Bench-Maji CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2010 to October 2010

\1 at 't a The Federal Democratic Republic of Ethiopia Ministry of Health Date su bm itted: 30 December 2009 NGDO dartner: The Carter Center COUNTRY/1.{OTF: ETHIOPIA : Bench-MajiNameProi Anorov alvear:2002 Launching year: 2003 Reportins Period: From: J.n1.r.U.A.ry..?0.1.0.......... To;.....Q.q.tp.b.er..?.Q.1.9....... (lVIonth/\'ear) ( Month/Year) o 8Proiect year of this report: (circle one) I 2 3 4 5 6 t0 I I I I( I i I -l ) I l Fcrr .Cri*tiaE: ANNUAL PROJECT TECHNICAL REPORT SUBMTTTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC DEADLINE FO SUBMISSION: To APOC Management by 3l January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting (r & I I i t I i : l'uv lr',iros,rc:bn Io, ! .&.ffi:-- -9, AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) '!I I t A ai Ci iE I D,R[ig WFIO/APOC. 24 November 2004 aANNUAL PROJECT TECHNTCAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm vou have read this report by signing in the appropriate space. OFFICERS to sign the report: Country Ethiopia Tizita i:::ii.: i,i:Jrllr I iii. ] Natior-ralCoordinator Name: pasror.r.[r,,i ii.:.:i.ir i-,,,.,,. tjrrrr:a=e- I}*eltion il Signalure Date: ( 'I A rr. ;s'-. :l ,i'F j-? ,? I I C Zonal Oncho Coordinator Name:- Tekilemariam * G (i eE- Signature Date lt.\,, '. I jc I ,I itt riist ry 6i i-cshome eeOreTpfrOr UoUntrv ReO resentafrveNGDO Representative Name:- Signature Date: ?/ Januarv 201 I This report has been prepared by Name :- Tekiremariarn Erget + NorF_ Des ignatio n'. Zone Onchocerc iasi s Coordi nator S ignature Date: January,20l1 lt \\/HO/APO('. 24 November 200.1 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOTI NGDO NGO NO'ftl PHC REMO SAE SHM ]'CC 1-O1- LINICEF tJTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Communify-Based Organ ization Communitl,-Di rected Distributor Corn mun itv-Di rected Treatment with Iverrnecti n Communitl' Self-Monitoring [-ocal Governntent Area Nlinistrr ol-l-lealth Non-GovernntcntaI Developrnent Organ ization Non-Covernmental Organization Nal ional Onchocerciasis -lask F'orce Prilnary health care Rapid Epiderniological Mapping olOnchocerciasis Severe adt'erse event Stakeholders nteeting 'l-echnical consultati'e committee (APOC scientific advisor1, group) Trainer of trainers Urrited Nations Children's Fund [J ltirnate l-reatment Goal World Health Organization iii WIIO/AI']O('. 2.1 Norcnrber 2004 Definitions (i) 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 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat rvith ivermectin in a given year. (iv) Ultinrate Treat t Goal(UTG): calcr.rlated as the ntaximum nulnber of people to be treated annually'in meso/hyper endenric areas within thc projec( area, ultimately to be reaclred rvhen the project has reached full geographic covcrage (norrnally the project should be expected to reach thc UTG at thc end ol'the 3"i 1'ear ol' tlre project). (v) 'lherapeutic coveraqe number of people treated rn a givelt vear over the total popLrlation (this should be cxpressed as a percenlage) (vi) Geographrcal coveraqe: nurnber ol- conrnr-rnities treated rn a given )'eal ovcr the total nuntber ol meso/lt-r'per-endemic conrrnunities as identiflcd by REN4O in the project area (this should be expressed as a percentage). (vii) lntegration: delivering additional health iuterventions (i.e. vitanrin A supplenrents, albendazole for LF, screening for cataract. etc.) through CDTI (using the satne s)'stenrs. trairting. supervision aud personne[) in order to rnaxirnize cost- elfectiveness and ctnporver communities to solve more of their health problems. This does not include activities or interventions carried out by comrnurrity distributors outside of CD-l-1. (viit) Sustainabilit-t:CDTI activities in an area are sustainable rvhen ther corrtinue to function effectivell' Ibr the foreseeable future, rvith high treatlnent coveragc, integlated into tlte available healthcare service, ivith strong comrnurritl, orvnership. using resources nrobilized b1' the contntunitv and the government. (ix) selt'-rnoni The process by u,hich the cornntunrty, is emporvered to oversee and monitor the performance of CDTI (or an-r,' communitl'- based health intervention programnte), rvith a vierv to ensuring that the programme is executed in the rvay intended. It encourages the cornlnunitl, to take full responsibilitv of ivermectin distribution and make appropriale ntodillcations rvhen necessar),. I\/ WIJO/APOC'. 2:l November 200.1 Table of contents Acronyms . Definitions Follow up on TCC recommendations ... .. Executive summary SECTION 1: BACKGROUND INFORMATION 1.1. General lnformation ..... 1.2. Population SECTION 2: IMPLEMENTATION OF CDTI 2.1. Timeline of activities 2.2. Advocacy . 2.3. lVobilization, sensitization and health education of at risk communities 2.4. Community involvement 2 5. Capacrty building 2.6. Treatments 2.7 . Ordering, storage and delivery of lvermectin . .. 2.8. Community self-monitoring and stakeholders meeting 2.9. Supervision SECTION 3: SUPPORT TO CDTI 3.1 . Equipment 3.2. Financial contributions of the partners and communities 3.3. Other forms of community support . ... 3.4. Expenditure per activity SECTION 4: SUSTAINABILITY OF CDTI 4.1. lnternal; independent participatory Monitoring, Evaluation 4.2. Sustainability of projects: Plan and set targets (Mandatory at Yr 3) . .. 4.3. lntegration . 4.4. Operational research SECTION 5 STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS .tv V 1 2 3 3 5 6 6 7 7 7 8 10 14 15 15 16 16 17 17 17 18 18 19 19 20 21 .21 FOLLOW UP ON TGG RECOMMENDATIONS TCC session 4 5 6 7 I 9 Number of Recommendation in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Adopt January to December reporting period It is Adopted 2 Indicste lhe role of each pqrtner in lhe projecl It is Indicated 3 Avoid treqtmenl during lhe rainy season lo reducc absenlees If Mectizun arrives on lime we will avoid lrealment during rainy seasons I nte nsifl' h ea lth e duca|io n and ntobilization of communi4, to address ltiglr number of refusals atd absentees We are inlensifl,ing health educaliott and ntobilizution to minimize obsenleeism an d refusals. Ettsure usage of remaining Meclizan tublets before expirl' ll/e ure ensuring lo use remaining Meclizan lablets before expiry Train more CDDs to achieve at leosl I: I|0minimum sel by APOC and dpossible, 20- 25 people targetedfor 2008 b1, proiect Numbers of CDDs have increased in 2009 even tltough the expected lurget (l/100) is not met. Increase number of femule CDDs This is o greut challengefor the projecl, for our culture it self is a great hindrance lo involve tltem in suclt aclivity. Tlrerapeutic covertge has rleclined from 83'% in !sa7 j to 73% itt 1,s67 4 and non, 70(% in year 5.There is a need to Jitrrl the reuson and avoid fu rther decline. Pay special attention lo MenetShaslra where I he rap e utic co v e rag e x)a s 63%. Tltis year (2009) lhe lherapeutic coverage has reqclted 77'% and ever1, efforl will be done lo inryrove il further. Regarding Meneal Shasho, there was shortage of community supervisors in 2007 which conlribuled for the decline of the coverage Veh icl e, molo rcy cl es a nd pholocopiers need to be repaired/replaced by APOC-5,h r The mainlenance is done by governmenl budget and We are expecting a replacement from APOC soon. \ /l IO/,,\l'OC. 2.1 Novernbcr 200.1 Executive Summary 1. Backsround on trea nt and population data Bench Maji is one of the 13 SNNPR zones bordering Kaffa zone in the Norlh and North East, Sheka Zonein the North West, Garnbella Region & the Sudan in the South West and South Omo Zone in the South East. The zone has a total area of 19,326.6 sq kms divided into l0 rural Woredas and I town administration having 221 Kebeles. The capital of the Zone.Mizan Teferi, is 574 km south west of Addis Ababa and 849 km. from Hawassa the regional capital. The cettsus result for the 2010 CDTI project shou,s that Bench Maji Zone has a popularion of 690.295. The annual therapeutic co\/erage is 78%o and Annual Treatrnent Objective (ATO) is 98%. The projcct also has achieved 100% geographic coverage. 2. Background on population movements. The comtttunities in the CDTI areas are rnainll'settled farnrers. pastoralists. daill Iabc'rers. gtrr,ernrlent etnploy'ees and cottee plantation rvorkers. The indigenous ethnic groups are Bench. Sheko. Dizi. I\1eneat. Surirna and Mezenger u'hich occupl'the entire Zone GLrraFerda rr'oreda has accepted nerv settlers fiour other zones of SNNPR. 3. Training data ln 2010 traininss rvere given lor l-14 health n'orkers. (r47 Comrnunitr,Supcrvisors and 6603 CDI)s Challenges and bow they were overcome. Challenges: ' Netv focal persorts assigned due to the business process re-engineering process implenrented ' 'l-ask tbrces at all levels are still inactive. . Village register updating was not regularly done in some kebeles ' Regular and continuous supportive supervision is lacking at HF, Woreda altd Zone level Solutions: ' Training was given to the newly assigned focal persons . All Kebele rnanagers have altended the CDTI training and \vere ver)'helplul in communitl rnobilization and supervision activities . Village registrations updating done during supervisiorr ' TCC Mizan olfice has facilitated vehicle tbrthe ZIID stafl-and liave supervised l0 \\/oreclas. 2 \\'l lO/APOC. 24 Novcrnber 2004 SECTION {: Background information 1.1. General information l.l.l Description of the project (Geographic location, topography, climate) The topography of Bench MajiZone is classified as 52%o lorvland, 43% Semi- highland and 5oh highland. The mean annualtemperature ranges from20oc-25oc and the mean annual rainfall ranges from 400 - 2000, mm. The estimated altitude range is 500-3000 rneters above sea level. Slopes, hills, fields rvith gorges and large river basins and streams dominate the landscape of the zone. About 24ohof the area is covered rvith tropical rain forest. About 90.01% o1- the populations are rural and 9,990h urban drvellers. Agriculture is the main econornic source of the zone. Harvesting occurs from October to December. leaving Januan' - April as the optirnal Mectizan treatnrent period. Communication system Road transpoftation is one ol the u'idc11 used urodes of Cominunication in the pro.lcct area. The rnain all rveatlrer road runs tiom Addis Ababa through Jimnra to Mizan'l-ef-eri (capital of the projecr zone), All of the l0 \\/oredas are accessiblc at present. Nine u,oredas dcl have Wireless telephtlue lines; Mizarr as u,ell as Sheko tou'trs are operatitrrl rvith digital telephonc.,\t prescnt the telepholte colnntunicatit'rn systent is improving u,ith netirork access in sorne \.\/orcdas. Health care dgliverl5yqlgnq The zone has I Hospital.30 Health Centers and 165 Health Posts har,ing 339 health u,orkers with dift-erent qualilications attd -169 Extension Health S/orkers. The health center staffs clo supervise and provicle Mectizan to the IJPs.'fhe IJEWs do provide Mectizan to the CDDs and carrv out traininq as rvell as suppotlit,e supervision to CDDs. CDDs are responsible lor the distributiorr of Mectizau. Table 1: Number of health staff invoh,ed in CDTI District Nurnbcr of health staff involved in CDTI activities Total Number of health s(aff in the entire project a rea Bl Number of health staff involved in CDTI (including l{ealth Extension workers) B2 Pe rce n ta ge Br=Bz/ Br * 100 Bero i/ 28 76 GuraFerda 77 95 Maii 73 43 59 Meneat Goldia 74 70 95 Meneat Shasha 7l 50 70 Ivlizan Aman 122 98 88 14 80 11 a, 61 North Bench Sheko 54 Shie Bench 74 61 82 South Bench 94 75 80 Total 808 548 68 J WIIOiAI']OC. 2.1 Nor entbcr 200{ 1.1.2. Partnership Since the beginning of the project, there were strong partnerships in planning, advocacy. rnobilization, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The rnain parlners involved are The Federal Ministry of Health, Regional Health Bureau, Zonal Health Department. Woreda Health Offices, front line health facilities, the community, The Carter Center Ethiopia, WHO (APOC) and other government sectors such as Zone and Woreda Administration, Education, Agriculture, Finance and Comrnunication Offi ces. APOC, l-he Carter Center, RHB arrd the ZHD are involved in planning. trairrings, nronitoring anci evaluation as wellas allocating funds and other supplies such as vehicle, rnotorcy,cles. contputers, printers and fax machittes etc. The Zonal and Woreda task lorces are responsible in thc lollorv up of the project and rnobilizing the population. TIre fiont line health facilities do facilitate trainings. conduct supervision. cL'nsus updating and allocate Mectizan to each village accordins to the censrrses.'lhe comrnunitv leacjels do rnobilize the population and flx the distribution date in agreelnent rvith their cornntunity'rtrernbers. a 4 WIIO/APOC. 24 Novernber 2()01 c{ () -o Eo oZ s(\ ,i o I I (,) q) qJ aL .al r!l - ^t b! -rll7]l L -clo04 E9t --ot tr bud E orl oclt-l() r^rl -E rl o(.lql (H e-o5o) aq (JE :C,foo tr0) 6) ru oebDc 'a) -o tr() L 92, O:E orLo ->.a U , L-c ,-, '5 0) o- 6 do =o L() - +. I9t3t -alq!l trU olEl I(!l cnl Q)a oo -.o a'= aP Q) '7 o0) c|3J:Y Ern> Z oZ a 0) o! oL 6) oo q) 6.) c) q U) (,) a c)L 0) o dq) 0.) o () cq c) q) q) o o) 5 A) ( c! q) o'= +r=Gtr =EO.oo(Jr.i 6.)q€l FFI r5 D .E2o_EE3E 3e F (o(Oo v(o @f.-(r) (o N o)tr) N lr) F- rr)sN oNo O) C.) N (oo(9 (f) Ir)(o(9 O) $Nsv vtr) tr)oo (o @Ns o) (o(t NN tr) rO + il .= aN E6F( oE rr) O)F. CO N N|.'-$ No .q N(.) 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O cl d = -oO cl <d -oo tL C O6l -oU LL o o CI L d = -oor ol .J a -oo O c.l CJ L -ou C O ol d a -oo = al d = -oatL o ccl d - -oO LL Oal >\ -o bo :tr a- 9 O6l = -oor+ al Cd = -o, tL cl CJ a -oa O c c'l (d _oo LL O acl d a o ?O al _o 6J LL o c.l d -oO c O ol (d = -o LL C o al 6 = -ou u- O al cd a -ou TL '.](J o o 0) c0 C! -o tL6 a(, 6 z(, d a) o 6T E CN 6 a)tr O E C(B N =z o o a trcZ osa s oC O co 9sa s o U co oa rr 6q) q) t () q) o dq) Al6q) d 0) € (h c)o5o'i +rq >(! v-orfi,H oE Oolaa o; t- .aO o) --o'.GNF Fo(, rts o tr o a- +,(E +, tr o Eg c! aaN z o -Fo IIJo 2.2. Advocacy State the number of policy/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. Task forces have been established atZone, Woreda and Kebele levels. The members of the Task Forces at all level were officials from respective sectors and from the community which have relevance for the CDTI activity. Decision makers including Kebele managers were involved during the training of health workers. The trained Kebele managers were very helpful in rnobilizing the comrnunity. 2.3. Mobilization, sensitization and health education of at risk communities Comtnunitv nrobiltzatiotr u'as conducted at eaclr village bv organizing corlnrunitv rrrcctirrgs. I{ealth education manuals and F'lipcharts \\ere distributed to all CDDs ancl con.unurritr supervisors (HH\[/s). Conlnunitr mobilization was carried out bt'H\\is. HLiWs arrd Kebele Managers. -[he Mizan l-efcri FIVI Radio media olflcer u,as included in our trairring and bascd on the training thc- IrN4 IVIedia has broadcasfed tbr 22 hours in 6local languages on Onchocerciasis transntissior.r, consequences olthe disease, prevention. on thc vector that trarrsnrits the diseasc and hcln'to prevent it . 'l'his helped to create colrnrunitt,a\\,areness ol- the progrant ancl therefbre communifv tnetnbers were keen to take Mectizan u,ithout an\ enforcement. The comtrunities testifled that Mectizan is also useful in eradicating sorne rntestinal parasites and scabies besides it main purpose. 2.4. Gommunity involvement Communities tion in the CDTI add more rows neces, 1 Number of comm unities/villages rvith communily members as supervisors Number of conrmunities /villages u,ith female CDDs District/LGA '[otal no. communities in the entirc projcct area B{ Number rvith communitv members as supervisors Bs Percentage Bo= Bs/ 81 *100 Numbcr of CDDs and the conrmunitics involved Male CDDs 'l-ota I B? Bs Be= B7+8, l-emalc CDDs Number of communitres u'ith female CDDs B,n Pe rce n ta ge Ilrr= B,o/8.* 100 Bero 43 {3 100 155 35 190 43 100 CuraFerda 120 t20 r00 442 68 510 ao 32 Maii 95 95 r00 3s5 77 ,132 93 98 Meneat Coldia l5.l 15.1 r00 625 185 810 117 76 Meneat Shasha r0l t0l r00 190 t2t 6lr 68 67 Mizan Aman 68 68 100 l6l l5t 57 84 North Bench 202 202 100 I 068 I28 Shcko I3ti r38 100 418 E] 3t2 I 196 505 91 54 Shie Bench t70 t70 r00 905 200 It05 105 45 39 ol South Bench 201 207 100 9t2 20 932 13 6 Total 1298 1298 r00 5531 1072 6603 679 52 WHO/APOC. 24 Novembcr 2001 Comment on Attendance of female members of the community at health education meetings Even though female health education attendants are not equal to that of, male attendants, their nur-nber is increasing yearly. Female attendants are shy to speak in public and most of the time they are overburdened with so many home and field tasks. . 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). Their attendance and their parlicipation is increasing and are having quite fair paaicipation in the discussion. -Incentives provided by communities for the CDDs The-"- are sontetirnes being helped in their larrns and arc ornifted fiorn othercotnrnunitv campaign activities dLrring lvlectizan distribution da1's. [:r'en ilthe comrrunilies do trot provide incentives. they don't cornplain much fbr thev are serving their relatives nnci neiglibors of 20-25 households cach. The \\rollOs sometimes involves thent in vaccinatiott campaigns and are being paid stlall antottnt of per-dient. -Attrition of CDDs. [s attrition a problem for the project? If ves, horv is it addressedl CDD attrition is not a problent for the project. If a replacernent is needed. it is done immediately and training is given b1' FLHW at their respective Kebele. -Other issues 2.5. Gapacity building - Describe the adequacy of available knorvledgeable manpower at all levels. Tlre staff 1nembers ivho have served long time in the pro,iect area are having good knort'ledgc of the pro.iect and the ttervly assigned health r'"orkers are givetr training yearly. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most tmportant tssue lo describe is whal rueasures were laken to ensure adequale CDTI implementalionv,here not enough knowledgeable nrunpotrer was ovailable or f sraffs arefrequently transferred during the course of the campaign). For the 2010 CD'l'l activity period The Carter Center Ethiopia has designed different Training modules, manuals and Fillip charts lor I-lealth rvorkers. HEWs and CDDs. Based on the designed modules and manuals. effbctive training was given alZonal, Woreda and Kebclc levels. The training addressed all issues related to Onchocerciasis (its transrnission. consequences. vectors that transmit the disease, hou, to take measure clients. eligibilitl' tbr Mectizan, dosage of Mectizan according to the rneasurement and tnanagement olSAEs). Most of the staffs are knowledgeable and there \\iere lro transfers during the carnpaign pe ritlcl. I 8 WHO/APOC. 24 November 200'1 b0 o U qJ -a € a \.,\ X/ ! a! a iJ .\ C 1 c a Oo > o\ -qJ OU aJ s \ a, U -a 7t + C,Jg : -9 * : (.) \ \ s t_ Cq o) q) F (, U) c) q) q) .q) O d oo F l..)l ol -ol(!l FI -? al oE d c 7_ --t cl j o c! q I (] z 6ll v o.: + qv U o\ C' oo t-- 00$ aa (\\o (\ CO$ c.l co$ O O oo oo t--\o cl ca \o O (o N ce co(\ o\ oo \o o\ = o\O o\ t-- oo c.l O o c.t a-t oo O N C.l tr- ca co co c-l C. o\ C.l aa o\ ta \o\o @to Nl(, t(,t(v) 6 o\ q) o q) <) \o FU o O) ocr)(o N cf)s O @ o, r cf) (o o, r (oo(') rf)O r r N cf, O) s(v) i-(o = =flQo,- + - t ,.r= be: Q (, i U F q) .=66t- E.- o q,) ,c) OrL z O C!N O N(\ (\ r.l c.lN O C\(...l N a.l O (\ (...l c-] C\ (-.l C.] O (..l c.l C\(-n O a-r ca O ON ON -$ c\ O $ a..l \t (\t o t C\ q o o a o\ (-.l a.l aa OC\ $a.l $(\ q) cqL oq r= tr)- 7,e (,) ?rr Q -(, U U Q s c< i F O co O)N o(o CO r-o f.- (o$ s$ c! lr)(o o)to (o 1...N tr) LO N(o cr) (o r.o co c! N N cet- r f.- N cr)s os co O@ N ro o)$ co s lr)(o lr)(o O 1()(o (\t ro c.) @!+ @(\l d tro o q) o c.) O)(o (os cf)l.- @tf) lr) cn l'r Eaa) q) z Err U Orl+ d d Q a< F ca ca O oo oo o @ $ .1- O -f O o\ O aa ca O aa tr- F- O r- r- r- O r- A O O O O o lo(o t{)(o o t{)(0 Eq) o ro J a L o o U 6 IJ- cJ =(, a s -o oI do Co d E 6 -c(n cJ O c o c c6 E E N > t o O a -Etr o z o t a E O a o; a -co o c! =o0 F Trarnees Type of trarnrng CDDs Other Communrty members e g Community supervlsors Health Workers (FLm) MOH staff or Other Polrtrcal Leaders Others ( spec r 11,) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report rvriting Others (specity) Table 6: Type of training undertaken (Tick the boxes where specilic training h)as carried out during the reporting period) AnY othcr comments 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100% geographrcal coverage and a minimunr of 75%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being rnade to rernedY this. The project has achieved 100% geographic. 78%olherapeutic and 98% UTC co\'erage irr 2010 t0 \ /H0/APOC. 2l Nor ember 2004 <- c! -o Eo o z s ol U o- CI (-) ..-- >x 'E- Ug :9) =d)oo EOJ 9q .*o .- -FC1<Z ; -o o (d() L a O(,) ol(kl -lOI -oltrl)l ZI (! C) cd (_) q) 'e L o- q) -c .E o aa, L! /1 _o -(, ot: '.5 C(J =a cO .v .= E E o(.) .9 E(.) () L(Jo oq 0) E o 0) .o E c G oF O x () (-) = .9 .= I E E oo o () -o E 1 z C) L O q-) d ! o- q) E '= '- o '.E c =E E oO() c 0) -o co I ! 0) o- ^,oalaOl or -l-._l tr ^l c -ul .- 9l ondI COl .-Ll >PI ._ OI ol= ul r ^l Nq-l =ol o,pl ool o ,ol _trl d;t :zl; F 0) L(n o 0) 'e L () E '= = tt -U L .9 E o L(-) oq C) E ;q) c! 0)L (J -o o (J o- o(.) o- o O -o E E oF (J OI L() o(.) =(,) o ! OJ oo OI -o o () o cdL C) b{ E oo o (g L ot! : ? U U ? \ qJ\ \ U a_ U) A) l] a U) t.] a 4,) o F r-l ,l -oldl FI O.fr d()L> o0) il-lo(J:: cd >:-,_ oL/Ot -qks 0) cO OJ oo d o oo;o^' o-- cd oo o OJ O 0) (d L OJ co(n L 0) oo O^ !^\ ="-(J o- p 6) F 6Y e*e** a9!=oisEiS o( oig o' o o! Eaz O O o C O O O - O o e2\a LO c O - O O O O O O ts.- 2-_ -7 eil d): on: !6!oL5[}EE7o; 6 N N N (.) tr) € N O OrN O € O N N o) @o(, !c C- =E a € 6 c, rr c1 r@ cl t N o al I: c6 t(o(\t(o o c6 l o-lot .-l li :U =uOL o - Pc DC F o) f.- @N @f.- O@ o,N O)N o@ O)N NN @r.- o)N o- . a- 9clgL-,?- E--9)f c-Z E O O @ I (o N(r)(o N cl I ar I Nr O f a t a O clro No € t 4PE (o coo $(') co f.r CO (o N o) ro N (r) N rOtF- o No o,(t N o CO|f)(o(.) O) sNvs $(O tr)oo (o @t-s O) (o(.) N N lJ)(o co,g ;E )u6.:-E tr) o) N(.) N O) N Ns |.-o$N(o o) N c.) O) (f) t- r.- @s (o (O N @ co (oo N O c.)tr)(r) N o,(o(r) N (, @v @ lJ) O)No o)(o 0(.) oo(g a uiI .91 .=lcl JI I oQ ll * =9o -oooF- ii oo o!a " 6a(, O = OC C -O a C C c CO cc C: !5 = UE ac>- + O o{ o. -j- O €\o (\ ON @ (-- F-o a.l @ ot(\I ! ia6z EEgr .l 9e' I O(\ o. -t o m\o No6l @ Ot- c-oc.l @ o)N \Oq6rta '- o=:0 =.^;o-6 - O> -! = tr oO9 tr : ES;JP o <f O cl o\ -t O €\o NO al rc f- r-O(\ @ o)N Ol 'E .: o- o o a d! oL! cd L(, 'e !:(, doc o 6 sa do q,) c(d E E .N Eo o tr oZ o -v, CJ -E CN E(.) o @ 9 a o 0) s o U) G F (-.l tr o o-() L o 0) cd o Lll a oZ X o -o() - ; .9 0)q (U(.) o- -o' o .C () o- bo 9l!0/uP ., uI - Y ^L - a FOJ aQ)7- r-t'..=q 4V\-^! lr) e .- bo ?'6- .9 .=Eo, -o =9= = -a 6" N ;iI0(9-|..r<l aD H 0., -:L:-<V) or-z-v >C')6E= = ; .Y,>:0) =L5I)6)UE '- :^ rUgtr € !-, 97U- .l r U <lor X oU^:ioo ; q9 - -HE.-c(:ooO E cl! U ? -Prr^,t - A\- - -: :r'c!q<) io.r)tll> Lvr cg bDo oY9r-2!'E ! I S aE = ; =aO,E.E !2 C .E' 0)6Y'^ >.t E g = E=L.U,-,o) u-Q (U ;-; 6UrALCO\J- = o' LA .+r,o ro€ .i o,lq o .it c N o -o Eo oZ v(\ l) o o :E .E L N 'r= o(J .o() (g o 'o o qJ =rc = I() C a L o- I 5 a) LL c ,F ! OJ .E 6 c o = .I .2c tt 0) O =() a -o E ?(] , ,a a -o u r) o-() L @() ,' =-,N5 ';- u=() * U2 oit o).* J-(g- -- ,9 AF t--E9 -trV U at!* 0/ ==9e 9rA?2? ,n)aiu 0)- Ad E6(J> C.E? q GL+q l)J. ,i .9 o.r Ora-L ;ELq^- v -lc: [j (J-oqCq^ SYor=o(d=--SieZL€," o(--O=E^,4 s)Z cR uLu-oO GdLA rl^&r: * )o.. n\o .i -o .9 0) o- .2 -o .I .2 +.: trc6ON O)ec)()e0) E>(n- c!'= Qc eaoa7)(! =0)c(@() bll 9.= ol: c! q.- :o -b 6lv .o e.i . \ obor'r d ^F oX (J ir o\ o\ € ci € o .6 I -l)l o-tol o-l o ilr ki t) r.l ^d(J d^ f o-\d>v -o o\ oo € o\ o. d@ al c\ o. 6 ll * tI, ,i ,dO 6^ A-oo\ ooEAF r € € r or r rr €tr kl ! oc D6 a : "1 O al \, dC € N ca r .f ? J --l v rr -J rt \. =t r € € = !.) -anz rp9 o. n cl ;1 cl € cl : .c -f a a{ -t -t "f (r) C\l @ o,s r N .c (o O) @ @ ro (o(, olNlr)lo = o i'r r= - o c ._^au o \, € n; -+ \c =t "l o' =l €\, o. .+ c! ro(o(r) o, C cl .o =f o\nr-\c lJ)g) No o)(o ho .J = o := E E o(, ll * rit, rI) ^o0 -o CI C c O O OO O -u= E;EGtL*,Plu 9"_oi,,: D'J;Oot') ?r r c C = c = C = Ir,l - = u- u = Yo =tr>L c\c\c ac' I -, o .o ! rCI @ o)(\I r 9J ?oa aF-- ,*ojaa' -') cO tc \c 3 3: c\ \o ca c\ r: @ o)N dEo9o o?€ E O6u: -;; o =r Ed o; 3 : e \o (-.l r! € o)N tL] oc CJ No (! m C a.l d O al OO C] 'ooO c1 rOON €co c] o..CO6l o ON .i- C C\ 0) _o E O o Z $6l U o o :E U) a ct3I o oo o a F D q) o l- b! q (,) a -lcolNl ^rllr)l -l q) q) () F 0) O q) a 0,) c)L = .a)(Jr q)N F9 .U v v L 3Etr0) GJ :>,E xLe .-CULo'9 0L-.<- *-O l- -(Jd -2 9bej 3 L)t.l dl EEIo I o.)l&o cql! -.c ultr(J ,o bo -olEij o,q)ooo ooL '= o 9,)(J() A --Nt- c) 9-FJ9 O-LE; GtsG q -,:.,I () E Le9:la ,-9E I l- !o;- F o'l v;r *l\o 6l e.i Fl 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)\totr z \\ I IOE t. \t('t.lr.[ ()thcr (plcirse spccit-r 1: \(;I)(E Mectizan@ delivered by - Qtlease tick the appropriate answer) \'IOH ry_' \\llOE t \t('[.t.! ( )tlrcr. ( plcu.c \1lccil_\ ). \(;t)(E Please describe horv Mectizan@ is ordered and horv it gets to the cornmunities The NOTF requests tbr Mectizan fiom MDP. After the drug reaches the countrf it follorvs the existing drug and other rnedical equiprnent delivery regulation system of the ministr,r,ol health. The drug is stored in the MOH rvarehouse from rvhich the project receives. Frotr the project level (Zone) the Woredas collect the drug and distribute to the FLHFs. [t is from thc ITLHFs that the cornnrunitl'supervisors (llE\\ts) get the drug and distribute to the CDDs and the CDDs to the crrttttttttttitr. Table l0: Mectizan@ Inventorl' (Pleuse add nrure rows if necessury) Note Horv are the remaining lverrnectin tablets collected and rvhere are they kept? At the end of the treatrnent period, the CDDs are requested to return the remaitting drug to their collection centers rvhich arc the fiontline health tacilities. Then the fi'otltline health facilities send to the Woreda health office and finall1'from there to the project coordination olfice (ZHD). Hence. the remaining Ivermectin is kept at the project office (Bench-t\4a.ii ZHD.) List and briefly describe the activities under Ivermectin delivery that are being carried out b1' health care personnel in the project area. . Trainiug of health rvorkers, comrnunity supervisors and CDDs on handling. distribution. maintaining stock balances. recording and reporting . J'he Carter Center Ethiopia delivers Mectizan to the respective project zones . The Woredas collect their Mectizan from their zotre . Clollection of lvermectin frorn the Woreda level by the frontline health u'orkers . Distribution of Ivertnectin to cotntnunitl' supervisors and CDDs ' SuPervision . Recording and reporling of data . Collection of rernaining lvermectin from tlte supen'isors and CDDs and retttrll ttl the Woreda and then to ZHD District/ LGA Number of Mectizano tablets Renraining from thc p revious year (2009) Req uested Receiyed (ava ila b le) Ll sed Lost \\'asted E rp retl Remaining Bcnch-Ma1r 218,838 1.557,500 t,776.338 1,508,7 t4 0 2,910 r7.53 t 242.18-i TOTAL 218,838 I,557,500 l,776,338 1,508,714 0 2,910 17,531 242, r 8l Any' other comrltent 1.1 \ /HO/APOC'. 24 November 200'1 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so,When? The HEWS and Kebele managers were trained on horv to conduct revierv meeting at kebele level, immediately after the Mectizan distribution is over involving kebele decision makers and CDDs. Table ll: Communifl'self-monitoring and Stakeholders Meeting (Add rows if needed) Describe horv the results of the community self- monitoring and stakeholders meetings have affected project implementation or horv they rvould be utilized during the next treatment cycle. CSM is lot done but the Kebele leaders. HEWs and CDDs have carried out revietv Ilreetings after the distribution at Kebele level. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy NOTF ) ZOTF) WOTF ) Health Facilitl') Community supervisors ) CDDs Usually supen'isiort is carried out b1,'fCC. Zf{D. WoHOs and F[-HFs What *,ere the ntain issues identified during supervision? o Shortage of village registcrs o Neu,colnr-rs to pick cof-fee and rvork in gold nrine into sotne Woreda's have contribLrted to the f'luctuation of the actual Woreda poptrlation r Delay'ed Mectizan arrival o Irregular and inconsistent supervision by' staft'fiorn the Zotte. [i rtrcdas and FLHFs. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self rnonitoring (CSM) No of Communities that conducted stakeho lders meeting (SHM) Bero 1i U 0 CuraFerda Nla.lr Nlcneat Coldra Nlcncat Shashr Nlrz-an r\rnan North llench Sheko Shic Bench South Bench 120 95 l5-1 l0l 68 202 ll8 r70 207 0 0 (.) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 l'o ta I 1298 0 0 t5 WHO/APOC, 2.1 Novernbcr 2004 2.9.3. Was a supervision checklist used? Yes What were the outcomes at each level of CDTI implementation? o Improvement in handling of documents o Tirnely report submission and improved report qualitl, 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? o Proper documentation is implernented o More CDDs recruited a Even though Mectizan has reached late. reports have arrived on tinre SECTION 3: Suppod to GDTI 3.1. Equipment Table l2 Status of equipment (Please udd more row's if necessar.l,) Source 1'r pe of cq u r prncnt *Condition oIthe equiprnent (F:Functional, CNFR:currentlt, non-lunctional but repairable) Hou, does the project intend to rnaintain and replace existing equipment and other nlaterials'.) In 2010 APOC has replaced 4 Motor cycles, horvever. with the existing government vehicles and other equipments being used for integrated health services a vehicle is still expected fiorn APOC.. Integrated health service is the government's policy and all equiprnents and other materials replaced flrom the governrnent and other NCOs are wisel;- utilized in an integrated lvay. ,\POC NI( )l I ./ortt- DIS IRIC] N(r txi Othc rs Ntt Condrtron No Corrd rtron No Cond r tron No Co nd rtron No (-ondrtron Toyota Hrlux 4W prckup 1 CNFI]. I F+ ICNFR Motor cycles 4 F a CNFR .l F Desk top computer 1 CNFR LaserJet pflnter 1 CNFR DeskJet Pnnter Photocoprer 1 CNI--R Fax machrne 1 CNFR Overhead proJeclor Meqaphones Radro Communtcatons ,| F l6 U/tlO/APOC, 2-i Nor ernber 2004 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years NGDO partners(1'CC) Comrnunities 'OC Trust lrund Dht-.l Duto not Llt'utldhla lhc ,\.1Olt btrrlgat tncltrde,\ rutttltng L'o.\l ds well os salor't lor Onchocercrttsrs f otul per\ont 0t :otlul ond v oratlo letel - lf there are problents rvith release of counterpart lunds, hou,rvere they'addressed'l 'fhere is no problern in releasing funds fi'orl TCC and the Governtnent. but APOC's {irnd alrvays reaclres late.'fhe budget is released alter allactivities are carried out trsing TCC and Government 1unds. Additional cornrnents At present. atl health prograrns are integrated and thc governlxent is using its etttire rcsourccs lor integrated health progratns 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) The comrnunity leaders and elders do give rnuch time in mobilizing the community,dtrring Mectizane treatment periods and CDDs are supported in their farm fields and are omitted flronr other canrpaigns during Mectizan distribution period. 3.4. Expenditure per actavaty Indicate in table 14, the amount expended during the reporting period foreach activitl' listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currenci'. Indicate exchange rate used here rusD: 13 65 Contributor \ear 6 (2008) Y ear 7 (2009) Y ear8 (20 I 0) TOTAL Cash Budgeted (uss) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + State) 0 0 DNr\ DNA t)NA DNA MOH (District + zone) 685_t 6855 {9.17t l8 4917 I l8 82.061 52 82.067 52 Local NGDO(s) ( if any) 0 (.) () () () 16 012 5e 0 0 )h l)lr 5r) () 1 9699 I 9099 0 0 2557 1 46 0 25571 46 () 237 6t) t6ji5 j.1066 7-s 31066 75 -t9,887 .10 re 803 97 TOTAL 50314 .12889 1 09, '1 09 59 109,109 59 127,987 51 127 ,904 08 t1 WI IO/APOC'. 2.1 Nor enrbcr 200J Activitv Expenditure ($ US) Source(s) of funding NGDO Drug delivery from NOTF HQ area to central collection point of comqrunlty Mobilization and health education of communities Training of CDDs r9690.96 MOI-I Training of health staff at all levels t2.118.80 TCC Training of health staff at all levels 6186.22 1,92 r 6-) ).416.19 r76-1r 00 :.261.61 5216..01 20861.52 t043.1 .7 r 0 3 004.2 5 0 APOC TCC APOC I\4Ot-l APOC MOI I MOH MOH Supervishg CDDs and distribution Internal monitoring of CDI-l activities Comrnunity Self rnonitoring IEC materials Stationarl and prtnttng Summarl, (reporting) forms for treatment Salary offocal persons Vehicles/ Motorcycles/ bicycles maintenance Fuel and oil Office Equipment (e.g cornputers. printels etc) Others MOH 0 TOTAL* Total number of pe rsons treated 86,418.62 Table 14: Indicate how much the project spent for each activity listed below during the reporting period SEGTION 4: SustainabilitY of GDTI 4.1. lnternatl independent padicipatory monitoringl Evaluation 4.t.1 Was Monitoring/evaluation carried out during the rcporting period? (tick anl' of the following rvhich arc applicable) \r'uc _Year I Participaton' Independent monitoring Mid l'erm Sustainabili[' Evaluation 5 y'ear Sustainability Evaluation Internal Monitoring b1' NO'l-F Other Evaluation b1'other panners t8 \\/llO/,APO('l. 2-l November 2004 t4.1.2. What were the recommendations? 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? no No Was a sustainability plan written? Yes When rvas the sustainability plan submined? on the 3'd 1,ear of the project What arrangentents have been made to sustain CDTI after APOC funding ceases in terms o1-l 4.2.1. Planning at all relevant levels -l-he CDTI actirities arc planned intesrated rvith thc'other PIJC prosrarn\ at all lercls l-hcrr.lbrc. the planning processes are carried out through participatorv rnethrtds. trsine bottont-up approaclt arrd integratcd rrith the basic health serviccs. Resources are uscd ttt all health actir ities t'rrr irrtegratecl basis. 1.2.2. Funds Ftrnds liortt the goverrunent and other donor agencies lrke TCC'and AI)O('are rrrrlizecl on integlatcd birsis fot al I health prograrns. 1.2.3 Transport(replacementandmaintenance) It is expected that APOC ri'ill replace a vehicle. Four ntotorcl'cles u,ere replaced by APOC. The RHB has allocated nr,o vehicles and two rnotorcycles receivcd fiorn other programs to be used for integrated health services. The existing APOC donated vehicle is not lunctioning at present. 4.2.1. Otlrer resources - 1.2.5. To what extent has the plan been implemented The plan is wellexecuted by'the support o1'the governntent. APOC, The Carter Centre Ethiopia and the communitl'at large.-fhe CD'fl activities are mostlv incorporated and integrated uith the other PHC prosranrs. horvever, support fiorn APOC and The Carter Center Ethiopia is highll'demanded.-l'his lear-lherapeutic and -l'tJG co\/erage has reached 7\oh ar"td 980/o rcspectivelv. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: All CDTI activities are integrated into PHC . Meclizan deliven, o 'lrain ing o Distribution o Supervisiort o []udget. a l9 WHO/APOC. 24 Nor crnbcr 200.1 4.3.1 Ivermectin delivery mechanisms Since the beginning of the program. there is no separate Ivermectin delivery system to the lower level; it follows the existing drug delivery system of the general health service. ln other words. lvermectin delivery is fully integrated into the existing drug delivery system of the country. 4.3.2. Training : CDTI trainings are integrated with the Primary Health Care (PHC) from the beginning at the National. Regional, Zona| Woreda and HF levels. The Disease Prevention and Health Development Core Process is responsible for taking care of the program at all levels. The Carter Center Ethiopia has developed modules. manuals and Fillip Charts to be used at Zonal. Woreda and Kebele levels. The trainings were ver)' r,aluable indeed at all levels. ,1.3.3 Joint supervision and monitoring rvith other programs As part of the system in the country. zrll sorls of supporlive supervision anci nronitoring activities ol-the CDTI progranl are carriecl out in an integr.irtccl manncr rvith other PFIC prograrns. 4.3.4. 4.3.5. Release of funds for project activities The govemment. The Carter Center €thiopia and APOC have released firnd for the 1,ear 2010 CDTI activities. 1-he government is paf ing the salarl olall local pcrsorrs and allocates budget lbr supervision. fuel. stationarv arrd vchicle rnaintenarrce. etc. All health activities are carried out on integrated bascs using the allocated budget fiorn the Government and NGDOs. l-he APOC parl \\'as released late. Is CDTI included in the PHC budgetr The budget itemized for communicable disease preventiott includes ['DTI. . Summarize in not more than one half of a page the operational rescarch undertaken in the project area within the reporting period. Not done Ho*'r'ere the results applied in the project? 4.3.6. Describe other health programs that are using the CDTI structure and hot' this rvas achieved. What have been the achievements? CDTI structure is being used fbr rnalaria prevention. national vaccination programs such as Irolio. TT, Measles and EOS. CDDs are very helpful during these catnpaigrrs and are shorving good achievements. . 4.3.7. Describe others issues considered in the integration of CDTI 4.4. Operational research 4.4.1. 4.4.2. 20 WllO/APOC. 24 November 2004 a: a SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: - Geographic coverage- l00o/o - High therapeutic (79%)and UTC (98%) coverage Weaknesses Lack of continuous and regular Supportive supervision at all levels High nurnber of Mectizan expired Number of Absentees and Refusals is still high Task forces at all levels are inactive as usual Opportunities: . Accelerated expansion o1'PllC to village lcvel. . Assignntent olIIE\\/s to Ke bele level. Threats (Challenges): . t'ligh turnover o1'hcalth statti especialll at front line health fircility anil Woreda levels . Overlapping of othcr health carnpaigns during [\'lectizan distribution pcriod. SEGTTON 6: Unique features of the proiect/other matters . Project Woredas are vcry relnote . Health staff unrvilling to stav in the area. o APOC's report format is so cumbersome and pleasc do consider to revise and make it short and precise for the ZHD has so many reports to be submitted to the government and other partner NGDC)s too. I a 2t \\'HO/APO('. 2.1 Nor crnbcr 20()l