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

The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC me AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOct t bt '" Ntr,. rl t\(2J (00 A#e ,:1.1.: l-,1 l1r |-.J.- - ll r,/+/ (-' AT il tit'r For 1,.,, :. 'i" t-'ttot' 2 5 Jtjtt zltnq Proiect Name: GambellaCOUNTRY/NOTF: ETHIOPIA Launchinq year: 2003Approval vear: 2003 From:Des.e.mh.e..r..?0..43-....To,;....N.q.y.e.mh.e..r..29.0-4.....(Month/Year) ( Month/Year)Reportins Period Proiectyearofthisreport: (circleone) OZ 3 4 5 6 7 8 9 10 NGDO partner: NoneDate submitted:24 July 2005 WHO/APOC, 24 Novemb er 2004 _l I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country Ethiopia National Coordinator Name: Dr Daddi Jima Signature Date: Zonal Oncho Coordinator Name: Ahmed Ibrahim Signature: Date NGDO Representative Name: NA Signature Date This report has been prepared by Name : ..Ahm.q.d.I-b.rah.im..t.N.Q.T[. Designation : Region onchocerciasis Coordinator Signature WHO/APOC, 24 November 2004 1 Date Table of contents ACRONYMS IV DEFINITIONS v FOLLOW UP ON TCC RECOMMENDATIONS 1 EXECUTIVE SUMMARY 7 SECTION 1: BACKGROUND INFORMATION ......3 1.1. GrNnRal TNFoRMATToN 1.2. Popu1erroN................. SECTION 2: IMPLEMENTATION OF CDTI........ .......6 .3 .5 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 3.2 3.3 3.4 4.1 4.2 4.3 Ttrranr-INg oF ACTIVITIES ............ ApvocRcy MosILzeTIoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK CoMMUNITIES CovutxrrY TNVoLVEMENT Cnpecrrv BUTLDTNG TRnaTUBNTS ............. ORonRntc, sroRAGE AND DELIVERv oF IVERMECTrN............... CouuuNny sELF-MoNrroRrNG eNo SrerceHoLDERS MeBrrNc SupeRvrsroN FTNRUcnL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES Orsen FoRMS oF coMMUNrry suppoRT............. ExpeNoIruRE PER ACTIVITY ,.6 .,7 ..7 ..8 ',9 1l l5 l5 t6 SECTION 3: SUPPORT TO CDTI....... 3.1. EqurrueNr 16 t6 ...1 8 ...1 8 ...1 8 SECTION 4: SUSTAINABILITY OF CDTI........ ..........19 INrnRNal; TNDErENDENT pARTrcrpAToRy MoNrroRrNc; EvnluerroN ..... SusrerNaert-rry oF IRoJECTS: ILAN AND sET TARGETS (ueNoaroRy AT . INtncnerroN ............. 4.4. OpenarIoNAL RESEARCH .19 .20 .20 .2r SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTUNITrES....... .................21 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS............22 iii WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community S el f-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization 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 lv WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in mesoftryper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-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 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-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 CDTI. (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 government. (ix) Communitv self-monitoring (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 prograrnme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. V WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS TCC session Not le Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY WHO/APOC, 24 November 2004I Executive Summa4y l. Background on treatment and population data Gambella CDTI has total communities (villages) of 403 which are distributed in four Woredas (Gambella, Godere, Dimma and A/Openo[Abobo]). Out of these 403 villages 368 (91%) of the villages were covered with Mectizan treatment during the treatrnent period. '[he total population, which is the same as the UTG, of the CDTI is 100,821. The Annual Treatment Objective for the year was 80,656 out of which 73,01 8 were treated with Mectizan wlrich gives the therapeutic coverage of 72'%. 2. Background on population movements. The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants. Generally, there is no major type of population movement in the project area. 3. Training data Training was given for a total of 46 health professionals. Those who were trained as trainers in turn trained 1680 CDDs who were selected from 368 communities (villages). l'his makes the average number of CDDs per villages to be 4. The number of CDDs per village increased because most of the "villages" are areas where population lives in a dispersed manner except in settlement areas and small towns. 4. Challenges and how they were overcome. Challenges: Overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, EPI, and measles. For the next distribution season, this will be solved through appropriate targeting of the training and distribution. Opportunities: The Health Service Extcnsion Programme in which there will be building a health post and assignment of 2 qualificd health extension workers in each and every Kebcle is a good opportunity for sustainability of onchocerciasis control, which helps to overcome the above mentioned challenges. 2 WHO/APOC, 24 November 2004 SEGTION {: Background information 1.1, General information 1.1.1 Description of the project Gambella CDTI project is found in Gambella regional state, which is locatcd in thc rvestern part of Ethiopia. It shares borders with Illubabor CDTI in the East and West Wollega CDTI in the North, the Sudan and Kaffa-Sheka CDTI project in the South. The Gambella Regional State is divided into tluee zones and the zones further divided into 7 Woredas. The Woredas are fuither subdivided into 288 Kebeles. Gambella CDTI project comprises of four Woredas. These are, Gambella, Godere, Dimma and A/Openo(Abobo). The project encompasses a total of 403 villages. The CDTI project area is an ecologically forest-savanna lowland area with altitudes ranges from 300-500 meters above sea level, with the exception of Godere Woreda, a highland fringe area with up to 2300 meters in altitude. The region has largely hot, humid and moist type of climate. The mean annual temperature ranges from 17.3 0C in the highlands to 280C in the lowlands (300-1500 meters altitude). The mean annual rainfall totals vary from 900-1500 millimeters in the lowlands to 1900-2100 rrillimeters in the highlands, 1200 mnr on average. The rainy season extends from May to Octobcr, July-August being the heaviest rainfall months. Majority of the population lives along the banks of rivers. These rivers are Baro, Gillo, Akobo and Aluero rivers. There are also a number of small rivers and streams. The rainy season extends from May to October with the heaviest rainfall taking place during July-August. The period from November to April is relatively dry. Agricultural activities (farming, rearing animals, and fishing) occur all year round in the project area. The status of infrastructure development in the region is very poor, apparently limited to the regional capital and the surrounding towns. There are about 585 krn all weather roads and about 197 km dry weather roads. There is one airport in the Gambella town in the region. Water transport over Baro River is available from Gambella town to Sudarr border. Access to rural communication is difficult particularly during rainfall seasons. Thc region has 1 there is one hospital, 8 Health Centers, 49 health stations/health posts and 16 rural drug vendors. The new government health policy of Health Service Extension Programme demands construction of new health posts in each Kebele and staff with health extension workers in the next 5 years. J WHO/APOC, 24 November 2004 Table 1: Number of health staff involved in CDTI 1.1.2. Partnership Partnership is a principle of APOC as well as the govcmment of Ethiopia, which helps CDTI projects for best achievement of their activities and gradually ensures their sustainability. Since the beginning of the project, there was strong partnership during plaming, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The main partners involvcd are Federal ministry of health, regional health bureaus, zone health desk, Woreda health office, health facilities, the community, WHO and other government and non government sectors. 4 District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Bt Percentage Br:Brl Br *100 Gambella 34 l1 32 Goderc 16 t4 88 A/Openo 15 11 73 Dimnra t2 l0 83 Total 77 46 60 WHO/APOC, 24 November 2004 $ c.l h 0) -o o o z$N U o Ar L' B a(! v) ': ah(€ otr(B C) (ri U) E i- o : E G) (c-O= 6)cdqlrc)H< - u -&e*oao =-''- .== oarart oi = .ZP E+?.= trIE ,a;(])o .-'i5 (h 4.i .a?! -.rSb -.:.o(6 oP;L :l()v dtrtr o =o-o)tr 'F()= trt; o.Y^o G)wfi I ?-od.= IAH(u .Y l*He E o:P =H3 3uo AC)}fc) ! .r 'uv- .L A.^€ QrOu)=-o dlw .5 lo :th -) U)'E; g :E 9!in,-- C) _.: (r w .r (J =0.)Li'--O I>'o '5r-V cs V!Fai troa),o 'Et-= '=6 .H 4!LE6 9 =o E EaO vPi Ec)ti= C)0) tu L{ .P>c) cB ar 'E -C();z€ CdF C) J Q() 'a Ha() +r o (D E oli O. C) (gI chH 0,) a o B r/) F c., bI)(t Ho x E oo (l) r, O a, o() ($ B c) (l) () bo d !o >\ ) o() L 0) o oo an oL(! ox +r o z 4$ .t Uq) o'L a. q,) q) \q) -s U q)L q) ,s 5 B!Ei.ru so'SL5\ 9!: .Y q- cl o'\r.\<J\JP .S -r EL *S qr >s ho'Sxv:$q) U$'it tL -u 13 u( QJ EJ$q,\* qUg9\T (D Io tro E G) (B oL (.) Lr Cd l< 0,) () B 6lq)L GI olr $\tET8 t* <l 5 \q, :Y -a Sh\t ^.!Y-S ^. q) *\B}a.Y\,\v\ ds sl\.s '-LE9Ng .s .Y 3$ NSBq) :bo{= ild \J(Jt\\l\q) e)L 0) Os J1t/) 1.. 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(, $ cl op o o o $ cl Eo ,o O $ c.l 0 o o o o fr U) UI tr a gE I t c.l q)4 o <l ct q)4 o \r a{ 7)sc o 'f, o a.l o o o b.D -E \t (\ o.oa s a.l o a at o a a at o.o a o) cllEq U) an q) U o EE Q cl o .+ cl o rt ai D :+ r! o H= 1iE ct= N z .+ 6l N v (..l 2 $ N 2 AI clLti o q) a o Q $ C{ cB z .+ 6l d s o.l (d 2 a o a.l z b!EE IE d= aE N L $ a.l r 9 cl 2 $ (\ xd z aC) .J.ii.jEG= Nii oo =9a o gE I $ N () a $ a.I oL a $ N kG .{- ON ! o. 3o= d:atr Gl oL 2 $O c.l o! a o{ o. $ O c.l q Fl a L U) a o!F o o oU o l)A t E E ! Fl t't o H \o U) c) oQ 1 L(6(l) >' P 0.)LLr a() (.) tr 0) dol< an(€() Lr CE o lr € (n(.) I o(! (H o() tr G) E F ".irol -.ol(Bl FI o o .I +. a- a-fl(, 6 5 o o E a- -o EtrF I - IN F CI(, rF o E .9g IEfl tr o Eg c E t!N - o IF(, UI o 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. High-level 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 fiom 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, lack of adequate knowledge about the disease has to some extent hampered the overall progress of the CDTI activities. 2.3. Mobilization, sensitization and health 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 thc task forces. The health workers rvorking at front line health facility level were responsible to organize the Kebele Task forces and giving health education for the task forces, community supervisors and CDDs. The I'ask F-orces at kebele levels rvhich, comprises of seven members and also responsible for all social, political and economical activities in the kebeles have played major role in mobilization and sensitization of the rvholc cornmunity at grass root level. CDDs were responsible in giving health education to the community at village level including women and minorities. The community mobilization has contributed a lot in awarcness creation and as a result the community involved in the first year CDTI activity with successful accomplishment. Thus, for the next heatment community mobilization and health education rvill be further strengthened. 7 WHO/APOC, 24 November 2004 sO N !oo (.) z$ c.1 O \J o B oio CB (.) dv (h c) U) rt) oth a0 () -o d)H(! rh 0,)t rn cn F o() d) B ch bo C,)o A.trtu\ol3' ch .iAtro)64L9pE !!H9 .i-iF 6)=€oxE-(n!0)8F X .r-Eo so Fr? ,; =x 0)9Ao? q-r -EH -dA.cOtr-!9o H -Gti$E -X>r-C) /\ * .!(Fi ti o5ts H€ d-vL H^U.V4Ai9ts.r:!9d88. bEg'6 r+< = !.r a'^ ,:E^.9X '- (v at P gI3E E -!:Xaitr3E 6 E.9 - 0)'= l-. !F!vrH'Fili!aoIl -L.HO:: x.E h; = Y.€ - H E 6'eE;hEtt!a : B tr >o: o'- I ri JHA-@o ^o *.1= c).. (.) -'- r, I -tr C$EO-'aoati!rX>!ca -ilu-.H9.r u v i.- u.:i^taliJLb 6 P"= b'tr 9 rPwLr\!* E<E tsE<o oOrrrrr od .Ee trd 5e :t r!9.o?3" zE o ilI .io' -i q) o!6l o o @ o\ $o, @ o\ *kqro'== tEgez e'= \o\c !t €\o ra q) o q) y> do -l- U oE z te +Ftr ll le n o t< co oo d\o @N oo coN €\o E 9oEN e r\lrv o\ \oO c'1 t-. Nr- \c F-trl F taUo ar! a c.lN ca N+ <. F-. \o\o !f, ic, ,gfia0i(l: >0t-r 'Eo Ec) EEEP otro>r o=Etr =oze ll * Era le ob! 6l eq) €) tu \oo\ o\@ o\ le Eafre7'i e .Z E E€ EEtrXO. 2EEa co \o $cA €\o ..l te 9?o(! EEt H -=e:E E:.iiE:e O.r I c-) c.l\o t-- @ ?.) t Fl a (! a)3 tr dU o o o oc n 6 E .E o 6i F A Bq qj qJ q) \- p p t AJq Bq) S F aO C) o CBa o trda r/)() ) oU .+t o-rl -oldlFI fl E o E o E o E +a E5 E E o(, sN @ 2.5. Gapacityr building - Describe the adequacy of available knowledgeable manpower at all levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meqsures were taken to ensure adequate CDTI implementation where not enough lmowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). There was a cascade of trainings on CDTI from the higher level to the community level in adequate amount to carry out the CDTI activities. llowever, there was a few situation rvhere there were turn over of trained staff particularly at front line health facility level which did not create any major problem on the project activify. 9 WHO/APOC, 24 November 2004 !(J + U fl (.) n tr U ,\ q i!t6 ca co @ .rr\o o oo$\o @ c.t oc c.l @ c! @ c.) c.l a\o a\o 0) clL ah o oU o L 0) z IF lr) @ ri-\o @(\ oocac\l 6\o Eo o o I s S.i nll I .O i.to O O O o o a,L 0) .=G clt FiLA r.Ho: .oE o.= r9!0)H z I o F O q) o q) c) Ua< Q = ..: E.'!+H-d o \l <. O O t \o! 0) c!h Eg a)0 €etr> zE q)() QF $ O \ot o () q) c) \c Q $ E.'l+F-d sq E a.) o ca c.) CO N N t, 0) GL !H CE an t, q) 0 o () z q) o tr c.) c.t GI (JJ o n o! E6 o c) o o oA < H Fl F Ei q) q) c) v a o\ C\ k 0) -o F() o z$C! O o Pi oH B bo o\ .3 p U{ L G x o bO o P o \ oL\ qt -o B (: o B\ > =* ?\n B a.a t4q) CJq) .S a4 > p p o \\ B q) v2 Bq) s o d tr() q) a F aU +r o (h o) 6.) 0.)k -o) :H td 0) d bI) (B HF .iir o.ll 5l(6t t-l Table 6: Type of training undertaken (Tick the boxes where speciJic training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving I00% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staffor Other Political Leaders Others (speciff) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) 11 WHO/APOC, 24 November 2004 $O N H(.) ! o o z sl a.l ri o Ai o B N r E .!l tr-tt-\ 00 t) ho \ rFl \vsIrJ$ \U3H{ Ua$F'$ i = xs €ss .=!ol -Clr\E.:t3E T !.l!$E l:oxrE;T().Ets HE.EII}e:$Fr$ a\ -q \i ll 6 .s '+dEE\.$! $ sR ? \ EIJ -, E F E*Ol ! v b\;l{ ! ss Et i : .!:Etr. E ss!l I : sbfl8s {t()ILsS-s ol o qr >t o[ 5 { ;E 3l E $ Ee Pl E s' .sS EIE S EIZll- s Itt:$ 3N '= oo ,, EBI r $$\ G{ I AL s Es\-bU T Stts E .s'$rr E )l L -C 'E U\H s s.s!, E ESFrrttS = i Ps6\ \ aS (! C)L{ €o(.) 'a cgXG)*Eo) 9!o 'AA LVAg*2,() ;,iid d A '= if I I - aa .;.io: .E c)trE d6trdEB oi .eE JE ot tro ol H! -l HE xl 8B El.go, 'dl trh el b+ el 'dA alcOl ; ol iri olol o o0.r ol -l tr .9l d -l o,xl I =l A xl Fsl.H tl ) ol'f;ot rn 6l- ol H HI.H EI 8 HI6Et > '=t o Et A!t .a Ht d gt v o.rl ; =l tr o,l tEIE EI: EIE ol .: El : ottrBIE 8lE 8i€ <*l = ql '! c*l Iola. oltr oli t-l O pl f pl ' -813 -81 tr 3lEtrltg trlcg trl=HI!HIUHIHllb =lo ,1trZll- Zl? Zl< (.)(! l< o oo!B^ o\ oo oF C) (dL o oo(0 Lr c) oo (! o- c0Lbo oo o o (B L o bo Glio oo O^ .H \oEo\dv0. C) F al 0)l bo rBlLl c)l >t olol EIol -qlol C6I Fd otol hrl EI(6l ol al OI(Bt lilol -cl9l bd cl 9l OI EI ol :l €l ,cl)l EI ol r!l ! _- o E;.: s*E AE; e{ zSe& O O o qElt<\U) ZE O b9 -otrcq)).ozd a.l coC\ @ ra6 (\l E .^ -E: E E:i e E['€E t'-\c C\ oo r-\o tN o\ o (B oo or ll r\o o 'Eo =boo(! =ooo -EoF co @ o\F- o\r-- (\Ir- o o- e6gEEE = o-uz c.. @ o\ O di N co co co oo cat co$ t'- € o(')t- =od o.=2E6E E.gT < 9P'F\J \o 6 \o c.l $ c..l co t @ r- \aia\o a .=.r6 E " &H1€ -?.gE-"b E = - E€ o *5F cl ao =J- v1 $ rf, t-- o\ 6t6 e rh(l) b0 d t)q) I oO ll rs E .9 ariboA6F'b Eo> uo o 6 o\ oo o\ o,@ o\ ;.9.p.E [i ! .8 E SHtr c= ii =tr>sz6o O ca co ao \o a.) a\o(+) a =od o.= =tr:.aE 8.9. < gP'F9 c.t aa N\o F- 6ca ot :E€ r $ sEg€:- . 8E E E c.l\o OF.- @ca c.) t a)4 ;v o! cd o o o oo i cll L.l c! oF -\ \J4q q) q) q) S ? o\ q) L \ B a) 14 Bq) E)i .h l< (€ U)(t G)lr(g (€ tr o F] () L rh ,o C')H a 'otrd tr C) lr (6() l-iF r-t o-rl -ol(Bl FI illt 2.6.2 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 refusals are due to less awareness about the disease and claiming that they don't have the disease especially in Gambella town. 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. ln 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 ,/ 13 WHO/APOC, 24 November 2004 D sO ct ! 0) .o I o z$N O L-,/ O{ H B $ -(h A o .tt 6l -I -6lI 0) u0 clLo a oI oH) I ct .l L oT 6l d .-t o2EUE !EC{JOc, FGI =9e= YctuoEgrE e6l .2 -ttreEO.ao)5o'2BE.q2c)l .=.Lt s!lC)trl(l)ot<l '=clNltr.c€lo. : o:l5el3ei-laHlr) o rv\ -alGtE:l q)eq hg-i Li I;9t EE(!l o(l)aJ '= -tIEall-o)+rl or q)ho= Ei:!q)(,)!r !O(FE () r,ror\/tr;F -9lv-) LY6 OJP9LtrE+.()9lrtr6)o.=rEE8 L;EFEEr oil '; ui91 2e €l -ue.i Fl Fr gEs O @ o CE pi o 0r 6 ili tri tr] ri o9Sata Oo\ o o, oo ll * rd td f-i o\ o !o ,boo(B E9ootoF N t-- f.l ,.o od rPOE Q- 5O Z',o o oo O. co t-t ri =o? b.u 4tr4) f eFFU \o ro^ O oc aa9 bE .S'E o i'. - .os€='Er.l ' -o. 39 o *6 (\ oo O a 0) bod aq) s) tr o(-) o ll + ri ri ri o9ffar Oo\< B-o o. -co=a.bo=Gl - 6 ,^ il ,:,' 5. s I E'!t Ootrl t1 LOo'i a b E 9PU €E=E;Eir>7 Od 6\o t{ -Eed o,= =troEE.g < P4'FU $ ood b_t " E gn.q€ XS - cB'=.='> E E o=ql oDF tr U 9! tro oo O <f, & H oo N o N N oN co N \t c.l ra, oN \oOo(\ F- oN 6 c.l o\o N ON Mectizan@ ordered/applied for by - MOH EI WHO 2.7, Ordering, storage and delivery of ivermectin tick the appropriate answer) UNICEF N NGDO tr Other (please specifu): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH EI WHO N UNICEF E NGDO tr Other (please speciff): 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 from which projects levels receive. From the project level (zone levcl) thc Woredas receive it and distribute to the hcalth facilities. It is from the fi'ontline health facilities that the community supervisors get the drug to distribute to the CDDs for them to distribute to the communities. Table l0: Mectizan@ Inventory (Please add more rows tf 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 facilitics. The hcalth facilities, in turn, send to the Woreda health office and finally from there to the zone health desk. Hence, 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 CDDs . Training of community supcrvisors and CDDs . Supervision . Recording and reporting of data Any other comments 2,8. Gommunityr self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No. If so, When? Qtlease tr District/LGA Number of Mectizan' tablets Requested Received Used Lost Wasted Expired Remaining Gambella CDTI 242,000 2r9,054 0 r,369 0 2l,5ll TOTAL 242,000 219,054 0 1,369 0 21,577 15 WHO/APOC, 24 November 2004 Table 11: 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 implementation or how they would be utilized during the next treatment cycle. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF ) ZOTF) WOTF ) Health Facility ) Community supervisors ) 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 woreda 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 liquidating of the used budget. Therefore, on spot training lvas given during supervision. The overall rcporting of the CDTI activities was also conectcd 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 geographic and therapeutic coverage is better in relation to the inaccessibility of some of the village. The utilization of the fund is also increased. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) District/ 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) Gambella Godere A/Opcno Dimma 130 138 66 34 130 t38 66 34 130 r38 66 34 Total 368 368 368 t6 WHO/APOC, 24 November 2004 Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle 1 F 2. Motor cycle(s) 4 F 3. Computer(s) 1 F 4. Printer(s) I F 5. Photocopier (s) I F 6. Fax Machine(s) I F 7. Overhead projector 1 F 8.25" TV set 1 F 9. Deiesel Generator I F *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? The 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 the government will be maintained using the govemment money. The projcct is trying its best to perform rvell so that APOC would replace these equipments after first five years while at the same time efforts will continue to allocate budget by the govemment fbr smooth takeover of the project gradually. l1 WHO/APOC, 24 November 2004 3.2. Financlal contrlbutlons of the partners and communltles Table 13: Financial contributions by all partners for the last three years 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 lndicate 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. lndictate exchange rate used here IUSD:8.65 Contributor Year 1 (2004) Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) MOH (Central + State) 14,145 13.000 MOH (District + zone) 34.750 33.470 Local NGDO(s) ( if any) 0 0 NGDO partner(s) 0 Communities 85,000 85,000 APOC Trust Fund 86.914 2.5.000 TOTAL 220,809 1s6,470 18 WHO/APOC, 24 November 2004 0 Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution lntemal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 400 6,000 2000 3460 3 160 0 3200 4000 I 500 2000 0 0 Gov Gov + APOC APOC APOC APOC APOC APOC TOTAL 25,720 Total number of persons treated 73,018 Table 14: lndicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. Internal; 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 I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? t9 WHO/APOC, 24 November 2004 J4.2. Sustainability of profects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?NO Was a sustainability p lan written? NO When was the sustainability plan submitted? NO What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. 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. 4.2.2 4.2.3 4.3.2. Planning at all relevant levels CDTI activity is part of the Health Sector Development Program. Therefore the planning activity is carried in an integrated manner at all levels. The govemment policy of empowering the woredas, the communities and Health Extension Package will also ensure the sustainability of the CDTI. Funds Short, medium, long-term (posrAPOC) financial sustainability plans will be prepared at woreda and regional levels. Budget line will be created for 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 be allocated and other vehicles from MoH and other partners will also be mobilizcd. Ivermectin delivery mechanisms Since the beginning there is no separate Ivennectin delivery system to the lower level; it follows the existing drug delivery system in the country. The request for lvermectin is to MDP through MOH. As soon as the drug arrived, the same as all other drugs and medical equipments, all the processes required are handled by a Phannaceuticals Administration and Supply Service in the MOH. The project levels, like any other medicines, receive and delivcr to the respective levels following the existing delivery system. Training: CDTI is integrated with the Primary Health Care (PHC) 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 JDescribe 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. Thc new structure of "Gott" 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 "Gott" (village) which has got a health committee and the Health extension Package program designed to reach all Kebeles with health posts, will play a major role for the integration and sustainability. 4.4. Operational research 4.3.3. 4.3.4. 4.3.5. 4..3.(i. 4.4.1. 4.4.2. 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 budgetr Yes, as part of PHC, CDTI is one of the priority activities. 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? SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: Even though the CDTI activity is new, the project is able to accomplish the distribution in short period of time with good geographical coverage and therapeutic coverage high above the minimum standard. This is due to high political commitment at all level, awareness and active involvement of health workers and the community at large. Weaknesses: Delay in reporting from the lower level. poor financial utilization and liquidation Challenges: Overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, EPI, and measles. For the next distribution season, this will be solved through appropriate targeting of the training and distribution. a 2t WHO/APOC, 24 November 2004 ( Opportunities: The Health Service Extension Programrne in which there will be building a health post and assignment of 2 qualified health extension workers in each and every Kebele is a good opportunity for sustainability of onchocerciasis control, which helps to overcome the above rnentioned challenges. SEGTION 6: None Unique features of the proiecUother matters 22 WHO/APOC, 24 November 2004 I