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

Ethiopian Program for Onchocerciasis Control Community Directed Treatment with Ivermectin(cDrr) 4th and sth Year Sustainability Plan For Andracha Woreda (District) Kaffa-Sheka CDTI Proj ect Project Period z 2004-2005 r iiffit,fi 0 I nEc, 2003 /\"P'.iL/DlR ll 2 ril{ Table of Contents Part I 1. lntroduction...... 2. Background I"f";;ii;; Part II 1. Rapid Epidemiological Mapping of Onchocerciasis Part III l. CDTI implementation and Results 2. CDTI training achievements ......... 3. Treatment coverage... Part IV 1. Financial Management of ApOC Trust Funds2. REMO Maps of Andracha woreda.... Part V Sustainability of Issues of Andracha woreda CDTI. 1. Planning 2. Leadership 3. Monitoring and Supervision .........,,...... 4. Mectizan supply and distribution.......... 5. Training/IIESAM...... 6. Project Budget FinancinglFunding ....... 7, Transport and other Material Resource. 8. Human Resources 9. Coverage 10' Sustainability plan frame framework for Andracha woreda... I l. List of Available Resources for program support 12. List of Materials, Supplies and Equipment Required for GDTI Activities Part V 1 . Budget justifi cation (Explanation ............... 2. Budget Summary Year fV..... 3.Budget Summary of Sustainability plan for year V 2 2 3 J 4 5 ..5 ..5 ,.5 .6 .6 .7 .7 .8 .8 .9 .11 .12 13 t5 16 1 2 Introduction Andracha is one of the three wordas (districts) of Sheka zone, Iocated about 620kilometers away Southwest of Addis Ababa. The woreda harbors around 24,ooopeople. The woreda contains 20 kebeles (smallest admin urlits), whose inhabitants mainly depe.d on subsistence agriculture' The climatic condition of the woreda: g2 o/o coldzo,es (high land)' 15 % intermediate and 3 o/olow land (warm zone).About 62,4o4hectares of la,din Andracha woreda is covered with tropical rain forest. A number of fast flowing riversflow in this woreda' In this woreda, there are one healtrr center, two hearth statio,s (one run by private co), and two community health posts. ln addition, three project health stations are in this GDTI woreda' The infrastructure i, the woreda is underdeveloped; ,o continuous electric power supply, etc. Background Information onchocerciasis co,trol program was launcrred through community directed treatment with Ivermectin/cDTl strategy in Andracha woreda in the year 20oL rhe project wasinitiated with a strong partnership between Apoc, affected communities, regiona l, zonal, woreda admin councils and health departments, Federal Ministry of Health and anNGDO partner (The Carter Cenrer). The program was initially designed and imple,rented as Kaffa-Sheka GDTI project witrrthe overall coordination role assumed by the zonal health departrne,t. However, trieKaffa-Sheka was later on split as two distinct zones and the readership rore r.vas trre, shifted to each zonar hearth office. Again, very recentry, i, accordance to thedecentralization policy of the goverrrment of Ethiopia, there was a paradigr, shift ofpower and authority from zonal to woreda levels. It was at triis juncture that the rnidterrnCDTI sustainability evaluation of Kaffa-Sheka project was undertaken. I, line with r,isdevelopment' it was recommended that tlie GDTI pla, be worked out at woreda (district) level. After the midterm evaluation of GDTI sustainability, there was swoT analysis done for each level of health delivery structure. As a result, coverage, Mectizan order and s,ppry, I 2monitoring and supervision, as well as training and HESAM were considered relatively as strong points at woreda and front line health facility levels. On the other hand, Financial Resources, Planning, Leadership, Transport and other materials and Human Resources were considered as weak points at this level. Efforts have been made to address these weak points in this action plan. Rapid Epidemiological Mapping of Onchocerciasis (REMO) The rapid epidemiological assessment carried out in some selected communities of Andracha woreda in 1997, found out that most communities to be hyper and meso- endemic to onchocerciasis. REMO map for this is attached (please see). CDTI Implementation and Results Although the woreda was known for its endemicity of Onchocerciasis, there was po mass treatment activity conducted before the launching of CDTL However, clipic-based treatments had been going on with diethylcarbamazine (DEC) in Gecha health center the woreda. As mentioned earlier, CDTI was implemented for the first time in the woreda during the year 2001. The major partners were APOC, FMOH, respective health authorities, Iocal governments, affected communities, and the partner NGDO (Carter Center). The mass treatment had 100 percent geographic coverage of the communities in the woreda right from the very beginning. CDTI Training in Andracha Woreda, Sheka zone Year Health Personnel CDDs 2000fi l9 tt2 2001/2 t7 tt2 2002/3 23 140 JTreatment Coverage, Andracha Woreda Financial Management of APOC Trust Funds The financial management of CDTI projects used to be carried out by zonal health departments in the past three years. It was, therefore, not possible to come across conect figures for each woreda by year. Moreover, due to the restructuring process in the country (which is still underway) and frequent change of staff (CDTI coordinators), it was not easy get access to the financial documents. However, efforts were made to extract some data from the existing financial documents at zonal levels. * NGDO support was mainly through material and technical support ** Data not available New Leadership Role and Integration of CDTI In view of the recent decentralization policy, devolutiorr of power and authority has been made to the woreda level structure. As a result of this change, CDTI has been considered as integral part of the overall three-year strategic health plan for Andracha woreda. During the CDTI sustainability-planning workshop, all stakeholders have participated and have expressed their commitment to assuming the leadership role in the implementation of CDTI in their respective areas. CDTI has been included in the malaria and other vector borne diseases prevention and control unit in the strategic woreda health plan. * Year Total Nbr. of villages ATO Mr. of Village S Treated Geograp hrc Coverag e (%) ATO Cover age (%) Total Popn. ATO Nbr. of persons treated Therapeut ic Coverage (%) ATO Covera ge 2001 56 56 56 100 i00 2J,460 21,968 20,943 '76.2 9s.3 2002 56 56 52 93 93 29,052 23,242 22,709 78.7 98.3 2003 70 70 70 100 100 22,890 19,685 19,061 833 9l Year Funds Received Other Sources Comments APOC NGDO* 2001 5,215 DNA** None The 2nd installment was not received from APOC 2002 8969.8 DNA None All approved budget from APOC was received! 2003 2,230 523 None Only the l" advance was received from APOC Total 16,414.8 4Kaffa-Sheka CDTI Project, REMO Map of Andracha woreda i,!:f_1iy ' I '')ltt L '\ I "'a ti+r;n ri6pi1; 'rT;'-; ( ::r r- . iyr,. , l ,H[ry, "T , "i, .'r.-,,'5' 'll ' ' r:,i".ir,r. . 5Sustainability Issues in Andracha Woreda CDTI Planning This is an area identified as weakness during the midterm evaluation that requires immediate corrective action. The CDTI is incorporated in the overall three-year strategic health plan of the woreda. However, in the past,.the woreda health office and FLHFs were not actively involved in drawing up the CDTI proposal and annual plans of action. It was mainly the zonal health department that was responsible for planning CDTI activities in particular. Following the midterm CDTI sustainability evaluation, however, it has been decided that all stakeholders at woreda and FLHF levels will assun-re the responsibility of working out their respective periodic plans of action from this time on. The woreda seeks capacity building support on bottom-up planning approach from NOTF or zonal health desk. Leadership As introduced earlier, currently there is a paradigm shift in the admin structure arrci organizational set up of the overall management of health and other development programs in the country. The general trend is to empower the woreda level structures and build capacities in all aspects of program management. The CDTI being one of the recognized and integrated health programs, the woreda will receive leadership arid close guidance from the woreda admin council and the taskforce organized at this level. Monitoring and Supervision Monitoring and supervision is very critical to tire success of CDTI if it is done in a tirnely and effective matrner. However, it was understood during the evaiuation that the frequency and coverage was inadequate. Supervisory checklists were not used regularly and feedbacks were not communicated in writing. ln most cases, supen,isory visits were not problem oriented and targeted to improving poor perfonnance of FLHFs and CDDs. During the sustainability-planning workshop, it was agreed that the weak points identified would be addressed very critically although shortage of health personnel and other competing health priorities at both woreda and FLHF levels could be possible threats in the implementation process. 6Mectizan Supply and Distribution This activity was considered as a strong point during the evaluation process. Mectizan procurement and distribution is fully integrated into the goverxment heaith care delivery system' Every effort will be made to maintain the good achievement obtai,ed thus far. ordering Mectizan in good time and in sufficient quantity is indeed a commendable job favoring sustainability. However, there are areas that need fine tuning at FLHF and CDD Ievels' Minimizing wastage, proper record keeping and timely and complete reporting are some of the areas requiring attention in the remaining project period. Training/HESAM organization and management of CDTI training programs were the responsibilities of the zonal program coordinator in the past three years. The woreda health office is pot fully empowered to handle this responsibility. The future direction is however to b,ild the capacities of the woreda health staff so that they can be in a position to plan a,d implement training sessions after carrying out needs assessment at FLHF levels. Efforls will be made to make CDTI training sessions focused on identified weaknesses of tl.re health personnel and other partners including CDDs. Similarly, the woreda health office will be making proper use of its meager resources by integrating training programs to the best of its capacity. Health education, sensitization and community mobilization has been very effective i, enhancing CDTI awareness to the general public. The perceived benefits of Mectizan are foundational grounds for the sustainability of CDTI in the woreda. There rvill be a need to produce more powerful health education and sensitization materials in order to enhance further the active involvemerrt of communities in decision-rnaking process. Moreover, the beneficiary communities will need to be mobilized to provide effective support for the CDDs serving their respective villages. This is believed to be one of the cornerstones for the effective sustenance of the program in the woreda. 1Financing/Funding During the first three CDTI years, there has been no specific budgeting for oncl-tocerciasis control activities in this woreda. Very recently, however, the woreda admin council has started allocating funds in block for all health programs in an integrated manner. Obviously, the amount of money is much smaller compared to the diverse needs of the woreda health office. Whatever the amount may be it is indeed a commendable start and it is hoped that it could be increasing over the remaining project period. Since the woreda health system functions in an integrated manner, it is hoped that CDTI could also benefit from funds coming from other sources like Global Fund, EPI, etc. Transport and other Material Resources In this woreda, at it is the policy of the Ethiopian government in general; available transport facilities are used in an integrated manner. tn the midterm evaluation, means of transport is one of the most important limitations identified at both woreda and FLHF levels. Ideally, it would be appropriate if a pick up could be provided for the woreda health service and at least one motorcycle for each FLHF. However, this may not be affordable at this point in time. The evaluation team has recommended replacement of the motorcycles that are found to be worn out and non functional in the evaluated woredas. ln addition, is also strongly recommended that each FLHF would need one motorcycle for effective monitoring and supervision of CDTI activities. At this juncture, it is very important to underscore the need to consider building the capacities of the woreda and FLHFs in order to be able ensure the sustainability of CDTI in this particular woreda. This woreda health office lacks irnportant office equiprner-rt like computer, printer, photocopy machine, etc. These deficiencies need to be tackled as soon as possible. Other CDTI material resources like treatment registers, reporting booklets, training manuals, posters, flip charts, T-Shirts, stationery, etc. should be sr.rpplied in sufficient quantities for the effective continuance of CDTI in the woreda. llr 8Human Resources It is known beyond any grain of doubt that the availability of skilled and motivated human resource is very critical to the success of CDTI. The midterm evaluators noted that there was a very high tumover of health personnel at both woreda and FLHF levels. It was also noted thatmost of the FLHFs are understaffed. In the coming couple of years, however, these shortcomings need to be addressed as much as possible. During the planning workshop, the woreda admin council and other authorities at higher levels promised to do their best in this respect. Plans have also been made to motivate health personnel and CDDs by means of rewarding best performing individuals and institutions. As stated above, training workshops will also be organized to filI the gap of knowledge, skills and competence of the available health personnel. Coverage This woreda has already achieved 100 percent geographic coverage and therapeutic coverage well over 65 percent. The woreda health believes the fact that if all other aspects and indicators of sustainability are well taken care of there won't be a problem to maintain the current geographic and improve further the therapeutic coverage levels. Efforts will need to be intensified to reduce the current rates of absentees and refusals to the best minimum levels. 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MOH Carter Center Total Allocation 1 Personnel 0 5283 2,900 8180 2 Capital Equipment 4000 \0 4,000 8000 J Supplies 0 250 990 1240 4 Training 1041.72 114.2 0 1155.93 5 Monitoring and Supervision 1789.8 402.89 0 2192.69 6 Material transportation 0 163.04 0 163.04 7 HESAM 480.42 633.42 880.42 t994.26 8 fuinual Review Meeting 0 0 6s8.64 658.64 9 Provision of Awards 0 {t 198.98 i 98.98 10 Total Budget 7,317.94 6,846.55 9,628.04 23,783.54 11 NGDO overhead (7.5%) 548 40 0 0 548.40 t2 Grand total 7,860 6,846.55 9,628.04 24,331.94 13 Estimated Treatments 20,416 20,416 20,416 20,416 t4 Cost per treatment 0.39 0.34 0.41 1.19 15 % lnput of Partners 32.3 28.t 39.6 i00.0 f .t 16 Year Five (2005) sustainability plan for Andracha woreda S.No lnuOget Line Item APOC MOH Carter Center Total Allocation 1 lPersonnel 0 6000 3,000 9000 2lCapital Equipment 0 0 0 0 3lSupplies 0 300 1000 1300 4lTraini ng 700 200 300 1 200 5lMonitoring and lsupervision 1200 500 0 1 700 6lMaterial transportation 0 180 0 180 TIHESAM 300 700 s00 1 500 SlAnnual Review Meeting 0 0 700 700 glProvis ion of Awards 0 0 200 200 t0lTotat Budget 2,200.00 7,880.00 5,700.00 15,780.00 1 I|NGDO overhead (7.5%) 165.00 0 0 16s.00 l2lGrand totat 2,365 7,880.00 5,700.00 15,945.00 13 lEstimated Treatments 21,028 21,028 21,028 21,028 l4lCost per treatment 0.1 I 0.37 0.27 0.76 l5l% Input of Partners 14.8 49.4 35.7 100.0 p b !