4th and 5th year sustainability plan Gimbo Woreda (district) Kaffa-Sheka CDTI project period: 2004-2005

Ethiopian Program for Onchocerciasis Control Community Directed Treatment with fvermectin (cDTI} 4th and sth Year Sustainability Plan For Gimbo Woreda (District) Kaffa-Sheka CDTI Project Project Period z 2004-2005 0 I DEC. 2003 { I E : .\ x "J i I 1l Table of Contents Part I 1. Introduction....................... 2. Background Information... Part II l. Rapid Epidemiological Mapping of Onchocerciasis Part III 1. CDTI implementation and Results 2. CDTI training achievements ......... 3. Treatrnent coverage... Part IV 1. Financial Management of APOC Trust Funds 2. REMO Maps of Gimbo woreda...... Part V Sustainability of Issues of Gimbo woreda CDTI...... 1. Planning 2. Leadership 3. Monitoring and Supervision ......... 4. Mectizan supply and distribution........... 5. TrainingAIESAM....... 6. Project Budget Financing/Funding 7. Transport and other Material Resource... 8. Human Resources 9. Coverage 10. Sustainability plan frame framework for Gimbo woreda ..... 11. List of Available Resources for program support .............. l1 12. List of Materials, Supplies and Equipment Required for GDTI Activities ............... lz Part V 1 1 2 2 2 J I 2 J Budget justifi cation (Explanation Budget Summary Year fV............ .Budget Summary of Sustainability plan for year V. 13 15 16 3 4 5 1Introduction Gimbo is one of the ten wordas (districts) of Kaffa zone, located about 420kms away Southwest of Addis Ababa. Gimbo has a population of around 112,746. The woreda comprises 43 kebeles (smallest admin units), whose inhabitants mainly depend on subsistence agriculture. The climatic zones of the woreda, in most places, are that of highland with longer annual rainfall period (6-8 months). In this woreda, there is one hospital, one health center, seven health stations, and three community health posts. The infrastructure in the woreda is underdeveloped; no continuous electric power supply, poor telephone service, inadequate roads connecting the kebeles (rural communities) to the capital town, etc. The woreda is well known for its diversified cultural and ethnic composition, although Kaffecho is the most dominant one amongst others. Backgroun d Information Onchocerciasis control program was iaunched through community directed treatment with ivermectin strategy in Gimbo woreda in the year 2007. The project was initiated with a strong partnership between APOC, affected communities, regional, zonal, woreda admin councils and health departments, Federal Ministry of Health and an NGDO partner (The Carter Center). The program was initially designed and implemented as Kaffa-Sheka CDTI project with the overall coordination role assumed by the zonal health department. However, Kaffa- Sheka was Iater on split as two distinct zones and the leadership role was then shifted to each zonal health office. Again, very recently, in accordance to the decentralization policy of the government of Ethiopia, there was a paradigm shift of power and authority from zonal to woreda levels. It was at this juncture that the midterm CDTI sustainability evaluation of Kaffa-Sheka project undertaken. [n line with this developrnent, it was recommended that the CDTI plan be worked out at woreda level. After the midterm evaluation of CDTI sustainability, there was SWOT analysis done for each level of health delivery structure. As a result, coverage, Mectizan order and supply, monitoring and supervision, as rvell as training and HESAM were considered relatively 2as strong points at woreda and front line health facility levels. On the other hand, Financial Resources, Plaruring, Leadership, Transport and other materials and Human Resources were considered as weak points at this level. Efforts have been made to address these weak points in this action plan. Rapid Epidemiologicar Mapping of onchocerciasis (REMO) The rapid epidemiological assessment canied out in selected communiti es 1997 indicated Gimbo woreda as partly hyper-endemic in Omach area (47 .2) and partly meso-endemic in Choba area (34.8) to Onchocerciasis. CDTI Implementation and Results Although the woreda was known for its endemicity of Onchocerciasis, there was no mass treatment activity conducted before the launching of CDTI. However, clinic-based treatments have been going on with diethylcarbamazine (DEC) in some of the health health institutions of Gimbo Woreda. As mentioned earlier, CDTI was implemented for the first time in the woreda during the yeat 2001'. The major partners were APOC, FMOH, respective health authorities, local governments, affected communities, and the partner NGDO (Carter Center). The mass treatment had 100 percent geographic coverage of the communities in the woreda right from the very beginning. CDTI Training in Gimbo Woreda, Kaffa zone Year Health Personnel Others CDDs 2001 56 9 406 2002 l6 82 460 2003 58 1 479 JTreatment Coverage, Gimbo Woreda, Kaffa zone Financial Management of APOC Trust Funds The financial management of CDTI projects used to be carried out by zonal health departments in the past three years. It was, therefore, not possible to come across correct figures for each woreda by year. Moreover, due to the restructuring process in the country (which is still underway) and frequent change of staff (CDTI coordinators), it was not easy get access to the financial documents. However, efforts were made to extract some data from the existing financial documents at zonal levels. Year Funds Received Other Sources Comments APOC NGDO* 200r 51,17 6 DNA** None The2"d installment was not received from APOC. 2002 4,405 ? None All approved budget from APOC was received! 2003 2,022 1,409 None Only the l't advance was received from APOC Total 57,603 * NGDO support was mainly through material and technical support ** Data not available Nerv Leadership Role and Integration of CDTI In view of the recent decentralization policy, devolution of power and authority has been made to the woreda level structure. As a result of this change, CDTI has been considered as integral part of the overall three-year strategic health plan for Girnbo woreda. During the CDTI sustainability planning workshop, all stakeholders have participated and have expressed their commitment to assuming the leadership role in the implementation of CDTI in their respective areas. CDTI has been included in the malaria ald other vector borne diseases prevention and control unit in the strategic woreda health plan. Year Total Nbr. of villages ATO Nbr. of Villages Treated Geogra phic Coverag e (%\ ATO Coverage (%) Total Popn. ATO Mr. of persons treated Therapeutic Coverage (%) ATO Coverage 200 r 230 230 230 100 100 120,209 100,820 96,244 80.1 95.5 2002 447 447 447 100 100 I10,260 88,208 83,870 78.2 97.8 2003 447 447 447 100 100 109,462 87,570 85,447 77.8 97.6 i iirl 'q 4 REMO Map, Gimbo woreda, Kaffa zone l' ,,ri-it'jlJi;, Y,'l iJ Iiiiy' jt f:r: i:fi+l\ r 1ri +_itl, -ii j1,' 5Sustainability Issues in Gimbo Woreda CDTI Planning This is an area identified as weakness during the midterm evaluation that requires immediate corrective action. The CDTI is incorporated in the overall three-year strategic health plan of the woreda. However, in the past,.the woreda health office and FLHFs were not actively involved in drawing up the CDTI proposal and annual plans of action. It was mainly the zonal health department that was responsible for planning CDTI activities in particular. Following the midterm CDTI sustainability evaluation, however, it has been decided that all stakeholders at woreda and FLHF levels will assume the responsibility of working out their respective periodic plans of action from this time on. The woreda, hence, seeks training support on this important issue from the National Onchocerciasis Taskforce/ NOTF. Leadership As introduced earlier, currently there is a paradigm shift in the admin structure and organizational set up of the overall management of health and other development programs in the country. The general trend is to empower the woreda level structures and build capacities in all aspects of program management. The CDTI, being one of the recognized and integrated health programs of the woreda, will receive leadership and close guidance from the woreda admin council and the taskforce organized at this level. Monitorin g and Supervision Monitoring and supervision is very critical to the success of CDTI if it is done in a timely and effective manner. However, it was understood during the evaluation that the frequency and coverage was inadequate. Supervisory checklists rvere not used regularly and feedbacks were not communicated in writing. In most cases, supervisory visits u,ere not problem oriented and targeted to improving poor performance of FLHFs and CDDs. During the sustainability-planning workshop, it was agreed that the weak points identified would be addressed very critically although shortage of health personnel and o'ther competing health priorities at both woreda and FLHF levels could be possible threats in the implementation process. )' 6 Mectizan Supply and Distribution This activity is considered as a strong point during the evaluation process. Mectizan procurement and distribution is fully integrated into the government health care delivery system. Every effort will be made to maintain the good achievement obtained thus far. Ordering Mectizan in good time and in sufficient quantity is indeed a commendable job favoring sustainability. However, there are areas that need fine tuning at FLHF and CDD levels. Minimizing wastage, proper record keeping and timely and complete reporting are some of the areas requiring attention in the remaining project period. Training/HESAM Organization and management of CDTI training programs were the responsibilities of the zonal program coordinator in the past three years. The woreda health office is not fully empowered to handle this responsibility. The future direction is however to build the capacities of the woreda health staff so that they can be in a position to plan and implement training sessions after carrying out needs assessment at FLHF levels. Efforts will be made to make CDTI training sessions focused on identified weaknesses of the health personnel and other partners including CDDs. Similarly, the woreda health office will be making proper use of its meager resources by integrating training programs to the best of its capacity. Health education, sensitization and community mobilization has been very effective in enhancing CDTI awareness to the general public. The perceived benefits of Mectizan are foundational grounds for the sustainability of CDTI in the woreda. There will be a need to produce more powerful health education and sensitization materials in order to enhance further the active involvement of communities in decision-making process. Moreover, the beneficiary communities will need to be mobilized to provide effective support for the CDDs serving their respective villages. This is believed to be one of the cornerstones for the effective sustenance of the program in the woreda. 7Financing/Funding During the first three CDTI years, there has been no specific budgeting for onchocerciasis control activities in this woreda. Very recently, however, the woreda admin council has started allocating funds in block for all health programs in an integrated manner. Obviously, the amount of money is much smaller.compared to the diverse needs of the woreda health office. Whatever the amount may be it is indeed a commendable start and it is hoped that it could be increasing over the remaining project period. Since the woreda health system functions in an integrated manner, it is hoped that CDTI could also benefit from funds coming from other sources like Global Fund, EPI, etc. At this rudimentary stage of the woreda, however, more support will be required from APOC. Transport and other Material Resources In this woreda, at it is the policy of the Ethiopian goverrunent in general; available transport facilities are used in an integrated manner. In the midterm evaluation, means of transport is one of the most important limitations identified at both woreda and FLHF levels. Ideally, it would be appropriate if a pick up could be provided for the woreda health service and at least one motorcycle for each FLHF. However, as the project is already in its 4th year, this may not be affordable at this point in time. The evaluation team has recommended immediate replacement of the motorcycles that are found to be worn out and non functional in this particular woreda. It is strongly recommended that each FLHF would need one motorcycle for effective monitoring and supervision of CDTI activities. At this juncture it is very important to underscore the need to consider building the capacities of the woreda and FLHFs inorder to be able ensure the sustainability of CDTI in this particular woreda. This woreda health office lacks important office equipment like computer, printer, photocopy machine, etc. These deficiencies need to be tackled as soon as possible. Other CDTI material resources like treatment registers, reporting booklets, training manuals, posters, flip charts, T-Shirts, stationery, etc. should be supplied in sufficient quantities for the effective continuance of CDTI in the woreda. 8Human Resources It is known beyond any grain of doubt that the availability of skilled and motivated human resource is very critical to the success of CDTI. The midterm evaluators noted that there was a very high tumover of health personnel at both woreda and FLHF levels. It was also noted that most of the FLHFs are understaffed. In the coming couple of years, however, these shortcomings need to be addressed as much as possible. During the planning workshop, the woreda admin council and other authorities at higher levels promised to do their best in this respect. Plans have also been made to motivate health personnel and CDDs by means of rewarding best performing individuals and institutions. As stated above, trainingworkshops will also be organized to fill the gap of knowledge, skills and competence of the available health personnel in planning and management of CDTI activities. Coverage This woreda has already achieved 100 percent geographic coverage and therapeutic coverage of well over 65 percent during the past three years. Participants of this planning workshop believe the fact that if all other aspects and indicators of sustainability are well taken care there won't be a problem to maintain the current geographic coverage and improve further the therapeutic coverage levels. Efforts will need to be intensified to reduce the current rates of absentees and refusals to the best minimum levels. v q) o! FE q) C! v, ri C)ot< oo Eg(!o(-) () (J Or gi o z O o o. J<o A (-) o Or ;i 0)tsi E c^(! 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P E PE c!r-lr<{rrFoH c.l $oo oiel\ca tnco N ^rr)il il ;<\,.) ? ? odll -a->|a€ € ..T€tr^, oallrrEr-E x x ;5 ex[q n ?E:qi5o\ O - g roi"-ro o 1sfrerQ >.9 I llPf r"-t ar [ 9!9EaE5E'sEEEOIP i EE E e [H Q a*;=&=FeisaF Q\o\o il oN c) <h o o() bo L €koa t/) C)p cA c.) *E 'J't 5F{OIrr A) ^6 - l-. .c) EEEI* Gt T\ E 3'.E 'o€ BEcBrO,A=,tr# uU L.F E.E.T 0)v^ codoC, t= €Eb ii=i '= 0) A oE SHBH'5 B =r-E E.E& d,E oIri Fl II< 'o (! ah do E(6 ,:A o= 'tH LLlo o. o\ =r-C, \T €uiEg o0.. .= tii- q)OQ i6 oo\Eg r.- o\F- ,; =fE() .VE e5titr acAthE -(!Ei O- HO fr. h o. -o() 6-) 2t* oli r) tl.ae'OE c^ ooEd E -.r .6 UH ,\ a ,^ irr€6)56:-o l: > EE KUt 6E.HX asH:Q( cv tr -m - Glo 6*i - = L ;i<^C O tsL=rtr> ou<C}() q L(u an O oo (ff o o tt) o o. \o t--. € a t6 Budget Summary for Year MDTI in Gimbo Woreda, Kaffa zone , a I S.No lnraset Line Item APOC MOH Carter Center Total Allocation llPersonnel 0 17,720 290 1 8010 2lCapital Equipment 22,400 0 4,000 26400 3lSupplies 2,310 385 0 2695 4lTraining 4393.12 202.96 138.65 4734.73 5lMonitoring and lsupervision 2633.52 331.08 0 2964.6 6lResource Mobilization 0 223.7 0 223.7 TIHESAM 3,975.24 318.01 320.36 46t3.61 8lAnnual Review lMeeting 0 0 1,637.r4 t637.14 glProvision of Awards 0 0 660 660 l0lTotal Budget 35,71 1.88 19,180.75 7,046.75 61,938.78 11 lNcoo overhead |t.sv,l 2,678.39 0.00 0.00 2,678.39 l2lGrand totat 38,390.27 19,180.75 7,046.15 64,6t7.17 13 lEstimated Treatments 90, I 09 90,109 90,109 90 ) 1 09 l4lCost per treatment 0.43 0.21 0.08 0.72 151% Input of Partners 0.59 0.30 0 11 1.00 a I il t7 Budget S Wo ummary of Year v sustainability plan for GDTI in Gimbo Kaffa zone S.No udget Line Item APOC H Carter Center otal Allocation I 19,420 2 t97 t 2 tal Equipment 0 J Supplies 1 1 50) 500\ 100 t7 50 4 2200 300 120 2620 5 toring and Su 1 500 400 150 2050 6 esource Mobilization 0 230 0 230 7 SAM 2,000.00 325 300 2625 8 Review Meeting 0 0 1,700.00 1 700 9 rovision of Awards U 0 700 700 10 otal Budget 6,850.00 21,775.00 3,360.00 31,395.00 11 overhead 5o//o(7 ) 513.7 5 0 0 5t3.7 5 12 rand total 7,363.75 211175.00 3,360.00 31,999.75 l3 mated Treatments ll6,24l I6,2411 116,241 Ll6,24l l4 ost per treatment 0.06 0.18 0.03 0.27 lnput of Partners1 0.23 0.66 0 1l 1.00 t J rl