Illubabor annual project technical report submitted to Technical Consultative Committee (TCC): from December 2003 to November 2004

The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC To APOC Management by 31 Julv for September TCC meeting 5* \): (20 C L.i) ? ',;'lior i\S\\ ! I I I I I I I I I t._ r\0 , hAlfl\]o i.AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) COUNTRYAIOTF: ETHIOPIA Proiect Name: Illubabor Approval year: 2003 Launching vear: 2003 From:D.essmher..?0..q3,...To;....I$.qy..cmb..p.r.2.Q0..4....(Month/Year) ( Month/Year)Reportins Period: Proiectvearofthisreport:(circleone) (J2 3 4 5 67 8 910 NGDO partn€r: The Carter CenterDate submitted: 20 January 2005 3 I JAit. 2005 WHO/APOC, 24 November 2004 l &!*!ffi ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSE,MENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rePort: Country rhioDla NationalCoordinator Name:....p.r. Signature: ....... / 0J0Date Zonal Oncho Coordinator Name Signature rv{Xlo{Date: NGDO Representative Name: ........Tesh.q.m.e..Gehrs.......... Signature: /++.--........ Date: . |il.a@ This report has been prepared by Name : .Ti.b.q.b.U Designation : Signature oii ,'joo ,, ,Qv , t a :! TI ?" 1,/1,+ t.r too fl' c l1 Date WHO/APOC, 24 November 2004 aJ Table of contents v FOLLOW UP ON TCC RECOMMEI\DATIONS...... ...................1 EXECUTIYE SUMMARY SECTION I : BACKGROUND INFORMATION........ l. 1. GrNrnel rNFoRMATroN............... 1.1.1 Description of the project (briefly) . 1.1.2. Partnership 1.2. Popur-RrroN............... SECTION 2: IMPLEMENTATION OF CDTI 2 3 3 3 4 5 6 6 7 7 8 9 2.1. 2.2. 2.3. 2.4. TIUBLINB oF ACTIVrrrES.....,........ Aovocacv MosILIzeTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES Cotrluuuny INVoLVEMENT ........... 2.5. ClplcrryBUrLDrNG...... 2.6. TRretunrrs................ ................ I I 2.6.1. Treatmentfigures............. ..... ll 2.6.2 V[hat are the causes of absenteeism? .......... .............. 13 2.6.3 What are the reasonsfor refusals?................ ............ I3 2.6.4 Briefly describe all lcnown and verified serious adverse events (SAEs) that ... l3 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year 14 2.7. ORDERTNG, SToRAGEANDDELTvERyoFIVERMECTIN ......... 15 2.8. Couuuxrry sELF-MoNrroRrNc Ruo STITBHoLDERS MBBrnrc... ........ l6 2.9. SupenusroN................ ................. 16 2.9.1. Provide aflow chart of supervision hierarchy. .......... 16 2.9.2. What were the main issues identified during supervision?............................. 16 2.9.3. lV'as a supervision checklist used?......... .................... 16 2.9.4. What were the outcomes at each level of CDTI implementation supervision? I6 2.9.5. Was feedback given to the person or groups supervised? ............ l6 2.9.6. How was thefeedback used to improve the overall pedormance of the project? 16 EqureunNr FINRNCIaT CONTRIBUTIONS OF THE PARTNERS AND CoMMUNITIES OtsBR roRvs oF coMMUNITy suppoRT ............. 3.4. ExpBNorruRE PER AcrIVITy... SECTION 4: SUSTAINABILITY OF CDTI .. 19 4.1. INrnmtu; INDEIENDENTpARTTcIpAToRyMoNIToRTNc; EvaruATIoN................... l9 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) .... ... . . ... .. . . .. .. I 9 4.1 .2. Vfthat were the recommendations? . .......... 19 4.1.3. How have they been implemented?.............. .............. 19 3.1 3.2 3.3 t7 18 18 l8 1lr WHO/APOC, 24 November 2004 4.2. Yn3) 4.2 4.2 4.2 4.2 4.2 SusrarNeuI-lTy oF IRoJECTS: nLAN AND sET TARGETS (utlNoeroRY AT l. Planning at all relevant levels..... 2. Funds........ 3 Transport (replacement and maintenance), . ... 4. Other resources 5. To what extent has the plan been implemented......... 20 20 20 20 20 20 20 20 20 20 2t 2t 2t 2t 4.3. INrBcRerroN............... 4.3.1. Ivermectin delivery mechanisms..... 4.3.2. Training..... 4.3.3. 4.3.4. 4.3.5. Joint supervision and monitoring with other programs . Release of funds for proj ect activities .... Is CDTI included in the PHC budget?...... 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements?............. .................. 21 4.3.7. Describe others issues considered in the integration of CDTI. ...................... 21 4.4. OpenerroNAl RESEARCH 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. .. .. . . 2 I 4.4.2. How were the results applied in the project?............. ..........,....... 21 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, A]rlD OPPORTUNITIES 2t SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........22 1V WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Sel f-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible oopulation: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/h1per-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year ofthe project). (") Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geosraphical coveraqe: number of communities treated in a given year over the total number of mesoftryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment. (ix) Community self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the progrzunme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifi cations when necessary. v1 WHO/APOC, 24 November 2004 FOLLOW UP 01{ TGG REGOUTENDATIOilS TCC session Not Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BYTHE PROJECT FORTCC/APOC MGT USE ONLY WHO/APOC, 24 November 20041 Executive Summaly 1. Background on treatment and population data Illubabor CDTI has total communities (villages) of 3,590 which ate diskibuted in six Woredas (Matu, Darimu, Alige-Sache, Yayu-[-lurumu, Alle-Didu and Bedele) and all the villages were covered with Mectizan treatment during the treatment period. The total population, which is the same as the UTG, of the CDTI is 675,642. The Annual Treatment Objective (ATO) for the year was 582,866 out of which 523,171 were treated with Mectizan which gives the therapeutic coverage of 77%. Hundred percent of the project area (geographical coverage) was covered by the treatment. 2. Background on population movements. The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants. However, there is a resettlement program in the neighboring Woreda. Generally, there is no major type of population movement in the project area. 3. Training data Training of Trainers (TO1) was given for 113 healthprofessionals. Those rvho werc trained as traincrs in tum trained 8,021 CDDs rvho wcre sclected by the communities from 3,590 villages. T'hcrcfbre, the average number of CDDs per villages is 2. 4. Challenges and how they were overcome. Threats (Challenges): Overburdening of health workers in peripheral health facilities in ditlbrent health programs such as malaria epidemic control, EPI. measles campaign and settlement programs. Opportunities: The expansion ol govemment structure down to village leveT "Garee" and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of onchocerciasis control, which helps to overcome the above mentioned challenges. The Ilealth Extension Package program in which there is a start of building a health post in each and every Kebele is also another good opportunity. 2 WHO/APOC, 24 November 2004 SEGTION'l : Background lnformation 11.1. Gencral information 1.1.1 Description of the project lllubabor CDTI projcct is fbund in Illubabor zone, which is located in thc wcstern part of Ethiopia. lt shares borders with Gambella CD1'l in the west, West Wollega CDTI in the Northwcst, East Wollega CDTI in the Nofth and Kaffa-Shcka CIDTI in the South. Illubabor zone is one of Lhe 72 administrative zones in Oromia Regional State. It is sub-divided in 13 Woredas. The zone is one the areas where settlement program canied out and hence, there is a new Woreda added for settlers which has a population of 83,195. The Woredas are further subdivided into 505 Kebeles. The Kebeles, according to a new government structure realized this year, is further divided in to "Garee" (village) that is composed of 30 * 50 nearby households and responsible for all development activities including health. Illubabor CDTI project comprises six Woredas. These are, Matu, Darimu, Alige-sache, Yayu- Hurumu, Alle-Didu, and Bedele. The project encompasses a total of 227 kebeles which are subdivided in to 3,590 Garees (villages). The CDTI project area has very complex terrain with altitude ranges between 1000-2576 meters above sea level. Ecologically it is a tropical rain forest. Climate in the area shows great seasonal and inter-annual variations which is traditionally classified into three broad geo-climatic zones, i.e. cold highland, sub-humid mid-land, and hot lowland area. The mean arurual temperature ranges from l0 t'C to 16 t'C in the highlands, 16 oC -26 0C in the nridlands, and 23 0C -33 0C in the lowlands. The annual rainfall totals ranges from 1000 millimeters in the lowlands to 2200 millimeters in the highlands. Some of the perennial fast flowing rivers that cross the zone include: Sor, Geba, Birbir Dedessa, Offa, Sesie, and Gumer rivers. There are also quite numerous small rivcrs and streams, which are tributarics of thc main rivers in many places in the zone. There are two distinct seasons in the project area, i.e., the rainy scason (April - October) and the dry season (Novcmbcr-March). 'lhere is a mono-modal rainfall pattcrn in the zone. Agricultural activities (clearing. fanning, and herding) occur all year round in the projcct area, but are most intensive during the rainy season. Harvesting occurs from October to December, lcavirrg January - March as the optinrum treatment period. The ntain road that r"uns 600 km from Addis Ababa to Mettu, the zonal capital town, passing through Jimma zone is Asphalt road and worcdas alongside of the road are connected with Mettu town. There are about 576 kilometers dry weather roads that connect woreda centers with Mettu town. All the CDTI woredas have all weather roads and are connected with Metu town. However, access to rural communities appears very difficult during rainy seasons. The health infrastructure in the Illubabor CDTI project area is relatively good. The zone has 7 z,onal hospital, 11 health centers, 63 health stations (59government,4 NGO) and 38 health posts. Out of these health facilities a total of 32 health facilities (1 hospital, 6 health centers, 12health stations and 13 health posts) are found in the CDTI project area. 3 WHO/APOC, 24 November 2004 IThe new government health policy of Health Extension Package (HEP) demands construction of new health posts in each Kebele and staff with health extension workers in the next 5 years. Table 1 : Number of health staff involved in CDTI District Number of health staff involved in CDTI ectivities. Total Number of health staff in the entire project area Br Number of health steff involved in CDTI Bz Percentagc Br=Brl Br *100 Matu 185 36 19 Darimu l8 18 100 Alge-Sache 34 r6 47 Yavu-Hurunru 27 19 70 Alle Didu 35 1l 3l Bedcle 44 13 30 Total 343 113 33 1.1.2. Partnership Partnership is a principle of APOC as well as the government of Ethiopia which helps CDTI projects fbr best achievement of their aotivities and gradually ensures their sustainability. Since the beginning of the projeot, there was sffong partnership during planning, advocacy, mobilization, drug distribution. nronitoring and evaluation of the CDl'l activities among difl'erent partners. The main partners involved are l.'ederal ministry of health, regional health bureaus. zone health desk, Woreda health office, health facilities, the community, the carter center, WHO and other government sectors. 4 WHO/APOC, 24 November 2004 +o c{ko -o 0) o z$N U A B o .:lr) o'Lrl&O ocoE(H OEo9 s6 C)() €.e €.= .sE 'a= €r,tr0))H -+oo: € =c)a(o a o ^iFgE !(.)P "i-rrFH €o-= .F Ee Bb sE 'i!Ub .9s 6 '= li b0 qi L.id )F.Ftr 5'c] +'!:==cllE ;E 9H itr €v€ oFr,O -c=oc)'{j ts'.= 'RE 9:E I = V,o 6) €w- 9{9v) 5=E 9b .=i ;[ Ed7)^'5 _C o0= dB cg 7 o Ho,l + ,E 3Y H. H! € -8s -E ^-Eeo .aE =s g* : = dfi (lt 5 .24 Eh !Eii g .= trg) Htr .ii - .o^.9 !E E"c :t-=csxE '5T Etr b; H L!g .qtr € 9 '=; .= ,! -'U Hqp Ee n .! tr'li =3 EE ;9 Zi Ect E: c)6r A !? .r=-o c)3.8 p H €(! lrl- qri cBF tr = r.} g' o 0)at) ctoL ?o o o z I I a oO .l E d o (d4.. ooLHEEci> td l.stul$)t'\to'ILt\lul.c t- t9 tila) (J q) nJ .a q) !s 's -< S9 sP'!\ -qr9t$t\bu!u -S -' SS bo' 9: Bq)()q) 'nt tssr\aJ< L\qJ! *E lauPSsx l.:sB< s$s* \J*u.: s=p-E o) o lr o Eq) C)Lr !) € lr c) G) B 6l 0)L ct q 6) o)L q) C) .5dt) L cl o f U)() 'oo troAct. b0 c)tr> 'EO OE Eg (D crl Eo)bot Es o:l cBtr'o €3 o(Hoo 'd o,rEe oI ,-+ (, !() €Eq.2 9E 6)+o, cd; azB= ot: s.E *Lts\ .a. p\r r$dsss !t! =hn.st{9s9qrlt.: ri E' s$tv.IEil\'r: .s t\B\q) at .t) o o O E oarfl IE -fc oE aN aF o ll 6l !r FP 9i!E o- = 3e @ car F- o\ N c-l @. oo Nt.* t.- (\$t-- st--N oi afi al!+\o viF-\o + il 5 .oitr -oo .= aN E e.: r aE o\ oo^ aal aa t-- al c-.1 @. c.) co Nr-q F-O attr- \o o\ $r-ol a.t 6l$\o rnr-\o -,d . L)E Ei'=! 6&8.=;;>.EoO*EEEg oor- $ c.t co ..l c.l(-- \0 t--\ o\ ; al c.l oo co .f a] r.o o, .! tt- ra .9E9U :5 h Fisgsi o\F- N \c$ od $F- v? a.t \o o\ \o d $@ F- =(t) o qD (D OT 6l ah 0) () o lrq)E z + il Iq) ON o.= Gt €) F t-- c.)@ <f c'lar\ oo 'rf a-'lN l-.. o o,l,n ca .:.qE9:a:-.cl 9E Eiect(l)E >>oFE N c- \o \o\o oo o\ =l\o a/^) ar) 'Egsg= k Fisgsi + C-l ,\o r- t*- m o\(.) ra tr GIE9 .egH cle=? = 6.1lX Bor 9' -fv-xtsai5a co co t-- o\ al c.i@. cn c.lr- t-- a.l -{t t-r \o $r-ct at Nq ra c-\o (n I 'Fc)CigE s5EEliq)! E.g.qArjO 9.= a e cn a E L o o 0 a C) EO E x a o o o oo Fl Er Fr It $o c{ H G) -oF q) z$N Q A B (A L 4)o a o g: s0trE Q rf c.l o a ol o Io <J- N oz $ 6l 7 =f N 7 <f N o z E'O +.E G!= aE \f, a.l 3 !t o.l >. = a (\ {) -o sf 6l o oo t ^l o ao N Eo o o L tt) at L n o =tr =9trEo(J $ o] o $ a.l o + N o -oo o a N oe oo <. GI tso -o o <t N o -oo Oo E'.c litr 6!= arE t e.l o $ a.l o a a.l Lo ,oo oo -f, 6l o -oo o <f N t- -oo oo $ c.l tso o 0) 6l g aD 0 q) U o 9: e0trE U $ N 6 z a ol d 2. v 6I tro a .t c.l Ua s N ot)a $ .l p. o a .E'e+,E aE $ N z n 6l :f at o a $ c.l ooa t ..1 o a -f, N c tJ a AT GL Fr o AEtrEo U $ N 6, z <t cl d 2. $ ol br) $ 6l o0 ii- N b0 "f, N boa Er.= ftr d= aE $ N )r z. a c-l d I N oo =t N oo $ N o0 .f N oo r(D E.E s= -otrootsr()a o Q) a oQ I oI 'tr a <t 6l o. a o] I u0 $ o.l b0 s al br) $ a.l bD .E'.e+Jtr 6r,= atr $ a] or(! t a a..l or(! 2 $ ol b0 t a-.t b0 <. 6l bD + ..1 br) rh Fl () L (h H 2 E d o o dt/) o br) a d IJ o o o o c0 Fl t'r F \o .n C) oO Hdo >. tr c)L!)o o E 0) c)tr U)(d(.) li(d (.) Fr € U)o (_)(d (H C)tr C) E F c.it o-rl .oldtFI o o a-g II .Ifl(, 6 tF o o E I- -o E IIF !F IN Fa(, 5 o E o IIfl Eg E o E o Ic .E llN - o Il-(, ulo 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. HighJevel political leaders and Onchocerciasis task forces at different levels particularly the Zonal, and Woreda were involved in the advocacy to support the overall CDTI activities. The members of the Task Forces at all level were officials from all sectors, which have relevance for the CDTI activity. This political commitment helped the CDTI activities to be started and successfully achieved its objective. However, some of the sectors, which are members of the task force, were highly involved in the ongoing restructuring of government organ, resettlement and other activities. This has to some extent hampcrcd the frequency of scheduled meetings. For the next keatmcnt period the Task Forces at all lcvel rvill contribute their part as expected since tlrc work loads they have because of rcstructuring and resettlement will bc minimized. 2.3. Mobilization, sensitization and hcalth education of at risk communities Community mobilization was done at each village organizing community meetings. The health workers at all levels have done their best in organizing the Task Forces and giving health education for the task forces. The health workers working at front line health facility level were responsible to organize the Kebele Task forces and giving health education for the task fbrces, community supen isors and CDDs. The Task Forces at kebele levels which, comprises of seven members and also responsible for all social, political and economical activities in the kebeles have played major role in rnobilization and sensitization of the whole community at grass root level. Cornmunity Supervisors and CDDs were responsible in giving health education to the community at village level including women and rninorities. In addition information regarding the CDTI project was further disseminated through local radio station. The community mobilization has contributed a lot in awareness creation and as a result the community involvcd in the first year CDll activity with successful accomplishment. T'hus, fbr thc next treatment community mobilization and hcalth cducation w,ill be strengthened. 7 WHO/APOC, 24 November 2004 $oo c.l 0) -o 0) o z$ c{ A o rJi > Cio (o E o (d t) C) ct) C,2 oa € bo tr 0) 0)lr cl U) c))a cn F O o B rh 9p o)(DHT!o (h .'- atro)f"= €c'tr E .;-E(d 'oii€ c)xtvatr o.:rtrt a .4il 9, :or.i oQ636 I '9A()= L -Et-i - - A.cBtri-0)..o -cjg o -(B'F(uH! >,.6 X o .ET H 9 = 6 iiE =-Vptr H o.:.OFV:- ts!'4)88. xEA.5 GE s.t a'A .E'VL L I ,^.F AH X o.E *Y *€ ! r anrOH'v *: -adPE X H OE !2'E EEEE38EErO-Cl , 6 .3 -8;a =are-HosE; .betjpo E A: E8 .. tl r.9 ;ts I c-!BECD-7,os 6 E.= 5.eUVF'F€.i. EEtso'EHE-E E f s 8.E { 6 Urrrrr oO .Eu ,gE! 6C =-rlBaEED =6zE oo[] dE d o OD 6t c) o + c\c.l @ \o o.a.t tr E.E * i EIEz e'i \o \t $N o\ a-.t c.l F..N sf €(.)o 0o A o 0E- EI6y a.= U o o E z le +F le il tr 6t oF cl @ al\o co oo cA o. N € tr 9- EEOa) \o $ { a.] o. c.] a..l t-- a.l Os cotl Ftr A U o cl a o\ F- o\ o. \o\o fn6 o\ \o >o s'lH! :'l ctX >o}:oEi 6t 'Eo EEEO otr9-rC o=EE trE -ozo P ll r trla tr 6J o! 6l {) oti O E EaH r EEE i EeaT r- @ *f a.t @ tr- oo\o$ ol c.ltr- e o\ m c.) tr ?od r.: L oE.EE E 5E9E -H-P t.t o a.l 6 $ N@ Ir- a + o.l c-'l t-- o\lr)(.) rl a 2 6, o o cn(h o oo >-d o o ? o oEo m 6t oF q qj (.) q) oL q)\ a)4 t3 s) E F o(J 0)flEE:o.HEcLAo.; r l.trc'6 ,.EE:rrX J()rr 'tsE.E -H -iEtrLEEHLAor-(, :. +#l6i ffl @ 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels' - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffarefrequently transferred during the course of the campaign). There was a cascade of trainings on CDTI from the higher level to the community level in adequate arnount to carry out the CDTI activities. However, there was a fbw situation where there u,,ere turn over of trained staff particularly at front line health facility level which did not create any major problem on the project activity. 9 WHO/APOC, 24 November 2004 U t. A< .i o .i + .(J ir *$ N N aa) oo oo 6l\o oo c.]\o oo @ @ \o o\ \o c.l .I a (\l 6 o tr CBL 0 a U 6)E z (J o F O a-l c'I @ at\o oo @ ca \o co o\ G,I a (D (D (D o s Q +- () il ri n F ,L 'b' A< is *d t $ ao N ol <t :t t-- ao t.- $F- + Ir- i\oN o $\o6l cl + t*- co <f, t-- i\6N o q) q) q) (J s o O o .=G cltFr LFT(l)' .oE L!Eo- z U t = glhY F-d Ge-u \c \o € oo \o .\o o\ c\ ao co c.) (.) o) =!ri:! !g €c 2E 0)() O o F \ocr) @ U ao (i Eo €) q) s o $q U3* ,! Ei':+F-d a,l c.l N c.l c.l c-l N c..l c.1 a'l N c'l al a.l o N e.l ol a'l .I q) c! 0 0 (J O q) z O ct a-.1 -] q) 0 a € 2 'tr d a o o 5da o50 = d u o o oEoo F] F o t-r q) q) q) (,) s o $ N (.) -o 0) o z$(\l Q A oo I{ { s) s o B o bO a. d o{ .: I a. ni B E \' .L g ! =* -\ a t; q) aq) b 4} L p o t q)q q) E o d o o A F Uqi o a 0) o C) -0)E E o (d h0 (d LrF .ii1 6)l -olcilFI Trainees Type of trainins CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Ottrers (specifr) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatmcnts 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65yo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. 11 WHO/APOC, 24 November 2004 a oN r 3 o o z$N U o. E B U $q) I B E a. U\) bo tU{ BqJ E * e)$s{sSE!. q) .a{Eoi B\! .ss .EE q, -. !.8!s{t' .EEf€PE ss €f S!iqlY s 's..l.i E..Ei *{\ s$r ss Flts' c FFS i=x o '!-lE !:s ssr E* .s ]iE CSt *;It !lt'si EiS :E B !ui $s .i s:$ sI:i ss EEB\ GsP €IE SE = E{t sp !l !'S € T\I ss E ES[ [:R PE\ ag N F cl(,) d o(.) 'a L(g o '= t ad(l) H o E(.) C) IL o)g o(t(.) E 0) d ot 9ol e -l o.lxl P -l oEI ; EIE tsl Ial qpl tiol u()l !ol 0)ol ! ol ELl -3l tr'dE =t 6Zll- olol -l oxl.L EIE EIR!t;oloot trot Eolb Elg Ll ' EIEtrt tr =t trzl< d(l) tr(g Poo 'a ctX(.)H-t P9()s 'AA LV o i,i €a H '=-o €8.9 qo.; .9E .= tiE=EHE- ^0)5'EHEtr ol tro Ol |r! al HE :I Bb El.eo. dttrF g-q\IYa 6tcot - aloel P Hl 'l "l ! =l ts€l.H < h fil i' 'glELt>-tuut-- lt sol- =l tr -l F XIGEP El e8l.E 8l E(!l 5 (rl =old oltr -lb ul5tit o- ot c €l= €l= =l -o =l bZI? ZI? a 0)b{dl-l6) oo (s o (dLbI o c) b{ E (B o o0 cltr C) OI o o o lr € GI tr otr 1\ r-\ V) qj Qq) S p t \J q)q q)g v U) Lr d rh cll olr cll (n (5 F1 o L o € >,p t) E] a €tr C) (B o F n-f ,l -oldtFI o C) o(d F s o clH (l) bo !!a6S oo F C) (B l.r (l) o0 cll<(l) oo f,^ -.co\'Q. -(s s o{,)o C) clH() o0 Lo oo(), .H \oEC C)a clL c) H qAgE J c 9< os'6. i a€*EE*z tE & o qql{J<Ea a.o o vob9 'cq zd <lr- a.l 9t-- tr-co 6l @ trr oo a'l \o o\\o o\ GT ail (H o..o--== EE.'O €BEEE2" EE oo\oq o\crl@ 00$ Olr-C.I t-r c.l$^ c.l \o F-o aa o d oA A3o\ o do6 o oo o o o. d o F F- F-F- o\f-. r-r-. o\tr- r-t-. r-F.- EEE EE9 = o!z \o €^ ot \c $ =t aO € st \ot.. a.l (\ F- (n G{\a =o.e 6.: l=of uFFl, \o t-- \o <t ol oo F-- F- .l a.l o\ o\ ca @ -f \o\oa al6 ra .9 'E E " BH4€ -?.et-!'b E E 9t ots o\ oo d; oF- o\ c..l e.l oo^ co c-lF-q F- N <-\\o O) s a-. a.l a,i alif,\o rarr\o an o o0(d rh 0) troO ll * a d .9 e^ F'b sEol- uo O tsE.^u.ts fi!o c bolt .o=6dtr q= o =E>!AO o F- 6 $ c.l co t-- oo .+ c.lct a- o\ra ca =oE E.: =EEEgt tr- a4@ -t a.l @ r-- @\o$ c.l c..lF- o\ ra(.) \Oq F OE X Oo.E e EErr ts'- h., - E EsEE" . 3E E E t-- @ $ N oo F-- 6 $ o! c{r* o' ra(n a)4 ;v d 2 d o o a o60 J e ! IJ o o o o EO .l oF I2.6.2 What are the causes of absenteeism? Most of the absenteeism was occurred because of the overlap of the farming time and the drug distribution. This unusual overlap has occurred because of late commencement of the overall CDTI activities. 2.6.3 What are the reasons for refusals? Most of the big towns, such as Matu, dwellers who do not feel sick were not voluntary to have the medication. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report r/ 13 WHO/APOC, 24 November 2004 sooN o -o () o z$ol or o = \r -an H o ./ +) cl -q) -GI c) c) a0 6l Lrq) oo rt\JF ,, 6l a ./ L o +a6l I .l t ULEcl c)(l)Eh6) !- E!gZ LLUAo)()L .sE.s +. L lai o cg .t)!!?'= viHc)r o.E .-A aJ :- aA E- CJE(.)olELI ci.-l !l :,161 .:. -- 6llE.E €IErrdlI .o F-lFi : \olRE Ivh- EEI E .i El c! -oil !!-l r)4ql q)e3l 'eEfllio*rl qagre .-- !v€H o(l)lr6rx€ E o rtronYtrEts5(!DclagE.E *roItEtr6) o El +,fEfi8 H-9F= - isl s F--r- (.) --qptr bs'\ >:- U ll r l-T hr ri e$s< a- t'. l-to\ o ll- *. r{ ld ri o '5o =o0o6 *bi:>oosoF ti .o O6, ,o ti E,Eo 5Ezfi o t-- aa| a-l @ N@ ti =oEEi c 6.4<86 N s. r--\o o (o aa opr h .,8 _; gH EEs€8"' a 8"9 r E6 ll + ri ti FT o o &o-. r Oa\ o 'o. oo =d- A^ri, F 3 E E;';-(Jotrl t{ AOo'u a UE*E? E= EEtr>L >o6 o\ o\ trl =oE E.: ,troE E.q}9.o' F9 o\ 0)bo q C) o O 00(! = .,3q>Hoi}E *E r:E.= { E oi E E g EE EOoo o\ oN O N il H OOo a.l c.l 9! o c.l N a al o N \o N \ o6l @ooN I 2.7. Otdering, storage and dclivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH M WHOtr UNICEFE NGDO tr Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH M WHO! UNICEFtr NGDOtr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests for Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery system in the country. Then the drug is stored in MOH warehouse frorn which projects levels receive. From the project level (zone level) the Worcdas receive it and distribute to the health facilities. It is from the fiontline health facilities that the conrmunity supervisors get the drug to distribute to thc CDDs for them to distribute to tlre communities. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs were requested to return the remaining drug to their collection centers which are the health facilities. The health facilities, in turn, send to the Woreda health office and finally from there to the zone health desk. Ilence, the remaining Ivermectin is kept at the project (zone) level. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Collection of ivermectin from the Woreda level . Distribution of ivermectin to CIDDs . Training of community supervisors and CDDs . Supervision . Recording and reporting of data Any other comments District/LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaininq Matu 374,000 321,470 0 2,111 0 50,419 Darirnu 252,500 239,460 0 1,795 0 tt,245 Alge-Sache 185,000 180,447 0 1,707 0 2,851 Yayu-l lurumu 232,000 225,433 0 2,089 0 4,478 Allc Didu 221,000 203,057 0 t.525 0 16.418 Bcdelc 374,500 276,485 0 2,148 0 95,867 TOTAL 1,639,000 1,446,352 0 11,370 0 181,278 15 WHO/APOC, 24 November 2004 2.E. Gommunity self-monitoring and Etakeholdenr Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No' If so, When? Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implernentation or how they would be utilized during the next treatrnent cycle. 2.9. Supcrvision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF ) ZOTI.) WOTF ) Health Facility ) Community supewisors ) CDDs 2.9.2. What were the main issues identified during supervision? . Delay in utilizing and liquidation of funds. . Failure to organize the collected reports on CDTI activities especially at ',voreda and front line health facility levels properly. 2.9.3. Was a supervision checklist used? Yes 2.9.3. What were the outcomes at each level of CDTI implementation supervision? Though the Finance officers have received proper training on handling the APOC/WHO fund utilization and liquidation system, still there was problem on Iiquidating of the used budget. Therefore, on spot training was given during supervision. The overall reporting of the CDTI activities was also corrected as much as possible. 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9,6. How was the feedback used to improve the overall performance of the project? The good geographic and therapeutic achievement of the project pertbrmances shows promising. DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Matu 357 0 0 Dalimu 830 0 0 Alge-Sache Yayu-Hurumu Alle Didu 431 782 468 0 0 0 0 0 0 Bedele 722 0 0 TOTAL 3,590 0 0 t6 WHO/APOC, 24 November 2004 a SEGTIOil 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment @lease add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? 1'he project expects APOC fund to maintain capital equipments that have been provided by APOC for the first five years. The capital equipments that are contributions of thc govemment will be maintained using the government moncy. The project is trying its best to perfbrm well so that APOC would rcplace these equipments after first five years while at the same time eflbrts will continue to allocate budget by the government fbr smooth takeover of the project gradually. APOC MOH - Zone DISTRICT NGDO Others No. Condition Source Type of equipment No. Condition No. Condition No. Conditron No. Condition 1. Vehicle I F 2. Motor cycle(s) 4 F 3. Computer(s) 1 F 4. Printer(s) I F 5. Photocopier (s) 1 F 6. Fax Machine(s) 1 F 7. Overhead projector 1 F 8.25" TV set 1 F 9. Deiesel Generator I F III t7 WHO/APOC, 24 November 2004 ,3.2. Financial contributlons of the partners and communlties Table 13: Financial contributions by all partners for the last three years * Indirect contributions such as stalf salaries, office supplies, utilities, communication, etc. **Contribution of CDDs and communi\t sr.tpervisors converted in to monitory value *'r'F Do not include fttnd.for capital equipnrcnt - If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) None 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here 1USD:8.65 Contributor Year I (2004) Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted rus$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released rus$) MOH (Central + State) r3,983* r3.983 MOH (District + zone) 40,475* 40,47s Local NGDO(s) ( if any) 0 0 NGDO partner(s) 67,970 67.970 Communities 200,900** 200,900 APOC Trust Fund 64.175*** 3s.000 TOTAL 387,503 3s8,328 18 WHO/APOC, 24 November 2004 aTable 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTIOil 4r Sustainabillty of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? Activitv Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of eollnulIv Mobilization and health education of communities Training of CDDs Training of health staff at all levels and distribution Internal of CDTI activities Advoc and authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Of-lg_-e-Eqqipment(egc.ompqlgls,pllllellglg) Others TOTAL Total number of persons treated 523,171 t9 WHO/APOC, 24 November 2004 o4.2. $ustainability of proiccts: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? NO When was the sustainability plan submitted? NQ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. 4.2.2. 4.2.3 Planning at all relevant levels CDTI activity is part of the Health Sector Development Program. Therefbre the planning activity is carried in an integrated manner at all levels. The government policy of empowering the woredas, the communities and Health Extension Packagc will also ensure the sustainability of the CDT[. Funds Short, medium, long-term (post-APOC) financial sustainability plans will be prepared at worcda and rcgional levels. Budget line will be created fbr CDTI activities by the respective local government Transport (replacement and maintenance) Efficient use of APOC vehicles will be ensured as long as they in a good condition. Budget for maintenance will tre allocated and other vehicles from MoH and other parlners will also be mobilized. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Since the beginning there is no separate lvcrmectin delivery system to the lower level; it follows the existing drug delivcry system in the country. 'lhe rcquest for Ivermectin is to MDP through MOH. As soon as the drug arrivcd, tlre same as all other drugs and medical equipmcnts. all the processes rcquired are handled by a Pharmaceuticals Administration and Supply Service in thc MOH. 'lhe project levels, like any other medicincs, receive and deliver to thc rcspective levels following the existing delivery system. 4.3.2. Training: CIDTI is integrated with the Primary Health Care (PHCI) from the beginning. At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector-borne Diseases Prevention and Control Units are responsible. Therefore, all the staff of these units has received training on onchocerciasis. Training of peripheral health workers has been carried out in integrated manner with other health issues. 20 WHO/APOC, 24 November 2004 { Joint supervision and monitoring with other programs As part of the system in the country, most of the supervision and monitoring activities are carried out in integrated manner with other programs. Release of funds for project activities Activities which were not funded by APOC have received the amount of money required in time to accomplish them. Is CDTI included in the PHC budget? Yes, as part of PHC, CDTI is one of the priority activities. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? In some malaria endemic villages, the CDTI structure is used for malaria control program. The new structure of o'Garee" is also responsible for all health activities in the village. 4.3.7. Describe others issues considered in the integration of CDTI. The new government structure of "Garee" (village) which has got a health committce and the Health extension Package progtram designcd to reach all Kcbeles with health posts. will play a major role for thc irrtegration and sustainability. 4.4. Operational researeh 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. NONE How were the results applied in the project? 4.3.3. 4.3.4. 4.3.5. 4.3.6. 4.4.2. SECTIOil 5: $trengths, weaknesses, challenges, and opportunities Strengths: Even though the CD'l'l activity is new, the project is able to accomplish the distribution in short period of time with 100% geographical coverage and therapeutic coveragc high above the minimum standard. 1his is due to high political commitmcnt at all level, awareness and active involvement of health workers and the community at large. Weaknesses: Delay in reporting fiom the lower level, poor financial utilization and liquidation Opportunities: 'l'he expansion of government structure down to villagc level "Garee" and being takirrg the responsibility of developmcnt activities as well as health is a good opportunity for sustainability of onchocerciasis control. The Health Extension Package program in which there is a staft of building a hcalth post in each and every Kebele is also another good opportunity. 2t WHO/APOC, 24 November 20M ) Threats (Challenges): Overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, EPI, measles campaign and settlement programs. SEGTION 6: Unique features of the proiecUother matterls None A 22 WHO/APOC, 24 November 2004