Illubabor annual project technical report submitted to Technical Consultative Committee (TCC): from January 2007 to November 2008

IIr ,l ? I The Federal Democratic Republic of Ethiopia Ministry of Health Prqieet llaue: IllubaborCOUNTRY/NOTF: ETHIOPIA Launching vear: 2004Approval vear: 2003 F r o m : J. a n u e.r.y. . .? 0. .A 2........ T o ;. ....N e..y e m h e r. .2 0.q,8.....(Month/Year) ( Month/Year)Reporting Period: P.ri""t ". (circle one) I 2 3 4 (, 6 .7 .8 9 10 Date submitted: October 2008 nartner: The Carter CenterNGDO ,3h_ I !i" D ffir r t)r i.',. - - Tor 5i f\,: ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO B TECHNICAL CONSULTATIVE COMMITTEE (TCC) b AI+ B DEADLINE FOR SUBMISSION: o APOC Management by 31 Januarv for March TCC meeting o APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) :: R ,T l}4,bd;tii irif L-r l:, f" L!\ (" \ 2 t unv 200.1 APOC/L,ii: ttI I E 1 $ I WHO/APOC, 24 October, 2008 t I I I I : I L a't ,( ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Ethiopia National Coordinator Name: Dr ,lirna. Signature: r Datet ...........1 Zonal Oncho Coordinator Name: Tibebu Amante Signature: .,fit.@ Date: ...t.9.1.t.t.1 o NGDO Reoresentative Name: Abate Tilahun Signature: Date: ./.3 Signature Date .l$ % / u lds; ,fit@ :/ .,, 2.. . i- l This report has been prepared by Name : ....T,ihEb.u. Designation : Zone onchocerciasis C + NOTF ,i ll III WHO/APOC, 24 October, 2008 /lrr \atr qTable of contents FOLLOW UP ON TCC RECOMMENDATIONS I EXECUTIVE SUMMARY ....,......2 SECTION 1: BACKGROUND INFORMATION....... .....................3 l.l GrNpRer INFoRMATToN.. 4 2.1. 2.2 Tnmrn'rp oF ACTrvITIES........... Apvocacy OROTRnC, STORAGE AND DELTVERY oF IVERMECTIN Corwnxry sELF-MoNIToRTNG RNo S rerrHoLDERS MBBrn rc SuprRvrsroN.. .......9 ..... 1 1 ,.,.12 .,.,14 .... l6 ,.,.23 '.,,24 ,.,.25 2.3. MoanzarloN, SENSITZATToN AND IIEALTH EDUCATIoN oF AT RISK coMMUNrrrES ll 2.4. CorwruNrryINVoLVEMENT 2.5. Cepecrry BUTLDTNG.. 2.6. Truem,reNTs.............. 2.7. 2.8. 2.9. SECTION 3: SUPPORT TO CDTI .............26 3.1. EqureunNr .26 3.2. FnveNcre,r coNTRTBUTToNS oF TlrE pARTNERS AND coMMLTNITIES 27 3.3. Orrmn FoRMS oF coMMUNrry suppoRT 28 3.4. E>crNprrunr pER AcTrvrry............. .................. 28 SECTION 4: SUSTAINABILITY OF CDTI ................29 4.1. INrenNar; TNDErENDENTpARTTcTpAToRy MoNIToRTNc; EvRruarroN 29 4.2. SusreNasll.lry oF IRoJECTS: ILAN AND sET TARGETs (uaxonroRy AT............... 30 Yn 3) ......30 4.3 INrecRenoN 30 4.4. OpBnerroNAL RESEARCH 31 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTUNITIES ......................31 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ..........32 WHO/APOC, 24 October, 2008 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Drug Distributor Community-Directed Treatment with Ivermectin Community S elf-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Emergency Fund Ultimate Treatment Goal World Health Office 1V WHO/APOC, 24 October, 2008 { lt. Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking), (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/h1per-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/h1per endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). ("i) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Inteeration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communit), self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the prograrnme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifi cations when necessary. WHO/APOC, 24 October, 2008 FOLLOW UP ON TGG REGOMMENDATIONS TCC session 26th Number of Recommendqti on in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY 6,i Report-related Adjust reporting period Januory to December to It is accepted Indicate role of each partner It is indicated in the main document Provide reasons for the increase in number of communities from 3503 to 3704 as indicated in table 9 Number of communities increased to reduce the workload from CDDs. Additionally 5 high endemic kebeles were included from neighborhood woreda due to the decentralization Provide information on partner equipment and condition It is corrected Review tables 13 & 14 and explain disparity in cash released and expenditure The expenditure allocated from MOH includes the salary of health staff that is in kind not in cash .and not considered as expense and leads to disparity in cash released and expenditure. in both tables (13,14) Project related Continue to work at increasing number of .female CDDs and improving the M:F ratio .The project has continued to work at increasing number of CDDs and improving the M:F ratio for the treatment period . Improve on calculation of Mectizan@ needs and ensure that remaining tablets are used The remaining tablets are used by the project each year. It is well taken recommendation I WHO/APOC, 24 October,2008 Executive Summaqy 1. Background on treatment and population data Illubabor CDTI proiect is one of the pto)ect found rn the Oromia Regional statel.vhich is located in the Southwest of F)thiopia. The 7,one is sub-divided into 23 wotedas with about 1.3 Million populations. .'I'he project consists of rrvelve CD'I'I woredas namely Mattu, Darimu, Alge-Sache, Yayu,Hurumu, Dorani ,Alle,Didu,Bacho,Bilo-Nopha,Dabo-Hana and Bedele There are 1 zonal hospital, 10 health ccnters, 47 health stations and 702 community health posts (CHPs) in the CDTI project area . ^Ihe CDTI woredas are further divided into kebeles, sub kebeles and 'Garees'wllch is the smallest admiflistration unit. 'I'here arc 3794 villages 'Garees' in the proiect a'feas The Illubabor CDTI project has been started since the year 2004. All the targeted villages ( with I O0 % of geographical areas) were covered with Mectizan treatment since the start of the programme. The total population for the project area for the year was 692,309 with the Annual Treatment Objective (ATO) of 567,693 out of which 556,106 were treated with Mectizan@ for this year which gives 80 oZ therapeutic coverage. 2. Background on population movements. Most of the Communities in CDTI areas are settled farmers, Merchants, daily laborers and civil servants. Overall, there is no major type of population movement in the project area.. 3. Training data Traimng and re training were given for health professionals, Commuruty supen isors and CDDS every ycar .I)uring thc treatrnent period 330 front hne health workets ,368 communiW supervisors and 9,202 CDDs were trained and retrained which gives the average number of CDDs two and above per villages. 4. Challenges and how they were overcome. Threats (Challenges): o Frequent restructuring at all administrative levels has been a major challenge. o High turn over of health workers atZonal, Woreda and peripheral health facilities 2 WHO/APOC, 24 October,2008 ? Over lap of several health programs and work overload of health workers that delayed the distribution and reporting period of the CDTI activities. Opportunities: o The expansion of health facilities and health posts and the increased number of health extension workers in the project area is a wonderful opportunity for CDTI implementation. J WHO/APOC, 24 O ctober,2008 SEGTIOil t: Background information 1.1. General information 1.1.1 Description of the project lllubabor zone is one of the 25 administrative zones in Oromia Regional State .lt is 600 kms away from Addis ababa .The Illubabor CDTI project is one of the project located in the western part of Ethiopia. The project is bordered with Gambella regional state in the west, West and Kellem Wollega CDTI in the Northwest, East Wollega CDTI in the North and Kaffa-Sheka CDTI in the South. The Illubabor Zone is sub-divided into 23 Woredas. According to the government structure woreada is subdivided into Kebeles and the Kebeles are further subdivide into'Gots'.The'Gots'are further subdivided into"Garee" (villages) which is composed of 25 - 35 nearby households and responsible for all development activities including health. The Illubabor CDTI project consists of twelve woredas namely Mettu, Darimu, Alge-sache, Yayu, Hurumu, Alle, Didu - lalo, Becho,Bilo- Nopha, Dorani, Dabo- Hana and Bedele. There are a total of 274 kebeles in the CDTI woredas which are subdivided into 3,794 Garees (villages). The CDTI project area has very complex terrain with altitude ranges between 1,000-2,576 meters above sea level. Ecologically it is a tropical rain forest. Climate in the area shows great seasonal and inter-annual variations which is traditionally classified into three broad geo-climatic zones, i.e. cold highland, sub-humid mid-land, and hot lowland area. The mean annual temperature ranges from l0 0C to 16 0C in the highlands, 16 0C - 26 0C in the midlands, and 23 0C - 33 oC in the lowlands. The annual rainfall totals ranges from 1000 millimeters in the lowlands to 2200 millimeters in the highlands. Sor, Geba, Birbir Dedessa, Offa, Sesie, and Gumer rivers are among the perennial fast flowing rivers that cross the zone. There are also many numerous fast flowing small rivers and streams, which are tributaries of the main rivers in many areas in the zone. The project Zone is covered with high forest and coffee plantation .The zone is well known with two distinct seasons that is the rainy season (April - October) and the dry season (November- March). There is a mono-modal rainfall pattern in the zone. Agricultural activities (clearing, 4 WHO/APOC, 24 October,2008 farming, and herding) occur all year round in the project area, but are most intensive during the rainy season. Harvesting occurs from October to December, leaving January - March as the optimum treatment period. There are about 576 kilometers dry weather roads that connect woreda centers with Mettu town. The main road that runs from Addis Ababa to Mettu, the zonal capital toum, passing through Jimma zone is partially Asphalt road and woredas alongside of the road are connected with Mettu town. All the CDTI woredas have all weather roads that connected with Metu town. However, access to rural communities appears very difficult during rainy seasons in the project areas. There is one zonal hospital, l0 health centers, 47 health stations and 102 health posts in the CDTI project area. The potential health service coverage of the zone is 85%. There will be construction of new community health posts with the assignment of health extension workers in each Kebele . Table 1: Number of health staff involved in Illubabor CDTI project,2007 5 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 Bt Percentage B.:Brl B, *100 Matu 40 40 Darimu 48 35 73 Alge-Sache 60 40 66.7 Yayu- 29 24 82.7 Alle 32 t6 50 Becho 28 28 59 Hurumu 36 36 100 Didu 23 23 100 Bedele 45 45 100 Dabo-Hana 36 32 88.9 Dorani l3 l0 76.9 Bilo -Nopha l5 l3 86.7 Total 405 342 81.7 WHO/APOC, 24 October,2008 1 .. 1.1.2 Partnership The Ethiopian Federal ministry of health, Oromia Regional health bureau, Illubabor zonal health Department, respective project Woreda health offices, health facilities, the affected community, The Carter Center Ethiopia , WHO/APOC and other government sectors in the zone are the main partners involved in the Illubabor CDTI project . There has been strong partnership during planning, advocacy, mobilization, drug distribution, monitoring and evaluation of the CDTI activities among all partners in the project area. 6 WHO/APOC, 24 October,2008 @N o!o o $GI op< o ll I 9' \) v p .o q) B BP *. .\ :,f p\a.9^. *: ^Y$ 'X h' \Eu9 .S ar rs q) %o' p: Bq) oq)'is ts -fB u( L.\$\J *s\* raU PS trs\*S\? st*Be\s, *-olJi\T YrSN!a ^. q) \\P\(s\r h=' .d!sl\s .PL59 SPq, I .s.Y 6Eq N$lSq) =bo{:x\ ildr: -s trB\q) o r-\ v) 0) 'tr 0)a @ ! o a. c)H 0) bo li)E 0) ot o a) 'a L Or q) k (n U) (l) o c'3 V)(d B k o E C) Cd C)tr OLd l{o q,) B clq) L CB (.)q) oL q) o }1(t) k (d E GI C')o a tr o ? tr o .TI G - - -c oE IN I F o z o o cl c o e. o F.( : a- =tr6n E uc ca c{ $ o\ ca o\ cO l'- n"\o N ca\o c.t 00 aa \o\o o\ ca $ caq cnt- F- oo\\o c.) al$ o. o\ cn l-- $ \o CI aa ca c.) oo rn cn ca o\\o t--\o d +d lt € .(DiE -()o .= o.N E E.: F EE s \o- \o\o co\o$^ a ca c-)tr) t-- c.) o\tr $ c-) ooq oo co co o, o\la) co rn$ o\ c.l (-- o\ \o 00 c.l o\ ca (-.I$ $ r-('-$ ca o\ ca N o\\o or !! . tlE Ei'=-d&E.E6;>t o o -E E E'E -xL cas F- -i. s o\\o|.- a.l s 6 cn a-l \o !t\o c-) oo\ oo € c.l c- o\F- c.t t-r t-- c.t t-- an (-- o\\o c.l (a) oo ca t-r o,s\o $ r-\o o.$ ca € $N c.l tr) @\ sf\ d (, 'EgE ^9! 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(,)!O ca A o -o(! ts Lr(s q) oda Iq) o0 I Fr + (!lr o t-.1 @oo c.l C)!o o IJ$(\l d g CC(.) E 0)tro (ri o U) c0 !H a.n oH (! bI) tr o Lr U) o L< € a Lr 0)JIL. o do (t< o O lr -otr(.) o o o o C)fr(.) v) 0)L. o 0) U) U)o €U) 'nd ij (.)()k !B (d-(.)EEg)0)os> o= 9^ i (i)otEQts l-< Cg 0.) q) H o o .-a Eo (B q)k U)(d q)L(d a.) L .o u)q) odqi (.) tr q) tr F ..il 6)l -ol.CBI FI o ot-# a- l-a(, G 5 o o E !- -o E a-F ItF !N F o(, |F o c o .Iflt!fl E o Eg c E llN - o IF(, uto o\ €N o -oo o $N O -A o > 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/ constraints being faced and suggestions on how to improve advocacy. During the treatment period 120 political leaders at each relevant levels were mobilized and the purpose of the mobilization was on the improvement of the treatment coverage, reduce the number of absentees and refusals and as well on how to sustain the programme .However, some competing activities limit the contribution of political leaders on the CDTI activities. 2.3. Mobilization, sensitization and health education of at risk communities The health professionals working at woreda health offices, front Line Health Facility workers, Health extension packages and Developmental workers were the major role player in the community mobilization and sensitization. Community Supervisors and kebele leaders were also involved in the mobilization activities. Community mobilization, sensitization and health education was conducted at each level during the treatment round. Health extension workers and CDDs were responsible in giving health information to the community at kebele and village level. The Community sensitization and dissemination of health information have contributed a lot in the awareness creation of the community .As a result of which the fifth year CDTI activities was successfully accomplished with high therapeutic coverage and 100% geographical coverage. 1l WHO/APOC, 24 October,2008 o cE -q) B 6) ooc ?A E o z oo ill t0: 05 €) BOql o q) \o O.N ("1 o\ ca f-. ral o. n\o c-t 9 caN o\\ci oo v? ca$ \o r*N ='i 6L qr-9Ev E tr: ==2>EEa E.e) o ca ca\o ca ++ r- c.) aa sfO, r- ca tat N c.l rn s oo o\ = o o o -€)E=6ry oZ (J o o z la +F ta tl le c oF $@F- ca\o ca ca+ ca $$s t-\o c..l oo\o \o+ r- € tr- r-- N \o I-r\o ttn cn\o$ OI OI o\ le .90 EIOa\[rv ca cn\o ca \t t-- ca ca $O. r-calr) C-l(.N can $€ o\ = la a aI q) GI 2 oo\o o ca $ aa $ $ (.)c.l oo ca r\(rl$ ca O.\o F. =f, $(n\o r-.@$ o\r- c.) ?aia € >o 8'lo0;dx >oBr 'io trc)5E E€) otr(.)>> o= .oE =oZ') o ll * trca la o bD 6l cq) 6)!i O la faHr i Eg flEtrEX EaET t-$ ca \o f- (n C.lN rf,\.) ca\o sf, lr)N C..l o\ oo \o ca$ o\ c-t N o\N ca o\ t o\r- ?e ce .=o d 8'gtrE ds -EO{)a; =.- qloE=FE6 oo()-E F-+ c.l \o f-- lr)N(-N $lr) ca\o$ ra)NN o\ oo c.)tf o\ c.) No'N ca o\ t o\t- rO tl c.) =z ooa c!3 ao z I o ca (.) IJ C) C) (.) H (d d op(! o Lrd t-.1 (.) C) a I() bo I >.d t- tr t-1 ql F @oo6t op o o $(\l o o N -\ v)t4q) Q a) ? o\ q) o t B q s\) S F oO o o 9d O. o E G,a U)o ! oO +r o-rl -ol'cdl FI fl E o E o a: o .E J .E 3 E E o(, { IN Comment on: - Attendance of female members of the community at health education meetings The attendance of female community members on health education session at each community showed a significant increase from year to year in the area. - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). The attendance and involvement of females' members has shown signif,rcant improvement for this round treatment period. The participation of females in the discussion on the issues of CDTI was increased. Incentives provided by communities for the CDDs The CDDs in this project area are serving their neighbor hoods (25-35) households voluntarily. No incentives were provided. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? There are no problems of CDD's attrition in this project. Other issues 13 WHO/APOC, 24 October, 2008 2.5. GapaciQl 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 most important issue to describe is what measltres were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). In the project area there is a great challenge of high turnover of health workers and transfer of health workers each year .The project was provided training and retraining for health workers at each levels every year to ensure adequate CDTI implementation. Training and retraining were given for community supervisors and CDDs. t4 WHO/APOC, 24 October, 2008 o.i + .U S.i i- *u \o $ oo c- oo\o c- co\o co ca\o co en .f c.t c.ls c-r $\t$ $ $ trr\o N F-\o a.l oo\o \o\o rr) N \o$ \o $ t r-ar* t-- oo F- I.* N F- oo t-- C.l c-l \or-\o \or-\o $ $(al a(a) ca\o .f, la) co N N o\ o\ C\ ca oo E c) E clL O nU o Lo! z ?=FL) oo cn\oca c.tsa.t $s$ t-.\oc.l cftt- \os t--oor- t-(\ \oF-\o o\N ca\o .f, r- c..ltr- o\ q) q) q) I Y \o tc o\ itl = S.: is =v o anLq) .taGt tr ,-i L[i o0) *9 r.C oL z IF q) o o I s II Q n o +I $,\A< i = $ $ \o C.l \o tr) c.) t'- t- \o $ c.l ct caN s ca (\ aa sCI oo ca c.l \o !f, s o.l o\ $N \oaa c.) \o c.I oo ca ca l-N c.l rr) q) !c!dL EE OQ €eE:- zEo q)() I o F .f, r-N a.lc.l caa.l (r)s \ocn a =f, \o $(\ \oca c-l o'ooan q) o c) (.) \! 6 =6 o E.''r +F'(5 $ $ $ aa .t $ rt $ o.l l/.) ca <t c.l (\ c.t a'l .tr $ c.) N co N s ao a.t o, () A clL cl O O C) L an o tiq) ! z I $ $ t t (\ ca $ $ ca s FI I 0 o z o oo FA d q z I m C) )! 0) o 0) (t (B -o E tr(! 0.) o(s a I C) o0 I >. 03 tr L FJr COlro j F otr c) q) 0) () o\ @ N ! 0) -oo o $N O U Jr \n ho og s -o o o p B I B o o 50\ a_ p i o \ o\{ B o s . s a\ V) qj U\) \ \ t v \)q !,) E o d i(.) o o F o(-) qr .h (.) C) () L .0)tr E 0) (! oo tr cdlrF .iir ol -ol(dt FI Table 6: Type of training undertaken (Tick the boxes where specific training was caruied out during the reporting period) Any other comments ;- No more comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65Yo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The geographical coverage for the project was I 00%o and the therapeutic coverage is above 65Yo. Trainees Type oftraining CDDs Other Community members e.g Community super,ryisors Health Workers (FLHF) MOH staff or Other Political Leaders Others (specifu) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifu) t6 WHO/APOC, 24 October, 2008 00o N op o o sf GI q r- aoq ,Yi-( 6Zs94e='d i E*?EE*z 8t & O #? =azz b.9 -oiE9)9z.r (as (-.l ca c-. + + c.l oo o.\oN o.\of- ! 9* E E.ei E E['€E o\(\ N tn ca oo oo t-- [n cAs o\N caN N sf\oN $@N cn o (o)g o o Ah a a 'E o) =ooo(n a.!) ootoF cl o\r\ oo n@r- 9 a N oo oor- \ot- 9 oo O.t\ \qt-. oo oo oo 6 a o --bEU TEE , o.!z ta) ooFNtrl NN ca $(r) oo$N caN$ oo cO \o\o c-) (n t-- r\ tF- rrl+ c-) N oo\o oo Ot \o$rn oo\o c-$ c\lI-* .+ ooN ca t--NNtrlN \o \o r(r) :c)E d.u =Eoj !J-o', Fv caN sf(r) o\ ca o\ c-l r- cnq \o e.l ca\o ca@ c.) \o\o Ot cn =fcaq cafr. t'r@\\o ca N$ ol o\ (n aa F- la) ta)$ \oN ca c.) c.) oo(n o.l ca O, .o^ t-\o(n .9 .,3 E " EHi€ -?.gE.H> E " - q€ oLdF .f, \o \o\o ci\o =t: oo c-l c.) \a) r-. cn o'\\ov ca € o\ oo ca cO o\ o\n c'). la)$ lr) o\ N r-- o\ \o oo N o\ co(a) N$ \t- t-- t**$ ca Ot c-l NO,\o U)() b0d oo ) o(-) ll *dd E .9 qrEbO o- su!q65o> do E.9 --}E$Etr tr= U =c)!z6 o r-.+ ca \o F- tl.)N c.l s(r) ca\o .<f, (n c..lN o\ @ \o caI O, ca No\ o.l ca o\ to\Fr ?.) =oE 6.2 ltr o t gPF\J F-+ ca \o r- tr)NN $tr) ca + hC\N o\ @ \o ca$ o\ cA N o\N ca O. $o\F- ?a H:E E 9.8; E Ss 5F e = EE==t Ud u Ei.E B 6 aFEts ET r-$ c.) \o t-- (nNN +rn ca\o$ (o olN o\ @ \o cns o\ ca c..l o\ o.l c-t Ot to\r- r') .p<gq E< C) a o o 0.) (d o zI o o q) ! 0) C,)!(.) (B (! iJ< o -o(n L(tr o () cBa IO o0 I >'(€ )H *r dLro t-l cl oF q V')q) Uq) p p o \ \)4 \) s )4 .t L P U) dOti(d rl Q trI an I C')H a (d o E (c(.) LF r.-l ol -olcolFI Formula for computing therapeutic and eeoeraphical coverages Therapeutic coverage rate : Number of people treated x 100(%) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate Number of communities/villaees treated x 100(%) Total number of mesoftryper-endemic communities as identified by REMO in the project area ATO coverage rate (%) %UTG achieved : areas within the project area (UTG) Number of people treated x 100 Annual Treatment Obj ective Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic ATO : The estimated number of people living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. UTG : The maximum number of people to be treated in meso/hyper-endemic areas within the project area, ultimately to be reached when the project has reachedfull geographical coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). *e A8 WHO/APOC, 24 October,2008 II 2.6.2 What are the causes of absenteeism? Some absenteeism was occurred due to the overlap of work activities during the drug distribution. 2.6.3 What are the reasons for refusals? Most individuals refused because they considered themselves as health and Others refused because of minor side effects. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ilng WHO/APOC, 24 October, 2008 00 (\l C) -oo (.) $N Q o o" B oN N -(r, -I o .-! G I _)q) -GI €) 00 clLq) o9(J 3) =cl -ri L ot) -I .i I .xccoc)E r.lq) .C6lE6)! ! .sl i5Eo'u)9LctLAL()a9! .) .= l^9Wv-)- -Hti5o.n H./9ri!F .EU ZEb=-o_o9(€ E=31 '= o) O)l!tNILr L (Ol .o rr)lt<YAEr\ c.) tlGt Edtveil Hr: 6l ri!-lc)E 8l .gF rl 9Ealriq)pl a q)bo= -Ei:+j9(l)li !OlaiEorson\/trEFEdDGtr.zlgE.E +.o*r!:tr<uO 5 {.'fEE8FfiE -tt- A" .iL' o) "i*l ftetl ge.i Fl 0r q) o09 PaF< 6)XL\ ></Po O o, o, 00 r- oo c'l \o o\ oo o\ (B lt :t ,5 r' rd 0)9Sala Oo\ o o o. o\ oo c- oo (a \o o\ oo o\ ll * !d rd ld o\ C) 'Eo ,00od su ooEOF t'-r- r- r-F- 00 oo rd -o ,,o od u9OE €- =OZI 'o r- caN $N ol\ov o,O O.r-s .t r- 00N o \o li :o? 6.2 i uFF\J \o\o 00- N co aodl oo c-) 00$ o\ € * co o\\o c-\o LAi,a.rd : 69 - *dE.X qr ho. ,oS€='Etl * q# o. L6 N$ ,o. F*\o \o |.- \o c.) v1 +N\o o\ o, C' ra)\o o, N o\ q() oo(o oo tr) o() ll i ld Ir) E] (.) ^bo9Eat- Oo\4>r -o o o o o O o-00=(0 - lg ^ " ;- F3 gEHh Oord oo O frl aq)O:E E-b E gPU tr E= U5 E-a !z8' o\ co caovl otr) c-lOv} ra t o\F- ca E] -Ee(! o.= !lt ot utrFq, o o\ c.) co ca aa "{.O\ c-t $o\r- aa oo =o!! ", b i)v a = o-:ilt oE x:: =.! c€;tiT E E q€ E -d o o\ c.) coovI ca co ca t F- aa .f o\F- c.) 4 gl OO N O N N o 6,1 cao o.l $ oN o c.l \oo a.l r-O N € N o\ o e{ oN 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH EI WHOtr UNICEFE NGDC Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH M WHON UNICEFE NGDC Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The Ministry of Health together with NOTF requests for Mectizan from MDP. After the drug reaches the country it follows the existing drug and other medical equipment delivery system in the country. Then the drug is stored in MOH warehouse .The project request for Mectizan@ from the MOH, following the existing drug distribution system. From the project level (zone level) each project Woredas receive the drug and distribute to the frontline health facilities. Then the frontline health facilities distribute the Mectizan@ to the community supervisors' .The CDDS directly receive from their respective community supervisors and they distribute to the communities. Table l0: Mectizan@ Inventory (Please add more rows if necessarf How are the remaining ivermectin tablets collected and where are they kept? The remaining Mectizan @ tablets were collected by frontline health facilities from Community supervisors and returned back to woreda focal person's .Finally all focal persons collected all the remaining Mectizan @ and returned back to zone and kept at zonal pharmacy store List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Training of community supervisors and CDDs I Request of Mectizan @ from different levels . Collection of Mectizan @ from the Woreda Pharmacy store . Distribution of Mectizan @ to Front line health facilities . Distribution of Mectizan @ to community supervisors . Distribution of Mectizan @ to CDDs . Supervision and follow up of treatment operation District/LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Illubabor zone 1,489,941 1,490,000 1, 522,798 0 5,298 0 48,860 TOTAL 1,489,947 1,490,000 1,522,798 0 5,298 0 48,860 28 ?-4 WHO/APOC, 24 October, 2008 . Management of severe Adverse effects . Recording and reporting of training and mass drug distribution data Any other comments 2.8. GommuniQl self-monitoring and Stakeholderc Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, When? Ycs. thc communitl,-sclf rnonitoring training has bccn conductcd in thc fi"ont line lrealth tiicilitics fbr hcalth workers and cornnrunity lcaclcrs. Accorclingly, nrost cornmunities havc carried otrt self nronil,rrins in thcit rcspective villages (comnrunitics). -fhc training \\,as given in Marech 2008 Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Note: SHM is conducted at Kebele level including community leaders of all endemic villages Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. In cach village thc comttrutitv supcrvisors and conrmunitl lcadcrs have supcrviscd and rnr:nitorcd the implomcntations er:rd thc pcrftrrnldrcc ol'(ll)'l'l activitics. 'l'hc Stakcholders ert each level have supporled the implementalions and the perlbnlance ol' CDTI arctivities. As thelesuh the numberol'absenteeisnr and rel-usal were reduced and lhe therapeutic coverage shorvecl increased during the period. ry L?_ wHo/APoC,24october,2008 DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meetins (SHM) Metu Becho Bilo-Nopha Alle Didu Bedele 347 160 171 22s 154 463 347 160 t7t 225 r54 463 JI l5 14 2l l5 42 Dabo Hana 225 225 l5 Darimu 809 809 42 Alge-Sache 436 436 36 Yayu- 319 319 25 Hurumu 292 292 t7 Dorani t93 193 t2 TOTAL 3794 3794 291 2.9. Superwision 2.9.1. Provide a flow chart of supervision hierarchy. NOTF )ROTF) ZOTF> WOTF ) Health Facility ) Community supervisors ) CDDs 2.9.2. What were the main issues identified during supervision? . Poor documentation and reporting. . Lack of focal person that lead to poor prograrnme coordination . Prolong of time of distribution of ivermectin and delay of reports from low levels. . Poor drug management and inventory . Lack of integration in some areas. 2.9.3. Was a supervision checklist used? Yes, supervision check lists were used at all levels. 2,9.4. What were the outcomes at each level of CDTI implementation supervision? Some improvement was seen for the year. Time of distribution was improved 2.9.5. Was feedback given to the person or groups supervised? Yes, verbal Communication during the field visit and written feedbacks were given for each level 2.9.6. How was the feedback used to improve the overall performance of the project? High therapeutic coverage and 100% geographic coverage is due to the continuous supervision and feed back. zl tg WHO/APOC, 24 October,2008 SECTION 3: Support to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? The project office and its partner's were effectively repaired and maintained the existing Capital equipment and other materials provided by APOC. The project is trying to handle and to improve the overall performances of all activities by integrating to the existing government system. It's expected that APOC would replace the capital equipment and materials by the end of the fifth year or mid year and at the same time efforts will continue to allocate budget by the government for smooth operation and management of the project by integrating into the existing health programme. Source Type of equipment APOC MOH - Zone DISTRICT NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle I F I F 4 F 0 0 0 0 2. Motor cycle(s) 6 F I F t2 F t9 F 0 0 3. Computer(s) 1 F 1 F 8 F 0 0 0 0 4. Printer(s) 1 F I F 8 F 0 0 0 0 5. Photocopier (s) 1 F 0 0 0 0 0 0 0 0 6. Fax Machine(s) 1 CNFR 1 1 0 0 0 0 0 0 7. Overhead projector 1 F I F 0 0 0 0 0 0 8.25" TV set 1 F 0 0 0 0 0 0 0 0 9. Deiesel Generator 1 F I F 0 0 0 0 0 0 Nz+ WHO/APOC, 24 October,2008 oo o N Lo -oo o o$(..l o a. o > $ N 0.) C') c C)q)(r) qi o (h o o (B c,) >.d c/) l< Q o qr o C) U)d(.) olrqi >.(d q) IJ o U) U)o! € €(€ h() q)! 0) =B U) ,E t< O.lio ) o(+r O U'd C) q)k t-, -Aa trU =t) €JA'A tD o)LLr- (B >.97() (/)(r ,FI cnLdO 0) c)lr U)(c o H .o U)l< 0) trda d s a) o ) -o 'tr oo (d o d i co o o a-# .E -) E E o(, E Et! ob o trt oc o -# h o o tr oarta5a L# E o(, -r! '6 Et! E a-E aN a 0r, € C..l ia 6,o EsEa \o+t nt F- o\N *\o t t\o\o\o o\ .EFl 0)^ TEBAbQEDFca =to\ .') \o o\ € 6l .+ o\ \O- a- (.) 6 \o t-. e..l t 6o EsEa a.l ca- + o\ F. + @ in t \o ,Ei 0)^if6*5895Fm (\ o\ a- o\in CI l..- \o 6l F) GIo EsEa t t-. c^..l o\ I N t rA\o F{ (l)^ < E ?,'aF- 3;o!?OUEFJ. r..rI $ o\ .') \o @ e.l @t \ot)N al 6l ct o) $3#=g -Jo4 rr 00q. + F- * N$ * + e.l r- * + * (\ o\ rr r+ o\ fl{fl's ao\s F--l:N +o\\o\o o\ ratat!r- s N at €) <f E 58*=Er. -.1 O4 J @ o\ a-<. $ r'. o\ F-\o €FI{ r-in r€7-c I .- c') ()^58i'aF 6<l € o\ m tr-$ t F- r- t.. =f\o \o \oa L E Li oU + (B ! o)O +i C) 2a + o 'tr v) o l=(DL)C<o<N 6 o o Oze =E(-) ,. J- U) o- :i€UHz& q1 o ts O v)3 t<F(J ^€ <d Fl F o Fr - Additional comments Integration of Malaria and Onchocerciasis control programme (MALONCHO) play a great role in the implementation and good performance of the CDTI activity for this year. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) The services of Community Drug Distributors(CDDs), Community supervisors and kebele task forces (KOTF) are considered as the major community contributions for the CDTI Project in the area.For this treatment round ,9,202 CDDs and 368 community supervisors are involved in 3794 communities in the entire project .. 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here lUSD :9.65 z,{ z6 WHO/APOC, 24 October, 2008 I'able 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? The budget assumed from MOH is not considered as expense (budget item as personnel cost, capital equipment), that leads to the difference of expenditure and expense in the listed above (table 13 & 14). Assumption of the exact budget for CDTI is not an easy due to the pooled finance management system and the integrated nature of the CDTI project to the existing health program. SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) None Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs [ei$r,s 9{ h*!O,s!?qs! 4 !- I e'ql q Supervising CDDs and distribution I#gryql mg,q{ggs 9-{qP.Tl activities _ Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 1450 4000 21,746 3413.40+2000 2,487+2000 0 945+1500 7542.86 1813.00 0 s00 0 NGDO APOC + NGDO NGDO+ APOC NGDO+ APOC NGDO + APOC NGDO NGDO APOC TOTAL 50,397.26 Total number of persons treated ?s L+ WHO/APOC, 24 October,2008 ( 4.1,.2. What were the recommendations? 4,1.3, How have they been implemented? 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? NO Was a sustainability plan written? NO When was the sustainability plan submitted? NO What uurangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2,4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. !ntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. Ivermectin delivery mechanisms The ivermectin delivery system is very well integrated into the MOH structure right from the onset. There has been no separate Ivermectin delivery system in this project; it follows the existing drug delivery system in the country. The project will be normally notified to collect the drugs as soon as it has been cleared by the WHO clearing agent in close collaboration with the MOH. The project coordinator will then allocate the drug to the respective project woredas and FLHFs. Training: All health professionals in the entire project were trained and retrained on Community Directed treatment with Ivermectin (CDTI) every year. CDTI is integrated with the Primary Health Care (PHC) particularly to Malaria and other vector borne diseases from the beginning. Therefore, CDTI is part and parcel of the health care delivery at all levels. /za WHO/APOC, 24 October,2008 lt rya 4.3.4. Release of funds for project activities For the treatment period the APOC Trust Fund was delayed .However the fund from NGDO was released on time. 4.3.5. Is CDTI included in the PHC budget? Yes, CDTI in this project area is an integral part of the malaria and other. vector borne disease control unit at all levels and have similar budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The CDTI structure is used for malaria control program panicularly for bed net distribution, for follow up the utilization of bed nets, in expanded program on Immunization (EPI) and for TB default tracing. 4.3.7, Describe others issues considered in the integration of CDTI. The Health Extension Package program which include many other health programme designed to reach all Kebeles that will play a major role for strong integration and sustainability of CDTI in the project area.. 4.4. Operational research 4.3.3. 4.4.1. 4.4.2. Joint supervision and monitoring with other programs Primary health care activity in the project area are supervised and monitored in an integrated manner. However, during the Mectizan@ mass distribution there will be separate supervision and monitoring system. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Not done How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: The project is successfully accomplished the distribution of Mectizan@ for the fifth round within the given period of time with high therapeutic coverage with in 100% geographical area. This great performance is due to the active involvement of the health workers, community supervisors, partners and the community at large. Weaknesses: Absentees of focal persons ,poor document handling and delay of reporting, delay in liquidating the utilized budget from partners , weakness in collecting leftover of Mectizan@ tablets after treatment from CDDs and poor inventory of Mectizan@ at all levels and storing atZonal Health pharmacy store . Opportunities: The expansion of Health Extension Package program and the increased numbers of Health extension workers is an opportunity for the programme. The government structure down to village level "Geree" and being taking the responsibility of development activities as well as health is a good opportunity for sustainability of Onchocerciasis control.. { ?-5 wHo/APoc,24 october,2oo8 >$ t Threats (Challenges): The high turn over of health professionals at all levels, the absentees of focal person and overburden of other activities, the continuous restructuring of woreads and kebeles , overburdening of health workers in peripheral health facilities, in different health programs such as malaria control and prevention activities ,HIV/AIDS l, polio campaign and routine EPI works .Lack of budgetary support from government are the major challenges for programme sustainability. SEGTION 6: None Unique features of the proiecUother matters 73o WHO/APOC, 24 October,2008