri ri ,j li -n Ij I, '5irR ttl 1r; fl _;r* ;." *. P r "iF; i I @,v AFRICAN PROGRAMME FORoNCHOCERCTASTS CONTROL (APOC) ".. :+{itj-... ,-. -.*n WHO/APOC, December 201 I DEADLINE FOR SUBMISSION: ; ! N\L-. ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country Ethiopia National Coordinator Name: Mihret Hiluf Zonal Oncho Signature Date N Name: Signature I\tihr* Hiluf (RN, BSc, lvII'H) Signature: Ytrk\Egrr rien Health Promotion and i\rgussle Direbtor\ f)isease D' 'l t ,iv t This Dut" dry1 20 tL by Name .- Worku Mulatu Desi gnati o n'. Zone Oncho cerciasis Coordinator Signature Date d.' E $':l , * *{ ll WHO/APOC, December 201 I I ( N l. Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UMCEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization I. WHO/APOC, December 201 Ill I Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in mesoAryper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (i") Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifi cations when necessary. ! WHO/APOC, December 201 I (i) lv FOLLOW UP ON TCC RECOMMEIIDATIONS TCC session 4 6 Number of Recomme ndation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Adopt January to December reporting period Reporting period of January to December is adopted 2 Indicate the role of each partner in the project The role of each partner in the project is indicated J Avoid treatment during the rainy season to reduce absentees lf Mectizan arrives on time treatment during rainy season will be avoided IntensiI health education and mobilization of community to address high number of refusals and absentees The number of refusals which was 14,726 in 2010 is reduced to 13,278. Similarly the number of absentees which was 18,588 in 2010 is reduced to 17,032 in 2011. Health education and mobilization of community will be further intensified to improve the situation. 5 Ensure usage of remaining Mectizan tablets before expiry No Mectizan tablets expired during the 201 I treatment period. Follow up actions will also be taken in the future to avoid Mectizan expiry Train more CDDs to achieve at least l:lO0minimum set by APOC and if possible,20-25 people targeted for 201 I by project Numbers of CDDs have decreased in 201l, as a result the l:100 minimum set by APOC is not achieved. Much effort will be exerted to remedy the situation in the future. 7 Increase number of female CDDs This is a great challenge for the project, for our culture it self is a great hindrance to involve them in such activity. 8 Therapeutic coverage has declined from 77oh in round 7 to 76Yo in round 8 and now 70.3% in round 9.There is a need to find the reason and avoid further decline. Pay special attention to Metema Woreda where therapeutic coverage was 67.Zoh. This year (201l) the therapeutic coverage has reached 70.1o/o and every effort will be done to improve it further. 9 Vehicle, motorcycles and photocopiers need to be repaired/replaced by APOC- I Oft The maintenance is not done by government budget and We are expecting a replacement from I WHO/APOC, December 201 I year project and other materials, like photo camera which will help to prepare pictorial presentation about Onchocerciasis needs also be procured APOC soon. 2 WHO/APOC, December 201 I Executive Summary l. Backsround on treatment and ponulation data North Gondar Community Directed Treatment with Ivermectin (CDTI) is funded by the African Program for Onchocerciasis Control (APOC) and its partner The Carter Centre. The implementers are the FMoH, Regional Health Bureau and its line offices such as zone health department, the woreda health offices and health facilities. Above all the cDDs and community supervisors are the key actors of the program. Nofth Gondar is one of among the I I Amhara zones and its bounders are Tigray Region in the North, waghemra zone in the East, Benshangul Gumiz Region in the South west, South Gondar in South and Sudan in west' The Zone has a total area of 53,170 sq kms divided into 20 rural woredas and 3 town administration having 577 Kebeles. The capital of the Zone, Gondar, is 73g km North west of Addis Ababa and 180 km. from Bahirdar which is the regionar capitar. overall, 77 kebeles and 869 communities were reported in GDTI project woredas. Based on the 201I census result, about 304,737 populations are living in Onchocerciasis endemic areas The Annual Treatment objective (ATo) for the year (2011) is B4%out of which 2l3,556were treated with Mectizane which gives annual therapeutic coverage of 70.1'%. The project also has achieved 97 .5% geographic coverage. Relatively, low therapeutic coverage is reported from Metema and Tach Armachiho woredas; 67.2 % and 68'5%o respectively. Both absentees and refusals make I 0 %o of thetotal population various activities such as advocacy meetings, Tor, health workers and cDDs trainings, communify mobilization, recruitment of new CDDs have been carried out prior to the commencement of drug administration. Training was given to 3261cDDs by HWHEW. Both the new comers and the existing cDDs were trained together for sharing experience. The cDD to population ratio for the entire project was l:93. The proportion of females CDDs still remains low (l 0.4%) and which gives a male to female ratio of g:1. The communities in the CDTI areas are mainly settled farmers, government employees and daily workers' Recently there were settlers coming from other Woredas of the Zones to be settled in both CDTI woredas' The indigenous ethnic groups are Amhara, Agew and Gumiz which occupy the entire CDTI Woredas. J WHO/APOC, December 201 I Train e data In 2011, new and refresher trainings were given for 271 health workers and 3261 CDDs selected by the communities from 869 villages. The following table depicts the treatment history of the project. YEAR Total population endemic areas Annual Treatment Objective Number of persons treated Therapeutic coverage ATO covera ge UTG 2003 126,806 101,445 86,428 68 85 8t 2004 235,712 197,998 180,054 76 9t 91 200s 234,054 196,605 183,945 79 94 94 2006 249,345 199,476 182,329 73 9t 9t 2007 302,604 254,187 211,953 70 83 83 2008 282,046 236918 2t0.604 75 89 89 2009 280,259 224,207 215,805 77 96 96 2010 283,773 238,369 215,632 76 90 90 20tl 304737 255,979 213556 70.1 83.4 83.4 Challenses and how thev were overcome Challenges: . Late arrival of the drug . High turnover of health workers is seen every year . Task forces at all levels are inactive . Proper document handling and record keeping remains a problem even though some woredas have shown significant improvement. . Village register updating is not regularly done. . Regular and continuous supportive supervision is lackingatall levels Solutions siven for the occurred Challenses The high turnover of health staffremains unsolved problem. The zonal health office was repeatedly told to move forward in strengthening their respective task forces. Proper document handling and record keeping is being practiced by all WoHOs and health facilities. Thus some woredas are showing improvement. In-order to improve the report quality, ZHD offrcials and The Carter Centre Ethiopia Amhara region and North Gondar staff have carried out supportive supervisions to some CDTI Woredas and health facilities. 4 WHO/APOC, December 201I SECTION 1: Background information 1.1. General information Description of the project The project "North Gondar CDU" is located in North Gondar zone. North Gondar is one of the I I zones in Amhara Regional State. [t located in the nofthwest part of the region and covers an area of 53,170 sq kms. It is boarding with Tigray Region in the North, Sudan in the west, Metekel and Awi Zones in Southwest, South Gondar zone in the South, and partly with Waghimera zone in East. The total population the zone is estimated at3,217,022. The majority (85%) of the population lives in rural areas where as the remaining l5% lives in urban and semi-urban areas. The average population density is 60 per km2 whereas the average household size is 4.3. Administratively, it is divided in to 23 woredas and 577 kebeles. All the CDTI woredas resemble by their topography, weather condition, disease pattern, natural resource and other factors. The climate of the CDTI woredas is categorized as tropical. Similar to others, there are two season i.e rainy and cool weather from June - October and hot and dry weather from November to May. The temperature ranges between 17 C' - 44 Co. The main source of income is mixed agriculture (farming and herding) followed by trade. During the wet season, a number of migrant workers and nomadic people travel to these woredas for daily labour.. Influx of people also occurs in accordance with the government plan to ensure food security. 1.2 CDTI woredas Mass drug administration with mectizan is operational in five woredas, 77 kebeles and the 869 communities. Updated village register indicates that there are 304,737 people living in these woredas. The annual treatment objective was set as 255,979 people; by taking 84o/oof the total population as eligible for treatment. At present, all CDTI woredas have all weather road access from the zone capital. Inter-kebele road networking is still underdeveloped in the majority of the kebeles. All woredas have better access in telecommunication. Of the total population, 213,556 (70.1%o) have received the drug. About l0 %o of the people didn't receive it due to absenteeism and unwillingness to take the medication (refusals). Geographically, all villages have been reached for treatment, but many absentees were documented. Inappropriateness of distribution time contributes for increased number of absentees. Health care deliverv svstem There are three hospitals, l13 Health Centres and457 health posts. One health centre is set up to serve 25,000 population and one health post to 5000 persons. Both health Centre and health posts are called Primary Health Care Unit (PHCU). Ninety seven percent of the population is believed to have access to primary health care. About 1063 HEWs are currently deployed in the health posts to provide basic 5 WHO/APOC, December 201 I family based health services. In general there are 414 different types of health wcrkers in all CDTI Woredas. Table l: Number of health staff involved in CDTI 1.2.1 Partnership The CDTI is being implemented with the financial, logistics and technical support from WHO/APOC, The Carter Centre,. the Zone and woreda administration ofhces The Zone Health Department, Woreda Health Offices, get involved in facilitating and monitoring the overall CDTI activities. Health workers in charge of health facilities and CDDs have played a paramount role in providing the drug to beneficiaries, providing key onchocerciasis messages, monitoring activities and submitting reports to the next level. 6 District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage Bz=Bzl Bl * 100 Quara tt7 97 83 Gendawuha 25 t6 64 Tach Arma 133 108 8l West Arm 66 48 73 Metema 77 67 87 Zone Summery 418 336 80 WHO/APOC, December 201 1 r- N L(.) () oo (, o - > vttrrl olEI(l)l0l ol -tr1 alEI 'El ol -ol -Elbd oIEI ol(.ll dlNI (H o !ot., o o. oo c) 00 CU 0.) (! C) o IA 6) t/)(B o (r) o oo(! Lo tr J oo o o F o C) 'a L c) (* o o) l{: o a 0) 'o (d t1 LoE a o o F q) oo(! tr o (_) o .t1 o t7 C) (! B o (.) o bo(! o >' oo o o bo ch C) (0 ^c) ;(l, I I I g' o o) (, do o an L() I I Io Q I I I I(n (h C)o E .9 (d 7 c)o 5(gA 0.)6> .re o z \ CT,I c\. o (l) E o L o -o o doL C) cd L c) 6) Go! GI Iq) o q) (l) J cn ,i (s !o L(.) o- bO -6)E> PE b- -e -s o(d Pc) bo.tr EQ orEtr'o E= ()(ri(l)o 'd arE9oi L(1) .o .q uD v) 9H G)tt)u <€;q3,dz.B= E cd (n() oO o 6l A 6l ca oo a.t\o t-- ca o\ cr r- oo t--\o \o$ F.- o\ c..l N vt-- o\t* o\ta) ta) o.l C) .'.9€tr6EeUfl St B gsoN ., cl <.rt EA'= - c! arr-196J q' '- c)r(! () oA E E'? "sx. IF + I \oo G)i- =Edtr o = ge r() aOO .= Q.Nt -?.g:> E - r3 rc) N ao o\ o\ !t+ o\ tr) c.tt'- oo N r+ lal ca t-- c! oo oo r- ca t--$Ofn z z z z z z z z z z z z Eq Il gsfrEg .. E.= q.,!q <,tg EA'=!c ar)-rv €3; EtA E E'= "SE. + lt o c) o Lq) 2t r{) :OO .= oN r -?.9EE FF E€ r€) o\ o\ latc..t !f, a.t $ ra) r-r-C\ r)\o € z z z z z z z z z z z z q)cl c.! I .9EeEo: .,1:: -. g) E +i i -AIA C\ co o\oo\ ssl o\ n c.t r-. oo C.r $(n ca c\ o.l oo oo r- eor- .+ cn Qh I .F0)GI .=LA)U).5 L =tc!Hor F.g.qAe o u.= trl cd t<(! o (€ B(!E o cg F o(!F ah() (! tr() (l) z t'(.) tr E at ol olNl N d oo c\l Lo -o ()() o O o o -o N o C) z 0) (H o (! l<Ld (.) (d ; o C) -o L o () Xi. cio -oE(dEeo 9al 6l)- P= 9a<a) 'd .= I(.)E E(.)gB Qo .9 ar Ee .=> 1?6 .:d .- c) .E ()il(!E F€h3 vo -.ENo 6)etr'otrc)AAGi(!L-o o)o-E or9 *(u va .9(/)()()E= BO)otr'E frt = oEEdd) -QoXLr-c< , ?7 L(s() >. C) L o C) '13q) d C) (r) o (n (,) ,.9 ot? '=> EgG.. -o)q)e =c)c)E ts .. .ol orl -(!l6t Fl F Q G q) c) N z FU rd0 o U2 L o) a c..l a a.l ) c\ N >. N E'O .:J E a- L(d- €x tJ. h.d- €x Ldr €x tJr t,(i- €x tJ< (!- €xf! tr U) ul L \,/ o c..l >.(! c.l z c\ z N (B C\ (o z P-e 1iE N L o. c.l L o. o{ L o. N Lo. o a..l L o- () GIEc U) O oU \JO o- d= zc\ 9- Z c.r ()- €5a a.t P- €5A..r o-LSoZN E'= :E d: o-Ls5Zc\ o- tIoZ c.{ o- <Ioac.r o-L. €5Z c\.1 o- *oz c.t u0 cirrF o c)! =E 5EU o- iioZ c.t s5Zc\ o- troZ..r o{ o (€ z o- d-\aAZc.l P-e 1nECE: a' o- Z c..t o- €5z6t o- <Iozc{ o- $oaat o- €5a...t -c) ijE s= -aEooE()z ar= ao Oc! >t ol oct >. c.l >. ot >' 3no ?E hdH tNg. h6JH €xE Ld* €x frr (OH €xlri tcgr €xtu FI (,) L .r) o (! o() a d (!, o o o -q(!OE -(!EF(B o o oC,()H (d B !Coo 2.2. Advocacy State the number of poticy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. An advocacy meeting was carried on at each level.The focus of the meeting was on how to increase number of CDDs, to activate Task Forces at all levels and properlollow up of the CDTI project.The Meeting was conducted together with other health activity evaluation session 2.3. Mobilization, sensitization and health education of at risk communities Health education manuals were distributed to all CDDs and community supervisors. Different fypes of posters were distributed to each village and posted at different places. More Philip charts were given to HEWs to be used as health education guide. Community mobilization and sensitization was done at each village organizing community meetings by HWs, HEWs and CDDs. Health education is given in the villages to be treated. The communify elders and the community administration as well as the community at large were the key players in facilitating the CDTI activities (selecting CDDs, fixing the Mectizane distribution dates and sites). 9 WHO/APOC, December 201 I 2.4. Communityinvolvement T : Communities in the CDTI add more rows N.B: NA = dato not ovailoble. Comment on: - Attendance of female members of the community at health education meetings The attendance of females in health education meetings is increasin g yearly even though they are occupied with so many home and field activities. Recently, women development is being establish at each villages in order to give more chance to females to participate actively in any development being implemented in their respective areas. Therefore, this will be a good opportunity to increase female participation in CDTI activities. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). - Even though women are given more chance to participate in all important decision making meetings, their number is still low compared with men. Women's association is formed at each village and more women participation in every developmental activity has increased. However, due to cultural barriers their attendance, participation and involvement in discussion is still less than that of men. -Incentives provided by communities for the CDDs The woreda health facilities sometimes give them a chance to participate in other health campaign activities (Polio eradication,. EOS, Measles & TT vaccinations) so that they could get small amount of per-diem as an incentive. NA Nu m ber of comm unities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs District/LGA Total no. communiti es in the entire project area Br Number with communit v members as supervisor s Bs Percenta Be: BslBt *100 ge Male CDDs Bz Female CDDs Br Total Bs: B7*Bg Number of communiti es with female CDDs Bro Percenta ge Btt: Bro/Bq*10 0 Quara t99 366 184 t629 u0 1739 NA NA Gendawuha 25 36 144 157 9 166 NA NA Tach Arma 3t4 57 l8 556 72 628 NA West Arm 54 t2 22 132 40 172 NA NA Metema 277 181 65 787 108 895 NA NA Total 869 6s2 75 326t 339 3600 NA NA l0 WHO/APOC, 24 November 2004 I -Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Attrition of CDDs is a problem for North Gondar project area. Attrition is common especially among settlement community. Replacement is the means to handle this issue. Some CDDs and supervisors are not willing to continue related to absence of incentive or recognition. 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is whot meosures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower wos available or if stffi ore frequently transferred during the course of the campaign). The ZHD, woreda health offices and HFs do have knowledgeable health workers even though their number is sometimes questionable. Woreda health offices with few health workers are supported by the ZHD staff during Mectizane distribution campaigns. The HEWs and CDDs do get adequate training before Mectizane distribution period. ll WHO/APOC, December 201 1 0) 6BL o o U q)E z n ?rQ F\J: U U ir *d +.$' o< o\ c.l\o o\ c!\o t--tat \o$ \o r.) rf-) \o o{ ca $ oo @$ t-- oor- .+ r\o a.t cn \o6l c.t o\\oO ca oi o\ \o o\ o\ q) o q) I s \o o\ o\ L) l-F o\c\\o t*- ra) \orr) olco ooo\t'* c\l(-- N ca th c) .=6 cC FrLl Lfro: , tt)oq)k9 r- Glol- EO z ?tt +9NC-Footr U isU r! =\, +.$)' o\t-r o\\o o\ \o ca ta) oo oo\o r\ @ c.t c-l c-t \o la) \o aa v t'-N Nc\ (a) q)SE e>c) 0) I o\U frlo o\rr o\ ta)00 @cO t--c\ e) CtLc)- =sv tlD 3H tr> Zz. q) o ls r + Fla - € €r\li e e v Nt) d *.q)' a< : qJ R oo : oo : \o : oo sf oo$ oo c\ @ c.l t--I t'rC\ r=$ :_ t'-$ A c) c) q) ohQio ooca \o oos ooN r-o.l tr-$ cl ah (r) c) ;U x.EHci Oe L Q)E z E ss, Li $ .L q : R o c.l lat o\ sl \n c.l oo c- oo .A tfi oo N c.{@ o\in ;c\ o Q) 9 C) I -oo\ Uio N o\ ra)c\ @ o (\ao I Fl (.) t- 0 c0 G, o d a E q) tr L)(oF L (n o (g o o z cl F + c.l o -o Eo o z$ a.l -f N bo ou q) -a € .J \q) ! q) L q ti -t s Uo t L Q q) t qt .a B ! *Ss- \tr-$' ts > -q) lf (-' ! 4 UqJ 3 \ q)L ^: q) riq) s o (g c) o o. FoO o (h C) C) () L .c)E (l) G, bo (! F ,Hl orl -ol(Bl FI Table 6: Type of training undertaken (Iick the boxes where specific training was carried out during the reporting period) - Any other comments 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100%o geographical coverage and a minim um of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. -The project has achiev ed 97 .5% geographic and 70.1%o therapeutic coverage in 201 I . Trainees Type of training CD Ds Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Politic al Leader s Others (specif v) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifr) l3 WHO/APOC, 24 November 2004 e.l 6J -o E oo(.) ! (J sl (,FD v (o olr(d 9 o() vL 6') 9 ts F .= - v)d 0.)L cd .9 E() I F o IL O) o. \U(t, o E s ;o!d 0)L9Ol Olool ol -o -lo-loxl> xl! -l '.= -l o.r9t:, vt-olHC)lo_ dl '=r dl !,elx 9l K -l - -l t-G)l = ()l ia -lL-lvo.[ 0.r otr I 8l E 8l-8ol, ad ol trr-l !; r*l Ibl ." ol =pl' rl -8lE -81 .EEl d El3 =l c =l'zl< zl C! C)L(d o o 'a L C) o a ir.ld E C) (') ,; th 0) ot = -l trXI EEI Q()l v =l o9l E!l ()0lnolc cq c)((1 | =l otl o >t h ol < '=l .r)rit 6) =l E EI OOl rol c)r-l .o el E 9l tr trlE =l .o zt? o) o C) 'a l< o- C) v7 C) oo() E C) o I 0.) at I -l (.)xl E -l- xl sH't ol -a+Eut v()l 'E o.t (d ol apl O Rl o trl d =l ozt? o(iELG) b0() 6)-0 o >o\ (EO vrt oyo\ks (.) (€ (.) o0dLro oo (!O- O</ uo o 0) 0.) (B C) oodk(,) oo .9^iJ ro =o\c)v o.(d o F . th O -c'X R 5 f 9.*'-o r 3 E E 9 E? E.E<EE,?=6aeothA\ d - -E E Iutr-o #qtr EZ* e ;=[;r*E- (no(o Ol6l r{ l/t r{o(.o lJ') Or r{ r.O(n cn(o @r\N cO r{ Lq)o() --L_^ E -.oAd t-{ @ r<(\ N sl sl ti riln F{ fn(n sl t-l oro st F.l t-.1 N rnoN F{ o (! o. 0. I adi C) b{)(0aL.oC) o\ >v oo o o 63k c) F v? .{F r.- \(\i c- ,r.l oo\o 9 aO c- c.l r-.\o r- r a 06) 2E -o=() EE T E Z Q''J tr- oo oo\o N\o oo\o o\ oo cO ra) \o \o(\ (\T oo c\to\ rr} \o ta) rf1 cO 6l I a tr() J L ;TEts-Ui.e trFL.) cO € co\o c- aO o\ r-- t-r oo t--\o \o$r- o\ c\t c\ =ff- o\r- o\rr|(a) c.l h a IL5 g<->E E E 5'E g =-er-(1)G).v=(*^frLF go; - (o(r0)c) l< o.l cO o\ o\ $t o\ |r) cOr- oo c\ $rn co r- N@@ f-- ca r.-$ cO .h o bI)d v't(.) oU rL>=Eia*- n =oo- bocd- (daL-L-Obo)\ ()o\o - >v €)o .i C) Oo O cllrt o\ r- oo ta rr o\ L.i6.)otroo! -o=d0)r9r-€E O E= QlF\U2 5;tsoo o\o\ N o\ o\ c.l r.. -+ c- tt- c.l r- .c € d n (gtr '.=3E=ts"c c) -'=<F 5 o\ o\ c.l $ ca sh r-r- o.l o\\o € Q'i= c I <.1o'= P'= t Er$e;€ su(J=oJq,F3 't Er o\ o\ lr}N $ cO slrn r-t-c! o\\o € .9<;va\ G,d (! E(BE oo (g t- o(gF (r, C) (! (.) o z c, o Fr 11 I44q) Uq) S q > \ q)\ o t q) F; S ,tzq) (h(n c)L(! (! tl o lr (h >. -o U) trl a (! C) C!oLF r-r orl -oldIFI il llil c.l c) -o oo 6) !(, o rn Eoo. c) o C) rt)do rrl a oz L 6-) o ,-r4 -eo =Ptrluqcl6) L AL;i (E 6r- = o_ cbob E 9.Et1O(i.i55tO. 'v-cUd .V-L()ooo(!o t..r 3A ^gLFU.; }S. E€ Ho' Ecvv^9AV&5' AE * 4JESH(JtrOurt)-O .) a oE C);o; =F Ex- -= a ui<gq);iA,iyE E ;.E .9 ., E b9 eAOPk()Eg .Ee fri-E -9 c)Yt,6? .-)O-9 o X.o € b ::-= E E!-o oY .Y 'iq E E\ L () .BE .ae B. -'q)=a7 o,, o.9 boE P '.,E -E .O €E=()(JcrI=!A r reE €'= -d d- €9 EE ;r E g99-o;rrlr''='26 A g.E 11 o e -q'tr:E =tj u€ E ;E4 EE Ee .E .= ^ !s t-Sl El o 9a =i= a v7 9= g 'lfy,F,, =6 6E z =v EC. "-'! r! EE TE b? R ?EE :Eq,fE 3 Ee.H :€; 3?: r .8. 3;€ 'E: E H = t H c€ !a a rqs e aoi .EE 3 6 +..E 6 .E ErE ts.i o 2E;: ",EHE Tg. E 3EEE fE5€ E.E'.H J €.EE EzEE EiES i 3EE EiHi {Et# i EEi fEIi gi€T Eh:; EEe a E'==i € *s; EEEE f;8Es $ =E t * 'E E- ^'E9=- ; ? g\oo !i\o N (l)6i? P'J..i H9tr(dotO(DF \ I.+ c-l o -o o o z v c.l U \o .t) C! e c!I o bo cl,t-q) I F c, o o C) ah cl o rr a0 o t) rt) ^lF-lo\l r.)l lf)l ^l Gq) rr fit (, o '= tr o L € F q) q) (, E (l) ar) G'q) cl e o l- e q) -o9!Gt I -v9 6t U *LEo.E9) cJlLo o') !-+ .o '- l-l-l cqu9. trLl EEIrr bl E(!IoolE5>a)obo (, 0) !oEo6rnr= cla o)eLE!c)trt (c =96J-LF o.l r; -91G*lei +l oo ,-dY b ",GL- > -o\. (-) @ o\ !f,o\ o\ ca@ o\oo \oo\ o\ nc.loo * ll - o6 rd rrl lL -e rd ri €ti rri tr5 8-.9 =E9).Fu: .d€=*g Er.YF qo 6 tr (Bo()c.) *F b{)A(BVLF !r orS<5 <- c) 3o)t s^(g (J L\ObE 9O -CaF5 qi o ua- o:!u :!a(! 5 g.sz -Ec)(g o.= =EE < 9*', rr.) oo o\ $o\ o\ cO@ o\oo \oo\ o\ -q ca oo oo\o \oF- o\r- cac- c- talc- c-F- \oIt- c- oo C\n\o oo $tr) O oo $ o\ a.) oo o\ o{ ca c.l oo ca ral o\ c..l .dF O\q (\ la) @ a{ N aO\o c..l \olr)(n c.t c{ ra <fs oo o\ o\ c- o\ ta) \o \o o\ \o c-s o\ o\ Ir- oo s ra) c.l oo o\ \o a.) c.l It-o C..l v^Nc\ o\\o ca oo aaN o\r- o\ tr) ta) a.l \o co \o c\l N t-r ,ri ca c! s s c-) c\ ra) .f, aO oi$ C.l rf,o\o c.l ca \o$ c.i oo c\ o\ N ooN cat'- r-. cA oo c.l r- ca (t- .f, ca * H * Nri s_ :, H',g i "8,!tB(,5 ua E= EE*t (!E :2E:UarE 9 6B> <F O =.-a tsB€ E.g +t '.= - >r ::!-Ea9 cd =.^'>;ElE E SE-q LFoq)o o9Sata Oo\ < >v -o o o la) c- o\ o .+ o a in c- o\ tt\o co !+ o\ $ o\ $ o\ $ o\ s 01 ao$a c.)\o ao r-s oo aO\o co $ o\ !f, o\ .dF o\ $ o\ sOo\ oo:f ao c?l\o oo o\\o oo <' o\ \f o\ $ o\ $ o\ $ o\ <f o\ @v oo aa\o oo o\\o oo r! & cooN .+ N ra) C.l \o a] t- c.l oo O c.l o\ ON oN N d ) 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHOf] T]NICErf] Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH EI WHO[] UNICEil NGDC NGDC Other (please specifu): Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests for Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery regulation system of FMoH. The drug is stored in MOH warehouse from which the project receives. This year, The Carter Centre has facilitated the shipment from Addis to Zone level. Each woreda have collected their amount by themselves. It is from the Woreda, the Health Extension Workers get the drug and distribute to the CDDs and the CDDs to the community. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs return the remaining drug to their collection centers (HPs). The HEWs return the tablets to HCs and the HCs to the Woreda health office. Hence, the remaining Ivermectin is kept at the Woreda level. List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. ' Training of health workers, community supervisors and CDDs on handling, distribution, maintaining stock balances, recording and reporting . Collection of Ivermectin from the Woreda level . Distribution of Ivermectin to community supervisors and CDDs . Supervision . Recording and reporting of data ' Collect the remaining Ivermectine from the supervisors and CDDs and return to the Woreda. District/LGA Number of Mectizano tablets Remaining from the previous year (2010) Request ed Received (availabl e) Used Los t Waste d Expire d Remaini ng Quara l0l 188,060 188,060 188,04 I 0 120 0 0 Gendawuha 238 20455 20455 i 18315 0 88 0 2,290 Tach Armachiho t2732 146590 I 46590 I 58503 0 98 0 721 West Arm l 1087 64843 64843 I tqZAO 0 0 0 1,670 Metema 8932 160570 160s70 i 16s989 0 t064 0 2,449 Total 33090 580518 580,s18 ] SrAlgl 0 1370 i 0 7,130 t7 WHO/APOC, 24 November 2004 - Any other comments 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so,When? o Training of trainers was not carried. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) NA NA 277 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. No report on CSM undertakings 2.9. Supervision 2,9.L. Provide a flow chart of supervision hierarchy. NOTF ) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs. Zones and woredas have made supportive supervision to CDDs and HFs What were the main issues identified during supervision? ' Lack of proper and continuous supportive supervision at all levels . Poor document and record keeping ' The involvement of woreda management staff to support HFs and CDDs was very low especially in Metema woreda . Delayed and report discrepancy in some woredas . Updating of village registers is not done regualrly 2.9.3. Was a supervision checklist used? Yes What were the outcomes at each level of CDTI implementation? The ZHD has carried out supportive supervision and that has helped on the improvement of document handling, record keeping and timely report submission. NA NA a District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (sHM) Quara t99 NA NA Gendawuha 25 NA Tach Armachiho 314 NA West Arm 54 NA Metema NA l8 WHO/APOC, December 201 I 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? . Heads of the frontline heath facilities and woreda health office heads are showing more concem to the CDTI program. . Integration of CDTI with the other PHC programs is being implemented at all levels. . Updating of village registers is being practiced . Record keeping and document handling is improving SECTION 3: Support to CDTI 3.f. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:ourrently non-functionalbut repai rable, WF:written off). How does the project intend to maintain and replace existing equipment and other materials? The existing equipments are being maintained by the government budget. The project is still looking for replacement of equipments from APOC Source Type of equipment APOC MOH _ Zone DISTRICT NGDO Others No Condit lon No Condit lon No Condit ion No Condit lon No Condit lon All kinds of cars I F 2 F 3 F I WF 2 NF Motor cvcles 6 NF t2 F J NF 2 F Desk top computer I NF 5 F l0 F LaserJet printer I NF 5 F t0 F Photocopier I NF 3 F I F Fax machine I CNFR I F I F Overhead projector I F I F LCD I F I F Megaphones 2 F TV I F I F VCR I F I F Generator 3 NF 2 F I F t9 WHO/APOC, December 201 I Contributor Year 5 (2009) Year 6(2010) YearT (2011) TOTAL Cash Budgeted (us$) TOTAL Cash Budgete d (us$) TOTAL Cash Budgete d (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (US$:17.29) TOTAL Cash Released (us$:r 7.29) MOH (Central+ State) MOH (District + zone) NA NA 6000 4723.45 3722.8 3722.8 Local NGDO(s) ( if any) 0 0 0 0 NGDO partners(TCC) 15,000 14242.86 12000 11922.98 1,673 1,673 Communities 0 0 0 0 APOC Trust Fund 8175 5722 l 1888.2s 8321.6 14574.9 14574.9 TOTAL 23t75 19964.86 29888.25 24968.03 19,970.7 19,970.7 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years DNA - Data not available - If there are problems with release of counterpart funds, how were they addressed? There is no problem in releasing funds, but APOC's fund reached late to the project area in 2011. - Additional comments The MoH is contributing for mobilizing their staff and other stakeholders, coordinating project activities, storing and distributing Mectizan, providing trainings, covering communication costs, offering office premises for CDTI coordination, managing project funds, providing other logistical support, solicit financial support, record keeping, reporting and providing transportation services, etc. 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The community leaders and elders do give much time in mobilizing the community during Mectizane treatment periods. t 20 WHO/APOC, December 201 1 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here IUSD = 16.65 Table l4: Indicate how much the project spent for each activity listed below during the reporting period Cost per treatment for the entire project is 0.056 USD. SECTION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) _Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Activitv Expenditure ($ US:I6.65) Source(s) of funding NGDO Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities 0 2060 APOC Training of Cads 0 Training of health staff at all levels 3490 APOC Supervising CDDs and distribution 84 APOC Intemal monitoring of CDTI activities 0 Advocacy visits to health and political authorities I 556 APOC IEC materials 0 Stationary and printing 0 Summary (reporting) forms for treatment 0 Salary offocal persons 2997.66 MOH Vehicles/ Mgtolcyg!9_sl les maintenance Fuel and oil 804. r4 ll30.ll MOH MOH O_ffice Equipment (e.g computers, printer_s el9) _ Others 0 0 TOTAL* 12,l2l.9l 2t WHO/APOC, December 201 I :31::1 il;l:l',',:?, H ;f n : ffi :', .. n,., E,h i o p i a 4.1.2. What were the recommendations? We are waiting for the ongoing monitoring results and once we receive the recommendations, we will act accordingly. 4.2. Sustainabilify of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan written? Yes when was the sustainability plan submitted? on the 3'd year of the project What arrangements have been made to sustain CDTI after APOC funding ceases in terms ofl 4.2.1. Planning at all relevant levels The CDTI activities are planned integrated with the other PHC programs at all levels. Therefore, the planning processes are carried out through participatory methods, using bottom-up approach and integrated with the basic health services. Resources are used to all health activities on integrated basis. 4.2.2. Funds Funds from the government and other donor agencies are utilized on integrated basis for all health programs. 4.2.3 Transport (replacement and maintenance) It is expected that APOC will replace a vehicle and motorcycles by the end of the lOth year. The RHB has allocated one vehicle to Quara Woreda received from other programs to be used for integrated health services. The existing APOC donated vehicle was maintained and is being used for integrated health services. 4.2.4. Other resources - 4.2.5. To what extent has the plan been implemented The plan is well executed by the support of the government, APOC, The Carter Centre Ethiopia and the community atlarge. The CDTI activities are mostly incorporated and integrated with the other PHC programs, even though support from APOC and The Cafter Center Ethiopia is highly demanded. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: The CDTI program is being carried on integrated basis with the other PHC activities. Supportive supervision, monitoring, treatment and evaluation, etc. are integrated. o 22 WHO/APOC, December 201 I 4.3.1 4.3.2. Training : CDTI trainings are integrated with the Primary Health care (PHC) from the beginning at tie NationaI, Region al, Zonal, Woreda and HF levels' The Malaria and other vector born disease section is responsible in takin g care of the program at all levels. Therefore, all the staffs of these units have received iraining on CDTI. Training of health work at FLHF has been carried out in an integraied manner with other health programs by the concerned professionals from the ZHD, Woreda health office and The Carter Center Ethiopia, Amhara region. 4.3.3. Joint supervision and monitoring with other programs As part oith" system in the countr!, all sorts of suppoftive supervision and monitoring activities of the CDTI ptog.a. are carried out in an integrated manner with other PHC Programs. 4.3.4. Release of funds for project activities The government, The burit. Center Ethiopia and APOC have released fund for the year 201I CDTI activities. The government is paying the salary of all focal p.rron, and allocates budget for supervision, fuel, stationary and vehicle maintenance, etc. All hea[h activities are carried out on integrated bases using the allocated budget from the government and NGDOs' 4.3.5. Is CDTI included in the PHC budget? CDTI is included in the PHC budget' 4.3.6. Describe other health programs that are using the CDTI structure and how thiswasachieved.Whathavebeentheachievements? CDTI structure is being used for malaria prevention, national vaccination programs such as polio, TT, Mea-sles and EoS. cDDs are very helpful during these campaigns and are showing good achievements. . 4.3.7. Describe others issues considered in the integration of GDTI. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Not done 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: - 97.5 geograPhic coverage - High therapeutic and annual treatment coverage Ivermectin deliverY mechanisms Since the beginning of the program, there is no separate Ivermectin delivery system to th; lowei level; ii follows the existing drug delivery system of the lln.rur health service. In other words, Ivermectine delivery is fully integrated into the existing drug delivery system of the country' a a 23 WHO/APOC, December 201 I Weaknesses: - Continuous and regular Supportive supervision is lacking at all levels - Proper record keeping and documentation is stilla problem in some woredas and HFs - Number of Absentees and Refusals is high in both CDTI Woredas - Task forces at all levels are inactive Opportunities: o Two Health Extension Workers (Females) deployed at each kebele level for a population of about 5,000 is a good opportunity for effective implementation of CDTI and other PHC activities. o The expansion of the government structure to a village level has made it easy to execute PHC activities to a lower level. . Females 'development is being established in each community this will give a chance to increase their participation in CDTI activities. Threats (Challenges): . High turnover of health staffs especially at front line health facility and woreda levels o Late arrival of Mectizan . SECTION 6: Unique features of the project/other matters North Gondar zone CDTI Woredas is very green, fertile and forests are very attractive too. Its virgin land is producing Cesum, Cotton and Gum which have great share in economical development of the country attracts a large number of daily laborers. The biggest National Park of the country, Alatish Park is also found in Quara CDTI Woreda has great tourist attraction. I ! a 24 WHO/APOC, December 201 I