Jimma annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2006

,{ ,,," ^}. ror AcuoD Tor {- 15 uttt ,! I I tt[;_ 1 ;, " '' i '1,,17 --. I r.-l0l OP IAPC. ?007 \ ****s'J I The Federal Democratic Repubtic of Ethiopia Ministry of Health gJ,tA l.gb UP Ail Bfu FO for kilondon To' DiR LO MI COUNTRY/NOTF ETHIOPIA e: JimmaNamPro iect Approval vear: 2003 Launchinq vear:2004 Month/Year eriod:rtinp P Jan ue.ry. 20..0.6.........mFro oT .Ds.q.e.m.b.e..r..2.9.06. Pro iect r of th ts re (circle one) I 2 45678910 Date submitted : 20 May 2006 NGDO nartner : The Carter Center ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TBCHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APoc Management by 3r Januarv for March rcc meeting To APoc Management by 3r Jurv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I | 5 Jutil 2007 ,:rr-\j*iL)l R WHO/APOC, 24 Novemb er 2004 {-****,ff'. !..., ,l I I AI\NUAL PRqJECT 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: Signature:.....#d Date rJ.d""t Zonal" Onc[o eoordinator Name : .........].Jas.irAb.dp. Signature: W Date: .....r.Y::1...(.1. l,aoo"7 NGDO Representative Name : ...........Aha1p..Ti.1.a1run.......... ! {li i Signature: t Date: ..At..fi/z,c. . J.e.q/.. ... This report has been prepared by Name : ..........N.as.ir..A.b.de...t.N.4lH........ Designation:Z.p.ne..Qnq.h.a..Cp.q.r.dinatp.r Signature v d- .-F > ?t rD Cro )-- * u t\ )L- WHO/APOC, 24 November 2004 &* "J ;\: *n' I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) EI\DORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country _Ethiopia National Coordinator N am e : ...... .. .. Dr..A.fe w.qr.k. H.ai.tq.ma.n a.m Signature: .... Date: Zonal Oncho Coordinator Name : ..........Nasir. Ahd.q.... Signature Date NGDO Representative Name : ..........Aba.te.Ti,lalrsn......... Signature: .......... Date This report has been prepared by Name : ...........Nasir.A.bdq...t.Alp..Tn........ D e s i gn ati on : Zsn e. g. nsh.q..C..q p. rd.in alqr Signature Date WHO/APOC, 24 Novemb er 2004ll l, Table of contents I Acronyms. FOLLOW UP ON TCC RECOMMENDATIONS SECTION I : Background information......... ^S-ECTION 2: Implementation of CDTI2.1. Tluu_tNr oF ACTrvrrrES..............2.2. Aovocecy 2.3. MogtI-tzerloN, sENSrrrzATIoN AND HEALTH 12 ......lV ,......6 ...... 8 ......8 ......9 .... I0 ....10 EDUCATION OFATRISK COMMLINITIES t2 2.4. CouuuuryrNvoLVEMENT 2.5. Cepecrry BUTLDTNG2.6. TRrerurNrs.. 2,7. OnosRINc, sToRAGE AND DELIVERY OF IVERMECTIN2.8. CoNaNrul.rlrysELF_MoNIToRTNG AND SrarBHoI-orRs Mmrnqc2.9. SuppRvlsloN SECTION 3: Support to CDTI3.1. EqunvrNr 3.2. FrNaructeL coNTRTBUTToNS oF THE PARTNERS AND COMMTiNITIES3.3. Olren FoRMs oF coMMUNrry SUPPORT..3.4. ExppNolruRE pER ACTIVrry... SECTION 4: Sustainability of CDTI.. 4.1 INTEruAL ; INDEPENDENT PARTICIPAToRy MoNrroRrNG; EveluanoN .4.2 SUSTAINAEILITY OF PROJECTS: PLAN AND sET TARGETS (vaNoeroRy AT..Yn 3) 4.3. INrrcnerroN. 4.4. OpenarroNAl RESEARCH . SECTION 5: Strengths, weaknesses challenges, and opportunitiesSECTION 6: Unique features of the project/other matters ..14 .. t6 ..18 ..22 ,,22 ,.23 .24 .24 .25 .25 .25 .26 .26 .27 ,27 27 28 28 28 a lll WHO/APOC, 24 Novemb er 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 Communi ty-Based Organization Community-Directed Diskibutor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Govemmental Organization National Onchocerciasis Task Force Primary health care Rapid Epi demiologi cal Mapping of Onchoc erciasi s Severe adverse event Stakeholders meeting Technical consurtative committee (Apoc scientific advisory goup) Trainer of trainers United Nations Children,s Fund Ultimate Treatment Goal World Health Organization IV WHO/APOC, 24 Novemb er 2004 I I Definitions (i) (ii) (iii) Tgtal population: the total population living in meso/hyper-endemic communitieswithin the project area (based on REMO und ""nru, tut,rgl.- Eligible population: calculated as g4%o of the total population in mesoflryper_endemic communities in the project area. Annual Treatrnent obiective: (ATo): the estimated number of persons riving inmeso4ryper-endemic areas that a CDTI project intends to treat with ivermectin ina given year. Ultimate Treatment Goar (-UTG): carcurated as the maximum number of peopre tobe treated annuaily -in, meso/hyper endemic areas within the project area,ultimately to be reach:d y!:, ,r,i p.q"" has reached fuil geographic coverage(normally the project shourd be expectld ," r"Jiir; uia at the end of the 3dyear of the project). Therapeutic coveragg:-number of people treated in a given year over the totalpopulation (this should be expressei ur'u percentage). Geographical coverage: number of communities treated in a given year over thetotal number of meso/hyper-endemic communities as identified by REMo. in theproject area (this should be expressed as a percentage). Intecration: delivering additionar hearth interventions (i.e. vitamin A supprements,albendazole for LF, screening for cataract, etc.) tt,ougtr CDTI (using the samesystems, training, supervision and personnel) in oider to maximise cost_effectiveness and empower communities to solve more of their health problems.This does not incrude activities or interventions carried out by communitydistributors outside of CDTI. Sustainability: GDTI activities in an area are sustainable when they continue tofunction effectivery for the foreseeabre future, *itt'tigr, t.eutmert coverage,integrated into the available hearthcare service, *itr, stong communityownership, using resources mobilised by the "o--urity "rJ rn" government. (iv) (v) (vi) (vii) (viii) (ix) sel The process by which the community isempowered to oversee and monitor the performance of CDTI (or any community-based health intervention programm e), with a view to ensuring that theprogramme is being executed in the way intended. It encourages the communityto take full responsibility of rvermectin distribution and make appropriatemodifi cations when necessary WHO/APOC, 24 November 2004 I I FOLLOW UP ON TGG REGO]UIMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describehow they have been addressed. TCC session 23 Number of Recommendation in the Report RECOMMENDATIONSTCC ACTIONS TAKENBY THE PROJECT FOR TCC/APOC MGT USE ONLYr9l accurate calculation of the quantity of future mectizan needs ofthe project. More trainings and the review meetings conducted have focused on this issue and it has been corrected. The corrected UTG in table 2, and, eve4nvhere etse in the report. Inclusion of Corrected The use ofcom is commended, munity supervisors but SHM is still recommended for implementation has beenSHM training conducted contribution which is indeed very significant To indicate government are done in integrated manner and is difficult to identifo the exact amount spent for the CDTI, we tried to estimate the MOH contribution which is Though, the health activitG indeed si rcant.To make financial promptly to avoid delay in transfer of funds. returns to APOC finance officers coordinators. On bJo was ventraining forgr and CDTI 6 WHO/APOC, l0 February 2004 JExecutive Summary l. Background on treatment and population data Jimma zone started implementing CDTI activity in 2001 and this year is the third year of the treatment lreriod. In 200(r there were a total of 800,927 people in the project^reawtth 640,74}Annual Treatment Objective (ATO) for the yeat which is the same as the UTG. The total number of people Eeared were 571,039 with a therapeutic coverage oF 71oh and 10096 geographic coverage. The project area has total communities (villages) of 3607,rvhich are distributed in 4 Woredas (l\4ana, Seka-Chekora, Shebe Sombo and Dedo) and all the t'illages u/ere covered with Mectizan treatment since the start of the reatrrrent. 2. Background on population movements. The communities in CDTI areas are mainly settled farmers, daily laborers and civil servants. Flence, there is no major type of population movement in the project area. 3. Training data Tlr'is year, training and refresher training were given for 106 health professionals, 114 communiw superwisors and 10,874 CDDs selected by the communities from 3,607 villages. Therefore, the average number of CDDs per villages is now tluee plus (3+). 4. Challenges and how they were overcome. Threats (Challenges): Overburdening of health workers in peripheral health facilities in different health programs such as malaria epidemic control, EPI and campaigns like Enhanced Outreach Strategies for child survival. Multiple responsibilities over coordinators and poor recording and reporting at health facility levels are also additional challenges. Opportunities: The govemment structures that are now stretching down to village level called "Garee" are taking the responsibility of managing several development activities, in which health is also a major component. This is a good oppoffunity for sustainability of CDTI in this zone. The expansion of Health Extension Package program to establish health post in each and every Kebele is also another good opportunity. 7 WHO/APOC, l0 February 2004 ISECTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Jimma CDTI project is located in the southwestern part of Ethiopia in Jimm a zoneadrninistration' which is one of the zones that constitute thl Southern o.l*iu Regional state.The Zone is further divided into r 6 administrative woredas. The CDTI project area covers 4 woredas which have a total population of 770,030. Theproject area shares borders with Kaffa-Sheka CDTI in trr. South. The 4 woredas are furthersubdivided into 137 Kebeles which, is ftrrther dirid;Jil; o 3,607..garee,, (village) composedof 25 - 35 nearby households a"d responsible for all development activities including health. The climate of the CDTI project is classified into three geo-climatic zones: highland, mid_landand rowland area The mean annuar temperature rages fi"* l;rc ;;?? #t " high rand, l6oc -26 0c in the midland ";Jrl'c' -ii bc irL*ffi.i-# annuar rainfar totars are highest inthe highlands of the zone reaching 2000mm. There ;;-;*o rainy seasons. The main rainyseason is between June and octobeiwhile smail rr;;;.;r;n is from January to April. Some of the perennialfast flowing rivers that cross Jimma zone include: Gojeb, Ghibe, GilgelGhibe' Dedessa' and Kawa' TherJ are also a number oir*ul rivers and sireams, which aretributaries of the large ones in many places in the zone. There is a main asphalted road about 340 Kms that connects Addis Ababa with the capital ofthe zone' Jimma town' Each CDTI woreda capitals are-torurected to Jimma town with arlweather roads' However, within the rural communities the roads are only for dry weather.There is also 3 times a week flight to Jimma town directry from Addis Ababa. The health infrastructure in the Jimma project area is relatively good. The zone has I zonalhospital, I district hospital, r s health centers, 64 health stations and 46health posts. There area total of 127 hearth facilities in the CDTI proje* *.ur. ----' Table I : Number of health staff involved in CDT I (please add more rows if necessary) 8 Number of health staff involved in CDTI activities. District B Total Number of health staff in the entire project area Number of health staff involved in CDTI *I00 Percentage Seka-Chekorsa 15 t2 80Shebe Sombo 27 25 93Dedo 25 24 96Mana 46 45 98Total 113 r06 94 WHO/APOC, l0 February 2004 \f,oo6t xLd atr F() IJ{ o d oA o *. B v1 -s Uq) o'L \) ^s q) .t o}rq) o o o(n (+< d 0)!(\l o 0.) 'a l-r o. q) o (B t o a. o o -o cd v)q) r<q.) 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Timeline of activities Fill in table 3' timeline of ac-tivities for areas treated in current year, indicating when the keyactivities were impremented by the month they began *J t " month they ended. 10 WHO/APOC, l0 February 2004 t$ooN >. d e ,oo Er o O oA{ o Ji > -\ ar \J O't qj l)q) .S oL q)\ t q) % \) $- t<dq) >' C) E o o !() CI 0)l< t)) 0)t< CB 0) Ii € (rt o o(B q< o C) (D F c.ir o)l -ol(Bt F.l o o o.=E=5tr() \ooo C..l 9 o. o,a \ooON 9o. c) a \ooo c.l o. 6) U) \oooc! P a. o)a bDtrE 'ti E \ooooi(l)) \ooo c! tt) = \oooN o E \oooN (:) a o E L U, 'o tr a o EE U \ooo c! o a \ooo o.l il) \oo c.t c) a \oooN ID aotrEi 1itr r!= \oooN (s z \ooo c! cg z \cooN d \ooo c! (\, z. (u D q) u, EI o)Q o EE Q \oooN h c! \ooo C.l >r GI z \ooo e.l >'(€ 2 \ooo c.l >r(d EotrE li tr ca= \oOo(..l Ct \ooo c.l rn 2 \o Oo c.l d 2. \ooo c.t (B udtr tr GI li F{ o Q \oo o.l (! z \ooO ci >'(d \oooN >.(! \ooO e.t (, ADtrE .iJ tr €= \ooo c! > \oOoN l\t \ooO c.l (d 2 \ooo c! C' Z ovD -€) .9 .:Pllclt{N= ooE()a o q)€ (J \ooo N (d \oooN >|(\t z, \ooo C\t >r(! o at (g hotrE 'ti trl \o ol G, \ooo c.t C, \ooON cl \oo N I F] <) ,r o a< GIoLox c) (J I clJ(l) U) o -otr oU) o -o(1) (n o:o(u o (l (B F] Er o F{ 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the currentyear; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. Political leaders and Onchocerciasis task forces at different levels particularly Woreda andKebele levels were involved in the advocacy meetings to support the overall CDTI activities.The biggest challenge in the area of advocacy is-that theie are several other competingpriorities in the project woredas which makes it very difficult for the policy makers to singleout such a control program out of the many so called "major killers" that are causing a lot ofdevastation to the communities. Community mobilization was done at each village organizing community meetings. Thehealth workers at all levels have done their best in-givin[ health education and follow up theactivity' Task Forces at kebele levels have played m-a;or lole in mobilization and sensitizationof the whole community at grass root level. Community Supervisor, *a CDDs wereresponsible in giving health education to the community at villageievel. The community mobilization has contributed a lot in awareness creation. The awar.eness ofthe community, their involvement in the CDTI activities and their interest in getting Mectizantreatment has shown significant growth. As a result therapeutic and annual treltment objective rate have been above the expected range. 2.3. Mobilization, sensitization and health education of at risk communities 12 WHO/APOC, l0 February 2004 \ i$oo o{ q) -o () o z vN (J oA o B $ o o) oO oE' _s 't 8F 'E r) 3_9Fr ot o L0 -o z o llr dE ta oo!t c0 I A- o$ cn \oC.l cac.l la :'t 6 !59 ==c>=E - EC o N o F-oo co No tN6 E o .9 I o d a L) o L0o z a + la I E i oF O o\ n € ooq \oo c?)oo^ (..t =t-r € le 2-!!a Or\ N O r- @ No !+ot € te a a(J g 6 2 \o co @ F- -J. r+ F- .c- N cn r-(..i ra Io o .: =E o ,a8'tEh .x )oOC 3 o o 0l) z o Irdd t0 o a0q o L oo oo o = oo o Er.rr f Ef E, \oo @ 6t\o c.l c.lOvl r-aa o\ t-o\o t) la .:8 .trd =oe !.= i ,E;cFtrO otr \o O oo c!\o c.) NO 3 F-C' o\ F- \o t) (J L .2 a d o :1() (J I(o JZ(l)(A o -otr o(A o) -o(l) cr) o!o o (d c RI 6l oF -:\ r\ s %Vjq) uq) L\- 3 o T\ g\ o L +.r *: S N q) V1 N q)\ a*! F oU (.) fl.q -!Lo.=trtr -on -o-O 'Fi -l.t-x J(Dr- -Pb'=f=EE -FEEO.:o: $l .olIt Eloi sl A. .o (l)8FC:).Yt< i:iE5(dE .;{o t) ^.F IJBoOO ^'fiEg xCll !HoHI{ c.. EU Hoo)o7 o'ox EAUci "3E(.) :' u -3; EE:o tr Fo ,cj o 6';;Q E TUAVA 'i€PAH =6 cloEA EH6.3 'tr ^:Lg Ef -o'5 .oE -!€ -UB ,i8 .:.E Q'a?At<g# il o. *3 i€ E E Es8€ -E z90 E=EZ < tr qt(-) tr cdEtro9Ig (n ot,t) 'Eot).fuo9tr ..6 .2 .otr9) .983??a):(nd dtD =I :Fua €QEltr {j€ -d(.) taXE :oPE X 'iox € FI ,>r Uri.=g "rii E sbotr = u)trh E: a !gHLEt E AHH()(Dc) EH E ;EE o q>oHrr)= :# b EUi! € E €3 E .E -9(d^E.=Q)(n--drtr -g trH; E Fi€ e x;< (! (n5o o ': HA E hOE- .9 .Eab E 6e-o a. ()9E '5 EU U! E H.:.fUAgF\*sHoL'",iD5L.;Y;ticscH -o j -ocFE fraH5H aEi = o >! tiE€ ^e e€ -(Dqi eE CEE; 5 E:ASE :EESs fr83x = c'i.0)g fr EE E<d E g> , vooN >\k R,3L ,ooIri =O o P. i< o *. B rr) t2.5. Gapaciez building - Describe the adequacy of availabre knowredgeable manpower at alr revers. - where frequent transfers of trained staff occur, state what the project is doing, or intends todo' to remedy the situation' (The most important issue to describe is what measures weretaken to ensure adequate 1DTI implementation where not enough knowledgeable manpowerwas available or if staff arefrequintly transferred durn[ ihe course of theiampaign). Trainings on GDTI from the higher level to the community revel has been given in adequateamount to carry ottt the CDTI activities. However. ,t.." *".. a few tum over of trained staffparticularly at the woreda and front line health facility i.r"ls. This effect of turn over wasalleviated by on job training of the n"*ty assigned staff at all levels. 16 WHO/APOC, 24 Novemb er 2004 IEq) cl (A a nU L o)E z o -a +F u.: i, *6 .Ltq O o, sf^ \o ra ca c\ \t @ ooq € oo o- oos \o O. ca F.. c.) N $(\ h co oo c.i $N oo o t F- € ia € F- r- o\ € o1 ?ol o\ o\ o c) o q) s?rFU oovl oo. =i: or- o-(o o\i- @ c.i oo o\ o(, o) .=GGl f-i ,- L, LF{ol oc)GF9 r- Glo)L z r-lJ 9 .U S.iqv i. *o o o o o o o o o o O o O q) q) o I sU o L o o O o o q) E6ldr< d)! !s c, tt, €ttri -- 2E c) c) E,q?F-d U U .L\.q t O r* co N \o 00 N c.l F- c.ltt o ca c.l 6 o\ r- 6 al ?o o\ q) OJ c) () \oo\Q oLF co \oa.l c! ca$ Loo q) 6l - 6l (o 0 (J tt, a o o)! z E,r?F-d G 6 \'q * c.t a\ o O a.l N O ca ca O ao co c) q) o C) s OF c! N 6 () Fl c) ,2 n ct o .v ID OI GIrzo(r) o .o E o(A c) -o c) (r) oo(D o c,tr Gt -l l-{ o Fr .{.oo c.l k ru -o Eo o z rt(..t (-) oA o *. B t\tc lo lhot !E o *$L og U $ N o\ s c c c oEt\ Itr o\\ I\'s ! * * v) 4q)(J q) S ? Y q)L o \\ q) U) q) E o cC () 0) o. H F a(J (H o (n o (D o L< _(D !Hg ! c) cd bo clLF ,iir o-rl -ol(Ol FI bO E t 8 :t o o R P -tc F- tTable 6: Type of training (Tick the boxes where sppctfic training was carried out during the reporting period) - Any other comments There was no specral training orgarrized on CSM using thetask was taken care by .o-rn*itfsufrerrisors which weie trai APOC manual. However, that ned by the respective FLHFs. 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving lQ}% geographical coverage and a minimum of 65%therapeutic coverage or the covbrage rate is fluctuating, state the reasons and the plansbeing made to remedy this Trainees Type of CDDs sors Other Community members e.g Community Health Workers (FLHF) MOH staffor Other Political Leaders Others (specify) Program management How to conduct Health education Management ofSAEs CSM SHM Data collection Data analysis Report writing Others (specifo) 18 WHO/APOC, 24 Novemb er 2004 $oo e\ xL fi, cp o trr o O oA{o B o\ t) 0O!t!su E{$ *bo d\HO$E5t'adeETHsESET8.Ea'Fi 5 Es\ 9H:St € A .E ii --coot .=4..=sE *' E iss x H.E E;ELE) ,g E I Sttr rilF .a . =F':rE r t,sE5 ,E H E{B 5 qE $ E =I E A S tF :l 8 H .: $s q :l: $[f:l -91 an :?l <Ail inl e- .Yl o tsI EI:E H q tl HIE Elf _cl 6l (g xl q)'cjl .;t E ,*l €lBl ol o. ol Elll sl O ul 5 :{ ol o- ail c Hl €l= Elt -l .=l O 5l 'o Hl zt? zt? zt< zttr S . *dl .s SI ol Eo $dEl :S iiHl E$BEl sS E1 E E SSIEr a, oo * !sEl E E c .- S Fh ;l i^;^; ts EEt:l is :s E.s € t s*sl d- E- -r 6. F- 8- !l E EsEl E Fo ; I rr rrs-bl "8 I E a P eIril tr 6 t s t S€ E€E i?EE € =o Lq) o Eo -o z o O o o +i2azz o o o o o3bs -occq) 5.o z6 oN oo 00 or)c\ oo caq \o ca $ a.l ?alr, N €in h e- s E:fr EE[}EE o.l N O$ Ns o\r-N N o d)p. oA ll t AQ H s o 'to =bolD6 EEoo .EoF o\\o €F- F..\o @r- F- a o --q5S -= !a ct 5 [rz \f r-O^ o\ .t N o\q o oo s ooo. cf) N ol o\ oo oo o\ rOo r-in -Eed o.=zEa c (B.:-? 9-o' FU 01@ Or F- c.) cl. N oo $ o. \o c.l s\o N N =r- t\o a E .=.rdti 69) < o tsgE€ -?.c o-:oE = - E3 .6 tsEF F- ooq s c! ca o\\ No N$q o.l ca ca o\O = r- .I o\ € (a 0,) b0 cn t) 0) oO oo ll r a'd's G .9oib0 o- !a!odboa83o oO oo oO o o tsE -p.ts [i 9o c M!,?D = d-=tr tr= U = E'r Ez6 o \oo oo N\o co olOvl r-.co o, r- \o re tso 6 o.= =EEE E.ST< 9e'FU \o O@ c.l\o c.l c.lo u') r-(oo\ r-o\o ?o :BE r $;EE*T $ ETE€" o>-6 \oo @ o.t\o co c'lov) l.-r.) o. r- \o ?o tuE< d E .odt -52v([:)6.ca() .8E6)E .qo ch c/) o!o o (o (! rl H oti , (t (J U1 L)q) q)\) v,5 oL p \\ N a) 14 N q)g .\1 aD 'tr cl (r, C,o li 6J c, o .l o t< U) x -o .A rI] a CB () (o 0.)L.F r-f o-rl -I -otcllFI !2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasons for refusals? 2.6.4 No SAE case to report Most of the absenteeism was occurred because of the overlap of the farmingtime and the d*g distribution. This overrap has occurred because ofoverburdening of health workers and community zupervisors. Most of them consider themserves as healtrry and were not wiling to takeMectizan. Briefly describe alr known and verified serious adverse events (sAEs) thatoccurred during the reporting period and provid. 1in iuu. g) the requiredinformation when available. In case the project did not have any cases of serious adverse events (sAE) during thisreporting period, please tick in the box. 20 WHO/APOC, 24 Novemb er 2004 ) t$oo N It) .o E(.) o z !f, c! C, oA i<o B C\ -(n tro .t I s) .9 GI() o bo 6lL €) R\oSCJ €e\ t-{PDi i&6tPtr .\'i =$t-pss ^) L$9-\ '--iH6\'E!c\E =$tr3 s35Fo)el\5 Ost.(a Gt Ct5Eei:6:rE E, .= o' .2E i5 .goq)e-.L2L!tSENIF{qNlatjol :E€IEH I E-El gEXI 6tU-El E63t .gErXYcr -ol =:oo)tr&'t6)Ltr9L5a.octXc) r)1YI9EF!(sD :eq,9tr6E .sEEFGIGI .o()ra .L. =.H9\o !te.i ?l ',EI .EFl F.,t () bo9 S,:F ()N 'r >:- O c') o' q o\ o\ o\ @ oo f.l il =rd q) o Ho^F 6Sd >v -o o c1 o\ o oiOl o. oo o il frl o 'Eo =boO d^O-F-o(l 9o\ oo .CoF cl oor- ca @ F- -o r_o O6 uQots4-Ec50z?o o- .if (n € F- oo $\o o. cf) o^ r- tso6 o.a =E6E H.ST<t6' @(o cY$ \o c\l oo .d$\o c\tr-drf,\o =: IE EEESE H ET N ooo oo$r- o or-r- r- o.t o\do oo il Td oo o Eo^F 6S o oo oo oo o=oo-@6-d-,'ts a L-o llSU 9Ctiq)o oo oo o = oO LO O't, a '- O-6 E 9PE SEET > ovi r-'o\o ca r- \o ca r-o\o- co tso6 o-a3E!;EOE H.3T "t6' F-o\o. F-O rc^ r- \o ra q o@(l q.) tr E oO ood = ,eiie pH _!--sg E.= >'E T E 3 E€E trEoo r-o\o- aa r-o .c^ c.) r-o .o- ca & tl oooN ooC\ c.tooN caOo C.l ifoO(\l oo6l \ooo ot r-oo o.t ooooN o\ooN o oc! ^Please describe how Mectizan@ is ordered and how it gets to the communitiesThe N0TF requests for Mectizan from MDP..+.ft". ur""a*g reaches the country it follows theexisting drug and other medical equipment.delivery .yo",i'ir*ffi;;;:tt.n ,t" drug isstored in MoH warehouse from which projects Ievels r"ceire. From the project level (zoneIevel) the woredas receive it and distribute to the health iacilities and the health facilities to .?ffi#,ll :#r:#Xil,l|; from the community supervisors that the coos eet the drug and Table l0: Mectizan@ Inventory (prease add more rows if necessary) 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by _ Q)l'ease tick the approprtate answer)MOH M wHon UNICETf] Other (please specify): NGDC Mectizan@ delivered by - (please tick the appropriate answer)MOH M wHon UNICETE NGDCOther (please specify) How are the remaining ivermectin tabrets coilected and where are they kept?No tablets remained. List and briefly describe the activities by health care persorulel in the under ivermectin delivery that are being carried outproject area Collection of ivermectin from the Woreda level Distribution of ivermectin to community supervisors/CDDs Training of community supervisors and CDDs Supervision Recording and reporting of data Any other comments Gommunityl serf-monitoring and stakehorders Meeting Zone Number of Mectizan tablets Received Used Lost Wasted RemaininJimma 1,456,500 I,456,500 1,609,735 13,784 419,726 0 TOTAL 1,456,500 1,456,500 1,609,735 13,794 419,726 0 2.9. 22 WHO/APOC, 24 Novemb er 2004 Requested t r 1l ] Has any training (of trainers) for community self-monitoring been done in the project area? No. If so, When? Table I l: 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. As explained above, CSM was implemented in a slightly modified manner by way of training a new cadre of monitors called 'commurity supervisors'. The idea came from the NOTF anJit was implemented effectively in this project area and have proved to be very effective in monitoring the performance of the CDDs at the community ievels. Moreove'r, the NGDOpartner has conducted what is called "ongoing monitoring exercised" in randomly selected 30 communities to validate the treatment activities. Findings were more or less in agreement with reporled figures. Annual program reviews were also conducted involving all stakeholders at zonal,woreda andFLHF levels. Program achievements and weaknesses were identified and future directions outlined. The SHM is conducted at zonal and woreda level. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF ) ZOTF) WOTF ) Health Facility ) Commturity supervisors ) CDDs 2.9.2 what were the main issues identified during supervision? . Delay in utilizing and liquidation of funds. . Delay in Metcizan treatment period. . Lack of proper document handling Was a supervision checklist used? yes DistricV LGA Total # of communitieVvillages in the entire project area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (Slilvt) Seka-Chekorsa StriUe SomUo Dedo Mana 806 362 1,502 806 362 1,502 806 362 I,502 937 937 937 TOTAL 3,607 3,607 3,607 2.9.3. 23 WHO/APOC, l0 February 2004 11 ar what were the outcomes at each rever of CDTI imprementation supervision? Because of the s,pervision projects have prepared to start the Mectizandistribution for 2007 exactry on the time prefJrreo-b, the community anddocument handling has shown some improvement. Was feedback given to the person or groups supervised? yes How was the feedback used to improve the overail performance of theproject? The good geographic and therapeutic achievement of the project showspromising trend. SEGTION 3: Support to GDT! 3.{. Equipment Table 12: Status of equipment (prease add more rows if necessary) xCondition of the WO=Written off). equipment (F:Functional, CNFR=Currently non-functional but repairable, 2.9.4. 2.9.5. 2.9.6. How does the project intend to maintain and replace existing equipment and other materials? The project is currently,in-its third year. Minor repair and maintenance of existing projectequipment is being handled by the zonal healtr, ornce. rrre project doesn,t have the capacity H":",?:iT big capital items like vehicles. The computer and -photocopie, *. ,o, currently Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle 2. Motor S 3 S 4 S 5 S 6. Fax s I J I I I I CNFR F CNFR F CNFR 'r.rullltIgI i) 7. Overhead projector 8. 25" TV set 9. Deiesel Generator I I ll F F --F F r-t- 24 WHO/APOC, t0 February 2004 t -., t. 3'2' Financiar contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years The project did not use APOC fund as it was not available on tirne. If there are problems with rerease of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support R:::oe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure per activity - lndicate in table 14, the amount expended gTng the reporting period for each activityIisted' write theamount expendedin US dollars using the current United Nationsexchange rate to local currency. rndictate exchan!".o:t"'ur"o here g.65 Contributor Year I Year 2 ('provide rte Year 3 ('provide the TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) I TOTAII castr Budgeted (us$) TOTAL Cash Released _{us$)MOH (Central + State) 15,823 14,943 MOH (District + zone) 37,096 35,823 27,435 27,435Local NGDO(s) ( if any) 0 0 0 0 0 0NGDO partner(s) 73,290 73,290 54,387 21,471 3 r,486 3 I,486Communities 0 0 0 0APOC Trust Fund 56,090*+ 30.000 56,949 30,000 36,97t 20,000TOTAL 353,979 325,736 I I I"336 sl,47l 95,992 78,921 25 WHO/APOC, l0 February 2004 Table 14: Indicate 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. 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) No. Year 1 Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF ffQ area to central collection point of commUryly Mobilization and health education of communities Tfei,ti,t_g-of CDDs tlai$gg of health staff at all levels I Supervising CDDs and distributiont------" [f4ternal monitoring of CDTI activities 2,406.34 !,_M 13,402.57 7,035 7,507.27 4,845.95 12,096 &?!e_,1"? APOC MOH APoc a Carier e.nt.i MOH APOC & Carter Center APOC & Carter Center MOH Carter Center _44yo.+p_yvisits.tobqdthaL4po.t_r1i_cela_rl_ttr_orities IEC materials S umm ary GSp ortilg)_& * I _fgt treatment V ehi c lf s/ M o torc y_c I es/ b i cy-c I es m 4ille4eqq 9 Q{! c9 _pqulp.m_elt ( e. g c o mpu,ters, pri nters_ et g ) Others 1,871.6 4,553 isr 1,469.47 3,285.99 t,o4i.oi APOC Carter Center aarGr Cert;- APOC APOC Carter Center TOTAL 78,921.00 Total number of peflons treated 26 WHO/APOC, l0 February 2004 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? FIECU ' r l| i lill'? i /rl)OC4.2. Sustainability of projects: plan and set targets atYr 3) Was the project evaluated during the reporting Was a sustainability plan written? N 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. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport (replacement and maintenance) 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 GDTI into the PHC structure and the plans for completeintegration: 4.3.1. Ivermectin deliverymechanisms Since the beginning there is no separate Ivermectin delivery system to thelower level; it follows the existin* l** delivery system in the tountry. Therequest for Ivermectin is to MDP is through Moli. As soon as the drug arrived,the same as all other drugs and medical equipments, all the processes requiredare handled by a Pharmaceuticals Adminlstiation and Supily Service in theMoH' The project levels, like any other medicines, receive and deliver to therespective revers foilowing the existing delivery system.4.3.2. Training: CDTI is integrated with the Primary Health Care (PHC) from the beginning. Atthe National, Regional, zonar, and woreda levels, the Mararia and othervector-borne Diseases Prevention and control Units ; -r*"nsible.Therefore, all the staff of these units has received training on onchoce.iiasis. 4'3.3. Joint supervision and monitoring with other programs As part of the system in the countrry,most of the supirvision and monitoringactivities are carried out in integrated manner with other programs. ,,1 WHO/APOC, l0 February 2004 P'o,.'6. 4.3.4 Release of funds for project activities This year APOC and The Carter Center have released the 2006 flrnd on time and there was no shortage of money for the CDTI activities. 4.3.5. Is CDTI included in the pHC budgetz Yes, as part of PHC, CDTI is one of the priority activities. 4-3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? None 4.3.7. Describe others issues considered in the integration of CDTI. The structure called "garee" (village) which has got a health committee and the Health extension Package program designed to reach all Kebeles with health posts is found important for integration and sustainability. 4.4. Clperational 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 feriod.NONE How were the results applied in the project? sEGTloN 5: strengths, weaknessesn challenges, and opportunities - List the strengths and weaknesses of GDTI implementation process. - List the challenges and indicate how they were addressed. Strengths: The project has accomplished the distribution in short period of time with 100% geographical coverage and therapeutic coverage high above the minimum standard. This is due to the awareness and active involvement of health workers and the community at large. Weaknesses: delay in starting Mectizan distribution, delay in getting report from the lower level, poor financial utilization and liquidation. Opportunities: The goverunent structure down to village level "garee,, and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of onchocerciasis control. The Health Extension Package program in which the building of health post going on to each and every Kebele is also another good opportunity. Threats (Challenges): Sortage and overburdening of health workers in peripheral healthfacilities in different health programs such as malaria epidemic control, ppt *a measles campaigns. 4.4.2. SECTION 6: None Unique features of the proiecuother matters 28 WHO/APOC, 10 February 2004