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

iEthiopian Program for Onchocerciasis Control Community Directed Treatment with fvermectin (CDTI)* 4th and 5'h Year Sustainability Plan For Cheta Woreda (District) Kaffa-Sheka CDTI Proj ect Project Period: 2004-2005 '1I ;., {., ,i,Ji 0 I DE[. 2003 ri'"i\-lDiRri lr ii Table of Contents Part I i. Introduction..........."........'. 2. Background Information ' Part II i. Rapid Epidemiological Mapping of Onchocerciasis Part III 1. CDTI implementation and Results 2. CDTI training achievements """"' 3. Treatment coverage." Part IV l. Financial Management of APOC Trust Funds 2. REMO MaPs of Cheta woreda""" Part V Sustainability of Issues of Cheta woreda CDTI 1. Planning 2. LeadershiP 3. Monitoring and Supervision """"' 4. Mectizan supply and distribution"""""' 5. Training/HESAM...... 6. Project Budget Financing/Funding 7. Transport and other Material Resource"' 8. Human Resources 9. Coverage 10. Sustainability plan frame framework for Cheta woreda 11. List of Available Resources for program support "":""'1""""' 12. List of Materials, Supplies and Equipment Required for CDTI Activities ' Part V 1 1 2 2 2 J J 4 5 ....5 ....5 ....5 ,....6 ,,,..6 .....7 ..,..7 .....8 .....8 .....9 ..... i 1 ...... t2 1. Budget justification (Explanation """""' 2. Budget Summary Year IV..... 3.Budget Summary of Sustainability plan for year V 13 15 16 J0i ,) ia Introduction cheta is one of the ten wordas (districts) of Kaffa zone, located about 509 kms away Southwest of Addis Ababa. cheta has a population of around 28'772' The woreda comprises i6 kebeles (smallest admin units), whose inhabitants mainly depend on subsistence agriculture. The climatic zones of the woreda, in most places' are that of highland with longer annual rainfall period (6-8 months)' In this woreda' there is one health station, one health post. The infrastructure in the woreda is underdeveloped; no continuous electric power supply, poor telephone service, inadequate roads connecting the kebeles (rural communities) to the capital town, etc. The woreda is well known for its diversified cultural and ethnic composition, although Kaffecho is the most dominant one amongst others. Background Information Onchocerciasis control progran-r was launched through community directed treatment with Ivermectin strategy in the year 2003. The project was initiated with a strong partnership between APOC, affected communities, regional, zonal, woreda admin councils and health departments, Federal Ministry of Health and an NGDO partner (The Carter Center). The program was initially designed and implemented as Kaffa-Sheka GDTI project with the overall coordination role assumed by the zonal health department' However' Kaffa- Sheka was later on split as two distinct zolles and the leadership role was then shifted to each zonal health office. Again, very recently, in accordance to the decentralization policy of the goverrlment of Ethiopia, there was a paradigrn shift of power and authority from zonal to woreda levels. It was at this juncture that tl-re rnidterm CDTI sustainability evaluation of Kaffa-Sheka project undeftaken. ln line with this development' it was recommended that the GDTI plan be worked out at rvoreda level. After the midterm evaluation of CDTI sustainability, there was SWOT analysis done for each level of health delivery structure. As a result, coverage, Mectizan order and supply, monitoring and supervision, as well as training and HESAM were considered relatively )as strong points at woreda and front line health facility levels' on the other hand' Financial Resources, Planning, Leadership, Transport and other materials and Human Resources were considered as weak points at this level' Efforts have been made to address these weak points in this action plan' Rapid Epidemiological Mapping of Onchocerciai\s (REMO) The rapid epidemiological assessment carried out in selected communities in 1997 indicated that cheta woreda as hyper and meso -endemic for onchocerciasis' CDTI ImPlementation and Results Although the woreda was known for its endemicity of Onchocerciasis' there was no mass treatment activity conducted before the launcl-ring of CDTI' However' clinic-based treatments have been going on with diethylcarbamazine (DEC) in some of the health institutions of Cheta Woreda' As mentioned earlier, CDTI was implemented for the first time in the woreda during the year 2003. The major partners were APOC, FMOH, respective health authorities' Iocal goveffrments, affected communities, and the partner NGDO (Carter center)' The mass treatment had 100 percent geographic coverage of the communities in the woreda right from the beginning. CDTI Training in Cheta Woreda, Kaffa zone Year Health Personnel Others CDDs 2001 NA NA NA 2002 NA NA NA 2003 t2 15 79 NA: Not Applicable t JTreatment Coverage, Cheta Woreda, Kaffa zone Financial Management of APOC Trust Funds zonalhealth department carried out the hnancial management of each QDTI during the year. Accordingly, data that has been extracted from the zonal document shows the following financial information (see table)' New Leadership Role and Integration of CDTI ln view of the recent decentralization policy, devolution of power and authority has been made to the woreda level structure. As a result of this change, CDTI has been considered as integral part of the overall three-year strategic health plan for cheta woreda' During the GDTI sustainability-plaruring workshop, all stakeholders have participated and have expressed their commitment to assuming the leadership role in the implementation of CDTIintheirrespectiveareas.CDTIhasbeenincludedinthemalariaarrdothervector bome diseases prevention and control unit in tire strategic woreda health plan' Year Total Nbr. of villages Aro I Nbr. of Villages Treated Geogra phic Coverag e I (%) ATO Coverage (%) Total Popn ATO Nbr. of persons treated Therapeutic Coverage (%) TO rage 2002 2003 122 t22 122 100 100 2'7,961 22,369 20,624 73.8 92.2 Funds Received CommentsOther SourcesNGDOAPOC Year 2001 2002 APOCfromedrecelwasvanceadOnl the 1None238.15t554.192003 238.151554.79Total M ,001 4REMO MaP, Cheta woreda, Kaffa zone \ L_r\ rl,r ^ 't,,lt rl. ?:rr!+r:!*+, ilt"r;r" , rifilr' :l r,+tin ? I ,i "rrrfr'lr' ' 5Sustainability Issues in Cheta Woreda CDTI Planning .r ., This is in ur.u identified as weakness during the midterm evaluation that requires immediate corrective action. The CDTI is incorporated in the overall three-year strategic health plan of the woreda. However, in the past, the woreda health office and FLHFs were not actively involved in drawing up the CDTI proposal and annual plans of action' It was mainly the zonal health department that was responsible for planning GDTI activities in particular. Following the midterm CDTI sustainability evaluation, however, it has been decided that all stakeholders at woreda and FLHF levels will assume the responsibility of working out their respective periodic plans of action from this time on' Short training course will be necessary to develop the planning skills of the health personnel working in these institutions. Efforts will be made to implement the bottom-up planning approach with the assistance of the NOTF in the remaining two project years' Leadership As introduced earlier, currently there is a paradigm shift in the admin structure and organizational set up of the overall management of health and other development proglams in the country. The general trend is to empower the woreda level structures and build capacities in all aspects of program management. The CDTI, being one of the recognized and integrated health programs of the woreda, will receive leadership and close guidance from the woreda admin council and the taskforce organized at this level' Monitoring and SuPervision Monitoring and supervision is very critical to the success of CDTI if it is done in a tirnely and effective manner. However, it was understood during the evaluation that the frequency and coverage was inadequate. Supervisory checklists were not used regularly and feedbacks were not communicated in writing. ln rnost cases, supervisory visits were not problem oriented and targeted to improving poor performance of FLHFs and CDDs' During the sustainability-planning workshop, it was agreed that the weak points identified would be addressed very critically although shortage of health personnel and fr ti 6other competing health priorities at both woreda and FLHF levels could be possible threats in the implementation process' Mectizan SuPPIY and Distribution This activity is considered as a strong point duriqg the evaluation process' Mectizan procurement and distribution is fully integrated into the government health care delivery system.Everyeffortwillbemadetomaintainthegoodachievementobtainedthusfar. Ordering Mectizan in good time and in sufficient quantity is indeed a commendable job favoring sustainability. However, there are areas that need fine tuning at FLHF and CDD levels. Minimizing wastage, proper record keeping and timely and complete reporting are some of the areas requiring attention in the remaining project period' Training/HESAM organizationandmanagementofCDTItrainirrgprogramsweretlreresponsibilitiesofthe zonal program coordinator in the past three years' The woreda health off,rce is not fully empoweredtohandlethisresponsibility.Tlrefuturedirectionislrowevertobuildthe capacities of the woreda health staff so that they can be in a position to plan and implement training sessions after carrying out needs assessment at FLHF levels' Efforts willbemadetomakeCDTItrainingsessionsfocusedonidentifiedweaknessesofthe health personnel and other partners including cDDs' Similarly' the woreda health office will be making proper use of its meager resources by integrating training proglams to the best of its caPacitY Health education, sensitization and community mobilization has been very effective in enhancing CDTI awareness to the general public' The perceived benefits of Mectizan are foundational grounds for the sustainability of GDTI in the woreda' There will be a need toproducemorepowerfulhealtlredtrcationandsensitizatiorrnraterialsinorderto enhance further the active involveme,t of communities in decisio'r-r-'aking process' Moreover,thebeneficiarycommunitieswillneedtobemobilizedtoprovideeffective support for the CDDs serving their respective villages' This is believed to be one of the cornerstonesfortheeffectivesustenanceoftheprogramintheworeda. 7Financing/Funding During the first three CDTI years, there has been no specific budgeting for onchocerciasis control activities in this woreda. Very recently, however, the woreda admin council has started allocating funds in block for all health programs in an integrated manner. Obviously, the amount of money is much smaller compared to the diverse needs of the woreda health office. Whatever the amount may be it is indeed a commendable start and it is hoped that it could be increasing over the remaining project period. Since the woreda health system functions in an integrated manner, it is hoped that CDTI could also benefit from funds coming from other sources like Global Fund, EPI, etc. At this rudimentary stage of the woreda, however, more support will be required from APOC' Transport and other Material Resources In this woreda, at it is the policy of the Ethiopian govermlent in general; available trapsport facilities are used in an integrated manner. In the midtenn evaluation, means of transport is one of the most important limitations identified at both woreda and FLHF levels. ideally, it would be appropriate if a pick up could be provided for the woreda health service and at least one motorcycle for each FLHF. This woreda has not received any vehicle from APOC yet. The evaluation team has recommended immediate replacement of the motorcycles that are found to be wom out and non functional in the evaluated woredas. It is strongly recommended that each FLHF would need one motorcycle for effective monitoring and supervision of CDTI activities. At this juncture it is very important to underscore the need to cousider building the capacities of the woreda and FLHFs inorder to be able ensure the sustainability of CDTI in this particular woreda. This woreda health office lacks irnportant office equipment like computer, printer, photocopy machine, etc. These deficiencies need to be tackled as soon as possible. Other CDTI material resources like treatr.t-tent registers, reporting booklets, training manuais, posters, flip charts, T-Shirts, stationery, etc. should be supplied in sufficient quantities for the effective continuance of CDTI in the woreda, t { "::, 8 Human Resources It is known beyond any grain of doubt that the availability of skilled and motivated human resource is very critical to the success of CDTI. The midterm evaluators noted that there was a very high turnover of health person:rel at botl'r woreda and FLHF levels. It was also noted that most of the FLHFs are understaffed. In the coming couple of years, however, these shortcomings need to be addressed as much as possible. During the planning workshop, the woreda admin council and other authorities at higher levels promised to do their best in this respect. Plans have also been made to motivate health personnel and CDDs by means of rewarding best performing individuals and institutions. As stated above, training workshops will also be organized to fill the gap of knowledge, skills and competence of the available health personnel in planning and management of CDTI activities. Coverage This woreda has already achieved 100 percent geographic coverage and therapeutic coverage of well over 65 percent during the past three years. Participants of this planning workshop believe the fact that if all other aspects and indicators of sustainability are well taken care there won't be a problern to maintain the current geographic coverage and improve further the therapeutic coverage levels. Efforts will need to be intensified to reduce the current rates of absentees and refusals to the best minimum levels. .k6efF d(.)UO () oo H \-/ Z (J o O. FL<(J a U o Ar 6 !2!EE tr.)(! 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Et-o l+r o C!N o z G)oL o U) C)& U' F"F Flf! tr(g ah CO C) kGt .9a dn E \.,>o\tq F- €uiEg oo'.c,( 'tr6op. t0 OF* >a, (!o BQr t_JO r)B- e-$ d,6Ea) >okC0).; *e@d r; (! 'i o fr. tr ,d o -oi)> 1-1 Cr) a* oo'c td(EF .- gH C) ()n0)'- =-.>EHH \ u.^ @2-9'=ooiia B 6€ B.o4dbaEB E;3 5r"li\Lvt zb E a !H ' U) o O O o o o o! (at \o t-- oo 15 Bu et Summa for Year IV CDTI in Cheta Woreda Kaffa zone , ! o udget Line Item C OH ter 1 9,500 97 Equipment 7,1 50 0 0 715 upplies 0 70 340 4t 1600.7i 80.24 63.45 1744. and 2543 153.01 0 2696.41 Mobilization 22.31 0 22.3 1,752.t t4t.33 138.98 2032.43 8 Review 0 0 555.37 55 5.3 sion of Awards 0 120 12 I otal Budget 13,046 9,966.95 1,507.80 24,520 GDO overhead11 s% 978.41 0.00 0.00 978.4 1 Grand total L4,024.70 9,966.95 1,507.80 25,499. 1 Treatments 23,018 23,018 23,018 23,018 per treatment1 0.61 0.43 0.07 1 1 1 Input of Partners15 55.00 39.0 5.91 100. a Efl 0 0 16 Budget summary of sustainability plan for Year V CDTI in cheta Woreda, Kaffa zone udget Line Itemo C Carter Center otal Allocation I 10, 30 1 ital Equipment 0 upplies U 75 J 425 1200 85 t345 and ervlslon 2000 155 2t55 Mobilization 0 25 2 1,500.00 t43 130 1773 Review Meeting 0 0 52s.00 525 of Awards 0 120 t2 1 otal Budget 4,700.00 10,483.00 1,485.0 16,668. GDO overhead (7.5% )11 352.s0 0.00 0 352. I rand total 5,052.50 10,483.00 1,485.0 17,020. Treatments1 23,686 23 6862 23,686 23 Cost per treatment1 0.2r 0.44 0.06 0.7 lnput of Partners1 29.68 61.5 8 100 I a a