fCIHl I UlllffiHH[ EUI THlEftilUffilffirf $I lif Ht ffi Affi. North Gondar Zone Amhara National Regional State ETHIOPIA Project Period: Year 2001-2005 AFRICAN PROGRAM FOR ONCHOCERCIASIS CONTROL (APOC) I I t t t MAY 2OOO l I I I It I I J \ \ t1 r qeot {e(tt +,J,I S JUN 2OOOnA.l'f*'.e L9-L41a f-{Dlt/.ft.(t l;t'.llt.lt fnuf r.n.f .Ll.,I.-l;C Federal Democratic Republic of Ethiopia Ministry of Health Date +Tc Ref. No. Dr. A. Sdk6t6li Director, APOC African Programme for Onchocericias is Control Ouagadougou, Burkina Faso Tel: (266) 3429 60, 34 29 59 Dear Dr. S6k6tdli, Subject: Submission of Metema{uara Area CDTI Project Proposal We refer to our letter Ref. No. 4l4tB6/41 regarding the submission of a revised NATIONAL PLAN OF ACTION FOR ONCHOCERCIASIS CONTROL IN ETHIOPIA- YEAR 20OO-2OM and PROJECT PROPOSAL FOR COMMUNMTY DIRECTED TREATMENT WITH TVERMEC'TIN FOR KEFA-SHEKA ZONE. We hereby enclose a copy of Metema Quara CDTI Proposal for the years 2001-2005 based which was prepared based on the above mentioned Five Year Plan of Action. We sincerely apologise for the delay in our submission and look forward for a positive reply from APOC in due time. Please not that the CDTI project proposals for Bench- Maj i and North Omo zones are not yet ready for submission. It is our hope that these will be sent to you before the 3TEember2000 We would like to take this , indirectly towards this project opportunity to thank all APOC and others who extended their support directly or With best regards Sincerely yours, '=,.{#r:if3ffi EXDAIHO Represenrati Addis Ababa Dr. Mary M. Alleman Associate Director Mectizan Donation Programme 750 Commerce Drive-Site. 40O-Decahrr, GA 30030 Atlanta- Georgia-USA Mr. Teshome Gebre Country Representative, The Carter Centre Addis Ababa Planing and Project Department Disease Prevention and Control Department Malaria and other Vector-borne Diseases Prevention and Control Team Ministry of Health Amhara National Regional State Health Bureau Bahir Dar a t1 .6( I *o c? iraalafL' na A$ oAiq- { .v -i1 g1L ( ot*t :1, E'.-{ a tic(|cra qfY {.hn +rc 5t9366 Fax No. s 1234fi&n lnq }\l-rAf Addis Ababa - Ethiopia .4rro fl.2rlnr. '1.x. f).f', f-4ta(I + ln reply Please Refer to our c 51701 I 5 l 7109 51783t 4.Ahd +. 21844 Telex 1'C Ref. f,T+(r No E-marl = MOH NCIC@padrs gn apc.org "r lEfat I TABLB OF CONTBNTS LTST OF ACRONYMS SBCTION 1: BACKGROUND INFORMATION l.INFoRMATIONoNTHEPROJECTAREAFoRCDTI............... Geographical and administrative areas"""' Topography, Climate, Access Onchocerciasis Endemicity Levels Community Structure 2. PAST AND CURRENT STATUS OF CDTT TN PROJECT AREA SECTION 2: PROJECT EXECUTION OUTLINE """""" 3. DESCRIPTION OF PROPOSED CDTI 3.1. Outline Plan and Timing ...... 3.2.HealthEducationandCommuniryInteractionandParticipation 3.3. Local OPerational Research SUPPLY, TMPORTATION, STORAGE, INVENTORY AND DELIVERY OF MECTIZAN TABLETS ............ lll I 1 1 7 8 9 r0 1.1. t.2 1.3 t.4 4. l0 11 t2 15 T7 20 20 20 23 23 24 25 25 5. SUPERVISION, MONITORING AND EVALUATION """"' 5.1. Supervision during Evaluation 5.2. Monitoring CDTI 5.3. Evaluation of CDTI 6, SUSTAINABTLTTY OF THE CDTI AFTER THE WITHDRAWAL OF EXTERNAL FUNDING .............. 6.1. Integration of GDTI into other community Based of PHC Systems 6.2. Cost Recovery System during CDTI 6.3. Other Issues 6.4. Methods of Measuring the Progress Towards Sustainability ... 7. CROSS BORDER CONSIDERATIONS 8. SPECIAL RISK ISSUES 7 7 8 1 I I I SECTION 3: ADMINISTRATION/FINANCIAL .......... 9. ADMTNTSTITATION 9. l. Organisational Structure for CDTI 9.2. FinancialAdministration 9.3. Timed Plan of Action IO. BUDGET 10.1. Budget Estimate 10.2. Budget Justification 10.3. Current Resources available in CDTI APPENDIX 1: 26 26 26 21 3l 33 JJ 36 37 38 4 l-s0 I APPENDIX 2: APPENDIX 3: LIST OF MAPS: MAP I: MAP 2: MAP 3: MAP 4: MAP 5: LTST OF FIGURES: FIGURE I FIGURE 2: FIGURE J: ESTIMATED NUMBERS OF COMMUNITIES AND PERSONS TO BE TREATED EACH YEAR BY ENDEMICITY LEVEL ....... INDICATORS FOR EVALUATION, SUSTAINABILIY /INTEGRATION OF CDTI BUDGET DETAILS Administrattve Map of Ethtopia Map of Amhara Region by Zone Map of North Gondar Zone by LYereda ........ Sketch Map of Metema Wereda CDTI Areas in Ethtopia........... Organisational Structure of National Onchocerciasis Control Program Request and Disbursement of APOC Fund Annual Treatment Objective by Endemicity Level . 40 2 3 4 5 6 26 28 39 il APOC ATO CDDs CDTI EPI FMOH GIS KAP MTS MOH MOVDC NGO NOTF PHCU RE,A REMO RHB ROTF TOT wHo ZHD ZCTF LIST OF ACRONYMS African Program for Onchocerciasis Control Annual Treatment Objective Community Drug Distributors Community Directed Treatment With ivermectine Expanded program of lmmunisation Federal Ministry of Health Geographic Information System Knowledge, Attitude, Practice Management lnformation system Ministry of Health Malaria & Other Vector Borne Diseases Control Non Governmental Organisation National Onchocerciasis Task Force Primary Health Care Unit Rapid Epidemiological Assessment Rapid Epidemiological Mapping of Onchocerciasis Regional Health Bureau Regional onchocerciasis Task Force Training of Trainers Woreda Health Office ZoneHealth Department Zone Onchocerciasis Task Force 1ll SECTION I: WOREDA PROFTLE I. INFORMATTON ON THE PROJECT AREA FOR CDTI. I.I GEOGRAPHICAL, ADMINISTRATIVE ARBA Please describe the area(s) of the countty in which the proposed CDTI will be carried out. (List the administrative units or parls thereof e.g., Local Government Areas, Districts, Health areas elc. that will be covered and provide a map showing thetr lay-out) Metema woreda is found in the west of North Gondar Administrative Zone of the Amhara Regional National State. [t has an area of 561.25 kms and is divided into 2l administrative localities with an estimated population of 68003 inhabitants. Geographically it borders Tsegedie Armachiho rvoreda to the north, Quara and Alefa weredas to the south, Chilga woreda to the east and the Sudan to the west. 1.2. TOPOGRAPHY, CLTMATE & ACCBSS 1.2.1. Please descrtbe the type of country or bio-climatic zones that wtll be covered by the CDTI (e.g., ratnforest, forest-savannah mosaic, Guinea savannah, Sudan savannah, mountainous orJlat), providing maps, if appropriate. The altitude ranges from 700 m up to 1860m above sea level on the average. Ecologically it is a forest Savannah, rich in variety of bird species and with perennial rivers namely: Guang, Jira, Lencha and Shinfa. The daily average minimum and maximum temperature is 2!c and 45'c respectively. The average annual rainfall is 880mm. 1.2.2. r.2.3. Give the approximate times of the rainy and dry seasons and the months covered by thefarming season. The rainy season starts on June and ends on September. Thus the fanning season is from May to December. The main agricultural products are cotton, oil seeds and sorghum. Provtde information on the state of the roads and the effect of thts on the movements of GDTI personnel in the area at different times of the year. (A mdp may be useful) There is l80km dry weather road, which connects the woreda centre with Gondar town. There are 22 elementary schools, one rural hospital, one health centre, 4 clinics and2 health posts within the woreda. (\ o =lio bo 0)& (o (gao 14(+< dlE{a C.) cqL{-) v) I q) cq lr o +J cg D t-{g cgr-a oo z =G E o U' o .9,!,! G 6ll E(g t o-zz U' t tG'cdF a) -v.s q h! & €o I oz[!(9 u.t St\n -tr \ D a- J zI(, lI E $ x E( tF 0 oi U u 0J o N o n E a}. 2d- a -l{bl. + trdS ?. Et \5 c. a{ .-l\ \ \ h-5q vl \- tsS\a ?ss \t. t, L \.+ <- m t L ] \-\ G(b c: ffh 1r $r {.t! rld,, r3i$ r ! t.l. ',-. I a-rj J '. 11, ' < . 'tt ar _n ,]i}l:i; ^, s ,.4 D \J .i rj <.J 'iI !1 T t' ., t, :;i-\. t\ ,7 t: i: i.. t- t-iEC{,t>r-. \;art:i,::> .-tiiril, ri. t f '4 z':::r+radrYL ,r'j;r\!).,.{ ,:i3t4ta :,,1 i^ -. i.F.t i i- - rSr.,<:l/ l;Y r ra f :- t,a,I d+ ):.\tt< t !.'-4)-t:,., i1 Il-tu 'l:S , La ' r,r/v'i, r. Iir 1r J {? i,' !,). !1+ -i,r 6 .a z. z,ilq,# -r o i".( . .tl1t' s :: ...-rl r r.,r,Fii!)c'xliri*ts)xeiil 'I ,z ?;\]r ry r,..;;{- .*<^ '* - .' r'',.:\r'F-3/ # rr:. . 1, ,:t)-+ {'l tr ','' r .' -. '.: rt , - -i'b: e. 'D'."-i'.,r.'.i 'l- ). . i. t1 s iU t.-* ,lt l t. \ I t' t5x -E'5+(5 E c.lb\ -. '=\ G'af,dJ+\\ 3- l-'G, =(-t qi, --<,, cf; ct-(t, = a b. c \i $ e +. t/l \$se dv$ N N s \ q :\ sl. S t ?.t tl) ut ...t{. \ -.t\-\ t{ \ tttq \t{u o{Ft R .t( Nt s 7 o (!,BL *(OEd)(L' =@ Man 4. Skctch Man of Mctcma Wercda N Ts<-9<Au- Nr'naJtho AuraSa ckera LEGEND Towns All-wcather Roads Saher CHILCA o JuPAH .tab ALrr,t Gunprr tl*i,1r ) $il},)t 1 + r H Ag &711 tJ*ha. Avrr D a,.S I I I o lr.riov oGubarl Dshcntr of sh\i 5 aaa Y** \ \(r!a ilBf a S"N oL& \ .\, 9I o =!i 2 Er' d, e5eE +' -ou,^B:J:frr,jireqYd 6,r:.rd?Ei, F E F tr EStr_oOO.U|)()z(JOA otr E,€o9.(!9Jo 2 t4& ::::l ' a*,: i ',.,< -<& o rr-F .g CL .9 F *, ut .s o GloL -F cr(J ro a CL G' = \oo\ og iC oz oo, o, o cf) ^qddde (tt tif ooooo l- I T I I 1.3. Onchoccrciasiscndernicitylcvcls. Thc levels of onchoccrciasis endemicitl, in comrnunilics irt the CDTI area ttrust be asscsscd by sintple methods before treatment starts. For the purpose of this proposal, lhe level of endemicity in a contmunity or a group of similar contmunities is deJined on the basis of the prevalence of nodule carriis (see Table t). The level of Onchocerciasis endemicity in the communities in the CDTI areas is classified based on the following criteria, though REMO is not conducted in all of the Onchocerciasis endemic localities. Table 1: Classification criteria for endemicity levels in rural communities I .3.1 Based on the system tn Table I and using the format in Appendtx l, please indicate the estimated numbers of communities at each endemic level a-nd the numbers of persons tn them. See Appendtx l. 1.3.2. Contplete Appendix I for each area covering the next 5 years of the project. I .3.3 If methods of assessing endemicity thresholds other than nodule prevalence were used when your endemicity data were collected, please indicate ihe method used. The levels of endemicity in communities of this zone are defined on the basis of nodule prevalence obtained by REMO exercises conducted in 1997. 1.3-4- For areas still to be covered, where endemictty levels are not yet known, please describe the method you will use to collect the necessary endemtcity data. Prior to the beginning of treatment activities REA will be conducted to complete the classification of all villages in the proposed treatment area. So far, based on REMO data 35 villages have been classified as meso- or hyper-endemic to onchocerciasis. Currently REMO activity is in progress in Quara wereda where some villages are going to be assessed. Quara woreda, which is neighbouring Metema wereda has a population of 42,261. 7 ENDEMICITY LEVEL and recommended type of treatment Percent of nodule carriers in REA sample (minimum sample 50 adult men) Estimated prevalence of O. vovulus in the whole com HYPER-ENDEMIC COMMUNITY Treatment (uRGENr) Greater than39%o Greater than 59Yo MESO-ENDEMIC Community Treatment ES 20-39% 40-59% HYPO-ENDEMIC ON-URG Less than 20o% Less than 40% 1.4 Conrnrunity,Structurc Provide background informatiott on tlrc social organizations of conununitics in tlrc C.D.T.I. areos. This may include informalion on: Seltlement pattern of the contmunity (e.g. hamlels, seasonal farmsteads, dispersed population, etc.) The communities in CDTI areas are settled farmers and densely populated The ethnic groups in the community The community in Metema woreda lives in hamlets. The ethnic groups are mainly the nativc Gumuzs, Amhara and few others. Please provide tnformation about the area covered by CDTI indicating whether they are migrants, nomads, refugees or internally displaced populations. a a a a a The community is, currently, organised in syndicates of 50 households subjected to a local administration (kebeles). The main occupation of the community is crop and animal farming. Other than these the Gumuzs are also engaged in handicrafts. The diagram below shows the community leadership structure. Zonal Council Chairman ) Woreda Council Chairman ) Kebele Chairman ) Elders/Religiousi Opinion Leaders ) Household Head Established distribution systems in the community The communities in the proposed CDTI project area are settled subsistence farmers. Some are displaced settlers from other parts of the country. The settlers came to the area more than twelve years ago. Community leaders hip s tructure In some of the localities the community has an experience of anti-malarial drug distribution through community health workers elected and trained from the communify itself. Social communal activities and months during which the activities take place. The important religions ceremonies celebrated in mass gatherings are : The foundations of the True Cross, on September, and Ethiopian Epiphany on January by the Christians while the Moslems celebrate the Arefa on April and Romedan and Mewlid at different times individually at home The Christians celebrate Christmas on January and Easter on April. t 8 aa Any previotts c4tcricttcc of thc corrttrtuttily with development/health projecls Most communities in thc zonc havc bccn involved in EPI, family planning, wcll construction, and spring protection activities. There are also community health posts managed by community health agents and traditional birth attendants in somc communities. The communities therefore have well-established systems of mobilization to enhance participation in communal events. Some anthropological characteristics of the Community The Gumuz live in-groups and have their own language. The males are full dressed while the females are half dressed. Their life is based on hunting, crop and animal farming and handcraft sales. There is no wedding ceremony , instead the then to be husband will take his wife in exchange of his sister by himself. The big ceremony celebrated by the Gumuz is a commemoration of a dead person. This is celebrated after the harvest season when there is plenty of crops for the preparation of food and drink. During the celebration there is a song and dance with glorious cultural antiquities dressed. The females are more responsible for market activities than the males. A pregnant woman will exercise delivery alone by herself away from her living village. Soon after birth the baby will be laid necked on the field. His survival is assured if he can resist the hot sunshine and will be taken home. However through health education this experience is reduced to some extent. 2. PAST AND CURRENT STATUS OF CDTI IN THE PROJECT AREA 2.1 Please indicate if the CDTI is an expansion of an existing CDTI. Since CDTI is to be experienced for the first time in Ethiopia there is no past experience in this regard. Currently this project proposal is developed to implement CDTI in the Onchocerciasis endemic area. 2.2 State the nuntber of years the programme has been operating, and d possible enclose previous statisttcal, financial and annual reports. NOT APPLICABLE 2.3 State the number of persons treated each yearfor the last 5 years: NOT APPLICABLE List the organisatton(s) involved in the programme, the sources and amount offunds used each yearfor the last 5 years. t 9 2.4 NOT APPLICABLE SECTION 2: PROJECT BXECUTION OUTLINB 3. DESCRIPTION OF THE PROPOSED CDTI The ntain stroteg/ of the project will be to develop and establish contmunity-based ivermectitt lreatment syslems, which can be sustained by the endemic communities themselves without external support after the S-year project period. This section should describe how the NOTF plans ro develop and implement CDTI in all high-risk communities in the project area. The plan should take into accouttt the need to develop approaches to CDTI which are appropriate, for the different local situations, and the need to carefully evaluate the implementation of the selected approaches and adjust them when required. The main goal of the proposed CDTI project is to establish a system that directs the treatment of target groups for the disease Onchocerciasis by the community themselves through the involvement of the health system to ensure its sustenance even after the, project phases out. , l0 j 3.1 Outlinc Plan and Timing Activity/Justification Length of Time Advocacy and sensitization at the regional and zonal level - emphasis will be placed on introducing thc APOC CDTI strategy, and enlisting the support of the regional level with the participation of the NOTFA.{OCP, regional administrative council offices 4 weeks Agreement on the definition of roles and responsibilities of all participants - through MOH with the region, APOC Proposals, etc 4 weeks Procurement of essential project equipment and supplies Computers, Mectizan drugs, and vehicles. l6 weeks Training/retratning ofproject trainers at the regional level: Training to those who will function as trainers and supervisors. 4 weeks Rapid Epidemiological Assessments : Epidemiological surveys for onchocerciasis have been completed in the SNNP Region. REA surveys however will be carried out to classify endemicity levels in the project area 4 rveeks Mobilization of regional and zonal authorities to support the project 2 weeks Conduct KAP Studies Since this is the first time treatment is to be carried out in Ethiopia, KAp surveys are essential to guide the development of appropriate health education materials in the zone 12 weeks Mobilization of endemic communities, stressing community ownership of the as well as the health education 4 weeks Selection and training of Community Directed Distributors (CDDs) Selection of CDDs is the responsibility of the community 3 rveeks Household registration, and census enunteration 2 weeks Mectizan @ Collection and Distribution in endemic communities 8 weeks Monitoring and supenision of Mectizan@ distribution activities by zonal and woreda supervisors 4 weeks Inspection of CDD distribution activities (spol checks)by regional supervisors and NOTF lves I week MIS (Management Infonnation Sys tent) Reporting of treatments and training will be required, as in the past, on a monthly basis and appropriate feed back sent to the providers to ensure the adherence to corrective measures recommended. Monthly NOTF/APOC evaluation team conduct internal and external evaluation of the project 4 weeks Review of Treatment Activities Annual reviews and reports will be generated and used to ensure continuous improvement in designing the following years action plan. I week Action Planfor the next year 2 weeks ll 3.2 Ilcalth cducation and community intcraction and participation. 3.2.1 How will you approach and intcract with the community There are already cxisting systems of communication with the proposed project area through other health programs as described earlier. However, the following strategy will beimplemented to maintain good relations with the communities: a) Discussions with zonal council chairmen and social affairs heads and then with Woreda chairmen, local farmers and urban dwellers associations, religious leaders, community elders and opinion leaders to better understand community protocol b) Focus group discussions with social and religious groups to further mobilise the community with the support of the community leaders c) Focus discussions with the community members as appropriate (separating men and women, or not, depending on the community traditions). The community members *il ulro be encouraged at this point to take ownership of the program, defining their ioles and distribution mechanisms 3.2.2. Health education Health education and community mobilization will conttnue be an integral part of all approaches to CDTI- Health education activities should ensure continuous exihange with regards to lcnowledge, awareness, perception and observable attitudtnal changel about onchocerciasts and its treatment. Appropriate health education messages tn tie form ofposters, pamphlets and verbal presentations will need ro be developed and tested. Health education should address thefoilowing issues (see Table under B): Health education is the best tool to produce change in behaviour and bring success onincreasing the health status in community. Therefore tJ achieve the goals of the Cbff program health education will be conducted by health workers and other partn"ers. A. venue The venue for health education will be schools, churches, mosques, treatment posts and otherpublic gathering places. l2 Il. Critical Issucs in the Dcvelopnrent of Ilcalth Education for CDTI Knowledge of treatment titude to treatment a) Have any KAP surveys been done in the project area and if so, what were the results? No KAP studies have been carried out in the project area b) Wot methods will be used to develop health education materialfor the communities and for the agents who will be responsible for ivermectin treatment? Health education materials such as posters, leaflets and flipcharts will be developed in local languages by the project and submitted to NOTF for standardisation. These materials will be field-tested and refined/adjusted in accordance with APOC accepted strategies prior to mass production. ISSUES Health Education Messages Knowledge of the disease . Local name of the disease . Symptoms . Causation/transmission(simple) o Previous experiences with Diethylcarb amazine (D EC) o lntroduceMectizan@ (ivermectine) o Dosage o Exclusions o Reactions . Beneficial side effects Advantages of Treatment: . Free . Yearly treatment . Possibility of self treatment at community level . Importance of maximal coverage Attitude to disease . The disease can be controlled . Onchocerciasis blindness and skin changes can be prevented Attitude to good record keeping . Minimum requirements for record keeping . Records are confidential and strictly for health use o Records required are for subsequent drug supply l3 c) k{/hat mcthods will bc ttsed to providc health education lo the cndemic communities and to the agcnl s responsible for treatment? The zonal health department has in thc past used several media for providing heatth cducation to endcmic communities. Such methods include face to face discussions with health workers, the use of town criers, traditional birth attendants, community health agents the use of posters and flipcharts in local languages. Community leaders will first be informed about the disease and the necessity for regular treatment with ivermectin. These community leaders will serve as agents for the program, encouraging community members to comply with ivermectin treatment. All community members will be engaged in discussions about the health education messages, and given the opportunity to ask questions they may have regarding any aspect of the program. Community members will also provide valuable input into the health education messages and materials C. Frequency: timing of regular mass health education will be determined in consultation with the community. 3.2.3. Community Participation ht community-directed ivermectin deliv,ery systems, mentbers of the endemic communities do the execution of iverruectin treatment themselves. Trained personnel, known as Community- Directed Distributors (CDDs) who should be fully supported by the community itself may provide treatment. The cotrununity should be responsible for the organtsation and execution of the CDTI with ninintum but effective medtcal supervision, once it has received the necessary tnformation and traintng. Various organisational structures at the community level, ranging from women's co-operative to traditional structures, are iruportant for sustaining and strengthening the support network of the CDDs. a) Explain the organisation of the intended community-directed iverntectin treatment in the project. The formation of an Onchocerciasis task force at all levels is essential in order to promote coordinated activities of Onchocerciasis control in all endemic areas. At Federal level the MOVDCU is responsible for routine program management and acts as the liaison between MOH, RHB, as well as with NGO partners within the country and outside. The NOTF will be the governing body for onchocerciasis control activities in Ethiopia. The head of this unit will act as NOCP coordinator. At regional level, MOVDC is represented by a department and will be responsible for program implementation at that level. The head of MOVDCD will act as a ROCP Coordinator. Similarly, at the zonal and woreda levels corresponding Onchocerciasis Control Task Forces (ZOTF and WOTF) will be established. The WOTF will be responsible for program implementation at Woreda level (ensure.selection of CDDs, supervision of treatment activities, record keeping etc). I l4 tAlso, local hcalth institutions under thc WOTF will be rcsponsible to co-ordinate, nronitor and supcrvisc CDTI at cach locality. The smallest unit for distribution will be the village (mender). Menders are clustered together to form administrative Kebeles (led by a Kebele chairman). North Gondor zone has 16 woredas. Although the lowest administrative level is kebele, the kebele is further divided into smaller villages locally known as "menders", the exact number of which is not known. For tlre purpose of ivermectin treatment the number of CDDs will be determined based on a guideline of 50 households or 250 people per CDD. Once communities select their CDDs, they will be trained in the CDTI APOC strategy for ivermectin distribution. CDDs and other local primary health care workers will then provide health education to communities on onchocerciasis (its cause, transmission, control and preventive mechanisms). Prior to the distribution exercise, registration of all households will be carried out and non-eligible individuals identified. After registration, ivermectin distribution will begin. The CDDs will follow up defaulters based on their treatment registers. Both Woreda and Zonal health staff will carry out supervision and monitoring activities How will iverntectin distributors be selected? The selection of CDDs will be the responsibility of the community through the farmers and urban dwellers associations. In some cases, leaders may make this decision on behalf of the community. They will be expected to be honest, dedicated, literate, and permanent residents of the community. c) How will non-eligibles be identified and defaulters followed-up? Non-eligibles are mainly identified by having a complete household registration census and defaulters are identified by referring to distribution record or house hold cards. about Defaulters, upon identification, will be treated by the CDDs. This is also done after previously non-eligible (such as pregnant women) have delivered, and therefore now eligible for treatment. 3.3 Local operational researches Are there any plans to conduct local operational research? ,/ YES NO If yes please gwe details The following are possible suggested areas for the operational research. a. Determining the prevalence of onchocerciasis associated blindness. b. Difference in prevalence of onchocerciasis between the natives and new settlers c. Acceptance of ivermectin in the community d. Effect of treatment on the health status of the community b) l l5 c. Mcasurcnrcut of cconortric irnpact of onchoccrciasis L Study on lcnralc acccptancc working as CDDsg clinical nranilcstations and trcatmcnt rcactions at diflcrcnt sitcs a) Whot lrotning will be provided to ensure the development and sustainability of the CDTI? Training of CDDs to operate CDTI is very vital to the program. To ensure sustainability of the CDTI program, TOT sessions will be conducted by the NOCP. Those trained here will represent both regional and zonal levels. These individuals will in turn train representatives from Woreda and health facilities. These will in turn train CDDs. The training sessions will focus on the following topics: . Epidemiology of onchocerciasis . Health Education and community mobilization o Mectizan@ distribution and its advantage over other methods o Management of adverse reactions . Record keeping and reporting . Monitoring and Supervision b) [ndicate criteriafor selecting trainees (supervisors and contntunity-directed distributors). I) Criteria for selecting CDDs: (i) Literate if possible(ii) Resident in the community(iii) Willing to serve the community(v) Must be honest(v) Must be available(vi) Must be selected by community II) Criteria for selecting supervisors: Zonal Supervisor: a (i) (i i) (iii) (iu) (u) Must be a PHC staff selected by the state RHB Must be knowledgeable Must be interested in helping the community Must be stable Must be honest d) Indicate nuntber, type and duration of training courses intended Table 2. Number, Type and Duration of Training Courses S.No Type of training Duration Session Remark I Regional Training 5 days I At Regional Level 2 Zonal Training 5 days I AtZonal Level 3 CDDs 3 Days I At Wereda Level 4 Supervisors 5 Days I At R'egional andZonal Levet l6 a 4 SUPPLY, IMPORTATTON, STORAGE, INVENTORY AND DELIVERY OF MECTIZAN TABLETS This sectiott is only a reminder and concerns lhe supply, importation, storage, inventory and delivery of ivermectin lablels, donated by Merck & Co, who will also pay handling charges for ivermectin to their accredited agents. Mectizan@ consignments will be received through WHO and stored in the MOH central stores in Addis Ababa. tt will then be transported by road to the regional health bureau, and from there to the North Gondor zonal health department. The zonal health department will be responsible for delivering the drug to the Woreda Health office and CDDs will then collect the drug from the health facilities. A report showing the use of the drug will be sent to TMEC at the end of every year, by the NOTF, with the subsequent application. Copies of the application and the report of its use will also be sent to APOC. An application for Mectizan@ tablets will be submitted every year by the end of September to the NOTF, using the standardised form of The Mectizan@ Expert Committee (TMEC). This application will then forwarded to TMEC in Atlanta for review and approval. 5. Supervision / Monitoring & Evaluation 5.1. Supervision during CDTI Projects are required to be supervised and monitored. However, APOC funded projects will need to be designed to function with effective but minimum supervision compatible with its objectives. a) Please describe the supervisory arrangements you consider will be required for the CDTI you propose how will this continue at the cessation of APOC support? There will be intensive supervision at all levels of program, especially during the early years. Since the program will be integrated into the Malaria and Other Vector Borne Diseases Control Unit, the supervisors and monitors will be staff of this department. The Woreda health rvorkers trained to train CDDs, will also be responsible for supervising their activities (proper record keeping, complete census enumeration, Mectizan@ inventory and dosage, and monitoring during the actual distribution process). The supervisory teams at the zonal level will be responsible for supervising health institutions (management of side effects, Mectizan@ accountability, and reporting on treatment coverage). Most important will be supervision at the community level where most treatment activities are carried out, and CDDs are responsible for proper distribution of ivermectin. Findings from supervisory visits will be reported along with monthly treatment data, and reporting on adverse reactions. As the program matures, the community will assume more and more responsibility, including deciding on methods of supervision, and those who will carry them out. This process may involve community, opinions, and religious leaders. i I t7 t ) Dcscribc how you u,ould cnsure that supervision will be carried out so as lo . fall within the reqttirement accountingfor ivermeclin use o be sustained when the program ends in 5 years . ensure maxintum involvement of the communities in the process To ensure that the above requirements are met, the program will support regular monitoring during the actual distribution process to ascertain that correct dosage is being administered, exclusion criteria are being observed, and the collection and proper storage of unused drug is occurring. In addition, the program will support advocicy visits to the weredas and villages by MOH, regional, and zonal representatives of the onchocerciasis task forces at each level to encourage the active support of the community. Once training of CDDs has been completed, Zonal and Woreda supervisors will check that household enumeration has been completed according to APOC requirements. 5.2 Monitoring of CDTI a It is important to collect information to monilor the progress of the CDTI. tndicators wtll be used to monitor: o Iverntectin dtstribution? . Health education and community participation? c Management systems? Thefollowing items may be considered Ive r mectin D istrib utt o n . Numbers of communities and persons treated wtth ivennectin c Treatntent Coverage c Regularity of treatment exercise . Contpliance c Reporttng adverse reactions Health Education and Communitv Participation . Numbers of communities participattng in the project o Evtdence of impact of heatth education c Are acttvities betng carried out according to plan and on schedule? o Inventory control, c Are recordforms accurale and completed on time? . Numbers of persons trained c Balance of genders in staff of the program LIthat Manapement , ? t8 Thc projcct will considcr thc following indiccs for monitoring the program of CDTI Ive rm ectin D tst rib u tio n : Since Ethiopia will be starting onchocerciasis control activities for the first time, there is currently no Management Information System (MIS) for onchocerciasis control. The NOTF will establish and standardise this system prior to the beginning of treatment. These will enable the NOTF to monitor the communities and persons treated with ivermectin, treatment coverage, regularity of treatment, treatment compliance, and drug reactions. In addition, the project will monitor the following rates and percentages using Annual Treatment Objectives established at the beginning of each year: Annual treatment objectives (ATO): High risk villages (number of high risk villages targeted for treatment) At risk villages (number at risk villages targeted for treatment) Estimated at risk population (total population at risk in the region) a a Treatment coverage (related to ATOs): Treatments (number of persons treated) High risk villages (number of high risk villages treated) At risk villages (number of at risk villages treated) f o Cost per person treated o Tablets distributed . Number of ivermectin tablets in store at HQ, in the field, on order, or to be ordered Health Education and Communit.v Mobilisation: The degree of community participation in mobilization activities will be used as an indicator of community mobilization. In addition, the support of the leaders and key opinion leaders in the communities wilI be indicative of successful mobilizationas well. The impact of health education messages will be measured tfuough periodic focus group discussions and KAP studies. Manasement The project will develop, through the integration of onchocerciasis control to the MOVDCU, a regional and zonal management/supervisory system that monitors: . The planning and implementation of activities according to a timeline o Mectizan@ inventory levels o Monthly reporting of treatment indices . Numbers of personnel trained . Attempt to balance gender in staffing l9 5.3 Evaluation of CDTI Annual external review incorporating field visits wiil be undertaken to ensure thar proiects are nteeting target indications outlined in this proposal. Such reviews will provide TCC with tlrc assurance that each project is ntoving towards its long rerm stated goal and if appropriate make recomntendations about any deficiencies or modifications to this proiect. Such reviews will draw on the indicators developed by TCC as a guide. 6, SUSTATNABILITY OF THE CDTI AFTER THE WITHDRAWAL OF EXTERNAL FUNDING The concept of sustainability refers to the abiltty of countries and alfected communities followtrtg tnitial external investnrcnt to matntain the viability and conttnuity of the ivermectin treatntent process without external support. For APOC funded projects, such support will normally last 5 years, as the APOC donors demand that there shall be a vtsible and achievable end point for the external donation aspect of the programme, ancl that the comntunity based distribution $tstems established shall thereafter be sustainable by the governnrcnts of the endemic countries concerned. Progress and plans towards sustainabtlity, includtng the phastng out of external and NGDOs support, must be reported annually and satisfactory progress in this dtrectton will be a condition for each succeeding year's funding instalments. Please address the following areds that relate to sustainability: integration into primary health cere, cost- recovery, and other sustainability issues. 6.1. Integration of the CDTI into other Community-based or Primary Health Care (PHC) systems. The principal goal of the APOC is to establish cosreffecttve tvermectin-based control for onchocerciasis, which can be sustained by the endemic communittes and countries. One way to ensure swtainability is to integrate the CDTI tnto the PHC system of the country, which medns more than just using the systentfor ivermectin distrtbution. 6.1.1 . Is there an olficial PHC policy and structure in the country? ,/ YES NO If yes, please give a brief outline of what tt is. Primary Health Care (PHC) policy in Ethiopia is to develop and strengthen grassroots and community participation in health care. The integration of CDTI into the PHC system will be done by including Onchocerciasis among priority health problems in the national health policy. At the regional, zonal, and woreda levels, the MoVDCU will be responsible for program implementation at the respective levels. In addition, combining training on CDTI with other on job training activities, including onchocerciasis control activities in the planning process at all levels, and including Mectizan@ in the list of national essential drugs delivery system will further enhance this. a , 20 , .'l'hc I'llC systcnr will bc uscd to achicvc full integration at pcripheral level by furthcr intcgrating CDTI into the activitics of thc PHC (training on CDTI into training of health workers). This way thc PHC system will be used to achieve full integration of CDTI into gcncral health service by obtaining support from Regional, Zonal and Woreda authorities, bilateral and multilateral organisations. In summary, the PHC structure is as follows: MOH (MOVBDCU) ) REGIONAL HEALTH BUREAU) ZONAL HEALTH DEPT.) WOREDA HEALTH DEPT./HEALTH FACILITIES (hospitals, health centers, health stations, health posts etc) ) COMMUNITY HEALTH poSTS (CHAs & TBAS) a) Howfunctional is the Primary Heakh Care system? - Fullyfunctional - Partlyfunctional The system fiom the National level is fully functional until the Woreda/health facility level. However, at the communiry level health coverage is limited. - Nonfunctional (Please specrfy) Does it cover lhe whole project area? '/ Yes No If no, in what part(s) of the project area is there afutlyfunctional pHC structure? Wat percentage of comntunities where onchocerciasis is endemic, and whtch are eligtble for community-based treatment, have an extsting and functional PHC system. Not Known. Wat organisations are supporttng the development of pHC in your project area? Government of Ethiopia (Ministry of Health), wHo, UNICEF, GTZ and some other NGDOs. Is there any past experience in the country of a programme integrating with the PHC? If so, what programme was tt and how successful was the integration? EPI, Malaria control, and family plaruring drug distribution. The integration continues successfu lly. Are there any plans to integrate other rural health programmes, such as the Expanded Programme of Immuntsation, Maternal and Chtld Health Programmes or programmes for the control of other parasitic diseases, wtth the pHC system? EPI, maternal and child health program are already integrated. Malaria control is under the process of integration. b) c) d) e) J) 2t i 8) Dcscribe lnw thc CDTI v,ill bc intcgrarcd into tlrc PHC systern,. the way tlrc pHC sy.ttcrrt will bc ttscd to achicvc ittlcgratiort and the kcy persons in the PHC systent who will be needcd lo achieve lhe integration. At the Federal level MovDCU will be responsible for routine program management and act as the liaison between MoH, RHB, as well as with NGo partners. Mcmbcrs of thc Malaria Team share responsibilities among themselves and hence a separate entity of vertical program nature will not be established. The head of this unit will act as NOCP co-ordinator. At regional level, MOVDC is organised as a department and will be responsible for program implementation (contacting community leaders, explaining the program objectives, discuss issues related to Mectizan@ security, at regional level, including monitoring and supervision). The head of MovDC will act as a Regional Onchocerciasis Control Co-ordinator. Similarly, at the zonal and Woreda levels will establish corresponding Onchocerciasis Control Task Forces (ZOTF and WOTF). The WOTF witl be responsible for program implementation at the Woreda level (ensure selection of CDDs, supervision of treatment activities, record keeping etc). In areas where access to the Woreda health off,rce is restricted, local health institutions will co-ordinate, monitor, and supervise CDTI activities h) Indicate how early in the CDTI the process of integratton will be tntroduced; howit will contintre thereafter, and after how many years within the externally supported lifetime of the CDTI it wtll be completed. CDTI activities in Ethiopia will be integrated from the very beginning. The establishment of the program witl rely on existing systems of health service delivery at all levels 6-1.2. If there is at present no PHC system in operation or in those areas where these structures are non-functional, describe how the CDTI may be used to initiate and expand into such a system, giving a timeframefor intended progress. NOT APPLICABLE 6-1.3. ln which way(s) can community-directed ivermectin treatment initiate or strengthen PHC? CDTI is likely to encourage and facilitate the acceptance of new health initiatives in the community. Also, through the new CDTI strategy, the community will likely play a greater role in the support and ownership of the PHC system. The structures already put in place would be utilised by the PHC to enhance effective planning and implementation of the project. For example, the CDDs will develop capacities and skills, which will strengthen other programs such as health education, other dmg distribution. 22 tj (r.2 Cost-rccovc r), Systcnrs d u ri ng Conrmu nity-bascd ivcrmcctin trcatmen t Cost recovcry for PI{C is mandatoty in some counlries and tt may be one nteans of sustaining a CDTI after APOC funding ceases. However, please note well that since ivermectin is donated free, there can no be cost recovery in respect to the value of the drug itself; cost recovery can only relate to the cost of distribution. 6.2.1. Please slale whether there will be any system of cost recovery $uch as is recommended in Initiative) to help cover on the distribution of ivermecttn in the present CDTI. NO. 6.2.2. State exactly how any such systenx will be organised, including answers to the questions listed below. ALL ARE NOT APPLICABLE. 6.3 Other Issues Please provide infurmation on other issues and constraints relating to sustainabtlity of CDTI you anticipate and tdentify how they will be overcome. For example: tlte ntobilization of endemic communities the maintenance of adequate supervision and monitortng inadequate human resources logistics and communications s o c i a I /cultur al fa cto rs decltning community compliance (l) Mobilization of endemic communities: Sometimes problems of mobilization of endemic community can be obstacle to sustainability of CDTI. This can be solved through sustained advocacy visits, by assigning individuals with good communication skills and expertise in conducting mass health education meetings to increase awareness of the community, KAP surveys to monitor belief systems. Obviously there will be a need to establish good relationships with the community leaders in order to have increased access the communities at times like these. (2) Maintenance of adequate supervision and monttoring, Mectizan distribution should include community leaders to further increase acceptability and sustainability of the program. All records should be verified during supervisory visits, and informal discussions should be encouraged to determine community perceptions of the Mectizan. 23 (3) Inadeqtrale Huntart Resourccs Inadequacy of traincd health staff and PHC units are expected to bc constraints in implemcnting supervision and monitoring. These can be overcome by allocating adequate time for supervision, in addition to training additional supervisors from health facilities and community members. [n absence of roads in some remote areas, mules and horses can bc used. (4) Logistics and Communications During the rainy season in October to December travel to the endemic areas may be restricted. Proper planning (Mectizan drug orders etc) will focus on providing all high- risk villages with their drugs during the dry season (prior to the Jan- March distribution window), and encouraging completion of distribution before the rains if convenient for the communities. (5 ) Social/Cultural facto rs : Careful attention will be paid to cultural and social factors such as: the appropriate gender for CDDs especially in Muslim communities, respecting the traditional religion, and selecting supervisors and distributors who speak the local languages. (6) Declining Contnutntty Compliance: Declining community compliance will be avoided through continuous mobilization activities prior to each treatment period. Community members could be interviewed to determine the reasons for the non-compliance, and corrective measures taken where possible and appropriate 6.4. Horv do you intend to monitor and measure the progress towards sustainability? (See Appendtx 2 for a list of possible indicators of sustainability) Progress towards sustainability can be monitored and measured by evaluating the project in terms of financial managemenUcontribution, communications, training and capacity building. This will help enhance integration. Financial management should be incorporated into the usual government financial administration. Financial flow in the CDTI project should comply with govemment financial management procedures so that there will be safe resource management. Regional and zonal health department heads and administration/finance managers at each level will be accountable for proper utilisation of CDTI resources. The ability of managers' at different levels to familiarise themselves with financial and human resources in the project can also be used to measure and monitor the progress of CDTI towards sustainability. In addition, the ability of community members to about understand the cause and effects of Onchocerciasis, and the mechanisms for its control can be considered indicators of progress of CDTI to sustainability. The success of the program will depend on the attitudes and practices of the community towards the disease. a 24 t l7. CI{OSS-BOITDIIITCONSIDETTA'TIONS llthere an ertdemic arca cxtends ocross the borders of two or morc adjacenl States, special problents of co-operation between the respective country CDTI may arise. In the event that there are areas to be covered by your proposed CDTI where the endemic zone exlends across thefrontier into one or more neighbouring countries, and where there are likely to be lransitory or even large-scale migrations of Onchocerca- infected persons either way across the border. 7.1 Please describe the particular situation, as tt is likely to affect ivermectin treatment, and the methods you will use to deal with it. People from neighbouring countries come to Metema as nomads, daily labourers and refugees. These people may have similar problem of Onchocerciasis or may contract during their stay. Therefore this type of situation will be dealt at the National level, by creating close contact with the Sudan programme. 7.2 Include pertinent observatiorxs on current political and health relations wtth the netghbouring State(s). There is good relation with Sudan. Recently the government of Ethiopia is establishing good relations in the field of Health. This particularly focuses on cross border health issues and collaboration in training of health personnel. 8. SPECIAL RISK ISSUES In some areas of some countries there may be special risks, which could hinder the smooth running of a CDTI- 8.1 Please describe the situation in any part covered by your proposed CDTI where this factor may in1"r1"re with the prograrn, and asses future prospects. There is a likelihood of high population movement during harvest time and during epidemics of malaria/meningitis. These conditions may occasionally interfere with the distribution of ivermectin in CDTI communities. However, some of these problems can be overcome through discussion with the communities and selecting suitable times for ivermectin distribution. 25 SI]CTION 3: ADMINISTRATION / FINANCE 9. ADMINISTRATION For the implementation of the CDTI project there should bc an efficient administrative path. Therefore the following administrative organisation is developed to fulfil the need for a good management 9.1 Organisational structurc for the CDTI 9.1.1 Please provide an organogram -for the CDTI showing the organisational structure responsible for implementing the proposal. Fig. I . O rganis at ional s tructure of O nchocercias is contro I programme. l r:{"'I31. :.r.R(-.f$t 26 'I'l&!8.,.' r t.t*jl i ir : its i riirft ta.., a9.2 [iinancialAdnrinistration Mcchanisms of disbursemcnts and transfer of funds from thc World Bank to countrics Funds lrom thc World Bank APOC Trust Fund will be transferred to the WHO country office account in Addis Ababa. On request through the propcr channels by authorised officer of the MOH, WHO Addis Ababa will transfer the fund directly to the bank account of the respective Regional Health Bureaux (RHBs) according to the approved CDTI project proposals. The signatories of the bank account into which APOC funds will be transferred at the regional level will be the head and the administration and finance officer of the regional health bureau. All the imperest returns will be submitted monthly by RHB to WHO country office in Addis Ababa that will forward them to APOC headquarters in Ougadougou. Monthly reconciliation statements witl be forwarded to the central Malaria and Other Vector-borne Diseases Control Unit (acting as the secretariat of NOTF) for Follow up. APOC will issue checks (advances) in accordance with WHO ruIes and the previously agreed project documents and/or plans of operations. When the total payment in cash required for the project exceeds $ 100,000, the payment must be made in installments. The first installment/advance could cover 3 months or 6 months of activity depending on the duration and magnitude of the project. Management of funds by projects and WHO/APOC mechanism for monitoring The size of the project will determine which of WHO's contractual systems is used, e.g. Technical Service Agreement, Letter of Agreement, Contractual Service Agreement or Agreement for the Performance of work. A document on administrative and financial procedure will be made available to project being funded by APOC. Built into this document is an impress mechanism, whereby the project will report its expenditure on a quarterly basis and receive further advances on that basis. Each project funded by APOC will require a periodic external audit at project expense. Each project must have one senior staff member who is accountable for the management and control of project funds. Standard internal financial checks and balances must be incorporated into each project's financial management plan. 27 Fig 2 Request and Disbursement of APOC Funds Sffieir I Health MOH -, ., _ .t#r, , Bureau Disbursement Financial Report o---------> 28 ',. ,':-'t ,9.2.1 Inputs from Minis(ry o[ Ilcaltlt a) lndicatc re.sources thal u,ill be provided b),the Minislr.l'of Healtlt artd olltcr governntenl age rtcic.s. l'ersonnel, logistics, o[lrcc accolnnrodation Countcrpart funding Sccurity b) Please provide a list of personnel assigned by the MOH to this project, including their name and proposed tinte ( State percentage of time allocated to lhe project) for tlte project and v,here appropriate , tlteir experience tn onchocerciasis control through ivermeclin trealment- Since this is the first time that Ethiopia will initiate onchocerciasis control through ivermectin treatment, none of the personnel has any prior exposure in this respect.. Regional Health Bureau Name Post ol,Time Mr. Sewnet Tegegne Vector Biology Expert 25% Mr. Mohammed Yassin epidemiology & Diagnostics Expert 25% Mr. Gashu Fentie Vector Biology Expert 2s% Name Post ToTime Mr. Mulugeta Aemero Head, MOVDC Team 30% Mr. Tadele Tegegne Epidemiology & Diagnostics Expert 25% Mr. Mulugeta Lakew Vector Biology Expert 250h Administration & finance Head 25% Driver 25% 9.2.2 Input from the partner NGDO(s) a) Please provide a letter from the Execattve Director or the Director of Onchocerciasis programmes of each participating NGDO stating their intentions to participate in and support the National Onchocerciasis Control Programme. Name Post ToTime Mr. Nega Norahun Head, wereda health office 20% Mr. Terefe Woldie MOVDC co-ordinator 20% Mr. Berihanu Alemu Vector Biology Expert 20% Ms. Elene Birhanu Vector Biology Expert 20% b) Give information of the tnputfrom each NGDO participating in this project. 29 aa a I'hc Cartcr Ccntcr's input will bc:- Funds: I)cr thc agrcenrcnt madc between APOC and the FMOll, 'l'hc Carlcr Ccntrc u'ill not havc direct responsibility or rolcs relating to the managcnrcnl and rcporting on APOC funds. Mcctizan: J'hc Carlcr Ccntre will not havc direct rcsponsibility or rolcs relating to thc accountability of ivermectin in Ethiopia. Thc drug u,ill bc consiqncd dirc<'ll-r, ro lhc WHO and scnl to MOH ccntral slorcs in Addis Staff and consultants: The Carter Centre has been involved in some areas of public lrealth in Ethiopia for over 6 years. In 1993, The Carter Centre, in collaboration u,ith the Centre for Disease Control and Prevention (CDC), began assisting tlre Ethiopia Guinea Worm Eradication Program through the Federal Ministry of Health. Since then, the burden of the disease has becn reduced by nrore thanT0o/o. The Carter Centre's agriculture program has been working with the Ethiopia Ministry of Agriculrure since 1993 in a partnership that led, within the firsr two years, to Ethiopia's first grain surplus since the devastating fanrine of the rnid-1980s. The Carter Centre, since 1997, has also been supporting training in five health science colleges in Ethiopia as part of a national public health training initiative. In lighi of this experiences, The Carter Centre, in collaboration with the FMOH has expressed its intention to continue providing technical, financial, and logistical support to the onchocerciasis control program of Ethiopia. a Office space and facilities: The Carter Cenhe will support the national secretariat by providing technical and logistical support through a local office in Addis Ababa. c) Please provide also a nominal list grading and post description for the personnel to be provided by partner NGDO(s). Indicate clearly what will be theirfunctions in the program and their experience in onchocerciasis control through ivennectin dtstribution. None of the staff members in Ethiopia have had any experience in onchocerciasis control through ivermectin distribution 9.2.3.Inputs from other agencies Please list any other agency or party that will be involved in the running or financing of the CDTI, and indicate clearly its role, functton and contribution. WHO Ethiopia / Country office / will assist the project in the importation and clearance of ivermectin from Merck & Company France, and facilitate the request and disbursement of APOC funds. 30 9.3 '['irncd plan ol'action Providc timc chart(s) showing hou, thc various activitics of tltc CDTI rvill procccd ovcr llrc coursc of tlrc proposed progranr. Nunrcrical annual targcls lor all planncd activitics should bc proi,idcd for cach timc point. Thc linrc chafl should also indicatc how suppofl would bc phascd pout over the 5 ycar pcriod. 3l cl \ \ \ \ \ \ \ \ \ \ an cr \ \ \ \ \ \ \ \ \ \ \ \ ailo a{ \ \ \ \ \ \ \ \ \ \ \ 6l \ \ \ \ \ \ \ \ \ \ \ \ \ o cl \ \ \ \ \ \ \ \ \ \ \ \ \ \ a >t EI d o oo 6) () d tro <(N q tr(.) o -uoc>(!() o6G,EooON <E 0) oL o q o trtE 0)! a) q o o 0) 0)p b04 o 0) 'a q o.E- '.= o oo-29OJ o'o -cc6(,) eECb9LE =o_o.;o)&8 (q Lotr (dp o() 'a rp. o @c- .;Oc> '= iD tJ-0)c, -b5 .! o( -O !d or F: (! qk G)tr dk o !t) 'a q o. o ootr tr(,oIr>bru oodtrtr '=o .=NG, rrfiE (! (.)q(,r oo 'a o. o @tr c(l) .FB E-gs bl) I .=o .EB !g c.r F! a tr(.) E0q G.)oq (! o bI) o o Eo a. Jrl ! o.d& tr o dN p o a e tr tro(J q It) ! E U) o. }Z () Ec o() o a(J o ootr tr(!b!l)9btr tr(!b !tr CI tro oIo CN @tr() o ttr G, i o C, q @ C)!E -o .9 Oi{ 6oqF oaJ-o co ..o 'trl o @cdN o a) z E o e() o. 'otrd @q Lo co z () '- .E (,) d tro .E ,o 'tr AJ o oO oy E()O() OO Oeoo C6 tr o (! tr eq tro o o06tr(o a oo Etr -oa;OJ :\&a o (€ (U o (U ELo x 0.) (o Eo E 6) o tr C) (! o F o i() od trd o. o o .c o al () GL o o d q) q) O. \ I ar0. Ilur)(;ti't' I0.I Iludgct Estimatcs Budget tnust indicate total ./ilnds lo urtdcrlakc tlt<'1tt'oicct.7'he amounl o.f'./itnding requesled .from /I'OC, und thc ontouttt 1tt'ot'idcd by tlrc A4Oll, ltt(il)O(.s) und othcr l)urttt(t'.\. r1ll ntust lx, ntudc itt US dollars. liach hrdcel musl include at lcasl lhe follov,in.q rttuior culcgories (see appendir 2) indicating tlte conlribution of the parlners to reflcct sustaittubilitl,ol CDTI. . Personnel (services) . Capital equipment . Supplies Training . I-lealtheducation/mobilization . Travel o Communication . Consultant . Operating expense . External audit 33 tYEAR ONE SUMMARY BUDGET FOR ONCHOCERCIASIS CONTROL IN METEMA WEREDA YEAR 2OOO 2000 CATEGOITY 7.5% NGO overhead cost NGOAPOC N{OII TOTAI, 12,500.00 25,354.00Pcrsonnel 0 12,854.00 Capital equipment 55,882.00 51,074.00 59,212.00 166. r 68.00 Supplies 4,788.00 0 7,835.00 t2,623.00 0 1,500.00Training 12,999.00 14,499.00 Health Education/mobilization 14,599.80 0 600.00 15,199.80 0 13,900.00Trarrel l 6,683.3 3 30,583.33 0 4,200.00Communication 3,200.00 7,400.00 Consultants 13,440.00 0 0 13,440.00 External Audit 0 0 0 Recapitulation 0 0 0 Operating expense 445.00 15,320.0015,668.00 3 1,433.00 Grand Total 137,260.13 64,373.00 115,067.00 316,700.13 Estimated No. Treatments 55,980 55,980 55,980 55,980 % input 43.3 20.3 36.3 r00.0 34 1I i I . -n n '- i 7 c q E 9 1 ! q cc E ! a I ,_ s : a E ct a E : 8 , t a t F 8 c F lt, l. t; I t' ? '- r l. '- t'- :, lt t- I II : t: li 9 I t o Z a 8 : c ; t 8i t8 E5 te 8: I 5 E ; 8 1 o 8 8 q F o F t 1 8 8 g 8 e1 8 c I z t a a .] 8 :- 8 t E = 8 8 8 d a 8 ! I d n: UI I9 J. 88 8 8I E3 J F F 8 8 -: 8 n s 8 8 8 &a 8 c z 8 ! t ! 8 8 8 .: 8 8 t a 1 8 8n E ! o E I s E :. 8 ; : q 8 I 8 t 8aU: 8 8 J ? oF 9 I 9 8a I x I E z e 6 : 8 s 8 q 8 :a 8 Q U E 8 = 8 8 8 n: e 8- o 5 I jq 8 ; nI U a a 8 9 = 8 3 8 I a Iq 8. : J F s 8: t d 8t : a = 8 e 8 a e t d E E o oz 5 e 8 :: I 8 8: 8 aY 8 x . 5 8n I = s E T ! 6 E I s nI t I 8 I 8 E I : 6 8q 6 e Ij tn d o F ! 3 EI = 9: E a E 9 E E 5 =E 9 ! a I :t E c & F t o f 9 5 E 3 5? u 6 E IF z! E a I10.2 Budgct justilicatiorr Pleasc prottidc a ttorralive dcscriptiott of'lltc rausons.for each proposcd linc ilcms t1f'tlt<, budge t. The proposed budgct lor sonrc of thc linc rtcrns;rrcsented lrere arc also nrcaut {br Quara u,crcd:r that will start its CDTI activitics thc lollou,ing ycar. Specific budgct for Quara wcrcda rs nol indicated herc as REMO data for tlrc arca is nol yet available. Fronr our knorvlgc the arca is known to bc highly endernic for onchoccrcrasis. I{owevcr, inclusion in CD'l-t proposal should wait forcopletion of REMO. Thereforc, mosl of the capital items and supply items will not go much higher than that indicated in the budget details in Appendix 3. I) Personnel The personnel budget reflects the amount nceded for staff at the levels of RHB, ZHD and WIIO to facilitate the CDTI activities at the conrnrunity level. The MOH rvill provide support to thc program in : . Mobilising authorities and communitl, leaders o Organising and leading the distribution program . Training of supervisors and CDDs o Getting and supplying ivermectin o Transportation of essential supplies . Regular supervision o Accounting for funds spent ( both APOC and others o Program evaluation 2 ) Capital equipment In order to run the program effectively the RHB and ZHD should be well furnished rvith the necessary basic equipment. 3) Supplies: Regular office supplies are essential to ensure sustainability of routine offrce works. More over as supplies Paracetamol and Promethazine are required to treat lO%o treatment reactions. 4) Training: Training is the decisive factor to make programs run smoothly and effectively. The CDTI project needs trained community drug distributors and supervisors. There fore to make the CDTI program effective, training will be given at different levels that incurs a reasonable amount of money. 5) Health education/ mobilization The best way to make a program accepted and implemented in a community is to produce awareness and a feeling of program ownership. This situation can be achieved through intensive health education that will bring change in behaviour. [n cirder to implement the CDTI program 36 hcallh ctiucation is thc bcst tool hcncc support is rrccdcd lrortr APOC, MOII and N(jl)O at diflcrcnt tirtrcs. 6)'l'ravcl ']-r'avcl is rcquircd lor advocitcy visrts, llairtirtg rctlarninrq, sultcrvision and ntorrilorinq, anci cvaluation of thc progranr. AI'OC and Global 2000 arc sourccs lor the budgct. 7) Ooiuliruliicatioit : At the National, Regional , Zonal and Woreda lcvcl there will be communication to pass important information on the situation of the CDTI progranl implementation. 8) Consultants : Consultants would be required to conduct local operational researches. Global 2000 is requested for this budget. 9) External Audit A budget for this item will be required to engage external auditors to audit project account. This rvill ensure proper accountability. The MOH and Global 2000 will be responsible for their accountant's participation in audit exercise APOC is requested to support the audit budget. 10) Operating expense: The whole operational activities need a huge amount of money in order to run smoothly and effectively All off,rce activities and some field activities are supported by the MOH. 10.3 Current resources available in CDTIs : No currently existing CDTI progmm. 10.3 Current resources available in CDTI Existing CDTIs (for conttnuation or expansion) will have resources already avatlable. Please provide a detailed list of all existing personnel, equipment and suppltes (includtng vehicles, etc.) belonging to the program, indicating their ownership (MOH, NGDO, other Agency, etc.) and thetr level offunctionality. NOT APPLICABLE. 37 APPENDIX I. ES'I'IMA'I'IiD NUMBERS OIT COMMTJNI'I'IES ANI) I'EITSONS'TO BIi TREATI'D IN I\,IETEMA WEREDA BY YEAR ANI) ENDIiI\,IICII'Y I-E\/EI, MIrSO- ENDEMIC ltYPo- ENDEMIC* a AIIEA CO\/IiITIiD COMI\,l UNITY EN I)EI\{ IC LEVEL HYPEII.- ENDEMIC TYPE OF TREATMENT Community Directed Conrnrunity Dircctcd YEAR r* - (200r) No. of communities to bc treated 20 I5 Total population in above communities 30,358 25,622 YEAR 2** - (2002) No. of communities to be treated 20 l5 Total population in above communities 31,238 26,365 YEAR 3*** - (2003) No. of communities to be treated 20 l5 Total population in above communities 32,144 21,130 'EAR 4**** _ (2004) No. of communities to be treated 20 l5 Total population in above communities 33,076 27,916 YEAR 5**** (2005) No. of communities to be treated 20 l5 Total population in above communities 34,036 28,762 38 I Ivermcctilr 'I'rcatlnents rcflccted in Appcndix I wcrc obtained as lbllorvs l'he total population oI the Mctcnra wercda in the year 2001 is 69,975. 'l'lris gii,cs us arr eligiblc populatiorr of 55,980 lbr thc ycar. An cstimatcd population ol- Zg,iO2liyc ip lrypcr cndcnric colrlrtttttilics rvhilc lhc rcrnaining 24,900 livc irr rrcso-crrclcnric conrnrurritics. YEAII I": A trcatrnent objectivc of l00oh EARP of both lrypcr- and rncso-cndcnric eorrrrrrtrrtitics irr i.irc ucrs.j.r rviii b,- iargei.cd. with some experience, the program will expand its coverage to the neighbouring Quara wereda. The estimated GDTI eligible population of Quara wereda is not yet known. However, with completion of the REMO in the region during 2000 we would be able to determine how nrany of the 42,622 people (year 2000 popularion) in the wereda will qualify for CDTI. YEAR 2.. YEAR 3***. From tlie third year, the program will plan to reach l0O% of the eligible Population in both weredas. However, the eligiblc popularion of CDTI communities in the trvo weredas will be difficult to estinrate at this ltoint as REMO is not yet complete in euara wereda. YEAR 4-5****'After the completion of REMO exercises the EARP may increasc over the thlee years. Fig. 3 Annual Treatmcnt ObJ€ctlyo by Endamlclty Level 40.00o 30.000 8..* 35,000 2s.000 15,000 10,000 5.000 2000 2003m Y€. 2001 200a 2005 39 I aA I'l'IiN I)lX 2: I N t)lCAI'ORS IrOR Ii\/A Lt lA'l'l ON, SUS'I'A I NA lll l.l'l'\' /INTEGITA'TION OIT CI)TI/ Projcct Evalua(i<ln Manageme nt [:inancial nranagcrncn( E,ffcclivcncss of conllllun icat ions Training and capacity building I nstitutiona I conrnrilrrcnl Fulfilment of otlrcr rclcvant sectors Problem solving capacity Integration of operational research Project effectiveness Result of KAP Srudies Treatment coverage Follow-up of non-eligible and absentees Management of adverse reactions Reliability of repo(ing Su s tain abi I ity/Integr a t io t t Political will of host government Political will as shown in policy statements and apparcnt commitment of high-level Officials Offrcial action assigning personnel, funds, vehiclcs to program Long-term planning ls there a long-term plan for sustaining the financing and the management of the program? Progress toward financial sustainability If program sponsors cannot continue their current level of commitment for at least another five year, what percentage of rururing costs is now paid for host govemments or fees? Progress toward integratio n to what extent has ivermectin distribution been integrated with other health service programs? evidence of community empowerment and ownership change in KAP over time 40 a! (U o lr) Lo o E o so ro t. u.lFz tUo d UIFd o tu -F ao oz oq$ r.) @- o{ J FoF I o = oo|r) N o oz fo oo c .9 Gc$ c,o G o oo o dz C'o E Jcc oo =oo oE o $ tr o oc s CLx ut sloN o E :E IE C, 0- slo(\t q) E tE(q(L slo(\t o) E IE$(L slr) ol o E .F IE(E(L c .9 cl s CLx TTJ s ro N o E IE o(L s rr) c\l o E IE o(L s ro N o E I L o(L is GI to (! oF oq oo$ oq oool $ oq tf) r- ocooN ood @ + i s Glt E oF oq [f)N(a aq roN ': oq ro N o_ N oq ro t'*t^(o E(! .a o dz N (I, o o dz lr) o) oc o -o a. o G, @ E atr c oo(o oo$ oo(o oo@ o (, ! .(E (I, U' E :, c c oo co oo O) Oo O) o o L a o .Jt orN oIN oIN o -N q, o L f o U) or 3 oI = oI = .tt c -9 =o o o. o (g .go ooo (E c oN LL t'-oN L o .z Lo b(I) oLo o U) c .9 .= o o(L o (o -cD ooo C,E oL o = TLFo B o o =:o(U E =C] o)I o(! .EE ooo FoO E o a -o :, U) 2q(Do LJC ioU,Loo)lc .o cceb .x=o(DCC(l)'- OJ o_ o - = =F UJ + -o = E o a -of U' TU z oN u ooz o(9 -Fd o 4 -o = zI o TUu d I ={I o = c o GIc s CLx ul so ro o E 'a aE o(L solo o E .F IE o(L sotr) o E It o(L solr) o E IE o(L so rr) o E IE o(L so ro o E .E IE(o o_ so ro o) E .F IE C, o. so rr) q) E IE o(L Z. G G th (E oF oq @ .f(o oq @ rr) oq @ rO oq @ Lo oq @ rO oq N rr) oq oo(o oq oo(o oq$o rr) .tr (I, th o c,z oc o! . o o @ G = c @$(O @rO @ l.r) @ rr) @ rr) c{1r) oo(o oo(o o o f oa coIt coIt coI x. coI x- coI u coIt CDIt CDI u oE o a oG (t) o Z o c =ooo c(o .9q)(n (U o (g .U' .E Eo -9 O)o .9 Eop o_ o E oox[T o (U c o oo(-) Gc .9 o)oL .;oo I o (II .EEL ooo (o C .9o o E. ts(o o =.E :) ii o a -o :, c, foo U) c o oc s o. x ul 6 c) 6c oN C, o o) :> o(u E o o v o 3I o)IE g o(o -c =o oE (t,E E o ts oE oo o D c(I, oc E o c o E G'(l) L o ELo c o o o 6o o 'o oc(I, Eo o.o Ec o U) I (I, c .og) o)t o 'a .> G'c o t o o.o Ec o o I oc oN ot o o. E o O)c c o. oc oN 9. oc o a o g;Eo o.o o c')c c o- Gc .9 o) o,d (J E =3 c o g c f, E E oo oc oN Ec o C'c .9g) ot a c o E fo oro oc o ot o o. o, o Co(, .9E fD 6c oN Dc o (E c .o ol(,t o ooo D((, E c(, ooo foo o) .c .E E E o .E c oNEc(U (U c .o o)ot. t>lo l3lot>IEl(trlolclo oooo E G Ec(! c o IlDo .icf E E oo (,Io Eo Ec o c .9 (E ofoo .ac =E Eoo c o o .s E ooo E E o)I(L (D c oN Ec o 6co o) E c. '= c o (6 oE =E E oo a o L ooE Ec o L(, (E 3 oc o Eq) oo 3oo ooE o o f =Ef u- o o(, t oF oq oo tr)- F- oq o$ I oq o @ oc rr,$ O) oq oo O) oq$ rr){ oq @|r)t- oq oo O) oq oo @. oq N o, rr) oq ol'- ol oq oo ct oq oN oo CJo(fr- N oq oo oq oo(r) oso ro F-.(9 oq oo lo- N oq t-(r, ro- I\ a., o = l o dz (') (f) N o{ N (f) Eq, .= o o o o .= c l oolr) f.- o @(?) oN lr)$ O) oo O) v rO$ 1r)N olr)$ oo O) (o o,N o O) ooN or- oo(o N oo oo(') o rO F. cf, oo 1r) c{ 0) o f oo I o tL I o Lr I o TL r o TL r o LL r o LL I o LL I o LL Io LL I o TL I o TL I o LL I o t,r- I o LL I o TL I o LL I o TL I o lL c o o. o6 oE = o(E clLIol ;t urlcl ol o-l xl url -9o o o o x o -o oo(, o o (D o o o o 0) (o B iE o @ "do o) .E oo @(I) oo o ct o fo E oo oo o-(! J o) (o 3 oa od q o .C ooo ooo o -c -_3 o) f o. Eoo o.o x,o oo o =E B oc(g Io(g o @ C, 0)E o. (l, o. o) E. .E o o oo(o J @ (o o -o.l '- oq <l -=t :l o)l CI LI oJ LI ol ol OI o) .ccoo E x(o LL o) .=Eo(, E o 'd. ooo oE(L o o o '5'1 q El tEl d)l -cl -lol >t ot o(l, c oE o. C, o)o o oo lr) ol oo P t.o at o (, .E oo G o so op -co I'ool so q, c oc.oo o l-- s o o .9 -- f s rr) o)o(El o]6 (l, o EI oi 6 o aa o f =c :,lt- N$ a 0)cE(o o- !c o a 0)ct C'(L 1C c(, Io .c .=3 co g c f E Eoo oCoN 1J c(U o o-c EPo):o.= 3, ,iD iO !o ;i(o';o EEb9 o.o, o){.E ) Io oo ta E o tafo I o =J d u,l o u,lr. tr .9 (E c, -g CLxtu 6 o Ec oN o o o) '5 o(! D o o lz o 3 ! o)E =o(E E =oq) -c ooo o ts U'E oo o) 1' c o o E o co E o o, o E o E o o(, 6o o 6 oc(E Eo o.o uc(u L I 6c .9oot -o ut (! c(, ts o o.o Ec(! L I oc oN oE o o. c)L o o:c c o. oc oN 9. =oc(, Lo siE oooL o oc tr L o. (E c _9oot a c o) E fooo Dc tI, ots oo o o co (U o =ofo 6c oN oc G' 6c _9o(, E oIo Eo Ec(! ooc c .E o -9 Ec oN oc6 6 c o oot (,)(o o o Eo Ec o co og .oo E Ecf E E oo ooo o Eo Ec o co (E o =Eo aCf E Eoo oooo E(It Ec o c o (E o fEq) .icf E Eoo o o(, E oF oq oo o-|r) N oq oo l'-- @ oq oo(, oq olr) c.) oq oo o-(r) oq N rr)- oo cio o- oq oo o-(9 oq oo o- @ oq o1\ Or- oq oo o, oq oo o- oq o|J)(t oo ciq, @- rO lO o =cl o ctz (r) (t (\ ot C\l (o E o = o o o o =cl oootr)N oo O)N oo orr, (., ooo(.) C\,t rO ooo oolr, ooo(, ro @ O) oo(t) ooo o|r)(9 (, o f oo oo o_ () o o- () o o_ oo(L oo(L oo(L o o o. o oL oo o- o o o- o o(L o o 0. o o o- c o o. (,, th oE = .:(,(! E og ooc o o- x UJ op rq) o.l f xJo 6l o B$ ol o >.tol o6 xo -o c)o(! o o q) o o o o o) (o] o od oo ooa o)(_) o(, c 't o, f o, Eoo olo .i Yooo o) o 3 o @ od o o) oaoooo(I, E,t o f o. Eoo oo o.(q J o) -_E] D c(, vo((, -o a C, o) -c o. 'c q, o. E(l) c 'c o- o oo(l' J o (o oE o- 'c(l) o. E --B o c o. o oo (l, .EEo(o E x(E LL (1, .c .c.o(I, E .9 o-oo o o .c.(L o (,) o o. E C,oE o o oq, c oE o.(t o) o) = o oo lr) N oo ts uo i oF a o o o. eolot llEI o5l -tol(r,l ot ol LI €l olol .olEI(Dl >t;lolzl lc o .Uc6 o. x ut 6l orl >l ol o (Il o .c .c E € c .9 at E(D o.l U) Ur1lot cl o)l(1)l EI -t>Jol(ol otol >tEI(El EI ol =_lolcl EI(El H C(D E5oloi1Jt OJ cl (5I ol ol =lol o f =cL =tL lo)lolc oE C, o o.l U' d) o1ol I'Icl(El OJCI 'El =lrlol OJ(r)l trl I 6l()I olEI -t0)l EI ;ltslolololLI *t :l ft an6 o (U (o attco (E(-t .E a @ o,c =oq) E (-, oo ol >1 o1(Ul ol6t sl -lut .cl cl (El FI I o oo (E o oIoo o- ro oq ooo- ro(o oq oo ro oq o ro (.) oq N ro- oq olf) N oq oo rr)- ocoo ro_ oq oo(r) oo o{ ol C" ro o =c a o dz E(l, .: o o oo .=cf ooolr) ooo ro(o oolo o(, (o (\l ro otof.- oo ro ooto oo (f) o)(,!f oo o oz o(9 z o oz o(, z o oZ o oz o(, z o oz o(, z (It o E(D U' f o sotr) (D o t o >l o B1 v1 c o CL (, o oo = (, (U E o ;lll)ci olol xtUI o l =c Doa l ol slol rolJ -ld)l oJ ol()I ol ol -Cl o-l op Eo o B .f l^lel(trl3 lol6 l.o @o oaa(D oo s_.1 -ld)1 rl ol EI otold ol ol _El 3l(Dl zl o) =E 3 oc(U v.o .q -o o(! o) c. o (l) o- o) c o- lo l'-)lol6l(trt;l(r,lol a o) rn :f o solr) --,,1 (D C c) ol(trl El xl('t tl-l o o(D .o. o,p oo -c. (D o ol ot o)l '6] q (r)lEI :lal .U oF E tuFz UJo t uJFt () IU fl" o oz oot o- r|r) J FoF 4 o = c o (o cg o-x uJ -=t _ol LI(Jt d)l d)l ul cl6lgl c)l (EI EI oco (U o o,o >.l (u o ooc o)Ec o o-oo Lo C) EC(E 6t o1 o.lolLI +lol 6! cl ol FI U' o(,, E oF oq ooN oq oo@ oq o|r, oq o ro @ o .=cf, o dz E o = o o o o .:c = oo6l oo(o o rr) oo f oo or ts oI3 oI B c o so g, o = l s tr) ooo o. al, o() Eo o) =(D o.l >lF 6 oF aIt :,a o -B =ruF UJ =II o = L .9 oc o CL x uJ C .o G .cE o oo E(U L o,I(L oc oN EC(I, 6c .9 o) oL E = 'c .9 oo .E :l E E o O :s oo El E C- T] 0) (tr =l ql ctot (trt (l.)l OJOI >l :l(Ul ol o o(, G' oF oq oo o- @ oq ol rr) N oq oo(o oq oo o) o e c{ rot- o) o =c :) o oz E o .= o o o o .=cl ooo@ N rf) C.t oo(r) oo O) o, o o @ oIN oIN oIN oIN c o o. L o o oE .= 'a o lE E o =ooc o CLx so op E, o) (,lc o 'i UJ s o1 ;lcl ol -c.t o] c)l olFI so o o : l sir) oo(I, o. U' c)o Eo 6 o .ct ao oIN tr oo z. o o IF &. oz -o = c o (! trs CL x Lrl c o o .sEL o 8 E E cI, e(L o)c oN ! c o Ec .o o,o E '= c .9 (E(-) c.l Ec oo '6 o o)(l)l ol c.(El -1(Dl (o =l o)ctot (uI d,l OJol >l([l ol o o o .U oF oq oo(f)- N oq rr)(\l oq lr)o oq lr)ot* o e ro(r, c\l Ci' o =cf, o dz E o = o o o(,, .=cf oo (f) N lo c! r()o lr)oF- @o L :l oo @It- mIt coIg. coIt c o o- o ao oE o 6F so at o : l s rO oo(U otn d)or- o f o lt :, U) so q) .9E o o)c .9.x LU (f)$ ooZ 'doE+ 9,flEr@ 'o_!q9Ebo o_o-o J f ultf lI! -FJ uJI J z. o o ul u. d - =f -o = -- ,z o a! E o =o oc ooxU $s c o Gltrs ELx IU o c,) E o o o iI at,E o o- oL o co EJoop o)c o- ooo oE(L =o-) o o f o- E oo C,)c .E c L& (, c C J o() oo .9, U' oc G o Go .ttco oLo o. o 3(I, o co E =()oLo o .9a o. =q) o oo E oF oq o .+ oq lr) N ol oq o(0 o eo(o oq o ro$ oq oo c)- t- oI ro a) @- t- o .= = o dz N (o N $ (9 E o .= o to o o .=cf oN ror- ocf) rr)r o(o ooo F.- ooL :, oo ooz o oz o oz o(, z o oz ooz c .9 o- L oooo .= .z oo E @ .= ootr o CLx ul U'q) =.d!6 o .q) o.ooo o _c o. o c) o)o E(o o L oc oF o =c 3 D c(, i<(u -o o(,) o t oo L o, c (L o o (u f,o oo boc o (U a .h .g o_ o- l @ o co Eo fooL(L E o tr o Gcsox IU o o)g o (r, g LL att oooL q, c(t) E fooE q C o.ooo oE(L =o :fo Lo =o. Eoo q) c c L(L U'E o. Eq Ut o. Cl E q) c c L(L (,) c c foooo .9, ah oc o C' oo oc .9 Eq) o.o3oo ooco .c. o.o o)o E Lo o U') E5Cc oo U' oo E o) o o o so .g al, oo ro op an o C o, E o c)L L oLr a o @ oo ro o) (o q) o so .s o C)o I o op tn o c o E o og L otL at, oo E o oq o(o oq oo(o oq o$N oq oN r oq o ol oq o ro c\t C\l oq olr) oq N cf)@ oq(o $ oq @ @\{ o .= trf o dz @ @ @ N @ 1r) oo ol N ro C9 E o = o o o() .=cf oN rr)F- ocf) o(0 tr, olo loq o (o N co o(, f oo o o(L o o(L o o(L o o(L o o(L () o(L o o(L o o(L O o o- oo(L tr o o- L o an @o = o o Eo =ooE o CL x UI .o o a.af a4 o(t Eo aD oto -Y .t4o L .q) o.ooo o c. o. oo o)E Lt C,o LoCoF (D =E, 3 o c.(, .:z C, _o q) oo LE(I, o L(l) c L(L o oo oop Lt oo Lo c .E (L o o (I, fo oo e o)co G' a - o (u -o oo bo to o o c oo U' _o !o ooo o ol E oo(o o E(I, d)o oL(E o_l c(! o U) _oq ooo o o) E tr)N q) c .N (o q) EoL(L E oF t I(I, oao.9 6 lo-o)=E,nco; E co q) x =(l)c-=(l)J o o- d ulFz lU(J u IIJFd o ul -F ao(9 z oo o- (o .f ! Itrlo (E E(U ax tU l^lLlo)t> o o. c)t Lo olC o ct)f o (f) E .oEL o)(LI C o Lo +.1 o.] oi EIol >J(EI ol\lolalll ol(olg EI ol E'I LIol o-l Lo Lo + ciou Lo C'E oaf o (f)YE(t) E' L] ol o-l 3o oL o E E(Uu o)oLo Lo :tr d) EL c) o-l o oo E o t-- oq oo CO o eoo (f) oq oo cf) oq oo(o oq oo ro- @ .=c = o dz o o o lf) E o .= o o oo .=c :) o c.) o(o ocf) oc\l oo L f oo ooz o(9 z o(9 z o(, z c o cLl LIolololol >I >l ol(El \l EIol -=l ololclol o-lxltul oo s. a -YL o 3 o) .g .g C,L ocoN o. oEa :< L o =o) .E .s o lLFo = o.oca ll o 3 g) .E .c(v L ooo o)c oo E 3o '5 o o, E E o q) oL(L J FoF c o otr s CLx UJ (u o o g) .E .c G,L C) d o c o E -c .tt oL E : o(I, oocoL(t) C. ool >,J L o1cl OI (E] 6-l EI(l,l EI LI(t)l o_l C o E c,ooL o)L ='6 (E o(,coLo co C) al o) C -ol (El ,-) EI(l)i r-lT'ILI(t)l(Ll q,l c c '61 -lFIol ol cq) EEo o o =() (U ooCo o) coo boco .F o a Eo E L(D o-l ooo(-) Ec o q) c oN dc .9 C,)oL Lo p o cf .an @L o .E oL L o ah op J o c .9 o)oL Ec o o cl o1II olsl aht -ol YI ol(l)l -clol oooo Lo o .9 v.(, oE,o o o(, E oF oq oo(o oq o(o @ o e(o r$ oq o(o(fr- (f) oq (f)(o o)- N oq oo o- s oq oo oq oo - oq oo(o oq o) o) o)-(\ o -E = o C,z (9 oo .f oN oN oo (f) E o .= o o o o .: trf ooN o(o @ (o s o(o cf) co CO(o o,N o (o lr) N o(, L a o U) oo(L oo o- O o(L () o o_ () oI Oo o- o o IL o o o- (J o o_ C o o- L oo oo .= o o E o2 o ,n E o o-x ul ol .c .c(I, L o) =ocL oo (U c .o o)ot Foo c o FoF (u CoN Fo() co FoF Fo() c o o) .Cc '(o ooo o) a fo IUt ta o o Gtr O) c (E\ o olc c\ o. U'E oEo .g o)p)q, E f, fo L L fo aq)p f o) o o(= LLFo = tLF oN op a o) ooo J FoF a U) E9o)(JCg:= EFco; C c.j P xE9 L(Ij)J o- o- u. UJFz ul() tr UJFt. o lUIF a o oz o o o- (o .f tr o oc s CLx UI co E .c. U' o)L E Ec o 6 coL : '6 olL co EE, al,oL o)L Ec o E c E := o(! tL co E -c(o oL 0)L Eco E coL := o o TL o o o E oF oq oo(\l oq ooN oq oo C\l oq oo(0 to .: f o dz E o = o o o o =cf ooN ooN ooN ooL f o(n o oz ooz o oz c o o- L o ooo .= .: o G' E @ .= ootr o CL x lU C .9 o c o o Ojc .E 'o (E c .9 o,ot C o .g(, cq) o o) .Cc '6 g ocoN Co .o(o cq) o o) .Cc '(u (o oo Lo E E oF c o otrs CLxlrl c .9 oo Eoo o(E oo E G 6c .9(, ot c .9o o. E(E o (, (E o o Eo 6coN c .ol(U o. Eoo o(l, oo Eo oEoL o = .Yo c, o. co .E (u EoLo .c .gEo aooo -o .9 -o) o. o -c (,) C oo)E o L otr o oo o .rC o :o C o c oFG .N -oo E .E f, E E oo L o u- o oo o D o Ec o C o o .N 5o E .E =E Eoo L o LL o ooo Eo EC o Co o .Nbo E .E f E E oo L otL oooo E o Ec o co o s -oo E ac :, E E oo Lo LL o(! oo :o (U Ec o co og -oo E .E J E Eo() Lo LL o o ot o oq oo(fr- oq oo ro oq oo @ oq rot* oq o(0 Or_ @ oq(o o)@ o e @(o N oq oo(o oq ooN oq oo o_ o oq o)q) .o + to .=c J o C,z ro @s$ (o O)@ @ O)@ oos oav ooto Eo = o o o o =cf, oo (f) oo ro oo @ lo oN cf)o q u? o c\l @o =oo o o& O o(L O o(L o o(L o o o_ O o o- O o o_ O o o_ (_) oc O o(L c o o. L oo oo .= .J G, E o .= ooE o CLx ut c .9(U cq) o O) .E .c C, oc .9g, o)t. c o .q o g o o o) .s .E o Ec oN c o .g(! co o o) .sc '6 L $EoL o = (o ro o)L o) 3 J(o c oN j (g c .9 o,o q) O)(I, x.oo o- c .9 G, E Lo c tn .g\o (U =u:c tr |E U' L o ao(L oE oEo .9 lJ- aoL l c.ooL(D U' o) o)(o oao E E, ; .t) L o .Yo U) oo o)oo U'o E .C, =3 o .EEoIF ooool ol -clolcl ot E o coe_E(trNEE6=O'CE.o co$ o(of .xEEcc.Pb o_ c = t TUFz TUo d UJFd. o ulIF a o(9 z oo o- o o ao al, E o) o.ll o1 ol(Et ol cl _tFIol o (E cl o E1 ol cl '-lEI cl(ql 6l 6l(Dl >I .tol ol J clll ol(Jl o(I, c o)p o .g 06 o(E o E c .o (lt EIo Eoo(-) l(! -16 6l EIolEI '61 cl .-t .tl(l'I ol EI cl ol (Ul arl ol EIolotol(!l ,;l cl cl(DlEI olcl "rlol EI co (trE o EIo o1o(!l l6t 6l cl olEI ol cl .tol(!l ol EI c oE @!,o Eooo o .d6 cl G,1bI olcl -lol6l(DI EI o o(, oq o t4) oq oo (f) oq oo{- @ oq oo c{ oq o ro og oosl oq o|r) oq ooN oq o rr) oq oo or c,t o =c o C'z 6t lo o o o o o E o = o o o o .= cf rot- oc{ o\f@ o c\l ra, oN r, oN |r) z oo f o ooz ooz ooz o oz o(, z ooz ooz ooz ooz .9 oo E oo _l ol >l6l Fl <t B .9 o o E E(o D c(u Ec o o E E(u oc cc(\l o rcc(U 3 .q o o E E E olo o, 6coN o E E oF cc(o oc(o 3 0) 't o oc cc(o o Ec(o ! C, 't o o E E(E o: e o, oE Eo3 E .9 !, o(L c .9 .9 a @o l <t) (o oo o E(! coN 6c .9 Ol @E E .9 E @ o- E .o Po o_ E .9T' o(L E -9t (D(L tr. ulFz uJo E,r!F tr. o UIIt; o C,z (o J FoF oo o. c -9 otr(E lololo l.aIN INlxt-lotot>lololo lE oo e x o(t)f o x c oo o o.l (f) 61 'o-1 'rl }] olql 'El ololrl al o o E\t X (U N EY oo c{ o o o E oF oq os(o- $ oq oN CO o Io(o(r,{ o =cl o dz N N E o :- o 6 o o .= cl N o_ N o @ o o a oo () (L o o o- c o o-Eo o @! >1 =>l =lol{l EI ol -lol6ltrlot o-lxl url Eq) D o) o- D c o c .9I z o o.fo oo o .= o o. o) q) oc o o C(o o 'tr o f Ef, lL ii o -of(r, o -3 =u.lF IrJ =i o = I oo 6 lol>rt(!IE lr.- oI ool o x c1 o @ oq('ri ot =iol >l -1 olal 2l @l OJflol l(uld,l>lo U'o EE o,t x p o U'f rO c? o x E EY e EY ol o1@l o o(, G oF oq o ott oq o F- oq o o){ o =cf o dz ot N E o = o o o(, =tr f o N lr)(, o(, J oo oo o_ oo o_ E .oE oo Ec o c .9o ao CT :,o (E coN .:(o o. o o 2'l o cl ol ol ct6lot 'El6lJl -l(l,lfl rLl E o .ctJ(t, o -N u. oozoo IFtroz Io = oo (, @o E q oE o CI x oaf, Eo c, oo E '- $lI @ =o U)ll ,o1 a?l ol II 0)l EI)rl el EIYI olololNI x co E(D o(9 o!o Lo6 .E @o l u) o o o I!- oF og oo(o (f, a?(.,(9 C.l e) a? c, c, @ o =cf o dz c! ol E o .= o o o o .= cf oo CO N o() f o U' () o(L oo o- c o o o .n o!t o(g Eo =oocoox TU E .9E q) o E c(E c .9 .9. eq) o. fo(' c .9 olod .=(o o.(l) o, z' Ec(E c6dl 'El olll -lolfl trL I E o -ofo = TT d.f dI IFJ UJI J zo (9 UJ G, d I ={! o = c o oc s o.l x ul o @ -o E o E TLF oz o o o- .C Ec J e o!F o o(, G oF oq oo{ og oo .c o =c :, o d z $ E o -= o o o(,) =tr l oo oo f o(n () o(L c o o. oo oo = (, (U E @ ;I ol aLl xlr, o c .qG o @o Eoo o (E E a E o Il :, U' N @ g q)Co o(6o -F;E oo= xc, o.cEJq) o- o- (J o o- c o CL] LoooDl n >l =to6l EI oI =lol6l cl ol OJxlul c o Gcg o x ul at c o EfooE c o o) :f, o Lo anc(\, t'- .n(l !o o =an oc oN oc .o o) E E .= 3 c .o ollc =E oo o oo 6 oF oq oo(o oq oo(o (f) oq oo o{$ o .=c :' o CJz N N E o .: o o o o .=cf otr) oo(o o o :, oU' ooz ooz c o o- ooq, o = oo E]o ol anlclol cLl xl rul o foo q) C orl o](l)l d,l F1 E o lt :,o t. ulFz UJ(J t UJF u. (J rUIt; ooz () o(L c o Gcs CL x IrJ U' c o E f,o oE c 0) o) f o o oc(, F @ C,Eo o3 .n oc oN oc .9 O)oL .C, '= c o 'a oo c =tr oo o oo (E oF o eo(O oq o(o Cf) oq o(\l!+ o .= cf o dz N C\I E o, .= o @ oo .:c3 o CO o (f) oo f oa o o o_ O o(L c o o- oo C)I' = 'z o(\, E o .= ooc o CL x IU o foo (l) C oE. o.l o6F E o t!lo E o Gc(E ax UJ o c o Efooo c o E = o (D at c EF .n(('Eo o =o oc oN att c .oo E -c = =c .9 o .9c :, E oo 6 oo t ot- oq o(o oq oo(o oq o(O ag o =cl o dz N N E o = o o o o -= f o(r, olr) o(, l oU' o o(L o o(L tr o CL o ooE .= .: o(! Eo =o6c o CLxtu .9 =oo x(U u- oc oE o. o oF E o II =o oI3 =ntFttl = -o = o -N tr ooz o o IFd o =I o = l u,df,(D IFJ IUI J zI o uJ d. s - =* I o = c o (t c(! axtu @ c, o E fo oo c oog f o o q, c(U F al,(UE oL o =al, o)coN U'c .9 o)o .c .= =c .o o .9cf E oo o oo E oF ocoN oq oo(o oq o c{t- o .=cf o C,z $ N E o2 o to o o .=cf o (f) o rO o(., :t oo () o o- O o o- c o 'a CL (, ooI, = .:(, lu Eo =o0tr o CLx uJ o =oo x(u tL oc oE o. o oF E o Ilfo tr o aucg o x uJ at, c o El(, oD c o ol) o c) an c o F o oDo(, 3 at, o)c oN oc .ooo E =3 c .9 o .9 cl E oo o oo E oF o eooN oq ooN. oo oot- o =c f o dz t N E o .= o o o o .=cf, otr) oo oo f oto Oo o- c oE o- .C o aa o,o = o(r, Eo =ootr o CL x lrJ o f oo (, o x(,tr oc o @$ 'nc'6 .9 O(llo.9 olo)co=]Edlo .. o(9 xFp9 9o o.= -o =lr o)s E o otrs CLxlu ooo o o =I.IJt acoc .C :0 EoEc c)(,) C 'at, oooo o oo E oF oq o\t$_ cf) oq o!+ -t_(?) @ =cf o C'z .f N c\.t E o .= o @ o(, .:cf o(o ooL f, o U' oo o- c o o- L o aD oo 2 o Cl E o =ol 9.1t-lot cLl xt ulI o =tU u. a uJ x. ii oF o '6 u,(l)cOogdPbdo (f) E .xgEcq)oco- '-'i o- oo o. tr o clc s o. x tu 5(u o d) 4i E dc (-, 'z c,o o ooo oo 'E o)o so ro .L o o. E g;(l,L a dc o .E ot, Lo ooo oo E o(r, so ro ano .gs(U F-oo oEo o =oc oN (u c .9oo Ec o (U o 6l TL oo E o oo ooc EJos 6 oo E oF oq ooo- 6l oIoo tr)- oq oNlr). oIoo (f, oq o o{c,d o =c o C,z co E o .: o th o o =f, oooN oo(o oNtr) oo c) o(, l o .t) ooz ooz ooz ooz c o o. oo oo :(, .lt E o =ooc o CLx ul p oo: o)oc(l, co .c(\, E o .9E o, (D oc(uco .s C, E o o o o o = ooc(l, fo .c o o Eo G oF E o)o l o: .E q) = op E(D t. UIFz ul() tr UJFt o UJIF o c,z oI B =tuF ul = o = c o Gtrg o x TU oc oE o. o)6 Dc o o) (D 3j -o o -9lU o oo E oF oq tr) c\t oq loN o =cl o C'z E o = o o o o .= :) tr)N oo =oo oIN c o o. 'tr oo oE .= o(! E o =ooco CLx UI o .9 -- 'a f oo o .u o .Ctfo c o (, c s CLx uJ oCoE o. o (I) -o c(U Lo (U; ao oo ul o o o E oF oq o F.- c,q o 1'- o e rr)tt o =cl o dz E 0, .= o o o(, z f o F- o(,, L f oo o :E B I o = c o =o_ o6 o! = .:(,(! E o =(D oc o CLx ul o(t) .z f (D o o (t o tt :, at, J FoF I o E o :EN t. ooz oo IFt oz -o = c o ocg ox uJ oc oE o. -qo Ec o o oij '6 o o) u, o oo E oF oq olr) C\ oq o ro(\t o =c3 o C,z E o .= o U' o o .= cf o ro C! oo J oto d)I E, o o. oo(D E :(, G, E o =o U,c o CL x ru al, o, = l oo o E o .Ctf U' o ro c o (u c IE CL x UI a o .c .co o E x(t ! c(o o 0) o- E oo o o) .9 e o) at, oc(I, .= o o. ot o)c oc o. o)6 Ec(I, o o;j '6 .E o -9 UJ oooo o .Y oo -o c o (I,q .9.oo o) oo D oI oc Eooo o LL U'ooo o (I, (D =o TL c .9 o)o 'oc(l, 0,c oN o .=(! o.o g; c) c;c o 'z oa c .9 o) o) 1C c o q) coN o .=(! o.o ui o oc :s a oo o an oo oo 'z o,o solr, .€ oal lr)q o @ co E =oo .t ! o U)l to c! o @ C o E =oo i oal ro c! o @ co E =o .t N (! Eo o) =o .=(l, o.o ,; E oc 'o 'z o al, o @oo (l) o .E (l) ah solr) =oaf, lo o! o @ c o E @ o o(, t oF oq oo o- C.l oq oo(r) oq $$(o- og ol F-(o ood(o oq oo o_ c{ oq oo o_ N og oo o.l oq oNol oq oN fr oq oo o-(o oq$ .f oI @t0 @ d o =c f o Ciz (o (f)(9 (o (f) (f) co(o (o @ Eq, ': o o oo =cf oooN ootr) <' N ooo N ooo c\t ooN o c! O) oo ro o C.lF. $N o o f o U' O o o_ O o o- Oo o_ oo(L oo(L oo(L O o(L oo o_ o o(L oo(L O o(L O o o_ 0) .9 a oo x(I, LL C) fo E oo oo = f Y ooo c o (t .0 olou a E o e(, E E lo c(D E (o (D F o E o e(, E E fo E f .9(L 3o c (D oc(E c(D o E o oE o I' o)al o() c(, c(D .s C' E o oEo Ec .oo o) 3oc o .gE f op Eo (u co N B o)c o) .s6 f op Eo ooo :f ol .E o l -g .9so o)oC(q co .g(, E oE(, o o o: .E o f, o o o o o .nfi8[f,igep.EdH IooEEg.ets = l u,ldf dl -FJ ul I J zI o UIt d I =*Io = () o .L o E ol- 9.3 'I'irncd plan of action Providc tirnc chart(s) showing horv Lhe various aclivilics o{'thc CDTI rvill procccd ovcr thc coursc of thc proposed program. Numerical annual targcts lor all planncd activitics should be providcd for each tirnc point. Thc tirle charl sltould also indicatc how suppofl would bc phascd pout over the 5 ycar period. 3t cl \ \ \ \ \ \ ll ll \\ \ \ \ rao c.r \ \ \ \ \ \ \ \ \ \ \ \ cll ct \ \ \ \ \ \ \ \ \ \ \ \ al \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ o ol \ \ \ \ \ \ \ \ \ \ \ \ \ EI , {JI(Jl E o @q)q o (d tro (o N q tro@ t()c>(,q) oddcooON <E o) or o tro tr rE(.) o -c tro tr() E 0)() bo4 oo 'a L o.E- 'Eo oo_q> &d,o9 C(!C)€Edb9KE =o.o.;oapor O-o (d C)tr (o k o a) 'a pa o @E_ .ioE> '89 E_odb5 .= o( -(l) !d orF€ (, q kotr(!k o C) 'a q o @C tr dtu EB oo6trtr .EN!o or F* d q kIt) tr d o c) 'd k o.q< o ootr cq) .FB E-Qd o0 s) .=o .g)!u crfi€ q q() Eq @ rt)oq (! o oo o o Eq) .o o. rq .o o.d& co dN =po a e c E E o C) @ ru ! E U) o< v o !tro(J q ao C)(H o o0tr tr 6bor hl) tr tr clb .o tr cl tro o(.) ru(A oc ruo tc(! co G,b@ o0 C)kct.9 oi{ -cLd)uaC5=o) .fr O tro -oEq o @c c,N o 0.) 2 co q E(.) o. !cd o0tr 'tr o tro () .: od tro o .E q a, o oo -J<E(Joo o() Oeo-o@o-Ca o CJ tr € o Eo o0(, tr C, z oo EHe9():\&a ao (! (! o (, u C) xo (o Eq) c ao () d(,) tr (!q) F o 3(.) 0.)& tr(( A tr .9 o V) Is cl o) c!t(ri () o cu q) q) a I(). I}UIX;E'I' l0.l Budget Estimatcs llurlgct ttttrst indicate total ./fund.s to underlake lltc ltrojt,t't. The emount o/'./ilnding rcquested fiom Al'OC, und tlrc onlount ltrutvidcd by the A4Oll. NGDO(,s) and olhcr purttt<'r's. /ll ntust bc muda itt US dollars. lioch hdrcl musl include ot lcast thc follov,in.q rnujor cutegories (see appendir 2) indicating the conlribution of the parlners to retlcct sustainubility o.l'CDTI. . Personnel (services) . Capital equipment . Supplies Training . Healtheducation/mobilization . Travel . Communication . Consultant . Operating expense . Extemal audit 33 YEAR ONE SUMMARY BUDGET FOR ONCHOCERCIASIS CONTROL IN METEMA WEREDA YEAR 2OOO 2000 CA'I'EGORY 7.5% NGO overhead cost AI'OC N{OH NGO TOTAI, Personnel 0 12,854.00 12,500.00 25,354.00 55,882.00 51,074.00 59,212.00 166,168.00Capital equipment 0 7,835.00Supplies 4,788.00 12,623.00 Training 12,999.00 0 1,500.00 14,499.00 0 600.00Health Education/mobilization t 4,599.80 15,199.80 Travel 16,683.33 0 13,900.00 30,583.33 4,200.00Communication 3,200.00 0 7,400.00 Consultants 13,440.00 0 0 13,440.00 External Audit 0 0 0 Recapitulation 0 0 0 Operating expense 445.00 15,320.00 31,433.0015,668.00 115,067.00Grand Total 137,260.13 64,373.00 316,700.13 Estimated No. Treatrnents 55,980 55,980 55,980 55,980 % input 43.3 20.3 36.3 r00.0 34 Fc F I 6 e q FI :. t :l : E : o o E 3 r I : ,_ t 3 t, t a ;. q c I t t : e € t t F F I 9 ' E 8i I:1.ili t z t 6 I E a 8 8 8 .: I a 8 E 8 e 8 : I I : z ; 8 I I o .: 8 Gi F t d 8 6 a a; 8I t 9 E a I 8 I a! 8 ._ t c t8 8 3 o t s 8 :q 8 d nI 5 q 8 8 8 6 n E e J F oF a 8 = 8 n9 I & 8 8 8 8 ea a E z t 8a! 8 ! n 8 8 5: 8 8 8 8 = 8 8q 6 o I s 8 : e n T 8 8 8 I 8U: e J F F 8 9 tn E9 d t ! t 3 t 8. I e o() z t 8 = 8 =n 6 E 8? I a B 8 a = E 8q E n: E q 3 3. 8 s E :9 E d nI t I 89 n 8 i 6 a I , n 8- J F oF E 9 s d tI : cn 8I a + n s f a t E o oz 6 8 8 s n E 8 8: t g sex d t 8 a : E t- = n o EI s I _9 E I s 3 8 8 a 8 $ e : E aq 8 d 8 g. 3 an i oo F ! t E9 g - ! I =E I : E 9 5i I n E E E E I = , z a B 3t & ts I o ! g !F z ! 5 d ; l3 l' 5 a 10.2 Budget justilication Plcose providc a ttarrative description of'lltc raosotts.[or cach prt4toscd linc item.s of thc budget. The proposcd budget lor sonrc of thc lrrrc itcnts prcsented ltere arc also tncant lbr Quara wcrcda that will start its CDTI activitics thc follon,ing year. Specific budget for Quara wercda is not indicatcd herc as REI\4O data for thc arca is nol yet available. Fronr our knowlge the arca is known to bc highly endelnic for onchoccrciasis. Howevcr, inclusion in CDTI proposal should wait for copletion of REMO. Therefore, nrost of the capital items and supply items will not go much higher than that indicated in the budget details in Appendix 3. I) Personnel The personnel budget reflects the amount needed for staff at the levels of RHB, ZHD and WHO to facilitate the CDTI activities at the conrnrunity level. The MOH rvill provide supporl to tirc program in : . Mobilising authorities and conrmunitl, leaders . Organising and leading the distribution program . Training of supervisors and CDDs o Getting and supplying ivermectin o Transportation of essential supplies o Regular supervision . Accounting for funds spent ( both APOC and others o Program evaluation 2 ) Capital equipment ln order to run the program effectively the RHB and ZHD should be well furnished rvith the necessary basic equipment. 3) Supplies: Regular office supplies are essential to ensure sustainability of routine office works. More over as supplies Paracetamol and Promethazine are required to treat lO%o treatment reactions. 4) Training: Training is the decisive factor to make programs run smoothly and effectively. The CDTI project needs hained community drug distributors and supervisors. There fore to make the CDTI program effective, haining will be given at different levels that incurs a reasonable amount of money. 5) Health education/ mobilization The best way to make a program accepted and implemented in a community is to produce awareness and a feeling of program ownership. This situation can be achieved through intensive health education that will bring change in behaviour. [n drder to implement the CDTI program 36 health cducation is thc bcsl tool hcrrcc suppor( is nccdcd fronr APOC, MOII and NGDO at diflcrcrrl tinrcs. 6)'l'ravcl Travcl is rcquircd lor adr,ocacy visits, trairrirrg rcllairrirrg, supcrvision and rr-ronitorirrq, and cvaluation of thc prograrn. AI'OC and Global 2000 arc sourccs forthe budgct. 7) Ooiunruliication : At the National, Regional , Zonal and Woreda lcvcl tliere will be communication to pass important information on the situation of the CDTI progranl implementation. 8) Consultants : Consultants would be required to conduct local operational researches. Global 2000 is requested for this budget. 9) Extcrnal Audit: A budget for this item will be required to engage external auditors to audit project account. This rvill ensure proper accountability. The MOH and Global 2000 will be responsible for their accountant's participation in audit exercise APOC is requested to support the audit budget. 10) Operating expense: The whole operational activities need a huge amount of money in order to run smoothly and effectively All office activities and some field activities are supported by the MOH. 10.3 Current resources available in CDTIs : No currently existing CDTI program. 10.3 Current resources available in CDTI Existtng CDTIs (for continuation or expansion) will have resources already avatlable. Please provide a detailed list of all existing personnel, equtpment and suppltes (tncluding vehtcles, etc.) belonging to the program, indicating thetr ownershtp (MOH, NGDO, other Agency, etc.) and their level offunctionaltty. NOT APPLICABLE. t 31 API'ENDIX I. ES'I'IMAI'ED NUMBERS OIT COMMUNI'I'IES AND PEIT.SONS'tO BIi TREATIiD IN I\,IETEMA WEREDA BY YEAR ANI) IiNDIiMICII'Y LE\/BL ATIEA CO\/I.]RED HYPEI(- ENDEMIC MIrSO- ENDEMIC IIYPO- ENDEMIC* COMI\{ UN ITY EN DEIVI IC LEVBL TYPE OF TREATMENT Community Directed Comnrunity Directed YEAR l* - (2001) 20No. of communities to bc treated I5 Total population in abo'r,e communities 30,358 25,622 YEAR 2** (2002) No. of communities to be treated 20 l5 Total population in above communities 31,238 26,365 YEAR 3*** - (2003) No. of communities to be treated 20 l5 Total population in above communities 32,144 27,130 YEAR 4**** - (2004) No. of communities to be treated 20 t5 Total population in above communities 33,076 27,916 YEAR 5**** (2005) No. of communities to be treated 20 l5 Total population in above communities 34,036 28,762 38 Ivermec(in 'l'rcatrncnts rcflccted in Allpcndix I wcre o[taincd as lbllorvs: l-he total population of thc Mctcma wcrcda in the year 2001 is 69,975, 'l'lris givcs us an cligiblc populatiorr o[ 55,980 for thc ycar. An cstimatcd population of 29,5021iyc irr lrypcr cndcnric contnruttilics rvhilc lhc rcrnaining 24,gOO livc irr nrcso-crrclcrlic cornlnunitics. YEAII I-: A Lrcal.rnent objectivc of 100%o EARP of botlr hypcr- arrd rncso-endcmic eorrrrrrur)itios irr ihe wereda rryiii bc targeicd. YEAR 2-- with some experience, the program will expand its coverage to the neighbouring Quara wereda. The estimated cDTI eligible population of Quara wereda is not yet known. However, witrr completion of the REMO in the region during 2000 we would be abre to detemrine how nlany of the 42,622 people (year 2000 population) in tlre wereda will qualify for CDTI. YEAR 3.-. From the third year, the program will plan to reach l0o% of the cligible population in both wercdas. However, the eligiblc popularion of GDTI communities in the two weredas will be difficult to estimate at this point as REMO is not yet complete in Quara wereda. YEAR {-$****'[f1er the completion of REMO exercises the EARP may increasc over the three years. Flg. 3 Annual Treatment Objoctiyc by Endemlcity Level 35,000 25.0@ 15.000 r0.000 .0.0@ 30.m0 20,m0oF 5.0@ 2000 Ys 2003N2mol 200{ mo5 39 tA PPENDIX 2: IN DICA'I'ORS I''OIt Ii\/A LtJAI'lON, SUSI.AINAIIl Ll'l'Y /INTEGRATION OII CDTI/ Project Evalua(ion Managcmcnl Irinancial rttarragcrtrctt( Effcctivcncss of cortrtttuttications Training and capacity building lnstitutional conrnrilrrcrrl Fulfi lmcnt ol- other relcvant sectors Problem solving capacity Integration of operational research Project effectiveness Result of KAP Studies Treatment coverage Follow-up of non-eligible and absentees Management of adverse reactions Reliability of reporting S u s t ain a b i I i ty/ In t eg r a t i o n Political will of host government Political will as shown in policy statements and apparent commitment of high-level Oflicials Official action assigning personnel, funds, vehiclcs to program Long-term planning Is there a long-term plan for sustaining the financing and the management of the program? Progress toward financial sustainability If program sponsors cannot continue their current level of commitment for at least another five year, what percentage of running costs is now paid for host govemments or fees? Progress toward integration to what extent has ivermectin distribution been integrated with other health service programs? evidence of community empowerment and ownership change in KAP over time 40 Cl o lo Lo o E =Lo = solo ooz t aD Joo E. 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E al, co E = oE o)c o. ooo o -c(L J o- =o L(l) f o- Eoo o)c c L o- o -co-(E Lq aa o-o E g) c c 'L-(L oc c =oooo ..t v) .> oc o o oo oco oL(D o. o (E o oocoE o. oq o E Lo (D th :, (o =cC al, oo Go ! o o o o so .E o (-) o r o) op o o c o E o oL o lJ- aq) o(o o :o o) (o o)L o so .= o o og o op o o c o E oq) L o u- o oo ii oF o eo(o oq oo(o oq o$N oco o,t r oq oN r oq olool N oq olo oq c\l C9 @ oq @ .t o e @ @ t*_ s o :=c J o C'z @ @ @ N @ ro ooN N|r) co E o = o o oo .=c = oN Ir)F.- ocf, o(o |r) otr) 1r)c! o (o c! CO oo a o U' oo(L oo(L oo(L O o(L o o(L o o(L o o(L O o o_ () o(L O o o- c o o- L oo @o .= o C' E o .= ooc o CLx IU a4 o a. a.5 .4 o(, Go o o)tq) .Y .ao .q o. o() o oE o- aq) oD t(U o LocoF o) = -c. =:o c(, -Yo -o o C,)o .E E oo L c) c (L o oO o cr,o t oo o c L(L th o o fo oo - oco 'a(t' a . oEo -o oo ao ,4 o,5 a c oo(t -o(o OOo o O) E ooto o E o oo(U L o(L c(o(-) @ -oI Ooo o O) E ro c! (l) C N(tr (I)i c1LI ol LI E oF P o(Do o.96tro)=E6co: Eco o) x ro9 c.L(l)J o_ o_ t UIFz u.lo d UJFd () ]UIF ao(9 z o o o- a to$ t C o .Ec(t,l cLl xl ur1 c) o + ciot Lo C'E o U)l o(9 tr d) E' L o) o-l L(l) Lo + ciot Lo (I, E o U)l o (f) E .o)ELo(L L o Lo + ci ou Lo oE oaf o (f)Y E](l, E]LI ori o-i =o oL o E E(U L o)oL o] Losl C1 L] o E'I LIol(Ll o oo E oF o eoo CO oq oo (f) o eoo(f) oo oo(o oq oo lo_ .o .= C,J o o o o o ro E o = o o o o .=cf o c.) o(o o(9 oN o o L f o U) ooz ooz o(, z o oz c o L o o @ o oE U' lz o 3 olcl 'El .-l GllLI -l(El clolNI o_ o c.a .:z o 3 o, -c C. (E L LLIFI ol =l o. o .c. U' x. o 3 gJ .E .c o ooo o:c o)o E 3o 't o) o, E E C, gJ oL(L J FoF tr o (E trg CLx IJJ 5(E ah o olcl '-l (o €l cnl =l@1 ot cq) EEo(t) L (l) L : '6 (E o(, coL(l) coo 5oc .9 (I, o EoELoL c o EEooL o)L =C)(U ooc Eo co()- Z"oc .9 C, .o E .gE Lo(L g, .Ec '(o L troo c o) EcooL oL : '6 o (t) ocoL o) coo boc o o o d .9oLo(L oooo EC o (D coN dc .o o)q) L o p o of .9, u, L o .E E L o oq)p :f o c .9 o, o)L !c o -q) c oN Lo I o o -:zo oE ol U'ooo g o ah .2 rzo o) -co o oo 1!- oF oq oo(0 oq o(o @ oq(o .f oq o(o (f)- (f) o e(o(o o)- c\l oq oo o_ .t oq oo o eoo r oq oo(o oq o) o) o)-(\ @ =c = o C;z (f) oo .f oN oc\l oo c.) E o = o o o(, .= C f ooN o(o @ (o $ o(o(.) c.) co(o O)N o ro lr) N o(, a o(n () o(L oo(L o o(L oo(L () o o_ oo o- O o TL o o(L o o(L E o o- L o oq, o = .> o G E o =ootr o o. x UJ O) .C .E(u L Lq) f o- Eoo (o c .o o)o u. Fo() co FoF (U CoN Foo co FoF o) e lo tUt Fo O c o o) .Ec '(o ooo ao (! t- o (! tr o) c(!\ o Blc \q. ot(o -c.o .s q)p =O) E l)(,) L lo (Dp 1 o) D o) TLF o > u-F oN op f o) ooo J FoF ! I J99o)tlcg:E ro- lTDtscC.;g x L(DJ o_ o- tr IUFz uJ(, E. TUFd o [JIF a o(, z o o o- (os c o otr G CLx TU c o EEooL oLp c(It o Cq) L : o o TL cq) EEo(l) L q) L Ec o E coL >l: '6 (E LL co EEooL (l) Lp c(I, E c o)L : '6 (I, LL o o(, E o oq ooN oq oool oq ooN oq oo(0 o .= f o c,z E o .= o u, o a .= cf ooN ooN ooN o oL f oa o oz ooz ooz c o o- L o o oo = .: o C' E o .: ooc o CLx]U C .9 o c o '= o o) .C .g C, oc .9q, ot c o .o(o c o o cr) .E .g(, ocoN co .(u o c o) o o) .C .c(o L (I,oo o = E oF c o ocs CLx uI c .9 oo E o C) o(E o o p o oc .oq o)t c .9 o o. E oo oooo E(E (u coN c .9(Uo E(U o o C,oo E(0 GE(l) Lo ts izoo o. co L(I, EoLo .g .o!o aooo -o .9 -o =o. o -c o)c oof 1f, o L otL o oo o Eo EC c, c o o .N -oo E 'e f, E E o() LotL oooo Do ac C, co o .N Eo E .E f, E Eoo g otL o(g oo E(o Eco co o .N -oo E =cl E Eoo Lo]L oooo E o Ec o c .o o .N Eo E Ec =E E o() Lo LL ()(o oo :o(u Ec(U co (o s5o E 'e l E E oo LoIL o oo E o oq oo(f)- oq oo rr) oq oo@ oq ro rr oq o(o O)- @ oq(o o)@ o e @(o N ocoo(o oq oo c\l o eoo o_ r o oq o)g) ro + o .=c = o C;z |r, @$$ (o o, @ (o O) @ oot oo$ oo 1r) E o = o o o(, =cf oo(r) oolo oo @ (o oN ao q u? o N oo) oo o o o- O o o- O o(L C) o(L Oo o_ o o o_ oo o_ O oL o o o- o o(L tr o o- L(.) ooo .: (-,(I, E o .= ooc o o.xtu c .9 C' c o o O) .E .g C, (I, c .9 o)o E, c o .q o c o .C o o .g .c oL tc oN C o .(I, o c o) o o) .5 .c(g (I, oq, Lq) 3 (g o o) L o 3 j (I, coN (U c .o ooL oo(, ru(-)(! o. co (o ELo C t4 o o (U E olc c Gt aL o) oo(L @t C,Eo etL at o f -c.o oLdl a o) o) oaaq) E E. =at,L otzo U) U'o o)(o g, U'o E _c '= o .EEo aF U'o(0 o o -coc o E oF coe_E(ENE€6=q)c E.9 co(troCD :] .xElC ccEb o C = d ulFz lUo d tUFd o u.lEF a ooz o o(L a lclo l6lc .E1 o..l xl uti l"lo,cl ol(Dl EI]l(t)l >l ol;l EI EIol EI ooE e!] ol -ccl 6t clot o1 .EI o)lol?l I o =o zoo z(D o fo o(t, o o troo o (E c @p os oc(u o(u o = at(! c oE1 ol cl;l ot(6t ol EI -tol >t 'El ol clol (olEI ol EIOIotol(!I lilEI clolbl olcl -lol6lol EI co oEo Eo(,o @ a; i6 e d, E1 ol sl Jal 6I ol EI cl ol 6l!rlol EIolotol(El 6l .sl cl olEI ol cl16l 6l ol EI clol 6t arlol EI OIotol(El .J6l 6l cl olEI ol cl :l6l ol ol EI o o(., E oF oo oo o-t oq o 1r) oeoo c.) oq oo$- @ oo c;o N oo ci ro oeooN og o 1r) oq oo(\t oeolo oq oo or-(n o =c = o dz 6r lo o o o o o o E([, .= o o oo =cl ooo ro N oN o{@ oN () N 1r) N |r, q, o l o u) o(, z o(9 z ooz ooz ooz ooz ooz ooz o(9 z o(, z c .9 o. o o 0,o\ 'rl ol(E1 EI @l ;lolclol o-lxl uJl -l(o clol 6tcl ol CI : ol >Ipl FI -t <l o'- (l) Eoo o g F e .o .o z(D o l U) (E oo @ = 6l c1olNI olclol olol sl EIol DI ol o-l l o^lc cc(U o. od 3 .9 o @ E E(E ol o o- (o c(! s-.] E] .!PlE o) o-1 o .9 c c o o EC6 Bo '5 o o E Eo oo o. (o c .9 o) @ G. E .9E o(L o -cCc o E. D c6 B .9 (D q) E E o olo o- (! c .9 oi o)g Eo E] o1(L1 o) .E cg(o o- c(u 3 -(l) o (t) E Eo ol o1 ol _t6lcl olNI EI(t,l ol ol o-l I It^lotc lclc l(5lo D c(,]o E o E E(o o) e o" '6 coU E .9 Po(L o)c .E c(u o Ec o] .g o o E E o B ol ol olElot oI 3I EI ol ol ol(LI lolc lclcl(ula D c(! i -o o @ E E(o ol o o. 6oo o3l EI ol Elgl ot o_l E oF t G. UJFz ulo d ulFd o ulEF o C, z. tr -9 G c6 CL x uJ oo o t C.,l c! x oo (u oo E (E ! o x o c,l o x co e o) o-(.) @ .=o 't ao a z c) o]f,la * o tn o E N X @ -- o U) f N o o(, G oF oq o (o- $ ood N(.) oq o(l, o)- t a =cl o dz N N E o = o 6 o(, =c f, o N o- N o(o o o f oa () o o- o o o_ c .9 o- oo 0,E .; 'a o C' E o!1 ololcl ol all xl EIo o o. !C o c9 E o) o. f,6 oo() -o o-q) o cC ol a1 Ci6lol 'El olf,l -lol =l1!l E o o3o or 3 =UJF lrJ =i o = o IN d oo z. o(9 IFtroz I o = c -9 tuc so xlt lolo o c,o] o (o E o : CL x o U'f o xl cl olo ol o.l col @l '6t >l -l ol6l 'Et (I)I olrl @l L C,o @ o @ E (\l x @ =o(t)l ro a? o x o = EY @ EY ooo N o oo E oF o eoo(o (?, c?(,(.)(\t c) c(.)(") @ o =cl o dz ot (\l E(D .= o o o(,, =cf oo c.) l'- oo 5 oo oo o- oo o- tr .9 o (, o oE >i .; (, 6 E ol -lol6lcl ol CLI xl url E .9o c)o Dc o c .9 Eo o. lo oc .9 olot .= o o- o 0) EC G @ c 3 'El olrl -tolf,llLl E o oJU' f, UJ E.) dl IFJ ulr J zI o u.t u. fr E =*I o = c -9 .E c G' o-lxl uJl oo o oo E at (oo N CI x oql o x c o6 o o.(o o =I a' oo .E @ o.l =lo o ot x C) =o U'f o o() E oF og oNs oq oF. oq o o){ o =cf o dz (t GI E o = o o oo =tr f o c{ ro (f) oo 5 o U' () o(L (-) o(L Eo o Dc(o q c f 6f tL E o -ofo E o G c .E CL x UJ 6 (D o E 0) El tr- I F1o z1 Llol ot d '--l ol clll oI ol!lFI q oo E oF o coo$ oq oot o =c :f o dz v E (D .= o o oo =cl oo o o f oa () o o- c o o o E o -o =U' N 9 4 E o)o6 ooo -F;E .0)o= xo o.cCJ oo (, o .L E sG .9 o o, E oo o (oE a lclo l(EItrl6 lo-lx ull o Eo Efo oE co Ef o L o an cg F o(I, !o o] o oC oN aE] ol dioiLI EI -=lil CI ol (I,t ol CI :il EIolol o o o (E oF oq oo(o oq oo(o- (r) oo c;oot t o .= o oz C\t N E o = o o oo .=cl oto oo cr) ooL a oto o oz o f,oo ,lclOIclol o)l d,lFI E o -ofq t ulFz uJo t u,lFd () ut -F ooz o o(L @$ c o clcs CLx uJ ol ct ol EI =lololrol -lclOIOI ll *tol -tol 6lCI(!l FI o oEo (D 3 oq) c oN ah c o o!o f -1i Bl C]o olol CIll EIol ol o oo E oF oq o(o oq o(o cf) oq o6ls o .=cf o dz N N E o .: o th o o =tr J o(o oCO o(, Ll oU' (-) o o_ O o o* tr o o .: o o E o := (r)l CI olrl OJ(l)I d)lFI E o tt fo tr o G .U E-x lU o c o E :,() oE c o o) :l o Lo oc G F U'(, ro E o =o oc oN U'c .oo(l) L -c =3 c .9 (U .()c f E oo o o(, E oF oq o(o oq oo(o oq o(o @ o .=cf o dz c! N E o = o o o o .=cl o C) oro o,o f oq Oo& O o o- -tol '=l flolol x(U LL o .ctJo c o (I, cg o x llJ at c o) E f,o oE c o El o o) oc o F U'(UD 0) o =ooc oN U'c .o ot(I) t =B _lL .9 (t, o C] fI EI o1()I o oo 6 oF oq o c{ oIoo(o oq o ol 1'- o =cf o dz .i. c{ E o = o 6 o() .= f, o(.) oro oo :, oo o o o- (_) o o- c .9 o. .E o Qo! = 'a (,, lol\]trt ot ;l 9ILId,i o-lxl utl o L f, oo x(, tL o)c oE o.(D oF G o -ofo tr o ocs CL x TU al, c o) Elooo c o o)LJ o o U' c o F o oE o) oi ooc oN oc .9 o) 6) E --3 c .9 o .9 c =E oo o oo E oF ocoo C\t oo C;o ry o eoot- o =cJ o C;z .t N E o .= o o o o .: cl otr) oo o o f, oq O(J(I o o- o toq, o ..- o(o E o! ololclol cLl xl o) J oo x(o TL 0)C o c. o_ o) oF E o lt fo oc '6 .9 oG,o-o colo)c:oLlE cno .. ()(.J .xEgo 8.eo- .= o -3 =uJF ul =I o = oIN t ooz o(, IF e. oz I o = :f uld lg) -FJ ul - J zI(, ul d. d I =sI o = x o =l! ( o(, z c oEo oooo .= o oc oox IU J F oF o o o- o,s tr o Gc s CL x IJI o o) o) o o LUt acoC .c :a EoEc o) Oic '6 U' o aho o oo E oF oq o$ sf- (.) oq o$ -a-(r) r @ =c J o dz .f NN E €, .= o o oo .:cf o(o @oL :, oa o o o_ c o .t o o =tU E. a r.uu ii oF o '6lo (l,cog 3, -9Eb6o(r) E .x9]CCO@c o_ '-'i o- ) a a (, o o. { o o, o o o o o cI)o o o o o (D 3 9. f (D fg) :)oo o =o(D cI :fio C a(Do o =d o cg f(o :J(D{ No f o) o 6' o cg l(o :l o{ (D(o o- f 0) (D =.a_ o 3L l o :l o) loo ca(D o-U o =6- o 3 P. l o :l o) loo l(D{ Io c o a, c 3 3 o) a o 3 a i (D o) 3o :, U'c 3 3 O) a o f a Toto 6' o) a3.o l g o ox C =6'o ololrlol cl (Dt e.l -n1 si x a o 3 o l, oo -t oo 1l oo !oo Too l,oo -o oo -o oo Too -D oo ! oo -o oo a otr r) @ N5 I -l-olN)olo (oNo t9oo N)ooo t\)ooo N) 5 (,oo N o c =o o6 o of O) O) O)@ (,(, O) (,(, o) z 9 o c3 an -(,l(D o) 90oo 55bo (,) -o oobo { N)obo '@ N)obo i\)oobo N) -o oobo N) -o oobo O) 90oo o) -..1 i\)oo -(, ssbo (JloIoo N) -o oIoo -{ o A' o oo o 3 oa o o i.J(, C U)o:\ (no s oo -?.oo ooa o oo ?. 9. lI ot, oo 9. o{o (D o_ o) l\)5o 3o = ,o o i.J(, Cao:\ = @o 3 o:, oIN(, C(t) o 5oo 3 o f o o i.J(, Ca0 = (rlo s oo 3.oo ooa o a oo 3.o 5I o :, oD 9. o No f o 0) l o_ o(o o' l U)o _?. o. f 9 (D ln oo 9. o No =o o, f o- oo o') 'Tt o =o o) o ooo a -n o ooo a.ao I 0) o_ c)o o o(o o' 0, *. oa ooox o ooo a m oo =.9. 5 € o) o ID) o. o 6-D =o l o voo 9. q) :, o- oo ?oo o oo 3oc o o o, l o- o) x 3 o)o =.lo a m xg !,f A'2 of ! oo o =oII =r v n mo oz t- r m r -lI tpC n m C ag(, og o 3oo c4 = =oo m xt of 3n o =o 3 0, o - o- o o oaEa o 7I @ (t oc o o N)(,o C3 o oo o o 3 z 9 o c) =6 N Orobo N)(,obo { og o oo m oo =.a. ; o, o 0,J o. o oo =ol o mxt o,f!, =o = tr:r>o6qE =q9;$eEEP6u(D9q.Eoo (, o =oI z o n{I o o z. o ov NI o @ c cr og o3oo c = o' a mx!,lot:to lo lotft\lo,to l<- l.< lololotol- t6' lo' rl NI o U' oc o o N) U] C :, o o att o o 3 z 9 o C a o t\) 9loo N(,l bo -log o o o m 6-o =-o. s €o o IDf o. o 6-o =o l o m xg A'J o,a oJ =o I -.1o -t r U'c cr og o3oo c =6'o mxo(Dfo o o 3 o,o3. o.ooo =.EI o a 3 oI €I o U, oE C) o -{ o C ='o oo o o 3 z 9 o CJ o A5!,oo -lobo --Jobo J og o oo m 6-o -.9. iq) o o) f o_ o oo =o fo mxtd a ot =of =o T =m{ m = €I o z o o{I m c) n{ mv c) mz{ mv {o 9L o =c)(D 5'oc o) oo o =.o(D cg)o co(D o o o o o (D 3 P.J o l(!) :loo (D =.c) o 3 9.3 (D f t!)l oo coo o_ x!o f oo (Dlf 0)o la =l< o oa o -1.T' 6- f z oo z oo z oo z oo (t, oc o o (, oo (rr No (,oo N) oo Cf o o o o o 3 (, z 9 o trf o -Or(r'No oo G)oIoo '(,l Nobo -(, oobo -lo 0i o oo =oc o, ,oo oo oilo(D -n cq. o o) *o f o. d 9. of .q No f .9r €o d o- o, oo -t E =.foo (rl o s U'o ? o(D oo U' o oo 3. 9. fI aI ao o) C'Ios o(D 3.oo ooo o5 oo 3. a. fI (D !t, (D lJ P. rrlxg q, f ol =o , I 0 N) -o oobo
fCIHl I UlllffiHH[ EUI THlEftilUffilffirf $I lif Ht ffi Affi. North Gondar Zone Amhara National Regional State ETHIOPIA Project Period: Year 2001-2005 AFRICAN PROGRAM FOR ONCHOCERCIASIS CONTROL (APOC) I I t t t MAY 2OOO l I I I It I I J \ \ t1 r qeot {e(tt +,J,I S JUN 2OOOnA.l'f*'.e L9-L41a f-{Dlt/.ft.(t l;t'.llt.lt fnuf r.n.f .Ll.,I.-l;C Federal Democratic Republic of Ethiopia Ministry of Health Date +Tc Ref. No. Dr. A. Sdk6t6li Director, APOC African Programme for Onchocericias is Control Ouagadougou, Burkina Faso Tel: (266) 3429 60, 34 29 59 Dear Dr. S6k6tdli, Subject: Submission of Metema{uara Area CDTI Project Proposal We refer to our letter Ref. No. 4l4tB6/41 regarding the submission of a revised NATIONAL PLAN OF ACTION FOR ONCHOCERCIASIS CONTROL IN ETHIOPIA- YEAR 20OO-2OM and PROJECT PROPOSAL FOR COMMUNMTY DIRECTED TREATMENT WITH TVERMEC'TIN FOR KEFA-SHEKA ZONE. We hereby enclose a copy of Metema Quara CDTI Proposal for the years 2001-2005 based which was prepared based on the above mentioned Five Year Plan of Action. We sincerely apologise for the delay in our submission and look forward for a positive reply from APOC in due time. Please not that the CDTI project proposals for Bench- Maj i and North Omo zones are not yet ready for submission. It is our hope that these will be sent to you before the 3TEember2000 We would like to take this , indirectly towards this project opportunity to thank all APOC and others who extended their support directly or With best regards Sincerely yours, '=,.{#r:if3ffi EXDAIHO Represenrati Addis Ababa Dr. Mary M. Alleman Associate Director Mectizan Donation Programme 750 Commerce Drive-Site. 40O-Decahrr, GA 30030 Atlanta- Georgia-USA Mr. Teshome Gebre Country Representative, The Carter Centre Addis Ababa Planing and Project Department Disease Prevention and Control Department Malaria and other Vector-borne Diseases Prevention and Control Team Ministry of Health Amhara National Regional State Health Bureau Bahir Dar a t1 .6( I *o c? iraalafL' na A$ oAiq- { .v -i1 g1L ( ot*t :1, E'.-{ a tic(|cra qfY {.hn +rc 5t9366 Fax No. s 1234fi&n lnq }\l-rAf Addis Ababa - Ethiopia .4rro fl.2rlnr. '1.x. f).f', f-4ta(I + ln reply Please Refer to our c 51701 I 5 l 7109 51783t 4.Ahd +. 21844 Telex 1'C Ref. f,T+(r No E-marl = MOH NCIC@padrs gn apc.org "r lEfat I TABLB OF CONTBNTS LTST OF ACRONYMS SBCTION 1: BACKGROUND INFORMATION l.INFoRMATIONoNTHEPROJECTAREAFoRCDTI............... Geographical and administrative areas"""' Topography, Climate, Access Onchocerciasis Endemicity Levels Community Structure 2. PAST AND CURRENT STATUS OF CDTT TN PROJECT AREA SECTION 2: PROJECT EXECUTION OUTLINE """""" 3. DESCRIPTION OF PROPOSED CDTI 3.1. Outline Plan and Timing ...... 3.2.HealthEducationandCommuniryInteractionandParticipation 3.3. Local OPerational Research SUPPLY, TMPORTATION, STORAGE, INVENTORY AND DELIVERY OF MECTIZAN TABLETS ............ lll I 1 1 7 8 9 r0 1.1. t.2 1.3 t.4 4. l0 11 t2 15 T7 20 20 20 23 23 24 25 25 5. SUPERVISION, MONITORING AND EVALUATION """"' 5.1. Supervision during Evaluation 5.2. Monitoring CDTI 5.3. Evaluation of CDTI 6, SUSTAINABTLTTY OF THE CDTI AFTER THE WITHDRAWAL OF EXTERNAL FUNDING .............. 6.1. Integration of GDTI into other community Based of PHC Systems 6.2. Cost Recovery System during CDTI 6.3. Other Issues 6.4. Methods of Measuring the Progress Towards Sustainability ... 7. CROSS BORDER CONSIDERATIONS 8. SPECIAL RISK ISSUES 7 7 8 1 I I I SECTION 3: ADMINISTRATION/FINANCIAL .......... 9. ADMTNTSTITATION 9. l. Organisational Structure for CDTI 9.2. FinancialAdministration 9.3. Timed Plan of Action IO. BUDGET 10.1. Budget Estimate 10.2. Budget Justification 10.3. Current Resources available in CDTI APPENDIX 1: 26 26 26 21 3l 33 JJ 36 37 38 4 l-s0 I APPENDIX 2: APPENDIX 3: LIST OF MAPS: MAP I: MAP 2: MAP 3: MAP 4: MAP 5: LTST OF FIGURES: FIGURE I FIGURE 2: FIGURE J: ESTIMATED NUMBERS OF COMMUNITIES AND PERSONS TO BE TREATED EACH YEAR BY ENDEMICITY LEVEL ....... INDICATORS FOR EVALUATION, SUSTAINABILIY /INTEGRATION OF CDTI BUDGET DETAILS Administrattve Map of Ethtopia Map of Amhara Region by Zone Map of North Gondar Zone by LYereda ........ Sketch Map of Metema Wereda CDTI Areas in Ethtopia........... Organisational Structure of National Onchocerciasis Control Program Request and Disbursement of APOC Fund Annual Treatment Objective by Endemicity Level . 40 2 3 4 5 6 26 28 39 il APOC ATO CDDs CDTI EPI FMOH GIS KAP MTS MOH MOVDC NGO NOTF PHCU RE,A REMO RHB ROTF TOT wHo ZHD ZCTF LIST OF ACRONYMS African Program for Onchocerciasis Control Annual Treatment Objective Community Drug Distributors Community Directed Treatment With ivermectine Expanded program of lmmunisation Federal Ministry of Health Geographic Information System Knowledge, Attitude, Practice Management lnformation system Ministry of Health Malaria & Other Vector Borne Diseases Control Non Governmental Organisation National Onchocerciasis Task Force Primary Health Care Unit Rapid Epidemiological Assessment Rapid Epidemiological Mapping of Onchocerciasis Regional Health Bureau Regional onchocerciasis Task Force Training of Trainers Woreda Health Office ZoneHealth Department Zone Onchocerciasis Task Force 1ll SECTION I: WOREDA PROFTLE I. INFORMATTON ON THE PROJECT AREA FOR CDTI. I.I GEOGRAPHICAL, ADMINISTRATIVE ARBA Please describe the area(s) of the countty in which the proposed CDTI will be carried out. (List the administrative units or parls thereof e.g., Local Government Areas, Districts, Health areas elc. that will be covered and provide a map showing thetr lay-out) Metema woreda is found in the west of North Gondar Administrative Zone of the Amhara Regional National State. [t has an area of 561.25 kms and is divided into 2l administrative localities with an estimated population of 68003 inhabitants. Geographically it borders Tsegedie Armachiho rvoreda to the north, Quara and Alefa weredas to the south, Chilga woreda to the east and the Sudan to the west. 1.2. TOPOGRAPHY, CLTMATE & ACCBSS 1.2.1. Please descrtbe the type of country or bio-climatic zones that wtll be covered by the CDTI (e.g., ratnforest, forest-savannah mosaic, Guinea savannah, Sudan savannah, mountainous orJlat), providing maps, if appropriate. The altitude ranges from 700 m up to 1860m above sea level on the average. Ecologically it is a forest Savannah, rich in variety of bird species and with perennial rivers namely: Guang, Jira, Lencha and Shinfa. The daily average minimum and maximum temperature is 2!c and 45'c respectively. The average annual rainfall is 880mm. 1.2.2. r.2.3. Give the approximate times of the rainy and dry seasons and the months covered by thefarming season. The rainy season starts on June and ends on September. Thus the fanning season is from May to December. The main agricultural products are cotton, oil seeds and sorghum. Provtde information on the state of the roads and the effect of thts on the movements of GDTI personnel in the area at different times of the year. (A mdp may be useful) There is l80km dry weather road, which connects the woreda centre with Gondar town. There are 22 elementary schools, one rural hospital, one health centre, 4 clinics and2 health posts within the woreda. (\ o =lio bo 0)& (o (gao 14(+< dlE{a C.) cqL{-) v) I q) cq lr o +J cg D t-{g cgr-a oo z =G E o U' o .9,!,! G 6ll E(g t o-zz U' t tG'cdF a) -v.s q h! & €o I oz[!(9 u.t St\n -tr \ D a- J zI(, lI E $ x E( tF 0 oi U u 0J o N o n E a}. 2d- a -l{bl. + trdS ?. Et \5 c. a{ .-l\ \ \ h-5q vl \- tsS\a ?ss \t. t, L \.+ <- m t L ] \-\ G(b c: ffh 1r $r {.t! rld,, r3i$ r ! t.l. ',-. I a-rj J '. 11, ' < . 'tt ar _n ,]i}l:i; ^, s ,.4 D \J .i rj <.J 'iI !1 T t' ., t, :;i-\. t\ ,7 t: i: i.. t- t-iEC{,t>r-. \;art:i,::> .-tiiril, ri. t f '4 z':::r+radrYL ,r'j;r\!).,.{ ,:i3t4ta :,,1 i^ -. i.F.t i i- - rSr.,<:l/ l;Y r ra f :- t,a,I d+ ):.\tt< t !.'-4)-t:,., i1 Il-tu 'l:S , La ' r,r/v'i, r. Iir 1r J {? i,' !,). !1+ -i,r 6 .a z. z,ilq,# -r o i".( . .tl1t' s :: ...-rl r r.,r,Fii!)c'xliri*ts)xeiil 'I ,z ?;\]r ry r,..;;{- .*<^ '* - .' r'',.:\r'F-3/ # rr:. . 1, ,:t)-+ {'l tr ','' r .' -. '.: rt , - -i'b: e. 'D'."-i'.,r.'.i 'l- ). . i. t1 s iU t.-* ,lt l t. \ I t' t5x -E'5+(5 E c.lb\ -. '=\ G'af,dJ+\\ 3- l-'G, =(-t qi, --<,, cf; ct-(t, = a b. c \i $ e +. t/l \$se dv$ N N s \ q :\ sl. S t ?.t tl) ut ...t{. \ -.t\-\ t{ \ tttq \t{u o{Ft R .t( Nt s 7 o (!,BL *(OEd)(L' =@ Man 4. Skctch Man of Mctcma Wercda N Ts<-9<Au- Nr'naJtho AuraSa ckera LEGEND Towns All-wcather Roads Saher CHILCA o JuPAH .tab ALrr,t Gunprr tl*i,1r ) $il},)t 1 + r H Ag &711 tJ*ha. Avrr D a,.S I I I o lr.riov oGubarl Dshcntr of sh\i 5 aaa Y** \ \(r!a ilBf a S"N oL& \ .\, 9I o =!i 2 Er' d, e5eE +' -ou,^B:J:frr,jireqYd 6,r:.rd?Ei, F E F tr EStr_oOO.U|)()z(JOA otr E,€o9.(!9Jo 2 t4& ::::l ' a*,: i ',.,< -<& o rr-F .g CL .9 F *, ut .s o GloL -F cr(J ro a CL G' = \oo\ og iC oz oo, o, o cf) ^qddde (tt tif ooooo l- I T I I 1.3. Onchoccrciasiscndernicitylcvcls. Thc levels of onchoccrciasis endemicitl, in comrnunilics irt the CDTI area ttrust be asscsscd by sintple methods before treatment starts. For the purpose of this proposal, lhe level of endemicity in a contmunity or a group of similar contmunities is deJined on the basis of the prevalence of nodule carriis (see Table t). The level of Onchocerciasis endemicity in the communities in the CDTI areas is classified based on the following criteria, though REMO is not conducted in all of the Onchocerciasis endemic localities. Table 1: Classification criteria for endemicity levels in rural communities I .3.1 Based on the system tn Table I and using the format in Appendtx l, please indicate the estimated numbers of communities at each endemic level a-nd the numbers of persons tn them. See Appendtx l. 1.3.2. Contplete Appendix I for each area covering the next 5 years of the project. I .3.3 If methods of assessing endemicity thresholds other than nodule prevalence were used when your endemicity data were collected, please indicate ihe method used. The levels of endemicity in communities of this zone are defined on the basis of nodule prevalence obtained by REMO exercises conducted in 1997. 1.3-4- For areas still to be covered, where endemictty levels are not yet known, please describe the method you will use to collect the necessary endemtcity data. Prior to the beginning of treatment activities REA will be conducted to complete the classification of all villages in the proposed treatment area. So far, based on REMO data 35 villages have been classified as meso- or hyper-endemic to onchocerciasis. Currently REMO activity is in progress in Quara wereda where some villages are going to be assessed. Quara woreda, which is neighbouring Metema wereda has a population of 42,261. 7 ENDEMICITY LEVEL and recommended type of treatment Percent of nodule carriers in REA sample (minimum sample 50 adult men) Estimated prevalence of O. vovulus in the whole com HYPER-ENDEMIC COMMUNITY Treatment (uRGENr) Greater than39%o Greater than 59Yo MESO-ENDEMIC Community Treatment ES 20-39% 40-59% HYPO-ENDEMIC ON-URG Less than 20o% Less than 40% 1.4 Conrnrunity,Structurc Provide background informatiott on tlrc social organizations of conununitics in tlrc C.D.T.I. areos. This may include informalion on: Seltlement pattern of the contmunity (e.g. hamlels, seasonal farmsteads, dispersed population, etc.) The communities in CDTI areas are settled farmers and densely populated The ethnic groups in the community The community in Metema woreda lives in hamlets. The ethnic groups are mainly the nativc Gumuzs, Amhara and few others. Please provide tnformation about the area covered by CDTI indicating whether they are migrants, nomads, refugees or internally displaced populations. a a a a a The community is, currently, organised in syndicates of 50 households subjected to a local administration (kebeles). The main occupation of the community is crop and animal farming. Other than these the Gumuzs are also engaged in handicrafts. The diagram below shows the community leadership structure. Zonal Council Chairman ) Woreda Council Chairman ) Kebele Chairman ) Elders/Religiousi Opinion Leaders ) Household Head Established distribution systems in the community The communities in the proposed CDTI project area are settled subsistence farmers. Some are displaced settlers from other parts of the country. The settlers came to the area more than twelve years ago. Community leaders hip s tructure In some of the localities the community has an experience of anti-malarial drug distribution through community health workers elected and trained from the communify itself. Social communal activities and months during which the activities take place. The important religions ceremonies celebrated in mass gatherings are : The foundations of the True Cross, on September, and Ethiopian Epiphany on January by the Christians while the Moslems celebrate the Arefa on April and Romedan and Mewlid at different times individually at home The Christians celebrate Christmas on January and Easter on April. t 8 aa Any previotts c4tcricttcc of thc corrttrtuttily with development/health projecls Most communities in thc zonc havc bccn involved in EPI, family planning, wcll construction, and spring protection activities. There are also community health posts managed by community health agents and traditional birth attendants in somc communities. The communities therefore have well-established systems of mobilization to enhance participation in communal events. Some anthropological characteristics of the Community The Gumuz live in-groups and have their own language. The males are full dressed while the females are half dressed. Their life is based on hunting, crop and animal farming and handcraft sales. There is no wedding ceremony , instead the then to be husband will take his wife in exchange of his sister by himself. The big ceremony celebrated by the Gumuz is a commemoration of a dead person. This is celebrated after the harvest season when there is plenty of crops for the preparation of food and drink. During the celebration there is a song and dance with glorious cultural antiquities dressed. The females are more responsible for market activities than the males. A pregnant woman will exercise delivery alone by herself away from her living village. Soon after birth the baby will be laid necked on the field. His survival is assured if he can resist the hot sunshine and will be taken home. However through health education this experience is reduced to some extent. 2. PAST AND CURRENT STATUS OF CDTI IN THE PROJECT AREA 2.1 Please indicate if the CDTI is an expansion of an existing CDTI. Since CDTI is to be experienced for the first time in Ethiopia there is no past experience in this regard. Currently this project proposal is developed to implement CDTI in the Onchocerciasis endemic area. 2.2 State the nuntber of years the programme has been operating, and d possible enclose previous statisttcal, financial and annual reports. NOT APPLICABLE 2.3 State the number of persons treated each yearfor the last 5 years: NOT APPLICABLE List the organisatton(s) involved in the programme, the sources and amount offunds used each yearfor the last 5 years. t 9 2.4 NOT APPLICABLE SECTION 2: PROJECT BXECUTION OUTLINB 3. DESCRIPTION OF THE PROPOSED CDTI The ntain stroteg/ of the project will be to develop and establish contmunity-based ivermectitt lreatment syslems, which can be sustained by the endemic communities themselves without external support after the S-year project period. This section should describe how the NOTF plans ro develop and implement CDTI in all high-risk communities in the project area. The plan should take into accouttt the need to develop approaches to CDTI which are appropriate, for the different local situations, and the need to carefully evaluate the implementation of the selected approaches and adjust them when required. The main goal of the proposed CDTI project is to establish a system that directs the treatment of target groups for the disease Onchocerciasis by the community themselves through the involvement of the health system to ensure its sustenance even after the, project phases out. , l0 j 3.1 Outlinc Plan and Timing Activity/Justification Length of Time Advocacy and sensitization at the regional and zonal level - emphasis will be placed on introducing thc APOC CDTI strategy, and enlisting the support of the regional level with the participation of the NOTFA.{OCP, regional administrative council offices 4 weeks Agreement on the definition of roles and responsibilities of all participants - through MOH with the region, APOC Proposals, etc 4 weeks Procurement of essential project equipment and supplies Computers, Mectizan drugs, and vehicles. l6 weeks Training/retratning ofproject trainers at the regional level: Training to those who will function as trainers and supervisors. 4 weeks Rapid Epidemiological Assessments : Epidemiological surveys for onchocerciasis have been completed in the SNNP Region. REA surveys however will be carried out to classify endemicity levels in the project area 4 rveeks Mobilization of regional and zonal authorities to support the project 2 weeks Conduct KAP Studies Since this is the first time treatment is to be carried out in Ethiopia, KAp surveys are essential to guide the development of appropriate health education materials in the zone 12 weeks Mobilization of endemic communities, stressing community ownership of the as well as the health education 4 weeks Selection and training of Community Directed Distributors (CDDs) Selection of CDDs is the responsibility of the community 3 rveeks Household registration, and census enunteration 2 weeks Mectizan @ Collection and Distribution in endemic communities 8 weeks Monitoring and supenision of Mectizan@ distribution activities by zonal and woreda supervisors 4 weeks Inspection of CDD distribution activities (spol checks)by regional supervisors and NOTF lves I week MIS (Management Infonnation Sys tent) Reporting of treatments and training will be required, as in the past, on a monthly basis and appropriate feed back sent to the providers to ensure the adherence to corrective measures recommended. Monthly NOTF/APOC evaluation team conduct internal and external evaluation of the project 4 weeks Review of Treatment Activities Annual reviews and reports will be generated and used to ensure continuous improvement in designing the following years action plan. I week Action Planfor the next year 2 weeks ll 3.2 Ilcalth cducation and community intcraction and participation. 3.2.1 How will you approach and intcract with the community There are already cxisting systems of communication with the proposed project area through other health programs as described earlier. However, the following strategy will beimplemented to maintain good relations with the communities: a) Discussions with zonal council chairmen and social affairs heads and then with Woreda chairmen, local farmers and urban dwellers associations, religious leaders, community elders and opinion leaders to better understand community protocol b) Focus group discussions with social and religious groups to further mobilise the community with the support of the community leaders c) Focus discussions with the community members as appropriate (separating men and women, or not, depending on the community traditions). The community members *il ulro be encouraged at this point to take ownership of the program, defining their ioles and distribution mechanisms 3.2.2. Health education Health education and community mobilization will conttnue be an integral part of all approaches to CDTI- Health education activities should ensure continuous exihange with regards to lcnowledge, awareness, perception and observable attitudtnal changel about onchocerciasts and its treatment. Appropriate health education messages tn tie form ofposters, pamphlets and verbal presentations will need ro be developed and tested. Health education should address thefoilowing issues (see Table under B): Health education is the best tool to produce change in behaviour and bring success onincreasing the health status in community. Therefore tJ achieve the goals of the Cbff program health education will be conducted by health workers and other partn"ers. A. venue The venue for health education will be schools, churches, mosques, treatment posts and otherpublic gathering places. l2 Il. Critical Issucs in the Dcvelopnrent of Ilcalth Education for CDTI Knowledge of treatment titude to treatment a) Have any KAP surveys been done in the project area and if so, what were the results? No KAP studies have been carried out in the project area b) Wot methods will be used to develop health education materialfor the communities and for the agents who will be responsible for ivermectin treatment? Health education materials such as posters, leaflets and flipcharts will be developed in local languages by the project and submitted to NOTF for standardisation. These materials will be field-tested and refined/adjusted in accordance with APOC accepted strategies prior to mass production. ISSUES Health Education Messages Knowledge of the disease . Local name of the disease . Symptoms . Causation/transmission(simple) o Previous experiences with Diethylcarb amazine (D EC) o lntroduceMectizan@ (ivermectine) o Dosage o Exclusions o Reactions . Beneficial side effects Advantages of Treatment: . Free . Yearly treatment . Possibility of self treatment at community level . Importance of maximal coverage Attitude to disease . The disease can be controlled . Onchocerciasis blindness and skin changes can be prevented Attitude to good record keeping . Minimum requirements for record keeping . Records are confidential and strictly for health use o Records required are for subsequent drug supply l3 c) k{/hat mcthods will bc ttsed to providc health education lo the cndemic communities and to the agcnl s responsible for treatment? The zonal health department has in thc past used several media for providing heatth cducation to endcmic communities. Such methods include face to face discussions with health workers, the use of town criers, traditional birth attendants, community health agents the use of posters and flipcharts in local languages. Community leaders will first be informed about the disease and the necessity for regular treatment with ivermectin. These community leaders will serve as agents for the program, encouraging community members to comply with ivermectin treatment. All community members will be engaged in discussions about the health education messages, and given the opportunity to ask questions they may have regarding any aspect of the program. Community members will also provide valuable input into the health education messages and materials C. Frequency: timing of regular mass health education will be determined in consultation with the community. 3.2.3. Community Participation ht community-directed ivermectin deliv,ery systems, mentbers of the endemic communities do the execution of iverruectin treatment themselves. Trained personnel, known as Community- Directed Distributors (CDDs) who should be fully supported by the community itself may provide treatment. The cotrununity should be responsible for the organtsation and execution of the CDTI with ninintum but effective medtcal supervision, once it has received the necessary tnformation and traintng. Various organisational structures at the community level, ranging from women's co-operative to traditional structures, are iruportant for sustaining and strengthening the support network of the CDDs. a) Explain the organisation of the intended community-directed iverntectin treatment in the project. The formation of an Onchocerciasis task force at all levels is essential in order to promote coordinated activities of Onchocerciasis control in all endemic areas. At Federal level the MOVDCU is responsible for routine program management and acts as the liaison between MOH, RHB, as well as with NGO partners within the country and outside. The NOTF will be the governing body for onchocerciasis control activities in Ethiopia. The head of this unit will act as NOCP coordinator. At regional level, MOVDC is represented by a department and will be responsible for program implementation at that level. The head of MOVDCD will act as a ROCP Coordinator. Similarly, at the zonal and woreda levels corresponding Onchocerciasis Control Task Forces (ZOTF and WOTF) will be established. The WOTF will be responsible for program implementation at Woreda level (ensure.selection of CDDs, supervision of treatment activities, record keeping etc). I l4 tAlso, local hcalth institutions under thc WOTF will be rcsponsible to co-ordinate, nronitor and supcrvisc CDTI at cach locality. The smallest unit for distribution will be the village (mender). Menders are clustered together to form administrative Kebeles (led by a Kebele chairman). North Gondor zone has 16 woredas. Although the lowest administrative level is kebele, the kebele is further divided into smaller villages locally known as "menders", the exact number of which is not known. For tlre purpose of ivermectin treatment the number of CDDs will be determined based on a guideline of 50 households or 250 people per CDD. Once communities select their CDDs, they will be trained in the CDTI APOC strategy for ivermectin distribution. CDDs and other local primary health care workers will then provide health education to communities on onchocerciasis (its cause, transmission, control and preventive mechanisms). Prior to the distribution exercise, registration of all households will be carried out and non-eligible individuals identified. After registration, ivermectin distribution will begin. The CDDs will follow up defaulters based on their treatment registers. Both Woreda and Zonal health staff will carry out supervision and monitoring activities How will iverntectin distributors be selected? The selection of CDDs will be the responsibility of the community through the farmers and urban dwellers associations. In some cases, leaders may make this decision on behalf of the community. They will be expected to be honest, dedicated, literate, and permanent residents of the community. c) How will non-eligibles be identified and defaulters followed-up? Non-eligibles are mainly identified by having a complete household registration census and defaulters are identified by referring to distribution record or house hold cards. about Defaulters, upon identification, will be treated by the CDDs. This is also done after previously non-eligible (such as pregnant women) have delivered, and therefore now eligible for treatment. 3.3 Local operational researches Are there any plans to conduct local operational research? ,/ YES NO If yes please gwe details The following are possible suggested areas for the operational research. a. Determining the prevalence of onchocerciasis associated blindness. b. Difference in prevalence of onchocerciasis between the natives and new settlers c. Acceptance of ivermectin in the community d. Effect of treatment on the health status of the community b) l l5 c. Mcasurcnrcut of cconortric irnpact of onchoccrciasis L Study on lcnralc acccptancc working as CDDsg clinical nranilcstations and trcatmcnt rcactions at diflcrcnt sitcs a) Whot lrotning will be provided to ensure the development and sustainability of the CDTI? Training of CDDs to operate CDTI is very vital to the program. To ensure sustainability of the CDTI program, TOT sessions will be conducted by the NOCP. Those trained here will represent both regional and zonal levels. These individuals will in turn train representatives from Woreda and health facilities. These will in turn train CDDs. The training sessions will focus on the following topics: . Epidemiology of onchocerciasis . Health Education and community mobilization o Mectizan@ distribution and its advantage over other methods o Management of adverse reactions . Record keeping and reporting . Monitoring and Supervision b) [ndicate criteriafor selecting trainees (supervisors and contntunity-directed distributors). I) Criteria for selecting CDDs: (i) Literate if possible(ii) Resident in the community(iii) Willing to serve the community(v) Must be honest(v) Must be available(vi) Must be selected by community II) Criteria for selecting supervisors: Zonal Supervisor: a (i) (i i) (iii) (iu) (u) Must be a PHC staff selected by the state RHB Must be knowledgeable Must be interested in helping the community Must be stable Must be honest d) Indicate nuntber, type and duration of training courses intended Table 2. Number, Type and Duration of Training Courses S.No Type of training Duration Session Remark I Regional Training 5 days I At Regional Level 2 Zonal Training 5 days I AtZonal Level 3 CDDs 3 Days I At Wereda Level 4 Supervisors 5 Days I At R'egional andZonal Levet l6 a 4 SUPPLY, IMPORTATTON, STORAGE, INVENTORY AND DELIVERY OF MECTIZAN TABLETS This sectiott is only a reminder and concerns lhe supply, importation, storage, inventory and delivery of ivermectin lablels, donated by Merck & Co, who will also pay handling charges for ivermectin to their accredited agents. Mectizan@ consignments will be received through WHO and stored in the MOH central stores in Addis Ababa. tt will then be transported by road to the regional health bureau, and from there to the North Gondor zonal health department. The zonal health department will be responsible for delivering the drug to the Woreda Health office and CDDs will then collect the drug from the health facilities. A report showing the use of the drug will be sent to TMEC at the end of every year, by the NOTF, with the subsequent application. Copies of the application and the report of its use will also be sent to APOC. An application for Mectizan@ tablets will be submitted every year by the end of September to the NOTF, using the standardised form of The Mectizan@ Expert Committee (TMEC). This application will then forwarded to TMEC in Atlanta for review and approval. 5. Supervision / Monitoring & Evaluation 5.1. Supervision during CDTI Projects are required to be supervised and monitored. However, APOC funded projects will need to be designed to function with effective but minimum supervision compatible with its objectives. a) Please describe the supervisory arrangements you consider will be required for the CDTI you propose how will this continue at the cessation of APOC support? There will be intensive supervision at all levels of program, especially during the early years. Since the program will be integrated into the Malaria and Other Vector Borne Diseases Control Unit, the supervisors and monitors will be staff of this department. The Woreda health rvorkers trained to train CDDs, will also be responsible for supervising their activities (proper record keeping, complete census enumeration, Mectizan@ inventory and dosage, and monitoring during the actual distribution process). The supervisory teams at the zonal level will be responsible for supervising health institutions (management of side effects, Mectizan@ accountability, and reporting on treatment coverage). Most important will be supervision at the community level where most treatment activities are carried out, and CDDs are responsible for proper distribution of ivermectin. Findings from supervisory visits will be reported along with monthly treatment data, and reporting on adverse reactions. As the program matures, the community will assume more and more responsibility, including deciding on methods of supervision, and those who will carry them out. This process may involve community, opinions, and religious leaders. i I t7 t ) Dcscribc how you u,ould cnsure that supervision will be carried out so as lo . fall within the reqttirement accountingfor ivermeclin use o be sustained when the program ends in 5 years . ensure maxintum involvement of the communities in the process To ensure that the above requirements are met, the program will support regular monitoring during the actual distribution process to ascertain that correct dosage is being administered, exclusion criteria are being observed, and the collection and proper storage of unused drug is occurring. In addition, the program will support advocicy visits to the weredas and villages by MOH, regional, and zonal representatives of the onchocerciasis task forces at each level to encourage the active support of the community. Once training of CDDs has been completed, Zonal and Woreda supervisors will check that household enumeration has been completed according to APOC requirements. 5.2 Monitoring of CDTI a It is important to collect information to monilor the progress of the CDTI. tndicators wtll be used to monitor: o Iverntectin dtstribution? . Health education and community participation? c Management systems? Thefollowing items may be considered Ive r mectin D istrib utt o n . Numbers of communities and persons treated wtth ivennectin c Treatntent Coverage c Regularity of treatment exercise . Contpliance c Reporttng adverse reactions Health Education and Communitv Participation . Numbers of communities participattng in the project o Evtdence of impact of heatth education c Are acttvities betng carried out according to plan and on schedule? o Inventory control, c Are recordforms accurale and completed on time? . Numbers of persons trained c Balance of genders in staff of the program LIthat Manapement , ? t8 Thc projcct will considcr thc following indiccs for monitoring the program of CDTI Ive rm ectin D tst rib u tio n : Since Ethiopia will be starting onchocerciasis control activities for the first time, there is currently no Management Information System (MIS) for onchocerciasis control. The NOTF will establish and standardise this system prior to the beginning of treatment. These will enable the NOTF to monitor the communities and persons treated with ivermectin, treatment coverage, regularity of treatment, treatment compliance, and drug reactions. In addition, the project will monitor the following rates and percentages using Annual Treatment Objectives established at the beginning of each year: Annual treatment objectives (ATO): High risk villages (number of high risk villages targeted for treatment) At risk villages (number at risk villages targeted for treatment) Estimated at risk population (total population at risk in the region) a a Treatment coverage (related to ATOs): Treatments (number of persons treated) High risk villages (number of high risk villages treated) At risk villages (number of at risk villages treated) f o Cost per person treated o Tablets distributed . Number of ivermectin tablets in store at HQ, in the field, on order, or to be ordered Health Education and Communit.v Mobilisation: The degree of community participation in mobilization activities will be used as an indicator of community mobilization. In addition, the support of the leaders and key opinion leaders in the communities wilI be indicative of successful mobilizationas well. The impact of health education messages will be measured tfuough periodic focus group discussions and KAP studies. Manasement The project will develop, through the integration of onchocerciasis control to the MOVDCU, a regional and zonal management/supervisory system that monitors: . The planning and implementation of activities according to a timeline o Mectizan@ inventory levels o Monthly reporting of treatment indices . Numbers of personnel trained . Attempt to balance gender in staffing l9 5.3 Evaluation of CDTI Annual external review incorporating field visits wiil be undertaken to ensure thar proiects are nteeting target indications outlined in this proposal. Such reviews will provide TCC with tlrc assurance that each project is ntoving towards its long rerm stated goal and if appropriate make recomntendations about any deficiencies or modifications to this proiect. Such reviews will draw on the indicators developed by TCC as a guide. 6, SUSTATNABILITY OF THE CDTI AFTER THE WITHDRAWAL OF EXTERNAL FUNDING The concept of sustainability refers to the abiltty of countries and alfected communities followtrtg tnitial external investnrcnt to matntain the viability and conttnuity of the ivermectin treatntent process without external support. For APOC funded projects, such support will normally last 5 years, as the APOC donors demand that there shall be a vtsible and achievable end point for the external donation aspect of the programme, ancl that the comntunity based distribution $tstems established shall thereafter be sustainable by the governnrcnts of the endemic countries concerned. Progress and plans towards sustainabtlity, includtng the phastng out of external and NGDOs support, must be reported annually and satisfactory progress in this dtrectton will be a condition for each succeeding year's funding instalments. Please address the following areds that relate to sustainability: integration into primary health cere, cost- recovery, and other sustainability issues. 6.1. Integration of the CDTI into other Community-based or Primary Health Care (PHC) systems. The principal goal of the APOC is to establish cosreffecttve tvermectin-based control for onchocerciasis, which can be sustained by the endemic communittes and countries. One way to ensure swtainability is to integrate the CDTI tnto the PHC system of the country, which medns more than just using the systentfor ivermectin distrtbution. 6.1.1 . Is there an olficial PHC policy and structure in the country? ,/ YES NO If yes, please give a brief outline of what tt is. Primary Health Care (PHC) policy in Ethiopia is to develop and strengthen grassroots and community participation in health care. The integration of CDTI into the PHC system will be done by including Onchocerciasis among priority health problems in the national health policy. At the regional, zonal, and woreda levels, the MoVDCU will be responsible for program implementation at the respective levels. In addition, combining training on CDTI with other on job training activities, including onchocerciasis control activities in the planning process at all levels, and including Mectizan@ in the list of national essential drugs delivery system will further enhance this. a , 20 , .'l'hc I'llC systcnr will bc uscd to achicvc full integration at pcripheral level by furthcr intcgrating CDTI into the activitics of thc PHC (training on CDTI into training of health workers). This way thc PHC system will be used to achieve full integration of CDTI into gcncral health service by obtaining support from Regional, Zonal and Woreda authorities, bilateral and multilateral organisations. In summary, the PHC structure is as follows: MOH (MOVBDCU) ) REGIONAL HEALTH BUREAU) ZONAL HEALTH DEPT.) WOREDA HEALTH DEPT./HEALTH FACILITIES (hospitals, health centers, health stations, health posts etc) ) COMMUNITY HEALTH poSTS (CHAs & TBAS) a) Howfunctional is the Primary Heakh Care system? - Fullyfunctional - Partlyfunctional The system fiom the National level is fully functional until the Woreda/health facility level. However, at the communiry level health coverage is limited. - Nonfunctional (Please specrfy) Does it cover lhe whole project area? '/ Yes No If no, in what part(s) of the project area is there afutlyfunctional pHC structure? Wat percentage of comntunities where onchocerciasis is endemic, and whtch are eligtble for community-based treatment, have an extsting and functional PHC system. Not Known. Wat organisations are supporttng the development of pHC in your project area? Government of Ethiopia (Ministry of Health), wHo, UNICEF, GTZ and some other NGDOs. Is there any past experience in the country of a programme integrating with the PHC? If so, what programme was tt and how successful was the integration? EPI, Malaria control, and family plaruring drug distribution. The integration continues successfu lly. Are there any plans to integrate other rural health programmes, such as the Expanded Programme of Immuntsation, Maternal and Chtld Health Programmes or programmes for the control of other parasitic diseases, wtth the pHC system? EPI, maternal and child health program are already integrated. Malaria control is under the process of integration. b) c) d) e) J) 2t i 8) Dcscribe lnw thc CDTI v,ill bc intcgrarcd into tlrc PHC systern,. the way tlrc pHC sy.ttcrrt will bc ttscd to achicvc ittlcgratiort and the kcy persons in the PHC systent who will be needcd lo achieve lhe integration. At the Federal level MovDCU will be responsible for routine program management and act as the liaison between MoH, RHB, as well as with NGo partners. Mcmbcrs of thc Malaria Team share responsibilities among themselves and hence a separate entity of vertical program nature will not be established. The head of this unit will act as NOCP co-ordinator. At regional level, MOVDC is organised as a department and will be responsible for program implementation (contacting community leaders, explaining the program objectives, discuss issues related to Mectizan@ security, at regional level, including monitoring and supervision). The head of MovDC will act as a Regional Onchocerciasis Control Co-ordinator. Similarly, at the zonal and Woreda levels will establish corresponding Onchocerciasis Control Task Forces (ZOTF and WOTF). The WOTF witl be responsible for program implementation at the Woreda level (ensure selection of CDDs, supervision of treatment activities, record keeping etc). In areas where access to the Woreda health off,rce is restricted, local health institutions will co-ordinate, monitor, and supervise CDTI activities h) Indicate how early in the CDTI the process of integratton will be tntroduced; howit will contintre thereafter, and after how many years within the externally supported lifetime of the CDTI it wtll be completed. CDTI activities in Ethiopia will be integrated from the very beginning. The establishment of the program witl rely on existing systems of health service delivery at all levels 6-1.2. If there is at present no PHC system in operation or in those areas where these structures are non-functional, describe how the CDTI may be used to initiate and expand into such a system, giving a timeframefor intended progress. NOT APPLICABLE 6-1.3. ln which way(s) can community-directed ivermectin treatment initiate or strengthen PHC? CDTI is likely to encourage and facilitate the acceptance of new health initiatives in the community. Also, through the new CDTI strategy, the community will likely play a greater role in the support and ownership of the PHC system. The structures already put in place would be utilised by the PHC to enhance effective planning and implementation of the project. For example, the CDDs will develop capacities and skills, which will strengthen other programs such as health education, other dmg distribution. 22 tj (r.2 Cost-rccovc r), Systcnrs d u ri ng Conrmu nity-bascd ivcrmcctin trcatmen t Cost recovcry for PI{C is mandatoty in some counlries and tt may be one nteans of sustaining a CDTI after APOC funding ceases. However, please note well that since ivermectin is donated free, there can no be cost recovery in respect to the value of the drug itself; cost recovery can only relate to the cost of distribution. 6.2.1. Please slale whether there will be any system of cost recovery $uch as is recommended in Initiative) to help cover on the distribution of ivermecttn in the present CDTI. NO. 6.2.2. State exactly how any such systenx will be organised, including answers to the questions listed below. ALL ARE NOT APPLICABLE. 6.3 Other Issues Please provide infurmation on other issues and constraints relating to sustainabtlity of CDTI you anticipate and tdentify how they will be overcome. For example: tlte ntobilization of endemic communities the maintenance of adequate supervision and monitortng inadequate human resources logistics and communications s o c i a I /cultur al fa cto rs decltning community compliance (l) Mobilization of endemic communities: Sometimes problems of mobilization of endemic community can be obstacle to sustainability of CDTI. This can be solved through sustained advocacy visits, by assigning individuals with good communication skills and expertise in conducting mass health education meetings to increase awareness of the community, KAP surveys to monitor belief systems. Obviously there will be a need to establish good relationships with the community leaders in order to have increased access the communities at times like these. (2) Maintenance of adequate supervision and monttoring, Mectizan distribution should include community leaders to further increase acceptability and sustainability of the program. All records should be verified during supervisory visits, and informal discussions should be encouraged to determine community perceptions of the Mectizan. 23 (3) Inadeqtrale Huntart Resourccs Inadequacy of traincd health staff and PHC units are expected to bc constraints in implemcnting supervision and monitoring. These can be overcome by allocating adequate time for supervision, in addition to training additional supervisors from health facilities and community members. [n absence of roads in some remote areas, mules and horses can bc used. (4) Logistics and Communications During the rainy season in October to December travel to the endemic areas may be restricted. Proper planning (Mectizan drug orders etc) will focus on providing all high- risk villages with their drugs during the dry season (prior to the Jan- March distribution window), and encouraging completion of distribution before the rains if convenient for the communities. (5 ) Social/Cultural facto rs : Careful attention will be paid to cultural and social factors such as: the appropriate gender for CDDs especially in Muslim communities, respecting the traditional religion, and selecting supervisors and distributors who speak the local languages. (6) Declining Contnutntty Compliance: Declining community compliance will be avoided through continuous mobilization activities prior to each treatment period. Community members could be interviewed to determine the reasons for the non-compliance, and corrective measures taken where possible and appropriate 6.4. Horv do you intend to monitor and measure the progress towards sustainability? (See Appendtx 2 for a list of possible indicators of sustainability) Progress towards sustainability can be monitored and measured by evaluating the project in terms of financial managemenUcontribution, communications, training and capacity building. This will help enhance integration. Financial management should be incorporated into the usual government financial administration. Financial flow in the CDTI project should comply with govemment financial management procedures so that there will be safe resource management. Regional and zonal health department heads and administration/finance managers at each level will be accountable for proper utilisation of CDTI resources. The ability of managers' at different levels to familiarise themselves with financial and human resources in the project can also be used to measure and monitor the progress of CDTI towards sustainability. In addition, the ability of community members to about understand the cause and effects of Onchocerciasis, and the mechanisms for its control can be considered indicators of progress of CDTI to sustainability. The success of the program will depend on the attitudes and practices of the community towards the disease. a 24 t l7. CI{OSS-BOITDIIITCONSIDETTA'TIONS llthere an ertdemic arca cxtends ocross the borders of two or morc adjacenl States, special problents of co-operation between the respective country CDTI may arise. In the event that there are areas to be covered by your proposed CDTI where the endemic zone exlends across thefrontier into one or more neighbouring countries, and where there are likely to be lransitory or even large-scale migrations of Onchocerca- infected persons either way across the border. 7.1 Please describe the particular situation, as tt is likely to affect ivermectin treatment, and the methods you will use to deal with it. People from neighbouring countries come to Metema as nomads, daily labourers and refugees. These people may have similar problem of Onchocerciasis or may contract during their stay. Therefore this type of situation will be dealt at the National level, by creating close contact with the Sudan programme. 7.2 Include pertinent observatiorxs on current political and health relations wtth the netghbouring State(s). There is good relation with Sudan. Recently the government of Ethiopia is establishing good relations in the field of Health. This particularly focuses on cross border health issues and collaboration in training of health personnel. 8. SPECIAL RISK ISSUES In some areas of some countries there may be special risks, which could hinder the smooth running of a CDTI- 8.1 Please describe the situation in any part covered by your proposed CDTI where this factor may in1"r1"re with the prograrn, and asses future prospects. There is a likelihood of high population movement during harvest time and during epidemics of malaria/meningitis. These conditions may occasionally interfere with the distribution of ivermectin in CDTI communities. However, some of these problems can be overcome through discussion with the communities and selecting suitable times for ivermectin distribution. 25 SI]CTION 3: ADMINISTRATION / FINANCE 9. ADMINISTRATION For the implementation of the CDTI project there should bc an efficient administrative path. Therefore the following administrative organisation is developed to fulfil the need for a good management 9.1 Organisational structurc for the CDTI 9.1.1 Please provide an organogram -for the CDTI showing the organisational structure responsible for implementing the proposal. Fig. I . O rganis at ional s tructure of O nchocercias is contro I programme. l r:{"'I31. :.r.R(-.f$t 26 'I'l&!8.,.' r t.t*jl i ir : its i riirft ta.., a9.2 [iinancialAdnrinistration Mcchanisms of disbursemcnts and transfer of funds from thc World Bank to countrics Funds lrom thc World Bank APOC Trust Fund will be transferred to the WHO country office account in Addis Ababa. On request through the propcr channels by authorised officer of the MOH, WHO Addis Ababa will transfer the fund directly to the bank account of the respective Regional Health Bureaux (RHBs) according to the approved CDTI project proposals. The signatories of the bank account into which APOC funds will be transferred at the regional level will be the head and the administration and finance officer of the regional health bureau. All the imperest returns will be submitted monthly by RHB to WHO country office in Addis Ababa that will forward them to APOC headquarters in Ougadougou. Monthly reconciliation statements witl be forwarded to the central Malaria and Other Vector-borne Diseases Control Unit (acting as the secretariat of NOTF) for Follow up. APOC will issue checks (advances) in accordance with WHO ruIes and the previously agreed project documents and/or plans of operations. When the total payment in cash required for the project exceeds $ 100,000, the payment must be made in installments. The first installment/advance could cover 3 months or 6 months of activity depending on the duration and magnitude of the project. Management of funds by projects and WHO/APOC mechanism for monitoring The size of the project will determine which of WHO's contractual systems is used, e.g. Technical Service Agreement, Letter of Agreement, Contractual Service Agreement or Agreement for the Performance of work. A document on administrative and financial procedure will be made available to project being funded by APOC. Built into this document is an impress mechanism, whereby the project will report its expenditure on a quarterly basis and receive further advances on that basis. Each project funded by APOC will require a periodic external audit at project expense. Each project must have one senior staff member who is accountable for the management and control of project funds. Standard internal financial checks and balances must be incorporated into each project's financial management plan. 27 Fig 2 Request and Disbursement of APOC Funds Sffieir I Health MOH -, ., _ .t#r, , Bureau Disbursement Financial Report o---------> 28 ',. ,':-'t ,9.2.1 Inputs from Minis(ry o[ Ilcaltlt a) lndicatc re.sources thal u,ill be provided b),the Minislr.l'of Healtlt artd olltcr governntenl age rtcic.s. l'ersonnel, logistics, o[lrcc accolnnrodation Countcrpart funding Sccurity b) Please provide a list of personnel assigned by the MOH to this project, including their name and proposed tinte ( State percentage of time allocated to lhe project) for tlte project and v,here appropriate , tlteir experience tn onchocerciasis control through ivermeclin trealment- Since this is the first time that Ethiopia will initiate onchocerciasis control through ivermectin treatment, none of the personnel has any prior exposure in this respect.. Regional Health Bureau Name Post ol,Time Mr. Sewnet Tegegne Vector Biology Expert 25% Mr. Mohammed Yassin epidemiology & Diagnostics Expert 25% Mr. Gashu Fentie Vector Biology Expert 2s% Name Post ToTime Mr. Mulugeta Aemero Head, MOVDC Team 30% Mr. Tadele Tegegne Epidemiology & Diagnostics Expert 25% Mr. Mulugeta Lakew Vector Biology Expert 250h Administration & finance Head 25% Driver 25% 9.2.2 Input from the partner NGDO(s) a) Please provide a letter from the Execattve Director or the Director of Onchocerciasis programmes of each participating NGDO stating their intentions to participate in and support the National Onchocerciasis Control Programme. Name Post ToTime Mr. Nega Norahun Head, wereda health office 20% Mr. Terefe Woldie MOVDC co-ordinator 20% Mr. Berihanu Alemu Vector Biology Expert 20% Ms. Elene Birhanu Vector Biology Expert 20% b) Give information of the tnputfrom each NGDO participating in this project. 29 aa a I'hc Cartcr Ccntcr's input will bc:- Funds: I)cr thc agrcenrcnt madc between APOC and the FMOll, 'l'hc Carlcr Ccntrc u'ill not havc direct responsibility or rolcs relating to the managcnrcnl and rcporting on APOC funds. Mcctizan: J'hc Carlcr Ccntre will not havc direct rcsponsibility or rolcs relating to thc accountability of ivermectin in Ethiopia. Thc drug u,ill bc consiqncd dirc<'ll-r, ro lhc WHO and scnl to MOH ccntral slorcs in Addis Staff and consultants: The Carter Centre has been involved in some areas of public lrealth in Ethiopia for over 6 years. In 1993, The Carter Centre, in collaboration u,ith the Centre for Disease Control and Prevention (CDC), began assisting tlre Ethiopia Guinea Worm Eradication Program through the Federal Ministry of Health. Since then, the burden of the disease has becn reduced by nrore thanT0o/o. The Carter Centre's agriculture program has been working with the Ethiopia Ministry of Agriculrure since 1993 in a partnership that led, within the firsr two years, to Ethiopia's first grain surplus since the devastating fanrine of the rnid-1980s. The Carter Centre, since 1997, has also been supporting training in five health science colleges in Ethiopia as part of a national public health training initiative. In lighi of this experiences, The Carter Centre, in collaboration with the FMOH has expressed its intention to continue providing technical, financial, and logistical support to the onchocerciasis control program of Ethiopia. a Office space and facilities: The Carter Cenhe will support the national secretariat by providing technical and logistical support through a local office in Addis Ababa. c) Please provide also a nominal list grading and post description for the personnel to be provided by partner NGDO(s). Indicate clearly what will be theirfunctions in the program and their experience in onchocerciasis control through ivennectin dtstribution. None of the staff members in Ethiopia have had any experience in onchocerciasis control through ivermectin distribution 9.2.3.Inputs from other agencies Please list any other agency or party that will be involved in the running or financing of the CDTI, and indicate clearly its role, functton and contribution. WHO Ethiopia / Country office / will assist the project in the importation and clearance of ivermectin from Merck & Company France, and facilitate the request and disbursement of APOC funds. 30 9.3 '['irncd plan ol'action Providc timc chart(s) showing hou, thc various activitics of tltc CDTI rvill procccd ovcr llrc coursc of tlrc proposed progranr. Nunrcrical annual targcls lor all planncd activitics should bc proi,idcd for cach timc point. Thc linrc chafl should also indicatc how suppofl would bc phascd pout over the 5 ycar pcriod. 3l cl \ \ \ \ \ \ \ \ \ \ an cr \ \ \ \ \ \ \ \ \ \ \ \ ailo a{ \ \ \ \ \ \ \ \ \ \ \ 6l \ \ \ \ \ \ \ \ \ \ \ \ \ o cl \ \ \ \ \ \ \ \ \ \ \ \ \ \ a >t EI d o oo 6) () d tro <(N q tr(.) o -uoc>(!() o6G,EooON <E 0) oL o q o trtE 0)! a) q o o 0) 0)p b04 o 0) 'a q o.E- '.= o oo-29OJ o'o -cc6(,) eECb9LE =o_o.;o)&8 (q Lotr (dp o() 'a rp. o @c- .;Oc> '= iD tJ-0)c, -b5 .! o( -O !d or F: (! qk G)tr dk o !t) 'a q o. o ootr tr(,oIr>bru oodtrtr '=o .=NG, rrfiE (! (.)q(,r oo 'a o. o @tr c(l) .FB E-gs bl) I .=o .EB !g c.r F! a tr(.) E0q G.)oq (! o bI) o o Eo a. Jrl ! o.d& tr o dN p o a e tr tro(J q It) ! E U) o. }Z () Ec o() o a(J o ootr tr(!b!l)9btr tr(!b !tr CI tro oIo CN @tr() o ttr G, i o C, q @ C)!E -o .9 Oi{ 6oqF oaJ-o co ..o 'trl o @cdN o a) z E o e() o. 'otrd @q Lo co z () '- .E (,) d tro .E ,o 'tr AJ o oO oy E()O() OO Oeoo C6 tr o (! tr eq tro o o06tr(o a oo Etr -oa;OJ :\&a o (€ (U o (U ELo x 0.) (o Eo E 6) o tr C) (! o F o i() od trd o. o o .c o al () GL o o d q) q) O. \ I ar0. Ilur)(;ti't' I0.I Iludgct Estimatcs Budget tnust indicate total ./ilnds lo urtdcrlakc tlt<'1tt'oicct.7'he amounl o.f'./itnding requesled .from /I'OC, und thc ontouttt 1tt'ot'idcd by tlrc A4Oll, ltt(il)O(.s) und othcr l)urttt(t'.\. r1ll ntust lx, ntudc itt US dollars. liach hrdcel musl include at lcasl lhe follov,in.q rttuior culcgories (see appendir 2) indicating tlte conlribution of the parlners to reflcct sustaittubilitl,ol CDTI. . Personnel (services) . Capital equipment . Supplies Training . I-lealtheducation/mobilization . Travel o Communication . Consultant . Operating expense . External audit 33 tYEAR ONE SUMMARY BUDGET FOR ONCHOCERCIASIS CONTROL IN METEMA WEREDA YEAR 2OOO 2000 CATEGOITY 7.5% NGO overhead cost NGOAPOC N{OII TOTAI, 12,500.00 25,354.00Pcrsonnel 0 12,854.00 Capital equipment 55,882.00 51,074.00 59,212.00 166. r 68.00 Supplies 4,788.00 0 7,835.00 t2,623.00 0 1,500.00Training 12,999.00 14,499.00 Health Education/mobilization 14,599.80 0 600.00 15,199.80 0 13,900.00Trarrel l 6,683.3 3 30,583.33 0 4,200.00Communication 3,200.00 7,400.00 Consultants 13,440.00 0 0 13,440.00 External Audit 0 0 0 Recapitulation 0 0 0 Operating expense 445.00 15,320.0015,668.00 3 1,433.00 Grand Total 137,260.13 64,373.00 115,067.00 316,700.13 Estimated No. Treatments 55,980 55,980 55,980 55,980 % input 43.3 20.3 36.3 r00.0 34 1I i I . -n n '- i 7 c q E 9 1 ! q cc E ! a I ,_ s : a E ct a E : 8 , t a t F 8 c F lt, l. t; I t' ? '- r l. '- t'- :, lt t- I II : t: li 9 I t o Z a 8 : c ; t 8i t8 E5 te 8: I 5 E ; 8 1 o 8 8 q F o F t 1 8 8 g 8 e1 8 c I z t a a .] 8 :- 8 t E = 8 8 8 d a 8 ! I d n: UI I9 J. 88 8 8I E3 J F F 8 8 -: 8 n s 8 8 8 &a 8 c z 8 ! t ! 8 8 8 .: 8 8 t a 1 8 8n E ! o E I s E :. 8 ; : q 8 I 8 t 8aU: 8 8 J ? oF 9 I 9 8a I x I E z e 6 : 8 s 8 q 8 :a 8 Q U E 8 = 8 8 8 n: e 8- o 5 I jq 8 ; nI U a a 8 9 = 8 3 8 I a Iq 8. : J F s 8: t d 8t : a = 8 e 8 a e t d E E o oz 5 e 8 :: I 8 8: 8 aY 8 x . 5 8n I = s E T ! 6 E I s nI t I 8 I 8 E I : 6 8q 6 e Ij tn d o F ! 3 EI = 9: E a E 9 E E 5 =E 9 ! a I :t E c & F t o f 9 5 E 3 5? u 6 E IF z! E a I10.2 Budgct justilicatiorr Pleasc prottidc a ttorralive dcscriptiott of'lltc rausons.for each proposcd linc ilcms t1f'tlt<, budge t. The proposed budgct lor sonrc of thc linc rtcrns;rrcsented lrere arc also nrcaut {br Quara u,crcd:r that will start its CDTI activitics thc lollou,ing ycar. Specific budgct for Quara wcrcda rs nol indicated herc as REMO data for tlrc arca is nol yet available. Fronr our knorvlgc the arca is known to bc highly endernic for onchoccrcrasis. I{owevcr, inclusion in CD'l-t proposal should wait forcopletion of REMO. Thereforc, mosl of the capital items and supply items will not go much higher than that indicated in the budget details in Appendix 3. I) Personnel The personnel budget reflects the amount nceded for staff at the levels of RHB, ZHD and WIIO to facilitate the CDTI activities at the conrnrunity level. The MOH rvill provide support to thc program in : . Mobilising authorities and communitl, leaders o Organising and leading the distribution program . Training of supervisors and CDDs o Getting and supplying ivermectin o Transportation of essential supplies . Regular supervision o Accounting for funds spent ( both APOC and others o Program evaluation 2 ) Capital equipment In order to run the program effectively the RHB and ZHD should be well furnished rvith the necessary basic equipment. 3) Supplies: Regular office supplies are essential to ensure sustainability of routine offrce works. More over as supplies Paracetamol and Promethazine are required to treat lO%o treatment reactions. 4) Training: Training is the decisive factor to make programs run smoothly and effectively. The CDTI project needs trained community drug distributors and supervisors. There fore to make the CDTI program effective, training will be given at different levels that incurs a reasonable amount of money. 5) Health education/ mobilization The best way to make a program accepted and implemented in a community is to produce awareness and a feeling of program ownership. This situation can be achieved through intensive health education that will bring change in behaviour. [n cirder to implement the CDTI program 36 hcallh ctiucation is thc bcst tool hcncc support is rrccdcd lrortr APOC, MOII and N(jl)O at diflcrcnt tirtrcs. 6)'l'ravcl ']-r'avcl is rcquircd lor advocitcy visrts, llairtirtg rctlarninrq, sultcrvision and ntorrilorinq, anci cvaluation of thc progranr. AI'OC and Global 2000 arc sourccs lor the budgct. 7) Ooiuliruliicatioit : At the National, Regional , Zonal and Woreda lcvcl there will be communication to pass important information on the situation of the CDTI progranl implementation. 8) Consultants : Consultants would be required to conduct local operational researches. Global 2000 is requested for this budget. 9) External Audit A budget for this item will be required to engage external auditors to audit project account. This rvill ensure proper accountability. The MOH and Global 2000 will be responsible for their accountant's participation in audit exercise APOC is requested to support the audit budget. 10) Operating expense: The whole operational activities need a huge amount of money in order to run smoothly and effectively All off,rce activities and some field activities are supported by the MOH. 10.3 Current resources available in CDTIs : No currently existing CDTI progmm. 10.3 Current resources available in CDTI Existing CDTIs (for conttnuation or expansion) will have resources already avatlable. Please provide a detailed list of all existing personnel, equipment and suppltes (includtng vehicles, etc.) belonging to the program, indicating their ownership (MOH, NGDO, other Agency, etc.) and thetr level offunctionality. NOT APPLICABLE. 37 APPENDIX I. ES'I'IMA'I'IiD NUMBERS OIT COMMTJNI'I'IES ANI) I'EITSONS'TO BIi TREATI'D IN I\,IETEMA WEREDA BY YEAR ANI) ENDIiI\,IICII'Y I-E\/EI, MIrSO- ENDEMIC ltYPo- ENDEMIC* a AIIEA CO\/IiITIiD COMI\,l UNITY EN I)EI\{ IC LEVEL HYPEII.- ENDEMIC TYPE OF TREATMENT Community Directed Conrnrunity Dircctcd YEAR r* - (200r) No. of communities to bc treated 20 I5 Total population in above communities 30,358 25,622 YEAR 2** - (2002) No. of communities to be treated 20 l5 Total population in above communities 31,238 26,365 YEAR 3*** - (2003) No. of communities to be treated 20 l5 Total population in above communities 32,144 21,130 'EAR 4**** _ (2004) No. of communities to be treated 20 l5 Total population in above communities 33,076 27,916 YEAR 5**** (2005) No. of communities to be treated 20 l5 Total population in above communities 34,036 28,762 38 I Ivermcctilr 'I'rcatlnents rcflccted in Appcndix I wcrc obtained as lbllorvs l'he total population oI the Mctcnra wercda in the year 2001 is 69,975. 'l'lris gii,cs us arr eligiblc populatiorr of 55,980 lbr thc ycar. An cstimatcd population ol- Zg,iO2liyc ip lrypcr cndcnric colrlrtttttilics rvhilc lhc rcrnaining 24,900 livc irr rrcso-crrclcnric conrnrurritics. YEAII I": A trcatrnent objectivc of l00oh EARP of both lrypcr- and rncso-cndcnric eorrrrrrtrrtitics irr i.irc ucrs.j.r rviii b,- iargei.cd. with some experience, the program will expand its coverage to the neighbouring Quara wereda. The estimated GDTI eligible population of Quara wereda is not yet known. However, with completion of the REMO in the region during 2000 we would be able to determine how nrany of the 42,622 people (year 2000 popularion) in the wereda will qualify for CDTI. YEAR 2.. YEAR 3***. From tlie third year, the program will plan to reach l0O% of the eligible Population in both weredas. However, the eligiblc popularion of CDTI communities in the trvo weredas will be difficult to estinrate at this ltoint as REMO is not yet complete in euara wereda. YEAR 4-5****'After the completion of REMO exercises the EARP may increasc over the thlee years. Fig. 3 Annual Treatmcnt ObJ€ctlyo by Endamlclty Level 40.00o 30.000 8..* 35,000 2s.000 15,000 10,000 5.000 2000 2003m Y€. 2001 200a 2005 39 I aA I'l'IiN I)lX 2: I N t)lCAI'ORS IrOR Ii\/A Lt lA'l'l ON, SUS'I'A I NA lll l.l'l'\' /INTEGITA'TION OIT CI)TI/ Projcct Evalua(i<ln Manageme nt [:inancial nranagcrncn( E,ffcclivcncss of conllllun icat ions Training and capacity building I nstitutiona I conrnrilrrcnl Fulfilment of otlrcr rclcvant sectors Problem solving capacity Integration of operational research Project effectiveness Result of KAP Srudies Treatment coverage Follow-up of non-eligible and absentees Management of adverse reactions Reliability of repo(ing Su s tain abi I ity/Integr a t io t t Political will of host government Political will as shown in policy statements and apparcnt commitment of high-level Officials Offrcial action assigning personnel, funds, vehiclcs to program Long-term planning ls there a long-term plan for sustaining the financing and the management of the program? Progress toward financial sustainability If program sponsors cannot continue their current level of commitment for at least another five year, what percentage of rururing costs is now paid for host govemments or fees? Progress toward integratio n to what extent has ivermectin distribution been integrated with other health service programs? evidence of community empowerment and ownership change in KAP over time 40 a! 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(E c _9oot a c o) E fooo Dc tI, ots oo o o co (U o =ofo 6c oN oc G' 6c _9o(, E oIo Eo Ec(! ooc c .E o -9 Ec oN oc6 6 c o oot (,)(o o o Eo Ec o co og .oo E Ecf E E oo ooo o Eo Ec o co (E o =Eo aCf E Eoo oooo E(It Ec o c o (E o fEq) .icf E Eoo o o(, E oF oq oo o-|r) N oq oo l'-- @ oq oo(, oq olr) c.) oq oo o-(r) oq N rr)- oo cio o- oq oo o-(9 oq oo o- @ oq o1\ Or- oq oo o, oq oo o- oq o|J)(t oo ciq, @- rO lO o =cl o ctz (r) (t (\ ot C\l (o E o = o o o o =cl oootr)N oo O)N oo orr, (., ooo(.) C\,t rO ooo oolr, ooo(, ro @ O) oo(t) ooo o|r)(9 (, o f oo oo o_ () o o- () o o_ oo(L oo(L oo(L o o o. o oL oo o- o o o- o o(L o o 0. o o o- c o o. (,, th oE = .:(,(! E og ooc o o- x UJ op rq) o.l f xJo 6l o B$ ol o >.tol o6 xo -o c)o(! o o q) o o o o o) (o] o od oo ooa o)(_) o(, c 't o, f o, Eoo olo .i Yooo o) o 3 o @ od o o) oaoooo(I, E,t o f o. Eoo oo o.(q J o) -_E] D c(, vo((, -o a C, o) -c o. 'c q, o. E(l) c 'c o- o oo(l' J o (o oE o- 'c(l) o. E --B o c o. o oo (l, .EEo(o E x(E LL (1, .c .c.o(I, E .9 o-oo o o .c.(L o (,) o o. E C,oE o o oq, c oE o.(t o) o) = o oo lr) N oo ts uo i oF a o o o. eolot llEI o5l -tol(r,l ot ol LI €l olol .olEI(Dl >t;lolzl lc o .Uc6 o. x ut 6l orl >l ol o (Il o .c .c E € c .9 at E(D o.l U) Ur1lot cl o)l(1)l EI -t>Jol(ol otol >tEI(El EI ol =_lolcl EI(El H C(D E5oloi1Jt OJ cl (5I ol ol =lol o f =cL =tL lo)lolc oE C, o o.l U' d) o1ol I'Icl(El OJCI 'El =lrlol OJ(r)l trl I 6l()I olEI -t0)l EI ;ltslolololLI *t :l ft an6 o (U (o attco (E(-t .E a @ o,c =oq) E (-, oo ol >1 o1(Ul ol6t sl -lut .cl cl (El FI I o oo (E o oIoo o- ro oq ooo- ro(o oq oo ro oq o ro (.) oq N ro- oq olf) N oq oo rr)- ocoo ro_ oq oo(r) oo o{ ol C" ro o =c a o dz E(l, .: o o oo .=cf ooolr) ooo ro(o oolo o(, (o (\l ro otof.- oo ro ooto oo (f) o)(,!f oo o oz o(9 z o oz o(, z o oZ o oz o(, z o oz o(, z (It o E(D U' f o sotr) (D o t o >l o B1 v1 c o CL (, o oo = (, (U E o ;lll)ci olol xtUI o l =c Doa l ol slol rolJ -ld)l oJ ol()I ol ol -Cl o-l op Eo o B .f l^lel(trl3 lol6 l.o @o oaa(D oo s_.1 -ld)1 rl ol EI otold ol ol _El 3l(Dl zl o) =E 3 oc(U v.o .q -o o(! o) c. o (l) o- o) c o- lo l'-)lol6l(trt;l(r,lol a o) rn :f o solr) --,,1 (D C c) ol(trl El xl('t tl-l o o(D .o. o,p oo -c. (D o ol ot o)l '6] q (r)lEI :lal .U oF E tuFz UJo t uJFt () IU fl" o oz oot o- r|r) J FoF 4 o = c o (o cg o-x uJ -=t _ol LI(Jt d)l d)l ul cl6lgl c)l (EI EI oco (U o o,o >.l (u o ooc o)Ec o o-oo Lo C) EC(E 6t o1 o.lolLI +lol 6! cl ol FI U' o(,, E oF oq ooN oq oo@ oq o|r, oq o ro @ o .=cf, o dz E o = o o o o .:c = oo6l oo(o o rr) oo f oo or ts oI3 oI B c o so g, o = l s tr) ooo o. al, o() Eo o) =(D o.l >lF 6 oF aIt :,a o -B =ruF UJ =II o = L .9 oc o CL x uJ C .o G .cE o oo E(U L o,I(L oc oN EC(I, 6c .9 o) oL E = 'c .9 oo .E :l E E o O :s oo El E C- T] 0) (tr =l ql ctot (trt (l.)l OJOI >l :l(Ul ol o o(, G' oF oq oo o- @ oq ol rr) N oq oo(o oq oo o) o e c{ rot- o) o =c :) o oz E o .= o o o o .=cl ooo@ N rf) C.t oo(r) oo O) o, o o @ oIN oIN oIN oIN c o o. L o o oE .= 'a o lE E o =ooc o CLx so op E, o) (,lc o 'i UJ s o1 ;lcl ol -c.t o] c)l olFI so o o : l sir) oo(I, o. U' c)o Eo 6 o .ct ao oIN tr oo z. o o IF &. oz -o = c o (! trs CL x Lrl c o o .sEL o 8 E E cI, e(L o)c oN ! c o Ec .o o,o E '= c .9 (E(-) c.l Ec oo '6 o o)(l)l ol c.(El -1(Dl (o =l o)ctot (uI d,l OJol >l([l ol o o o .U oF oq oo(f)- N oq rr)(\l oq lr)o oq lr)ot* o e ro(r, c\l Ci' o =cf, o dz E o = o o o(,, .=cf oo (f) N lo c! r()o lr)oF- @o L :l oo @It- mIt coIg. coIt c o o- o ao oE o 6F so at o : l s rO oo(U otn d)or- o f o lt :, U) so q) .9E o o)c .9.x LU (f)$ ooZ 'doE+ 9,flEr@ 'o_!q9Ebo o_o-o J f ultf lI! -FJ uJI J z. o o ul u. d - =f -o = -- ,z o a! E o =o oc ooxU $s c o Gltrs ELx IU o c,) E o o o iI at,E o o- oL o co EJoop o)c o- ooo oE(L =o-) o o f o- E oo C,)c .E c L& (, c C J o() oo .9, U' oc G o Go .ttco oLo o. o 3(I, o co E =()oLo o .9a o. =q) o oo E oF oq o .+ oq lr) N ol oq o(0 o eo(o oq o ro$ oq oo c)- t- oI ro a) @- t- o .= = o dz N (o N $ (9 E o .= o to o o .=cf oN ror- ocf) rr)r o(o ooo F.- ooL :, oo ooz o oz o oz o(, z o oz ooz c .9 o- L oooo .= .z oo E @ .= ootr o CLx ul U'q) =.d!6 o .q) o.ooo o _c o. o c) o)o E(o o L oc oF o =c 3 D c(, i<(u -o o(,) o t oo L o, c (L o o (u f,o oo boc o (U a .h .g o_ o- l @ o co Eo fooL(L E o tr o Gcsox IU o o)g o (r, g LL att oooL q, c(t) E fooE q C o.ooo oE(L =o :fo Lo =o. Eoo q) c c L(L U'E o. Eq Ut o. Cl E q) c c L(L (,) c c foooo .9, ah oc o C' oo oc .9 Eq) o.o3oo ooco .c. o.o o)o E Lo o U') E5Cc oo U' oo E o) o o o so .g al, oo ro op an o C o, E o c)L L oLr a o @ oo ro o) (o q) o so .s o C)o I o op tn o c o E o og L otL at, oo E o oq o(o oq oo(o oq o$N oq oN r oq o ol oq o ro c\t C\l oq olr) oq N cf)@ oq(o $ oq @ @\{ o .= trf o dz @ @ @ N @ 1r) oo ol N ro C9 E o = o o o() .=cf oN rr)F- ocf) o(0 tr, olo loq o (o N co o(, f oo o o(L o o(L o o(L o o(L o o(L () o(L o o(L o o(L O o o- oo(L tr o o- L o an @o = o o Eo =ooE o CL x UI .o o a.af a4 o(t Eo aD oto -Y .t4o L .q) o.ooo o c. o. oo o)E Lt C,o LoCoF (D =E, 3 o c.(, .:z C, _o q) oo LE(I, o L(l) c L(L o oo oop Lt oo Lo c .E (L o o (I, fo oo e o)co G' a - o (u -o oo bo to o o c oo U' _o !o ooo o ol E oo(o o E(I, d)o oL(E o_l c(! o U) _oq ooo o o) E tr)N q) c .N (o q) EoL(L E oF t I(I, oao.9 6 lo-o)=E,nco; E co q) x =(l)c-=(l)J o o- d ulFz lU(J u IIJFd o ul -F ao(9 z oo o- (o .f ! Itrlo (E E(U ax tU l^lLlo)t> o o. c)t Lo olC o ct)f o (f) E .oEL o)(LI C o Lo +.1 o.] oi EIol >J(EI ol\lolalll ol(olg EI ol E'I LIol o-l Lo Lo + ciou Lo C'E oaf o (f)YE(t) E' L] ol o-l 3o oL o E E(Uu o)oLo Lo :tr d) EL c) o-l o oo E o t-- oq oo CO o eoo (f) oq oo cf) oq oo(o oq oo ro- @ .=c = o dz o o o lf) E o .= o o oo .=c :) o c.) o(o ocf) oc\l oo L f oo ooz o(9 z o(9 z o(, z c o cLl LIolololol >I >l ol(El \l EIol -=l ololclol o-lxltul oo s. a -YL o 3 o) .g .g C,L ocoN o. oEa :< L o =o) .E .s o lLFo = o.oca ll o 3 g) .E .c(v L ooo o)c oo E 3o '5 o o, E E o q) oL(L J FoF c o otr s CLx UJ (u o o g) .E .c G,L C) d o c o E -c .tt oL E : o(I, oocoL(t) C. ool >,J L o1cl OI (E] 6-l EI(l,l EI LI(t)l o_l C o E c,ooL o)L ='6 (E o(,coLo co C) al o) C -ol (El ,-) EI(l)i r-lT'ILI(t)l(Ll q,l c c '61 -lFIol ol cq) EEo o o =() (U ooCo o) coo boco .F o a Eo E L(D o-l ooo(-) Ec o q) c oN dc .9 C,)oL Lo p o cf .an @L o .E oL L o ah op J o c .9 o)oL Ec o o cl o1II olsl aht -ol YI ol(l)l -clol oooo Lo o .9 v.(, oE,o o o(, E oF oq oo(o oq o(o @ o e(o r$ oq o(o(fr- (f) oq (f)(o o)- N oq oo o- s oq oo oq oo - oq oo(o oq o) o) o)-(\ o -E = o C,z (9 oo .f oN oN oo (f) E o .= o o o o .: trf ooN o(o @ (o s o(o cf) co CO(o o,N o (o lr) N o(, L a o U) oo(L oo o- O o(L () o o_ () oI Oo o- o o IL o o o- (J o o_ C o o- L oo oo .= o o E o2 o ,n E o o-x ul ol .c .c(I, L o) =ocL oo (U c .o o)ot Foo c o FoF (u CoN Fo() co FoF Fo() c o o) .Cc '(o ooo o) a fo IUt ta o o Gtr O) c (E\ o olc c\ o. U'E oEo .g o)p)q, E f, fo L L fo aq)p f o) o o(= LLFo = tLF oN op a o) ooo J FoF a U) E9o)(JCg:= EFco; C c.j P xE9 L(Ij)J o- o- u. UJFz ul() tr UJFt. o lUIF a o oz o o o- (o .f tr o oc s CLx UI co E .c. U' o)L E Ec o 6 coL : '6 olL co EE, al,oL o)L Ec o E c E := o(! tL co E -c(o oL 0)L Eco E coL := o o TL o o o E oF oq oo(\l oq ooN oq oo C\l oq oo(0 to .: f o dz E o = o o o o =cf ooN ooN ooN ooL f o(n o oz ooz o oz c o o- L o ooo .= .: o G' E @ .= ootr o CL x lU C .9 o c o o Ojc .E 'o (E c .9 o,ot C o .g(, cq) o o) .Cc '6 g ocoN Co .o(o cq) o o) .Cc '(u (o oo Lo E E oF c o otrs CLxlrl c .9 oo Eoo o(E oo E G 6c .9(, ot c .9o o. E(E o (, (E o o Eo 6coN c .ol(U o. Eoo o(l, oo Eo oEoL o = .Yo c, o. co .E (u EoLo .c .gEo aooo -o .9 -o) o. o -c (,) C oo)E o L otr o oo o .rC o :o C o c oFG .N -oo E .E f, E E oo L o u- o oo o D o Ec o C o o .N 5o E .E =E Eoo L o LL o ooo Eo EC o Co o .Nbo E .E f E E oo L otL oooo E o Ec o co o s -oo E ac :, E E oo Lo LL o(! oo :o (U Ec o co og -oo E .E J E Eo() Lo LL o o ot o oq oo(fr- oq oo ro oq oo @ oq rot* oq o(0 Or_ @ oq(o o)@ o e @(o N oq oo(o oq ooN oq oo o_ o oq o)q) .o + to .=c J o C,z ro @s$ (o O)@ @ O)@ oos oav ooto Eo = o o o o =cf, oo (f) oo ro oo @ lo oN cf)o q u? o c\l @o =oo o o& O o(L O o(L o o(L o o o_ O o o- O o o_ O o o_ (_) oc O o(L c o o. L oo oo .= .J G, E o .= ooE o CLx ut c .9(U cq) o O) .E .c C, oc .9g, o)t. c o .q o g o o o) .s .E o Ec oN c o .g(! co o o) .sc '6 L $EoL o = (o ro o)L o) 3 J(o c oN j (g c .9 o,o q) O)(I, x.oo o- c .9 G, E Lo c tn .g\o (U =u:c tr |E U' L o ao(L oE oEo .9 lJ- aoL l c.ooL(D U' o) o)(o oao E E, ; .t) L o .Yo U) oo o)oo U'o E .C, =3 o .EEoIF ooool ol -clolcl ot E o coe_E(trNEE6=O'CE.o co$ o(of .xEEcc.Pb o_ c = t TUFz TUo d UJFd. o ulIF a o(9 z oo o- o o ao al, E o) o.ll o1 ol(Et ol cl _tFIol o (E cl o E1 ol cl '-lEI cl(ql 6l 6l(Dl >I .tol ol J clll ol(Jl o(I, c o)p o .g 06 o(E o E c .o (lt EIo Eoo(-) l(! -16 6l EIolEI '61 cl .-t .tl(l'I ol EI cl ol (Ul arl ol EIolotol(!l ,;l cl cl(DlEI olcl "rlol EI co (trE o EIo o1o(!l l6t 6l cl olEI ol cl .tol(!l ol EI c oE @!,o Eooo o .d6 cl G,1bI olcl -lol6l(DI EI o o(, oq o t4) oq oo (f) oq oo{- @ oq oo c{ oq o ro og oosl oq o|r) oq ooN oq o rr) oq oo or c,t o =c o C'z 6t lo o o o o o E o = o o o o .= cf rot- oc{ o\f@ o c\l ra, oN r, oN |r) z oo f o ooz ooz ooz o oz o(, z ooz ooz ooz ooz .9 oo E oo _l ol >l6l Fl <t B .9 o o E E(o D c(u Ec o o E E(u oc cc(\l o rcc(U 3 .q o o E E E olo o, 6coN o E E oF cc(o oc(o 3 0) 't o oc cc(o o Ec(o ! C, 't o o E E(E o: e o, oE Eo3 E .9 !, o(L c .9 .9 a @o l <t) (o oo o E(! coN 6c .9 Ol @E E .9 E @ o- E .o Po o_ E .9T' o(L E -9t (D(L tr. ulFz uJo E,r!F tr. o UIIt; o C,z (o J FoF oo o. c -9 otr(E lololo l.aIN INlxt-lotot>lololo lE oo e x o(t)f o x c oo o o.l (f) 61 'o-1 'rl }] olql 'El ololrl al o o E\t X (U N EY oo c{ o o o E oF oq os(o- $ oq oN CO o Io(o(r,{ o =cl o dz N N E o :- o 6 o o .= cl N o_ N o @ o o a oo () (L o o o- c o o-Eo o @! >1 =>l =lol{l EI ol -lol6ltrlot o-lxl url Eq) D o) o- D c o c .9I z o o.fo oo o .= o o. o) q) oc o o C(o o 'tr o f Ef, lL ii o -of(r, o -3 =u.lF IrJ =i o = I oo 6 lol>rt(!IE lr.- oI ool o x c1 o @ oq('ri ot =iol >l -1 olal 2l @l OJflol l(uld,l>lo U'o EE o,t x p o U'f rO c? o x E EY e EY ol o1@l o o(, G oF oq o ott oq o F- oq o o){ o =cf o dz ot N E o = o o o(, =tr f o N lr)(, o(, J oo oo o_ oo o_ E .oE oo Ec o c .9o ao CT :,o (E coN .:(o o. o o 2'l o cl ol ol ct6lot 'El6lJl -l(l,lfl rLl E o .ctJ(t, o -N u. oozoo IFtroz Io = oo (, @o E q oE o CI x oaf, Eo c, oo E '- $lI @ =o U)ll ,o1 a?l ol II 0)l EI)rl el EIYI olololNI x co E(D o(9 o!o Lo6 .E @o l u) o o o I!- oF og oo(o (f, a?(.,(9 C.l e) a? c, c, @ o =cf o dz c! ol E o .= o o o o .= cf oo CO N o() f o U' () o(L oo o- c o o o .n o!t o(g Eo =oocoox TU E .9E q) o E c(E c .9 .9. eq) o. fo(' c .9 olod .=(o o.(l) o, z' Ec(E c6dl 'El olll -lolfl trL I E o -ofo = TT d.f dI IFJ UJI J zo (9 UJ G, d I ={! o = c o oc s o.l x ul o @ -o E o E TLF oz o o o- .C Ec J e o!F o o(, G oF oq oo{ og oo .c o =c :, o d z $ E o -= o o o(,) =tr l oo oo f o(n () o(L c o o. oo oo = (, (U E @ ;I ol aLl xlr, o c .qG o @o Eoo o (E E a E o Il :, U' N @ g q)Co o(6o -F;E oo= xc, o.cEJq) o- o- (J o o- c o CL] LoooDl n >l =to6l EI oI =lol6l cl ol OJxlul c o Gcg o x ul at c o EfooE c o o) :f, o Lo anc(\, t'- .n(l !o o =an oc oN oc .o o) E E .= 3 c .o ollc =E oo o oo 6 oF oq oo(o oq oo(o (f) oq oo o{$ o .=c :' o CJz N N E o .: o o o o .=cf otr) oo(o o o :, oU' ooz ooz c o o- ooq, o = oo E]o ol anlclol cLl xl rul o foo q) C orl o](l)l d,l F1 E o lt :,o t. ulFz UJ(J t UJF u. (J rUIt; ooz () o(L c o Gcs CL x IrJ U' c o E f,o oE c 0) o) f o o oc(, F @ C,Eo o3 .n oc oN oc .9 O)oL .C, '= c o 'a oo c =tr oo o oo (E oF o eo(O oq o(o Cf) oq o(\l!+ o .= cf o dz N C\I E o, .= o @ oo .:c3 o CO o (f) oo f oa o o o_ O o(L c o o- oo C)I' = 'z o(\, E o .= ooc o CL x IU o foo (l) C oE. o.l o6F E o t!lo E o Gc(E ax UJ o c o Efooo c o E = o (D at c EF .n(('Eo o =o oc oN att c .oo E -c = =c .9 o .9c :, E oo 6 oo t ot- oq o(o oq oo(o oq o(O ag o =cl o dz N N E o = o o o o -= f o(r, olr) o(, l oU' o o(L o o(L tr o CL o ooE .= .: o(! Eo =o6c o CLxtu .9 =oo x(U u- oc oE o. o oF E o II =o oI3 =ntFttl = -o = o -N tr ooz o o IFd o =I o = l u,df,(D IFJ IUI J zI o uJ d. s - =* I o = c o (t c(! axtu @ c, o E fo oo c oog f o o q, c(U F al,(UE oL o =al, o)coN U'c .9 o)o .c .= =c .o o .9cf E oo o oo E oF ocoN oq oo(o oq o c{t- o .=cf o C,z $ N E o2 o to o o .=cf o (f) o rO o(., :t oo () o o- O o o- c o 'a CL (, ooI, = .:(, lu Eo =o0tr o CLx uJ o =oo x(u tL oc oE o. o oF E o Ilfo tr o aucg o x uJ at, c o El(, oD c o ol) o c) an c o F o oDo(, 3 at, o)c oN oc .ooo E =3 c .9 o .9 cl E oo o oo E oF o eooN oq ooN. oo oot- o =c f o dz t N E o .= o o o o .=cf, otr) oo oo f oto Oo o- c oE o- .C o aa o,o = o(r, Eo =ootr o CL x lrJ o f oo (, o x(,tr oc o @$ 'nc'6 .9 O(llo.9 olo)co=]Edlo .. o(9 xFp9 9o o.= -o =lr o)s E o otrs CLxlu ooo o o =I.IJt acoc .C :0 EoEc c)(,) C 'at, oooo o oo E oF oq o\t$_ cf) oq o!+ -t_(?) @ =cf o C'z .f N c\.t E o .= o @ o(, .:cf o(o ooL f, o U' oo o- c o o- L o aD oo 2 o Cl E o =ol 9.1t-lot cLl xt ulI o =tU u. a uJ x. ii oF o '6 u,(l)cOogdPbdo (f) E .xgEcq)oco- '-'i o- oo o. tr o clc s o. x tu 5(u o d) 4i E dc (-, 'z c,o o ooo oo 'E o)o so ro .L o o. E g;(l,L a dc o .E ot, Lo ooo oo E o(r, so ro ano .gs(U F-oo oEo o =oc oN (u c .9oo Ec o (U o 6l TL oo E o oo ooc EJos 6 oo E oF oq ooo- 6l oIoo tr)- oq oNlr). oIoo (f, oq o o{c,d o =c o C,z co E o .: o th o o =f, oooN oo(o oNtr) oo c) o(, l o .t) ooz ooz ooz ooz c o o. oo oo :(, .lt E o =ooc o CLx ul p oo: o)oc(l, co .c(\, E o .9E o, (D oc(uco .s C, E o o o o o = ooc(l, fo .c o o Eo G oF E o)o l o: .E q) = op E(D t. UIFz ul() tr UJFt o UJIF o c,z oI B =tuF ul = o = c o Gtrg o x TU oc oE o. o)6 Dc o o) (D 3j -o o -9lU o oo E oF oq tr) c\t oq loN o =cl o C'z E o = o o o o .= :) tr)N oo =oo oIN c o o. 'tr oo oE .= o(! E o =ooco CLx UI o .9 -- 'a f oo o .u o .Ctfo c o (, c s CLx uJ oCoE o. o (I) -o c(U Lo (U; ao oo ul o o o E oF oq o F.- c,q o 1'- o e rr)tt o =cl o dz E 0, .= o o o(, z f o F- o(,, L f oo o :E B I o = c o =o_ o6 o! = .:(,(! E o =(D oc o CLx ul o(t) .z f (D o o (t o tt :, at, J FoF I o E o :EN t. ooz oo IFt oz -o = c o ocg ox uJ oc oE o. -qo Ec o o oij '6 o o) u, o oo E oF oq olr) C\ oq o ro(\t o =c3 o C,z E o .= o U' o o .= cf o ro C! oo J oto d)I E, o o. oo(D E :(, G, E o =o U,c o CL x ru al, o, = l oo o E o .Ctf U' o ro c o (u c IE CL x UI a o .c .co o E x(t ! c(o o 0) o- E oo o o) .9 e o) at, oc(I, .= o o. ot o)c oc o. o)6 Ec(I, o o;j '6 .E o -9 UJ oooo o .Y oo -o c o (I,q .9.oo o) oo D oI oc Eooo o LL U'ooo o (I, (D =o TL c .9 o)o 'oc(l, 0,c oN o .=(! o.o g; c) c;c o 'z oa c .9 o) o) 1C c o q) coN o .=(! o.o ui o oc :s a oo o an oo oo 'z o,o solr, .€ oal lr)q o @ co E =oo .t ! o U)l to c! o @ C o E =oo i oal ro c! o @ co E =o .t N (! Eo o) =o .=(l, o.o ,; E oc 'o 'z o al, o @oo (l) o .E (l) ah solr) =oaf, lo o! o @ c o E @ o o(, t oF oq oo o- C.l oq oo(r) oq $$(o- og ol F-(o ood(o oq oo o_ c{ oq oo o_ N og oo o.l oq oNol oq oN fr oq oo o-(o oq$ .f oI @t0 @ d o =c f o Ciz (o (f)(9 (o (f) (f) co(o (o @ Eq, ': o o oo =cf oooN ootr) <' N ooo N ooo c\t ooN o c! O) oo ro o C.lF. $N o o f o U' O o o_ O o o- Oo o_ oo(L oo(L oo(L O o(L oo o_ o o(L oo(L O o(L O o o_ 0) .9 a oo x(I, LL C) fo E oo oo = f Y ooo c o (t .0 olou a E o e(, E E lo c(D E (o (D F o E o e(, E E fo E f .9(L 3o c (D oc(E c(D o E o oE o I' o)al o() c(, c(D .s C' E o oEo Ec .oo o) 3oc o .gE f op Eo (u co N B o)c o) .s6 f op Eo ooo :f ol .E o l -g .9so o)oC(q co .g(, E oE(, o o o: .E o f, o o o o o .nfi8[f,igep.EdH IooEEg.ets = l u,ldf dl -FJ ul I J zI o UIt d I =*Io = () o .L o E ol- 9.3 'I'irncd plan of action Providc tirnc chart(s) showing horv Lhe various aclivilics o{'thc CDTI rvill procccd ovcr thc coursc of thc proposed program. Numerical annual targcts lor all planncd activitics should be providcd for each tirnc point. Thc tirle charl sltould also indicatc how suppofl would bc phascd pout over the 5 ycar period. 3t cl \ \ \ \ \ \ ll ll \\ \ \ \ rao c.r \ \ \ \ \ \ \ \ \ \ \ \ cll ct \ \ \ \ \ \ \ \ \ \ \ \ al \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ o ol \ \ \ \ \ \ \ \ \ \ \ \ \ EI , {JI(Jl E o @q)q o (d tro (o N q tro@ t()c>(,q) oddcooON <E o) or o tro tr rE(.) o -c tro tr() E 0)() bo4 oo 'a L o.E- 'Eo oo_q> &d,o9 C(!C)€Edb9KE =o.o.;oapor O-o (d C)tr (o k o a) 'a pa o @E_ .ioE> '89 E_odb5 .= o( -(l) !d orF€ (, q kotr(!k o C) 'a q o @C tr dtu EB oo6trtr .EN!o or F* d q kIt) tr d o c) 'd k o.q< o ootr cq) .FB E-Qd o0 s) .=o .g)!u crfi€ q q() Eq @ rt)oq (! o oo o o Eq) .o o. rq .o o.d& co dN =po a e c E E o C) @ ru ! E U) o< v o !tro(J q ao C)(H o o0tr tr 6bor hl) tr tr clb .o tr cl tro o(.) ru(A oc ruo tc(! co G,b@ o0 C)kct.9 oi{ -cLd)uaC5=o) .fr O tro -oEq o @c c,N o 0.) 2 co q E(.) o. !cd o0tr 'tr o tro () .: od tro o .E q a, o oo -J<E(Joo o() Oeo-o@o-Ca o CJ tr € o Eo o0(, tr C, z oo EHe9():\&a ao (! (! o (, u C) xo (o Eq) c ao () d(,) tr (!q) F o 3(.) 0.)& tr(( A tr .9 o V) Is cl o) c!t(ri () o cu q) q) a I(). I}UIX;E'I' l0.l Budget Estimatcs llurlgct ttttrst indicate total ./fund.s to underlake lltc ltrojt,t't. The emount o/'./ilnding rcquested fiom Al'OC, und tlrc onlount ltrutvidcd by the A4Oll. NGDO(,s) and olhcr purttt<'r's. /ll ntust bc muda itt US dollars. lioch hdrcl musl include ot lcast thc follov,in.q rnujor cutegories (see appendir 2) indicating the conlribution of the parlners to retlcct sustainubility o.l'CDTI. . Personnel (services) . Capital equipment . Supplies Training . Healtheducation/mobilization . Travel . Communication . Consultant . Operating expense . Extemal audit 33 YEAR ONE SUMMARY BUDGET FOR ONCHOCERCIASIS CONTROL IN METEMA WEREDA YEAR 2OOO 2000 CA'I'EGORY 7.5% NGO overhead cost AI'OC N{OH NGO TOTAI, Personnel 0 12,854.00 12,500.00 25,354.00 55,882.00 51,074.00 59,212.00 166,168.00Capital equipment 0 7,835.00Supplies 4,788.00 12,623.00 Training 12,999.00 0 1,500.00 14,499.00 0 600.00Health Education/mobilization t 4,599.80 15,199.80 Travel 16,683.33 0 13,900.00 30,583.33 4,200.00Communication 3,200.00 0 7,400.00 Consultants 13,440.00 0 0 13,440.00 External Audit 0 0 0 Recapitulation 0 0 0 Operating expense 445.00 15,320.00 31,433.0015,668.00 115,067.00Grand Total 137,260.13 64,373.00 316,700.13 Estimated No. Treatrnents 55,980 55,980 55,980 55,980 % input 43.3 20.3 36.3 r00.0 34 Fc F I 6 e q FI :. t :l : E : o o E 3 r I : ,_ t 3 t, t a ;. q c I t t : e € t t F F I 9 ' E 8i I:1.ili t z t 6 I E a 8 8 8 .: I a 8 E 8 e 8 : I I : z ; 8 I I o .: 8 Gi F t d 8 6 a a; 8I t 9 E a I 8 I a! 8 ._ t c t8 8 3 o t s 8 :q 8 d nI 5 q 8 8 8 6 n E e J F oF a 8 = 8 n9 I & 8 8 8 8 ea a E z t 8a! 8 ! n 8 8 5: 8 8 8 8 = 8 8q 6 o I s 8 : e n T 8 8 8 I 8U: e J F F 8 9 tn E9 d t ! t 3 t 8. I e o() z t 8 = 8 =n 6 E 8? I a B 8 a = E 8q E n: E q 3 3. 8 s E :9 E d nI t I 89 n 8 i 6 a I , n 8- J F oF E 9 s d tI : cn 8I a + n s f a t E o oz 6 8 8 s n E 8 8: t g sex d t 8 a : E t- = n o EI s I _9 E I s 3 8 8 a 8 $ e : E aq 8 d 8 g. 3 an i oo F ! t E9 g - ! I =E I : E 9 5i I n E E E E I = , z a B 3t & ts I o ! g !F z ! 5 d ; l3 l' 5 a 10.2 Budget justilication Plcose providc a ttarrative description of'lltc raosotts.[or cach prt4toscd linc item.s of thc budget. The proposcd budget lor sonrc of thc lrrrc itcnts prcsented ltere arc also tncant lbr Quara wcrcda that will start its CDTI activitics thc follon,ing year. Specific budget for Quara wercda is not indicatcd herc as REI\4O data for thc arca is nol yet available. Fronr our knowlge the arca is known to bc highly endelnic for onchoccrciasis. Howevcr, inclusion in CDTI proposal should wait for copletion of REMO. Therefore, nrost of the capital items and supply items will not go much higher than that indicated in the budget details in Appendix 3. I) Personnel The personnel budget reflects the amount needed for staff at the levels of RHB, ZHD and WHO to facilitate the CDTI activities at the conrnrunity level. The MOH rvill provide supporl to tirc program in : . Mobilising authorities and conrmunitl, leaders . Organising and leading the distribution program . Training of supervisors and CDDs o Getting and supplying ivermectin o Transportation of essential supplies o Regular supervision . Accounting for funds spent ( both APOC and others o Program evaluation 2 ) Capital equipment ln order to run the program effectively the RHB and ZHD should be well furnished rvith the necessary basic equipment. 3) Supplies: Regular office supplies are essential to ensure sustainability of routine office works. More over as supplies Paracetamol and Promethazine are required to treat lO%o treatment reactions. 4) Training: Training is the decisive factor to make programs run smoothly and effectively. The CDTI project needs hained community drug distributors and supervisors. There fore to make the CDTI program effective, haining will be given at different levels that incurs a reasonable amount of money. 5) Health education/ mobilization The best way to make a program accepted and implemented in a community is to produce awareness and a feeling of program ownership. This situation can be achieved through intensive health education that will bring change in behaviour. [n drder to implement the CDTI program 36 health cducation is thc bcsl tool hcrrcc suppor( is nccdcd fronr APOC, MOII and NGDO at diflcrcrrl tinrcs. 6)'l'ravcl Travcl is rcquircd lor adr,ocacy visits, trairrirrg rcllairrirrg, supcrvision and rr-ronitorirrq, and cvaluation of thc prograrn. AI'OC and Global 2000 arc sourccs forthe budgct. 7) Ooiunruliication : At the National, Regional , Zonal and Woreda lcvcl tliere will be communication to pass important information on the situation of the CDTI progranl implementation. 8) Consultants : Consultants would be required to conduct local operational researches. Global 2000 is requested for this budget. 9) Extcrnal Audit: A budget for this item will be required to engage external auditors to audit project account. This rvill ensure proper accountability. The MOH and Global 2000 will be responsible for their accountant's participation in audit exercise APOC is requested to support the audit budget. 10) Operating expense: The whole operational activities need a huge amount of money in order to run smoothly and effectively All office activities and some field activities are supported by the MOH. 10.3 Current resources available in CDTIs : No currently existing CDTI program. 10.3 Current resources available in CDTI Existtng CDTIs (for continuation or expansion) will have resources already avatlable. Please provide a detailed list of all existing personnel, equtpment and suppltes (tncluding vehtcles, etc.) belonging to the program, indicating thetr ownershtp (MOH, NGDO, other Agency, etc.) and their level offunctionaltty. NOT APPLICABLE. t 31 API'ENDIX I. ES'I'IMAI'ED NUMBERS OIT COMMUNI'I'IES AND PEIT.SONS'tO BIi TREATIiD IN I\,IETEMA WEREDA BY YEAR ANI) IiNDIiMICII'Y LE\/BL ATIEA CO\/I.]RED HYPEI(- ENDEMIC MIrSO- ENDEMIC IIYPO- ENDEMIC* COMI\{ UN ITY EN DEIVI IC LEVBL TYPE OF TREATMENT Community Directed Comnrunity Directed YEAR l* - (2001) 20No. of communities to bc treated I5 Total population in abo'r,e communities 30,358 25,622 YEAR 2** (2002) No. of communities to be treated 20 l5 Total population in above communities 31,238 26,365 YEAR 3*** - (2003) No. of communities to be treated 20 l5 Total population in above communities 32,144 27,130 YEAR 4**** - (2004) No. of communities to be treated 20 t5 Total population in above communities 33,076 27,916 YEAR 5**** (2005) No. of communities to be treated 20 l5 Total population in above communities 34,036 28,762 38 Ivermec(in 'l'rcatrncnts rcflccted in Allpcndix I wcre o[taincd as lbllorvs: l-he total population of thc Mctcma wcrcda in the year 2001 is 69,975, 'l'lris givcs us an cligiblc populatiorr o[ 55,980 for thc ycar. An cstimatcd population of 29,5021iyc irr lrypcr cndcnric contnruttilics rvhilc lhc rcrnaining 24,gOO livc irr nrcso-crrclcrlic cornlnunitics. YEAII I-: A Lrcal.rnent objectivc of 100%o EARP of botlr hypcr- arrd rncso-endcmic eorrrrrrur)itios irr ihe wereda rryiii bc targeicd. YEAR 2-- with some experience, the program will expand its coverage to the neighbouring Quara wereda. The estimated cDTI eligible population of Quara wereda is not yet known. However, witrr completion of the REMO in the region during 2000 we would be abre to detemrine how nlany of the 42,622 people (year 2000 population) in tlre wereda will qualify for CDTI. YEAR 3.-. From the third year, the program will plan to reach l0o% of the cligible population in both wercdas. However, the eligiblc popularion of GDTI communities in the two weredas will be difficult to estimate at this point as REMO is not yet complete in Quara wereda. YEAR {-$****'[f1er the completion of REMO exercises the EARP may increasc over the three years. Flg. 3 Annual Treatment Objoctiyc by Endemlcity Level 35,000 25.0@ 15.000 r0.000 .0.0@ 30.m0 20,m0oF 5.0@ 2000 Ys 2003N2mol 200{ mo5 39 tA PPENDIX 2: IN DICA'I'ORS I''OIt Ii\/A LtJAI'lON, SUSI.AINAIIl Ll'l'Y /INTEGRATION OII CDTI/ Project Evalua(ion Managcmcnl Irinancial rttarragcrtrctt( Effcctivcncss of cortrtttuttications Training and capacity building lnstitutional conrnrilrrcrrl Fulfi lmcnt ol- other relcvant sectors Problem solving capacity Integration of operational research Project effectiveness Result of KAP Studies Treatment coverage Follow-up of non-eligible and absentees Management of adverse reactions Reliability of reporting S u s t ain a b i I i ty/ In t eg r a t i o n Political will of host government Political will as shown in policy statements and apparent commitment of high-level Oflicials Official action assigning personnel, funds, vehiclcs to program Long-term planning Is there a long-term plan for sustaining the financing and the management of the program? Progress toward financial sustainability If program sponsors cannot continue their current level of commitment for at least another five year, what percentage of running costs is now paid for host govemments or fees? Progress toward integration to what extent has ivermectin distribution been integrated with other health service programs? evidence of community empowerment and ownership change in KAP over time 40 Cl o lo Lo o E =Lo = solo ooz t aD Joo E. UJFz ulo d TUF E, o TU :trF a ooz oo .+|o @_ o{ J FoF -o = ooloN o ot o G,o E)c c o o L J o U) oc o E oF $ tr -9 Gc Gl -cL x ul slo ot o E IE o(L s ro N o E .E IE o o- s rr) ot o E *o(L slo ot o E t G(L tr o og s cL x TU slo C\t o E JL(U(L s ro C\l o E IE(!(L sloN o E IE o(L Dg oo GI oF oq oo$ oq oo c\l .{. oq rot- oq oo c\l oodt\@ -f a GI o to (E oF oc|r) N C9 aq lf, C\l - oc(o N o- N oq rot- -+- (f) o @ lF o C,z N G o o dz to o) =ocq) -o a o oa 6 fcc oo(o oo$ oo(o oo@ oc o! b(E G, @ E fc c oo cf) oo o) oo O) oo L f o .t) orN oIN oIN oIN q, o Lf o tt) oI B oI B oI = o C, .EE ooo Ec oN oc o G o o- TLFoN o Lo - o q) Loo U) E o a .ctJa 01cl ol el6t ol(LI o o o ooo oEo o B tLFo = o o .= o(U E =(o o)I o(, D ooo troo E o a .ctfo 9_(!(Do JC :iova/,)U'goo:l o-io trco6 .x=E(x)CC(I)'- oJ o- o - = =F UJ +I o = UJz oN u ooz oo -Fu oz aI o = zI o tUd d I = aI o = tr o G'tr GI CL x UJ so ro o E .F IE o(L so ro o E .F IE o o- solo (l) E 'i= IE(u(L so ro o E IE o(L so rf) o) E IE o(L so ro o E aEo(L solo o E IEo o_ so ro o E .E IE C, o- B G G o (E ot- oq @\t(o oq @ ro oq @ (r) oq @ (O oq @ rO oq N rr) oq oo(o oq oo(o oq to rr) + 5 o o o ctz oc o -o b(, (! o tf C @$(O @tr) @ tr) @ tO @ rO (\Ilo oo(o oo(o q, oL a o c) coIt coI u coIx CDId coIt coI(. coI x. coI u oc o a o o. o CI .Eo ooo (o C .9 o)o L oo o o .Eo ooo oc .ooot Lo o C(, c =ooo c(U .u)a(n(o (D (I, .ut .c EE -9 oo .9 Eq) o 'd q) E o)ox tU Eo al, = f E o altf U' J -=tLIftololal c oE G c s o. x ut 6 o Ec oN o oo 't o(l, I(l) o lz o 3 ! EiE g o(, E =(I, o)E GE o) o3 ot oo o D C' at, E o c o E oo o E o co '- oo Eo o a C' c o E o o- o ! c o 9. I 6c .9 o)otr .oo (I, c(u t o o.o Dc o a I o oN ot o o. E o oC c o oc oN 9. o c, L o o;E oo o) o o)c c o. Ec .oo o)t o c o E f,o oE Dc C, anEo o. o o co oo =o.a! (E c oN D c(, Ec .9 olq)t o(I, o o E(t, Ec(I, ooI f oo o) .g .s E 6 o aoc oN oc o (u c o o)otr o(E o o oo E c(u c o(!g oo E .a J E E oo o(E o o o(U Ec(o co (u olI'o E -eJ E E oo () (E o o E(o Ec rg co 6o =oo E J E E oo co (! .sEL ooo E Eoo oc oN Ec o 6c o o)o t '= c .9 (E oE =E E oo a o L o o o Ec(l, L Q) (E 3 !,c o E o o. o 3(E o oo oI f =cLa LL o o o t o oq oo to- t- oq o$ $ oq o @ ood .f o) oq oo o) oq$tr) v oq(o tr) F. oq oo o, oq oo @- oq N o, ro oq ol'- c\t oq oo(\l oq oN oo oo (f)_ N oq oo oq oo(r) oq o ro l'-- C) oq oo tr)- c\I oq N(9lof(r) o = f, o dz (.) (.) N N ol (a E o .= o o o o .= , oo|r) f..- o @(o o C.{ lr)$ o) oo o, $tr)$ @ 1r) f.r olr)$ oo O) (o O)N o O) ooN oN oo (f)(\I oo oo (f) o roi.-(9 ootr) c\t 0) o oa I o tL I o LL r o tL I o IL I o tL I o LL I o LL -o TL I o tl- T o TL I o TL I o LL I o tL I o LL I o LL I o LL T. o LL I o LL c .9 o- .C o @oE o(ol E o -=1 6,l61 C ol o- x ul (l, o o o os x -o oo o o o oE o o o o) G] E o od a 0) o @ o)oo(U c. =3 C) :f o. E oo o. o o.(u J o o 3 oa od aq) ooa c)oo(, c. t o f o. E oo o. o Yo c)o q) =L] o C c, Yo(o -o @ (o oEo o o. (l) c .E o. .9. oo C'J a o 0)E o 0) o. E =B o C L o. o oo q) .gEo o E x(o TL 0) .=Eo € E (1, 'd. ooo o =(L o o(D 'd o. o(I, oE o o oocoE o.(I,(, o o o() lr)N o th e t.() att o o .(E o(, t o so (l) ,()Eo a,ool so oc oc o. c, o)F s o o c) z l lr) o,o(U o an ooEo c!$ o ocE o& Dc C, E =3 co (!(J .E ooe(s9 o:o5 -E ,fl Eo !o ;o'; (_) 'o;5E o_o_ o){.E J o o a q) :J .=c l tL o 0, t4 E o a4fo -oE J d lUo ul u- c o (E cg CL x uJ 6 -96c oN o o o, 't o(U D o) o v o 3 D q) =(-, (E E =o o) -c (o oo o B ot o o- o !C o o E o co E (u E o E o co o o): oo o 'o .>(! c(I, Eo o.o oc(E 9. I 6C .9oo G. -.n an .>(I, c(o to o.(D Dc(, a I (D c oN ots oo(l, o oc c .E ct oc oN a ! c o 9. o !6too E og L C L ct (trcloloo lG. .J' c o E f,ooD Ec o ot o o.q, o c o (u(J =o. fE 6c oN oc o (uc -9o) @t o(6 o o E(U Ec o att o:ss(U 6 o Ec oN og o 6c -9oo d. o(! o o E(U Ec o c o o .N -oo E DC:, E Eoo o(o o o E(l, ECo co I foo EJ E E oo oooo o(It oc(U c o (6 o =Eo .acJ E E oo o o o E oF oq oo o- lr)N oq oot-. @ oq oo cf) oq olr) (f' o eoo o-(') oI(\t ut oq oo o_ (f, oq oo o-(O ocoF- Or- o eoo O) oq ooq oq o(, (Y) oq N@ @d lO @ =cl o C,z (?) (, (\l ol N (t E o .= o o o o =cl oootoN oo o, C! oo otr) (o ooo c.) (\,t lr) ooo oo rr) ooo d) rr) @ O) oo(r) ooo o 1r) (f, o a 5 o al, O o o_ O o(L o o o_ oo o- oo(L oo o- o o o. O o(L o o o- o o(L o o(L o o o- O o o- c o o- (J o oE = .z o(E E o =ooc o o.x ut o) Eco o. l !o 'o o 3v o) (u B o .6 a(D ooa(D oo(o c.t (l) f o. Eoo oo Y o(l, o o 6l 31 .fl o od .J o) o @6 o) oo o - = :l o) l o.l E] oodol e _5 x o -o o)o(, o o o o o o o (1) o o o o (l, =E; oC(o )ao(o -o a (o (DE o. c) o. o c L o. .9, (l, o C,J o(, oEo (D o -c -= B G, c o o oo o .gE(,(l, E x(, I,L ocZo(! E .o) o.ooo o -c.(L o o(D 'o' o- EooE (l) o o oc oEo oo o o oo lf, N oo ts t O E oF t () o o- s (D cE o 0- !c o :E o ! .; c o Ec f E E oo 0.,c oN Ec o Ec .9 c,od oo ooo c o 6tr G ax UJ U' o o) =o o(, .c .c(E L 06 c .oo E o o-l U) o fo 06 =oz o f =CLflt (t) oc c)oc o o.] U')(l)t LIolol EICI(El OJEI 'El;l EIolol0)lEI .lotOIEI bl -cl ;lEIolol(t)l :I EI cI =o G oc .9 (u .9 ol Eiol EIflol olEI olCI (El .91 ol =lol ololCI olol EI ,{ol(!I olol >t 151 sl el c,lcl 'El EI -ooo (E oF oq oood oq oo o- lo(r) oq oolo oq o ro c.t oq(\t rr)- oIolr) i\ o eoo|r.- o eoo 1r)- oo oo(f) oo ci ol(n la) o =c l o dz E o = o o oo =cf ooo ro ooo ro co oo ro oto CO N lr) o rot- ootr) oo ro oo cf) q)(, f oo o oz o(, z o oz o(, z o oz o oz o oz o oz o oz o o oo o oc (l)p c.o o B$ (D l -=c = ooEo o) =c. oc(o vo(o: o (o 0) .C o-'- o) o- o) E ol o) -l -l0)lal(!l ol(1)I alll d) (U] o a od a o) -- oao(D oo(, I f o_ E oO olo ol(tJIilolzl o o) arl el ot sl ol9l a)lCI 5l(Itl EI HI rLl a(l) o l solr) --1 (1} ol ool ol ol -cl o_t ol ol ol 'o-1 OJ ol(6l d)l €lol 6l o o(D 'o- o. op a (U oF (, o ooo l o s olr) (D o =o o =v - t ;q ti- o- u uJFz trJ(J t tUFd (J uJIF a o(9 z J c o Gcsox IU =t .olLI otol crl EIcl6l LI(r)l (EIi oco (E Lo o. o 3 oo I)c o I o o ot oF oo C,oN oq oo(o oq o ro oo cilf, @ o =cf o dz E o = o q o o =cl ooN oo @ olo (l) o L f o U' oI B or = o :f = C o o- L o @ oE = (,(g E o =ol o cl oi cLlXI uJl slOI -t6l(l)l -=l :l ll s 1r) (l) o([ o.la ol o1 EI ol I E oF -o:,t) oI = =luF uJ = -o = c o (! c(Ul cLlxl IIJ I c o =(I, c ELo oo E o o o(L (D c o N Dc(u GC .o ol(l) E '=l CI ol (Ut ol clfl EI EI ol ol =o o (U B .nlcl ol(!l 0)l OJ otn :l(!l ol o o o 6 oF oq oo o- @ oq N|r) N o eoo(o oq oo o, oq N rot- ol o =c :) o C'z E o = o o o o = :) ooo @ N(r) N oo (f) oo o, O) o L o U) o IN oIN o IN oIN c .9 o- o o oE = .; o o E o so o) o -E (l) >l otcl 61 'ii LU1 slol FI al ol :l rl so q) c o -c. o. o (1) s(o oo(u o.l U'I dllol EI ol E o -of U' o IN t ooz o o IFd oz I o = tr o .E c .E E.x url .l ol (El cl EILIol 8l EI EIciolLI(Ll oc oN oc o Ec .9 o, E E .E c o (U(J C f EC]Lo()l 'ti o(D ol EJc sl ol (El BI U' clot (El ol o.tot >l(oI ol o o(, 6 oF o eoo c) oi o elo C\l oq loo oq root- oq(,(, C\l c,) o =cf, o dz E(D .= o U' o(,) .=cf, oo(o N ro c\l roo lr)ot- oo J oU' coIt (Dru d) :ft- coIt c .9 o- L o ooE 't o(o E] o1 =lol 9tLI ot cLtxl uIl \ol ot9 i I (Dp -c.(l) q c -ox s O d)coE o.l(l)l o1 F1 slot -lal o)l :I .- | ll o\(o oo(, o_ U' oo Eo E o?tt :, U) I c.)$ o .t z,EP3+9,fl9.6e!q9Ebe o-o_o J f UJtf o IFJ UJI J z 9 o uJ u d I = -o = t- vt otC (1)t d)l EI -l ol Grlol ol>tEI(!I ol El cf ._cl cl sl o)oC ooc o o.o o o C) atttro or E] -Jol o!cl o.l >! o .E i ol o.l v$ E o ocg CLx tu o C,) oL o o o iI U't ooq) L lt, c o E lo oE o)c o- oo o oE(L =o- f o g q) f,o E oo(,) c .E c L(L o)c c foooo .t2o oc o o (5 o ac o (E L(Doot:(o ol c(l) E:,oIq o .9 -do =U) o o o E oF o eo .{. oq roNN oq o(o oq o(o oq o ro!t oq oa o- F.- oq to(e @_ t- o .=c = o C'z N CO N .f Cf) E o .= o @ oo .=cf, oN 1r)N o(o |o olr) oooN o o f oo o oz o oz o(9 z o oz o(9 z o(, z c .9 o- L oooo = .z o(E E o =ooc o o.x u, aoEol( .9o .q) o- o() o o _c. o- o, o) O)D E oo L oc oF q) -_C, B E c(g -Yog o) o)D LE oo L(l, c L(L o o (u fo (o o -(D c .9(, a a .9 o- o_l <t) o c o) E(D foo(L 6 oF c o c,E o cLx ul o(,i oL o og u- oEo o. E al, co E = oE o)c o. ooo o -c(L J o- =o L(l) f o- Eoo o)c c L o- o -co-(E Lq aa o-o E g) c c 'L-(L oc c =oooo ..t v) .> oc o o oo oco oL(D o. o (E o oocoE o. oq o E Lo (D th :, (o =cC al, oo Go ! o o o o so .E o (-) o r o) op o o c o E o oL o lJ- aq) o(o o :o o) (o o)L o so .= o o og o op o o c o E oq) L o u- o oo ii oF o eo(o oq oo(o oq o$N oco o,t r oq oN r oq olool N oq olo oq c\l C9 @ oq @ .t o e @ @ t*_ s o :=c J o C'z @ @ @ N @ ro ooN N|r) co E o = o o oo .=c = oN Ir)F.- ocf, o(o |r) otr) 1r)c! o (o c! CO oo a o U' oo(L oo(L oo(L O o(L o o(L o o(L o o(L O o o_ () o(L O o o- c o o- L oo @o .= o C' E o .= ooc o CLx IU a4 o a. a.5 .4 o(, Go o o)tq) .Y .ao .q o. o() o oE o- aq) oD t(U o LocoF o) = -c. =:o c(, -Yo -o o C,)o .E E oo L c) c (L o oO o cr,o t oo o c L(L th o o fo oo - oco 'a(t' a . oEo -o oo ao ,4 o,5 a c oo(t -o(o OOo o O) E ooto o E o oo(U L o(L c(o(-) @ -oI Ooo o O) E ro c! (l) C N(tr (I)i c1LI ol LI E oF P o(Do o.96tro)=E6co: Eco o) x ro9 c.L(l)J o_ o_ t UIFz u.lo d UJFd () ]UIF ao(9 z o o o- a to$ t C o .Ec(t,l cLl xl ur1 c) o + ciot Lo C'E o U)l o(9 tr d) E' L o) o-l L(l) Lo + ciot Lo (I, E o U)l o (f) E .o)ELo(L L o Lo + ci ou Lo oE oaf o (f)Y E](l, E]LI ori o-i =o oL o E E(U L o)oL o] Losl C1 L] o E'I LIol(Ll o oo E oF o eoo CO oq oo (f) o eoo(f) oo oo(o oq oo lo_ .o .= C,J o o o o o ro E o = o o o o .=cf o c.) o(o o(9 oN o o L f o U) ooz ooz o(, z o oz c o L o o @ o oE U' lz o 3 olcl 'El .-l GllLI -l(El clolNI o_ o c.a .:z o 3 o, -c C. (E L LLIFI ol =l o. o .c. U' x. o 3 gJ .E .c o ooo o:c o)o E 3o 't o) o, E E C, gJ oL(L J FoF tr o (E trg CLx IJJ 5(E ah o olcl '-l (o €l cnl =l@1 ot cq) EEo(t) L (l) L : '6 (E o(, coL(l) coo 5oc .9 (I, o EoELoL c o EEooL o)L =C)(U ooc Eo co()- Z"oc .9 C, .o E .gE Lo(L g, .Ec '(o L troo c o) EcooL oL : '6 o (t) ocoL o) coo boc o o o d .9oLo(L oooo EC o (D coN dc .o o)q) L o p o of .9, u, L o .E E L o oq)p :f o c .9 o, o)L !c o -q) c oN Lo I o o -:zo oE ol U'ooo g o ah .2 rzo o) -co o oo 1!- oF oq oo(0 oq o(o @ oq(o .f oq o(o (f)- (f) o e(o(o o)- c\l oq oo o_ .t oq oo o eoo r oq oo(o oq o) o) o)-(\ @ =c = o C;z (f) oo .f oN oc\l oo c.) E o = o o o(, .= C f ooN o(o @ (o $ o(o(.) c.) co(o O)N o ro lr) N o(, a o(n () o(L oo(L o o(L oo(L () o o_ oo o- O o TL o o(L o o(L E o o- L o oq, o = .> o G E o =ootr o o. x UJ O) .C .E(u L Lq) f o- Eoo (o c .o o)o u. Fo() co FoF (U CoN Foo co FoF o) e lo tUt Fo O c o o) .Ec '(o ooo ao (! t- o (! tr o) c(!\ o Blc \q. ot(o -c.o .s q)p =O) E l)(,) L lo (Dp 1 o) D o) TLF o > u-F oN op f o) ooo J FoF ! I J99o)tlcg:E ro- lTDtscC.;g x L(DJ o_ o- tr IUFz uJ(, E. TUFd o [JIF a o(, z o o o- (os c o otr G CLx TU c o EEooL oLp c(It o Cq) L : o o TL cq) EEo(l) L q) L Ec o E coL >l: '6 (E LL co EEooL (l) Lp c(I, E c o)L : '6 (I, LL o o(, E o oq ooN oq oool oq ooN oq oo(0 o .= f o c,z E o .= o u, o a .= cf ooN ooN ooN o oL f oa o oz ooz ooz c o o- L o o oo = .: o C' E o .: ooc o CLx]U C .9 o c o '= o o) .C .g C, oc .9q, ot c o .o(o c o o cr) .E .g(, ocoN co .(u o c o) o o) .C .c(o L (I,oo o = E oF c o ocs CLx uI c .9 oo E o C) o(E o o p o oc .oq o)t c .9 o o. E oo oooo E(E (u coN c .9(Uo E(U o o C,oo E(0 GE(l) Lo ts izoo o. co L(I, EoLo .g .o!o aooo -o .9 -o =o. o -c o)c oof 1f, o L otL o oo o Eo EC c, c o o .N -oo E 'e f, E E o() LotL oooo Do ac C, co o .N Eo E .E f, E Eoo g otL o(g oo E(o Eco co o .N -oo E =cl E Eoo Lo]L oooo E o Ec o c .o o .N Eo E Ec =E E o() Lo LL ()(o oo :o(u Ec(U co (o s5o E 'e l E E oo LoIL o oo E o oq oo(f)- oq oo rr) oq oo@ oq ro rr oq o(o O)- @ oq(o o)@ o e @(o N ocoo(o oq oo c\l o eoo o_ r o oq o)g) ro + o .=c = o C;z |r, @$$ (o o, @ (o O) @ oot oo$ oo 1r) E o = o o o(, =cf oo(r) oolo oo @ (o oN ao q u? o N oo) oo o o o- O o o- O o(L C) o(L Oo o_ o o o_ oo o_ O oL o o o- o o(L tr o o- L(.) ooo .: (-,(I, E o .= ooc o o.xtu c .9 C' c o o O) .E .g C, (I, c .9 o)o E, c o .q o c o .C o o .g .c oL tc oN C o .(I, o c o) o o) .5 .c(g (I, oq, Lq) 3 (g o o) L o 3 j (I, coN (U c .o ooL oo(, ru(-)(! o. co (o ELo C t4 o o (U E olc c Gt aL o) oo(L @t C,Eo etL at o f -c.o oLdl a o) o) oaaq) E E. =at,L otzo U) U'o o)(o g, U'o E _c '= o .EEo aF U'o(0 o o -coc o E oF coe_E(ENE€6=q)c E.9 co(troCD :] .xElC ccEb o C = d ulFz lUo d tUFd o u.lEF a ooz o o(L a lclo l6lc .E1 o..l xl uti l"lo,cl ol(Dl EI]l(t)l >l ol;l EI EIol EI ooE e!] ol -ccl 6t clot o1 .EI o)lol?l I o =o zoo z(D o fo o(t, o o troo o (E c @p os oc(u o(u o = at(! c oE1 ol cl;l ot(6t ol EI -tol >t 'El ol clol (olEI ol EIOIotol(!I lilEI clolbl olcl -lol6lol EI co oEo Eo(,o @ a; i6 e d, E1 ol sl Jal 6I ol EI cl ol 6l!rlol EIolotol(El 6l .sl cl olEI ol cl16l 6l ol EI clol 6t arlol EI OIotol(El .J6l 6l cl olEI ol cl :l6l ol ol EI o o(., E oF oo oo o-t oq o 1r) oeoo c.) oq oo$- @ oo c;o N oo ci ro oeooN og o 1r) oq oo(\t oeolo oq oo or-(n o =c = o dz 6r lo o o o o o o E([, .= o o oo =cl ooo ro N oN o{@ oN () N 1r) N |r, q, o l o u) o(, z o(9 z ooz ooz ooz ooz ooz ooz o(9 z o(, z c .9 o. o o 0,o\ 'rl ol(E1 EI @l ;lolclol o-lxl uJl -l(o clol 6tcl ol CI : ol >Ipl FI -t <l o'- (l) Eoo o g F e .o .o z(D o l U) (E oo @ = 6l c1olNI olclol olol sl EIol DI ol o-l l o^lc cc(U o. od 3 .9 o @ E E(E ol o o- (o c(! s-.] E] .!PlE o) o-1 o .9 c c o o EC6 Bo '5 o o E Eo oo o. (o c .9 o) @ G. E .9E o(L o -cCc o E. D c6 B .9 (D q) E E o olo o- (! c .9 oi o)g Eo E] o1(L1 o) .E cg(o o- c(u 3 -(l) o (t) E Eo ol o1 ol _t6lcl olNI EI(t,l ol ol o-l I It^lotc lclc l(5lo D c(,]o E o E E(o o) e o" '6 coU E .9 Po(L o)c .E c(u o Ec o] .g o o E E o B ol ol olElot oI 3I EI ol ol ol(LI lolc lclcl(ula D c(! i -o o @ E E(o ol o o. 6oo o3l EI ol Elgl ot o_l E oF t G. UJFz ulo d ulFd o ulEF o C, z. tr -9 G c6 CL x uJ oo o t C.,l c! x oo (u oo E (E ! o x o c,l o x co e o) o-(.) @ .=o 't ao a z c) o]f,la * o tn o E N X @ -- o U) f N o o(, G oF oq o (o- $ ood N(.) oq o(l, o)- t a =cl o dz N N E o = o 6 o(, =c f, o N o- N o(o o o f oa () o o- o o o_ c .9 o- oo 0,E .; 'a o C' E o!1 ololcl ol all xl EIo o o. !C o c9 E o) o. f,6 oo() -o o-q) o cC ol a1 Ci6lol 'El olf,l -lol =l1!l E o o3o or 3 =UJF lrJ =i o = o IN d oo z. o(9 IFtroz I o = c -9 tuc so xlt lolo o c,o] o (o E o : CL x o U'f o xl cl olo ol o.l col @l '6t >l -l ol6l 'Et (I)I olrl @l L C,o @ o @ E (\l x @ =o(t)l ro a? o x o = EY @ EY ooo N o oo E oF o eoo(o (?, c?(,(.)(\t c) c(.)(") @ o =cl o dz ot (\l E(D .= o o o(,, =cf oo c.) l'- oo 5 oo oo o- oo o- tr .9 o (, o oE >i .; (, 6 E ol -lol6lcl ol CLI xl url E .9o c)o Dc o c .9 Eo o. lo oc .9 olot .= o o- o 0) EC G @ c 3 'El olrl -tolf,llLl E o oJU' f, UJ E.) dl IFJ ulr J zI o u.t u. fr E =*I o = c -9 .E c G' o-lxl uJl oo o oo E at (oo N CI x oql o x c o6 o o.(o o =I a' oo .E @ o.l =lo o ot x C) =o U'f o o() E oF og oNs oq oF. oq o o){ o =cf o dz (t GI E o = o o oo =tr f o c{ ro (f) oo 5 o U' () o(L (-) o(L Eo o Dc(o q c f 6f tL E o -ofo E o G c .E CL x UJ 6 (D o E 0) El tr- I F1o z1 Llol ot d '--l ol clll oI ol!lFI q oo E oF o coo$ oq oot o =c :f o dz v E (D .= o o oo =cl oo o o f oa () o o- c o o o E o -o =U' N 9 4 E o)o6 ooo -F;E .0)o= xo o.cCJ oo (, o .L E sG .9 o o, E oo o (oE a lclo l(EItrl6 lo-lx ull o Eo Efo oE co Ef o L o an cg F o(I, !o o] o oC oN aE] ol dioiLI EI -=lil CI ol (I,t ol CI :il EIolol o o o (E oF oq oo(o oq oo(o- (r) oo c;oot t o .= o oz C\t N E o = o o oo .=cl oto oo cr) ooL a oto o oz o f,oo ,lclOIclol o)l d,lFI E o -ofq t ulFz uJo t u,lFd () ut -F ooz o o(L @$ c o clcs CLx uJ ol ct ol EI =lololrol -lclOIOI ll *tol -tol 6lCI(!l FI o oEo (D 3 oq) c oN ah c o o!o f -1i Bl C]o olol CIll EIol ol o oo E oF oq o(o oq o(o cf) oq o6ls o .=cf o dz N N E o .: o th o o =tr J o(o oCO o(, Ll oU' (-) o o_ O o o* tr o o .: o o E o := (r)l CI olrl OJ(l)I d)lFI E o tt fo tr o G .U E-x lU o c o E :,() oE c o o) :l o Lo oc G F U'(, ro E o =o oc oN U'c .oo(l) L -c =3 c .9 (U .()c f E oo o o(, E oF oq o(o oq oo(o oq o(o @ o .=cf o dz c! N E o = o o o o .=cl o C) oro o,o f oq Oo& O o o- -tol '=l flolol x(U LL o .ctJo c o (I, cg o x llJ at c o) E f,o oE c o El o o) oc o F U'(UD 0) o =ooc oN U'c .o ot(I) t =B _lL .9 (t, o C] fI EI o1()I o oo 6 oF oq o c{ oIoo(o oq o ol 1'- o =cf o dz .i. c{ E o = o 6 o() .= f, o(.) oro oo :, oo o o o- (_) o o- c .9 o. .E o Qo! = 'a (,, lol\]trt ot ;l 9ILId,i o-lxl utl o L f, oo x(, tL o)c oE o.(D oF G o -ofo tr o ocs CL x TU al, c o) Elooo c o o)LJ o o U' c o F o oE o) oi ooc oN oc .9 o) 6) E --3 c .9 o .9 c =E oo o oo E oF ocoo C\t oo C;o ry o eoot- o =cJ o C;z .t N E o .= o o o o .: cl otr) oo o o f, oq O(J(I o o- o toq, o ..- o(o E o! ololclol cLl xl o) J oo x(o TL 0)C o c. o_ o) oF E o lt fo oc '6 .9 oG,o-o colo)c:oLlE cno .. ()(.J .xEgo 8.eo- .= o -3 =uJF ul =I o = oIN t ooz o(, IF e. oz I o = :f uld lg) -FJ ul - J zI(, ul d. d I =sI o = x o =l! 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