't- ; 't t The Federal Democratic Republic of Ethiopia Ministry of Health 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 oNcrrocERcrAsrs coNTRoL (APOC) -----3o *"G+ffid*6r Fcrr "Al*tios] " Ii ANNUAL PROJECT TECHNICAL REPORT SUBMTTTED TO I ! .'. TECHNICAL CONSULTATIVE COMMITTEE (TCC){.r1,fr'"lt | ftx in&x.s<:ion i Io,StRI n,o "b"-i: '-=*-*- t,t I{ \s COUNTRY/1.{OTF: ETHIOPIA Proiect Name: Bench-Maji Approval yearz 2002 Launching year: 2003 Reportine Period: F ro m : J. en ua.r.y..20.1.0.,... ( Month/Year) To ;.....Q e.te.b.e.r..?.0. !. 0.. .(Month/Year)o Proiect year of this report: (circle one) I 2 3 4 5 6 7\ [, 910 Date submitted: 30 December 2009 | NGDO dartner: The Carter Center WI IO/APOC,24 November 2004 ANNUAL PROJECT TECHNTCAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sisn the report: Country: Ethiopia National Coordinator NGDO Representative EEme Gebre rphDlCountry Renresentativ*' Date: ? / Januarv 201 I ..__f- report has been prepared by Name :- Tekilemariam Erset + NOTF Des ignatio n : Zone Onchocerc ias i s Coordi nator Signature : WHO/APOC. 24 November 2004 t Da!e; ,Jqquary lQl I Tizira ir''lii.r Gu,irLe (Lii.) (I Acronyms APOC African Programme for Onchocerciasis Control ATO AnnualTreatment Objective ATrO Annual Training Objective - CBO Community-Based Organization CDD Community-Directed Distributor . CDTI Cornmunitl,-Directed Treatment with Ivermectin CSM Community,Self-Monitoring LGA Local Governntent Area MOH N{inistry of Health NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Govenrnrental Organization NOTF National Onchocerciasis -lask Force PHC Prirnary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meering TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children,s Fund UTG Ultimate'l-reatment Goal WHO World Health Organization iii WHO/APOC. 24 November 2004 Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). 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 meso/hyper-endemic areas that a CDTI project intends to treat r.vith ivermectin a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in nreso/hyper endemic areas within the project area, ultimately to be reached rvhen the project has reached full geographic coverage (normally the project should be expected to reacl'r the UTG at the end of the 3'd year olthe project). (i) (i i) in in (v) (vi ) Therapeutic coverage: number of people treated in a given )/ear o!'er the total population (this should be expressed as a percentage). Geographical coverage: number ol corrrrnunities treal.ed in a giverr year orer lhe 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 supplenrents, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to nraximize 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 the1, s6n11rr.,. function effectively' lor the foreseeable future, rvith high treatnrent coverage, integrated into the available healthcare service, rvith strong comrnurrity orvnership, using resources mobilized by the community and the government. (ix) Communit-v 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 vierv to ensuring that the programme is executed in the way intended. [t encourages the community to take full responsibility of ivermectin distribution and make appropriate modiflcations when necessarl,. iv WHO/APOC. 24 November 200{ Table of contents Acronyms Definitions Follow up on TCC recommendations ... .. . . . . ... ... . 1 Executive summary . .....2 SECTION 1. BACKGROUND INFORMATION ...... .. ..3 1.1. General lnformation..... ....... .....3 1.2. Population ......5 SECTION 2: IMPLEMENTATION OF CDTI . .. 6 2.1. Timeline of activities . .... .... .6 2.2. Advocacy .. .. . .7 2.3. Mobilization, sensitization and health education of at risk communities .. 7 2.4. Community involvement . ... ... 7 2 5 Capacity building .. 8 2.6. Treatments .10 2.7 . Ordering, storage and delivery of lvermectin .. .. .. 14 2.8. Community self-monitoring and stakeholders meeting . ..'1 5 2.9. Supervision 15 SECTION 3: SUPPORT TO CDTI . 16 3.1 . Equipment 16 3.2. Financial contributions of the partners and communities .....17 3.3. Other forms of community support ... . . 17 3.4. Expenditure per activity . . 17 SECTION 4: SUSTAINABILITY OF CDTI 18 4.1. lnternal; independent participatory Monitoring, Evaluation ......... 18 4.2. Sustainability of projects: Plan and set targets (Mandatory at Yr 3) . . .. . ..1 I 4.3. lntegration .....19 4.4. Operational research .... ... .20 SECTION 5. STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES . .21 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ..21
FOLLOW UP ON TCC REGOMMENDATIONS TCC session Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I Adopt January to December reporting period It is Adopted 2 Indicate the role of each partner in the proiecl It is Indicated 3 Avoid treatment during lhe rainy seoson to reduce absentees If Mectizsn urrives on lime we will avoid lrealmenl during rainy seasons 4 I ntensify h ealt h e du c a tio n and mobilistion of comntunity lo address higlr number of refusals and absenlees Ll/e are intensdying heafth educution stul mobilization lo minimize ubsenleeism and refusals. 5 Ensure usage of remaining Mectizan tablels before exDin, l/'e are ensuring lo use remaining Mectizan lablets before expiry 6 Train more CDDs to achieve at leasl I: I00minimum sel by APOC and if possible, 20- 25 people turgetedfor 2008 bv proiect Numbers of CDDs have increased in 2009 even though llte expected target (l/100) is not met. 7 Increase number of femile CDDs This is q great cltallengefor tlte project, for our culture it self is a great hindrance lo involve lhem in suclt aclivity. Therapeulic coverage lt as declinedfrom 83'% in yssT j to 73% in year 4 and now 70'% in 1,s07 S.There is a need toJind the reuson and avoid further decline. Pa1, special atlention lo MenetShaslta wltere lherapeutic coverage was 63%. This year (2009) the therapeutic coverage has reached 77% and every efforl will be done to improve il further. Regarding Meneul Shasha, lhere wus shortage of community supervisors in 2007 which contribuledfor the decline of lhe coverage 9 Vehicle, motorcycles qnd plrolocopiers need lo be repaired/replaced by APOC-th vear proiect The mainlenance is done by governmenl budget und ll/e are e-upecling q replacement from APOC soon. WHO/APOC. 24 Novernber 200.1 Executive Summary l. Background on treatment and population data Bench Maji is one of the l3 SNNPR zones bordering Kaffa zone in the North and North East, Sheka Zone in the North West, Gambella Region & the Sudan in the South West and South Omo Zone in the South East. The zone has a total area of 19,326.6 sq kms divided into l0 rural Woredas and I town administration having 221 Kebeles. The capital of the Zone,Mizan Teferi, is 574 km south rvest of Addis Ababa and g49 km. from Hawassa the regional capital. The census result for the20l0 CDTI project shows that Bench MajiZone has a population of 690,295. The annual therapeutic coverage is 78o/o and Annual Treatment Objective (ATO) is 98Yo. The project also has achieved I 00% geographic coverage. 2. Background on population movements. The comtnunities in the CDTI areas are mainly settled farmers, pastoralists. daily laborers. goyernment etnployees and coff'ee plantation rvorkers. The indigenous ethnic grogps are Bench. Sheko, Dizi. Meneat. Surima and Mezenger which occupy the entire Zone CuraFerda rr,oreda has accepted nery settlers fiorn other zones of SNNPR. 3. Training data In 2010 trainings r.vere given for 1.14 health rvorkers,647 Comrnunity Supervisors and 6603 CDDs Challenges and how thev were overcome. Challenges: ' New focal persons assigned due to the business process re-engineerilrg process irnplenrented . Task forces at all levels are still inactive. . Village register updating was not regularly done in some kebeles ' Regular and continuous supportive supervision is lacking at HF, Woreda and Zone level Solutions: ' Training was given to the newly assigned focal persons ' AllKebele rnanagers have attended the CDTI training and rvere very helpful in community, rnobi I ization and supervision activities , Village registrations updating done during supervision ' TCC Mizan office has facilitated vehicle for the ZIID staff and have supervisecl l0 Woredas. WHO/APOC. 24 November 2004 SECTION 1: Background information 1.1. General information l.l.l Description of the project (Geographic location, topography, climate) The topography of Bench Maji Zone is classified as 52%o lowland, 43% Semi- highland and 5%o highland. The mean annualtemperature ranges from20oc-25oc and the mean annualrainfall ranges from 400 - 2000, mm. The estimated altitude range is 500-3000 meters above sea level. Slopes, hills, flelds with gorges and large river basins and streams dominate the landscape of the zone. About24o/oof the area is covered rvith tropical rain forest. About 90.01" of the populations are rural and 9.99oh urban drvellers. Agriculttrre is the main economic source of the zone. Harvesting occurs from October to December. leaving January - April as the optirnal Mectizan treatment period. Communication system Road transportation is one of the u'idelv used rnodes of Communication in the project area. The main all weather road runs fionr Addis Ababa through Jimma to Mizan Teferi (capital of the projectzone). All of the l0 \\/oredas are accessible at present. Nine u,oredas do have Wireless telephone lines: Mizarr as rvell as Slieko torvus are operatitrg rvith digital telephone. At present the telephone collnrunication s),stem is improving rvith netrvork access in sorne \\/oredas. Health care deliverv system The zone has I Hospital.30 Health Centers and 165 Health Posts having 339 health workers rvith difterent qualilications and 469 Extension Health Workers. The health center staffs do supervise and provide Mectizan to the HPs. l-he IJEWs do provide Mectizan to the CDDs and carry out training as rvell as supportive supervision to CDDs. CDDs are responsible lor the distribution of Mectizan. Table 1: Number of health staff involved in CDTI District Number of health slaff invoh.ed in CDTI activities. Total Numtrer of health staff in the entire project a rca Bl Number of health staff involved in CDTI (including Health Extension workers) B, Percenta ge Br:B:/ Br * 100 Bero )t 28 76 GuraFerda 77 73 95 Maii 73 43 59 Meneat Goldia 74 70 95 Meneat Shasha 71 50 70 Mizan Aman 122 14 11 North Bench 98 80 aa Sheko 88 54 61 Shie Bench 74 61 ol South Bench 94 75 80 Tota I 808 548 68 WIIO/APOC. 24 Novenrber 2004 1.1.2. Partnership Since the beginning of the project, there were strong partnerships in planning, advocacy. mobilizatiorr, drug distribution, monitoring and evaluation of the CDTI activities among different partners. The main partners involved are The Federal Ministry of Health, Regional Health Bureau, Zonal Health Department, Woreda Health Offices, front line health facilities, the community, The Carter Center Ethiopia, WHO (ApOC) and other government sectors such as Zone and Woreda Administration, Education, Agriculture, Finance and Communication Offices. APOC, l-he CarterCenter, RHB and theZHD are involved in planning, trainings, nronitoring and evaluation as wellas allocating funds and other supplies such as vehicle, rnotorcycles. cornputers, printers and faxmachinesetc.TheZonalandWoredataskforcesareresponsibleinthefollorvupoftheprojectand mobilizing the population. The front line health facilities do facilitate trainings. conduct supervision. census updating and allocate Mectizan to each village according to the censuses. The communitl, leaders do rnobilize the population and fix the distribution date in agreement rvith their community nrernbers. WIIO/APOC. 24 Novernber 200.1 $ (\ L(.) -o E o o z $(\ .i- o o- o :E q) c) q) OL(,) q,) U) FjI .: ol vttj.,l >91 oq .: LlEol < -ot - -cltrbi Eolotrlt-l -E ql a6l()(! e-oE()qq -O- -E €oCg .) toJtoo oi: oJc!Ec) 0)!o0cc(o 0-) OcO -oBa tr o.) =boq, -: E> 6)a !E oo =- a,;X. ol-o >-o () , L-.c ;r O.F ,;. '5 o o- d O oq (.) -dr / >lol -alq!l oc df) Grl -cl -t dl ql ol oc) ooa= ae. 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O c{ >r d = -ootL O O cl d a -oO O c.t (d -ootL O ol dJ -o 6t Cd a -oO LL ON -.oO 6iaE 1itr (r) - O 6I CO _o o =ON >! d = -oo O O ol <d) _o !.) cl (n a L _o C) 6l cd _c o O O c] >. d L -oo al d -oU o 6l = -oo!L C oCI d L _o0(L o{ L cd -o a)tL '](.) (h o o @ d -o 0) L =(, := 6 -6 o(, CJ a)c o 2 6T a Cg o o tr(d E C(( .! soc o tr Z o o -ca s c o c0 .9 U) s o {) co -c oa L c!q) ! q) LL I q) 9 ;q) €F3o!OH rtsg Ocq 6,) -L-o: # ,.YGu)30)? la56 .E:iE :!:EL>dO .5r. -o. 9EE ;U _ oE O q.rN .EEZ EEo .Ei: F F c.;lo .elts r€l@ NFI 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 have been established atZone. Woreda and Kebele levels. The rnembers of the Task Forces at all level were officials from respective sectors and from the community which have relevance for the CDTI activity. Decision makers including Kebele managers were involved during the training of health workers. The trained Kebele managers were very helpful in rnobilizing the comrnunity. 2.3. Mobilization, sensitization and health education of at risk communities Cornmunity mobilizatiorr rvas conducted at each village by organizing cornmr.rnitl'rncetirrgs. IJealth education manuals and Flipchafts \vere distributed to all CDDs and comrnunitr supervisors (HEWs). Comnrunitv mobilization was carried out b1, HWs. HEWs and Kebele Managers. -[he Mizan J'eferi FM Radio media olficer u,as included in our training and based on the training the FM Media has broadcasfed for 22 hours in 6local languages on Onchocerciasis transmission, consequences of the disease, prevention, on the vector that transnrits the disease and horv to prevent it . -l'his helped to create cornmunit-\' awareness ol the program and therelore communif,v mernbers were keen to take Mectizan without anv enforcement. -lhe cornmunities testified that Mectizan is also useful in eradicating some intestinal parasites and scabies besides it main purpose. 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if nece District/LGA Number of communities/villages rvith communi(y members as supervisors Numbcr of CDDs and the involved ommunities Number of communities /villages u,ith female CDDs Total no. communities in the entirc project area B4 Number rvith community members as s u pe rviso rs B. Percentage Br= Bs/ 84 *100 Male CDDsI Il7 Femalc CDDs Br Total Bq= 87+Br Number of conr m unities rvith femalc CDDs B,N Pe rce n ta ge Btr= B,o/B! * 100 Bero 43 43 100 r55 35 190 43 100 GuraFerda 170 120 100 442 68 5t0 38 32 Maii 95 95 r00 355 77 432 93 98 Meneat Goldia 154 154 100 625 r85 8t0 117 76 Meneat Shasha r0l l0l 100 490 t21 6ll 68 67 Mizan Aman 68 68 100 l6l l5t 3t2 57 84 North Bench 202 202 100 I 068 t28 I 196 91 45 Sheko 138 ll8 100 4r8 87 505 54 39 Shie Bench 170 170 r00 90s 200 I r05 105 62 South Bench 207 207 r00 912 20 932 13 6 Total 1298 1 298 r00 5531 1072 6603 679 52 WHO/APOC. 24 November 2004 Comment on: - Attendance of female members of the community at health education meetings Even though female health education attendants are not equal to that of male attendants, their nurnber is increasing yearly. Female attendants are shy to speak in public and most of the time they are overburdened with so many horne and field tasks. . - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). - Their attendance and their participation is increasing and are having quite fair participation in the discussion. -Incentives provided by communities for the CDDs Thev are sorttetimes being helped in their farms and are ornifted from other cornrnunitv campaign activities during Mectizan distribution da1,s. Even if the comrrunities do not provide incentives, they'don't complain much for they are serving their relatives and rieiglrbors of 20-25 households each. The Wol{Os sometimes involves thent in vaccination campaigns and are being paid small amount of per-diem. -Attrition of CDDs. [s attrition a problem for the project? If yes, horv is it addressed? r CDD attrition is not a probleni for the project. lf a replacement is needed, it is done immediately and training is given b1, FLHW at their respective Kebele. -Other issues 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. The staff members rvho have served longtirne in the projectarea are having good knowledge of the pro.iect and the newly assigned health workers are given training yearly. - 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 measures were taken to ensure adequale CDTI implementationv,here not enough knowledgeable ntanpov,er was available or f staffs are frequently transferued during the course of the campaign) For the 2010 CDTI activiry period The Carter Center Ethiopia has designed different Training modules, manuals and Fillip charts for Health workers. HEWs and CDDs. Based on the designed modules and rnanuals, eff'ective training was given atZonal, Woreda and Kebele levels. The training addressed all issues related to Onchocerciasis (its transrnission, consequences, vectors that transmit the disease, horv to take measure clients. eligibility fbr Mectizan, dosage of Mectizan according to the measurement and management of SAEs). Most of the staffs are knowledgeable and there rvere no transfers during the carnpaigrr period. WHO/APOC, 24 November 2004 q) €Il O Q q) z 6ll v o.: +F\/: -U O O (-.l co$ @ \o (-.l ca \o o\ V-) lr) c\ o\ ?a \0\o €o\ o q) q) i' .:qv c.) oo r- oo$ o.l\o c.l CO$ @ t--\o ca C\ o\ o\ O(\ ca al c.l c- c{ aa o\ @I{)(\() a: av O o.l CO O o\oo f'-@ C\ tr) oo co co aa t(,$(a ?3 oo, oCO(o N COs O @ (o O) cr) (o o) r r (oolr) (o o r C! 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F ra)l d)l -ol6lFI O O Trainees Type of trainrng CDDs Other Communrty members e g Community supervisors Health Workers (FLFIF) MOH staff or Other Polrtrcal Leaders Others (specrfy) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Table 6: Type of training undertaken (Tick the boxes where specifrc lraining h)as carried out during the reporting period) - Any othcr comments 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100% geographical coverage and a minimunt of 7570 therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project has achieved 100% geographic, 78%otherapeutic and 98% UTG coverage in 2010 l0 WI-IO/APOC. 24 November 2004 $O c.l a) _o Eo Z s cl(, o C :E\JF =(!-o(! 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Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)\{oU M \\,I tOE t. \t('[.r.[ \(;IXE()tltcl iplcasc s1-rccil-v ): Mectizan@ delivered by - (please tick the appropriate answer) \.10H !" \\,I I()E t. \r('rit.[ \(;I)(E Othcr ( plcr.c rpccilr ): Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests for Mectizan tiom MDP. After the drug reaches the countrl,it follorvs the existing drug and other rnedical equipment delivery regulation s),stern of the ministrl, sf health. The drug is stored in the MOH u,arehouse from rvhich the project receives. From the project level (Zone) the Woredas collect the drug and distribute to the FLHFs. It is from the FLt{Fs that the cornu.runity,supervisors (HEWs) get the drr,rg and distribute to the CDDs and the CDDs to the corntuunitr. Table l0: Mectizan@ Inventorl' (Please add more rows if necessary) Horv are the remaining lvermectin tablets collected and where are they kept? At the end of the treatment period, the CDDs are requested to return the remairring drtrg to their collection centers rvhich are the frontline health facilities. Then the fi'ontline health facilities send to the Woreda health office and finally from there to the project coordination office (ZHD). Hence. the rernaining Ivermectin is kept at the project office (Bench-Ma.ii ZHD.) List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area. . Training of health workers, community supervisors and CDDs on handling. distribution, maintaining stock balances, recording and reporting . The Carter Center Ethiopia delivers Mectizan to the respective project zones . The Woredas collect their Mectizan from their zone . Collection of Ivermectin from the Woreda level by the frontline health u'orkers . Distribution of Iverrnectin to communitl' supervisors and CDDs ' Supervision . Recording and reporting of data . Collection of remaining lvermectin from the supervisors and CDDs and return to the Woreda and then to ZHD - Any other comment t4 District/ LGA Number of Mectizano tablets Remaining from the previous year (2009) Requested Received (available) Used Lost \\/asted Expired Remaining Bcnch-Malr 2 r 8,838 l .5 5 7,500 t,776.338 1,508,714 0 2,910 17.53 t 242,t83 TOTAL 218,838 1,557,500 r,776,338 1,508,714 0 2,910 17,531 242,183 Note WHO/APOC. 24 November 2004 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so,When? The HEWS and Kebele managers were trained on how to conduct review meeting at kebele level, immediately after the Mectizan distribution is over involving kebele decision makers and CDDs. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders rneetings have affected project implementation or how they rvould be utilized during the next treatment cycle. CSM is lot done but the Kebele leaders, I{EWs and CDDs have carried out revietv meetirtgs after the distribution at Kebele level. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF ) ZOTF) WOTF ) Health Faciliry ) Community supervisors ) CDDs. Usually supervisiotr is carried out by'fCC, ZHD, WoHOs and FLHFs What were the main issues identified during supervision? o Shortage of village registers a Nevv colrers to pick coffbe and rvork in gold mine into sotne Wot'eda's have contributed to the fluctuation of the actual Woreda poptrlation r Dela-ved Mectizan arrival o Irregular and inconsistent supervision by staff lrorn the Zotte. Woredas and FLHFs. l5 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out selI monitorins (CSM) No of Communities that conducted stakeholders meetins (SHM) Bero 43 0 0 GuraFerda N,laj i Meneat Coldia I\,leneat Shasha IVIizan Arnan Nortlr Qench Sheko Shie Bench South Bench 120 95 154 l0l 68 202 138 170 207 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1 298 0 0 WHO/APOC. 24 Novernber 2004 What were 2.9.3. Was a supervision checklist used? Yes 2.9.5. 2.9.6. the outcomes at each level of CDTI implementation? o Improvement in handling of documents o Tirnely report submission and improved report qualitl, Was feedback given to the person or groups supervised? Yes How was the feedback used to improve the overall performance of the project? o Proper documentation is implemented t More CDDs recruited t Even though Mectizan has reached late. reports have arrived on time SECTION 3: Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add more rows if necesstry) *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable). How does the project intend to maintain and replace existing equipment and other rnaterials'/ In 2010 APOC lras replaced 4 Motor cycles, horvever. u,ith the existing government vehioles and other equipments being used for integrated health services a vehicle is still expected from APOC. . Integrated health service is the government's policy and all equiprnents and other materials replaced from the government and other NCOs are wisely utilized in an integrated way. t Radao Communrcalons l6 WHO/APOC. 24 November 2004 Source 1-1 pe of eq u rprnent ,\POC NIOH - Zone DISTRICI' NGDO Others No Cond rtion No Cond rrron No Condrtron No Condltrorl No Cond rtron Tovota Hllux 4W orckuo 1 CNFR I F+ I CNFR )lor cvcles 4 F 1 CNFR ,1 F esk loo comouter 1 CNFR LaserJel pnnter 1 CNFR DeskJet Pnnter Photocoprer 1 CNF'R Fax machine 1 CNFR Overhead ororector Meoaohones 1 F 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years DN.4-Dtttonot available Thell4OltbtdgattncludesrtmntngL'oslosvell os.salat'y.forOnc'hocdcrosrs-/bc'al persons ttl:onul ond v'oredu level - lf there are problems rvith release of counterpart lirnds, horv were they addressed? There is no problem in releasing funds fi'onr TCC and the Governtnent, but APOC's fund alrvays reaches late. The budget is released after allactivities are carried out ttsitlg TCC and Governmenl firnds. - Additional comments Or rr"r.n,, all health programs are integrated and the government is using its entire resotlrces for integrated health progralxs 3.3. Other forms of communaty suppolt - Describe (indicate forms of in-kind contributions of communities if any) The comrnunity leaders and elders do give much time in mobilizing the community during Mectizane treatment periods and CDDs are supported in their farm fields and are omitted from other caurpaigns during Mectizan distribution period. 3.4. Expenditure per activitY - Indicate in table 14, the amount expended during the reporting period for each activity tisted. Write the amount expended in US dollars using the current United Nations exchange rate to localcurrency. Indicate exchange rate used here - lUSD: 13.65 Contributor \ear 6 (2008) Y ear 7 (2009) YearS (2010) TOTAL TOTAL Cash Cash Budgeted Released(us$) (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + State) 0 0 DNr\ DNA DNA DNA MOH (District + zone) 68-s5 6855 1911 | 38 1947 I 38 82.061 52 87.067 52 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partners(TCC) 1 9699 I e6ee 25571 46 25571 46 26 032 59 26.t)32 59 Comrnunities 0 0 0 0 0 0 '0C Trust lrund 23760- I 6ji5 34066 15 31066 75 -l 9,887 {0 1e.803 97 TOTAL 50314 1288e 109,'109 59 109,109 59 127,987 5'1 127 ,904 08 l1 WIIO/APOC. 24 November 200.1 Activity Expenditure ($ US) Source(s) of fundine NGDO Drug delivery from NOTF HQ area to central collection point of comryy!Lty Mobilization and health education of communities Trainins of CDDs 19690.96 MOH Train ng of health staff at all levels 12,118.80 TCC Train ng of health staff at all levels 6186.22 1,921.65 2.446.19 l7q1! 90 2.264.61 5216..04 20867 1043.1 3 004 52 1l 0 25 0 APOC TCC _S yp_e1y is i ng C DDs and d istri b,uti o_n Internal monitoring of CDTI activities Community Self monitoring IEC materials Stalloniry an! p{nting Summary (reporting) forms for treatment APOC MOH APOC MOH MOH MOH Salary offocal persons Vehicles/ Motorcycles/ bic;'cles ma i ntenance Fuel and oil Office Equipment (e.g cornputers. prinlers etc) Others MOH 0 TOTAL'K Total number of persons treated 86,418.62 Table 14: Indicate how much the project spent for each activity listed below during the reporting period SEGTION 4: SustainabilitY of CDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) \one Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 1,ear Sustainabilrty Evaluation Internal Monitoring by NOTF Other Evaluation by other partners I f a 18 WHO/APOC. 24 November 2004 4.1.2. What were the recommendations? 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? no No Was a sustainability plan written? _Yes : ,hen was the sustainability plan submitted? on the 3'd year of the project " What arrangelnents have been made to sustain CDTI after APOC funding ceases in terms of.7 4.2.1. Planning at all relevant levels fhe CDTI activities are planned integrated rvith the other PHC prograrns aI all levels Thcrc.lbre. the plattning processes are carried out through participatorl'methods, usiue bottom-Lrp approach and integrated rvith the basic health services. Resources are uscd to all health activities on integratecl basis. 4.2.2. Funds . Funds liom the govenrnlent and other donor agencics like TCC and APOC are utilized on inlegrated basis lor all health programs. 4.2.3 Transport(replacementandmaintenance) It is expected that APOC will replace a vehicle. Four motorcl,cles u,ere replaced by, APOC. The RHB has allocated trvo vehicles and two motorcycles received fronr other programs to be used for integrated health services. The existing APOC donated vehicle is not functioning at present. 4.2.4. Other resources - 4.2.5. To what extent has the plan been implemented The plan is wellexecuted by the supportol'the governrnent. APOC, TheCarterCentre Ethiopia and the cornrnunitv at large. The CD'fl activities are rnostlv incorporated and integrated w,ith the other PHC programs. however, support frorn APOC and The Carter Centel Ethiopia is highly dernanded.l'his l,s2p Therapeutic and TIJG coverage has reached 78oh and 980% respectively. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: _ All CDTI activities are integrated into PHC . . Mectizan delivery . Training ' . Distribution ' SuPervision o Budget. l9 WHO/APOC. 24 Novcmber 200.1 4.3.1. Ivermectindeliverymechanisms Since the beginning of the program, there is no separate lvermectin delivery system to the lower level; it follows the existing drug delivery system of the general health service. ln other words. Ivermectin delivery is fully integrated into the existing drug delivery system of the country. 4.3.2. Training : CDTI trainings are integrated with the Primary Health Care (PHC) from the beginning at the National, Regional, Zonal, Woreda and HF levels. The Disease Prevention and Health Development Core Process is responsible for taking care of the program at all levels. The Cafter Center Ethiopia has developed modules, manuals and Filllp Charts to be used at Zonal. Woreda and Kebele levels. The trainings were very valuable indeed at all levels. 4.3.3. Joint supervision and monitoring with other programs As part of the system in the country. all sorts of suppor-tive supervision and monitoring activities of the CDTI progranr are carried out in an intL-gratcd manner u,ith other PHC prograrns. 4.3.4. Release of funds for project activities The govemment, The Carter Center €thiopia and APOC have released fund for the year20l0 CDTI activities. The governnrent is paving the salarl'of all focal persons and allocates budget lor supervision, fuel. stationarl'and vehicle rnairrtenance, etc. All health activities are carried out on integrated bascs using the allocated budget frorn the Government and NGDOs. The APOC par-t was released late. 4.3.5. Is CDTI included in the PHC budgett The budget iternized for communicable disease prevention irrcludes CDTI. . 4.3.6. Describe other health programs that are using the CDTI structure and horv this was achieved. What have been the achievements? CDTI structure is being used for rralaria prevention. national vaccirration prograrns such as Polio, TT, Measles and EOS. CDDs are very helpful during these campaigns and are shorving good achievements. . 4.3.7. Describe others issues considered in the integration of CD'f I. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Not done 4.4.2. How were the results applied in the project? 20 WIJO/APOC. 24 November 2004 SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: - Geographic coverage- l00oh t High therapeutic (78oh)and UTG (98%) coverage - Weaknesses: r - Lack of continuous and regular Supportive supervision at all levels - High number of Mectizan expired - Number of Absentees and Refusals is still high - Task forces at all levels are inactive as usual "":":::.,.*,.0 expansio, orpr{c to village level. . . Assignntent o{'llEWs to Kebele level. "':"'J;:iff;:l'"rheartrr starr! especiauy at rront rine hearth racirity,and woreda revers Overlapping olother health campaigns during Mectizan distribtrtiorr period. SEGTION 6; Unique features of the proiect/other matters . Project Woredas are very relnote . Health staff unwilling to sta)' in the area. o APOC's report format is so cumbersome and please do consider to revise and make it short and precise for the ZHD has so many reports to be submitted to the government and other partner NGDOs too. I 21 WHO/APO('. 24 Novernbcr 2001