Kaffa-Sheka CDTI annual project technical report submitted to Technical Consultative Committee (TTC) : January 2007 to October 2007

I-.j . / r' "..t COUNTRYAIOTF: ETHIOPIA Proiect Name: Kaffa-Sheka Approval year: 2000 Launching year: 2001 From: Januarv 2007 To: October 2007(Month/Year) ( Mo(h/Year)Reportinq Period: Proiectvearofthisreport: (circleone) | 2 3 4 5 U 0t 9 10 Date submitted: 30 December 2006 NGDO partner: The Carter Center I The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL RBPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (AP I z For iii;: To: 2E For Tor irt csb c!? nilt .EFOhY -b i. I WHO/APOC, 24 November 2004 t i 06FEV 2008 f.t ,- .[".-;;-- - LI I I IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFF'ICERS to sign the report: Country Ethiopia National Coordinator Name: Dr. .Jim.a Signature Date Zonal Oncho Coordinator Name: Signature Date: NGDO Representative Name: Signature Date This report has been prepared by Name : ....B.ekeLe..Kjdane.t.N.QTH......lllr Designatiot Zone cerciasis Coordinator Signature ,.'.' i r' .-,,r' .'\ . "-& j-- ,.) I i:5 ":i,al r.. t;\,f,' * a, ,\r1F .i t,412 (. .5 \..r ,, Date ?.,. :,J ti: ll LAIINUAL PROJECT 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: Ethiopia National Coordinator Name: I)r Jima Signature: Date: Zonal Oncho C o ordinator Name :,..BekeLe.K.idan-e...... Signature: Date NGDO Representative Name:,.........Alate.T.i.l.ahrr.n Signature: Date This report has been prepared by Name : ....B.ekElE.Kjdans..t.N.el[....... Designation : Zone onchocerciasis Coordinator Signature Date I I I I 1l WHO/APOC, 24 November 2004 Table of contents FOLLOW UP ON TCC RECOMMENDATIONS E>ccurnry Suuraany .. SECTION I : BACKGROUND INFORMATION....... 1 2 3 1.1. 1.2. EqunwNr FweNcrer coNTRIBUnoNS oF TrrE pARTNERS AND coMMUNrrrES J 5 SECTION 2: IMPLEMENTATION OF CDTI .............7 2.1 Tnunvr oF ACTTvITIES.. 2.2 Apvocecy. 2.3 . MosnzerloN, SENSITzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMt NITIES. 2.4. CorwruNrry rNVoLvErvIENT............. Cepecrry BUrLDrNG.... TnrenvmNTs............... It Onoenntc, sroRAGE AND DELIVERv oF TvERMECTIN .................. COuvruwrry SELF-MONIToRING euo SrexrHoLDERS MEETI.TG . SuppRvrsroN ............... l8 SECTION 3: SUPPORT TO CDTI .............19 7 8 8 9 2.5 2.6 2.7 2.8 2.9 ..... l3 .....17 ..... I 8 3.1 3.2 ........19 ....,,.,20 .....,.,20 ..,.,,..20 22 22 22 23 3.3. Oumn FoRMS oF coMMuNrry suppoRT 3.4. E>cpNpmnp PER AcrrvrrY SECTION 4: SUSTAINABILITY OF CDTI 4.1. INrenNer-;rNDEIENDENTpARTrcrpAToRyMoNrroRrNG;Everue1oN................... 4.2. SUSTAINABILIry oF rRoJECTS: rLAN AND sET TARGETs (uaNoaroRy AT YR 3)............ 4.3. INtncRRnoN .............. 4.4. OppnarroNAl RESEARCH . SECTION 5: STRENGTHS, WEAKNESSES, CIIALLENGES, AND OPPORTUNITIES ... SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS .......... 22 24 24 lll WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community S el f-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epiderniol ogical Mapping of Onchocerci asis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory goup) Trainer of trainers United Nations Children's Fund Ultimate Treatrnent Goal World Health Organization t lv WHO/APOC, 24 November 2004 Definitions Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84%o of the total population in meso/tryper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesolhyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treaftnent Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage(normally the project should be expected to reach the UTG at the end of the 3d year of the project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coveraqe: number of communities treated in a given year over the total number of meso/h1per-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Inteeration: delivering additional health interventions (i.e. vitamin A supplemenrs, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. communitv self-monitorine (cSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifi cations when necessary. (i) (ix) v WHO/APOC, 24 November 20M FOLLOW UP (,1{ TGG REGOilIMENDATIONS TCC session 25th Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY I Continue disctusion on collaboration on operational r es e ar c h w ith Uin ivers ity of Jimtna Discussion was carried on previously on how a proposal has to be prepared by Jimma University. 2 Delays in reporting at lower I ev el s acc ount ing for fund expended Supportive supervision and proper follow-up is being done to each woreda and frontline health facility to improve the reporting system. J Continue integration of CDTI into PHC as means of addressing high turn oyer rate of health staffat woreda and health facility levels The CDTI program is well integrated with the other PHC programs. 4 Explain expiration of 69,897 Mectizan tablets and check drug inventory The Mectizan tablets were damaged due to heavy rain during transportation to nomadic areas in Decha Woreda which is 5 days journey from Bonga, the capital of Kaffa zone and was reported as expired. 5 Make effort to attain WG Great effort is being done to attain higher UTG I WHOiAPOC, 24 November 2004 Executive $ummary 1. Background on treatment and population data Community Directed Treatment with Ivermectin (CDTI) has been successfully implemented in Kaffa and Sheka zones of South Nations Nationalities and Peoples Region (SNNPR) since May 2001, for seven consecutive years. Kaffa-Sheka CDTI is divided into 13 woredas and 3 administrative towns (Bonga, Masha and Teppi) that previously were part of Gimbo, Masha and Yeki woredas respectively. The project has reached a geographic coverage of 100% and the consecutive therapeutic coverage of the project is so remarkable and is indicated below. YEAR Population Total population of the meso/hyper-endemic areas Annual Treatment Obiectivc Number otfn dr"p*tiqu. loto persons treated lcoverage (%) lcoverage (%) LJTG Coveragc (%) 2001 902,687 306,297 233,309 DA ia 3l 2002 928,69r 654,250 sr6,2t7 Iso lts 66 2003 955,443 955,M3 7 t8,24t llS lts 89 2004 981,198 824,206 768,642 IZA lss 93 2005 1,020,679 857,370 787,766 ltt lgz 92 2006 l, 012,611 8 10,088 778,188 ltt lse 96 2007 1,075607 899325 843373 hs lsq 94 2. Background on population movements The communities in CDTI areas are mainly settled farmers, daily laborers, civil seryants, tea and coffee plantation workers. Generally, there was no major type of population movement in the project area in 2007. 3. Training data Training of Trainers was given for 5l I health professionals and those trainees have trained 6859 CDDs who were selected by the communities from 3726 vtllages. 4. Challenges and how they were overcome. Threats (Challenges): o Delayed activity reports and financial liquidation from woredas o Expectation of incentives by some CDDs in urban areas . High staff tumover (health workers) To solve this problem the following measures were taken:- o Thorough supportive supervision was carried out by the zone and woreda staff o Replaced new health workers were trained to solve the high staff turnover o Discussion was carried with the community to solve the CDD dropouts and on the requested incentives. o The Health Extension Workers were assigned to serve as community supervisors 2 WHO/APOC, 24 November 2004 I SEGTIOil {: Background information 1.1. General information 1.1.1 Description of the project Geogaphic location, topogtaphy, ctimate Kaffa-Sheka CDTI is located about 447 and 680 km consecutively from Addis Ababa to south west of Ethiopia. The project is found in Kaffa and Sheka zones, which are two of the thirteen zones that constitute the Southern Nations, Nationalities and Peoples' Region (SNNpR). The project area constitutes 13 rural woredas and 3 administrative towns (Bonga, Tapee and Masha) which were part of Gimbo, Yeki and Masha woredas consecutively. A. ShekaZone Masha, the capital of Sheka zone is located 680 kms from Addis Ababa situated in the South 'Western part of the country. The zone's boundaries are Illubabora zone in the north and west, Bench Maii zone in the south, Kfifa, zone in the east and Gambella tegion in the south east. The total surface area of Sheka zone is 2175.26 sq. kms and its annual rainfall tange is LOOO-ZIOO rffrrs. Agdculrure is the backbone of the zone's economy B. Kaffa Zone Bonga is the capital city of Kaffa zone which is situated 447 km south west of Addis Ababa. Kaffa zone has a surface area of I1350. 64 sq. kms and its topography are 70% semi-high land, 3.5 o/o high land and26.5Yo low land. Population: activities, cultures, language The communities in CDTI areas of both zone are mainly settled farmers (92.3%) and,7.7%o arc urban dwellers who are government employees, merchants, daily laborers, tea and coffee plantation workers. The languages of the community are Kaffinono and Shakinono, and some of the people speak Oromifa and Amharic. The offrcial language is Amharic which is also the nationat language of the country. Communication system Eleven woredas have all-weather road and the reaming 5 woredas have dry weather road. Masha, Tapi,Bonga, Gimbo and Chena woredas have digital telecommunication service where as the rest seven woredas are being communicated with the help of satellite telecommunication system. Administrative Strucfures Even though Kaffa -Sheka is treated as a single project, administratively they are two independent zones. Kaffa zone has ten districts and one town administration and the dirtri"t, *" divided in to 301 Kebeles (sub-districts) having 3155 villages. Similarly, Sheka Zone has three rural districts and two town administrative setups under it and the districts are divided in to 69 Kebeles (sub-districts) having 571 villages. 3 WHO/APOC, 24 November ZO04 tIlealth and health care Table l: Number of health staffinvolved in CDTI District Number of health staff involved in CDTI activities. Total Number of health stalf in the entire project arel Br Number of health staff involved in CDTI Bt Percentage Br=Brl Br *100 Gewata 33 27 82 Gimbo 77 55 7',l Saylem 20 17 85 Menio (Adiyo) 37 33 89 Gesha 44 39 89 Bitta 43 30 70 Chena 75 58 77 Cheta 30 26 87 Tello 33 25 76 Decha 59 40 68 Bonga town 40 36 90 Yeki 58 50 86 Andracha 27 26 96 Masha 44 27 61 Tappi t2 9 75 Masha town l5 13 87 Total 647 511 79 1.1.2. Partnership There is strong partnership which helps the Kaffa-Sheka CDTI projects for its best achievement of its activities and gradually ensures its sustainability. The main partners involved are Federal Ministry of Health, Regional Health Bureaus, Zone Health Departments, Woreda Health Offices, health facilities, the community, The Carter Center, WHO and other Govemment Sectors the as Education, Agriculture and Finance, etc. The FMoH, And Zonal Health Departmet are involved in planning, and Supervision activities. The Carter Center is involved in planning, Supervision and in providing financial and technical support. Woreda health Offices are involved in training, community mobilization, supervision and follow up of the CDTI activities. FLHF do implement the CDTI activities and supervise the health posts. The community is involved in community mobilization, Health Education and in selecting CDDs as well as in fixing the Mectizan treatment dates. 4 Zone No. of Health Extension Workers No. of district hospitals No. health centers No of growmg health centers ofNo. health posts No. of health workers ofNo. CDDs Kaffa I 20 123 451 3606 5720 Sheka 8 10 94 72J 1139 Total I 9 28 133 545 332 6859 WHO/APOC, 24 November 2004 .+oo6t (l) .o Etl) oz v c..l t,o Ar o *. B ook =o(r, l-. o) o o) I (.} o aU o z o lio Eq) GIot{ € Q)L. 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E o Eg c E a!N - oIF(, lll o 2.2, Advocacy State the number of policy/decision makers mobilized at each relevant level during the cunent year; the reason(s) for undertaking the advocacy and the outcome. Describedifficulties/ constraints being faced and suggeition, on how to improve advocacy. A total of 192 policy makers were mobilized,atzonaland woreda levels. 335 Kebele Taskforce members and 154508 community members have been mobilized in Sheka zone.Mobilization of policy makers is carried on to incite policy makers in mobilizing the community and play significant role in CDTI activities. 2.3. Mobitization, sensitization and health education of at risk communities Community mobilization was done at_each village by organizing community meetings.Frontline health workers, Community Supervisorr 6ffewl and CDbs were responsible ingiving health education to the community at village level. Health education manuals weredistributed to each CDDs and community supervisois. Three types of posters were distributedto each village and posted at different ptu..r where people could look at and discuss on it.The cornmunity mobilization and the Health Education activities have contributed a lot in awareness creation on CDTI program. Due to the active mobilization process done in the community, the response of the community to the CDTI program is remarkably good and the Mectizan distribution period is eagerly waited in most of the villages where CDTI program is launched. 8 WHO/APOC, 24 November 2004 Fl o E B 0, o J ,.l Dtic 6 o, a.p o D' oE TDo oaD Uo9. E -lo o o o E o o E tE ET !o oo to e r=. o U'E o 3 o CTo oo 4E b t q. 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(The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if stffi arefrequently transferred during the course of the campaign). Well organized trainings have been given on CDTI program at all levels by the concerned health professionals. Short term replacement of staff members was done in areas where there was shortage of health workers in-order to facilitate the CDTI activities 1l WHO/APOC, 24 November 2004 l*lls l6- l,r, ;Ft F) il 0q 0o (D p- H( .D'Ft(D o (D IA oPf) oU -l 'd (D iJo FO o e(\ a r-a(\ s_ s_ o\(\\o s6 (\ c)(\ A) a4 s !) 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(s|tr >i 916t5 ljl EA ald3r 8d3rltr .9l5 xl I ?l r -ol.I <l a frl B glEtrl ' 'Fl c>el .;{ =l C3B El€ BIE HI Eqrl =J (Hl =ol o. ol ElplO ul5 _813 -81 :trl 'd trl d 1IE EIE g€(Bo o(l) s,sE 6 -pebks c) dH o oo(dL C) oo N^ .X..o EV(tl t<b0 o(l) o o dL. o bo(!ko oo oa 9^\ JV c)r RIko -qt- al(1)l sl.l 9l !l Gllol -cl0l(tll L.lb{ ot 0.)l s EI ol .rl9t BI al(tll l'<lot -cl!l bddt 9l)tol EI 8l *.1 €l cl ,l EI ol r!l Ill o ts ;;gse o o o o o o o o o o o o o o o tllo(r)o o r$ba Eg Z6 o(, tt F. @(7' $@ tt- @ro @ O) ro @ N u)(\l c) F-o ro c1$l o o)ot- l'- @ co @ @ o) rO(.,(\t oT\ o)(! @(n(o l'-(o(t o)ot- o @C'N o$ @ ia!la ! N ot6t (o (")(t ts.c i '-- .E er EE329, ,E.Eg (')(o @ o N O)(O$ o,s@s @(o(') c) @l'- @(, (') F-l'- (v)\tt- () ot(n t6 Nf,- ooltr (o Fa ra(.) o Id .9 ao o. d otF o bI) d b oa GIL a o @ o @ (, F- (ot- oq, Nt- (DF. (")l"- o,F. rot- (\o) o@ F.N (o@ o@ o)N olt\ (\t ro o_ (Dlo @I-@ + u) o E {rt ,Eg o stF- rf)F. (.) Nlo ro(o (o(r)(.r- CO t-(o o-(o(o N(Y) co lo(\l @o ro +N N(o t--(., ro q, 9- @@ o)o(o @(\ ott\.(o @ roN(')_ @ lo @(o- (o N t.-(o(o (o(i,(o t{) c)Frr !a $@(r) o @ a c9o> EEEiE8 $@(D- (o (') tlt Ir,- o,N N(o(o r-(') (oq) co- i.-@ Nt. o(o N@$l- s 6t(7) o- @ o,t lr)$|-t- ro t O)o. F. o) o @(D(,(\t trlt) o_ o) (t, N o_ ool F-@o Fi N (,(o(\t F. \t(o(tlo la al a6\6 (\ (fr_ o @ o$- aoo F.(., @ o c{ tro s ao oA c., 'Eos >-5e d aE H8.9 -otsdEi D E€Es ()$ot $N (\I @(o- lr, O) (o|r) c\{ ro\t (o o) o_ roo l(,loo CO @ No c.i N \t(\ @ rt(o ot(o(\- @(o $o @ F-t.(D- @N (o stN.(o CO (l lo- o(\ oo t- l'-o(o rr) F-o .i E :8 =oF's r-AE oEiGIL.>o59AO o o o o o o oo oo oO oo o o oo ou6 o '5 '=EbEg5E(9 EEJ,23td ro N ot(Y' @lr)N O) (t F. (") rt(\l roN(o g) t-- (o(o N @F- c{ (t,(o t(o(t v(o O) o$ v (o 6at\(,, a E9 EE$ r.C) N ort(') @lf)(\t o, (')t- (?)$$t roN(o (n F. (o(o GI (ot-(\I o)(o t(o(") t(o (n os t (oNT\(o IbI6 audd oF qou,5 *,r rg>\a =EU€ -E ba rr) N ot(o @ .o(\ o) (Y) t\. (o\t(\ I()(\(o (nf,- @(oN @N(\t o)@ $(r)(o t(o o, o$ t ro GI]\(., o !Euo{ d d Boo oD E 6 o d t/) d oo € ta clco C) so O oF a, oo db!troa !o € o6 E c 6E o rocF lo d I IoF :es% a4\)\)q) S b o\\)Lo \\ \3 \) a4\lq) s -Vu, L (tI U) cd c)L.(€ (\l tr (, -.1() ti vt .o ,o (n rI] aEc ctl o cB(l) liF. t{r ol5l cllFI C')o @lo I'l la)ld lH lo lor :. -l el -l *6sOS- *r(\- s-B !;J(\h%d6 SE(\^ TE RO :t) c) \S S. OC s <a c:s\\(\\ o \\ ='Oq s-G\ €o\ OC\(\\ oS o EoFl b U)Eoog FoE o a{ T. 0q U A'd F) 0)5 Fo v) o U F' to o o (D o o5 a *? o V)? F'E, F) oao tso oFn a frjq) (DH 5€ 0o 5a o o o Etro lriop) It FU r.t o oaH O) tr E F) 0) 0qo E(D FI t' o) 3oo oFl n|d Ar. o a UE \ \ \ \ oUU \ \ \ \ p oE o;iOat1i B +6 E'E H o -=' o@< 3 3t oI'dq€ \ \ \ \ \ \ a 1!I, se-& did 5 \ \ \ \ \ \ gBF d +Y o \ \ \ \ \ \ t.*uooo-i1 ='o=' og o a 'ooo a ! O-l s qH'b'!t:)HffE€ Ioii ()9H } PEB .Z ooA+ HH)dxaDBr sg[ 86'g E1;^ E&H s ='K 6A) o-+sxp)x HD)$e(Da 1c(DA 5'EOi!a(,6 o:(e* <n9+L68iJ(i0Q cD+.aIt* +r< tf p)(DP o' 'O -.Fl+ €.<(D^:96 HNO'5trP.iJ o- ir<Oo5H tsa 'O g|O:JoFo5P-(D5(D ',4 oFl IJHg;. o'oFriJs H(D9' ,,, +OfooE ou)cf !DtAdqe- <q .DEO. Ea .*. B.HPCDEp? Y.AE A'<5aE+ N I .o .t j !,) '{po\t(DLo E:!lH'}E=3[3atO5P3hDLit .rtrO 5tr 5' =lotro.E t!(io \oo\ oq(D o oa F-.tp) o TD oo oH sD 0a -o\]\o\o5\ FD a- ooO\o oFt A)t o + o o o oHp0 0qo o'Ft 7{ Do +) !r' p0 o-(n (D 7f t0 No)o TA Ft(D (n rJ(D() o t,) { *{ o ts o -o t.)s z o ol, ct otl t\)oos 2.6.2 2.6.3 2.6.4 What are the causes of absenteeism? People usually go any where to earn their living during treatment periods What are the reasons for refusals? Urban dwellers claim that Oonchocerciasis is not a problem in towns and there is no need of taking Mectizan. This happens due to Iow a\r/areness on the severity of the disease. Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required Information when available. t In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ,/ 15 WHO/APOC, 24 November 2004 No o Noo\o Noo6 Noo{ b.Joo o\ NJoo() tJ $ N)oot, N)ooN i.Joo E' F (j) -tf.J o\ (rf N -I{ t/) N) -J -J (rJ N -l -J (l) -N) -t -t UJ N -t -l t]) N -l -) ItlO 5 O O hJ "'+E'3 BE<- C- o:s -.5PEl,E:$? g*aa =td^oqa + o o c IJ o0 : AI 0a(D o UJ -JN) o\ (rf N) -I{ UJ .N{{ UJ l..J -J\] UJ N\t -J l..) o co co 5\o5 9iPJI.G =fliE OJ F' (/) -IN) o\ (, t) -_l -t (,) -N{ -J u) N -J -l UJ N -l\] N oo @ 5\os zt 36o o o 3 3c o da- sr. o=o.fi o It, O O Oo O O o\s trf 8g sE' -q, E di+qilHftIJ]8(,i O o oo Oo oo O (:a >e6 d FO oqo FI lt F' F' + { o\ -J o N) o\ t\)O o\{\o \o ca \o oo \o(^ "5 5 UJ \o N)6 "o\ \o \oON o\ oo -J EO 5 g! Fl 'Fg *€ g ,> [;6'< ?. -'o aE = E?@O F+) FU p) o oo\c)\o u) N.) @ PO oo @ @{ UJ{ co NJ .}IJo o\ \o "S 5L' o\ 5 "N o t,o o\ N\o{ 9iPdl-o =fl$E ri5 FJ @5 UJ u) -J(,) -]{ @ oo @ {@j-J{Or Or \t o\ @ -o\ 5N { C,o N)A Or N{ l..J u)(, "tJ O\o \z ul 3 6q o A' o o. o t! -I\o -Ioo -T -I -J* -l Ut o\ No\ '1 O FlXO.t'v5 EIN fiE 9.o lal il EIt_ E' * oo \o5 \o{ \ob.J \o { -I\o -lo\ GR >t6 d !, oa o Er tr, E' ll * \o5 \o -J \oN \otr) 6\o o,o\ UJ GOCo\O >iv<.x(! r<lt D) 0qo l-l Plsh15- !r'lro F.i F{ t!Ft-E(D7i 5o5Er(DF| Bii+ t'D(r) p Ex t] (D ottoFi (Drt p) =.oa(D r+(D}:Elsgls' 3lB9lhE o \lHq+tso' gi{(Dts. e8 =i+dt; HtD;E' rD= !ie(D=r De(D t.) r.lilI (D D'rt Fg o B' ah(D Ee o FT(! (D H o o.Fl E(D r.l o (D f) ErFl (D !i €\oOu5 UI (, (D t, =r0a r.t (D D](, (D r tD o le o te F.l o ao oi D' 0ao o E' a tl o tr TA o\ I * o U op N)5 z o o d oh N)ooA 2.6.2 2.6.3 What are the causes of absenteeism? People usually go any where to earn their living during treatment periods What are the reasons for refusals? Urban dwellers claim that Oonchocerciasis is not a problem in towns and there is no need of taking Mectizan. This happens due to low awareness on the severity of the disease. ! 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required Information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ,/ l5 WHO/APOC, 24 November 2004 NJo o t.Joo\o 1..)Oo @ tJoo -t Noo o\ Noo(, N)oo5 Noo u) tJooN N)oo rf, ts UJ{ N) o\ u) N){ -J (,) tJ{ -l (J) N -l -l tJ) -N -l -l rlo N{ -) u) "N -t{ EO 5 (D O F.l ='*E'g g E > 2-os -.r H E = B:O5> =FEs o o E tsc E. o@ F) 0qobu){N o\ t, t.){ -J (,) NJ -l -l UJ t\){ -l UJ N{ -) NJ "o @ @ s\os 9fPdt.o = sBE. dT E' UJ -IN) o\ (fJ N){ -l (/) "N\){ t, 'N -l{ t, N --l -l tJ "o oo @ s\os q?azI S.5 E Xo)5d*oc c og 2.n 5'q tll oo o Oo oo oO o\5 EYRq E.S' -gt g oE *ai:1 oa .goo!a_o) o o o oo O a--a > "83 s F' tr'\il Ir' e { o\{ O f.J o\ f.)O o\ -J\o \o oo \o oo \o s5 \o t-.) oo o\\o \oo b.) O,6{ EO 5 g'C' >-1a-X 6 6^9 q6-3 E bj ,#N ^vLiiB s E?ho Fr) Ftr o F O) d o @\o\o(r) l..JIt @ o oa @ 6 -l()) *Jo @tJs 'b.J O o\ \o(,r -s 5tJ) o\ s N(,t O t, o\ -N \o{ 9iPdl.o =g3E 16d5 E' co5 UJ UJ -J(, -l -t6 oo oo -tco{{ o\ o\ \t Ot 90 o\5N -l @ f.J5 o\ N){ Nt(,) UJo\o E>o= xc';q o c, oo. o El -I\o -too -.1{ -l@ -l (no\ N)o\ eB f50 fiEf EI I F' t11 + o \os \o -t \oN \o(j) { -l\o {o\ G8 >t6 3 F) 0q(D It' t5 F' ll * oo \os \o -t \oN \oUJ @\o Oto\ u) GOeo\O >lv< A(!kl 9l 0ao FE l-l P6- lg o\B IFh 3. lro Fl XF1 .6 -HRsr =bo(DiEr FIOFl'X3.6v)s a| =Er.: T} (D((l o tr *O+ F!(DA :1 Er -Pi.5q3g Et.+(Dr.tljiIs.t:6t! li\i Es 16' 1,PIAEgIHE ,''5oIN Itr=r*')16 o'l\oH-l€r+=Its e- E.l(rr g Bl=i+lE.1r.r5l(Di')Ir'9'^I3 LVi-L-i6BE El+F| =.Dro0 tl Fla(DEfE'F: -tr- .D FI D)dOu )9t.|tvtD .d o. D9 iD Fl E o ET oFl g Fl C) (.) o (Drt ET 0e(D o D] o It o tat/ o\ I E o _o t.J5 z o d d on N o5 2.7. Ordering, storage and delively of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHOf] I]NICEII Other (please speciff): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH M WHON UNICETI] NGDC NGDC Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the commturities The NOTF requests for Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery system of MOH. Then the drug is stored in MOH warehouse from which projects receive. From the zone the Woredas receiue and distribute to the frontline health facitities. It is from the frontline health facilities that the community supervisors get the drug to handover to the CDDs making it ready for community distribution. Table l0: Mectizan@ Inventory (Please add more rows if necessary) The remeining brlnncc does not include thc 169,552 leftovcr Mcctizan from 2006. How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs are requested to return the remaining drug to their collection centers which are the front line health facilities. The front line health facilities, in tum, send to the Woreda health offices and finally from there to the zone health department. Hence, the remaining Mectizan is kept at the ZHD store. But sometimes there are woredas and Front Line Health Facilities which keep the remaining drugs in their store as they are remote and transporting the left over Mectizan to the zone is so difficult and costly for them during rainy seasons. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Training of community supervisors and CDDs . Woreda health offices collect Ivermectin from the Zone ' Frontline health facilities collectf Ivermectin from the Woreda level ' CDDs get their lvermectin from frontline health facilities and distribute to the community . Supervision and follow up . Recording and reportingI Return the left over Mectizan DistricULGA Number of Mectizeno tab Rcquested Rcceived Used Lost Westcd Expired Rcmrining Kaffa-Sheka 2368837 2369000 2278265 0 5975 0 84760 TOTAL t7 WHO/APOC, 24 November 2004 a 2,8. GommuniQr self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No. If so, When? and Stakeholders rows 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 CSM is conducted at each village by the Community Supervisors 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF ) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? . High turnover of trained health workers especially at Woredas and frontline health faci lities. . Delay in utilizing and liquidation of allocated funds. ' Delay reporting on CDTI activities especially at some woredas and front line health facilities. r Poor documentation systsem 2.9.3. Was a supervision checklist used? Yes What were the outcomes at each level of CDTI implementation supervision? . The overall recording and reporting system of the CDTI activities has shown some improvement, even-though the high tumover of health workers is still un solved major problem. DisEicU L,GA Total # of communiticVvillages in thc entirc project area No of Communities that carried out sclf monitorine (CSM) No of Commrmities that conducted stakeholders meetine (SHM) Gewata Gimbo- b;yie,1 t"t._nt_o Gesha Bitta Yeki Andracha fta^n"* 'fappi Musha io,rn D-e9ha Bonga ch;" Ct.t" - t-eito 91 1 119 258 215 340 40 14 173 243 *iis 79 *zoo- 276 911 173 14 243 325 40 266 276 69 215 340- 258 _11 64 119 215 911 'l 19 14 276 69 334 64 40 173 243 340 258 325 79 Ioo TOTAL 3726 3726 3726 2.9.3. 18 WHO/APOC, 24 November 2004 79 69 334 64 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? ' All project woredas and FLHF staff are now fully aware of the basic principles of CDTI and APOC's philosophy. Efforts are being made in incorporating CDTI into the overall health progr.Lm of each woredas and health facilities. This progress is mainly attributed to the frequent dialogues and feedbacks provided by project coordinators and senior level supervisors with woreda health office and FLHF staffmembers. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Worn off). How does the project intend to maintain and replace existing equipment and other materials? The project expects APOC's fund for replacement of all capital equipments that have been provided by APOC. The two vehicles provided for both Kaffa and Sheka zones are now completely worn out due to the bad roads and long period of service. Sometimes the rnaintenance of vehicles (the two cars and motor bikes) was taken care by the respective zonal health offices and the partner NGDO. Due to the nation-wide decentralization policy, the available office equipment and vehicles are used in the pool system at zorral, woreda and FLHF levels. Sourcc Type of cquipment APOC MOH** DISTRICT NGDO Others No. Condition No. Condition N o. Conditi on No. Condition No. Conditi on Toyota Hilux 4W pickup 1 CNFR 0 Motor cycles storage boxes 3 wo 0 Photocopier 1 CNFR 0 Fax machine 1 CNFR 0 VCR ,| F 0 Meqaphones 6 F 0 Typewriter 1 CNFR 0 Video projector 1 wo 0 Stensil Desiner 1 CNFR 0 Desk top computer 1 CNFR 0 LaserJet printer 1 CNFR 0 LaptoD computer 1 wo 0 Deskjet printer 1 wo 0 TV 1 CNFR 0 Overhead proiector 1 CNFR 0 Radio communication 1 F 0 Portable eleclric qenerator 1 CNFR 0 t9 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years The two zonal health departments (Kaffa and Sheka) have signiJicant contributions for the CDTI project in their respective projecl areas. This includes indirect contributions such as staf salaries, ffice supplies, utilities, communication, etc. In addition, CDTI activities are caruied oul in integrated manner and it is estimated amount . If there are problems with release of counterpart funds, how were they addressed The Carter Centre has transferred the necessary fund on time to both zones for performance of 2007 CDTI activities, but delay in liquidating the utilized anount is still a problem. ' Additional comments 3.3. Other forms of communiQl support Describe (indicate forms of in-kind contributions of communities if any) The CDDs who givefree service are part of the community and the community at large does support the program even-lhough it might not be quantified in monetary value. 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations a ! exchange rate to local currency. Indictate exchange rate used here IUSD = 9.00 Contributor Year 3 (2004) Yerr 4 ('2005) Ye* 5 ('2006) Yerl 6 ('2007) TOTAL Cash Budgeted rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgded (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Rcleased (uss) MOH (Central + Statc)* 0 0 0 0 DNA DNA 0 0 MOH (District + zone)* 0 0 0 0 DNA DNA 27,255.00 27,2s5.O0 I-ocal NGDO(s) ( if any) 0 o 0 0 DNA DNA 0 0 NGDO partner(s) 84,U6 84,846 r 5,980 28,068 3 I,037 3l ,037 72,920.00 72,920 00 Cornmunitiest* 0 0 0 0 0 0 0 0 APOC Trust Fund 2',1,000 15,000 12,882 0 0 0 0 0 TOTAL I 11,846 99,E46 28,862 28,068 31,037 31,037 5 1000.00 51000.00 20 WHO/APOC, 24 Novemb er 2004 A!q"rry Expenditure ($ us) Source(s) fundins of _p.e.gdly9'y_t_o*-\9f E_LtQergelg central collection gl-csuu4rry Mobilization and health education of communities NGDO8160.00 Training of CDDs of health staff at all levels 0 16108.00 NGDO NGDO and distribution Intemal monitoring of CDTI activities 9690.00 4080.00 NGDO NGDO Adyggf"yU_r{_r!o_-h_e_?l$-and authorities IEC materials SUttt+u.y, GqportulC) forms for treatment -EEr&{-l4elqrerc}v!_l-cv9Eutsq,9Elg99_9".___ o-lEggEf,tip.p"n!*(g€_c_o_Tprl!9lt,pgr1[e-19elc)._ Stationary and printing 12696.00 5,104 742 2,120 0 729 NGDO NGDO NGDO NGDO Fuel and oil 54.00 NGDO Others 13,437 TOTAL 72,920 Total number of persons treated 843737 Table 14: Indicate how much the project spent for each activity listed below during the reporting period* *It is extremely difficult to separately quantify the amount of money allocated from MOH, it includes staff salary, fuel and other expenses incurred for the integrated CDTI and other PHC programs. r+The above table contains the budget expenditure of Kaffa and Sheka zonei. a 2t WHO/APOC, 24 November 2004 SEGTION 4: Sustainability of GDTI a 4.1 . 4.3. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF monitoring by The Carter Center 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. sustainability of projects: plan and set targets (mandatory at yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? When was the sustainability plan submitted? 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 andmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented !ntegration a Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin deliverymechanisms Since the inception of the project, Ivermectin delivery has been fully integrated into the existing PHC program at all levels. 22 WHOiAPOC, 24 November 2004 4.3,2. Training: CDTI is integrated with the Primary Health Care (PHC) from the beginning. At the National, Regional, Zonal, and Woreda levels. The Malaria and Other Vector-borne Diseases Prevention and Control Units are responsible for the CDTI progftlm. Therefore, all the staff of these units have received training on Onchocerciasis. Training of peripheral health workers has been carried out in an integrated manner with other PHC programs. 4.3.3. Joint supervision and monitoring with other programs As part of the system in the country, all supervision and monitoring activities are carried out in an integrated manner with other health program activities. 4.3.4. Release of funds for project activities The project accomplished the 2007 Mectizan treatment activities by the fund released from The Carter Center and MOH which is used in an integrated manner with other health activities. 4.3.5. Is CDTI included in the PIIC budget? CDTI is one of the priorities for the ZHD. Although there is no specific budget line item for CDTI from MOH, it is implicitly included in the health department's budget with other PHC activities. 4.3.6 Describe other health programme that are using the CDTI structure and how this was achieved. What have been the achievements? Health campaigns such as malaria control and prevention, Polio eradication and EOS do use the CDTI structure. CDDs are the core partners in those activities. . 4.3.7. Describe others issues considered in the integration of CDTI. The government's Health Extension package at Kebele level having HEWs and health posts is playing a major role for the integration and sustainability of the program. Each kebele has its own administration which takes care of political, social and economical issues. 4.4. Operational research I 4.4.t. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Operational research was not done in this physical year even though discussion is under way with Jimma University 4.4.2. IIow were the results applied in the project? I 23 WHO/APOC, 24 November 2004 SECTTON 5: Strengths, weaknesses, challengesr and opportunities Strengths: The project was able to accomplish 100% geographical coverage and 79o/o therapeutic coverage getting fund from MOH and The Carter Centre for the 2007 Mectizan distribution. . The community is highly aware of Mectizan treatment and does cooperate in the implementation phase. Integration of CDTI with other PHC programs is in good track Weaknesses: Intensified supportive supervision is lacking at all levels, delayed reporting from the lower level and poor financial utilization and liquidation were core problems of 2007. Opportunities: The expansion of government structure down to kebele level and taking the responsibility of developmental activities is a good opportunity for sustainability of Onchocerciasis control. The Health Extension Package program having HEW and health post in each Kebele is also another good opportunity for follow up of the progrilm. Threats (Challenges): High tumover of trained health staff and overburdening of the existing staff with so many activities is a great challenge for the project. SEGTION 6: None Unique features of the projecUother matters 24 WHO/APOC, 24 November 2004