Illubabor CDTI annual technical report submitted to Technical Consultative Committee (TCC): January 2009 to November 2010

$. I ;1\ {" The Federal Democratic Republic of Ethiopia Ministry of Health COUNTRY/1.{OTF: BTHIOPIA Proiect Name: Illubabor Approval year: 2003 Launching year: 2004 Reporting Period F ro m : J. en u e. r.y. .,2 p. .Q 2. ... ... . T o ;... ..N p..y s.m h e r..2 0.10.. . ..(Month/Year) ( Month/Year) Proiect year of this report: (circle one) I 2 3 4 5 6 8910 Date submitted: October 2010 NGDO partnet: The Carter Center ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) M For ;4a6iro fo: i Firr to, DrR , n tsa^b'*- i RECU tE 0 7 FEt/. lSit ^lggfqt_f ir 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 Tizita Haflu Guileta (Dr') National Coordinator Name ralist Heelth Pl'onrot-on anrlPasto Diseasc ' Piit'-,'Uritt'dt''f )i*ector ate -1 Signature Date Zonal Oncho Coordinator Name: Husen Abate Signature ,, I I I -i' J I O * Di -\i ints'ir-l Date: . .January 2011 .... Tashome Gebre (FhD) NGDO Representative Name: ......Q9t+glg Signature Date: ... . ft: This report has been prepared by Name : ....Hu.qsn.A.hat.e...t.N.QT.8......... Designation : Zone onchocerciasis Coordinator Signature Date 20tt I ll J WHO/APOC, 24 October, 2008 Table of contents ACRONYMS Iv DEFINITIONS ............v FOLLOW UP ON TCC RECOMMEI\DATIONS EXECUTIVE SUMMARY................... SECTION I : BACKGROLIIID INFORMATION................ I,I. GpNeneI INFORMATION 1.2. PopulenoN SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. Tltr,rnI-tNp oF ACTIVITIES .............. 2.2. Aovocacv 2.3. MoeILIzaTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES CoNaNarNtrv INVoLVEMENT .............. CepeclrY BUILDING TnEervpNrs.,.............. ................... ORDEzuNG, STORAGE AND DELIVERY OF IVERMECTIN................. CotrluuNtrv sELF-MoNIToRING RNo StRxeuoLDERS MpprlNc. SuppRvrsroN ............... SECTION 3: SUPPORT TO CDTI I 2 3 J 6 8 8 I 9 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 3.1. 3.2. 3.3. 3.4. l0 12 t4 19 20 21 25 25 25 26 26 EeurpnapNr FmaNCTRL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES OrHpn FoRMS oF coMMUNITY suPPoRT ExppNoltuns PER AcrlvlrY................ 22 22 23 24 24 25SECTION 4: SUSTAINABILITY OF CDTI..... 4.1. INrcn5al-; INDEPENDENTPARTICIPATORY MoNITozuNG; EvRLunuoN..., 4.2. SUSTRINASILITY OF PROJECTS: PLAN AND SET TARGETS (rr ANonrORY AT Yn 3) ......... 4.3. INrecnertoN................ 4.4. OPPNATIONAL RESEARCH SECTION 5: STRENGTHS, WEAKNESSES' CHALLENGES, AND OPPORTLII\ITIES 11 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS..........27 ill WHO/APOC. 24 October. 2008 IAcronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Com mun ity-Based Organization Community-Dru g Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organ ization Non-Governmental Organ ization 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 Emergency Fund Ultimate Treatment Goal World Health Office lv WHO/APOC, 24 October. 2008 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 84o/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 meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatmpnt Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 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). (ui) 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) lntesration: 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. WHO/APOC, 24 October. 2008 , FOLLOW UP ON TGC REGOMMENDATIONS TCC session zgth Number of Recommendqti on in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Ileporl-relcttql Aeljust reporling, period Jonuarv ttt Decentber lo Wcll takcn and c()rrcctcd Provide reasons tbr the increase in number of communities fionr 3791 and then to 3894 as indicated in table !) I)ue to populirtion settlenrent littrr non cndcnric to prtljcct ot'cas und continuous and liequent rcstructuring ol CD'l'l Worcdas I:g I)abo I lana A lge szrche & Dolani Wurcdas Prrlec't rcluled ('ontirute lo wot'k al increa,sittg number of jbnrule CDDs untl itnltntving tha ill:F rutio . I)1Ibr1 vvirs ntade to increase thc nurnbcr ol' li'nralc ('DDs. nonetheless. due to cultrtral harlier' thc nurrbcl ot f'emllc (lDDs is still {-eu. . Improve training to address poor docurncntatiolt atrd reportittg. Wcll organizcd and rvcll prcparcd trrinrng supported b1 tritinine manual \\'as cortcluctccl sucocsslirlly. Improve on funds liquidation to enable access to all APOC Futtds l.ou' crpacitl rncl sholtagc of linance,uvorket's r-ouldn't allttws trs kr scttlc APOCI Iruncls tirnclY. WHO/APOC. 24 October,2008 Executive Summary 1. Background on treatment and population data Illubabot CDTI project is onc of the projccts found in the Oromia Regional statc, and ts locatcd m the Southwestern part of Ethiopia. TheZone is sub-divrded into 24 \\/oredas wrth about 1.4 N'Iilhon populattons. Thc pro,jcct consists of twch,e CDTI Woredas namely Mattu, Darimu, Alge-Sache, Yayu, Hurumu, Dorani ,Alle, Didu. Bacho, Bilo-Nopha, Dabo-Hana and Bedele. Tl-rere are 1. zonal hospital, 24 heakh centers, {7 health stauons and 1.02 cornmunlty health posts (CHPs) in the CDl'l project area 'I'he CD'fl Wotedas are further divrded into kebeles, sub kebeles and 'Garees'whrch is the smallest adminrstration unit. There are 389{ vrllages 'Cl.arees' tn the pro;ect areas . The Illubabor CDTI project has been under implementation since 2004. All the targeted villages (with 100 % of geographical areas) were covered with Mectizan treatment since the start of the programme. The total population for the project area for the year was 772,321 with the Annual Treatment Objective (ATO) of 648,750. out of which 639,-s-t.1 were treated with Mectizan@ this year resulting in 83 %otherapeutic coverage. 2. Background on population movements. Most of the Communities in the CDTI areas are settled farmers, Merchants. daily laborers and civil servants. Overall, there is no rnajor type of population movement in the pro.iect area 3. Training data Trarnrng and re-training were grven for l-realth professionals, Communlq, superusors and CDDS every year l)uring the treatment period 5tt9 front line health rvorkers, 375 commurlin' strpcrvisors aod, 7,712 CDDs werc traincd and re-trained rvhich gvcs thc avclagc numbcr of CDDs two and above per villages. 4. Challenges and how they were overcome Threats (Challenges): . Frequent restructuring at all adrninistrative levels has been a ma-ior challenge. The change in number of villages during the campaign was the result of this restructuring. . High tum over of health workers atZonal, Woreda and peripheral health facilities . Over lap of several health programs and work overload of health rvorkers that delayed the distribution and reporting period of the CDTI activities. 2 WHO/APOC, 24 October,2008 Opportunities: o The availability of health facilities and health posts and the existence of health extension workers in each of the CTDI kebeles are good opportunities for the project implementation. SEGTION 1: Background information 1.1. General information l.l.l Description of the project Illubabor Zone is one of the 25 administrative Zones in Oromia Regional State. located in the south western pafi of Ethiopia at about 600 kms distance fiom Addis Ababa.The Illubabor CDTI project is bordered with; Garnbella regional state irr the west, West and Kellern Wollega CDTI projects in the Northwest, East Wollega CDTI project in the North and Kaffa- Sheka CDTI project in the South. The Illubabor Zone is sub-divided into 24 Woredas. According to the government structure Woreda is subdivided into Kebeles and the Kebeles are further subdivide into 'Gots' which are further subdivided into "Garee" (villages) which is composed of 25 - 35 nearby households and are responsible for all development activities including health. The Illubabor CDTI project consists of twelve Woredas namely Mettu. Darimu, Alge-sache, Yayu, Hurumu, Alle. Didu , Becho, Bilo- Nopha, Dorani, Dabo- Hana and Bedele' There are a total of 273 kebeles in the CDTI Woredas which are subdivided into 3,89-1 Garees (villages). The CDTI project area has a very complex terrain with altitude range of 1.000-2,576 meters above sea level. Ecologically it is a tropical rain forest with great seasonal and inter-annual clirnatic variations which is traditionally classified into three broad geo-climatic zones, i.e. cold highland, sub-humid mid-land, and hot lowland area. The mean annual temperature rangesfrom l0nCto l60Cinthehighlands, l60C -26ocinthemidlands,and230C-330C in the lowlands. The annual rainfall totals ranges from l000 millimeters in the lowlands to 2200 millirneters in the highlands. Sor, Geba, Birbir Dedessa, Offa, Sesie, and Gumer rivers are among the perennial fast flowing rivers that cross the Zone. There are also many numerous fast flowing stlall rivers and streams, which are tributaries of the main rivers in many areas in the Zone. The project Zone is covered with high forest and coffee plantation .The Zone is well knorvn rvith two J WHO/APOC, 24 October,2008 distinct seasons that is the rainy season (April - October) and the dry season (November- March). There is a mono-modal rainfall pattern in the zone. Agricultural activities (clearing, farming, and herding) occur all year round in the projectarea, but are most intensive during the rainy season. Harvesting occurs from October to December, leaving January - March as the optimum treatment period. There are about 576 kilometers dry weather roads that connect Woreda centers with Mettu town. The main road that runs from Addis Ababa to Mettu, the zonal capital town, passing through Jimma zone is partially Asphalt road and woredas alongside of the road are corrnected with Mettu town. All the CDTI woredas have all weather roads that connected with Mettu town. However, access to rural communities appears very difficult during rainy seasons in the project areas. Cenerally in all llubabor zone there is one zonal hospital, one Fistula center, 34 health centers. 47 health stations and 408 health posts in the CDTI project area. The potential health service coverage of the zone is 89%. Table l: Number of health staff involved in Illubabor CDTI project,20l0 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 Br Percentage Br:Br/ Br *100 Mattu 95 76 80 Darimu 100 46 46 Alge-Sache 70 70 r00 Yayu- 34 34 r00 Alle JI 37 100 Becho 4t 4t 100 Hurumu 42 42 100 Didu 39 39 100 Bedele 100 r00 I00 Dabo-Hana 40 40 100 Dorani 34 34 100 Bilo -Nopha 30 30 100 Total 662 589 89 4 WHO/APOC, 24 October,2008 1.1.2 Partnership The Ethiopian Federal ministry of health, Oromia Regional health bureau, Illubabor zonal health Department, respective project Woreda health offices, health facilities, the affected community, The Carter Center Ethiopia , WHO/APOC and other govemment sectors in the zone are the main paftners involved in the Illubabor CDTI project . There has been strong partnership during planning, advocacy, mobilization. drug distribution. monitoring and evaluation of the CDTI activities among allpartners in the project area. 5 WHO/APOC. 24 October,2008 €a{ L c) -oo oo s6l () o- o I d l.)q, \\ s q) : q) $ o a U IP s$ i\ -P!i .Y\ \Es9 -s >, -( ': .r Bq)UP Ei:* .}Y B $<\\$o \-s $B -Ee =9iS S6 \E <> :s\d\a_!\ta s=' -o: {}s9 -s .Y ci $\S.sryB$\bo{=): *\ il; t\B\U o u0 q) q) oo q) o o o () o c) d I 6) q) 0) q) o) c{ c! 6 q) a.9 O'= +r=Gtr aEs-ao9r oir ol N4lFFI \o cg F= o- = iiv (o O)o @ ro o CO(o CA @NN(o N sl-$ @ ro @ @$_ ro(f, sst- c.)t- N @ o) os Nf- cf, CONr @ o,(f) COt- o(, o$ oNF- o cf, N f--\ r(e olr) t-_ @$(o + il .o -oo .= o.N 6 !.-E> E r- () t N(o r o,(o rr) rN cos r @ ry C9 N r(o o,(o lr)sN N$ o o) F- l'-@ O) ro co C.i ro Nf.- @(o$r @t- (f) N@ co @$_ o ro lr) O)o @$ sN@ N cr) rN cr) NNf.- . sE Ei'=t 6tE.=;; >,E o cJ - *,dEP'Na o cf)ot-$ @@ CY) o)N rNN N O)$c)Nv (o NF- @N Nt-(o O)lr) so @lo CO Nt-@ o) O) f.- s o) rO Nf.- O) cf) s$ cf, r cf) oNt- ro N N O) r rr)N|r, EgE :!6 ?oEgsi N cf) r NN O)N@ cr) r o ro o co @N NN o, rlr) co r @ r @N rO LO f.-(o r oo o- t-s r @ o) N N F.- N @ r r|r) f-- sr $or Nr o,s r N$N ah 0) o0 oq) (J o q) z + il L o3o ON 3.2 -q) 6O F $lf, cf) @ o) r tr) r-- r (o NN o(o f--f.-$ f.- CY) N O)o@ t- co$ Ns cf) @ @ N ooN $ O) @ cf) .eEE'- ;o- E o :''lqJE Eie cg otr >r()+E N ro(o N @s o,N tr)t-r oNr (o O) co CO o, r o @(o (o(o cO @ @N r$N CO @r r(o cr) 'EEE :€6 ?crUgsi O) @ olJ) Ns rro o$ ro Ns o)Nr rt- s|r) f.-$ f.-co co CO f-- 6l -G) .iek9.- -=i9t = 6.9I *q.r 9'Y9-rF AE E N(o r o,(o ro rN cos r @N. r co Nr(o o,(o (o$N N$ o O) t-_ f-@ O)ln co N rO Nt- @_ COs @N (f) t-@ @@ n" @lr) lr) O) o-(os sN @_ t- CO rN cv)_ N F-t- O o ':' o c! ir,E t =ic!Fq,EFE.-A!O C) z o o C) @ cO o- o z I o o 0) ! o o o C)o (o c0 o -o(o l-.1 E (B o () o(n a Io 90 I cg =E k .E Lo o J F F €N 0) .o o o - $ c.l U o / o() L q) o I I oL o. o I E (! ar')! C) g o '- a !.: UL ;-=0J '(J .rn(J= oo o 0.)dilo =tr)=>.oo 3;A6N6 LA acua-.Lq(! F u-! c) 9o-(! L(.) ! c) !Yv v)6Y0)O- = .- o-) P U9P2Hc ou! qJQ id\'= €.EH ,v= :Ao)= -EUr=o)O- 989 € ct6=oo )^d(Ju:a-o (u >o! :.23v-L =o)9-; =C)(HcbooL(d Y' uLd FACtra!0()o),9 oo ; -3c=? =3>ULt-cutro1.9 b9<gar-c/-.() Fq- L7- a o z I-r .b o()oth C)ok o U) Lo ov. o t-.1 O u)' tt) (.) C) o d4.. 0)9-rcg ^()(n> 0) o -o o -o(! () (g 0) (* oor o c/) C) a z(H o -o o ! 0.) o. bo 1i o a. C) () oo H 0) o o 0) 'e L o. 0) L ,o th) V> (.) c) 0(o B .r) P o a o o.6EE o(.) c.l o o.l () c.l o = c.l o = 6l o 3 at o o.l o cl (.) a.l o a-l o a.l o 5 O e.l 0) tr hDtrt c!: c.l -oof! a-'l -o IL a.l -o(,) f! N -oof! 6l ,o() f! O N -o() f& al -o0) tJ- N -oolL a.t -o0)lL a.l -o6) LL c'l ,o r! at q)lr o ah AI o o= a.l o = N () = 6l o c-l o a.l 6) a{ 0) C.l () c.l tr c\ O (\ () cl c.) N CJ u0EE 1itr a- a.t o- 6l o. ct Lo al L o- a.l L a- ot o- 6l o- o{ o- ol a.l L o- N o- o a.t Lo q) (h U) q,)(, E6EE U 6l d O ot a] L o.l d a.l L a c] L d c.l cd O al CO al L -< at L(n 6l L 2. a.l d u0rE liE 6: a- c.l d ct C! o.l L N L CO z- a.l 6 O a{ O al (o a.l( a.l c\Ld o al d c.l bI F o.:trE U O ol d z- c..l d 2 o a.l c-l 2 al 6.1 L an L N d N L z. a'l d d c..l L d z. u0Er 1itr c!: c.t -c 0.)f! ol (.) LL aq -oalL o6l -oo CL a.l -o C) N ,o otr c.l .o() rL at ,a 7)lL 6l -oo E. aa ,co a] -o q CI -o() r cE=N- !Eoo -oa o.5EE Q 6l o a.l o a al o a.l o a 6l () O 6l o ol 0) c.l O = o.l o c.l (.) c.l o N () a0 PE 6l -oq) lL a.l _o() iL at oIr N -ooE o.] -oo o.l q) a o] ,o o lL c.l -oO!L OI -oolr a.l q) t! O al -o a) al -oo(! 4 F] e ah o z. o o() co o. oZ Io =o ! C) o 0) m d I o -o(g a = (! t-.1 0.)Eo(t Io bo I L f (d o oo 00 a\ q) -oo o o <. c.l o I(! C) (! !oL q- th bo FE oL oo O L C) oL E q L O -v,L o C! o q- o o -oL 0) O o 6) -o (-,) L C) Cd 0)Lo o o0 q() .. Ieul(JL L>'^- o15E9 0.)O a= o,- Lcd r\ (l-vo q) o I c) 0) c) ah q) G q) .o q) q) Q c! 6) o l-t ?ol ol -aldlFI o .9t +, o(! rF o o E o E F F c,i Fo(, lF o ? -o IIfl IEfl tr o Eg c! aaN z o IF(, IIJo 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. During the treatment period more than 170 political leaders at each relevant levels were mobilized and .The purpose of the mobilization was on the improvement of the treatment coverage, reduce the number of absentees and refusals and as well on how to sustain the programme .Horvever, some competing activities limit the contribution of political leaders on the CDTI activities. 2.3. Mobilization, sensitization and health education of at risk communities The heatth professionals working at woreda health offlces, front Line Health Facility rvorkers, Health extension packages and Developmental workers rvere the major role plal'er in the community mobilization and sensitization. Cornmuniry Supervisors and kebele leaders were also involved in the mobilization activities. Community mobilization, sensitization and health education was conducted at each level during the treatment round. Health extension workers and CDDs were responsible in giving health infbrmation to the community at kebele and village level. The Community sensitization and dissernination of health information have contributed a lot in the awareness creation of the community .As a result of which the sixth year CDTI activities was successfully accornplished with high therapeutic coverage and 100% geographical coverage. 9 WHOiAPOC. 24 October,2008 oo O a\ o ,o o o o '+c.l O o I o Ib! cl ?t) .-! =z II ; a0 cl oe $ c.l o.(n od \o oq ca \lrl N nrn aa 9aoC.l n ca $ $\o ='t 5L 9:-x=v E E* =Fr '- E.q \o oo (-- aa sN NN t'-N -f,$ \o aa oo oo a.) ooN 0\ (f)\o o E ( HQ L z + fl ca d F $+\o .f, aO\f, ooN \o$ co$ co ao o\ oo \o r- .i- r- cn t'.- oo\o oo $\o N\o t- cat (.1 t-- r-.r- co 3-(a \o oo t- ao $ c..l c.l a'l r.- c.l $$ \o CA oo oo an oo c'l o\(-)\o H Q( 2 oo V')tr) t-- aa oo c! \o aot \o ol oo (r- *f, ao o\\o C\ aa t-- ca oo $ C.l \o ?a ff) r- ?e Eo E9 oE oa zQ ll * ca ca ca o o0 c! f 'ng s ,'ee2 9 tr-o E EEE+ Zeca O o O t--s ao co oo \oN c.] O c- a-s r- C. c..l o\ @ t-- a.) -i- c.l$ Ce \o oo C.l c.'l =J @ H d 8'gtr.E d" -EoOs t.-:: Fg6 oo9E r-$ co oo o\ oo\o c..lN O\o r-c-.$ tr-. c.l c-l o\ oo t-- ao$ c.l .{. aO \o ooN o.l oo ,.1 H () z o o C) c0 O. Z I o q 0) () C) C)o .r. o -o(! (! ! (J o a Io oo I d L dL o ! F : U)q qJ(J q) V) \ q)q q){, 3 U q) {J .E; o5 o& 2.9o? tra. ah flij E= LEE_ao\Jo+r arllElNFI Comment on: - Attendance of female members of the community at health education meetings The attendance of female community members on health education session at each community showed no significant increase from year to year in the area because of cu ltural problem. - 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). Participation of female is still low . Incentives provided by communities for the CDDs The CDDs in this project area are serving their neighbor hoods (25-35) households voluntarily. No incentives were provided. 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. - ' Other issues il WHO/APOC, 24 October. 2008 2.5, Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The mosl important issue to describe is what measures v)ere taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff are frequently transferred during the course of the campaign). In the project area there is a great challenge of high turnover of health workers and transfer of health workers each year .The project was provided training and retraining for health workers at each levels every year to eusure adequate CDTI implementation. Training and retraining rvere given for cornmunity supervisors and CDDs. 12 WHO/APoC. 24 October. 2008 aCI o _o o ,J o <'6l r" c o- o ca oo o a o o B c 5 a B o E ot \ a 1 IUt: t,l!lol\ S l F ; N N(o t(, tlo |,- o, a,) @ co (o (\l F- r--r- cttvrr (f) f.) $ co$ NN .f, I O)@N C"(t otf, o(ot otot o @$(t t@(\t $ @ (v) o,@ (? O)F. oor (0 1.. sf (0 l.- rl o (Y)t- t-(Y) i- : o @(o @ o @ @ o a< = all \t$(o t- @ ro F.tf, t-F) h,- @(o @ rt @(o N(o tf, F. o, C.) (\l F-r-r- o q) q) \o + o\ \ft(0 $ ca$ o,@N o(0 r+ @t(Y) c)q) @ (ot*rt q) G a U q) z F \ q z Icll F \./ q) o o\ a q) .a'o'ctt- LF(). oq) .o Lcl ol- z F co an t-- .a rn Vt \o(\ro\ O$ aa \o\o $ (..l (-l o{ O t-- aa $ c.t ca ca aa o.l s tr- ca \o o\ t--ca \o ao i z \ U ?r ts .'? o\\o r*aa \o CO \o a.l \o o.l O € + ao o q) -oo\o\ c..l r- aa a.) r- rai,a F- ao O$ \oc-co \oN c.)ca t--c.l q) ;ie P3 E-> zE q,)() LF o\\o O ca aa C. $ $ $ s .f, $ (-) q = dll:' Fv r- t-- -f, $ ca (\Ira (tr rn o\t ?o ca \o \o s ra) O .f, $ C{ o] (\ IF t-- t q) CI C! o q 0 q) z o () o s I (! ! (o o IJ F F 0)() !oo d -o(! L ! () -coda I o30 o o() cd a- o z I o =o o L.l Fl o z. i q I q.) q: q) \J q)q U 6 c) q) F U o U) o C) c) .o q) 6 oo G F r,nl ol .al6tFI $ @ @ t @(o o N Table 6: Type of training undertaken (Tick the boxes where specilic training wus carried out during the reporting period) Any other comments ;- No more comments 2.6. Treatments 2.6.1, Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% 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 Districts it is above 83%. Trainees Type of trarnrng CDDs Other Communrty members e g Cornrnunlty supervisors Health Workers (FLHF) MOH staff or Other Polrtrcal Leaders Others (specrfo) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) 14 WHO/APOC, 24 October, 2008 €c..l q) -oo o * N () o. o : qq qJ q,) q1 4 qJ 3 .t) c! andq) I o o rr) ri a 6 q) q) F F-l -l -ol6l FI :EEEJ c 9< o= 5.3 q Ee;eaEE€EH:; z 9q: o 'aoo OL O rrl €?\U) AO vo !Eca z6 o o o o O o o o o o o o o L E.- O .3 9:E EET}EEZ* gE O o o o o o o o O o o o o d o o- ll *,xA' H o\ o5o =boocd E-9 oo -CoF cl oo q aa CO \$ oo \ c.t co \ t--. \ c.) oo q co F-. oq c.l oo t oo \N oo q c..l oo c-l oo € o 6*0be Eb9 z tr)$(O- r.- rr) (r) |.c) @- rO(e @@$_(o N @N(D- t- rO rr)(o- C'o |f) tr) v- (Ot- O) (r)- s N @- N N @ (f)_ (f) N oN cA^ @$ o) O) @(r) (f)(.) N. N CO ss o. a E6z ,ab FU @ O) o- @() O (f)- (o(r) @ r.-N.(o N $ r.-$- @ rr) (o @$. lr) cO s$\ c.) r-- N @ OJ cO$ NN(o coN @ o,(r) cON o CE O)$ ON r.-_ @(O NN N. cr) o|r, t-. @s(o a =rdE Eg = o FG LE)q ;-:dE G 9.E .o N(o o,(o () ol (f)s @N. (.) N (o- O)(o (O vN- N .t o o)f.- N @ O)lr) CO N rO N F- @-(os @ F- cO_ r.- @ @ @ s- @|r) rf) o) o_(o$ $N @ N CO N(9- NNN oobo(d (t) C) oO ll IJ/i H o\ q oo cd o oo (! I o-d oo oo O O :o L=oPo c oo.lg -o5didI C= o =c>!Aa a t--s cO oo o\ oo\o \oc.l c..l O\o I.rt--$ t-- aa c.l o. oo c- c.l$ c..ls ca \o @ c.l c.l d o. @ =aEUZ EEgia9' Fl, tr-$ c.) oo oo \o c'l c.l \o c-r-$ c- ceN o\O oo c- c.)$ N$C. \o 0|o a-l ON d o\ oo tsEp" 3.: o* 5E-3.?H 3 - =E=->€9rOj:c>c;treO !- - o oF3T Ei t--s ca oo o, oo\o \oNN \o r- r--s t-- co c'l o\a oo t- cas c.]t aa \o oo C.] O N -f @ .-J o Z. o o() cn o, o z I q C) = ! ! o o () o (d -o(d E H(c (.) o a Io bo I 63 L 'r' cOL o LJ ( F Formula for computing therapeutic and geographical coverages Therapeutic coverage rate Number of people treated x 100(%) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate Number of communitiesivillages treated x 100(%) Total number of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate (%) Number of people treated x 100 Annual Treatment Objective % UTG achieved Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG) ATO : The eslimoted number of people living in meso/hyper-endemic ureos that a CDTI project intends lo lrest with ivermeclin in u {iven yssl. aTG: The maximum number of people lo be treuted in meso/hyper-endemic aress within the project area, ullimately to be reached when lhe project has reachedfull geographical coverage (normally tie projeci should be expectetl to reach the UTG ul the end of the 3'd year of the projectl. l6 WHO/APOC. 24 October.2008 2.6.2 What are the causes of absenteeism? Some absenteeism was occurred due to the overlap of work activities during the drug distribution/ movement of community for trading or agricultural activities during the campaign. 2.6.3 What are the reasons for refusals? Most individuals refused because they considered themselves as health and Others refused because of minor side effects. 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 t7 WHO/APOC, 24 October, 2008 @ o ol o -o o $ GI o o co q; I I c{ o () q) u0 trq) a 9 O rltvF D L 98! cgtr c)vcrtrH'F€y.a_E eqr!tr.:0q)aid!For 6-= -.F00vt- El-lH:u.2j3L€ tr;q) OdU)5_E.=A= EtHl 'a5$l L rx (Ol aLt.ol rG(olFi9balU;IEl dE EI q,, 9q,| : ,!fl| ;!UE>IOJqr -ol '= EoLoooa>6 v: vEtr-cqU.o I 6E!,FGt-Eab)t:\ !r o)Eq)E --E! -ajq)oc!:EEU L' IL:LH , o\l -.1 o) .n{l 2\o6l g c.i t-{l 0r o oo F oX -o O o. o\ 00 F.. 0a rc;o\ € o\ \o o\o\ U a. o ll r I.;. rrl li o ^oo9 S.]r @o\ <,>v -o o o. 00 F- oo cq \o o\ 6 ll r Ii E] 'I1 o\ o oo € o I o a o. d o F t--t-. l-- r-r\ 00 a co co !o 6o o oo o -o E z t- cl -f,(\ a..l\od |-.<1' F- € ol @o (O ro lO + <1- + r, 7a?62 EES tq5' F9 \c\o& c.iE' @ @ n O)- @$ rO (f, @ O)- t-- @lr) r- \c $O qo +3 - x p.d :Y 5 0 a'o e o 6€< =EJ O o; o a.tt r-\o \o t-. '.).+ al\o \o O)o cr) N O)(o F- o.lo clr F- C) b0 c = .9 .= - E E U rirI] a ^oo(r !!- F 06\<3- o -EoPO-bO=S=EGtL;- *ii 9Cr.ir.t (, o tr) O O O O ri oiq UEPE :q>hz3' $ o\r- r- $ & =a.Ed> i ij.a O o\v) - $ F- =o\r- f-) r- <f 6 oO6 = ,3 O> 9 3-H+ot>.:: jitr-oE oaqlaaF. tr u 9-o EO o O -f,o\ =a- o,a- =t€ & g N ol c.l a{ O c.l <. N O c.l \o 6l t-O on ooo N OO(\ o o.l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHO[] UNICEil NGDC Other (please specifr): Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH M WHOf] UNICETtr NGDC Other (please speciff) Please describe how Mectizan@ is ordered and how it gets to the communities The Ministry of Health together with NOTF requests for Mectizan fiom MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery system in the country. Then the drug is stored in MOH warehouse .The project request for Mectizan@ from the MOH, fbllowing the existing drug distribution system. From the project level (zone level) each project Woredas receive the drug and distribute to the fiontline health tacilities. Then the frontline health facilities distribute the Mectizan@ to the community supervisors' .The CDDS directly receive from their respective community supervisors and they distribute to the communities. Table l0: Mectizan@ Inventory (Please udd more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The remaining Mectizan @ tablets were collected by frontline health facilities from Community supervisors and returned back to woreda focal person's. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Training of community supervisors and CDDs ' Request of Mectizan @ from different levels ' Collection of Mectizan @ frorn the Woreda Pharnlacy 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 . Recording and reporting of training and mass drug distribution data Any other comments 19 WHo/APOC. 24 October, 2008 District/LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining lllubabor zone 1,7 50,250 1,750,250 1,714,668 0 5s37 0 30045 Total 1,750,250 1,750,250 1,714,668 0 5537 0 3004s 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, When? Yes. the conrurunitr'self nronitoring training has beeu conducted in the tiont Iine healtlr lacilitics lbl health u'orkcrs ancl comurunil_r'leaders. Accordingly'. nrost cornurLrnitics hrrc carriccl out scl{'rnonitoring in thcir rcspcctil'c villagc-s (cornrnunitics). l'lre training u'as give n irr lv'larch 2010 Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows d needed) 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. In cach village tlre cornniunitl'strpervistlrs itrrd cotnrttunitr leaclct's harc rttpt:n'iscd ancl nrorritorcd thc inrplcmcntations and thc pcr{brmancc of'('l) I I actir itics. I lrc Stakeholdel's at each levcl lrave sLrpprlr'1ed the irnpleurcnlltiorts ltntl thc pcrlot'tnunce ril' ('l) I I activitics. As thc rcsult tlre nunrbcr ol'abscntccisrrr uncl re lirsrrl \\crr' re.lrrccrl lurd thc thcrapcutic covcragc slrou cc'l irtcrcrrscd r'lttrittt-t thc pclirid. 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) Metu Becho Bilo-Nopha Alle Didu Bedele 347 r98 r68 226 r60 477 347 ri8 168 226 t60 477 29 t7 t6 2t l5 4l Dabo Hana 237 237 t5 Darimu 809 809 42 Alge-Sache 437 437 32 Yayu- 342 342 l7 Hurumu 286 286 l6 Dorani 200 200 l2 TOTAL 3894 3894 273 20 WHO/APOC, 24 October,2008 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 supervision? ' Though some improvement have been observed further improvement is still required. . High turnover of health workers in some of CDTI woredas. 2.9.3. Was a supervision checklist used? Yes, supervision check lists were used at all levels. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Some irnprovement was seen fbr the year. Distribution still going on rainy season. 2.9.5. was feedback given to the person or groups supervised? Yes, verbal Communication during the field visit and written f-eedbacks were given for each level How was the feedback used to improve the overall performance of the project? fuig-t., tt,"rupeutic coverage and 100% geographic coverage is due to the continuous supervision and feed back. 2.9.6. 21 WHO/APOC. 24 October,2008 SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) xCondition of the equipment (F:Functional, CNFR:Cunently 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 efTectively repaired and rnaintained the existing Capital equipment and other materials provided by APOC. The project is trying to handle and to improve the overall performances of all activities by integrating to the existing government system. lt's expected that APOC would replace the capital equipment and materials by the end of the fifth year or mid year and at the same time eflorts will continue to allocate budget by the government for smooth operation and management of the project bf integrating into tlie existing health programme. Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No Condrtron No Condrtton No Condrtlon No Condrtron No Condrtron l. Vehicle I F I F 3 F 0 0 0 0 2. Motor cycle(s) 6 F 1 F 12 F 19 F 0 0 3. Computer(s) I F I F t2 F 0 0 0 0 4. Printer(s) I CNFR I I t2 F 0 0 0 0 5. Photocopier (s) 1 CNFR I 0 0 0 0 0 0 0 6. Fax Machine(s) 1 CNFR I I 0 0 0 0 0 0 7. Overhead projector I F I F 0 0 0 0 0 0 8.25" TV set I F 0 0 0 0 0 0 0 0 9. Deiesel Generator I F I F 0 0 0 0 0 0 22 WHO/APOC, 24 October,2008 00o N 0) -o o s(\ (-) o o - CA N I -()Uotr(n v)= -o .:na9d reE r()o -coeo()0H(*6)^ ?a -al^ -vo -co d a9!o d ,)E (d 1J C) (n o-LCEoc9L a6 o^P -U^ o,=a o2 )oL -qoP daFLHL =oo .:-.o c)a^q cECg 'l 6(I)Vp g t- (B l+ >,u =()]L-LUeeo) o(F n l+r o o +, =?E8OF(, -E!:E -u)GS o9 o: -= k?oEOE .trE +, l* F=oc{ ok,E?{r .= .o:EE o9 G'6 (,G Loii E !! .'ll;l .-l0! €trlFl F] F F a F (-)AE <ri 0) E oQ o IJ z(o = Cl ECC) rt JZ o o N + .9 a.2 =A2= o(!(, + EL o_q >g(.) rV} d r o. c']. a{ r o\ ct N € (ssn) peseeleu qseJ lelol Or € cl cl r N 6t N eJ r N a{d O @. € N r L pa1,(aBpng r.JSPc .]VJOJ OO rV) r co a\,. O cl CO @\o ($sn) psseeleu qSEJ lVIOJ O @ n € rna € o\ I ON O 09 o d L € ($sn.) paleBpng r.lsEJ .IVJOJ O \o = \o o\ O O +\ N O ($sn) peseeleu qSEJ .IVJOJ O 6 9.r o\ €O NI sf a (ssn) patsEpng qseS .]VJOJ €O d |r) E c! O C. 6 n * \0 O r Cale. = O (ssn) pese0leu qseS .IVJOJ c O q a\ dF. C O r O O ON O r N ( ($sn) peleBpng qseS lVJOJ O ON r+6 .1 € O r N OO (ssn) pesBe[3u qSPJ .IVJOJ @ € n. \o alo. -.a Or t OC L 6o (ssn) peleBpng qSEJ .IVJOJ v) O - Additionalcomments Integration of Malaria and Onchocerciasis control programme (MALONCHO) play a great role in the implementation and good performance of the CDTI activity for this year. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) The services of Community Drug Distributors(CDDs), Community supervisors and kebele task forces (KOTF) are considered as the major community contributions for the CDTI Project in the area .For thls treatment round , 7772 CDDs and 375 community supervisors are involved in 3894 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. lndicate exchange rate used here lusD: 13.65 Table 14: Indicate how much the project spent for each activity listed below during the reporting Period Any comments or exPlanations? the budget assurned frorn MOH is not considered as expense (budget item as personnel cost, capltalequipment), that leads to the difference of expenditure and expense in the listed above (table 13 &. 14). Assumption of the exact budget for CDTI is not an easy due to the pooled finance management system and the integrated nature of the CDTI project to the existing health program. Expenditure ($ usl Source(s) of funding Drug delivery from NOTF HQ area to central collection point of comm Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising and Monitoring CS_M Vehicles/ Motorcycles/ bicycles maintenance Others 0 6,886.28 0 t1:els.44 7,145.28 4,486.87 3002.82 1964.18 0 1,28t.96 TCC 0 NGDO APOC NGDO APOC APOC TCC TOTAL 38,682.83 Total number of Dersons treated 24 WHO/APOC, 24 October, 2008 SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoringl Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) None Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 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 peri od? NO Was a sustainability p lan written? NO When was the sustainability p Ian submitted? NO What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 25 WHO/APOC. 24 October,2008 SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: The project is successfully accomplished the distribution of Mectizan@ for the seventh round within the given period of time with high therapeutic coverage (83%) with in 100% geographical area. This great performance is due to the active involvement of the health workers, community supervisors, paftners and the community atlarge. Weaknesses: Delay in liquidating the utilized budget from partners , Opportunities: The commitment and availability of Health Extension Package program and the increased numbers of Health extension rvorkers is an opportunity for the programme. '[he government structure do'wn to village level "Geree" and being taking the responsibility of development activities as rvell as health is a good opportunity for sustainability of Onchocerciasi s control.. Threats (Challenges): The high turn over of health professionals at all levels, and overburden of other activities, the contirruous restructuring of woreads , kebeles and villages. SEGTION 6: None Unique features of the project/other matters 27 WHO/APOC, 24 October.2008