Jimma annual project technical report submitted to Technical Consultative Committee (TCC): December 2003 - November 2004

,_ lt - ,t Proiect Name: JimmaCOUNTRY/NOTF: ETHIOPIA Launching vear: 2003 Reportins Period: From: D.essmher.20..Q3.... To;....1i.q.v..e.mb..p.r.2.Q0..4....( Month/Year)(Month/Year)p."i..t". (circleone) O 2 3 4 5 6 7 8 9 10 Date submitted: 20 January 2005 NGDO partner: The Carter Center I I I The Federal Democratic Republic of Ethiopia Ministrv of Health ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: / I I I I I I I I I I I I (tl0 \1 E,S. \tt', co 7l L .-';fn \ "' To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) F0, ,1i , , ,. 'i' ",, L .-t 3 1 JAN. 20fi5 WHO/APOC, 24 November 2004 Approval vear: 2003 tl; ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Ethiopia National Coordinator ,iDate: /-1 /;/ Zonal Oncho Coordinator Name: .......N.as.ir Signature: ..... Date: .. 11ls,lo( NGDO Representative Name: ........Tesh.qme.G..ebre...... This report has been prepared by Name : Na.si.r..A.b..de..t.N-O..T.E Signature: ftf.=....... Date: Sr/zt/r{ Desi gnati on I Zqln.Ql.chq..Cp.ptdinetqx ., r -" /-n Signature ,...W;rT Date . ..n.k:.t.1.P.!. 1l WHO/APOC, 24 November 2004 ITable of contents ACRONYMS..... v DEFINITIONS.......... VI FOLLOW UP ON TCC RECOMMENDATIONS...... EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION 1 . 1 . GBNSRaL INFoRMATIoN ... .... .... ..... .... .... 1 .1 . 1 Description of the project (brieJly) 1.1.2. Partnership 1.2. Popur-erroN SECTION 2: IMPLEMENTATION OF CDTI 2.1. Trupr-meoFACTrvrrrES.............. ......................6 2.2. Aovocecv ...................7 2.3. MosllzetroN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT zusK coMMuutrtss . 7 2.4. CotvttvtuNtry INVoLVEMENT ........... ................... 8 2.5. Cepacrry BUrLDrNG... ..................... 9 2.6. TReemapNrs ................ ................ 1l 2.6.1. Treatmentfigures............ ...... 11 2.6.2 What are the causes of absenteeism? .......... .............. 13 2.6.3 What are the reasons for refusals? ................ ............ 13 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that... l3 2.6.5. Trend of treatment achievement from CDTI project inception to the current year 14 2.7. ORoeruNG, SToRAGEANDDELIVERyoFIVERMECTIN ......... l5 2.8. Counauury sELF-MoNrroRrNG eNo STeTBHoLDERS Mrnrmc ........... 16 2.9. SupenvrsroN................ ................. 16 2.9.1. Provide aflow chart of supervision hierarchy. .......... 16 2.9.2. What were the main issues identified during supervision?............................. l6 2.9.3. Was a supervision checklist used?......... .................... 16 2.9.4. What were the outcomes at each level of CDTI implementation supervision? l6 2.9.5. Was feedback given to the person or groups supervised? ............ 16 2.9.6. How was thefeedback used to improve the overall performance of the project? l6 I ) 3 J 3 4 5 6 3.1. EqutrureNr 3.2. FrNeNcrRr- coNTRIBUTIoNS oF THE pARTNERS AND coMMUNTTIES 3.3. Orupn FoRMS oF coMMUNrry suppoRT 3.4. ExpeNonuRE PER ACTIVITy t7 l8 l8 18 SECTION 4: SUSTAINABILITY OF CDTI.. ............19 4.1. INTERNIL; INDEIENDENTpARTTcTpAToRyMoNTToRTNG; Eve1ueuoN................... 19 4.1.I Was Monttoring/evaluation carried out during the reporting period? (tick any of thefollowing which are applicable)............ ........ 19 4.1.2. What were the recommendations?. .......... 19 4.1.3. How have they been implemented?.............. .............. 19 111 WHO/APOC, 24 November 2004 ';ar 4.2. SusrerNestt-lTy oF IRoJECTS: ILAN AND sET TARGETs (ueNoaroRY AT......... ......20 Yn 3)......... ...........20 4.2.1. Planning at all relevant levels..... ............ 20 4.2.2. Funds........ .. Eruor! Bookmark not deJined. 4.2.3 Transport (replacement and maintenance)........ Eruor! Bookmark not deJined. 4.2.4. Other resources .................... 20 4.2.5. To what extent has the plart been implemented................ ............ 20 4.3. INrpcneuoN ............... .................20 4.3.1. Ivermectin delivery mechanisms .............. 20 4.3.2. Traintng..... .........20 4.3.3. Joint supervision and monitoring with other programs ............... 21 4.3.4. Release offunds for project activities.... .................... 2l 4.3.5. Is CDTI included in the PHC budget?...... ................. 2l 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the acltievements?.............. ................. 21 4.3.7. Describe others issues considered in the integration of CDTI. ...................... 2l 4.4. OppnartoNAl RESEARCH ...................21 4.4.1 . Summqrize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ...... 2l 4.4.2. How were the results applied in the project?............. .................. 21 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES 2t SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........21 lv WHO/APOC, 24 November 2004 aAcronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization 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 Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 24 November 2004 IDefinitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-endemrc areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesolhyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normallythe project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) 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). (vir) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower comrnunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, wrth 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-monitorins (CSM): The process by which the community rs 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. vl WHO/APOC, 24 November 2004 FOLLOW UP ON TGG RECOTMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session Not ,le I Number of Recommendation in the Report TCC KECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 24 November 2004 Executive Summaly 1. Background on treatment and population data _]unn-ra Cl)'l'l has lotal comrnunrucs (rrllagcs) of 3(107, u-l-rich are distuburccl m 3 \\/orcdas (l\[ana. Scka- (lhekora and Dedo) ancl all the villages u,-etc covered rvith N{ectrzan treatment during the treatmeut period. 'l'hc toral population oI thc projcct rs 7.18,082. ']he .,\r'rnual 'freatment Obicctivc (IYI'O) for thc I'car \\'as 614,238 rvhich ts thc same as thc [.r'l'(] ancl otrt of u'hich 585,114 rvcrc trcatcd rvrth \[cctizarr rr,lrrch gir.cs tl'rc thcrapcutlc covcralte c>i 78.2''io. Hundred pcrcclrt of the projcct arca fucographical cor-erage) rvas covered by the treatment 2. Background on population movements. 'I'hc communltics lrr C[)'l'l arcas atc rnaltrlv scttlc:d farmcrs, dailt'laborers atrd ctvil scn'ants. Hctrcc, thcrc rs no rnajr>r npe clf population tno\-ement rn the proiect arelt. 3. Training data 'l'rarning r>f 'I'raincrs (1,()1) u.,as givcn for 8(r hcalrh profcssiouals. 'l'hosc u'ho rverc tratncd as trainers tn tutn traincd 7,247 CDDs who rvcrc sclcctcd by the collrmurrrties from 3,(107 villages. 'I'hcrefote, thc avcragc rrumbcr of Cl)l)s pcr villagcs is 2. 4. Challenges and how they were overcome. Threats (Challenges): Overburdening of health workers in peripheral health facilities in different lrealth programs srrch as malaria cpidemic confi'ol, EPI, and mcasles campaign. Opportunities: 'l'he cxpansion of government structure down to villagc levcl "garce" and being taking the responsibility of dcvelopment activities as well as health is a good opportunity fbr sustainability of onchocerciasis control, rvhich helps to o\rgrcomc the above mentioned challcnges. 'l'he Health Bxtension Packagc program in which thcre is a start of building a heallh posl in each and every Kebele is also another good opportunity. 2 WHO/APOC, 24 November 2004 1. r , r) SEGTION'l: Background information 1.1. Genera! information 1.1.1 Description of the project (briefly) .limma CD'I'I projcct is located in the southwcstcrn part of Ethiopia in Jimma zone administration, which is one of thc zones that constitute the Southem Oromia Itegional State. 'l-heZone is further divided into 13 administrative Woredas. The CDTI project area covers 3 ou1 of the 13 Woredas found in the zone and the project woredas have a total population of 748,082. The project area shares borders with Kaffa- Sheka CDTI in the South. The 3 Woredas are further subdivided into 137 Ketreles which, according to a nerv government structure reaTiz,ed this year, is further divided in to 3,607 "gal'ee" (village) which is composed of 30 50 nearby households and responsible for all development activities including health. 'l'he climate of the CD-I'I project is classified into three gco-clinratic zones: highland, nrid- land ancl lorvland area. 'l'he mean annual tcmperature ragcs fiom 10 0C to 16 0C in the high lancl, 16 "C -26 0C in the miclland and 2l t'C -33 0C in lowlancl. The annual rainfall totals are highest in the highlands of the zone reaching 2000mm. There are two rainy seasons. The main rainy season is between June and October while small rainy season is fiom January to April. Some of thc perennial fast flowing rivcrs that cross Jimma zone include: Gojcb, Ghibe, Gilgel Ghibe, I)edessa, and Kawa. 1hcre are also a number of small rivcrs and sffeams, which are tributarics of the large ones in many places in the zone. 'I'hcre is a main asphalted road about 340 Kms that connccts Addis Ababa with thc capital of the zone, .limma torvn. Each CID'l'l Woreda capitals are connected to Jimma town with all rvcathcr roads. Howcver, within the rural communities the roads are only for dry weather. 'l'herc is also 3 times a wcek flight to.limma town dircctly fiom Addis Ababa. The health infrastructure in the Jimma project area is relatively good. The zone has I z,onal hospital, I district hospital, 15 health centers, 7l health stations and 38 health posts. The new govemment health policy of I-lealth E.xtension Package (HEP) demands construction of new health posts in each Kebele and staff with health extension w,orkers in the next 5 years. There are a total of 27 healtlr facilities in the project areas. J WHO/APOC, 24 November 2004 ITable 1: Number of health staff involved in CDTI (Please add more rows if necessary) District Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area BI Number of health staff involved in CDTI B2 Percentage B:=Bzl Br *100 Scka-Chckorsa 35 35 100 Dcdo 1'' ,,) 100 Mana 28 28 100 Total 85 85 100 1.1.2. Partnership Partnership is a principle of APOC'as well as thc govenrment of Ethiopia which hclps CD'I'I ploiects fbr best achievemcnt of their activities and gradually ensures their sustainability. Since thc bcginning of thc project, therc rvas strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among differcnt paffncrs. 'l'he main parrners involved arc Federal ministry of hcalth, regional health bnrcaus, zonc hcalth dcsk, Woreda hcalth ofticc, hcalth facilities, tlre community, thc carter ccntcr, WHO and othcr governmcnt scctors. 4 WHO/APOC, 24 November 2004 $ C.l o -o (.) z $N (J > dLo 0) € o oth +i (.) L(d oo 'a La C) aoo o o d aotro +i o 63 li Ho >' () li C) a oC)O '= a.) Ll ex qiO OE o(.) arEo 9rn YoE rr1 E cdd9=AHHcg(.:)fi:. =d) d5b0o: *'c, =o 'c€ao =g o 06)/bo +=dc/j ;-i d) -.!- b i:F itu ! '=troo L )Fri E + U tr d=5 EPo 6.=(.)FaE=c) '!H.lE 9:EPl! .A Yog a 5=tro- /v *io-E Pe .20 !B ego trq)C(qurii tA -g 9cd d ."€ bo(d o-:,AAAP lr U;FA'iU F^ .: tr9) I^\aE S;E Etn3 >x troaHg .q=9 '*; iU o0 trotrs '=.tr()Y4 0au=o-oL'1 .R = 0h A)-L>.u I a aLrl-u E.o() B doLr) 2 H 0) L./ o o(J a ah oo CB (€4.. o(-) ;. 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Fl t'r F i a ct Hq) -o (.) z$ c.l(, o o. o B eh L 6) a iE =9trE U .f al $ al t z a al to z a0 .,E ?tr ct=(r) - a (-t -c $ a.l uo v a.l b0 lr t, o,[ L 3E U $ al .f al; o z 9 ol; oZ T.c !E #E =t ...l d z. -t N o a ON o a q) 6lE a, an 0) U 9:3EtrE Q $ c.l >' ad 2 -t Nj o.o a -t N -a.oa Er= Ftr aE $ a.l o s al !o CJ U) \t al t C) o, AI ctL Fr o *EtrE U sf O a.t tr -f N bO a c..l a o0 Eoo 1itr d=i;E .f 6t oLd $ o.l d0 <f c.l o0 -o) irtr s= -atrooFroa 9: a=trE(, =t N d $ a.t b0 $ al bo $. LE aE $ at oLd v a.l {' a.t .E Fl () ar) d oJo U OJa o o o (t Fl t'r t'r \o ->. q qj Qq) UL v q)q N q) Qa lr(€ C) >' c) E o o €o(! 0)H ch(d olr o tr a C) o(! +i o C) o) F ".iro.,l -ol(€t FI o o IIfl .I IIfl(, 6 rF o o E II -o E a-F a F IN Fa(, rF o E oIIfl ofl E o Eg B! atN - o IF(, lllo ll 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. High-level political leaders and Onchocerciasis task fbrces at different levels particularly the Zonal. and Woreda *'ere involved in the advocacy to support the overall CDTI activities. The members of the Task Forces at all level were offioials fiom all sectors, which have relevance for the CDTI activity. This political commitment helped the CDTI activities to be started and successfully achieved its objective. However, some of the sectors, rvhich are members of the task fbrce, were highly involved in the ongoing restructuring of government organ and other activities. This has to some extent hampered the fi'equcncy of schedulcd meetings. For thc ncxt treatment pcriod the 'l'ask Forccs at all lcvel will contribute their paft as expected sincc the rvork loads they havc because of rcstr-ucturing and resettlement will bc minimized. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilizati<ln was done at each village organizing community rneetings. The health workers at all levels have done their best in organizing the Task Forces and giving health education for the task fbrces. The health workers working at fiont line health facility level were responsible to organize the Kebele Task forces and giving health education for the task forccs, community supenisors and CDDs.',I'he'Iask Forces at kebelc levcls u,hich, compriscs of sevcn mcmbers and also rcsponsible for all social, political and economical activitics in thc kebelcs havc playcd major rolc in mobilization and sensitization of thc rvhole comntunity at grass root lcvcl. Cornmunity Supervisors and CDDs were rcsporrsible in giving hcalth cducation to the community at villagc level including womcn and minorities. 'l'he community mobilization has contributed a lot in awarcncss crcation and as a result thc comntunity involved in the first year CD'l'l activity with successfull accomplishment. 'fhus, fbr thc next trcatmcnt community mobilization and health education will bc strcnglhened. 7 WHO/APOC, 24 November 2004 $ c{ ro .o o o z .t N Oo B d o 0) (, C)aa oa bI) (.) ,o olr(! a C) a U) F O 0) a oo 5o() - c-.tr€b9 .'r ato) .^JL$E = UHV ijE();{!ox -vatro .9L e,tso t oQa'16 I,9A ()= L iLiEC)i-A.(EH!()..o !-!(l3 'R -4Y;.8 x a!9!.\ 'Eq= o.H5 I r) -i-vlr H i.i qJ,v F.r! EPPdE8. xE9'6 q= E!'-A^PE()Y ts S.O:E 3 anrC)H'vHX-PE9E = H OE e.i E:EqE38E ErO-cE ,6'9-fq = >r'u -HoqU; .6'atpo:'B tr >oE 9': HU *HAAo ^ o -q 0); BE'E3=Aos b E.= b.= L--al-!HEEE"EHE-8Eis EEi6 Orrrrr ta ll * ^itQ tr E.g * ! EEEz i'i o ODG o o oO 'E l,/ E6 EE =€r!9o troD zi c- F- c.l oi oo \o €t EE + tr il ra ca F n 6 oF 9- €E6E a Q 6l 2 =aL= a!y U z (.l F-- $t-- @. r-tf, ar F- Ir- a.l at oo \oco = .t c.i @ N @ r- \o =?>o u:'l Br Eo EO rC s= zo ll * co cti EA AD 6t E o cr tr EaHrl'= - o I =E i ioz=Zeeo co al F- o' r- \o t) l0 ?s6r.= L oE.EE: SEgE -E-9 6 a.l v-l a- F-\o j .J r -:zC) -cO .o a (J d z oF a' 4q q)(J q) k U\ q) L = U4 qJ f.t _! F o() C)JtE=o.=EEo.; -9o'5 ,'5E:r-X fl()ar .-E.E -H -aEEEEOrI(, :. .sl .Qltbtoi f;l oo 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the sifuation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff arefrequently transferred during tlte course of the campaign). There was a cascade of trainings on CDTI from the higher level to the community level in adequate amount to cary out the CDTI activities. However, there was a f'ew situation where there were tum over of trained staff particularly at the zonal level and front line health facility lcvcl rvhich did not crcatc any majorproblem on thc project activity.'['his effect of tum over rvas allcviatcd by on job training of the newly assigncd staff at all lcvcl. 9 WHO/APOC, 24 November 2004 *a.l r 6) -o C) o z$N O o or B O rb a { a\ o s p o c to o\ ni L o \ o a. o a e 6) cq O U c) z d + $ ir *(j il U ( .L a< ca al \o rl at F- : F- c.i s a- .+ t-- @. F-$GI t-- F-t6l r- o\ €) q) q) t) Q rr a.l $cl c.; wt--09 o, F- O q) .=6 ctl Fr ()l .oE L!ro- z LU 9 i^ Rv ,L a< -l i oo oo <l- <t -t \o \o o\ o) o q) \v QF i 6.i- -t 6) Ed IT *; TEES ZY, o)o Ei'r+ U U A< = cl a.l c.l c.l oo a.l @ a.t rA € ]n 00 o C) q) (.) c.tc.l @c.l ra @ c) 6l G O 0 (.) O o q) z E.'i+F-d \) U .L a< z Or- t-- at$ a-.t € G) q) 9 q) \v UF 01 c- 6l.t 6 .] oo U C)a o o F] ti F -:. qq q) q) q) 4 > o\ q) r. o B q) 4 qJ el (! o (.) p. F nOqr a C) C) 0)lr +i € (.) cB bo !F ,ii1 ol -lstdtFI Trarnees Type of training CDDs Other Commumty members e.g Community supervisors Health Workers (FLHF) MOH staff or Other Pohtrcal Leaders Others (specrfr) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report wdting Others (specify) Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other 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 flucfuating, state the reasons and the plans being made to remedy this. 11 WHO/APOC, 24 November 2004 $ c.l 0.) .o (.) o z$ c'l(, o B C.l ql ho E! ! Eqtlt'\ $" hO \]o+ l<EFrt /L vq CdB0)sks(dg U oo'Es \V:Ua.\reii -boi .=!r €.s-i>.s E6V\E i3Hbs o.il 'Er!' 6'ISE E€qTE 9S$tsa\ *E *tlF -:Ua .S 'ts'sH r \.i: .s !$ .; ( *\E ro Ss * a 'r:.al tr Q e\9l -hEE;13 E Ei Xl € u '!-f xl 0? s si irl * t :i!l 6 .9 Y;gl.a s ba3b t *i BI U $ E:el -O ! ? liHl tr X Ir. El = s- .:s EIE E ETZt? .s EEE UUg €\ .i ss : s\!,, E El. .* q- il\. :';s Ga! €tE S: = ls\-qts \ sp> E E.Y .Y S ';I -c 'r d\H s ssO E ESF rr l!? P PS o\ \ aS olOI -l o,xl > El I EIF ol : ol o)ol trot Eol i{ <*l 9,1 el f-kl ' .8tE EI H =l czl< (n(.) H(o €oo:,v <gH G)H-t !9o; 'a^ LVAH 2,c) i,i n4 =d =-o!>() -tl a .:.i(.) = .= 0.)tr'o3 -a Eai- c)5'5 od tr ot c(.) ol H! *l HE xl R rHl -h ul <> a. dltr> 9t 6 - qlc, 8I E H3 -l E -=l oxl - Ft P -t Hat 'ut 'F \t igl P 6l: :xt .= tt 6Ylt =loel .! Hl - o,ll - =l tr *l - HIL o.t^ lll HEI; FI:Xl 'cd Xl o) -"1 = --l -o9tf9t-ol i1 0l trrlO plIolo- olcpl !l-trl Gi trl <o =lo =loZll- Zl? al C)lbll rdlLI 0)l BI :l(€l ol -ql a.l(dl s olbll ol trl(dl ,-, I =lo al cdlLI o)l -ql bd cl )tOI EI ol ol -l €l cl EI 5t fr.l q 4q) Qq) S L. UL o q)q q) E )4(h L (! a olrd d (, Fl o L a € >.p ch El a 'o (! C) doHF :t -oldtFI 0) L() bo L:^'C)\ o(.) F 0) (6! C) o0 C6 o) o C) ct s oq) (.) H q) o0 H C) oO()^ 0) a. clH 0) F GP =E#s€* > o P iit H E HE B9E otP o' o o o!tr z IElPn4 =aAO vo EO -OEa z6 r- @- i @ -f,(") al6 rA$ ao3E eE €gEEEJo. tiY> c.n @ at 9 s -i' : alFI t d g iLko\ =ooo€ E-t) oo -EoF aS F- r- n 6 t-- al 0cr- o --qoll EbE = o!z al {<t a.l cl oiclN oo = rn 00 ro H =or b.Z =E:E E.gT < 9*'.Fq/ r- (.l @ @ -lal d-i r- @ ?a)6t !+ H € - &H1€ i.ga!b E d I'IJ oF a! =t +t-- f) o\ al \o $ (\ co €tr- aobo(! a 0.) U IIFbs5b>voy ov =oE.= o ko tr ao.ysJdkE E= O z6 a a .o - N r- r- at =uE E.: e 6.4 < 94'FL, € NO vl r- o\ F- \Oaa-tdG o= i oo:E c EE+--> - - q+.=^ E EBE"E Y.F E Ceao @ al r'r F- \ot) <)4 ;q H ! *a:;o al) o o o cd 2 Fl F t'r r{) I 2.6.2 What are the causes of absenteeism? Most of the absenteeism was occurred because of the overlap of the famring time aud the drug distribution. This unusual overlap has occurred because of late commencement of the overall CIDTI activities. 2.6.3 What are the reasons for refusals? Most of the relatively big towns dwellers who do not feel sick of onchocerciasis were not voluntaty to have the medications. 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 13 WHO/APOC, 24 November 2004 )', $ c{ E 6) -otr 0) o z$ol A B $ dtI v '5 cc -I 6tI q) oo 6l L. 0) Ig) r: ^\Js'Fsp\_\? .\ .= LLss a!8+ E3.s E ==E,sL\.eL\ro) -e3€ :t E9l- EUAOoLl= +jaBE E e)q)! .+IV :, u):)oH\looll '=Ll9tl-!laElFeSlAEOIo.b s]E H F..ILLI0(€lL0)I; il Iqq hEHI - all !6);t i) oolE>l !CJ J-rl O- LY0) :OO= t!w€96Lli>oE8-qJ \JEEF rEdD va IE\ LItrC)eotrd) LFiiia! 'oc.) ui.'E vi '.. .= ei o\l ; ol .A =l ctHsFl Fr o u0 rtd^tr bs\ >:-JO O q @r- o (n ao ll { rrJ l.l e o ^DO9 Ec - Oo\ o n o ll * rI]I! li o\ o 'Eo =b0od e-!, oo<oF .J @ F- t! € .o o6 .o o5EaFC -a z,'o o { ri co ti =oEE: !:oi.e PFV rc ca c.l + \o q9 bE SEo)-. .o c€S =Ll' d_ Ee o c.l € @$F- @(,) bo o O ll * kl li r{ o o Bo- - 06\ -o o o-o0=!!-9!-rrrFg 954.i oetrl ti oEt!1 b E gPU tr tr= dl =E>ts>O6 r-- ri :o = 6.1 < 94F9 |.- bod =aa>xoo> 9 Kh+ 9E h;: - ==trt.=!d € = E E€ EO o r- 9 c.l N N c.l c.l t N c-l a.l r- N € a! o\ o .i c.l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH M WHOtr UNICEF'tr NGDO tr Other (please specifu) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH M WHO tr UNICEF tr NGDO D Other (please speci|l) Please describe how Mectizan@ is ordered and how it gets to the communities The NOTF requests lbr Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery system in the counhy. Then the drug is stored in MOH warehouse from rvhich projects levels receive. From the project level (zone lcvcl) the Worcdas rcceive it and distributc to the health facilitics. It is from the fiontline health facilities that the C'DDs gct the drug and distlibutc to thc communities. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? At the end of the treatment period,lhe CDDs were requested to return the remaining drug to their collection centers rvhich are the health facilities. The health facilities, in tum, send to the Woreda health office and finally fiom there to the zone health desk. Hence. the remaining Ivermectin is kept at the project (zone) level. 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 ivermectin to CDDs . Training of community supervisors and CIDDs . Supervision . Recording and reporting of data Any other comments State/District/ LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Seka-Chekorsa '772.000 7 | t,s74 3.8r8 56.608 Dedo 754,000 628.284 10.771 114.945 N'lana 3_12.500 325,000 0 7,500 TOTAL 1,858,500 1.664.858 14,589 r 79.053 15 WHO/APOC, 24 November 2004 2.E. Gommunity setf-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the projectatea? No. If so, When? Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if 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. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF' ) ZOI'F) WOTF ) Hcalth Faciliry ) Conrmunity supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? . Delay in utilizing and liqtridation of funds. . Failure to organize the collected repofts on CIDTI activities especially a1 r.voreda and front line health facility levels properly. 2.9.3. Was a supervision checklist used? Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Though the Finance officers have received proper training on handling the APOC/WHO fund utilization and liquidation systern, still there rvas problem on liquidating of the used budget. Therefore, on spot training rvas given during supervision. The overall reporting of the CDTI activities was also corrected as much as possible. 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? The goorl geographic and therapeutic aohievement of the project performances shows promising. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSI\tr) No of Communities that conducted stakeholders meetins (SHI\O Sel<a-C'hekorsa Dcdo Mana 1,168 1.502 937 0 0 0 0 0 0 TOTAL 3607 0 0 t6 WHO/APOC, 24 November 2004 ISEGTION 3: $upport to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-fi.rnctional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? 'I'hc project expccts APOC fund to maintain capital equipments that have lreen provided by APOC fbr the flrst five years. 1'he capital cquipments that are contributions of the govcrnmcnt u'ill be maintained using the gorzemment moncy. 1-he project is trying its bcst to pcrform well so that APOC lvould replacc these cquipnrents after first five years while at the samc timc cflbrts will continue to allocate budget by thc govcmment fbr smooth takcover of the project gradually. Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No. Condrtron No. Condrtron No. Condrtron No. Condrtron No. Condiuon 1. Vehicle I t' 2. Motor cycle(s) 2 F 3. Computer(s) I F 4. Printer(s) 1 F 5. Photocopier (s) 1 F 6. Fax Machine(s) 1 F 7. Overhead proJector I F 8.25" TV set I CNFR 9. Deiesel Generator 1 F t7 WHO/APOC, 24 November 2004 a3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years * [nrlirect contribution,s such as stoff'.salories, olJicc supplies, utilities, communicotion. et(. **Contrilsution ol CDDs and conmunil.l' supervi.sors convefled in to monitory vulue *'k* L)o not inclLtde fund fbr capital equipment - If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community suppoil Describe (indicate forms of in-kind contributions of communities if any) None 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. Indictate exchange rate used here Contributor Year I (2004) Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) MOH (Central + State) 15.823* 14.943 MOH (District + zonc) 37,096* 3s,823 Local NGDO(s) ( if any) 0 0 NGDO partner(s) 13,290 73.290 Communities I 7 l,(r80** 17 r,680 APOC Trust Fund 56.090*+* 30.000 TOTAL 353.979 325,736 18 WHO/APOC, 24 November 2004 lrt lat Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTIOil 4: $ustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? Activitv Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of ,cgryryunjty _ Mobilization and health education of communities Training of CDDs Jfar"rng,o ___ Supervising CDDs and distribution Internal monitoring gf CDTI activities Advocacy visits to health and political authorities IEC materials Summ_ary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others TOTAL Total number of persons treated t9 WHO/APOC, 24 November 2004 I I t 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NQ Was a sustainability plan written? NQ When was the sustainability plan 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 CD'l'l activity is part of thc Health Sector Devclopment Program. l'hercfbre the planning activity is carried in an integTated maltner at all levels. 'l'he govcrnment policy of empowering thc worcdas, the communities and Hcalth Extcnsion Package will also cnsurc the sustainability of thc CD'll. Funds Short. medium, long-tcrm (post-APOC) financial sustainability plans willbe prepared at rvoreda and rcgional levels. Budget linc will be crcated for CID'I'I activities by the respective local government Transport (replacement and maintenance) Efficient use of APOC vehicles rvill be ensured as long as they in a good condition. Budget lbr maintenance rvill be allocated and other vehicles lrom Mol I and other partners will also be mobilized. 4.2.2. 4.2.3 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.!. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Sincc thc bcginning there is no separatc Ivcrmectin delivcry system to thc lowcr lcvcll it follows thc cxisting drug delivcry system in the country. 'l'he rcqucst fbr lvermcctin is to MDP is through MOH. As soon as the dmg arrivcd, the same as all other dnrgs and medical equipmcnts, thc all the proccsses rcquired are handled by a Pharmaceuticals Administration and Supply Servicc in tlre MOH. 'l'hc projcct lcvcls, likc any other medicines, rcceivc and delivcr to thc rcspcctive lcvels fbllowing the cxisting dclivery system. 4.3.2. Training: CDTI is inlegraled with the Primary Ilealth Care (PIIC) from the beginning. At the National, Regional, 7.ona1. and Woreda levels, the Malaria and Other Vector-borne I)iseases Prevention and Control Llnits are responsible. Therefore, all the staff of these units has received training on onchocerciasis. Training of peripheral health rvorkers has been carried out in integrated manner wilh other health issues. 20 WHO/APOC, 24 November 2004 I tlla t (rl 4.3.3. 4.3.4. 4.3.5. SEGTION 6: None Joint supervision and monitoring with other programs As part of the system in the country, most of the supetvision and monitoring activities are carried 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 tin-re to accomplish them. Is CDTI included in the PHC budget? Yes, as part of PHC, CDTI is one of the priority activities. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? None 4.3.7. Describe others issues considered in the integration of CDTI. The new government structure of "garee" (village) which has got a health committee and the Health extension Package program designed to reach all Kebeles with health posts, will play a major role for the integration and sustainability. 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. NONE 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and oppoilunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. Strengths: even though the CDTI activity is new., the project is able to accomplish the distribution in short period of time with 100%, geographical coverage and therapeutic coverage high above the nrinimum standard. 1his is due to high political commitment at all level, awareness and active involvement of health workers and the community atlarge. Weaknesscs: delay in reporling fiom thc low'cr levcl, poor financial utilization and liquidation C)pportunities: 'I'he cxpansion of govcmment strucfure down to villagc level "garce" and being taking the responsibility of developmcnt activities as well as health is a good opportunity flor sustainability of onchocerciasis control. The Flealth Extension Package program in which therc is a staft of building a hcalth post in each and every Kebele is also another good opportunity. Threats (Challengcs): Overburdening of health rvorkers in peripheral health facilities in diffcrent health programs such as nralaria cpidcmic control, EPI and nreasles campaigns. Unique features of the proiecUother matters 2t WHO/APOC, 24 November 2004