Bench-Maji CDTI annual project technical report submitted to Technical Consultative Committee (TTC) : January 2005 to 31st December 2005

t The Federal Dernocratic Republic of Ethiopia Ministry of Health COUNTRYNOTF: ETHIOPIA Proie Name : Bench-Maji Approval year: 2002 Launching year: 2003 Beporting Period: F ronr : J.a nu.a ry.?.40.5........ To ;.... D-ese.mher..20.05....(Month/Year) --- ( Month,rYear) Proiect year of this rerrort: (circle one) I L@tsGT8eto Date strbmitted: 04 June 2006 NGDQpartner: The Carter Center I ANNUAL PROJECT TECHNICAL REPOITT SUBMITTED TO ' t E C H N i C A i, C () i.is U LTr\TI'v' E C O ir I irl i T'f EE (i'C C To APOC Management by 31 Julv for September TCC n-reeting ffi"t_ t ir i I 1 J3c{ 'lff - & i.j. :-'t i: i3it, 'o{ ,.-DEADLINE FOR SUBI\TISSION: To APOC Managenrent by 31 .Ianuarv for March TCC meeting r ril;-r liCnFor I To' bi B I A# il Attir I I t t1 r( qgr AFRICAN PROGRAMMtr FOR ONCHOCERCTASIS CONTROL (APOC)q 2 6 JUIN 2006 WHO/APOC, 24 November 2004 _t ?i,l " st t!,('l\ I{tl a: ANNUAL I'ROJECT TECHNICAL RT'PORT TO TECHNICAL CONSULTATIVE, COMMITTE,E, (TCC) trNDORStrMtrNT Please confirnr I'ou have read this report b1'signing in the approltriate space l-\Dr}rr\L-I)Q +^ -:^,. +t.^ ts,..\^F+.\r.l'l'l\-l-l\r) lt, Srtsrr lrrE r ( lr\rr l. Jl Country Ethiopia National Cloorclinator Nanre: Dr Dadcti Jinia Signature l)llte (: L Zonal Onclio Coordirtator Name: [I S ignaturr- ri DaLc: . . t."l-../ :.'./,..L.{t NGDO Represetrtative Narne: .......Tes.l.r.p.t1g.Gelutg..... -t"-- :<-.- C't r Signatrre:. '#'Z-' t'lr/' Dnte: . . .,1. { .' .1v! C. . .t,t.t.. . Tl-riq t'ennrt ltec lre,-rr t-u'et-rlred lrrr NTqr..p Llamrrc l\,,[elrrrri" r NTf)TI.- Designation Zone chocercrasis Cocrrdrnutor' Signatur )/ Date It ll t lat WHO/APOC, 24 November 2004 r: }, t i _----l : l l t- "] Table of contents AcronYms """""""" ivDefinitions ................ v FOLLOW UP ON TCC RECOMMENDATIONS .......... I Executive Summary ....................2 SECTION l: Background informarion ....-........ ...............41.1. GeueRet- Ir.{FoRMATroN............... .................... 41.2. PopulatroN ................6 SECTION 2: Implemenr.arion of CDTI..... ......................72.1. TluBlrue oF AcrrvrrrEs.............. .....................72.2. ADvocACy .................. g 2-3. MostI-znrloN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUMnEs g2.4. CoNaNlur.nry INVoLvEMENT............. ................ 92.5. Capecrry BUrLDrNc... .................. l02.6. TReeruevrs ................ ...............122.7. ORDERTNc, sroRAGEANDDELrvERyoFIVERMECTrN.......... ................ l62-8. colvnvrumrv sELF-MoNIToRTNG er.ro srnxeHoLDERs MserrNc .......... ll2.9. SupeRvrsroN................ ................17 SECTION 3: Support to CDTI .................... l83.1. EqurueNr ................ 183.2. FINaNcIer-CoNTRIBUTIoNS oFTHEPARTNERS ANDCoMMUMTIES ........................ I93.3. OrnenFoRMsoFCoMMUNITysuppoRT ......... 193.4. ExpENolruREpERACTrvrry ......... 19SECTION 4: Sustainabiliry of CDTI......... ....................214.1- INreRNal; TNDEpENDENT pARTrcrpAToRy MoMTozuNc; EveluATroN...... ............214-2. SustetNnstLITYoFpRoJECTs: rLANANDsETTARGETs (runNoeroRy AT......... .....25 Yr< 3),........ .........254.3. INrEcRnnoN................ ...............25 4.4. OpenerroNAr- RESEARCH ..................26 llgTIoN 5: Strengths, weaknesses, challenges, and opportunities................ ..................... 26SECTION 6: Unique features of the project/other matters ..............27 l l I l l J J J J J .T J I J J III WHO/APOC, 24 November 200.,1 o Acronyms t APOC ATO ATrO CBO CDD CDTI t Srvl I-GA MOH NGDO NGO NOTF PHC REN,IO SAE SHN{ TCC TOT UNIC]EF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Tmining Objective Comrnunity'-Based Organization Commu ni ty-Drrec ted Drstributor Cornmunity-Directed Treatnient rvith Ivennectin Cornrnunr i1' Sei i-irioniloring Local Goi,erntnent Area Ir{inistry of Health Non-Goverunrental Development Organtzatiott Non-Govelnrneutal Organization National Onchocerctasts Task Irorce Prirnarl' h.'ai tit c arc Rapid Epiderniological Mapping of Onchocerciasis Severe aclverse event Stakcholders rnceti rlg Technical Consultatrve Conr rni ttee (APOC scie nti fic advi sot l, gr c-rup) 'frainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organizatiorr lv WHO/APOC, 24 November 2004 i_ t Definitions (i) Total population: the total population living in meso/hyper-endemic communities rvithin the project area (based on REIr{O and census taking). (ii) Elieible poplrlatis!. calculated as 84Vo of the total population in meso/hyper- endemic communities in the project area. (iii ) Annuai Trea t (.,ntectl\'c rr - - -.:_ -^._ J -_--__L^_ ^a _^_^^_^ t: '(A i Ui: tlrc cslltnrrtecl irurrlDer oI personS li\'ing irr meso/hyper-endemic areas tliat a CDTI project intends to treat tlith ii'ernrectin in a given 1'ear. (iv) Ultimate Treatment Goal (UTG): calculated as the maximunr nttntber of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached rvheu tlre project has reached full geographic coverage (normally the project should be erpected to reach the UTG a,t the end of the 3'd 1'ear of the project). (r) Therapeutic coverage: nutnber of people treated in a given )'eal' over the total population (this should be expressed as a percentage). (vi) Geographical coveraqe: number of communities treated in a given 1'ear over the total nunrber of meso/hyper-endemic communities as identified by REMO in the project arca (this should be expressed as a percentage). (vii) Inteqration: 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- cffectivcncss and emporver comnunities to solve more of their health problems. This docs not include activities or interventiclus carried out by corrulunity distributors outside of CD II. (r'iiit Sustainabilitl': CDTI activities in an area are sustainable tvhen the 1' contrnue to function effectively for the foresceable future, lvith high treatment coverage, integrated into the available healthcare sert,ice, rvith strong community ownership, using resources mobilised by the community and the government. (ix.t Communitv self-monitoring (CSM): The process by which the community is emporvered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a vierv to ensuring that the programme is being executed in the rvay intended. It encourages the community +^I.^ c.lt -^^-^.^^:L:l:+., ^f i.,^-^^+l- l:^+-:l-,,+:^- ^-l -^I.^ ^---^--:^+^ru rdNL rurl rsJpurrJrurrrtJ ur lY9rrlruuLlrr ulJLlruutrurl 4rlu llr4^9 4PPruPrrdLc rnodifi cations rvhen necessary. WHOiA?OC, 24 November 2004 ! a- FOLTOW UP ON TGG REGOMMENDATIONS TCC session 'l I th a- Number of Recommend ation in tlte Rcport TCC RECOI,ILTEAD,{r/ONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC TTGT USE ONLY r 83 (i) lntensrfy health education, target lelusal, and absentees; Trainings and retraining have been given to health rvorkers, Communtty Supervisors and CDDs emphasizing of health education ^-l --^L:l:-^l:^.,allu llltlulltzdtlult. 183(rr) Pror ide mor e cletlil orr use ot' IEC ni:rtelials Three t1'pes of posters, bloachers and CDD guides rvere produced and the posters were distributed to all villages; the broachers to corrrnrunity leadels; [eachers and staff of other sectors and the CDD guides distributed to each CDD. 183 (rir) Request comrlunrties to select arrd train nrore Cf)Ds; The number of CDDs hrs been increased and this tinre trvo CDDs are serving 25 to 30 households. I 83 (rr') Inrplement CSIt4 and SHNI; -frarn cornnrunrtl, n)cnlbers to act as supelvisors: SHN{ inrplcrnented. iniplerne nted. Fully rnrplernented CSN{ rrot )et 183 (r) 183 (vr) Educate conrnturity nrenrbers on the need to fix drug distribution ^-.. .J ^,,r, :,1-' f,'-,-,,.., -'.;^,1Pruuu wt,rrru\ r.",,.,,'i, P\,'\,u. Efforts have been nrade to distribute Mectizarr before rainy season but u'e could -^r ,l^ .r ;,, anir< }.,.^,,,.d ^r ^l-..r,^,,r rvr uu several polio campaigns and delay rn the release of APOC fund. 183 (r,ri) Address rdentified rveaknesses and challenges i e delav in reportnrg, pool- frnancial utilization arrd .;ustilication, and overburdenrng ol' health rvorkers in FLHFs. APOC Fund was not available during distnbutiou for 200-5. But the finance pool sy'stenr is still a major cause for effective lrnancral uti liz-ation and reporting. I WHO/APOC, 24 November 2004 a Executive Summary 1. Background on treatment and population data Bench Maji is one among the l3 SNNPR zones and it is bordered to Sheka zone in the North. to South Ouro in the South & Sudan, to Kaffa zone in the East and to Gambella in the West. The zone lias li toial area of 19,325 sq knrs divided intc 9 rvoreCas,230 Kebeles anC 965 villages. Bench ivlaji CDTI has total comrnunities (r,illages) of 1,053 u'hich are distributed in eight Woreclas (Bcnch, Sheko. Gulaferda, N{eanit-Shasha. N{eanit-Goldya, She-Bench. Bero and N'taji (Maii uoreda hirs been divided into trvo u'oredas; Bero and lv1aji). The total I,opulatioil for the f'DTI ii,as 549,(r81. The Annual Treatinent Objective (AT'O) fot the 1's21 2005 rias 461 .'t32 ont of vrliich 451,828 rvere treated u'ith Mectizan rvhich gives annual therapeutic coverage ol83o/o. The project also has achieved geographic coverage of 100%,. 2. Background on population movements. -il.ie coininiji-ritittii i'':' CIDTI cieiis are niainli settled fanr-iei's, daili'laborers aii.i ci'''il sei'i'iints. Ho*,ever, there is a resettlement program in one of the rvoredas (Guraferda). Generally, tlrere is no knorvn nrajor population ntovetnent in the project area. 3. Training data 'lrainings arnd relleshel trarnings *ere given for 17.i health;lrofessionals.335 ContntuttitY Supervrscrrs and 2,798 CDDs w'ho were selected by the communities frotn 1,053 villages. Therefore, tlte average uumber of CDDs per village is tu'o. 1. Challenges and hou' [he1, 11'31. overcome. Threats (Challenges): High turnover of trained health staff and program coordinators at all Ievels, shortage of health rvorkers in peripheral health facilities and poor document handling are among the major challenges facing the CDTI project rn Bench-Maji. There were some occasional incidents like irnmunizations campaigns and epidemics that interfered rvith CDTI activities in some rvoredas during the period under review. t 1 WHO/APOC, 24 Novernber 2004 Prompt actions rvere taken to tackle these problems. In some instances. discussions were held with concerned authorities to resolve some of the problerns and improvement has been shown by integrating some acrivities rvith CDTI. a J WHO/APOC, 24 November 2004 SECTION {: Background information {.{. General information 1.1.1 Description of the project Bench-Maji CDTI project is one of the thirteen zones of Sotrthern Nations Nationaiities and Peoples Region (SNNPR). The Zone is divided into 9 administrative Woredas. The CDTI project area covers 8 out of the 9 Voredas found in the zone and has a total population of 549,681. The project area shares borders q'ith The Sudan in the South, Gambella Region in the West, and Kaffa- Sheka CDTI in the Nonh. The climate of the CDTI project area is classified as tropical and the lveather is cold and laining from May through September and dry frorn October to April. The mean annual temperature ranges from 20oc-25oc and the mean annual rainfall ranges flom 400 - 2000, mm. The estimated altitude range is 500-3000 rneters above sea levei. Slopes, hills filled rvith gorges and large river basins and streants. dominate tlte topography. Less than 247o of the area is covered b1, tropical rain forest. About 90%'of the population lives in rural areas depetrding on agticulture. There are two distinct seasons in the project area: Rainy season (April - Septernber) and dry season (October - N,{arch). Agricultural activities (clearing, fanning, and herding) occur all year round in the project area, but are most intensive during the rainy season. I{arvesting occurs from October to Decernber, leaving January - March as the optimum treatlnent period. iioad transportation is oue of u'ideiy useci rnode of transportatiott itt tire' projcct area. Tiie main all rveather road runs frorn Addis Ababa through Jimrna to Mizan Teferi (project area) extending to the capitals of tr.r,o project u,oredas (Bench and Sheko). The rcst six rvoredas are accessible through dry ri'eather roads. The zonal capital city Mizan Teferi is located 555 kms south rvest of Adciis Ababa. in acidition to road trausportation, tirere are t\\ icc a n'eek flights to Mizan Tefen (capital of the zone). The indigeuous ethnic groups of Bench, Sheko, Dizi, NIe init, Suri and lr'[czhc'nger occupy the area. The zone has I hospital, 7 Health Centers, 24 Health stations, 22 Health Posts and 292 health ri,orkers with different qualifications. There are eight CDTI rvoredas and all ltave started CDTI activities in 1,053 r'illages. AT l 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 Bs=Bzl Br *100 Bench t96 97 49.5 Sheko 22 18 81.8 Guraferda I2 t2 100.0 Meanit-Goldya ZJ 12 52.2 Meanit-Shasha 5 5 100.0 She-Bench l5 15 100.0 Maji 10 10 100.0 Bero 5 5 100.0 zoo ll+ Ut-,.+ Table 1: Number of health sraff involved in CDTI 1.1.2. Partnership Partnership Is a principle o1'AI'OC as u'ell as the go\rernrltent of Ethiopia rvhich helps CD1I projects achievement their targets and gradualll, ensures their sustainability. Since the beginning of the project, tltere was strong partnership during planning, aclvocacy, mobilization, drug distribution, rnonitoring auc[ evaluation of the CDTI activities among different partners. The mrin partners inyolyed ale federal rninistrl, of health, regional health bureaus, zonal health desk, rvoreda health office. front line health facilities, the community, The Carter Center, WHO and other go\/ernment sectors like Adrnin Councils, Education and Agriculture. 5 WHO/APOC, 24 November 2004 .+ OOC\ k() ,o C) oz .rf(\ U Or a) a! o i) o O\/-) I ca o 0)q op. 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L AN o.: -o 6O F o L a o o N o q) ,() >, (,) tr a) z (o .+ t-- O) (o cr) rOs sO) |t-{ $lr) $(o @(o oN (.)ra o) oN C9 Nc9 cO $ s crlN @ cf) $t- @ c! tr) {rO @ (n(.la f_) trFQ5qL!< li su 6e-E = 6.9E 39 P'F o.ij 0. N@ @- N cr) N .t d co- tr) N @(r)(o_ $ .{- voo .fo cr)(o o(o @(o @- rON Noo oiN Ir)N o,^ @ o\$t) r. co!c U) q) XE6 --.9F;.9Aeo .Coc o co (d 13 o g l o olz(U ca -coc o -o .a o -ca .qD o(, =c(! o) (UE o a -_C(! o ,a o o) co -l F F * tr -+(>O c.'l roo o oz N Uo o- o (a () (o *E|i9 EEU *oo cr o0 t+oo cl =bo r+oo a.l b0 a \too al b0 !f,o cl DO $oo ol b0 vooCI d0 .to c.l o0 a a0ct9c i;E o o{ o. oo(\ o- oo c{ o. oo N o Oo cl 'T o oo al o ool E o. ooCI 'i o. € L ch o0 , o: =H =95-Q oo cl - bo a O ol a OD = OON o0 f, OON a OD oo ot oo a OON { a Oo N d o 6l a bo a b.0 d= O N z OON OON z OON al oO al oOcl oo ol q) c( U) t) q) Q g: =9, L) oo a{ € oo cl z o Cq 2 o ot ocl >.6 4 oOcl oO c{ 2 oo ol d b, a- oo N o- c.l o- O c.l L o- al =a. o ol A O c.l c. C.l Lo O c.l o oa 3 O:E:i= EEQ oON c OOC\ Oo c.l o. c.l oO c.l o. (\ a- c.l rc. oo(-.l E UD ooN o ot 'tr O cl 'c o CN E c- O c.l Oc.l O 'E a o N oq ir2 60gi(Jz o o: a= (J oo ol o- c.i O o{ o ol 'E A c.l qn r)O c.l rn o(\ o. o c.l o u0cE '!- tr a- r) O C.l O c.l a. I c.l o. o c) ol La C](\ r I N o. aa a.l a. aaN L o. (,J (J lr ch o o cq l< 6)q< cnli o J4o v) (J o Fq I 4) U) (, I tr o a q U) I 0) a 'a A otr C) Fq F] F o Ei t-- t a C) U f ! 0) F (-) () d) 6) :< q (_)L C) k o(H a o O cd o O o H F c"ir ol -ol(dl FI q o = +. o fil|- o o tr o E F aF tN Fo o ll- o tr .9 rl, c, rl, tr o E o E o. .E aaN z o IFolu 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 difficulties/ constraints being faced and suggestions on how to improve advocacy. Task forces had been establishecl. Tlre mernbers of the Task Forces at all Ievel were officials from all sectors, rvhich have relevance for the CDTI activity. Though, the political commitment helped the CDTI activities to be started and successfully achieved its objective but their support became insignificant in 2005 as they were highly involved in the national election process, resettlement schemes and other activities. Advocacy Forum rvill be organized by the NOTF rvhich involves all political leaders and concetned officials and stakeholders responsible for national, regional and zottal levels to discuss about the decline of comrnitme nt of high level political leaders. 2.3, iiiobiiization, sensitization and heaith eciucation oi at risk communities Community mobilization was done at each village organizing community meetings. For healtlr education manuals rvere distributed to each CDDs and cotnmunity supervisors and also three types of posters also distributed to each villages artd posted at different places rvhere people look at artd discttss it. The cornntunity ntobiliz.ation lras contributed a lot in awareness creation atld as a result the cornurunity involved in CDTI activity rvitlt successful accornplishment. 8 WHOiAPOC, 24 November 2004 Nunrber of communities/villages rvith community members as supervisors Number of CDDs and the communities involt.ed Number of communities /villages with fenrale CDDs Total no. comnrunities in the entire project area B,I Number with community members as supervisors Bs Percentage Br= By' B{ +100 I\Iale CDDs B7 Female CDDs B8 Total tsy= Bz+Bt Number of communities rvith female CDDs Bto Percentage Brr= B ro,rB4*100 Bcnch 461 264 57.3 987 54 104 I 54 I 1.7 Gu.raferda 45 45 100.0 180 l8 198 l8 40.0 Sheko 94 94 100.0 359 26 385 26 27.1 She-Bench 147 144 98.0 486 2! _s07 2t l/t'l lvleanrt-Goldl a 154 154 100 0 266 42 308 42 lvleanrt-Shasha Ma.;r 64 30 46.9 125 J t28 3 68 68 100.0 133 l6 t49 l6 Bclo 20 20 r00 0 41 4l 82 2A 100.0 Total 1 053 819 71.8 2577 227 2798 217 20.6 2,4. Gommunity involvement Table 4: Communities participation in the CDTI (Please addntore rows if necessary) tricULGA Conrrneni on: - Attendance of female lnembers of the comntunity at health edr:catiou meetings In areas \\'here community supervisors or health workers organize health education sessiolls a t'easonable nurnbef of rr,or)ren atiend those rneetings. ijo\\,ever, dut: to probletns related to the ttational elections, it \\'as not possible for the iield staff to orgapize such meetings in rnost localities. Itr general, lror,r'do )'ou rate the partrcipatlon of f'ernale meutbers of the cornrrlunity meetings rvhen CDTI issues are being discussed (attendance, participation in the discussion etc). In tnost instances, attendance and participation of women is very limitecl. There only ferv outspoken participaltts in ntost places. The majorit),are sh1, to spcak in such forurns. Incentives provided by communities for the CDDs Cotnmunities do not provide incentives to the CDDs. Actually this is not a problem in our case as CDDs are serving their neighborhoods (30-50 households). Attrition of CDDs. Is attrition a problenl for the project? If yes, horv is rt addressed? CDDs attrition is not a big problern in our case. When there is attrition the commulities select other CDDs and the Front Line Health Workers provide training irnmediately. Other issues 27.1 4.7 23.5 J I 9 WHOiAPOC, 24 November 2004 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 nlost itnportant issue to describe is w'Jtat tileasLtres Y'ere raken to ensLtre adeqtnte CDTI intplententation where not enough knowledgeable nnnpotter was available or if staff are frequently transfen'ed dttring the course of the cantpaign). There w,ere trainings on CDTI from the higher level to the cotnmunity level in adequate alnount to calt'y or-rt the CDTI activities. Horvever, there were situations tvhere rve had tum over of trained staff particularly at Woreda and front line health iacilitl' levels which didn't cause any major problenr on the project activity as training rt'as given irnmediately for the nerv healttr stirff. 10 WHOIAPOC, 24 November 2001 q) c! , U) Q o L OJ z 6ll 9J o -: +Fr\J :Q { du Uz. co 6 ,-i l _: O m ca oo @ ooo @ c.) O o.(-.1 C \o c..l \D O co o\N O C.l oo o\ .f r) \f, o\ o\ ca N@ (\ @ cog\ r- cl 6 @6 t C) q) (.) -ob\oL: ol =t: Oo.l F- o. ca 01 C{ @ co s \f c.l@ r-\o al o thLo .=q c! Fr L,< cl- €o .oE rr !!OJH z :? tr Q o -: +F-rJ:U nav -! .l<! .- c) O q) q) o ,ob\ Q o t- o O q) (!l- !<!6.rh -oQ E\ zz G,rdE.i +F"d U ! ". $ oO $\c C'l -J ON @ c.l \o r- r { ca - @ O oo c.) @r) t- v \o o () o I Na QF 6c/) O CI € @ s !H U) k! +< r: r<q) A ?', dE.'l +F"u U Q \' a< c.l (\ O N o a.l cl CI ...l N O cl N O on (..l O al a'l O al N o q) q) o rao\ Q o F c.l N a.l N cl 6l c! N o rl o tr 6 o 0) FA tr 0)(H L oJi o V) O o ca I o a d € o I d C)!ia lr)(!(, I cd o e 'a z ol<o FA Fl F E< \tOOcl !O -o qJ oz !t C\ U p- d. I o o o G lo * o s o \ o e_ o ! o T a B J u l- l: F = a, %qJ ! !e a\ o "tr -ri \JO) q, o C) tr F U o q o 0) li 0) 0) I t<F ,Ar drl _ol 631FI t Table 6: Type of training undertaken (Tick the boxei where specific training was carrted out during the reporting period) Trainees Typ. of training CDDs Other Community members e g CommunttY supervisors Health Workers (FLttr) MOH staff or Other Political Leaders Others (specrfy) Program management How to conduct Health education Managernent of SAEs CSM SHM Data collection Data aualysis Report rvritrng Others (specrfy) - Any other comlnents The Comrnunity self rnonitoring was not doue in the rvay APOC designeci rt to be cione but it is done iu a rnoclified u,ay. It was difficult to follorv because of time constraint to train and implernent as it has been designed. SHM has beeu conducted at Zonal and woleda levels and its contribution ''vas significant in identifying strength, weakness of the programs and proposed solutions and divide responsibilities among stack holders. 2.6. Treatments 2.6.1.'Ireatlnetrt [igures - If the project is not achieving 100% geographical coverage and a minimum of 657o theraper.rtic coverage or the coverage rate is fluctuating, state the reasons and the plans being rnade to remedY this. Tlre ploject is doing ivell in terrns of both geograpliic and therapeutic coverages as shown beloll,. a- t2 \"'HO/APOC, 24 November 2004 i.+ C\ r a) -o E() oz .+ C! Uo A. o ci) F C3() tr Cd o C) a}r a.() a t< c6 o 0) € 4) I!Oa q 0) u 0) cd C)H ol -o -l oxle 'ol o,>ul = -l^el ;i5l - ,l IEIO ol !ol 0)ol -o tsl E bl ; -ol -cl (€ 5l ozt? OiOI *l o,xl.u -Ifl -el u EIH -Et:o.[ o)ol tr BI Ebls sl=trt c =l czl< ()L CJ O (_) 'e k or o airlil -o 'o o 0) 'o q q() ol trol = -l cxl otoEl ,.., EI E -l 'oal c, 5rl Y -l ! -t 6) =l o.>l >.\t-3l= =l o):t dJt u El .*cl oUI ^l!ul q - l!EI E ul =0)l c -ot _trld 5l^zl; 6JLd () C) 'e a (J q C) E o(.) (J q-) U E() Ik() a.>' ^,9Ol o *l -'t tr xl -5l .-gl cldl E(Jl .=. orl - -l EH.e RI E .'1 =ol o. rl O0)l o- .oltrl (! =l ! ZIJ o 6l orl st :t(Jl -t3t EIc6t EI $ 3l EI BI cll bl -cl "J =J EIOI ;l :t -l -l EI '!l -:\ r-. v) 4 \J Q\) aL q) ! \ \o aa S \J o_ .Vq t< (J oJ .) O L q E q sl (n -o 0-) 0)L -r r-f .l -t_61 'cdl FI IIlt -o 0) C) o \,F no5\ o cd o bo 6AA oo oF q) clL 0) bo o o o,1 a!-(d r<bo 0.) r'1 o o b0 o oo O^ C) o. H c) F H A3E ;;€?qE€ o o o o o q p.]E4 z-o o o o o -oLO .EE9 zd o. N\ $01 o o\$" d al\o .o rr^ tr-r o.\o C{o ic r'. o e.I rE^OO ^ uC -fr i,s o LEh}EE 2-oE r c v" @ o s ro\o, 'd-\c c'l N N N 6 ol at .a- cl o c, oo lt + HH !MO 6^ oL,sd 90-9a F r @ @ @r \2r @r rc cl6 \o€ co6 o h_Ec!PoY EbE z r6l o\ cl @\o cl c.l$ -f r or r@ =f oNo) N N O\\o N o,\o- r 66t0q tr- !t a zn.a r a9' FU @ r_(9o c{ O)@N. c! (o O)$_ r- C9 (f)(o(r) t- @ O)(o t-- co tr) O)NN. N (o(o c/){N O)o ro t- N aa ts- v ,='dE 69J? o tr-E +=r9 a: o L o";F N @ @_ =fN $$ c9^ rON @ (o^ $ $OO vO (f)(o O)- @ co(o @- (\ f--o o- N rO F. O) ao cc\o o\v q C)ho cd q o d oU ll * H OiJ ^ &: _- 6o o OI -c CI O? o O = Co O: tsu -e = 6'13 E HHtr c= o o (ot ro{ $o) N$ sltr) s@ @€ ool rn a _E-:d o.: :;U / J!' FU (o ro$ $O) l'-.f Ir) $(o 6 ool roro \O6dtdq o= h d) I E:5X^! EgEE- v>u (o$ lr)$ O) N .i, $lf) \t@ @(o oN c)nq 9< 6- 0 o ta d o 6 - o J<I CA o o cq o (/) .=$ OA >d L- dE 3E atA o F il a2.6.2 What are the causes of absenteeism? This year, very unfortunately, the major cause of absenteeism is due to the overlap of the farming seasqn with the commencement of CDTI activities. The drug distribution period was pushed further to the month of June as a result of the May 15 national election campaign. 2.6.3 What are the reasons for refusals? In most cases, it is the urban dwellers that openly refuse to take Mectizan. These people consider themselves free from Onchocerciasis and at lorv risk of contracting the disease. So they do not want to take Mectizart. 2.6.4 Briefl1'describe all knou'n and verified serious adt,erse events (SAEs) that occurred during the reporting period and provide (in table 8) the requirerl iuformation rvhen available. In case the pLoject did not have any cases of serioits advet'se events (SAE) during this reporting period, please tick in the bor. No SAE case to report 1t Lt+ \IIIn/ ADn^ a/ \t^-.--L-- ^nnrYYll\J/ru\-/Ut 4+ r\Uvtrlllutrl zvu+ 9lo l:i !') aD lP- o\i. tudl:;.!^(Dt o-Hr!i.El rlCD= 6b=:; aCD6 -rt.fo tD+ !JH PrDlr,1 ^ -' (, /h-+U/ATE1 dEHr+ts;-xoerD 1 9t+(9 ,vVJ -. l^ tt rDlor5taI;+a+ lO :..l+dIDIH= k r (D (-)IPUll -. -llg -'13.E-L9l^ 15(!{.tciil*i+ lH ltoo 6t9 ,a A-,i6 L. 6to=;'o) ++ 9 =F6ooaS -lJtDF,l 66- hFl tn i r,D vptD6!) iJ F' Fl t9 E] !.,1 t.) (D Fl oa(D lo (1 DT rn (n + o 'tro(l i"s z (D o.o N)OoA [..) N N)o & t.)oO{ N)Oo\ NJoo Noos N) O(,) t.)oON) N)oO tr, H (]J (, oo ::- il qE * E iHil <-='E.P < ao lt HE a 5so,' h= p 0c o o (D EJ0a(D "O \o O a\ -lqaY :6P (/) o. o\ - ?9 4 6,H = E*Eio FI OO \o i JO (r) c L, tsr ::.: 'iir 5 3 3*H =mE O 3- ^< >sE. 'HoGxll +. m +- I 56 J-@ -(r, @ 1!1tr.>:iP o _ "':' ru = so* og : FU o 13 FO o 5 i TJ 'L)m N) '5 IJ UJ .L,)u \o ^-l.9e! zIp_o= ItJ J. S co oo a 6 Orq l.JOU) "LJ !o- a1 ^C a-d Elo pO o o. lrj co(,) cn -J ,l o@ -od r!o-a€vp ooqtr o lrj 15 t! +I o \o co oo\o o o- -<.Ddsq -r -oq o o xtrl r'ir oo \o \t5 (i(,l o ,': < (< e"$ B0a 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHON UNICEFtr a NGDO t] Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer') NIOH g WHO X UNICEF tr NGDO E Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the cotnmunities Ttre NOTF requests for I\4ectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equiprnent delivery system in the country. Then the drug is stored i1 MOH rvarehouse from rvhich the project receives. Frorn the project level (zone level) the Woredas collect the drug and distribute to the FLF{Fs. It is from the FLFIFs that the comnrunity super.,,isors get the drug to distribute f-o the. CDDs for them to distribute to the communities Table l0: Mectizan@ Inventory (Please add ntore rotvs if necessary') *'fablets carried tortvard frorn previous year 170,572 - iioil ai.e tiie leiiiaining iveitrieciin tabiets coiiecied arrrj s'irere Ji'e tiley ke[it? At the end of the treatment period, the CDDs were requested to return the remaining drug to their collection centers u'hich are the health facilities. The health facilities, in turn, send ro the Woreda hcalth office and finally from there to the project coordination office. Ileuce, the i'einaining Ivcniiectin is kept at the project office icvel (Bench-Nleji Zcne Health Dept.). List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. ' Collection of ivermectin from the Woreda level . Distribution of ivennectin to community supervisors and CDDs . Training of cornmunity supervisors and CDDs on handling, distribution and maintaining stock balances . Supervision . Recording and reportirrg of data A nrr nthcr c^mmcnte District/LGA Number of i\{ectizant tablets Requested Received Used Lost Wasted Expired Rernaining Bench-lvlalr 1,124,520 946,000 1,123,127 0 2,455 0 24,35i TOTAL r6 WHOi.LPOC, 24 November 2004 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any tratning (of trainers) for community self-monitonng been done in the prolect area? No If so, When? Table I l: Comrnunitl' self-monitoring and Stakeholders N{eeting (Add rotvs if neecled) Describe hou' the results of the community self- monitoring and stakeholders meetings have affected project implementatron or horv they would be utilized during the next treatment cycle. CSM, as designed by APOC, has not yet been implemented due to several other competing priorities. Horvever, u'e can say it has been implemented in a slightly modified mannerby the trained community supervisors. The NGDC partner, Clalter Ccnter, has conducted u,hat is called "ongoing ntonitoring exercise" in landomly selected 30 villages to validate the treatment activities. Findings indicated that llre treatment coverage "vas slightly lower than the reported figures. Actions Itar'c beeit taken to rectify c,ibserved flari.'s during tlre aunual proglanr revierv rneeiing and again during the zonal consultatit,e meeting of parlners. On the otlter hand, SHM has been conducted at FLFIF and Woreda levels and was very instrumental in identifying strengths, u'eaknesses. opportunities and challenges and r.vays of addressing them accordingly. 2.9. Supervision 2.9.1. Providc a florv chart of supervision hicrarchy. i.IOl-F ) ZOTF) WOTF ) Ileaith Faciiity ) Community supen'isors ) CDDs 2.9.2. What ryere the main issues identified during supervision? . Delay in utilizing and liquidation of funds. . Weakness in organizing and proper handling of documents District/ LGA Total # of communities/villages rn the entrre project area No of Communities that carried out self monitoring (CSN'I) No of Communities that conducted stakeholders meetr!8 (sHnal Bench Curaferda Sheko She-Bench Meanit-Gold1,a Nleanrt-Shasha Majr Bero 461 45 94 147 I54 64 6B 20 0 0 461 45 94 147 154 64 68 20 0 0 0 0 0 U TOTAL 1053 0 1053 t7 \\aHO/APOC, 24 November 2001 I2.9.3. Was a supervision checklist used? Yes 2.9.3. lYhat lvere tlte outcomes at each level of CDTI implementation supervision? Document handling has shorvn some improvement but it still needs additional effort by training health u,orkers and conducting targeted supervision. There is still problem on liquidating the utilized project funds. Much effort should be exerted by providing on-the-spot training and close supportive supervisiotl. 2.9.5. \Yas feedback given to the person or groups supervised? Yes 2.9.6. Florv u'as the feedback used to improve tlte overall performaltcc of the project? The good geographic and therapeutic coverages are indicators of the encouraging pertbrmauce of the project. In addition. some improvemeuts have been observed in tinreliness of reporting of activities artd in proper hanclling of CDTI docuinents. SEGTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipnrent. (Plea.se cLdrl more rov's d neces.sutl') *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, V/O-rVritten off). Horv does the project intend to maintain and replace existing equipment and otlter materials? The project would need APOC funding to support nraintenance of vehicles that have been provided by APOC for the first five years. The project is trying its best to perfonn rvell so that APOC woulcl replace these equipments after the 5m year rvhile at the same time efforts will continue to allocate budget by the government for srnooth running of the project gradually. Source Type of equrpment APOC N{OH - Zone DISI'RICl- NGDO Others No Condrtlon No. Condrtlon No Cortdrtron No Condrtron No Condrtron Tovota Hrlux 4W Dlckuo I F Motor cycles I -sF&3CNFR Desk top computer 1 F LaserJel printer 1 F DeskJet Printer 1 F Photocopier 1 F Fax machine 1 CNFR Overhead proiector 1 F Meqaphones 5 F Radro Communicatons 'I F w 'I F VCR 1 F Generalor J F 18 WHOiAPOC, 24 November 200i 3,2. Financial contributions of the partners and communities Table I Financial contributions by all partners for the last three years * AII pro_ject costs inclurling colutttl' office e.xpendtturcs. *+DirectLS, tr cutsfe rred atrloutlt in ca.sh ancl rnaterial *+'+ APOC Jlrtrl v'as releascd r{te r tlte corrtpletiort of llectizart dtstributiort DNA - Data rtot at ailctblc - If tlro.o o.o nr^l-.lon.c ruith .-l-..- nf anrrnfornarf frrnrlc l.^rv r'p.c thprr nrl,-lrpccarl')tt lrrvrL Yes, the project suffered a great deal due to the delayed release of APOC funds. Ou,ing to the integrated nature of all health programs in the Ethiopian health service delivery, the project used other available funds to support CDTI activities. - Additional colnments The MoH at all levels has contributed a great dcal in tenns of mobilizing their staff and other stakeholders, coordinating project activities, plocuring, storing and distributing Mectizan, providirrg trainings, covering communication costs, offering office premises for CDTI coordination and n)anagenrent, rnanaging project funds, providing other logistical support. soliciting financial support in the absence ofcounterpart funding, record keeping and reporting, etc. Obviousll,, it is very diflicult to quantify and attach monetary values to such kinds of contributions. The financial management pool system is a serious impediment for the effective utilization and repo:-ting of APOC and other counterpart funding. 3.3. Other iorms oi community support Describe (indicate fonns of in-kind contributions of cornmunities if any) CDTI cornmunities have done their best in mobilizing the communities for treatment, recruiting and training CDDs, conducting mass treatments, record keeping and reporting. All CDDs and community supervisors were fully supported by their respective communities. t Contributor Year 1 (2003) Year2 (2004) Year 3 (2005) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) NIOH (Central + State) I 0,800* t0,800 t2,000 r 2,000 DNA DNA MOH (District + zone) 2 I.000" 2 I,000 50,000 50,000 DNA DNA Local NCDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) 80,000 80,000 181 ,25r 187,251 26,3t2" 13,818 +- Communities APOC Trust Fund 0 0 0 0 0 0 160.625 -50,000 80,830 5l,500 34,8-s.t I 5,QQ6*** TOTAL 473,125 261,800 s30,98r 450.7s1 3.4. Expenditure per activity l9 WHO/APOC, 24 November 2004 ,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 Iocal currency. Indicate exchange rate used here lUSD =8.67 a ,)^ w[{n/ap.lr- 11 Nn,amk., )nnrrv I vrrruvr -v4 Activity Expenditure ($ US) Source(s) of fuqding Drug delivery from NOTF HQ area to central collection point of 9ommyni151 Mobilization and health education of comrnunities Training of CDDs T.ei_lpg of health_staff at all tgygl_! -_ Supervising CDDs and d:istribution llle_qe! llo1llo4rlg of CDTI activities ,A,dvo_cagy visits to lql_1!1, and political authorities IEC materials Summ forms for treatment Vehicles/ Motorcycles/ bicycles rnaintenance Ofiice Equipnrent (e.g cornputers, printers etc) Others DNA 2,115 4,1 l5 MOH* NGDO NGDO MOH NGDO NGDO MOH NGDO/APOC NGDO MOH DNA 4,t9C 1,250 DNA 807 t,341 DNA DNA MOH/APOC TOTALT 13,818 Total nunrber of persons treated Table 14: Indicate how much the project spent for each activity listed below during the reporting period *Carter Center is the NGDO partner for this project. It is difficult to show the MoH contribution as it is carried out in an integrated manner. And no APOC fund rvas available rvhen the 2005 CDTI activity rvas carried out. SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoringl Evaluation 4.1.1 Was l\Ionitoring/evaluation carried out during the reporting period? (tick any of the following rvhich are applicable) _Year I Participatory Independent monitoring x Mid Terrn Sustainability Evaluation 5 1,ear Sustainability Evaluation Internal N{onitoring by NOTF Other Evaluation by other partners 1.1.2. \Yhat rvere the recommendations? The ]\{id-Term Evaluators Recommendations a 2l WHO/APOC, 24 November 2004 e_ Zonal Level . Re-orient zonal health team on the need to prepare yearly overall liealth plans reflecting CDTI activities There should be plan of integrated health activities scheduled yearly for the Zone Re-orient the Zonal leadership on their roles in the CDTI prograrllme Training of Zonal project staff on data managetnent and documetttatiott lr{onitoring should be targeted to needs. Staff at this level should fully empou'er those at lower levels to conduct monitoring aud supervision. An integrated supervisory checklist should be developed Train zonal staff on Mectizan ordering Organize a high level advocacy meeting with zonal administrative and political leader ship Training should be based on identified training needs Partners should contribute funds to the programme, particularly Governmertt. Zonal accountant should be trained on the need for proper CDTI retirement and documentation of funds otherrvise dedicate a separate accountant for handling CDTI accounts. Maintain payment vouchers. Vehicles sliould be labeled Policies on movement of transport and nraintenance schedules should be in place Orient ner.r, staff on CDTI plogranr Coverage should be maintained Woreda Levels . Woredas must produce work plan . Report of meeting for rvork plan plodr-rction should be al*'ays available . Continues integration of CDTI u'ork plans w'ith Health programs operating at this level . Continues integration of tll)Tl w'ork plans ri'ith Health progrems opr'rating at this level . Woreda should initiate their orvn program of action having in mind that mectizan will come at a particular time not relying on the arrival of mectizau . Monitoring and supervision should focus on areas of need. . Supervisory report should be available. . Supervisory checklists should be available for all u'oredas. . Integrated supervisory checklist should also be developed for use in the field. . Staff must be enrpowered to supervise only the next level . Distribution of lr{ectizan should be dependent on th timing and ag'eed on by the communities . Training sliould not be routine, it should be directed to areas of deficiency (based on need) . More training & HSAM materials should be made available. . Reports of training should be rvritten each time. . Staff at the woreda level should advocate the administrators and policy makers at woreda on CDTI activities and their responsibilities. . Training should not be routine, it should be directed [o areas of deficiency (based on need) a a a LL \trLr.r / A Dr\r\ a,{ NI^,,--L^- 1^n /rr rlvrru vL, 4i lruvurrtu!t 4utl+ D aMore training & HSAM materials should be made available. Reports of training should be written each time. Staff at the woreda level should advocate the administrators and policy makers at rvoreda on CDTI activities and their responsibilities. There should be a plan at the woreda for the replacernent and repairs of existing motorcycles Log books should replace log sheet for monitoring vehicular movernent. Copies of the certificate of commendation should be made available at the woreda level Coverage should be encouraged not to be less than 65Vo. Line Health Facility Level FLF{F should be trained on how to lnake detailed plans Continues integration of CDTI u'ork plans rvith Health programs operating at this level FLf# to be emporvered to initiate CDTI activities at their lei,el. FLHF staff to cany out targeted supervision when there is need FLHF staff should write supervision reports and use Supervisorlr check[st A copy of success comrnendation certificates should kept The project is encouraged to sustain this activity at this level. FLFIF request to conform u'ith the communities timing for collection and distribution of Mectizitu. Targete triiinirrgiHSAlvl at specific a'reas of ireed. Proper planning and needs identification. Nerv and old CDDs to be trained FLHF should nrake their ou'n budgetary plans for CDTI activities and f<-rnvard to Woreda l{ealth Office for encompassing into the overall compregensive health budget Future plans to incorporate and made adequate provisiou for transport at this level. Carter Center/ NOTF to produce training/IECiHSM materials in resonable qLrantity In-service training for FL[{F staff should put in place to rnotivate the sraff N{aintain coverage for all health facilities trt> 657o yearly a i Front a a a a a Community Level . Cornu-runities are encouraged to strengthened and enforce the b1, - lau's ' HSAM should emphasize rnore on conrmunity ow'nership of the program . A re-tt'aining of CDDs on record keeping ' Cornmunities are encouraged to support their CDDs in collecting Mectizan. . Mectizan should be delivered at the time required by the comnrunity . Targeted HSAM to address community ownership ' NGDO/NOTF to ensure that adequate IEC materials are pro.Juced and circulatecl ' HSAM to communities and their leaders should emphasize support to CDDs. . a1^.--',^:f:^^ ^L^'.ll L^ ^-.^^,,-^^^J +^ ^^l^^+ ^-Il^ ^^ eL^,.^^-uurrrrrrurrrLrun Jllvu u uw vrrwuutqSuu r\J D9l9vL 4D trr4rrJ vLl\tJ dl, utt y udll . Cornmunities should be sensitized to recognize their CDDs . HSAM should encourage selection of women CDDs . FLIIF staff should train CDDs on proper data entry. 4.1.3. Hory havc they been implemented? As per the recommendation, Partners' Consultative Meeting has already been conducted successfully sponsored by The Cater Center - Ethiopia. The meeting was conducted for two days (6-7 April 2006) in the Capial of Bench Maji Zone (Mizan Teferi). The participants were represented from Bench Maji Health Bureau and administration, Woreda Health Office a L3 WHO/APOC, 24 November 2004 a Heads and Woteda administrators of the eight CDTI Woredas and Mizan Aman Town administration. The participants agreed on the fotlowing action points to be impletnented in the course of the 4th year project period: Planning ' Emporver u'oredas/FlHFs ott planning ' Develop integlated overall health plan incotporating CDTI . Empower woredas/FlFlFs on planning ' Develop integlated overall health plan incorporating CDTI ' Prepare CDTI work plan at all levels ' Prepare annual plans of action involving all rvoredas/partners . Develop sustainability plans Training . Conduct training needs assessment . Document training reports ' Conduct targeted training ' Train all health staff . Train all HEWs as colnmunity supet'visors . Train at least 2 CDDs/State Teatn . Train CDDs within their Kebeles . Trainers should come from the next higher level I\{onitoring & Supervision . Develop integrated supervision checklist ' Conduct targetted supportive monitoring & superv'ision ' Provide written supervisory feedback . Docurnent supervisory feedbacks/checklists Iutegration . Incorporate CDTI in all other health ptograms (EPI, Malaria, etc.) Iai nances ' Lrclude CDTI in the overall health budget " Document all financial allocations, expenditLrres properly' . Maintain separate financial records ' Provide copies of Letters of Agreements (LoAs) to alI u'oredas(Joverage . Identify lorv coverage areas and reasotts for low treatment coverage . Involve cornmunities in decision making: selection of CDDs, selectiort of time/method of treatment, etc. 1\{ectizan Procu rement . Training staff on Mectizan Ordering - Use Mectizan Application Fomr . Train staff on keeping track of Mectizan stock balance Health Education & Community l\Iobilization . Sensrtrze/mobrhze polrtrcai ieaders inciuciing Kebeie acirnirt . Provide adequate quantities/types of health education materials ' Conduct targeted health education (based on identified problems) Leadership . Involve political leaders at all levels in planning, implementation and program reviews . Empower communities to assume full orvnership of the programa aAL- WHO/APOC, 24 November 2004 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 p lan written? Yes When was the sustainability plan submitted? Yes What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.7. Planning at all relevant levels The CDTI activities are integrated ivrth tlie otlrer health activities at all health management and health service delivery levels. Therefore, the planning processes are carried out through participator-y methods, using bottom-up approach and integrated with the basic health service. 4.2.2. Irunds Ensuring the availability funds is essential for the sustainability of CDTI. It is expected that the govenlment contrilrution r.i'ill increase for the implementation of core CDTI actil'ities. In addition to thrs most of the CDTI activrties that are carried out in an integrated manner ri,ill receive resources from different prograins. The i{GDO piiitner is also expected to continue its critical funding suppoll for the same. 4.2.3'fransport(rcplacementandmaintcnance) It is expected that APOC will provide replacement of the vehicles (car and motorbikes) by the end of the 5th year. The local govemment doesn't have the capacity to replace such capital items as vehicles but rvould definitely support the use of otltcr project vehicles as appropriate and as available frorn its vehicle pool system. 4.2.4. Other resources 1.2.5. To rvhat extent has the plan been inrplemented The prepalation of sustainability plans has just been completed. The irnplementatiorr is underu,al, in ntost project rvoredas. It is too early to report the progress made. 4.3. lntegration Outline the extent of integ'ation of CDTI into thc PHC structrrre and the plans for complete integration: ,{.3.1. lverlnectin delivery mechanisms Since the beginning there is no separate Ivennectin delivery system to the lor.ver level; it follows the existing drug delivery system in the general health service. In other words, CDTI is fully integrated into the existing health service structure from the central level all the way down to the peripheral or FLHF levels. Training: CDTI is integrated r.vith the Primary Health care (PHC) from the beginning. At the National, Regional, Zonal, and Woreda levels, the Malaria and Other Vector-borne Diseases Prevention and Control units are responsible, a 4.3.2. 25 WHO/APOC, 24 November 2004 4.3.6 Describe other health programmes that are using the CDTI structure and horv this rvas achieved. What hal'e been the achievements? In some rnalaria endemic villages, the CDTI structure is used for malaria control program. The CDTI structure and the CDDs n'ere in particular very helpfLr! during the recent community based bed net distribution exercise. The sarne structure was used for polio carnpaigns and deworming activities. 4.3.7. f)cscribe others issucs cousidcrcd in the ilrtegration of CDTI. The governlnent structure of village which has got a health coururittee and the Health extension Package designed to reach all Kebeles with health posts, will play a major role for the integration and sustainability of CDTI. 4.4. Operational research 4.3.3. 4.3.4. 4.3.s. ;1.4.1. 4.4.2. Therefore, all the staffs of these units have received training on Onchocerciasis. Training of peripheral health workers has been carried out in integrated manner with other health programs. Joint supervision and monitoring rvith other programs As part of the system in the country, most of the supervision and monitoring activities are can'ied out in integrated manner with other programs. Release of funds for project activities Activities which were not funded by APOC have received the amount of money required in time to accomplish them. Is CDTI included in the PHC budgetr CDTI is part and parcel of the malaria and other vector borne diseases control program activities. Onchocerciasis control is clearly indicated as a priority program in the country's third five year health sector development plan (HSDPIII). Following this comprehensive document. the Bench-Maji zone health department has also included CDTI in its overall strategic health plan. Surnmarizc in not more than one half of a page the operational research undertaken in the project area t'ithin tlte reporting period. NONE I{orv u'erc the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: 'l'he pro.;ect is able to accomphsh the drstnbutron rn short period of trrne u'rtlr lO07o geographical coverage and therapeutic coverage high above the mininrum standard. This is due to active involvement of health u,orkers and the community atlarge. Weaknesses: CDTI documents are not handled properly and no handover protocol developed for smooth transfer of documents/responsibilities and poor financial utilization and reporting. Opportunities: The accelerated expansion of PHC structure dorvn to village level is a good opportuniry for the sustainability of CDTI. The Health Extension Package in which at least a a_ 26 V'rHO/APOC, 24 November 2004 two health extension agents (mostly women) will be deployed at community Ievels foi a population of about 5,000 is also another good opportunity for the effective implementation of CDTI and other PHC programs. Threats (Challenges): High tumover of health staff especially at front Iine health facility and woreda level, overburdening of peripheral health rvorkers rvith various regular health progralns and periodic itnmunization campaigns including emergencies like rnalaria epidernics is a major challenge for CDTI. sEcrloN 6: Unique features of the projecuother matters The Bench-Maji CDTI project area is one of the remotest parts of the country with very backward attd ttnderdeveloped infrastructure. Sorne of the CDTI 'uvoreclas are vcry in accessible by car particularly duriug the rainy season. The con-imunication netu,ork is very poor and tnost of the woredas can't be reached by phone. Some of the comrnunities have a nomadic character. Due to such obvious reasons, health rvorkers do not stay longer in those places of assignment. Such high tumovers would for sure rnake it difficult for us to br_rilcl capacities and establish sustainable progralns. t a a 27 WHO/APOC, 24 November 2004 .l a a e I a t t a q 3