Sheka CDTI annual project technical report submitted to Technical Consultative Committee (TTC) : January 2013 to December 2013

COUNTRYAIOTF: ETHIOPIA Proiect Name: Sheka Approval yeaf: 2000 Launching year: 2001 Reporting Period From : Ja.n.qa.ry.2.8.1.3........ (Month/Year) To ;.....D e p.e..mh s.r..2 0.1- 3...... ( Month/Year) r of this ort: circle one t 2 3 4 s 6 7 8 910 lttz Date submitted: Februa ry 10,2014 NGDO partner: The Carter Center rl U ) The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FO SI]BMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) a h ( I WHO/APOC, 24 November 2004 I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSTILTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: f Country Ethiopia National Coordinator Name: Mr. Oumer Shafi Signature Date: Zonal O n c ho C o o rd i nato r Name : A..d.a.mu. Aysn.qw Signature Date NGDO Reoresentative Name: Dr. Zerihun Tadesse Signature Date: This report has been prepared by Name : ...Adamu..Ay.enq.w........ Des ignatio n : Zone Onchocerciasis Coordinator Signature 1l Date WHO/APOC, 24 November 2004 a i' I I I ! I I I I I Table of contents ACRONYMS.... DEFINITIONS ........... FOLLOW UP ON TCC RECOMMENDATIONS.......... Exrcurrvr SunltnanRv... SECTION 1: BACKGROUND INFORMATION..... L.1. GTTTRRIINFoRMATIoN 1.2. Popumrroru SECTION 2: IMPLEMENTATION OF CDTI 2.1,. Ttue ltrue oF AcIVtIES 2.2. Aovocacy... 2.3. MoalLtzArtoN, sENSrrzATroN AND HEALTH EDUCATIoN oF AT RtsK coMMUNtlEs.... 2.4. Courvururw 1ruvo1vrurruT..............., 2.5. Capacrw BUTLDTNG 2.6. TnEerve rurs IV V I 1 2 2 4 5 5 6 6 6 7 9 2.7 2.8 2.9 Onorntruc, sroRAGE AND DELtvERy oF tvERM Ec1N............... Corvrvururry sELF-MoNtroRtNG AND SrarrHotoe ns Mrrrrruc Supe nvtstott r3 t3 t4 l5SECTION 3: SUPPORT TO CDTI........ 3.1. Eeurprrltrrur 3.2. Frnerucral coNTRtBUTtoNs oF THE pARTNERS AND coMMUNtlEs.......... 3.3. DescRtsr (truotcarr FoRMS oF rN-KrND coNTRrBUTroNs oF coMMUNtlEs rr aruv)...... 3.4. ExPENDTTURE PER Acnvtry. 4.L. lnrrnruRl; TNDEeENDENT pARTtctpAToRy MoNtroRtNe; EvnluRrtoN .................. 4.2. SusrnrNaarury oF pRoJEcrs: eLAN AND sET TARGETs (uaruoaronv ar Yn 3) ....... 4.3 lruteenRrroru .. SECTION 4: SUSTAINABILITY OF CDTI ................16 .........15 ....,....15 ......... l6 .........16 t6 l6 t7 4.4. OprnnroNAl RESEARcH ............. ................ 18 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........18 18 D lu 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 TUG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization lv WHOiAPOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities u,ithin the project area (based on REMO and census taking). (i i) Eltetble population: calculated as 84%o of the total population in meso/hyper-endcmic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper- endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be trealed 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). (v) t Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) 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 service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. v WHO/APOC, 24 November 2004 Number of Recommendqt ion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECI FOR TCC/APOC MGT USE ONLY 1 More work is needed to maintain coverage at least 82%. The project is mointaining therapeutic coveroge in the severol yeors 82% lost 2 Health education is to be intensified; lntensified heolth educotion ond i m p rove d treatme nt cov e ro ge 3 CDD to the population is still high at U150 and the low ratio of female CDD CDD to populotion rotio is 1/37. Rotio of Female CDD was 67%, which is very encouroging FOLLOW UP ON TGG REGOMMENDATIONS TCC session Executive Summary . Background on treatment and population data Community Directed Treatment with lvermectin (CDTI) has been successfully implemented in Sheka zone of South Nations Nationalities and Peoples Region (SNNPR) since May 2001. Sheka CDTI project is having 3 rural woredas and 2 administrative towns ( Masha and Teppi). The project has achieved a geographic coverage of LO\% and the consecutive therapeutic coverage of the project in the last L2 years is indicated below:- YEAR Population Total population of the meso/hyper-endemic areas Annual Treatment Objective Number of persons treated Therapeutic coverage (%) ATo coverage (%) UTG Coverage (%) 2001 186,088 \54,O22 137,065 74 89 89 2002 196,935 155,168 L57,22t 80 95 95 2003 191,861 15s,000 150,865 79 91 91 2004 18s,846 7s5,ttt t48,460 80 95 95 2005 190,3 19 159,868 757,77L 80 95 95 2006 195,498 L57,L98 L54,402 79 95 96 2007 193,135 162,233 153,807 80 94.8 94.8 2008 213,1.54 179,058 76L,892 75.9 90.4 90.4 2009 212,414 L78,428 777,168 80.6 95.9 95.9 2010 214,349 180,053 177,540 82.8 98.5 98.6 2011 219,47L 184,305 t66,474 75.9 84 84 2012 218827 183810 178983 82 97 97 1" round 226869 190570 185687 81.8 97.4 97.4 2nd round 2,',20L9 178,096 L792Lt 84.5 101 101 a WHO/APOC, 24 November 20041 Background on population movements The communities at Sheka zone are mainly settled farmers, daily laborers, civil servants, tea and coffee plantation workers. Due to its cash crop (coffee and tea) many people from all over the country come to pick coffee and tea. There is a population increase during Mectizan distribution period for many people migrate to work in the coffee, tea and spice farms. The main economic source of the Zone is lnset, honey, coffee, tea and spice. Challenges and how they were overcome Threats (Challenges) . Delayed Mectizan arrival in the L't round has forced us to carry the MDA campaign in the big rainy season . Overlapping of other health campaigns such as Polio and EOS o Village registers were not properly updated e HC and HP relation as well as supportive supervision from HCs was not strong . Delayed report in some kebeles To solve this problem the following measures were taken:- . Efforts have been made to accomplish the 1't round MDA successfully . The HEWs and the CDDs were forced to do all health campaigns side by side during the MDA session . The HEWs updated their village register after the CDTI training ' Experts from the ZHD and WoHOs were assigned to each woreda and Kebele to help the HEWs in report compiling SECTION {: Background information L.L. Generalinformation 1.1.1 Description of the project Geographic !ocation, topography, climate A. Sheka Zone Sheka is a Zone in the Ethiopian Southern Nations, Nationalities and Peoples Region (SNNPR). Sheka is bordered on the south by Bench Maji, on the west by the Gambela Region, on the north by the Oromia Region, and on the east byKeffa. The administrative center of Sheka is Tepi. Sheka is the western part of former Keficho Shekicho Zone. Population: activities, cultures, language The communities in Sheka Zone are mainly settled farmers, and 8L.8% rural and L8.2% urban dwellers (government employees, merchants, daily laborers, and tea and coffee plantation workers.). The ethnic composition of Sheka Zone is quite diverse today. Of the total population, the the major ethnic groups are: 34.7o/o Shekacho, 20.5% Kafficho, 20.5o/o Amhara, 9.6% Oromo, 5.0o/o Sheko, 4.8% Bench, and 2o/o Mezengir. Communication system o All the five woredas are accessible by road throughout the year. o Network access is available in allworedas Administrative Structures :- o Districts - 2 urban and 3 rural o Kebeles - 62 o Development units 'L289 l't round 20L3 2 WHO/APOC, 24 November 2004 District Number of health staff involved in CDTI activities Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage Br=Bz/ Br *1oo Andracha 43 4L 95 Masha 65 65 100 Masha Town 26 10 38 Tepi 27 L7 63 Yeki 77 80 1.O4 ZHD 72 L2 100 Total 2s0 225 90 D istrict Number of health staff involved in CDTI activities Total Number of health staff in the entire project area B1 Number of health staff involved in CDTI B2 Percentage B?=B?/ B1 *100 Andracha 64 64 100 Masha 69 68 99 Masha Town 42 42 100 Tepi 1.4 t4 100 Yeki 1.4 14 100 ZHD 1.7 11 100 Total 21,4 273 100 HEWs and other health workers are involved in the CDTI activities 2nd round 20L3 HEWs and other health workers are involved in the CDTI activities L.L.2. Partnership The CDTI program has strong partnership which is very essential for its great achievement and gradually ensures its sustainability. The main partners involved are Federal Ministry of Health, Regional Health Bureaus, Zone Health Department, WoHOs, Zone and Woreda Administration, Zone and Woreda Finance offices, the community, The Carter Center Ethiopia and APOC(WHO). o The ZHD, WoHOs, APOCand The Carter Center Ethiopia are involved in planning, training review meeting, monitoring and Supervisions. o The government, APOC and TCC/E provide financial, logistics and technical support o The community is involved in supporting the CDTI activity by selecting CDDs and community supervisors, decide on mode of Mectizan distribution, dates, and sites. 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L a,E (o (J(o LE L ca r{oN E'cJ o ! cN rn FIo c! -o c f, o FI h(u Pc g f,() -F.go:(r; *r(uOE o -L y .98+.9GEEeo:tre -onB _v.: o.E.E ,>.=Ei?EI Ef ..toN;Y z EiOEE I.-l-F F ,ri'(, ol ltJ -.: =lO ..j g 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. ln the 1't round 239 Tonal and Woreda level political leaders/administration staffs,HEWs& 133 other HWs were mobilized and trained. ln the 2nd round 117 Kebele leaders, 87 HEWs, 178HWs and 38 zone and woreda administrators were mobilized 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done at each village by organizing community meetings. Kebele Leaders, HC staff, Community Supervisors, HEWs, and CDDs were responsible in mobilizing and giving health education to the community. lnvolvement of Kebele leaders was so effective in mobilizing the community through the newly setup government structure called 1:5 connection and development unit. 2.4. Community Involvement Communities artic ation in the CDTI Please odd more rows if necessory) 1't round 201-i Table 4: Communities pa ation in the CDTI (Please odd more rows necessory) 2nd round 6 Number of communities/Development unit with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs District/tGA Total no. communities in the entire project area Ba Number with community members as supervisors B5 Percentage 8r= Bs/ 81 +100 B1 Male CDDs Female CDDs B1 Total Be= Br+1. Number of communities with female CDDs Bro Percentage Brr= Bro/8..100 Andracha 85 85 100 2L5 L57 372 79 93 Masha 138 138 100 379 196 575 98 7L Mamateriasl sha town 42 42 100 53 46 99 23 55 Tepitown 45 45 100 193 9L 284 45 100 Yeki 340 340 100 LL4L 709 1850 340 100 Total 650 6s0 100 1981 1199 3180 585 90 Number of communities/vllla8es with community members as supervlsors Number of CDDs and the communities involved Number of communities /villages with female CDDs District/tGA Total no. communities in the entire project area B4 Number with community members as supervisors B5 Percentate 86= Bs/ 84 r100 Male CDDs 87 Female CDDS 88 Total 89= B7+BB Number of communities with female CDDs 810 Percdntage 811= 810/84i100 Andracha 165 16s 100 322 32s 647 694 100 Masha 175 175 100 377 267 638 L34 76 Masha town 42 42 100 0 168 168 163 98 Tepitown 213 213 100 0 to44 LO44 2L3 100 Yeki 694 694 100 7170 2000 3170 42 100 1289 L289 100 1863 3802 5667 7245 97Total WHO/APOC, 24 November 2004 Comment on: , Attendance of female members of the community at health education meetings Female health education attendants are increasing from year to year due to the awareness created by different groups including CDDs and HEWs. The present government structure called 1:5 connections is also playing a great role to get female health education attendants. Most of 1:5 structural connection leaders and members are female ones. Therefore, this structure has helped to involve more female health education attendants. ln general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). The female health education attendant is rated as very good at present. Because they are the ones leading the CDTI activities at community level. Incentives provided by communities for the CDDs All in all CDDs are volunteers, but some time community members do invite them with coffee and food during MDA Attrition of CDDs. ls attrition a problem for the project? lf yes, how is it addressed? o At present CDD attrition is not a problem. Because theywere selected with active participation of community members. 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels. o Retraining and training for HWs, HEWs and Political leader at all levels is given twice per year before MDA starts. The training is facilitated properly using training manuals by TCC/E, ZHD and WoHOs. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most importont issue to describe is what meosures were taken to ensure odequote CDTI implementation where not enough knowledgeable monpower wos availoble or if staffs are frequently tronsferred during the course of the compaignl. o There was no transfer of trained health staff during the MDA session.But,there was lack of proper supportive supervision from WoHO and HC staff. 7 WHO/APOC, 24 November 2004 n .Table 5a: Training at the different levels of CDTI implementation (Please odd more rows if necessory) Tround Number of Districts/ staff trained Number of Health center/post staff trained District/LGA ATrO Cr : C2+Cr New totQ= Cz Refr Ct ATrO Cs New Cc Refr Ct i rotq= i Ce+ Cr Number of other trainers of trainees ( TOTs) (Administrative staff) Relr Cu New Crc ATrO q TotCrr= C1e+C11 Andracha 13 132 i 11 26 4i 2zi 26 3 3 30 Masha Woreda 16 162 !4 38 sl 33i 38 4 4 0 4 Masha town 5 0 5 5 3 oi 3: 3 0 0oi o Tepitown 10 100 10 7 0: 7 7 2 2 0 2 Yeki t9 19 190 57 6i 51: 57 7 1. 0 7 7HD 27 270:27 0 oi 0 0 7 7oi7'i TOTAL 93 4:89r93 131 13115 : L16 t7 10 I t77 % Achievement 100 % Achievement 100 % Achievement 100 Nt ATI C,: 1 * 'New', 'Refi'/ : lf detoil not ovotloble, provide the corresponding totol only. Moke sure thot therc 6 no double counting. Table 5b: Train ing at the different levels of CDTI implement ation (Pteose add more rows if necessory) 2nd ro, Number of Districts/ staff trained Number of Health center/post staff trained Number of other trainers of trainees ( TOTsf (Administrative stafff District/LGA ATrO Cr New Cz Relr Cz : Totq=i c:+ c: ATrO Cj New TotC.= c5 Refr Ct Cc+ Cz ATrO q New Cn Refr i TotCr= cu i cro+crr Andracha 13 0 13 13 29 0: 29t 29 33 33 io i33 Masha 16 0 16 16 52 0 52 52 35 35 0 35 Masha town 8 0 8 8 6 5 L 6 6 6 0 6 Tepitown 10 0 10 10 4 0: 4i 4 8 8 0 8 Yeki 19 190 19 45 0: 45i 45 39 39 0 39 ZHD 11 11 LL0 0 00: 0 0:010 TOTAL 77 770 77 136 5i 131: 136 127 727i 0i 121, % Achievement 100 % Achievement r 100 % Achievement 100 6 7 1( ATr( cr: 1 3 2l ' 'New', 'Reft' : lf detoil not ovoiloble, provide the corresponding totol only. Moke sure thot there is no double counting. 8 WHO/APOC, 24 November 2004 Table 6: Type of training undertaken (Tick the boxes where specific training wos corried out during the reporting period) 1't round and 2nd round 2013 Table 6: Type of training undertaken Any other comments 2.6. Treatments 2.6.L. Treatment figure lf the project is not achieving 100% geographical coverage and a minimum of 75% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this Therapeutic coverage of L't and 2nd rounds - 81.8% and 84.5% respectively ATO of lrst and 2nd rounds -g7.4% and hOL% Geographic coverage 7OO% in both treatment rounds Therefore, the geographic and therapeutic coverage's are to the set standard 9 Trainees Type Of training CDDs Other Community members e.g Communrty supervisors Hea lth Workers (FLH F) MOH staff or Other Politica I Leaders Others (specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis WHO/APOC, 24 November 2004 .f, ON L(.) -oF 0,) o z .i- N _a(J \J o- o > r eEEPaI E=iE,Ib..;- :gEE E o o o o o o o E c I -^ c o o c jj ='= > odisEaa o o o o o o Eoo6y i 6d @;EE E E!'OiE : g€ # g o o € Fl c\t r{o sf o O) rl(o o3 Eg!cEo :6j3 stN ot c{o Ot rJ)(n(n rl r.r.| r.. @ rn sl rl CN oo * a ^ll \96 0 .9 5., 8.F OLE9toFU ro @ rJ)6 Otr\ @r\ (o@ r/)@ o o b=o!:oEF6 =agz di ln sl ol Fl c{ ."1r\ rn r-l rn € rn c{lc) o r{6 ol ci F. sf(o O) O) r_l rl N Ol NFl o Eo@> 6Efl =tu = o'F <FO t,l,NN a{ @ r\l rlFt(o 6 c!('o(.o NoN r{f{ (n @ oo(o O) (o O)o @r\ rl c .9 s =o oc bt -o =>tsnAE E oEoo'= E E +;, sf Ol <l(ON N rnor\ ao r'{ ot@N osfr{lrl r\l r\ rnfn r/) F{ F{ Or FloN rl N oC' * o ^X\90 0 ; .9{o F'Ha:oY3g oo oo ooH oo oo oo ='t *.EE :EE3EE :EOi I Pd rJt(O r-l lnNri c{ <t (o rl c{ sf Ol(o Ol6N 6 _9.>6E? =f;uE 9!- <FO rn(o r{ rnr\ Fl N <l rnr'{(\.l sf Ol(.D or CX'N F{ o@g 5 .g2cJ E E oU o.= o n d ,='E - -g Ef nEt#EIHa l/'l(O r{ rJtr\ c{ N <t (n d N st Ol r€| o €(,N F{ 6 oF ! c 3 oF(! vl(o (! EIA(o (!sU(o LE - s\ G(/) r/t qJ(J AJtrS tai o qJ o E !B o qJq B AJ o- Jtn '= P(o (o(u L(o (o .= (9 J P(J '= P .ul -o -o VIIJ VI Ec(o PC oEm (tl AExF .E' ... cFl =oJl o -lLol-ol EFI NE o -V c =oF (o vt(! l! -cvll! (o .C,(J(! LE - .9<!(, i5\ b e5E h 6!E i+XUaoo;<=!r5-t;Eo o o o o o o ts - " -^ISHE'I EEiH6 o o o o o o E-E -C LC-O -3 95 e EEE;=Ez *-= ! o o ooOl ri r- rn c{ r\o r{ N$tl oBbs!cco f, z@ sl6 rn r\N (O co Fl olo Fl rl LN(n CD rl 6(n ,:2 foo @ oE F o @6 o o oo t o ^ll\50 0 .J] N 6 q Olr\ n r{ @ \ Orr\ q N @ q Fl @ o o b=o E"E* tn,Oz a! t/t(o Ol Fl N rc)(O rno rn ro sf rnr\ (0(o r\ OtFl sf sf € t.r)o Fl 6(o ulqt F{ 6 LOq> 6E! =6o = '=iF6 tro(n NN ro(n N c\t(n ro @|.\F sf(n €oN otn(n r\o Fl or\Ino CD Fl c o :lol olal t* -o5> E;P6.q6 oEeo= E E ",+ €=5d st c!(o(o N r.O r\ rf) @(n cn r.c) N CN No@ stN @ olr\r\N r{ gr(oqt(o NN E .9o *o 9 sH *-cob oE : c'rL-\(, u960 oo d oo oo oo d oo oo LN oo @(o ri N sl LNsf o st(n o!n(o oo.=>s @) oE-c gEO o=c :EOEEoiEEa o Coo>qE6 =6or.u! <FO rn @ @ fi.) r-{ r{$ LNst ost(n orn(o rn @ @(n Fl (\ <t rn st o sf(t') ol'l ro .3Ef c o Eo o @ oo .oiCf E E oU o,= oo .!l *- iEd' s+eEs* s o(/)(4 qJ(.) qJ sb 14i o\ AJ o c\B B AJ(4 trqJ o- .Ytn 'g- (o u)(!(u L(o (o .= (9 -J +)() L P .tnE -o vtl! ,Jl E C(! c(u Em Z?l ,"'i OiNFE r-f IIJol o -ol L(ol; Fl F{ Formula for computing therapeutic and geographical coverage Thera peutic coverage rate %l the project area Geographical coverage rate (%l REMO in the project area Number of people treated x 100 Total population living in meso/hyper-endemic communities within Number of communities/villages treated x 100 Total number of meso/hyper-endemic communities as identified by Number of pcrople tI€ated x 1Qo Annual Treatment Objective Number of people treated x 100 ATO coverage rate (%) % UTG achieved Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG) 2.6.2 What are the causes of absenteeism? a ln the l't round delayed lvermectine arrival was the main cause. MDA was carried out during farming period ln the 2nd round some people have gone to other neighboring woredas to work in the coffee farms a 2.6.3 What are the reasons for refusals? . Lack of awareness. . Government employees think that Black Flies are not found in towns and no transmission . The signs and symptoms of the disease is no more seen in towns and people are reluctant to take lvermectine 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 lnformation when available. Serious adverse effects (SAEs)were not observed during 2013 Mectizan distribution periodI ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. 2.6.5. Trend of treatment achievement from CDTI project inception to the current year . Therapeutic and UTG coverage of this project is satisfactory and it is to the set standard ,/No SAE case to report ll WHO/APOC, 24 November 2004 Table 9: Treatments and coverage bv calendar year for the entire project area. Please indicate the UTG for the project area:- 190570 and tzgogo 1't and 2nd rounds 2013 (use this figurc calculations.) ulation Number persons t Et 1_37, 1,51, 150, t48, 151, t54, 153, 1.61, t7L, 177, L66, 178, 185 179 t2 Communities/Development units YEAR Total # of communit ies/Dev. Units in the meso/hyp er- endemic areas Er Annual Treatment Objective E2 Number of communitie s/Dev. Unit treated E3 Geographi cal coverage (%l Er= E3/ Elr1oo ATO coverage (%l Er= E3/ E2r100 Total population of the meso/hyper- endemic areas Er Annual Treatment Oblective Et 293 293 100 100 186,088 154,0222007 293 100 196,935 165,1682002 293 293 293 100 2003 293 293 293 100 100 191,861 165,000 100 185,846 156,71.72004 293 293 293 100 200s 293 293 293 100 100 190,319 159,868 293 100 100 196,498 t57,1982006 293 293 2007 577 577 571 100 100 193,135 1,62,233 100 100 273,!64 179,0582008 618 618 618 tl8,4282009 627 627 627 100 100 212,474 647 647 100 100 2L4,349 180,0532010 647 184,30520tL 639 639 639 100 100 2t9,4tt 642 642 642 100 100 2L8821 1838102072 100 226869 1905701't round 2013 650 650 650 100 1289 1289 100 100 2120L9 778,0961't round 2013 1289 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (pleose tick the appropriote onswerl MOH g WHO E UNTCEF E Other (please specify) Mectizano delivered by - (please tick the oppropriate onswerl MOH g WHO E UNICEF E NGDOE a NGDOE Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests Mectizan from MDP. After the drug reaches the country it is stored at FMoH warehouse from which TCC/E transports to the project zones. From the zone the Woredas receive and distribute to the health centers. lt is from the health centers that the community supervisors (HEWs) get the drug and handover to the CDDs and the CDDs to community. Table 10: Mectizan@ lnventory (Please odd more rows if necessory) District/LGA Number of Mectizant tablets Carried from 20L2 Received in 2013 1" round Total available Used Wasted Remaining Sheka 28863 1060000 1088863 t02L7L5 548 66500 How are the remaining ivermectin tablets collected and where are they kept? o At the end of the treatment period, the CDDs return the remaining drug and the village registers to HPs and the HEWs submit their compiled report and the remaining Mectizan to the HC. The HCs to the WoHOs where it is kept. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Mectizan delivery systems:-(FMoH}TCC/E >ZHD>WoHOIHC>HPICDDs) Community) Training of HWs, community supervisors and CDDs Supervision and monitoring Recording and reporting Return the left over Mectizane (CDDs ) HP > HC> WoHO) Annual review meeting at Zonal and Woreda level MDA coverage survey 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? lf so, When? o Training was given to HC and HP staffs on how to conduct CSM during the CDTI training sessions o Four development were supposed to be randomly selected and 10 people from each development unit in 10 HHs were to be interviewed by independent interviewers. o The questioner was supposed to be analyzed by the HEWs and the Kebele leaders so that the strength and weakness of the program wasevaluated andpresented to the community. 13 WHO/APOC, 24 November 2004 Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total fl of communitres/Dev. Unit in the entire prolect area No of Communtties that carrred out self monitoflng (CSMI No of Communrties that conducted stakeholders meetrng (SHM) Andracha Masha Masha Town Tepi Yeki 165 175 42 213 694 165 775 42 273 694 165 775 42 213 694 Total 1289 L289 L289 Describe how the results of the community self- monitoring meetings have affected project implementation or how they would be utilized during the next treatment cycle. . Based on the result the strength and weakness of the program was revierved with the community. . The communities were rvell aware of the program and are willing to take Mectizan twice per year . Communities witnessed that CDDs and site selection, as well as mode of Mectizan distribution is decided by the community members.. 2.9. Supervision 2.9.L. Provide a flow chart of supervision hierarchy. NOTF)RHB)ZHD) WoHO ) HC)HP ) CDDs The flow chart is not some times regularly and continuously moving forward as it ought to be a a 2.9.2. What were the main issues identified during supervision?! Proper selection and training of additional CDDs and community supervisors Delayed Mectizan arrivals in the 1tt round . Overlapped health programs during the 2nd MDA r The newly setup structure of 1:5 connection and development unit was being used successfuly . Village registers were not updated . Number of absentees is still high but refusals have decreased . Lack of continuous and regular supervision at WoHOs and HCs level. 2.9.3. Was a supervision checklist used? Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? r Village registers were revised and updated r Reports were compiled properly . WoHO and HC staff were assigned to support the HEWs , MDA was facilitated properly by the HEWs and HWs 2.9.5. Was feedback given to the person or groups supervised? o Feedback was given at the spot during supervision o Written feedback was given to each supervised woreda and HF 2'e'6' H ow wa st t "J;:::i::;,11 ilIfi ;[:::"Tera I I perro rm a n ce or t h e p roi ect ? The report quality in some HPs has improved The 2nd round Mectizan has arrived on time 14 WHO/APOC, 24 November 2004 Source Type of equrpment APOC MOH++ DISTRICT NGDO Others No. Condition No Condrtion No. Condr tion No Condrtion No. Condrtr on Toyota Hrlux 4W prckup 7 F 0 0 0 0 0 0 0 0 Motor cVcles storage boxes 0 0 0 0 0 0 0 0 0 Motor cycles 4 F 1 F L4 F 0 0 0 0 Photocoprer 1 NF 1 NF 2 NF 0 0 0 0 Fax machrne 1 NF 1 NF 0 0 0 0 0 0 VCR 0 Megaphones 0 0 0 0 5 F 0 0 0 0 Typewriter 0 0- 0 n 0 0 0 0 0 0 Video projector U 0 0 0 0 0 0 0 0 0 Stensrl Desrner 0 0 0 0 n 0 0 0 o 0 Desk top computer U 0 1 F 5 F 0 0 0 0 LaserJet printer U 0 I F 5 F 0 0 0 n Laptop computer 0 0 0 0 0 0 0 0 0 0 DeskJet pnnter 0 0 0 0 0 0 0 0 0 0 TV 1 NF 0 0 0 0 0 0 0 0 Overhead prolector 0 0 0 0 0 0 0 0 0 0 Radio communicatron 0 0 0 0 0 0 0 0 0 0 Portable electfl c generator 1 NF 0 0 0 0 0 0 0 0 SECTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipme nt (Pleose odd more rows if necessory)7st and td round *Condition of the equipment (F=Functional, CNFR=currently non-functional but repairable, WO=Worn off) 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Contributor Year 11 ('2011) Year 12 ('2012) Year 13 (2013) TOTAL Cash Budgeted (USS) TOTAL Cash Released (uss) TOTAL Cash Budgeted (USS) TOTAL Cash Released (uss) TOTAL Cash Budgeted (uss) TOTAL Cash Released (uss) MOH (Central + Sstate)* DNA DNA DNA DNA DNA DNA MOH (District + zone)* 27,426.42 27,426.42 1,4074.18 14074.18 tl4t7 5.48 114175.48 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partners(TCC) 6046.70 6046.70 8384.O2 8384.02 67,955.95 67,955.95 Communities* 0 0 0 0 0 0 APOC Fund Trust 13,860.51 9952.97 1659.19 1659.19 L236.99 1236.99 TOTAL 47,333.63 43,426.09 24,717.39 24,'1,17.39 183,368.42 183,368.42 *MOH contribution is for Focal person's salary and running cost too. , lf there are problems wath release of counterpart funds, how were they addressed The government and TCC/E's budget was released on time where as there was delay of APOC's budget released 15 WHO/APOC, 24 November 2004 3.3. Describe (indicate forms of in-kind contributions of communities if any) o The communities do support the CDDs by providing coffee and food and contributed on other community social activities during MDA 3.4. Expenditure per activity In table 14: the amount expended during the reporting period for each activity listed and the amount expended in US dollars using the current United Nations exchange rate to local currency are listed. The exchange rate used: IUSD : 18.6 Table l4: Type of activity. expenditure and source of fundine durine the reporting period of 2013 SEGTION 4: Sustainability of GDTI 4.L. lnternal; independent participatory monitoring; Evaluation Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable)- Not done 4.t.L Year 1 Partic ipatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation 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 Activify Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization, Advocacy and sensitization Training and Health Education CDTI Activities Supervising and Monitoring Supervising and Monitoring Others 5 5.87 7523.57 14,810.45 1t4,175.48 1236.99 7,945.40 0 TCC TCC TCC MoH APOC TCC TOTAL 145,747.76 Total number of persons treated 1st round 2nd round 185,687 l79,2ll Was a sustainability plan written? Yes t6 WHO/APOC, 24 November 2004 tr When was the sustainability plan submitted? on the 3'd and 5th years What arrangements have been made to sustain CDTI after APOC funding ceases in terms of? o As agreed the government will take care of the project 4'2'L' t:"?LTt::::::,:i:Jil"1i,,,"*,. pran is prepared incruding cDr at ar revers by the 4.z.z. rrnoiouttn ment' - All health activities do share funds allocated from the government. One plan and one budget and one report is the set policy by the government 4.2.3 Transport (replacement and maintenance) o The government is replacing and maintaining Vehicles and motor cycles to be used for all integrated health services including CDTI for ZHD, WoHOs and HCs 4.2.4. Other resources o The government provides additional resources such as photocopier and printers to ZHD, WoHOs and HCs computers, Fax machine, 4.3 4.2.5. To what extent has the plan been implemented o Achieved therapeutic coverage of 81 - 85% lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: o All CDTI activities are implemented in an integrated manner with PHC o planning o Mectizan delivery and Distribution o Trainings o Supervision . Review meetings 4.3.L lvermectin delivery mechanisms Since the inception of the project, lvermectin delivery has been fully integrated into the existing PHC drug delivery system of the country FMOH>TCC/E >ZHD>WHOs>HC>HP>CDDs> community 4.3.2. Training: o All sorts of CDTI trainings are integrated with the other health service trainings. a 4.3.3. Joint supervision and monitoring with other programs o As a rule all supervision and monitoring activities are done jointly on integrated manner using the existing checklist. 4.3.4. Release of funds for project activities The government and TCC/E have released their fund on time where as APOC's fund was released late. a a a l7 WHO/APOC, 24 November 2004 4.3.5. ls CDTI included in the PHC budget? o Yes it is included 4.3.6 Describe other health programmed that is using the CDTI structure and how this was achieved. What have been the achievements? o Campaigns such as malaria prevention, Polio eradication, Meningitis A campaign and Measles vaccinations do use the CDTI structure. CDDs are always involved in these activities. o Describe others issues considered in the integration of CDTI. 4.4. Operational research 4.4.L 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 2OL3. 4.4.2. How were the results applied in the project? sEcTloN 5: Strengths, weaknesses, challenges, and opportunities Strengths: Geographic coverage- LOO% and High therapeutic& UTG coverage The new strategy of MDA, twice per year done successfuly lnceased Nnmber of CDDs and community supervisors Weaknesses: . Number of Absentees is still high Opportunities: Assignment of 2HEWs to kebele level, increased females' participation in communities Establishment of health development army lntegration of all health activities lncreased commitment of political leaders Threats (Challenges) o Late arrival of Mectizan o Overlapping of other emergency programs during Mectizan distribution period o High staff turnover (Health workers and HEWs) SEGTION 6: Unique features of the projecUother matters o The zone is implementing twice per year MDA, and for that the ATR format has to be modified and simplified too. o We have claimed separation of Kaffalsheka project as they are separated and became administratively independent zones since 2002. Thus, we request APOC to make it practical and send separate fund and resources to Sheka project. o a a a a 18 WHO/APOC, 24 November 2004 L a The Federal Democratic Republic of Ethiopia Ministry of Health I I T COUNTRYAI ETHIOPIA Proiect Name: Kaffa Approval vear: 2000 Launching vear: 2001 Reporting Period: F ro m : Jn n ue. r. y. 29 1?.......... To ;.... .D.e.c..e.m.b. .qr .? 9.!2.....(Month/Year) ( Month/Year) r of this rt: (circleone) | 2 3 4 5 6 7 8 910 11 Date submitted: 30 December 2012 NGDO nartner: The Carter Center WHO/APOC, 30 December, 2012I at i I G Table of contents 1.1. GpNeRelINFoRMATIoN............. 1.2. PopulerroN. SECTION 2: IMPLEMENTATION OF CDTI ..............6 2.1. TrvELtNe oF ACTIvITIES... 2.2. Aovocecv J 5 MOEILTZETION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES CouvttxtrY INVoLVEMENT Cepecrrv BUILDING. TRpRrveNTS..... OnoeRrNG, sroRAcE AND DELIVERY oF IVERMeCTIN............... Couutxrry sELF-MoNIToRINc aNo StarpHoLDERS MBerlNc.. SupeRvrstoN.... SECTION 3: SUPPORT TO CDTI....... .......16 3.1 EqurnveNr ...............t7 ...............183.2 FrNIeNctA,t- coNTRIBUTIoNS oF THE PARTNERS AND coMMIJNITIES..... 3.3. ExpeNolruRE PER ACTIVITY. ......19 SECTION 4: SUSTAINABILITY OF CDTI ................20 4.1. INreRNel-; INDEPENDENT PARTICIPATORY MONITORING; EVALUATION....................20 4.2. SusrnrNnsrr-rry oF IRoJECTS: ILAN AND sET TARGETs (ueNoeroRY AT Yn 3) .....20 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 6 6 7 7 8 9 4 5 5 1 1 1 2l 22 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTUNITIES .,...22 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATT8R5...........22 4.3. INrEcRenoN............. 4.4. OpeneuoNAl RESEARCH. 111 WHO/APOC, 30 December, 2072 t APOC ATO AtrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF TUG wHo Acronyms African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization lv WHO/APOC, 30 December, 2072 r) Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (i i) Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expictld to reach the UTG at the end of the 3'd year ofthe project). (iv) (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) 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 service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the 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. v WHO/APOC, 30 December, 2012 FOLLOW UP ON TCC RECOMMENDATIONS TCC session - Number of Recommendation in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT USE ONLY I UTG to be calculated at 84Yo and not 80% ofthe total poPulation. Based on the country's health indicator 4Yo are suppose to be pregnant mothers and 16%o are children less than 5 years of age which comprises 20%o of the population which are not liable to take Mectizan 2 Report on the reasons for and outcome of advocacy. Advocacy meeting was conducted with woreda political leaders so that community mobilization could be done effectively J Report on the use of media and community response to mobilisation and sensitisation activities Local medias have disseminated on Onchocerciasis prevention program with the local language of the community during Mectizan distribution period (20 12) 4 Address the issue of high refusals and high absenteeism. These issues have been discussed with Zonal and woreda political leaders and have agreed that 2 female and 2 male CDDs will be selected from each development unit. For 20 l3 to minimize this challenge 5 The issue of project equiPment, most of which are either written off and non-functional, needs to be addressed. This is an old project with l2 years duration and replacement is being done by the government. Most of the woredas are hard to reach and the Motorbikes in those woredas do not last long. Other equipments are also being replaced by the government. 6 Communities to decide on appropriate timing for drug treatment as the current Period coincides with farming season, Distribution timing, mode & site is decided by the community but some times delayed Mectizan arrival is the cause which coincides with farming season 7 Increase Therapeutic coverage to 80%. Therapeutic coverage has increased in 2012to79.7% which is almost 80% 8 Plan to undertake CSM ln2012 each kebele has practiced CSM at 4 villages. The communities have gathered and discussed on the strength and weaknesses of the CDTI program based on the CSM study result. 1 WHO/APOC, 30, December, 2012 Executive Summary . Bagkground on treatment and population data Community Directed Treatment with lvermectin (CDTI) has been successfully implemented in Kaffa zone of South Nations Nationalities and Peoples Region (SNNPR) since May 2001. Kaffa CDTI project is divided into 10 rural woredas and I town administrative, Bonga. The project has achieved a geographic coverage of 100%. The last 12 years therapeutic and ATO coverage of the project is indicated below:- YEAR Population Total population of the meso/hyper-endemic areas Annual Treatment Obiective Number of persons treated Therapeutic coverage (%) ATO coverage (%o) UTG (%) Coverage 200 I 716,599 100,820 96,244 80 95 l6 2002 731,756 365,852 358,996 79 98 58 2003 763J82 610,866 567,376 74 93 93 2004 795,3s2 668,096 620,182 78 93 93 2005 830,360 697,502 63s,995 77 9l 9l 2006 8l6,ll3 652,890 623,786 76 96 96 2007 877,490 737,092 689,566 79 94 94 2008 930,584 78 1,69 1 691,439 74 88 88 2009 948,859 799,143 753,81 I 79 94 94 20 l0 1,001,055 840,844 784,716 78 93 93 20tt 1,013,706 851,513 777,507 77 9t 9l 20t2 1,031,105 866,128 822589 80 95 95 Background on population movements The communities in Kaffa zone are mainly indigenous farmers, new settlers from other zones, semi- pastoralist, daily laborers, civil servants, tea and coffee plantation workers. Each year numerous numbers of people from all over the country come to Kaffa to pick coffee and tea. Challenges and how they were overcome Challenges o As usual lack of continuous supportive supervision at HF and WoHO levels using checklist. o Delayed report o High number of absentees and refusals o The set standard for CDD population ratio is not met (low number of CDDs) To solve this problem the following measures were taken:- . Discuision was carried on with the WoHOs so that continuous and regular supportive supervision could be carried on at all levels. r Reports were compiled based on the village registers' . Early treatment was done in order to decrease number of absentees and refusals, but still the problem is not alleviated yet. . Additional new CDDs were supposed to be added on, but this was not done. For 2013 Mectizan distribution period we have agreed with the zone and Woreda political leaders is to have 2 female and2 male CDDs from each development unit. Biannual Mectizan treatment will begin in 2013. 2 WHO/APOC, 30, Decemb er, 2012 Sectionl. Background 1.1. General information 1.1.1 Description of the project Geographic location, topography and climate A. KaffaZone Kaffa zone is located in the south West of the Ethiopia and the capital city of the zone, Bonga is about 469 km from Addis Ababa and746 km away from Hawassa, which is the capital city of the SNNPR. Kaffa is considered as the birth place of Coffie. Coffee and livestock are the main economic sources of the community. Its boundariei are Jimm a zone on the east, Bench Maji zone on the south and south west, Konta special woreda and South Omo on the south and south east, Sheka zone on the north east and Illuababora ,'on. o, the north. The mean annual rainfall is 100l-2200 mm, Agro ecology Dega 7.30yo, Woinadega 70.O% and Kolla 22.7%. Elevation- 501-5300 meters above sea level. Population: activities, cultures, language The main language of the Zone is kuffinuno. It is also the official language of the zone' Some of the inhabitants speak Oromifa, Amharic and other languages of the country. Communication system :- r Transportation: - All woredas do have all dry weather roads linking with the zone capital City. o Telecommunication: - All woredas do have a wireless telephone line and network access is available frequentlY. Administrative Structures o 10 rural districts o I town administrative o 313 kebeles . 2,65lOnchocerciasis villages. The number of villages at Gesha and Decha woredas have increased due to new settlement in Decha and restructuring of the villages in Gesha woreda. Table l: Number of health workers involved in Kaffa CDTI project. 2012 District Number of health workers involved in CDTI activities. Total Number of health workers in the entire project area Br Number of health workers involved in CDTI Bz Percentage B3:B2lBr *100 Adiyo t2t 70 58 Bitta 100 76 76 Bonga town 44 22 50 Chena 193 134 69 Cheta 7l 34 48 Decha 178 118 66 Gesha 122 108 89 Gewata r28 88 69 Gimbo 169 95 56 Saylem 80 72 90 Tello 104 67 64 Total 1310 884 67 - The above table indicates number of health workers and HEWs 1.1.2. Partnership The main partners involved are Federal Ministry of Health, Regional Health Bureaus, Zonal Health Departmenti, Woreda Health Offices, Zone and Woreda Administration, Education, Finance Offices, 3 WHO/APOC,30, December,2}l2 Communities, The Carter Center Ethiopia and APOC (WHO). There is close relationship among the partners. The Carter Center Ethiopia, ZIID andWoHOs are involved in planning, Supervision, conducting trainings and review meetings. Hlalth Centers and HPs implement the CDTI activities at the community level. 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Attendance of female in the community health education health education attendants this year. In the health service section l:5 unit comprises female unit members and most of the unit leaders are female too. Therefore, this structure has helped to involve more female health education attendants. In general, how do you rate the participation of female in the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). where high female l:5 connection team leaders who are responsible in every health activity. Incentives provided by communities for the CDDs As usual the community members sometimes support the CDDs working on their farm fields and some times they are invited to take coffee and food. The IIEWs do assign CDDs to participate in other health activities such as vaccination campaigns, and for that they are given small amount of per-diem as an incentive. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed?a 2.5. ln 2012 the number of CDDs have decreased from 20 I I .Additional CDDs were suppose to be recruited and trained, but still the expected number of CDDs (l:100 ratio) is not met. Therefore, we have planned with the Zone and Woreda political leaders as well as with ZHD and WoHs to recruit 2 female and 2 male CDDs from each development unit in order to increase the number of CDDs for 2013 Mectizan distribution. Capacity building Describe the adequacy and availability of knowledgeable manpower at all levels. - Yearly training and retraining is given for the HEWs, HWs and political leaders by the ZHD and TCC-E Staff, based on training manuals. Therefore, everybody is well aware of what is expected from CDTI program. Where frequent turnover of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if staffs are frequently lefi during the course of the campaign). Transfer of trained HWs and FIEWs during the Mectizan distribution campaign was not a problem. The HWs and HEWs were well experienced and there was no knowledge gap even though lack of commitment was observed in some kebeles. a a 8 WHO/APOC, 30, December, 2012 I N ON C) -o 0)a() n c.) d o o trr o\ ; c.)tr) \o ao sf I-r F- tr)\o t-- o\ v \o € ! r,a6 =\o ra) r t'-(r} o..l ; oo t-- ca € t-- oo c!\o ra| N\o co .+ t-- co$F- € oo oo Ns oo \o$ oo oo a € o o\\o ao o\\o a.) ;$ an \a) ct $ +.b$' -\a<9 6l t{ \)q)R Uil+9i UQ t-- oo cO F- oo c.) o t \o oo -oo\ q) q) q) I o\ € cl\o co F* \o c.t[a] sf r*r- o\\o co \n c.l rr\n c.too(-- tr- oo ca oo € € oo oo (J LF Eq) A 6lL ah n (J Lq) z o o o a o o q il^*o i - dd U Q +. n< S U5* q) c) q) I .\oaU Ll)to q) a!!6)L r-OE c) E.=E'= t E E'EtE r-'E: o<tl.l t, Y E.Ef;a = !s(J llzE?a o\o $ \o $ct oo $r- t/.| F- co o\ t c.t c.t oo c.)@ o € c.t s tr@ co t-- t--\o s\o c.t .f,\o \o $ r- \o oo € € c.l \o olel cn $(\ \o Q +IQ U +.$' ,p : S) R E,ut.lU o\ oo s + : c) q) q) I s co oo N6 t'-\o \ooo 6c\ c.) c.t caot-F U .t\o r* o Lq) q)() clq) trX XL tsEl6lZ-- t-- c* O\o \o ra) r.1 oo a o lrI r.1 k1 r,.i o $ $ \o \o + <f, ta-) tr} E 'tFU(J \) s +. F< > * \o \o r- o\o (.l oo ra)\0 r.1 $ \o str t-. d q) (ltr cl ah ah o L u2 L c)E z o G)F Fl F F q) q) q) CJ s .\ : (!, o c) (s an 0) o cg CB Bq) o p () 0.) >.(B a o ,bE (€ ca B o (d bo o ca a!0 o U (t o O Fl (J tr U2 c cc d(i i (H o E( q F C( + ( L d + ( + + t V 0 (l F N o co Table 6: Type of training undertaken in Kaffa. 2012 Treatments 2.6.L. Treatment figure If the project is not achieving 100% geographical coverage rate and a minimum of 75%o therapeutic coverage rate or if it is fluctuating, state the reasons and the plans being made to remedy this condition. Kaffa: CDTI Project has achieved 100% geographic coverage, 80% therapeutic coverage and95%o UTG coverage in2012. 2.6. a 9 Trainees Type Of training CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Others (speciff) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing WHO/APOC, 30 December 2012 N c{ o .o 0)oo o o .rr O o. o B d c,)Lr () o L<a O .E c/) 0) '= E o o trol6*lEXItr-t9UtLPI eElPI I =Elv!flC)qtE=l :''lLi \t .a alb0 .91tr .El't Etrl JlaEl6Et 9Ut ,(s ol = (!l =, olEEIEtrIP=l o ;Jlt- '71IL HI ol =lil 0)l (d c.)LP di) a] () +< o tr(.)s z 0) (d t< o b0dLrq) o dO a. CB L< bo oo O 0) cdL. (.) bo(€ L.o o o^ 5o\G)v o. CBli Q) F alol b0 631Lrlol >l ot 'l cBlol -cl0l c6lLrlbll ololbllrl cldt ol 9l =lC)l ol(dt Lrl 0j)l -cl €l bd ct =tol EIol :l €l cl JI EI ol fr.l (tO)A Ll+l_.- ae<u- -2aa Y, t<E .!.) 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Jr cO LGI U)oo >rtr E5(D .'!r-ELO GII =a 9l.)o=l8E ElsE '51EE El .!.: orlE.c .!lg3 El 'rS c)ls9alQ)a=l .g 6 r-l e.ts €lQc Ll -OCllE$ ilUE EI -.! ?lFe -El .! d ctl;-q elEl oilq) oo -alEE ol a)q)a[ ()O frl EE eI +.Hrla) =lHE HIET fITE EIEH.EIEE 8Ig tr '..1Fr O\l "io fil\o ctl .i Fl ti 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHON UNICETE NGDC Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer) MOH M WHOtr UNICETE NGDC Other (please specify): Please describe how Mectizan@ is ordered and how it distributed to the communities from which TCC-E transport's to the projects zones. From the zone the Woredas receive and distribute to the health centers. It is from the heath centers that the community supervisors (HEWs) get the drug and handover to the CDDs making it ready for community use. Mectizan@ In How are the remaining lvermectin tablets collected and where they are kept? - At the end of the treatment period, the CDDs return the remaining drugs and the village registers to HPs and the HEWs return the collected drugs from CDDs and their report to the Health Centers. The health centers deliver the collected drug from HEWs and the compiled catchment report to the Woreda health offices and the drugs kept in the WoHO store. O List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. . Training of HWs, community supervisors (HEWs) and CDDs on how to handle the drugs. . Community mobilizationand health education. . Conduct Population census by CDDs. . The Carter Center Ethiopia delivers Ivermectin to the CDTI Zones. . Woreda health offtces collect Ivermectin from the Zone. . Heath Centers collect Ivermectin from the WoHOs. . HEWs receive Mectizan from HCs. . CDDs get Ivermectin from HPs and distribute to the community. , Leftover Ivermectin is handed over to HEWs by CDDs. . HEWs compile their report and hand over the remaining Mectizan and their report to HCs. District/LGA Number of Mectizano tablets Number of Mectizano tablets Remaining from 2011 Requested 20t2 Received (available) Used Wasted Remaining Kaffa 3,593 2,452,500 2,456,093 2,203,12 5 2 J02 250,666 t4 WHO/APOC, 30, Decemb er, 2012 . The HCs compile their catchment report and handover the report and the remaining Mectizan to the WoHO. . Supervision and follow up is done at all levels even though it is not regularly done. ' Conduct Review meetings at woreda level.2.8. Community self-monitoring and Stakeholders Meeting . Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? - Training *ur given during the CDTI training session to HEWs and HWs and a questioner was develop.d by TCC-E and was distributed to each kebele to be filled by an independeni persons. Four villages from each kebele were randomly selected and ten p.opl" from ten HHs at each village were randomly selected and interviewed. Table l1: tv self-monitoring Stakeholders Meetins in Kaffa .2012 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (sHM) Adiyg Bitta Bonga town Chena 209 225 34 324 82 qist 224 -2t8 296 270 332 4 4 4 4 4 4 4 4 4 4 4 0 0 0 0 0 0 0 0 0 0 0 Cheta Decha Gesha Gewata Gimbo Saylem Tello Total 265r 44 0 a IJ o 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. After gathering the questioners and analyzing the result, kebele leaders have discussid on the result of the CSM. The result in most of the kebeles indicated that mobilization was not properly done, CDD: population was not clearly known by everybody. People were negligent to take Mectizanfor the signs and symptoms of the disease have subsided drastically. Finally in most of the kebeles the communities have decided to increase number of CDDs and the HEWs were told to the kebele leaders on the challenges which hinder the program. 15 WHO/APOC, 30, December, 2012 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy NOTF )RHB >ZOTF> WOTF ) Health Facility ) Community supervisors ) CDDs This is the normal flow chart which must to done, but due to so various reasons supervision was carried out in this manner: - ZHD and TCC-E ) WoHOs, ) HCs) HPs) CDDs 2.9.2. 2.9.3. 2.9.4. 2.9.5. What were the main issues identified during supervision? . CDDs were not properly selected and trained . Updated Village registers was lacking . WoHOs and HFs did not conduct continuous and regular supportive supervision . Delayed in reporting (Woreda, HC & HP) r Document handling problem Was a supervision checklist used? o Yes supervision checklist was used What were the outcomes at each level of CDTI implementation supervision? o Village register updating was done o Repots were compiled from the village registers. o Proper document handling was practiced (on job training) in some HPs Was feedback given to the person or groups supervised? Yes, oral feedback was given during the supervision session and a written feedback was given later on. o 2.9.6, How was the feedback used to improve the overall performance of the project? o Village registers updated o Document handling improved t6 WHO/APOC, 30, Decemb er, 2012 Source Type of equipment APOC MOH** DISTRIC T NGDO Others No Condit lon No Condit lon N o. Condi tion No Conditio n No Con ditio n Toyota Hilux 4W pickup 1 NF 2 F 4 F 0 0 0 0 Motor cycles storage boxes ) wo 0 0 0 0 0 Motor cycles 8 F 5 F 1 7 F 0 0 0 0 Photocopier I NF 1 F 1 F 0 0 0 0 Fax machine 1 NF I F 4 F 0 0 0 0 VCR 0 0 0 0 0 0 0 o o o Megaphones 0 0 0 0 0 0 0 0 0 0 Typewriter 0 -0 0 0 0 0 0 0 0 0 Video projector 0 0 0 0 0 0 0 0 0 0 Stensil Desiner 0 0 0 0 0 0 0 0 0 0 Desk top computer I NF 1 F 1 1 0 0 0 0 0 LaserJet printer I NF 1 F I 1 0 0 0 0 0 Laptop computer I NF I F 5 F 0 0 0 0 Deskiet printer I wo 0 0 0 0 0 0 0 0 TV 1 NF 0 0 0 0 0 0 0 0 Overhead projector 0 0 0 0 0 0 0 0 0 0 Radio communication 0 0 0 0 0 0 0 0 0 0 Portable generator electric 1 NF 0 0 0 0 0 0 0 0 SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO:Worn off). o How does the project intend to maintain and replace existing equipment and other materials? o Government budget is used to maintain and replace existing equipments and other materials. Some times other NGDOs do help too. o APOC has replaced 8 motorbikes in 2012 t7 WHO/APOC, 30, December, 2012 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for last three vears MOH contribution is for Focal persons' salary- and running cost. If there are problems with release of counterpart funds, how were they addressed - APOC's fund reached late. We have discussed with APOC (WHO) office accountant but still no remedy is found. Describe (indicate forms of in-kind contributions of communities if any) - Some times the community members do assist CDDs in their farm. - During Mectizan distribution some people invite coffee and food to CDDs. I Contributor Year l0('2010) Year ll('2011) Year 12('2012) TOTAL Cash Budgeted (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) MOH (Central + State)* DNA DNA DNA DNA DNA DNA MOH (District + zone)* 88,447.76 88,447.76 47,851.81 47,851.81 77,451.8 6 77,451.86 Local NGDo(s) ( if any) DNA DNA DNA DNA DNA DNA NGDO partners(TCC) 39,077.08 39,077.08 22,575.26 22,575.26 12,916.1 2 12,916.12 Communities* * 0 0 0 0 0 0 APOC Trust Fund 0 0 62757.9r 43679.92 7,178.59 7,178.59 TOTAL 110,324.8 8 110,324.8 8 133,184.98 114,106.99 97,546.5 7 97,546.57 18 WHO/APOC, 30, December, 2012 ND E o o" QI - E e, E ?o da &ri o LF9-EE<l- 0 o o(J "fte)z a z 11 €O" N I d 6r .{ O 6F dn € d I a d o =4 Eo Fz tsl z,z& FI E s B ao ' C Eo E c o C oF 6 6\r a a6r r Nq rr dq rF \ \q raF!r € €hn I6 -.:n rr h m 09 Na oq -d 6 r r6 rr rN \o h N ainrI tr s ao r a r ? 6 € a I €N I N o\a NrIN n d aa I o tz a0! FA do a\ S EI S6r 6r SN Gr SF! cr Scr N Sar N Sa\ SN 6r S SN 6l S6{ Gr Sa{ e\ SN 6l Sar Gl S6r N Scr c\ S SGr cr SN 6t S a\ S 6t S 6l S6! 6r S6r a\ S .I .I S6r rdz Fl tr E]IDE dENS ==aEqs = Eirais nESEEa.a* o( E z. o dN ch d 69 r1 o d E .A S a4 Or B o N 6 o B n'F = o oo -aaE!9lg!E; E- :.E-g d .A sV) u E= :=6 \6.PS s=%.8\:s =S\s a U) u 2 d o( !t r{ OI o ' o il i lJ 4 ?) *\t .s s :'EussssE s:ls g.E :ESi \:S ' B EO >= +.9 *9 E> trog"E E 'i,ddEg .i3 on \ Bx dsU) B \ \l a Fi\ 6 d v) 0 d l, o m \ sx d V1 J F F z & .,E :o.N i( d(v d( v dv d 6v C d d V G dt C v d d 6 € dv n d d 6v d dV ( 14 d dv il( )4 d dV (( v n V C nv d Gv i dv d 6Y i d|4 L :o OCaz ( oo f.t d c rrl d o rd G ET C ri n t, 6 a ri C rd n o r.l ilq o ri 6 co rrl ( oo ri 6 rrl ( q ri n o rd C o rd d o E] d ti d oo r.1 C ri d c ri d oo El d rr1 6 o ri -ldt rrl ;l OIal)t -l o o 6 obo 6 axo o F <io o 6 o o E o da o o d o bD oxo .E d z oo 2 o E o oE oo e6 = € U) !o € oox o 6 o !Nl €-l coldNt >-d ti Nl661 !Hto€l uql -o'-l o>lhEt6.6l eP6l F€IL:l oXl - €Hl .g 9;l .z 'tr l{ 9 '5=la -aotL X ..1e Eol o Q.lL q-lE r€l L= xE frl €o F .i o\ SECTION 4: Sustainability of CDTI 4.1. Internal; independentparticipatorymonitoring; Evaluation 4.1.1 a Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) Monitoring or Evaluation is not done in 2012 _Year 1 Panicipatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation 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? Yes When was the sustainability plan submitted? on the 3'd and 5th years What arrangements have been made to sustain CDTI after APOC funding ceases? 4.2.1. Planning at all relevant levels o Yearly integrated strategic plan is prepared by the government including CDTI at all levels. 4.2.2 Funds o The Government is allocating budget for the integrated health activities including CDTI (Supportive supervision, review meeting). o The government covers the salary of the HWs and HEWs who are the key roll players of the CDTI program which is a huge amount of money. The basic policy of the government at present is one plan, one budget and one report. 4.2.3 Transport (replacement and maintenance) o At present the government is replacing and maintaining vehicles and motorbikes which are very helpful to all health service programs including CDTL Other resources The government does supply other equipments like fax machine, photocopier, computers and printers 4.2.4 20 WHO/APOC, 30, December, 2012 4.2.5. To what extent has the plan been implemented o The plan is implemented to 80% 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: All CDTI activities such as:- o Communitymobilization o Mectizan delivery o Trainings o Mectizan distribution o Supervision . Review meetings are integrated into PHC 4,3.1, Ivermectindeliverymechanisms Since the inception of the project, Ivermectin delivery has been fully integrated into the existing PHC drug delivery system of the country FMOH>TC C-E >ZHD>WHOs>HC>HP>CDDP community 4.3.2. Training: o CDTI trainings are integrated with the Primary Health Care (PHC) program from the beginning atZonal, Woreda and HF levels' o Disease Prevention and Health Promotion core process at all level is responsible for the CDTI program. Therefore, all the staff of DPHP is responsible at Zone, woreda and HF level in organizing CDTI trainings every year in collaboration with The Carter Center/ Ethiopia' 4.3.3. Joint supervision and monitoring with other programs o As part of the system in the country, all supervision and monitoring activities are done jointly on integrated manner. 4.3.4. Release of funds for project activities The government and TCC-E his released on time, where as APOC's fund was released late. 4.3.5. Is CDTI included in the PHC budget? o Yes CDTI is included in the PHC budget. 4.3.6 Describe other health programs that are using the CDTI structure and how this was achieved. What have been the achievements? . Campaigns such as malaria prevention, Polio eradication, TT, Measles vaccinations and EOS do use the CDTI structure. CDDs are always highly involved in these activities. 4.3.7. Describe others issues considered in the integration of GDTI. t a 2t WHO/APOC, 30, December, 2012 4.4. Operational research 4.4.1 4.4.2 Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. o Operational research was not done in20l2 How were the results applied in the project?t SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: - Geographic coverage- l00o/o - Therapeutic and UTG coverage- 80Yo &95% respectively Weaknesses: . Continuous and regular Supportive supervision is lacking at WoHO and HF levels . Number of Absentees and Refusals is still high . Mectizan wastage is still high . Village registers were not properly updated . CDD: population ratio did not meet the set standard - lCDDl2}HHs (1 :100 people) Opportunities: o Integration of all health activities . Assignment of 2 HEWs per kebele level. o Establishment of Health Development Army o 1 to 5 connections at each village assigning female leaders of the unit. Threats: o o Overlapping of other emergency programs during Mectizan distribution period Work overload to health staff High staff turnover (HWs & HEW) SECTION 6: Unique features of the project/other matters If possible APOC's ATR should be reduced in size for t he ZHDhas so many reports to deliver to the goverlment and its other partner NGDOs. APOC's fund has to reach on time so that the ZHD could be able to use and liquidate the 7 5o/o on time and be ready for the remaining 25%o to be used before the fiscal year elapses. O a I a 22 WHO/APOC, 30, December, 2012 I I a r I