tCOUNTRYAIOTF: ETHIOPIA Proiect Name: Illubabor Approval vear: 2003 Launchins vear:2004 Reportine Period: From: Je.n.Ufl.IT...20..4.9......... To;.....DSS.9.Lnhp.tr.2.4.02.... ear Proiect vear of this report: (circle one) l2 3 4 5 78910 Date submitted: October 2009 NGDO partner: The Carter Center The Federal Democratic Republic of Ethiopia Ministry of Health ANNUAL PROJECT TECHNICAL RBPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) j I i I I DEADLINE FOR SUBMISSION: i-c: A,fr To APOC Management by 31 January for March TCC meeting To APOC Management by 3l Jutv for September TCC meeting fs AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) R,ECU CO To cAo eo 6 rri;an I ,{ x n- 2 s lnr. zoro APu,L/Urtt WHO/APOC, 24 October, 2009 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Ethiopia National Coordinator Name: Signature: Zonal Oncho C o ordinator Name : .. T.ihebu..Amanl9.......... Signature: ..... Date NGDO Representative Name : ..........A-b.als..Ti.l.ahu.tt Signature: Date This report has been prepared by Name : ....T.ib..elpu..Annenjp...f.Ng[E-.... Designation : Zone onchocerciasis Coordinator Signature Date Date ll WHO/APOC, 24 October, 2009 t Table of contents FOLLOW UP ON TCC RECOMMENDATIONS.. ........1 EXECUTIVE SUMMARY 2 SECTION 1: BACKGROIIND INFORMATION ...........3 1.1. GnNnnel TNFoRMATToN 1.2. Popur.RuoN 4 ,.,,7 SECTION 2: IMPLEMENTATION OF CDTI ..............9 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 3.1. 3.2. 3.3. TtvtBLmn oF ACTrvrrrES ......... 9 Aovocecy ..................... l0 MogILzRTIoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK CoMMUNITIES 10 Covruuqrry TNVoLVEMENT .........-...12 Cepecrry BUTLDTNG .......14 TRIRnraeNts l6 OnoBnrNc, sroRAGE AND DELIVERv oF IvERMECTIN............... CouvruNrry sELF-MoNrroRrNG aNo SrarnHoLDERS MBsrn rc.. 2.9. SupeRvrsroN ..21 ..22 ..23 SECTION 3: SUPPORT TO CDTI....... ........24 EeurpupNT............... FrNeNcw- coNTRrBUTroNs oF THE pARTNERS AND coMMUNrrrES.. OrHBn FoRMS oF coMMUNrry suppoRT................ 24 25 26 263.4. ExpeNorruRE PER ACTrvrrY.. SECTION 4: SUSTAINABILITY OF CDTI 4.1. INrenNRl; INDEeENDENT pARTrcrpAToRy MoNIToRINc; EvelunrroN.......... 4.2. Susreneulrry oF rRoJECTS: ILAN AND sET TARGETs (ueNonroRy AT Yn 3) 4.4. OppnerroNAl RESEARCH. .28 28 28 28 29 30 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTUNITIES .....31 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........31 lll WHO/APOC, 24 October, 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.]NICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Drug Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Govemmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Commiuee (APOC scientific advisory group) Trainer of trainers United Nations Children's Emergency Fund Ultimate Treatment Goal World Health Office lv WHO/APOC, 24 October, 2009 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o 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 mesoftryper-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 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 expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraphical 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 October, 2009
FOLLOW UP ON TGG REGOMMENDATIONS TCC session 28th Number of Recommendati on in the Reoort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 64 I Adjust repofting period form January to December Well taken and corrected Reasons for lncreasing number of communities from 3704 to 3794 Due to population settlement from non endemic to project areas and restructuring of woredas by the government leads to increase the number of communities (example , Dorani Woreda is formed from endemic and non endemic communities ) I Increase number of female CDDs Well accepted continuous effort but needs ll Improve training to address poor documentation and reporting Focused training were conducted each year and there is some improvements though high turnover of staff affected it. lil Improve on funds liquidation to enable access to all APOC funds Liquidation process was solved ,however delay of APOC fund remain a problem I WHO/APOC, 24 October,2009 n Executive Summary l. Background on treatment and population data The Illubabor CDTI project is one of the projects located in the western part of Ethiopia. Illubabor zone is about 600 kilo meters from central capital city of Addis Ababa. . The Zone is sub-divided into 23 woredas with about 1.5 Million populations. There are 12 CDTI woredas in CDTI project, namely Mettu rural, Darimu, Alge-sache, Yayu, Hurumu, Alle, Didu , Becho,Bilo- Nopha, Dorani, Dabo- Hana and Bedele woredas . There are a total of 273 kebeles with a total population 730,035 in the CDTI woredas which are subdivided into 3,791 villages "Garees". The Illubabor CDTI project has been started since the year 2004. All the targeted villages with 100 Yo of geographical areas were covered with Mectizantreatment since the start of the program. The total population for the project area for the year was 730,035 with the Annual Treatment Objective (ATO) of 615, 557 out of which 594,051were treated with Mectizan@ for this year which gives 81 0/o therapeutic coverage. 2. Background on population movements. Most of the Communities in CDTI areas are settled farmers, Merchants, daily laborers and civil servants. Overall, there is no major type of population movement in the project area.. 3. Training data The project have conducted training and te taining for ftont line health professionals, health extension workers ,Community supervisors and CDDS eaich year.Duting the treatrnent round 678 ftont line health workers , 363 community supeflrisors and 8,778 CDDs were uained and rerained which gives the ^ver^ge CDDs tado of one per 83 persons in the proiect area. 4. Challenges and how they were overcome. Threats (Challenges): . The high turn over of front line health professionals at all levels, 2 WHO/APOC, 24 O ctober,2009 o the ever change of focal persons and overburden of other priority governmental activities, o the continuous restructuring of woreads and kebeles , overburdening of health workers in peripheral health facilities in different health programs such as malaria control and prevention activities Opportunities: o The expansion of health facilities and the assignment of two female health extension workers at each kebele in the project area is a wonderful opportunity for CDTI implementation. J WHO/APOC, 24 October,2009 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project The Illubabor CDTI project is one of the projects located in the western part of Ethiopia. Illubabor zone is about 600 kilo meters from central capital city of Addis Ababa. .lt is one of the 25 administrative zones in Oromia Regional State. The project is bordered in the west with Gambella Regional state, in the Northwest with West and Kellem Wollega CDTI projects, in the North with East Woltega CDTI project and in the South with Sheka CDTI project .According to the Government structure the Illubabor Zone is sub-divided into 23 Woredas and the woreada is subdivided into Kebeles and the Kebeles are further subdivide into 'Gots '.The 'Gots ' are further subdivided into "Garee" (villages) .The "Garee"(village) is the smallest administrative unit consists of 25 -30 households which is responsible for developmental activities including Health . There are 72 CDTI woredas in Illubabor CDTI project , namely Mettu rural , Darimu, Alge- sache, Yayu, Hurumu, Alte, Didu , Becho,Bilo- Nopha, Dorani, Dabo- Hana and Bedele woredas . There are a total of 273 kebeles with a total population 730,035 in the CDTI woredas which are subdivided into 3,791villages(Garee ).- The Illubabor CDTI project area has very complex topography with altitude ranges between I,000-2,576 meters above sea level. The zone is a tropical rain forest area. The Climate in the area shows great seasonal and inter-annual variations .It can be classified into Cold highland, sub-humid mid-land and hot lowland areas. The mean annual temperature ranges from 10 0C - 16 0C in the highlands, 16 0C - 260C in the midlands, and23 0C - 33 oC it the lowlands. The annual rainfall totals ranges from 1000 millimeters in the lowlands to2200 millimeters in the highlands. There are many perennial fast flowing rivers among which Sor, Geba, Birbir Dedessa, Offa, Sesie, and Gumer Rivers that cross the zone. There are also many numerous fast flowing small rivers and streams, which are tributaries of the main rivers in many areas in the zone. The project Zone is well known with its high forest, coffee plantation and animal raring .There are two rainy seasons that is(April - October) the highest rainy season and the dry 4 WHO/APOC, 24 October,2009 season (November-March). There is a mono-modal rainfall pattem in the zone. In most cases Agricultural activities such as clearing, farming, harvesting and herding occur all year round in the project area. However, the most intensive agricultural activities are during the rainy season. Harvesting occurs from October to December, leaving January to March as the optimum treatment period. The main road that runs from Addis Ababa to Mettu, the zonal capital town, and passing through Jimma zone is 600 Kms of which about 400 kms is Asphalt road .The remaining kms is partially asphalt road. There are about 576 kilometers dry weather roads that connect woreda centers with Mettu town. The project woredas have access to all weather roads that connected with Metu town. However, access to most rural communities during rainy seasons appears to be very difficult in the project areas. There is one zonal hospital, 1l health centers, 40 health stations and230 health posts in the CDTI project area. The potential health service coverage of the zone is 90Yo.Each kebeles have two female health extension workers. There will be construction of new community health posts and health centers in the project areas. Table l: Number of health staff involved in Illubabor CDTI project, 2009 District Number of health staff involved in CDTI activities. Total Number of health staffin the entirc project area Br Number of health staff involved in CDTI Bz Percentage Br=Brl Br *100 Mettu Rural 95 90 100 Alle 50 50 100 Hurumu 49 45 90 Didu 49 39 80 Darimu 99 99 100 Alse sachi 66 65 99 Bilo nopha 42 39 93 Dorani 32 32 100 YaYu 35 35 100 Bedele 91 91 100 Dabo hana 40 40 100 Bacho 53 53 100 Total 701 678 96.7 5 WHO/APOC, 24 October,2009 1.1.2 Partnership The affected Communities ,the Zonal Health Department ,the project Woreda Health Offices ,Zonal and Woreda Sector Offices ,Oromaia Regional Health Bureau, Federal Ministry of Health, The Carter Center Ethiopia , WHO/APOC and other Governmental Sectors in the Zone are the main partners involved in the Illubabor CDTI project . 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G# tr o Eg c! alN - o IF(J IJJ o 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 diffrculties/ constraints being faced and suggestions on how to improve advocacy. During the treatment period 30 zonal and 120 woreda decision makers were mobilized. The mobilization is mainly focused on how to reduce absentees and refusals, and maintain high therapeutic coverage, and increase communities' participation. The zonal health focal person and each woreda health focal person at the project woredas were actively involved in mobilizing different stake holders at all levels. As a result of which the number of absentees and refusal were reduced, high therapeutic coverage was gained, and 100% geographical coverage was maintained. In spite of all, there are some competing activities that inhibit the contribution of political leaders on the CDTI activities. To tackle such problem all Task force at levels should be responsible to timely conduct advocacy for decision makers to over come constraints seen during the treatment period. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization, sensitization and health education have been conducted at each level during the treatment round. Health extension workers and community Drug Distributors (CDDs) were responsible in giving health information to the community at kebele and village level. The health professionals working at various levels including nurses, sanitarians, public health nurses, Health extension package workers and Developmental workers were the major role player in the community mobilization and sensitization. There are also Kebele task forces including Kebele leaders and Community Supervisors which are involved in the mobilization activities. Dissemination of health information, Community sensitization and advocacy have contributed in the awareness creation of the community .As a result of which the sixth year CDTI activities was successfutly accomplished with high therapeutic coverage and 100% geographical coverage was maintained . l0 WHO/APOC, 24 October,2009
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E8 lg 0eo { 6' D o hJ b,J UI I oo N)@ I\o \o { t, o\b l..Jpoo l'J(-lr { t,p u) tJp o\ Fg (D o lc 00o EE II *ll N) 4 Ed o _o N)5 oo oC(D5 N.Joo\o Comment on: - Attendance of female members of the community at health education meetings No significant change was observed in the attendance of female community members on health education session at their communities during the treatment round. In 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 participation of females on the issues of Community Directed treatment with Ivermectin (CDTD in the community is fair. Female's attendance and involvement shows good improvement from year to year. Incentives provided by communities for the CDDs In some communities, the community members support CDDs .The community support is in kind but not in cash. In most cases CDDs serve voluntarily. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? There are no problems of CDD's attrition in this project. However, no developed mechanism for identifying the attrition of CDDs at all levels. Other issues l3 WHO/APOC, 24 October, 2009 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. Focal person at each levels have better knowledge on program implementation .Those Front line health workers who service in the project areas for over two years have good knowledge about the program. - Where frequent transfers 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 meosures were taken to ensure adequate CDTI implementationwhere not enough lcnowledgeable manpower was available or if staff are frequently transferued during the course of the campaign). There is many health staff turns over, transfer and new assignment in the project area each year .Focal person at each levels were not constant at all time. CDTI activities such as Plaruring, training, supervision, drug management and reporting and recording are identified as knowledge gaps for most newly assigned front line health workers. The project was provided training and retraining for health workers and health extension workers at each level each year to ensure adequate CDTI implementations and to resolve knowledge gaps. At community level training and retraining were given for community supervisors and CDDs by front line health workers. t4 WHO/APOC, 24 October, 2009 o\ o c..l L o) -oo (.) o$ c..l d op< tn oq Q .o € I \.r a .o B E E o t\ \' s Itr 3 I .(J $.itv iu: .+ o\\o o o)(o tt co\o co ca\a co o orri co o ot(f) €$s o(\t$ oN \o o\ c{ F*(o N o) c! @\oo F-(ao ..: (f) r-\o!+ o @t N \o co € (oot- .: o(o o\ o\ rn F* o)s .:. c!o \of-\o F-(o lf, $\or.i o$lo sN \o oo cn o @(f) (o \of- ca oor-F- € C\.lo+ oo o) E 6tr o a a(J ti o z ?eFU $o\r- co\o ca (os(a @s$ o)@(o o\ o\o t-(o\t (o cr) @ o) o)|o (oN(o o rO(o (Y) @$ \o o\ q) q) q) <) o\ 6 \o o\ s,iqv o -= +L\J = is zv anL €) .=6cifrl- h, bts !Ooo *9 r- 6l6)L z Q o F o o () o -o c\ *. Ei!+F-d €$ r.r co ca oo \o c! o\$ cn C\.l l.r c.t \r| o c{ \o .+ \oN ool F* co c.I ( c\| o\co r a \o$ \o co o\ tr- tr-+ co o\ \o$ \o ca co €N oN O co O$ r- o.l co o\ c.l o\ O t(\l\o \o ra ?a a6N q) -E dt-(DI-Ets!E TE E: zE q) I Q?F \o € o\+ \nca \o(n r\ca taoo \oc.t cno\ \o ca o$ o\c! r-r+\o q) {) (u c) .o o\ R\o o\ g.L a< o = ts.'l +F-d c.l r- (r) !t ea s co + $ o (\.l ol o \o \o o =f, cn \o .+ N $ $ o \n (r) o Tr} \n o co C\ tin in = o\ o CBL lE 6l qh o I L o o o li oE z (JYF Fr =f $ $ N \o $ \o $ \.) \n cn !+la I Fl (J O o z o oo EA d q o 4 o m o )E n q) or3(I) ca (B Cd os(u Lrd a o o(€a Io b0 I >\ CB 5L clL{o F] tr oH e q) q) o (,) \c r\ B4V)\)uq) .S t1 1 t\ t s q)q t3 a) s o Cd o o at F O +ro t) (.) (.) trot{ .(uq.i q) GI bo tr tr crlkF .iir d)l .ol6tFI Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Political Leaders Others (specifr) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifu) Table 6: Type of training undertaken (Tick the boxes where specific trainingwas carried out during the reporting period) Any other comments; - No more comments 2.6. Treatments 2.6.1. Treatmentfigures If the project is not achieving I00% geogaphical coverage and a minimum of 65oh therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The geographical coverage for the project was 100% and the therapeutic coverage is relatively good. In most communities it is above 80%. t6 WHO/APOC, 24 October, 2009 o\ooN Lo -oo() o$ c.t d o o ac)! rit€ SZs9(er'6. E f€rEEg z gqi o ' 6 g o. o o o o o O rrl €? =azz o o o o o o o o o o o o o8 b.s -6CE8 zd o o o o t-N o o o o o o o N6l E- -t= .E E.er E E[=68 o o o o @N o o o o o o o @N Io (B ao ll * .sX6\ o 'E() =oo(.).d sb ootoF $@ oo caoo (oo \oF- F-f- o\r- t00 € F-f- Noo @ € A (* Q o- iDxG) 5 [gz Nlo$_ @lo o@ @_ rr)(9 (Y)(o rr, @N t- o) 1r, N\t @@(o- o(a N(a rO o,(o $o(Y) F-(r) s (o- $@- t- @@(o- s r-|o(o- t-(f) 6tlo \t_ o(f) loo + o)lo :c)E 5.1 =Eoc (0,= < g*'t-9 (f) o, o)- @ r() @N@(o cf, l- o)q.(o N No @- Ns (f)(o o- s(o o f-_ r{)N o, o,(o o)(f) 1r)N Or- @o o- sN @(f) (f)- l()!t @$(f) @(t) rOo rJ)- CO I-l() lJ) lo (o .9 .,3BXo *. F.H6-E lo o-=oE = o; -oF $o$_ o,(o (os@ c.,$ (o @\ (f) o \ o,s (o r()- ot (\t o o, $o o) @s (o tO a.N(Y) lr)o @ @ s Or_ (f) ro (f) rO(o- rO\t (oo t.() F*(9 l() (f) o_ o(f) U'o o0((l u)o I LT o(-) ll r ^.4 \o ?o., -c o0o.F!d65bl8E oo oo oo o oo oo oo ao oo oo oo oo Oo !Bv',= @ -3 5 go#tr tr= ii5E';5 AO o r\$ ca o\o \.|f- $N c{ t\.| cn\os \4,N e.l o\o € \al cn$ o\ ca oo oo(\l N o\ o\F.-tr) A tsoE 6.2 =E'oE H.9.<t6 r-+ co O\o rr- +ol C\l $\n co\o$ (n N c! o\o oo (4, cot+ o\ cn € ooN No\ o\rrta rEg=Et *" r- .+ co o\o rat- *c\lol $\n c.)\ot \.lNN o\o oo \.t cat o\ co € €C\ N o\ o\F.-(.l .9<Eq t C) z o ()(l) m c\l 0 o 4 o o q) € n o o € Q) co cldd o -o(B a tr d o (l) (.) GIa Iq) b0 I x(! L cBLio o c, oF f- ':. L' 44q)() q) a) t q) Fi q) U J1 U) L (d adoL c, (\, I -l o k U' E xs U)r! U) ! crl O E (B o)lrF r-f ol -ol(Bl FI o\o o.l C) -o () o$ c.l (-) o o Ff{ > E! suBp la G\ Eq) '5 .L\\\.s ix Y s)v.=.s =boi)BtrE: * i E P8 .q N s'SU\Ya x s\ €E t'S .E i Eb E E II t^ r tir E € $! o N h:l5.E $sv;:deC Y *Rfl i -sI E S SE E t as : E BS "s!EE u"S -s E SEol # s s odl 6)uq)\{l! s [EHa $ S$.ils \ ss 61 6 <\' sSOl r - €t€ s E"s r.l J $ !.! Rl tr .= \BEIE [o p'b zl1 E !$e *s *ssil E&EAr!ib !s 'a ':l ^,i s00\SR s \hxsY osoE B SUI .S 'EE() : s.xE 6 tr* .E S S$Y rr ll85 o pSS \ SR oo GI(D l< Cs Io C) 'a L3alr O)c! -q99 C)F0).= 'a r-L 9Hi& IJ .L9 - Ith(1)= H .=otrE3AAEd )<h6.9oe .BEH ot tro ol =-o -l E6 xl I -r El --E. .HI E >i 916I 9I E3r s3rl E -:!t a)j; Et *u'a B*tEl.E 5l ;ul t '=l q)!l= =ls3.E El eBIH 8t E cHl '= ql ?ol i1- ol trplo rll0)lo- oltrpl- pl-Els Els =tb =tozl? zl? ol -l o.rxl > EI E El8 -el EOI G)ol trol E ol, inql Iol- Ll ' EIEtrl tr zl< (D dL (D bI)!ia EE oo F c) d q) bodLr C) oo(^ .Y ro =v6 bo o o)o oP c! o) bo(€ (l) oo oaE5q)a(Bko F k € llil 2.6.2 What are the causes of absenteeism? The main reason for absenteeism from treatment in this community is movement of community for trading or agricultural activities during the mass campaign. The numbers of absenteeism was reduced from year to year. 2.6.3 What are the reasons for refusals? Some individuals refused because they considered themselves as healthy, and other refused due to fear of minor side effects after treatments. 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 ,/ t9 WHO/APOC, 24 October, 2009 o\ o C.l Lop o o o + c.l d o O. rJi o.l -(n tro .tU d =)O - (€ o() b0dLro oo o F-F1 .=(!(tLC':)8H.F}E EE.=qsg=Ll+tr =cro9LE9E€Eoor8F€EEHOU ..Ll<oo=q)-o00 a)(dtEE-O.^ d 9€o '?oYVA =€i/t*l.Nl -,olo13:lolR E"it E r.l <olF€l iddFt s!;l dE 8l EE .el .b c)oo* '=(Bc) -Lc.)oE E8€(l)rtrh =vEHi cBra)gEe PC)+i v : H 6) -dE =!.)oH.lai-tLtrtr o\l ": *l H\oEl q e.i Fl o. o o0ri (B ^F bs Q o o\ o\a r-€ cr'! \o o\ @ o\ t.) \o o\ o rt frl il r{ ts *H - E FHd.= .r 4.,!n!:s,: _e_!y=-> c ' 6. 89o E=r L6 :o? b.u 5E5 {) e Se'l- ()o\d>v o o 'E() =b0(l) cE^ A-qro\()o .Eo F- ,,O o6 L-()uE9_@ =ozE o. o o\ o\€ r\€ c.l \o o\ oo o\ n\o o\ F-f- rarr F-t- oo o€ @ rr co oi r sC\ c\l\os o\orr OrF-$ +rr|\ oo c{ rat (oo (o to l() \a o^$o\(.l \o\o oo c\ oo(n \.) co co € (n coas \.}(n o)_ ost{) (o @ o) F-(o to tr-\n\.) \a \o c{+\o^ (l.i rr\o r\o tr- \o colartr) + c.I\o o\ o\ c.I \n\o o)o co- N o)(o \n co o^ o cor- o 0) ood ho o(-) lL .- !-1 fi ri o P Sc.F (l)o\ <. >v o o oo oo oo o OO 'o- o0 =E= EG'lL+-10u 99)ir.1 (,or.l oo o oo Oo o oo ri Lq)o= 8* E 5 $E E tr= o5EtJj704 o o\ ,rI ca co \.) co ca r.l ca s tr- ca to\ r.- co o\r- co frl Eo? 6.2 itre) d (€.=<t6 o o\ ,rr ca coo\.l cn coO rr) ca $or- co =fo\F- cn o\tr- co b0 d =vltE g IE +h.9= h; - .: c'- o E e78Ve EO o O o\ ,rr c.| coo rf1 ca cao rr) co $O\ ca $ o\r- co o\ c- ca & rrl oooN o c] c\oo o.t a.t o c.l $oo a.I o c.l \ooo .I F- c.l € o a'l o\O c.l ot 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH EI WHON UNICEXE NGDO Other (please specify): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH EI WHOtr TINICETE NGDO N Other (please specify) : Please describe how Mectizan@ is ordered and how it gets to the communities Based on the target population the drug is requested from the project to Ministry of Health (FMOH). The Ministry of Health together with NOTF requests for Mectizan from MDP. After the drug reaches the country it is stored in Pharmacy and other medical equipment Authority. The project request for Mectizan@ from the MOH. From the project level (zone level) each project Woredas receive the drug and distribute to the frontline health facilities. The CDDS directly receive from their respective community supervisors or from the health facility and then distribute to the communities house to house or at central location based on the community decisions. Table l0: Mectizan@ Inventory (Please add more rows if necessary) NB:-Fromtheremaining 76,300tabletsduringthe2008,27,000 tabletsweregiventoEastWellegaproject - How are the remaining ivermectin tablets collected and where are they kept? The front line health workers are responsible to collect the remaining Mectizan @ tablets from Community drug distributors and retumed back to woreda focal person's .At the end the collected remaining Mectizan @ was returned back to zonal health office and kept at zone pharmacy store. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Advocacy Meeting with stakeholders S ocial mobilization and community mobilization Training of community supervisors and CDDs District/LGA Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remainins lllubabor zone l,7og,g60 1,709,860 1,640,740 0 3370 0 65,750 TOTAL 1,709,860 1,709,960 1,640,740 0 3370 0 65,750 2t WHO/APOC, 24 October, 2009 . Request of Mectizan @ from different levels . Collection of Mectizan @ from the Woreda Pharmacy store . Distribution of Mectizan @ to Front line health facilities . Distribution of Mectizan @ to community supervisors , Distribution of Mectizan @ to CDDs . Supervision and follow up of treatment operation , Management of severe Adverse effects . Collecting treatment reports . Collecting the left over Mectizan@ tablets from community drug distributors . Recording and reporting of training and mass drug distribution data Any other comments 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the projectarea? Yes ,If so, When? Training of trainers has been conducted at the project level during March 2009. Woreda CDTI focal persons, Woreda health office heads and Woreda health office communicable disease experts were involved in the training. The training topic includes community self monitoring. During the treatment period , most communities have done self monitoring at their respective villages " garee" .. Table l l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSlt) No of Communities that conducted stakeholders meeting (SHM) Metu 347 347 37 Becho 160 160 l5 l4Bilo-Nopha 175 t75 Alle 224 224 2t Didu t54 t54 l5 Bedele 463 463 42 Dabo Hana 22s 225 l5 Darimu 809 809 42 Alge-Sache 435 435 32 Yayu- 319 319 25 Hurumu 288 288 t7 Dorani t92 192 t2 TOTAL 3791 3791 287 22 WHO/APOC, 24 O ctober,2009 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. The Stakeholders at each level have supported the implementations and the performance of CDTI activities. The community supervisors and community leaders at each levels have supervised and monitored the implementations of the prograrnme at their levels. As the result, the number of absenteeism and refusal were reduced. Geographical coverage was maintained and high therapeutic coverage was gained during the period. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )ROTF) ZOTF) WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during superuision? . Lack of planning . Lack of integration into other health programs . Knowledge gap in CDTI activities r Poor record keeping I Inconsistence of reports . Turn over offocal person . Prolong time for mass distribution and delay of treatment reports . Poor drug management and inventory . Lack of support from Administration bodies. 2.9.3 Was a supervision checklist used? Yes, supervision check lists were used at woreda level when they supervise health facilities, but health facilities do not have standard check lists for supervising community level. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Planning of CDTI was integrated into health system, recording and report showed improved number of treatment absentees and refusals were reduced, high treatment coverage gained. 2.9.5. Was feedback given to the person or groups supervised? Yes, written and oral feedback have been given at all levels .At the spot corrective measures have been taken during the supervision. 23 WHO/APOC, 24 O ctober,2009 2.9.6. How was the feedback used to improve the overall performance of the project? Increase health workers skills in conducting supportive supervision at community level, developing integrated plan, improve the reporting and recording the program activities at all level .As a result 100% geographic coverage was maintained and increased therapeutic coverage in all project areas. 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:Written off). How does the project intend to maintain and replace existing equipment and other materials? The project office and its partner's were effectively repaired and maintained the existing Capital equipment and other materials provided by APOC. The project expected that APOC would replace the capital equipment and materials by the end of the final year and at the same time efforts will continue to allocate budget by the govemment for smooth operation and management of the project by integrating into the existing health program. The project is trying to handle and maintain the exiting equipment and materials in order to improve the overall performances of all activities by integrating to the existing govemment system. Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle I F I F J F 0 0 0 0 2. Motor cycle(s) 6 F 1 F t2 F 19 F 0 0 3. Computer(s) 1 F I F t2 F 0 0 0 0 4. Printer(s) I F 1 F t2 F 0 0 0 0 5. Photocopier (s) 1 CNFR 1 F 0 0 0 0 0 0 6. Fax Machine(s) 1 CNFR 1 F 0 0 0 0 0 0 7. Overhead projector 1 F 1 F 0 0 0 0 0 0 8.25" TV set I F 0 0 0 0 0 0 0 0 9. Deiesel Generator 1 F 1 CNFR 0 0 0 0 0 0 24 WHO/APOC, 24 October,2009 o\oo C.l L() -oo o o$c\ Ci o o<{o 'Jr lalN C) tr (€ v) E oo()(n q< o rh v) o o al o CT C) >.d 'otrd (n L U o Or H o (Dt)(d 0) okq< o x Cd C) IJ €() IA U)(DtrEE(B h() (l) o B Bo V) .o ,tr Ld a.Lr(u ooqr o q) u) CBo ol{ U) c,) Io L<&() L. Cd o)tro (+i I tro tr CB (t) U) l< r.E >t o ar') P .ta o\ c{ \o o o -Q€Q 9G 3+3b(F 00 \o o \o\o N o iar-ia F- € a@za(dF1 ,E agoL)E 'c0 € \o o\o\o c.I o €cr)\o la ra € a) o\ € c.l rA (lt() ixsaYv oUF& \o+q o ns F- o\N o *\o\o -l: oa\o\o\o o\ rJo^NER.*F d OovrOQED o -lo\ \o o o\ € e.l+ o\O\o rJ (.) a € \o Fr (\l i 6() gs*a r<& o 6t00 -f o o\ ,.I r- o +oo 00 ra t \o E1 (D^ f,EEAO(.)Es o o a.l oo\ t{(?) O o6\ ra(\F \o N ?a) clo *E B=a!rv6 D -rlOZ v sl, F- c.l o\ \o ol (r)t)rc F)\o f,gg'3 r-.+ tat o\ \o 00\o c.l oot \oft al o c.'t FI a6{) E3f=a -r& s cn € o\ + c- -f Ns o + + 6l t- * * * at q r- ! o\ f,gf'3 €o\-l r--fNsf * o\ \o\o o \o o\ o laiGI ?t- a C.l 6o 83#=a -,r& a ooq F-q s o oc-q. r-\o O o o t) €6l =r..ia rE7-c9 .- r, O)a5893(m- H.v oo o\ ca r- +-ot o F-o\ r-\o F- +\o €to\o \o6 fr o E L EoU + (Btr o(-) *i(DOH za + o Lr v, o OE\<oZN G o o zeEE E= -l- G E8OEz& U,(l) tr oO I U) LrF (-) A€ <ri Fl Er o3 o .!9 =trf EE?OEoE Ec)s 0.)L|<o€ ORus?o +. tiJL:G,5 cei v,oh .EE+rtr hAo:OEExo.o -2JO .o '5 LAe= utiOEOUTEOEscU -4G .-=fE{ -li ir .qlNEIct Sl
- Additional comments There is an Integration of Malaria into Onchocerciasis control program (MALONCHO) by The Carter Center Ethiopia which would play a great role in the good program implementation and performance for both activity during the treatment round . 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) The services of Community Directed Distributors(CDDs), Community supervisors and kebele task forces (KOTF) are considered as the major community contributions for the CDTI Project in the area .For this treatment round ,8,778 CDDs and 363 community supervisors are involved in 3791 communities in the entire project . 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 exchange rate to local currency. Indicate exchange rate used here 1USD : I 1.55 26 WHO/APOC, 24 October, 2009 Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communr 600.00 NGDO Mobilization and health education of communities 4000 APOC of CDDs 0 of health staff at all levels I 8,169+3500 NGDO +APOC S CDDs and distribution 1,226+600 NGDO +APOC Internal of CDTI activities 0 APOC NGDO visits to health and authorities 2000 IEC materials 0 forms for treatment 0 NGDO Vehicles/ maintenance 8,135 MOH Zonal, MOH ZonalOffrce e etc 837 Others 605.00 NGDO TOTAL 39,672.00 Total number of Persons treated Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or exPlanations? The budget assumed from MOH is not considered as expense (budget item as personnel cost salary cost for focal persons at all levels ), that makes difference of expenditure and expense in the listed above on table 13 & 14. Assumption of the exact budget for CDTI is not an easy task due to the pooled finance management system and the integrated nature of the CDTI project to the existing health program 27 WHO/APOC, 24 October,2009 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) yes _Year I Participatory Independent monitoring X_ Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? o Creation of a budget line for CDTI atZone and Woreda levels o Development of annual plans that is activity-based with cost implications o Targeted supervision utilizing developed checklists and production of reports of such visits that will serve also as feedback for those supervised o Training sessions to focus on identified areas of weaknesses 4.1.3.How have they been implemented? It have been implemented by the project zone and project woredas as well as its partners 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? yes Was a sustainability plan written? yes When was the sustainability plan submiued? on June .2009 What ilrangements have been made to sustain CDTI after APOC funding ceases in terms of? 4.2.1. Planning at all relevant levels Sustainability plan was developed at all project woredas by all concerned bodies including partners 28 WHO/APOC, 24 October,2009 4.2.2. 4.2.3 4.2.4. 4.2.5. Funds The program was integtated into Malaria and other vector borne diseases and the government have allocated budget for the program implementation and was supported from its partners. Transport (replacement and maintenance) Replacement for the vehicle was asked for APOC during the sustainability Plan Other resources It is government's mandate to allocate necessary resources To what extent has the plan been implemented . Ivermectin delivery mechanisms There is no separate Mectizan @ delivery system in this project .Right from the onset of the project, the delivery system is very well integrated into the existing Ministry of health structure. The project will normally notified to collect the drugs as soon as it has been cleared by the WHO clearing agent in close collaboration with the MOH. According to the target the project zone will then allocate the drug to the respective project woredas. The woreda will distribute the drug to the FLHFs.. Training: Community Directed treatment with Ivermectin (CDTI) is integrated into Malaria and other vector bome diseases. In the entire project, all health professionals and supportive staff were trained and retrained on planning, Supervision, reporting and recording in CDTI activities' Joint supervision and monitoring with other programs All health service activities have supervision checklists and in most cases supervision was integrated into the existing health system. .However, during the Mectizan@ mass distribution there will be separate supervision and monitoring system by front line health facilities. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. 4.3.3. 29 WHO/APOC, 24 O ctober,2009 4.3.4. Release of funds for project activities The transfer of APOC trust fund was delayed .Training of Trainers (TOT) was conducted by the partners support. 4.3.5. Is CDTI included in the PHC budgetr Most likely, CDTI in this project area is an integral part of the malaria and Other vector bome disease control unit at all levels and have similar budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Malaria control and prevention is one of the health program that are using the CDTI structure. when they conduct population census and mass drug administration CDDs also involved on environmental management to control malaria, educating and demonstrating families on Bed nets, on how to hang ,when to wash and were to dry net , the importance of early and prompt treatment ,record and follow up the net in the households. As a result of which high net utilization was observed in the project area .Malaria morbidity was decreased. 4.3.7. Describe others issues considered in the integration of CDTI. The Health Extension Package program which includes many other health prograrnme designed to reach all Kebeles that will play amajor role for strong integration and sustainability of CDTI in the project area. 4.4. Operationa! 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. Not done How were the results applied in the project? 30 WHO/APOC, 24 October,2009 SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: The successful accomplishment of the mass distribution of Mectizan@ for the last six rounds with high therapeutic coverage with in 100% geographical area. The great performance is due to the active involvement of all stakeholders including the health workers, community supervisors,CDDs ,partners and the affected community at large. Weaknesses: collecting leftover of Mectizan@ tablets after treatment from CDDs and poor inventory of Mectizan@ at all levels and storingatZonalHealth pharmacy store ,tum over of focal persons in some project woredas ,poor document handling , delay of reporting, delay in liquidating the utilized APOC trust fund Opportunities: The government structure down to village level "Geree" and being taking the responsibility of development activities as well as health, the expansion of health service at all kebels and the assignment of two female health extension workers at all affected kebeles is a good opportunity for sustainability of Onchocerciasis control. Threats (Challenges): The high tum over of health professionals at all levels, the ever change of focal persons and overburden of other priority governmental activities, the continuous restructuring of woreads and kebeles , overburdening of health workers in peripheral health facilities in different health programs such as malaria control and prevention activities as DDT spraying,HMAIDS , PMTC and VCT campaigns , the polio ,Vit A, Measles campaign and enhanced outreach surveys (EOS) ,Lack of budgetary support from government are the major challenges for program sustainability. SEGTION 6: Unique features of the proiecUother matters None 3l WHO/APOC, 24 O ctober,2009