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

NOTF ETHIOPIA The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 Ianuarv for March TCC meeting To APOC Management by 31 Iulv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) 6*e o9 Fcr Ac -'! To: eo? For l.,l:r;::.cn : c5b 't1z B[b fo COLINTRY/: ETHIOPIA NOTF ETHIOPIA NOTF Approval year: 2001 Reportine Period (Month/Year): January 20OO December 2006 Project vear of this report: (circle) | 2 3 @ s tolttz Date submitted t 15 /OZ/ 2OO7 ( 0 I FEV, ?009 APOC / DIR I I Or rt.B-l6t- I II I I I ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Eth National Coordinator Name: ...........Gp..1c...Ej.e.qa... Date NOTF Chair N ame, lD..r..Daddi..J.im.a Date: . This report has been prepared by Nam Gole..Eic.ta Des ignatio n : ........ . ...N.af ip.na.[.Qp..q.r.di.na.qa,r Signature: ........... Date... I WHO/APOC, December 15,2004 t TABLE OF CONTENTS 1.1. GrNrnel NFoRMATIoN..... 1.2. PopuranoN AND Hsalrn sysrEM.... SECTION 2: SUMMARY OF CDTI IMPLEMENTATION........................... Z.l. DrsrrunurroNPERroD 7.2. Aovocacv aNo STNSITIZATIoN 2.3. INroRuauoN, EoucAttoN AND coMMUNICATIoN STRATEGY AND MATERI.ALS DEVELOPMENT 2.4. Cour'tuNITrES' TNVoLVEMENT IN DECtstoN-MAKtNG 7.5. Capecrry BUTLDTNG V V a 1 1 3 5 5 5 6 6 7 7.6. ORormNG, sroRAGE AND DELtvERy oF tvERMECTiN 7.7. Tnr,arurNrs... 7.8. SuprnvrsroN... 2.9. CoutuuNlTy sELF-MoNIToRING AND SrerruoLDERS MEErtNc 11 1,3 t9 Z7 33 SECTION 3: OTHER ACTTVITIES OF THE NOTF.... ....24 SECTION 4: SUPPORT TO CDTI ....26 4.1. FmaNcrer coNTRIBUTtoNS oF THE pARTNERS ,,,....76 .......764.7. OrHsR FoRMS oF coMMUNiry suppoRT 4.3. RpsouncEMoBrLrzATIoN EFFoRTS Z7 4.4. ExpeNnmuRE PER ACTIVITY BY THE NOTF SECRETARIAT........... .........77 ?o .,....... L,4.5. Eeutpt'lENr SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDENT MONITORING AND OTHER REVTEWS....................... 3 1 5 .l . INoppENoENT pARTrcrpAToRy MoNrroRtNc/Evel-uATtoN ...................... 3 1 5 .2. SusraNaerlrry oF pRoJECTS: prAN AND sET TARGETS (ueNoeroRy AT YR 3) 33 5.3. INrpcRarroN ......... 5.4 OpsnnrroNAl RESEARCH SECTION 6: STRENGTHS, WEAKNESSES, CIIALLENGES AND OPPORTLrNITIES.......... .................. 35 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community8ased Organization CDD Community-Directed Disributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self.Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting Technical Consultative Committee (ApOC scientific TCC advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal \7HO \Uorld Health Organization ) ll WHO/APOC, December 15, 2005 Definitions I (i) Total population: the total population living in meso/hyper'endemic communities within the project area (based on REMO and census taking). (iil Eligible population: calculated as 84o/o of the total population in mesor/hyper-endemic communities in the project area. (iii; Annual Treatment Objective' (ATO), the estimated number of persons living in meso,/hyperendemic areas that a CDTI project intends to treat with ivermectin in a given year. (rr) Ultimate Treatment Goa[ (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 of the project). (") Therapeutic coverage: number of people treated in a given year ovef 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, The bringing together of rwo or more health programs, removing barriers betrveen/among them, in order to maximise cost- effectiveness and permit free and equal association. For example 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) Sustainability: 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 selice, a lll WHO/APOC, December 15, 2005 with smong community ownership, using resources mobilised by the community and the government. ) lv WHO/APOC, December 15, 2005 FOLLOWUP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session _24_ No recomm endation was madc to NOTF ilntng this session bJ TCC24 Executive Summary Prepare an Executive summary of the report in not more than one page. t. Summary of treatment and population data comparing projects, trends in ffeatment over time i.e.. Total number of communities, communities' treated, total population, UTG, ATO and persons treated. Ethiopia has got nine C[)TI projects; namely Kaffa-Sheka, Bench-Maji, North Gondar, Illubabor, Jimma, .West'S7o11ega, East'Wollega, Metekel and Gambella. The first project is at 6'1' year of implementation, where as the next two are at 4s year and the last six are in their 3'd year of implementation. Otrt of 20,625 communities in all the projcct areas, a total o{ 20,625 communities werc trcatcd making an overall gcographic coverage of 100%. In 2006 ffeatment period a total of 3,661,278 peoplc arc trcated making a therapeutic coveragc of 690/o. Each of the projects has achieved a good geographical as wcll as thcrapeutic covcrage scparately. All the projects were trcated during this treatment pcriod havc achieved a geographic covcrage of 100% and a therapeutic coverage abovc 650/o. Z. Summary of rraining data of projects (nationally) for, - Project Officer (training of trainers and/or other specific training), total number of CDDs and health workers rrained, total population per active CDD trained. Training of traincrs was givcn to a total of 7781 hcalth professionals and those who were trained as traincrs in rurn gavc training for a total of 38,786 CDDs. 3. Extent of integration of CDTI projects into the health system. WHO/APOC, December 15, 2005 CDTI is integrated with the Primary Health Care (PHC) from the beginning. At the National, Regional, Zonal, and Woreda levels, the }rdalaria and Other Vector-borne Diseases Prevention and Control Units are tesponsible. Therefore, all the staffs of these units have received training on Onchocerciasis. Training of peripheral health workers has been carried out in integrated manner with other health issues. Ivermectin delivery starting from the higher to the lower level is also integrated into the routine drug delivery system in the country. As part of the system in the country, most of the supervision and monitoring activities are carried out in integrated manner with other programs. The CDDs are involved in other health activities such as malaria prevention promotion in collaboration of health extension workers. Generally the CDTI activities are given priorities as part of PHC. 4. Strengths and weaknesses of the national onchocerciasis control program; challenges and how they were overcome; and opportunities that will strengthen the program. The most important strength of the CDTI projects is their abiliry to accomplish the ivermectin distribution with high geographical and therapeutic coverage. This is due to high political commitment at all level, integration of the activities to the existing health system and awareness and activc involvcment of health workers and the community at largc. Incomplere utilization and bcing slow in liquidation of APOC trust fund is one of the wcakness of the projccts. In addition to that delay in submission of both technical and financial reports is a weakness. To overcome such problcms, thc projcct levels wcre given on job trainings and advices during supportive supcrvision. The good opportunity for thc CDTI activities to be sffengthencd is the expansion of governmcnt health sffucturc down to village level and bcing taking thc rcsponsibility of de..,elopment activitics as well as health care. Through thc Health Scrvice Extension Program in which therc is a start of building a hcalth post in cach and cvery Kebele is also anothcr impressivc oppornrnity. 5. Key activities undertaken by the NOTF during this reporting period Launching workshop for ncw C[)TI projects Training of trainers at projcct levcls for new CDTI projects Carry out National Annual Rcview Mecting YI WHO/APOC, December 15, 2005 Make supportive supervision to the CDTI projects Conduct Ongoing Monitoring CDTI activities Conduct regular NOTF meetings Assist project levels in report writing and report keeping. 6. Progress on vector elimination activities (where applicable) Not applicable. vll WHO/APOC, December 15, 2005 SECTION 1: Baclground information 1.1. General information 1.1.1. Description of the country program -CDTI and vector elimination (briefly) Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, and infrastrucflrre (.g. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structure. Health system & health care delivery (state any problems related to health system that impede program implementation). Provide map locating all projects (CDTI and Vector Control, if any) within countr1/. The land area of Ethiopia is estimated at about 1.1 million square kilometers and the total population at that time was approximately 70 miilion, of which more than 85 percent live in rural areas. Ethiopia is a Federal Democratic Republic composed of 9 National Regional Statest Tigray, Afar, Amhara, Oromia, Somalia, Benshangul-Gumuz, Southern Nations, Nationalitics and Peoples Region (SNNPR), Gambella and Harari, and trvo Administrarive states (Addis Ababa city administration and Dire Dawa council). Thc rcgions and the city administrative colrncils arc furthet dividcd into zoncs then worcdas and kebelcs. An estimated 60 to 80 percent of hcalth problems are due to infectious and communicablc discases and nutritional problcms. The hcalth care system was trnderdeveloped and only ablc to provide basic service to about 670/o of the popularion. Much of the rural population has limited access to primary health care, that lead to the inability of the health care delivery systems to respond both quantitatively and qualitatively to thc hcalth nccds of the peoplc. The health policy of thc Fcderal f)cmocratic Republic of Ethiopia was dcvclopcd bascd on tl-re critical examination of the nature, magnifudc and roor causcs of the prevailing health problems of thc country and it is deccnmalizcd and integrated. Since 1990, thc governmcnt dcsigned a twenty.year Hcalth Sector Development plan to realize its health devclopmcnt objcctivc with five-year rolling invcstmcnt programs. Ethiopia has bccn implemcnting nine (9) CDTI projects since the timc of inception in 2000; namely KaffaSheka, BencLr'Maji, North Gondar, I WHO/APOC, December 15,2004 Illubabor, Jimma, '$7est Wollega, East'!ilollega, Metekel and Gambella' The projects are now found at different year of implementation. KaffaSheka project is at 6'l' year of implementation, where as BenchMaji, North Gondar are at 4'l' year and Illubabor, Jimma, 'West'Wollega, East'\il7ollega, Metekel and Gambella are in their 3'd year of implementation. The nine project areas cover a total o{ 20,625 communitiesAillages. A11 of these communities were treated during the 2006 treatment period making an overall geographic coverage of 100%. In 2006 treatment period a total of 3, 661,2?8 people are treated making a therapeutic coverage of 69'/o. Each of the projects has achieved a good geographical as well as therapeutic coverage separately. All the projects have achieved a geographic coverage of 100% and a therapeutic coverage above 650/o. Mrp 1r Dismibution of Onchocerciasis with CDTI Project Areas, Ethiopia,2004 2 l. Borth Gondrr COTI 2. ilctckcl C0Tl 3.WGrtWoleg! cDTl { Eirl Wblleg. CDTI 6. ilubrbor C-OTI 6. G.mball. CDTI 7, X.f.-Shck. COTI i. Jlmmr CDTI t, Bcnch-iut coTl LEGEIID L,1,2. Partnership WHO/APOC, December 15, 2004 W m Co t) + (! ti # Indicate the partners involved in project implementation at all levels (MOH, NGDOs -national, international) Describe overall working relationship among partners, clearly indicating specific areas of project activities where all partners are involved (planning, supervision, advocacy, resources mobilization, endemicity rnapping / assessment, development of IEC materials, srudies or surveys etc). State plans if any to solve any issues arising as regards CDTI implementation. As a principle of APOC as well as the government of Ethiopia, the CDTI activities are carried out with a partnership of different actors such as Ministry of Health, universities, research organizations, regional health t'rureaus and NGDOs at national level. The partnership extends from the project levels to community. The partnership is strong during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The main partners involved are Federal ministry of health, regional health bureaus, zone health desk, 'lToreda health office, health facilities, the community, the carter center, \flHO, Light for the world and other government sectors. This string partnership help CDTI projects for best achievement of their activities and gradually ensures their sustainability. 1,2. Population and Health system Table 1, Projects and population at risk in the entire country, whether they are treated or not during the reporting period. (Plc,ase ad.d more rows if necessary) J Name of CDTI Project Total communities in meso/hyper. endemic zone Total population in meso/hyper- endemic zotte LJltimate Treatment Goal (UTG) by 2010 KaffaSheka j,277 1,012,611 978,426 Bench-Maji 1,053 555,293 493,947 North Gondar 914 z4g,j45 235,046 Illubabor j,503 624,553 673,7 j4 Jimma j,607 800,927 7 45,969 'S7. \Tollega 4,034 927,957 88l,jiz E. \7o11ega j,679 6i6511 7 42,914 Metckel 2,89 118421 1L9,894 Gambella 403 85765 100,536 WHO/APOC, December 15, 2004 TOTAL 20,758 3,992,772 4,971,798 Source: From Oncho Project rePorts: National census: Other source, specifu year of sources 2006 UTG: Calculated as the maximum numbet 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 of the project). 4 X WHO/APOC, December 15, 2004 SECTION 2: Summary of CDTI Implementation 2,1. Distribution period Chart the actual dismibution period for each CDTI Project in the country in the table below. Table 2, Overview of distribution undertaken by project (insert rows as needed) Briefly note any problems/issues (one paragraph). 2.2. Advocacy and Sensitization a) State the number and type of policy / decision makers mobilized at the narional and lower (state and district level) during the current year; the reasons for the sensitization and outcome. lr4obilization of decision makers was done before the start of the CDTI especially for those projects that has started distribution in 2004 for national as well as project levels. The members of the Task Forces at all level were officials from all sectors, which have relevance for the CDTI activiry. This political commitment helped the CDTI activities to be successfuliy achieved its objective. b) State progress made towards intemal resource mobilization 5 Project Name Distribution Period J".t Feb Ma r Apt Ma v Jr.r.t J"1 Au dtt S"p Oct No v Dec Kaffa-Sheka Bench-Maji North Gondar Illubabor Jimma \7. \Tollega E. \Uo[[ega Metekel Gambella WHO/APOC, December 15,2004 The CDTI activity is included in the twenty year health sector development program. The CDTI activities are carried out in an integrated manner. Most of the resources are shared for health activities. Therefore, resources mobilized through different health programs also are used for CDTI activities. The NOTF was able to mobilize CDTI spccific resource from WHO, Light for the'World and The Carter Center- c) Describe any policy.related consffaints being faced by any particular project and describe what was done to assist the project (outcome). Explain any plans on how to improve advocacy. The government has adopted a new financial system in which all the donations are put into a common basket. In addition to that different sectors financial resolrrces are managed by singlc finance administration offices by few accountants. This to some extent created sort of delay of APOC impresses accollnt management. To solve this problem the APOC financial officer has assistcd the projects and refresher trainings. 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the country for CDTI. The IEC sffategy being used for CDTI is similar to the strategy for other major communicablc health problems. Thc major stratcgics arc usc of mcdia (mainly radio), wriftcn materials (posters, information brochurcs) dircct communication during meetings, health facility visit, traditional public gatherings, at school ctc. The projects are using the standard IEC materials and no new IEC materials produced. Thc IEC matcrials arc produced at the projcct levcls through the IEC offices and distributed to lower levels. Community mobilization was done at each village organizing community meetings. The health workcrs at all levcls havc donc their best in organizing the Task Forces and giving health cducation for the task forccs. Thc health workers working at front line health faciliry lcvel arc rcsponsible to organize the Kebele Task forccs and giving health education for the task forccs, and CDDs. Frontline hcalth workers and Cl)Ds are responsible in giving health cducation to thc community at villagc lcvcl. Thc community mobilization has conffibuted a lot in awarcness crcation and as a result the community involved in thc CDTI activity with succcssful accomplishment. 2.4, Communities' involvement in decision'making Comment on community participation making comparisons among projects 6 WHO/APOC, December 15, 2004 The lower government structures especiafly the kebele leaders being members of onchocerciasis task force, are responsible for all social, political and economical activities in the Kebeles, and have played major role in mobilization and sensitization of the whole community. Civil associations such as female, youth etc are the active participants. 2.5. Capacity building Training of national, district [eve[ staffs in CDTI and general management skills (computer applications, project planning, etc.) Briefly describe any training done by the NOTF for specific CDTI or Vector Control Projects (Objectives, participants, outcomes, any follow.up needed). Training of rrainers was given to a total of l l6project coordinators and decision makers for the six newly launchcd CDTI projects in 7004 at the national level. The main objectivc of this training was to enable the projcct coordinators to conduct cascadcs of trainings to CDDs levels so that the CDTI activity would be carricd out. Table 3' Typ" of training undertaken at national level by the GTNO/NOTF (Tick theboxes where specific uaining was camied out duing tlle reporting peiod) Type of training Project staff MOH staff Opinion Leaders Others(speci fu) Ncoo Program management x x x x How to conduct Health education x x x x Management of SAEs x x x x CSM x x x x SHM x x x x Data collection x x x x Data analysis x x x x Report writing x x x x Others (specifir) 7 WHO/APOC, December 15, 2004 Briefly describe any technical assistance provided to the CDTI projects. 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C)\ir .E tro =U)ol c!9l E| 'ifxl .: rul !C)l -:I E ul rtrt 5 ."'al(J6.)l 'rbi .:jl E =l o)>l Eit F :El b L;t vr Et st-l \alo 51 3ul t\!l ol : t-rl vol l.4l RLI ? :IF 2t= G! o rF cd C)! cg +J(J o '5 H A. c) J-rP H t-J B U) .9 .: li t tr o(J .9 E(.) .(, tq) PI B =l Bxl -cd>C)l 9UI V) EI H!l HLJI _9I .E oL bo al .E HI .E \!lol tr -l O(Jt jJ -ol cs El =5l a.zl& c!l.J oilF t 9J C) E(J6 cF) s oP6tr C) bo l-r(.r a .)o\6- oF o}J cdlr Obodlrgr o(J 6U a.x cd i/ bo (.) c c)P dl.i 0) bo cdti -0) o o !^ c) o\ c!F C)d.F 0,)b/ c!lr q,) o(J cdU I a CTF bJ oo ur E E Cd o +J oI troI! bJ a L)n 0 E oU ti € c! / lr o IJ. - If the projects are not achieving 100o/o geographical coverage and minimum of 650/o therapeutic coverage rate or if coverage rate is fluctuating, state reasons and plans being made to remedy this. The geographic coverage of all CDTI projects was 100%. This is so because the projects did reach at their fult UTG coverage. The therapeutic coverage of all CDTI was above 650/o. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF dealing with them? Absenteeism and refusal is atrributed to low awareness of the communities to wards the treatment. This issue was especially pronounced in township areas where the community feels they are not sick. To solve this problem we have discussed with the project levels and planned to exempt big towns from the drug distribution through CDDs and instead passive ffeatment cases at health faciliry level will be used preceded with intensive mobilization. In some of the projects absenteeism was also due to overlap of farming season with actual distribution time, and will be minimized by appropriately targeting the community preferred distribution time. 2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. Not applicable 2,7.4.In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report x Table 7, Cases of Serious Adverse Events (SAEs) that occurred during the reporting period (Plnase add more rows if necessary) Name of project Number of verified* SAE cases reported Action taken Number of cases with sequelea Number of deaths Kaffa-Sheka 0 0 0 Benclr-Maji 0 0 0 North Gondar 0 0 0 Illubabor 0 0 0 t7 WHO/APOC, December 15,2004 Jimma 0 0 0 !7. !7o11ega 0 0 0 E. \7o11ega 0 0 0 Metekel 0 0 0 Gambella 0 0 0 * SAEs slwullbe venfiedby project coordinator Sequelea is defined as those cases that have not recovered fully {rom the SAE and are le{t with lasting neurological or other debilitating effects, 2,7,5. A summary o{ the trend of treatment achievement per project from inception of first CDTI project to the current year What is the ultimate ffeatment goal for the entire countryl 5,000.000 Table 8, Treatments and coverage's by calendar year for the entire projects areas. (Please fill in the required data for the country as a whole - combine data {rom aII CDTI projects into a national figure) YEAR Total # ol comm./ villages in the meso,/hyper' endemic areas Er Geographic al coverage e/.) Ef Et/ El*1oo Total population ol the meso,/h1per- endemic areas E6 Annual Treatment Objective E7 Therape utic coverage (olr) Es= Er/ E6*1oo UTG Coverage e/,) 2007 3,277 15 902,687 306,297 26 31 2002 3,277 64 928,691 654,750 56 66 2003 5,744 81 1,563,635 1, 290,247 66 78 7004 20,368 80 4,985,887 3, 270,035 60 7r 7005 20699 60 5083049 4269761 68 2006 ZO,625 100 5,290366 4443907 69 2007 2008 2009 2010 l8 WHO/APOC, December 15, 2004 2,8. Supervision 2.8.1 Note the supervision that was undertaken by the NOTF (Proiect supervised, date, by whom, objective of superwision mission, outcome, follow,up needed) Table 9, Supervision undertaken by the NOTF (Please ad.d more rows if necessary) l9 WHO/APOC, December 15,2004 too cl -i k o) -o () oo a U o Or o N t C) (,) o H P. Jt o € 0) E oo!Fl o atr \J \.Jr'EEo;s a I T*: Xo.Y q = UPLi arli)r-. T E $E iH:-b.sE * E € ?€IEE 5tsrodo3:EG Th€E.;.8'l-i d) tl bD =O.E E E U - xn ,r v) trE 8,8€ 6 o; $.3 a*i) +r L) d)d.i=;}Ht-rltrcd i. 0.) u) Q)+UP(J E_d')iJIJ .Ed- !r()cnF!o.r.t - 9.9l+ J-r ) >\ t-r * 0.)l-.] a! tI bO r) K cd dV .- l-i li oE PP/u- * LF,-r UoU t U V)t C) A. U)\+r o q) .a!(.) o -oC bo/H .E L) li -dAfl; -E FqJ l+ # .t :, >ht -(l.) 7 t<ox t R E']J()U c6= C A -tr .,: f:. > G c€e(Jtl .5^^d 9 6tL1 d = ia[j.9Lrl-='i9iJ u CE c!H'S.gr= =.s.-^-F--!lrH(J:;i H f 8 E E q) +-) cd a \ooO c-] -oc) IJ. \ooO c-..1 z- \ooo!(-.t A\O!.?roX daL-.,1 6g t^.l RZ* 9Po bd ES \o .a !1O \OHR : lJ (J 'nO. Orc XsqEi \oo ..oS ^-+f O AvEV- ,ac)A lr o U) t() A. U) - --. (t.l t-v)t -Cocdd '-i -F6st e j > -(Jc! 0)tr-iYH-lU =,> F v_\ (--.Itrv F{=C ii *rUc(c!d .;iF oTn,J45J:0)(Jd-ir x2A?-vlJ() !LH)o># vA. ). Iilo)cqi FO or* +J q/ *>t-v 0) .: !) 2F .ricd -vF .-r-r =c9 LU+ V t)AJi: ! a.r F OA 0., * u)!U'-cs<rca\ ,< n-tti F .<i .!v -z?a F-{ (...l cCt-v * =2f;H*vt)cd c! d4ta)vEr'rtr< ._F OA I0,,* @ € E>HAt-v<,C) Ltsc>#> - cnYd -d !.catrac!acd3-v3O'o) O <-r<4ZA A\)cn .r-.ir slE 'U cn u<F< ilt+. ---zzz P8e 9cd&z .Vo a CN \+i cd 5Z A o o ca t{ .cd{-o tr trooZC ti op cd -.o F tr d bo c) o a $oo o^l ra, L(.)p () oo o Ci ogr o F! N .d .oOOooN c..I >z \oOc.lOO .-{ ^,HrA!vo,'d oo doA cn (^.l \dP R=!>o, =c) =,a od 16 -Hr1. aHU)(€ccd3_vJ()'o.r O U) u. U) r s2EE EE<F< rjilil -<-zzz C.)d E.g -V bouo,\<r U2a< -ilcd(.) liL) G.)cg -,F< +. trzz tr (! li -o E Ei +r z LU boO o ET C)J C) +J a) A c) -o Ed o 2.8.1, What were the main issues identified during superwision? One of the issues identified during the supervision period was delay in udlizing and liquidation of funds in almost all CDTI projects. Delay in reporting of CDTI activities especially at Woreda and front line health facility levels was also observed in some CDTI projccts. 2,8.2. Was a standard supervision checklist usedl YES 2.8,3. What were the outcomes at each level of CDTI implementation supervised? The CDTI projects were able to finalize the treatment of the ycar with good geographical and therapeutic coverage. To solvc the financial liquidation problems, on job training was given to the accountants during supcrvision. The overall reporting of the CDTI activities was also corrected as much as possible. 2.8.4. Was feed,back given to the supervised, and how was the feedback used in improving the overall performance of the project? Feedback is given immediately after the supervision and all the concerned levcls were informed. This feedback helped in the projects to achicve good coverage. 2.9, Community self-monitoring and Stakeholders Meeting Table 10: Community self.monitoring and Stakeholders Meeting (Plcase add more rows if necessary) Project Name Total # of districts in the entire project area No. and o/o of districts that carried out self monitoring (CSM) No. and o/o of districts that conducted stakeholders meeting (SHM) Kaffa8heka BenclvMaji North Gondar Illubabor Jimma 'W. \7olle_ga E,'lUollega Metekel Gambella t3 8 -) 6 4 9 8 4 4 T3 8 3 6 4 9 8 4 4 t3 8 3 6 4 9 8 4 4 TOTAL 59 59 59 22 WHO/APOC, December 15,2004 Describe how the results of the community se[f- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cYcle. Since the community owned the program, all activities of CDTI are facilitated by community. They planned according their convenient time to and effectively cxecute CDTI acr ivies. During Stake holder meeting they decide how to under take drtrg distibution in effective and efficient manner. 2.10 Compliance to long,term treatment with Ivermectin Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projects comply with longterm mass treatment with ivermectin! (Fot projects 4 and above years old) Table 11, Activities that promote compliance to long'term ffeatment with ivermectin Objective Specific Activities Project targeted 1. Promote Integration of CDTI with other health care servlces -Since the beginning, the CDTI activities are integrated in the existing health system, -Allocation more fund for CDTI activities All projects 2. Maintain high therapeutic (> 650/o) and geo graph ic (100o/o) coverage -Continuous refresher trainings to FLH\U, and the CDDs -Strengthen community ownershiP -Advocacy and sensitization of the decision makers A11 projects 3. Promote strong community ownership -Allow and facilitate for the community to make decision -lnvolve the community in planning, M&E All projects 4. Promote high government commitment -Conduct continuous advocacy and sensitization meetings All projects 5. Support strong partnership -Advocate for partnership, involve all parties, work in close collaboration A11 projects 6. Put in place a strong IEC strategy that encourages continued ffeatment -Messages through different medias - Advocacy and sensitization meetings -Use different formal and informal community gatherings to transfer information A1l projects Other 23 WHO/APOC, December 15, 2004 SECTION 3r Other activities of the NOTF 3.1 Describe any additiona[ activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). None in 2006 3.?, What was done to coordinate CDTI Project activities? Supportive supervision to the projects were done, identifii problems and give fcedback. Conduct annual rcvic',r, mecting to sharc expcriences among diffcrent CDTI projccts and review the achicvements, identifu problems and their solutions, challenges and opportunities. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow,up needed) The NOTF mectings had becn taking place every quartcr. Howevcr, during this treatment period the NOTF met only three timcs (|an 2006 Nov 2006 Fcb2006) due to unforeseen problems. Thc main objective of the meetings where to, assess the progress of the CDTI activities, identifi, any bottlenecks as carly as possible and propose possible solution. The outcomes of tl-re mectings arc applied at thc projcct levels. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. In addition to Onchocerciasis malaria control is thc responsibiliry of thc team in the ministry of health and down to thc 'Woreda lcvels. 3,5 Briefly state any administrative duties undertaken Number and rype of reports reviewed (technical, financial), Reports forwarded to APOC management, Administrative assistance or rrouble shooting for projects Thc NOTF have reviewcd a total of 9 technical and 14 financial rcporrs and submitted all thc tcchnical and 10 financial reports to APOC managemcnt. Thc projccts wcre receiving different administrative and tcchnical supports especially during sttpervisory visits. 3.6 Insert the Plan of Action for the NOTF activities for the current year indicating activities by month, which were implemented. 24 WHO/APOC, December 15, 2004 3.7 Insert the Plan of Action for next year. Sent to APOC Management 25 WHO/APOC, December 15, 2004 SECTION 4: Support to CDTI 4.1. Financial contributions of the partners Table 12, Summary of financial conmibudons by all partners to all CDTI Projects for the year under reporting Note: figures should include contributions in kind such as salaries paid by the MOH, etc. If there are problems with release of counterpart funds, how were they addressed? No problem State the number of projects that had no funding from APOC Trust Fund? None State the number of projects that had no funding from any outside source? None State the number of projects that are late in submission of the financial reports to APOCI 9 4,2. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The community has contributed towards the CDTI in different ways in most of the CDTI projects. Some of them are involvement in mobilization, ffaining, 26 WHO/APOC, December 15,2004 Name of project Contribution (money or items in kind released) Ministry of Health NGDO Partner Local CBO/ communities District Others KaffaSheka 41000 31037 0 0 0 Benclr-Maji DNA 14937 0 50,000 0 North Gondar 14,000 2153 0 0 0 Illubabor 27040 t6393 0 0 0 Jimma 27435 31486 0 W. \Tollega t3,983 50,000 40,47 5 0 E. \flollega 17,000 69920.50 100,000 30,678 0 Metekel 1100 10068 560 3700 0 Gambella t3,983 0 95,000 33,470 0 Total rs554t t75994. 5 235560 t58323 0 CDD selection, farm work for the CDDs, supervision of CDDs. In few CDTI projects the community has also conffibuted money as an incentive for the CDDs. 4.3. Resource mobilization efforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. The NOTF has tried to mobilize financial conffibution from donors and succeeded to get from \7HO country office. It has also got NGDO called Light for the 'World as member of NOTF and an NGDO partner for East and'S7est '!7o11ega CDTI projects starting from 7005 ffeatment period. 4,4. Expenditure per activity by the NOTF secretariat . Indicate the expendirure on activities below in US dollars using the current United Nations exchange rate to local currency Table 13: Indicate how much the NOTF secretariat project spent for each actMty listed below during the reporting period Activity of. NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH II I I NGDO OTHER Drug delivery from NOTF HQ/entry point to projects, districts, etc** Monitoring and supervision of CPTI Proje_cts Training of Project officers, TOT, NOTF staff, etc. Advocacy visits to health and political authorities at national level IEC KAP studies, materials development Annual review workshops Bi annual NOTF Fuel and maintenance of Vehicles Maintenance of office equipment Statlonery Others 3000 I 670 5000 2,000 2,000 500 3,496 2000 6800 67 50 1200 500 120 100 500 27 WHO/APOC, December 15, 2004 TOTAL 10,000 18140 6,496 34,636 Tota[ number of persons treated 3661287 ** The project level carries out these activities in an integrated manner. 28 WHO/APOC, December 15, 2004 4.5. Equipment Table 14r Starus of equipment of NOTF Secretariat Project (Please ad.d more rows if necessary) *Condition of the equipment (Functional, Currently non-functional but repairable, Written ofO. ALL the equipmenu mentioned aboqte none e functional at tfiat time. " "-[h.e CDTI actiuities are higliy integrated into tlle otlwr lwalth system and tlwrefore t|rc availnbb equipments at tlr.. MOH dt different lauek is used in an integrated manner. How does the project intend to maintain and replace existing equipment and other materials? The NOTF as well as the projects are expected to maintain moat of the equipments from the government in an integrated manner. However, few types of cquipmcnt will bc cxpcctcd to be replaced cspecially for CDTI projects by APOC aftcr first five years while at the same time cfforts will continuc to allocate budget by the govcrnmcnt for smooth takeover of thc project gradually. The capital equipments thar are contributions of thc government will bc maintaincd using thc government moncy. . Describe the adequacy of available knowledgeable manpower at all levels. Typ. of Equipment APO C MOH Other donors NGDO Private 1. Vehicle Toyota Land Cruiser 4\7 1 1 0 1 0 2. Desk top computer 4 1 0 1 0 3. Printers 3 1 0 1 0 4. Photocopier 1 t 0 1 0 5. Fax machine 1 0 0 1 0 6. LCD projector 1 t 0 1 0 7. Overhead projector 1 0 0 1 0 8. Slide projector 1 0 0 1 0 9. TV, VCR & stand 1 0 0 1 0 10. Scanner 1 0 0 1 0 11. Digital camera 1 0 0 1 0 12. Video Camera I 0 0 1 0 29 WHO/APOC, December 15, 2004 - Where frequent ffansfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is wh.at measwres were taken to ensure adequate CDTI impltmentation wh,ere not enough knowledgeablc. manpower was aq,tailable or saff often uansfened dunng tlle course of the campaign). At the NOTF secretariat level their adequate trained and knowledgeable human power. The turnover or the ffansfer of trained personnel is infrequent. As a matter of fact all staff of the Malaria conmol programs in MOH have got enough knowledge regarding CDTI at all levels. Trainings were given in a cascade manner from the higher level to the community level in adequate amount to the appropriate personnel. At Woreda and health facility levels, there were a few situations where there was turn over of trained staff which however, did not create any major problem on the project activity. 30 WHO/APOC, December 15, 2004 SECTION 5: Evaluation for sustainability of CDT[, Independent monitoring and other reviews 5.1. Independent participatory monitoring/evaluation 5.1.1 was any independent Participatory monitoring and/or evaluation carried out during the reporting period?NO Table 15t Overview of when monitoring and evaluation undertaken (Plcase add more rows if necessary) 5.1.2 In general, what were the recommendations? The general recommendation made during the mittrterm sustainability evah.ration at its third year of implementation of Kaffa- Sheka was that the project is making satisfactory progless towards sustainability with improvement on some of the key sustainability indicators. The preliminary findings of the ongoing internal monitoring by the NOTF also indicates that the projects marked "X" were carrying out the CDTI activities with high therapeutic and geographic coverage, and comrnunity involvement. Project Name (After Year 1) participator v independen t monitoring Mid-term sustainabilit y evaluation (3'd year) Indepen dent monitori ng after 4'h year Evaluatio n for sustainab ility (56 year if necessary ) lnternal monitori ng by NOTF Other evaluati on by partner s KaffaSheka X x X X Bench-Maji X X x North Gondar X X X Illubabor X Jimma \7. Wollega E. \7o11ega Metekel Gambclla 3l WHO/APOC, December 15,2004 5.L,3 In general, how have they been applied/ implemented? The recommendation made during the mid-term sustainability evaluation was fu[ly implemented and TCC members reevaluated its level of implementation during their visit to Ethiopia to attend the national annual review meeting conducted in February 2005. The recommendations made during the internal monitoring of the projects was discussed with the project coordinators and indicated for implementation. 5.1.4 Any other cornments? 32 WHO/APOC, December 15, 2004 5,2. Sustainability of projects: plan and set targets (mandatory at Yr 3) \7'hat arangements have been made to sustain CDTI after APOC funding ceases in terms ofl 5.2.1. Planning at all relevant levels. Since the beginning the CDTI activities were integrated with the other health activitics at all health management and health sewice delivery levels. Thercfore, the planning processes are also carried out in an integrated manncr through participatory methods, using bottom'up approach and integrated with the basic health service. 5.2.2. Funds Ensuring the availability of fund is essential for thc sustainability of the CDTI. The governmenr has already increased the financial conffibution for critical CDTI activities. In addition to rhis most c,f the CDTI activities that was carried out in an intcgrated manner would have rcceived resources from different programs. 5.2.3. Transport and equipment (replacement and maintenance) Thc APOC dqnatcd vehicles for CDTI project were well functional at that time. Maintenance cost was covered from government. The government also used othcr vchicles, in an intcgratcd manner sincc the govcrnment uscs pool system 5.2,4. Human resources As mcntioncd abovc, thc CDTI activities are carricd out in an integrated manncr. Thc responsible person for Onchocerciasis control is also responsible for other diseases control programs such as malaria control and is usually thc hcad of malaria and other vector l'rone diseases conttol team. A11 thc othcr membcrs of the tcam wcrc also activcly involvcd in CDTI activities. 5,2.5. Which projects have submitted sustainability plan? Kaffa-Sheka CDTI, Bench Maji and North Gondar 5.2,6. To what extent have the plans been implemented? The fourth ycar Kaffa8hcka sustainability plan is succcssfully implemented. 5.3. Integration Outline the extent of integration of CDTI into the PHC sffucture and the plans for complete integration. 5.3. 1. Ivermectin delivery mechanisms 55 WHO/APOC, December 15, 2004 Since the beginning there is no separate Ivermectin delivery system to the lower level; it follows the existing drug delivery system in the country. The request for Ivermectin is to MDP through MOH. As soon as the drug arrived, the same as all other drugs and medical equipments, a Pharmaceuticals Administrarion and Supply Service in the MOH handle all the processes required. The project levels, like any other medicines, receive and deliver to the respective levels following the existing delivery system. 5,3,?,. Training CDTI is integrated with the Primary Health Care (PHC) from thc beginning. At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector.borne Discases Prevention and Control Unirs arc responsiblc. Therefore, all the staff of these units has received training on Onchocerciasis. Training of peripheral health workers has been carried oLIt in integrated manner with other health issues. 5.3,3.Joint supervision and monitoring with other progranrs As part of the system in the country, most of the supervision and monitoring activitics are carried out in integrated manner with othcr programs. 5,3,4, Release of funds The government allocated money especially for critical CDTI activitics was released in time. In addition to this most of thc CDTI activitics that arc carried out in an integrated manncr ar-rd resourccs rclcascd for othcr programs wcre also uscd. 5.3.5.Is CDTI included in the PHC budget? Yes, as part of PHC, CDTI is one of the priority activities. 5,3.6. Describe other health programmer that is using the CDTI structure and how this was achieved. What have been the achievements? In some malaria endemic villages, the CDDs arc used for malaria conmol program especially in community mobilization. Thcy also collaborate with health cxtension workers dudng mosquito ncts distribution, in environmental control and advocacy. 5.3.7. Describe other issues considered in the integration of CDTI 5.3.8. Describe the integration of other progranrs into CDTI in your country and the results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening {or cataract of primary eye care interventions integrated in all or some 34 WHO/APOC, December 15, 2004 projects, if no integration has taken place, are there plans to pilot test a strategy, etc?) For instance malaria and Oncho is integrated and all activates are being done in integrate manner 5.4 Operational research 5,4.t. Summarize in half of a page the operational research undertaken in the country area within the reporting period. Nonc 5.4,2. How were the results applied in the project? 5.4.3.Note the issues that have been identified by the NOTF for future operational research. Factors affccting sustainabiliry of CDTI SECTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weaknesses, opportunities and threats of CDTI implementation process. Strengths: Almost all thc projects were able to accomplish the dismibution in the intended pcriod of timc with good geographical and therapeutic coverage high abovc the minimum standard for APOC. This was due to high political commitment at all level, awarencss and activc involvemcnt of health workcrs and the community at large. Thc intcgration of thc CDTI activitics to thc existing health system was strengthcncd CDTI activities for strstainability. Weaknesses: Dclay in reporting from the lowcr lcvel, poor financial utilization and liquidation Opportunities: The expansion of government structure down to village. Thc new government health policy of Health Service Extension Packagc program Threats (Chaltenges): Overburdening of hcalth workcrs in pcripheral health facilities in different health programs such as malaria epidemic control, EPI, measles & polio campaign. List the strengths, weaknesses, opportunities and threats of the vector elimination project (where applicable). No Vector control activity Indicate how challenges were addressed. 35 WHO/APOC, December 15, 2004 Indicate how opportunities can be utilized to improve CDTI. The expansion of governmcnt srructLrre down to village level and being taking the responsibility of development activities as well as health related activities would enable the overall coordination of the CDTI activities at the community levels. The new government health policy of Health Service Extension Package program in which there was a start of building a health post in each and every Kebele assigning a traincd,/qualified health service extension workets have been also another good opportunity for close supervision of CDTI activities at the community level, and enhanced the reporting and Mectizan delivery to the CDDs. 36 WHO/APOC, December 15, 2004